Why England can learn from Scotland after first measles death in a decade

Telegraph

3 days ago

The NHS in England could learn important lessons from Scotland after a measles death in Liverpool last week, experts say.
Comparative data shows that vaccine uptake in Scotland is considerably higher than in England, with nearly 90 per cent of children fully protected against measles by age five.
The difference, say experts, is most likely to be explained by the fact that access to GPs and other primary health care facilities is much better north of the border
'Everybody talks about [vaccine] hesitancy, but the main thing that's stopping uptake is access,' Dr Helen Bradford, Professor of Children's Health at University College London, told The Telegraph.
'That includes knowing what vaccine is due and when, being able to make an appointment, and actually getting to that appointment – all of which can be really difficult for some families.'
News of the death of a child in Liverpool of measles comes as Britain's vaccination rates have fallen to the lowest of any G7 country, including the US.
The problem appears to be being driven by the performance of the NHS in England.
At least 89.2 per cent of Scottish children are fully vaccinated with the measles, mumps, and rubella (MMR) vaccine by age five, compared to just 83.9 per cent in England.
At the same time, Scotland has much better access to primary care – with 76 GP's per 100,000 people, compared to just 58 per 100,000 in England.
'General practice [in England] has continually had resources withdrawn, but at the same time delivers most of the childhood vaccinations,' said Dr David Elliman, an honorary senior associate professor and medical doctor at UCL.
Access, he added, was the most important issue.
'In a GP practice, most parents are happy to have their children immunised. Some may have questions, but as long as they receive clear and satisfactory answers, they're usually comfortable proceeding,' he added.
During the pandemic – a time where nearly all health systems saw a noticeable decrease in routine vaccinations – Scotland's coverage of routine childhood jabs actually increased.
Researchers at the University of Edinburgh found a 14.3 per cent increase in children receiving the second dose of the MMR vaccine on time during the first lockdown in Scotland compared with vaccination levels in 2019. England saw a net fall in the same period of 1.93 per cent.
The researchers linked the boost to flexible working for parents – which meant they could attend vaccination appointments – and better access to mobile vaccination centres.
In 2018, the Scottish Government took the decision to transfer the responsibility for delivering vaccinations from GP practices to regional health boards as part of a plan to boost uptake.
While most vaccines are still administered by GPs, the shift gave health boards the flexibility to tailor services for harder-to-reach communities.
Unlike in England – where families often struggle with rigid booking systems, the so-called '8am scramble' for same day appointments, and limited availability – Scotland offers vaccinations in several different settings like schools, A&E departments, and at home visits.
'We need to get away from being too rigid in what sort of settings we give the vaccine in. Traditionally it's either been a community clinic or general practice but we ought to be doing it more in the places that parents go to, and particularly children who are at high risk,' said Dr Elliman.
'That means more immunisations in hospital settings and in neighbourhoods,' he added.
Scotland's better vaccination rates appear to be positively influencing outcomes. So far this year, England has recorded 529 measles cases, while Scotland has had just 27.
In 2024, those numbers were even more dramatic: 2,911 cases were recorded in England, compared to just 24 in Scotland.
While population size partly explains the disparity – England's population is more than eleven times larger than Scotland's – it doesn't account for an almost 120-fold difference in infection rates, say experts.
Only last week, the health secretary Wes Streeting acknowledged the need for better access to primary health care in England.
Under the government's new NHS 10-year plan, he committed to rolling out 'neighbourhood health services' to try and 'end the 8am scramble and make it easier to see your GP,' referencing the country's maddening and archaic GP booking system.
The document also includes a plan to boost vaccine uptake by allowing nurses and midwives that carry out home visits to administer vaccines in England.
Yet it is unclear when the new measures will come into force: England currently faces a 5,000 shortfall in the number of health visitors needed to provide the mandated four at-home visits required for every child in the country under school age.
Scotland outcompetes England in this area, too. About 90 per cent of Scottish children receive at least their first four scheduled reviews, compared to just short of 65 per cent in parts of England, including London.
'These are the public health nurses that have contact with all young families with young children, often the first port of call, the first place that parents will ask questions about immunisation. The numbers [in England] have gone down dramatically, which for those people who have got questions means there isn't always somebody obvious to ask,' said Dr Bradford.