I was born in the 1960s and I remember seeing children who had suffered long-term effects of infectious diseases.
I lived across the road from a boy who could not walk to school as a result of polio. A sister of one of my classmates had profound disabilities and was cared for in a long-stay hospital because her mother had contracted rubella during pregnancy.
Like many in his generation, my father had more personal experience of the potential consequences of childhood infections – his sister Eileen died of diphtheria in 1934 aged only 13; the fact that I was named after her three decades after her death highlights the enduring fallout in our family. Unsurprisingly, my parents and their contemporaries saw vaccinations as an amazing development in medical science.
“We now rarely see the tragic consequences of childhood infections”
After decades of nationwide childhood immunisation programmes, we now rarely see the tragic consequences of childhood infections. But has this made us complacent about the role of vaccination in protecting ourselves, our children and the most vulnerable in our society?
My children were vaccinated in the early 1990s at the height of the panic about the MMR vaccine being linked to autism by the discredited former doctor Andrew Wakefield. I remember the fears other parents expressed about vaccination, their lack of understanding of herd immunity and their mistrust of the medical profession.
And I also remember how those fears were exacerbated by the misinformation they were being bombarded with from newspapers – primarily the Daily Mail – looking for a headline that would boost sales, regardless of the harm it might cause.
Just this week, my local BBC News in Nottingham reported on four suspected measles cases, and concerns are yet again being raised about the uptake of vaccinations in the UK and across Europe. Unicef suggests that 527,000 children in the UK did not receive the first dose of the MMR vaccine between 2010 and 2017.
There are concerns that parents are being influenced by misinformation peddled on social media by ‘antivaxxers’ posting false messages that are difficult to monitor and challenge. A recent survey by The Royal Society for Public Health indicated that 41% of parents have been exposed to negative messages about vaccines on social media but this increased to around half for those with children aged under five.
So what is the solution?
One suggestion gaining traction is to make vaccination mandatory. At first glance this is an appealing option and linking it to children’s entry into education would – on the surface – would solve a difficult problem.
However, a debate at last week’s RCN Congress challenged this view and revealed mixed opinions among delegates, with many speaking out against the idea. One suggested that a mandatory system would be difficult to police. Another highlighted the importance of parents being able to talk to a health visitor about vaccination. But do we have health visitors available to have those conversations?
Traditionally health visitors had a vital role in caring for young children and supporting parents. As an anxious first-time mother in my mid-30s, I found my health visitor invaluable in helping me negotiate the challenges of looking after a young baby.
More than 20 years later, parents do not have the same access to these services. As we reported earlier this month the new chief executive and general secretary of the RCN, Dame Donna Kinnear, has expressed concerns about health visitors’ traditional role being eroded as their safeguarding responsibilities have increased. Meanwhile, health visitor numbers in England are falling as central government funding for local authorities shrinks.
As a consequence, health visitors have to prioritise those with the greatest – or most urgent – need, but as a consequence their important public health role is squeezed.
“Mandatory vaccination is a headline-grabbing option, but it is not a replacement for personalised support from trusted experts”
If we are serious about supporting parents to make informed decisions about vaccination we need a comprehensive, responsive health visiting service for the under-fives that can help parents navigate not only the minefield of misinformation about vaccination but also the wider challenges of becoming a new parent.
Mandatory vaccination is a headline-grabbing option, but it is not a replacement for personalised support from trusted experts in child health. This should be high on the agenda of policymakers as they address concerns about vaccination uptake and the influence of social media in shaping parents’ opinions.
The issue of health visitor numbers has to be a critical part of these discussions if we are to prevent childhood infections becoming as familiar today as they were in my parents’ childhood.