Should the UK adopt mandatory vaccine schedules?
As the uptake of the MMR vaccine in the UK falls to dangerously low levels, is it time to consider a return to the system of compulsory vaccination known as the "Leicester method"?
In May 1877 police used a crowbar to force open the door of a private dwelling in Leicester and remove several items of furniture. After loading the furniture onto a van, the policemen drove to a nearby vacant lot pursued by a hostile crowd. There, they staged an impromptu auction as the crowd pelted them with rotten eggs.
The purpose of the auction, according to a report in The Times, was to settle a fine levied on the householder, Robert King, for refusing to vaccinate his child against smallpox. Never mind that at this point King’s child had been dead for more than a year. Under the 1871 Compulsory Vaccination Act, and what was then known as the “Leicester method”, the British state required all new-borns to be vaccinated before the age of four months on pain of a fine of 20 shillings and/or imprisonment.
We do things differently in the UK today. Unlike in France or Italy, Britain does not mandate vaccines for school-age children. Instead, we try to persuade parents to vaccinate their children against measles, and other diseases such as diphtheria and polio, voluntarily using positive medical messaging and by making vaccines easily accessible. And by bundling vaccines such as mumps, measles and rubella (MMR) into a three-in-one jab, we also make it less likely that people will fail to fully inoculate their children out of laziness or hesitancy.
That, at least, is the theory. Unfortunately, the news that the UK’s Health Security Agency (UKHSA) has declared a national incident following an explosion of measles cases in the West Midlands is leading some experts to ask whether it might be time to bring back the Leicester method.
Until a few years ago I would have said no. But that was before the Covid pandemic eroded trust in the pharmaceutical industry and resistance to lockdowns pushed scepticism about vaccines to dangerous new levels. In the West Midlands, there have been 216 confirmed cases of measles and 103 probable cases since October – 80 percent of them in Birmingham. Meanwhile, in Hackney only 68 percent of children have received their first MMR jab and only 56.3 percent have had the two jabs which confer complete protection.
Overall, cases in England and Wales doubled from 735 in 2022 to 1,603 last year. What makes these numbers so concerning is that measles is incredibly infectious, with a reproduction rate of between 15 to 16, compared to 2-3 for Covid. Moreover, seven years ago measles had technically been eliminated from Britain, with the main threat coming from overseases introductions of the virus.
For some, hesitancy about vaccines may be due to cultural and religious beliefs – that vaccines containing pork products are ‘haram’, even though alternative vaccines without pork gelatine are available. For others, it may reflect the influence of pseudo-science beliefs, such as the notion that the MMR jab might “overwhelm” children’s delicate immune systems.
This is not only an issue for parents of school-age children. In areas where MMR coverage has fallen below the 95 percent level required for herd immunity, thousands of young adults will also be at risk of contracting measles because they missed out on the jab when they were children themselves. This is the so-called “Wakefield generation”, the offspring of parents who were taken in by the British gastroenterologist Dr Andrew Wakefield and his now discredited claim linking the MMR jab to autism. There was little evidence for a causal relationship at the time and multiple medical studies have discredited it since but that didn’t stop The Lancet from publishing Wakefield’s flawed 1998 study or the Daily Mail and other British newspapers from amplifying his bogus theories in the years that followed (it was also Wakefield who floated the immune overload theory in relation to MMR).
In 2010 Wakefield was barred from practising medicine in the UK but his bogus theory continues to feature prominently on antivax and conspiracy sites, as well as on the WhatsApp chats where many parents get their medical information. Indeed, it is only now that some parents who were taken in by Wakefield are beginning to realise their error.
Take Debbie Roscoe, whose daughter Ellie, contracted measles at the age of 22 as a direct consequence of her failing to get the second MMR jab. Like many other parents at the time, Debbie was influenced by the media coverage of Wakefield’s Lancet study. The other factor was a friend with two severely autistic children.
"The choice was ‘do I go ahead with the second vaccine or not? Am I risking measles or autism?’” Roscoe told Sky News.
"And I thought at the time that the autism was far worse than the measles…. Obviously now we know different… If I could go back, I would take a second vaccine."
But for every parent who has come round to vaccination there are others who continue to harbour doubts. As in other historical periods, this suspicion of vaccines is animated by concerns about the role of the state in matters of bodily health. But perhaps the key factor is the way that the act of inoculation—from the Latin word for graft or implant—is able to draw on a diverse range of metaphors, from fears of “contamination”, to anxieties about environmental “pollutants” and our absorption into the “herd”.
So, what to do? I have no easy answers. Certainly, we need to do a better job of getting positive vaccine messages out to communities who, for whatever reason, may be distrustful of the state and its medical emissaries. But we also need to make vaccination clinics more accessible for transient urban populations and provide more health visitors, who, thanks to government cuts and the contracting-out of local services, have seen their numbers plummet in recent years.
But should vaccination rates continue to fall – in some parts of London, as few as half of children have had both MMR jabs by their fourth birthday – we may have no choice but to consider a return to some form of the Leicester system.
The danger in so doing of course is that we fuel further distrust and resentment. That is what happened in 1877 when Robert King became a martyr for the Anti-Compulsory Vaccination League, leading to huge demonstrations in Leicester and other English cities. But with the UKHSA predicting that a new measles outbreak in the capital could see tens of thousands of news cases and dozens of deaths, we may soon have no choice.