Medics and teachers have raised alarm over a back-to-school disease surge as NHS England data shows none of the main childhood vaccines hit their 95 per cent uptake targets in 2023/24.
Public health experts have warned that measles outbreaks can occur “quickly” when vaccination rates fall below 95 per cent, causing harm and disrupting children’s education.
The UK Health Security Agency (UKHSA) told i that just one measles case in a school or nursery where many children are unprotected could cause numbers to “suddenly surge”.
Dr Vanessa Saliba, consultant epidemiologist at UKHSA, said this could force many children to miss school for up to three weeks at the start of term, while others could develop more severe infections leading to “life-long complications, which will impact on their schooling”.
Low vaccine uptake and increasing hesitancy also means rare, highly infectious diseases such as polio and diphtheria, which can be fatal, are at risk of re-emerging.
Parents have been urged to vaccinate their children as new NHS figures show nearly one in six had not received both doses of the MMR (measles, mumps and rubella) jab by the age of five.
The latest annual data on vaccinations, published by NHS England last week, shows 16.1 per cent of children who turned five between 1 April 2023 and 31 March 2024 had not received both doses of the MMR vaccine – the lowest level since 2010-11, although 91.9 per cent of five-year-olds had been given at least one dose.
The figures also show one in nine children (11.1 per cent) who had their second birthday in 2023-24 did not get the first dose of the MMR vaccine, and one in 12 babies (8.8 per cent) had not received all three doses of the 6-in-1 vaccine, which includes protection against whooping cough and other serious diseases such as diphtheria and polio, by the age of one.
It comes as the Department for Education (DfE) has told parents it is “usually safe” to send children to school with a mild illness.
But Dr Simon Williams, a behavioural scientist and public health researcher at Swansea University, urged parents to think twice before sending their children to school with symptoms of a virus during the “crucial” back-to-school period.
The DfE urges parents to ensure children are up-to-date with vaccinations and to defer to NHS guidance to decide whether their child is too unwell for school.
Pepe Di’Iasio, general secretary of the Association of School and College Leaders (ASCL), told i that childhood vaccine rates are “concerning” and warned that low uptake “increases the chances of pupils missing out on education through illness and isolation”, as well as posing a public health risk.
“It’s important to understand why vaccination rates have dropped and work towards encouraging greater take up as this will benefit public health, education and society in general,” he said.
Babies born during the Covid-19 lockdown are starting school for the first time, sparking fears that they could have less immunity against infectious diseases due to trends of vaccine hesitancy.
The UKHSA and the World Health Organization (WHO) have taken urgent action to ensure communities catch up on vaccinations missed during the pandemic, but research by Unicef suggests that vaccine confidence is declining globally.
Dr Williams, a WHO consultant, said avoiding infection through vaccines, basic hygiene and good ventilation is always better than allowing children to get sick to promote herd immunity.
But he added that the pandemic has created a unique cohort of children who have been “relatively isolated” over the last few years. They may not have been exposed to certain illnesses, meaning they could be more “at risk” when thrust into a group setting.
According to the WHO, nine in 10 unvaccinated people are at risk of becoming infected when in close contact with a case. One in five may develop serious complications and one in 1,000 may die, increasing to three in 100 in low-income countries.
NHS England childhood vaccination statistics for 2023/24 show London had the lowest uptake of MMR.
In Hackney, just 60.8 per cent of children have had both doses of the MMR jab by their fifth birthday.
There is also a high risk of a breakout in Camden, where 65.7 per cent of children have been fully vaccinated by the age of five. The figures fall to 64.3 per cent in Westminster and 63.8 per cent in Islington.
MMR vaccine rates are also low in other major UK cities including Birmingham, Nottingham, Liverpool and Manchester.
A national incident was declared last winter following a surge of measles cases in London, the West Midlands, Birmingham and Coventry.
Dr Saliba told i parents should be “very concerned” about childhood vaccine uptake, with 2,465 confirmed measles cases so far this year due to low MMR vaccine uptake in some areas.
“If vaccination rates across all the childhood vaccine programmes continue to decline, then we are at risk of seeing other diseases re-emerging,” she said. “It is especially tragic to see kids suffering when these diseases are so easily preventable.”
Serious diseases that are at risk of re-emerging include polio and diphtheria.
Dr Williams, of Swansea University, said schools can be like a “petri dish of germs and viruses”, especially for young children who have had minimal exposure to viruses which spread during the first few weeks of term.
He warned that allowing viruses to spread could mean vulnerable children miss long periods of school, adding there is “always a concern” that some may be unable to finish the academic year.
NHS vaccination schedule
1 year
- Hib/MenC vaccine (1st dose)
- MMR vaccine (measles, mumps and rubella, 1st dose)
- Pneumococcal vaccine (2nd dose)
- MenB vaccine (3rd dose)
2 to 10 or 11 years
- Children’s flu vaccine (every year until children finish primary school)
3 years and 4 months
- MMR vaccine (measles, mumps and rubella, 2nd dose)
- 4-in-1 pre-school booster vaccine
Dr Williams told i: “I think there is a risk towards a culture of presenteeism in schools where we shouldn’t be too quick to say children should go in if they’re feeling unwell. I think it’s a judgment call the parents need to make, guided by medical professionals.
“With measles, the case is clear. But even some respiratory illnesses can be quite contagious. Even if that child doesn’t necessarily miss much school, another child could be a little bit more vulnerable and could miss school.”
Jason Elsom, chief executive of Parentkind – a national charity representing a parental voice in education – said the NHS statistics will be a “cause of concern for many parents” and urged them to ensure their children are fully vaccinated.
Kamila Hawthorne, chair of the Royal College of GPs, also expressed concern over low childhood vaccination rates, saying maintaining high rates is a “top priority” for GPs.
“This is especially important when children are starting school or nursery for the first time, or heading back for a new school year – or when students are heading to university away from home – as mixing with lots of new people can often lead to disease outbreaks, and vaccination will be the best protection,” she told i.
Dr Saliba, of the UKHSA, emphasised the need to continue improving vaccine uptake to protect children from serious diseases. She said: “These vaccines offer the best protection as children start their journey into nursery and mixing more widely.”
Steve Russell, NHS national director for vaccinations and screening, said vaccinations have been protecting children for decades, “saving thousands of lives and preventing tens of thousands of hospital admissions every year”.
He urged parents to check their child’s vaccination records to ensure they do not become unwell, meaning they “miss time off school”.
The DfE has been contacted for comment.