Measles outbreak was ‘a time bomb waiting to explode’

Europe’s measles epidemics are the inevitable outcome of the MMR vaccine controversy that erupted in the late 1990s, a UK-based doctor has claimed.

Immunisation rates were hit by unfounded fears that measles vaccines were responsible for the rise in reported autism cases in the developed world. The issue hit the headlines in 1998 when Dr Andrew Wakefield published a paper in The Lancet and suggested a connection between MMR and autistic spectrum disorders.

As the story was found to be fraudulent and scientifically flawed, Wakefield lost his medical license and the paper has been withdrawn by The Lancet. However,  the impact of the scare story and the  subsequent loss of confidence that it caused in the MMR vaccination can be seen in measles outbreaks across Europe, according to Dr Charlie Easmon founder of Your Excellent Health Service, in Harley Street, London, which specialises in travel medicine, occupational health, mental health, and aid and development.

“This is a time bomb that’s been waiting to explode since the Wakefield scandal,” he told Vaccines Today in a wide-ranging interview. Teenagers affected by measles can miss crucial school days which potentially impacts on their chances of academic success.

“This can permanently alter your chances of success with exams and work, in addition to other serious health problems caused by measles, mumps and rubella, such as disability which can include deafness and cognitive problems, and even death,” he added.

Dr Easmon said health workers have an important role in protecting against preventable diseases, not least by ensuring that they themselves are immunised.

“Here [in the UK] we only achieve 14% flu vaccinations for health workers. In some hospitals in America they’ve achieved 98%. I see it as a dereliction of duty not to be immunised,” he said. This situation, according to Dr Easmon, could be improved simply by changing the way vaccination is provided to health professionals.

 “What happens currently is a poorly running occupational health service says, ‘Flu vaccines are available on Ward 35, on the fifth floor, between 9am and 11am’, and no one turns up. They need to say, ‘We’re coming at 10am to offer flu vaccines, and your job depends on it.’”

This prescriptive approach may cause consternation among health workers in Europe but Dr Easmon believes doctors and nurses have grown complacent about immunisation.

He is also concerned that doctors in Europe are unprepared for the increasingly exotic range of infectious diseases their patients are presenting with. Conditions which once seemed rare are becoming more common due to globalisation.

“It’s a massive problem; I call this the ‘Zebra Principle’. A GP in the UK hearing hooves expects to turn around and see a horse, but increasingly it’s a zebra. It is easy to think malaria is flu unless you ask the right questions.”

This is a full transcript of the Vaccines Today interview with Dr Charlie Easmon.

Vaccines Today: You are based in the UK where there has been an increase in measles cases (according to the ECDC). Have you seen this in your own practice? Why do you say it is particularly important for teenagers and young adults in the UK to check whether they are adequately protected against measles?

Charlie Easmon: We have not seen this in our practice but we expect to as we work with more schools.  It’s a time bomb that’s been waiting to explode since the Wakefield scandal. The government did not counter the claims at the time; they needed to forcefully come in and fight the material and myths being passed around at the school gates, and by ill-informed nurses. 

For that age group, time off school can permanently alter your chances of success with exams and work, in addition to other serious health problems caused by measles, mumps and rubella, such as disability which can include deafness and cognitive problems, and even death.

VT: Given that France has been enduring a particularly dramatic upsurge in measles cases since 2010, is measles vaccination something you discuss with patients travelling from the UK to mainland Europe?

CE: If a school trip is going somewhere with an outbreak, then of course. Notably, we’ve also recently been advising adults going to Australia to have the whooping cough vaccine. Australia had a particularly unsuccessful programme and is seeing the impact of that now.    

VT: You have worked with companies as an occupational health specialist. To what extent does immunisation play a role in occupational health and how did the 2009 H1N1 flu pandemic influence attitudes to influenza vaccination?

CE: We noticed a much higher corporate interest in flu vaccination after swine flu [2009 H1N1]and also the message seems to have filtered through that the US is much more pro-active about global flu vaccination. They are way ahead of us; you can’t get your child into school in the States unless they have had a flu shot. Equally, in US hospitals they have realised that healthcare workers are propagators of flu, and that by struggling into work when they feel ill, they are causing deaths. Here we only achieve 14% flu vaccinations for health workers, in some hospitals in America they’ve achieved 98% – it’s a dereliction of duty not to be immunised. I would be strongly in favour of incorporating this into Occupational Health plans over here too.

As one of the biggest employers in the world, the NHS need to fully operationalise their guidance for flu vaccines for health care workers.  What happens currently is a poorly running OH service says, “Flu vaccines are on Ward 35, Fifth floor, between 9 and 11”, and no one turns up. They need to say, “We’re coming at 10am to offer flu vaccines, and your job depends on it.”

It plays a key role and I advise that travel health in particular is a ‘hard hat issue’. On a building site you wear a hard hat, if travelling you should get the best travel health advice and the required vaccinations.  

I’m also a great fan of companies encouraging women to have cervical cancer vaccines. The vaccine reduces Human Papillomavirus by at least 70% so we could prevent a significant number of women getting cervical cancer. The government funds the vaccine between the ages of 12 and 18 but, in my opinion, companies employing many women in their 20s and 30s should be more pro-active about subsidising the vaccine and offering it as a choice to their employees. Similarly, companies employing waste disposal people should consider providing Hepatitis A and Hepatitis B; a policeman patting down a drug user needs to be protected too, and many professions are exposed to TB.

VT: Given that we live in a globalised world in which more people are travelling long distances for work and on holidays, are GPs prepared for the variety of communicable diseases which now present at their clinics – particularly given that some of these preventable diseases are very rarely seen in the UK population?

No and it’s a massive problem; I call this the ‘Zebra Principle’.  A GP in the UK hearing hooves expects to turn round and see a horse, but increasingly it’s a zebra. It is easy to think malaria is flu unless you ask the right questions.  

Last week I saw an ex-soldier who had been in Belize in the early 1990s. He had a rash on his nose, but had never had eczema and didn’t wear glasses. I think he’s got a parasitic infection that has been latent for twenty years, called leishmaniasis. I’m referring him to a tropical medicine specialist, but GPs don’t think that way as it just looks like a red rash and the history is two decades old.

VT: Looking to the role of immunisation in improving global health, you have been critical of some aid agencies. Do you support the work of The Gates Foundation and the GAVI Alliance which put vaccination at the heart of development aid policies?

CE: Yes, because it is more focused.  Organisations like the World Health Organisation and many aid agencies should be honest about their skills gaps – my experience is they need to improve ‘distribution’ (Coca-Cola and the dreaded cigarette companies are brilliant at this, however…) There is nothing sadder than mothers trooping miles barefoot with their children to a poorly planned vaccination programme. When I was working in Rwanda, the WHO had distributed the cold chain for the vaccines in portable containers. But no one there had considered the most obvious thing: the wicks wear out. I saw waste like this time and time again. 

VT: What are the challenges that arise when vaccines are in short supply?

CE:  We need more generics that we can trust, and hopefully China or India will be big here. The challenge now is for China and India to reach the stage where someone like me would trust the quality of the products, then when, for example, the typhoid vaccine is in short supply, I could phone up a company abroad and know that the Medicines and Healthcare Regulatory Authority had approved their standards. Private clinics are thinking about other places they can source their supplies which meet UK regulatory standards.

In the past when we’ve had a shortage of injectable Typhoid we’ve found other solutions such as the oral Typhoid vaccine. It’s always been out there, just not as part of British medical culture. We have to be open to innovation and progress.