health & science

‘Shameful’ measles outbreak predicted

Scientists think the current outbreak of measles could have been avoided if the Ministry of Health had acted on recommendations for a catch-up campaign.

For years scientists have been predicting the measles outbreak which has infected 1541 New Zealanders. Their requests for a catch-up campaign to plug immunisation gaps have been ignored. 

Measles cases are rising daily and 118 babies have been admitted to hospital this year. So far none have died, but it’s believed some have come very close.

There’s also a vaccine shortage. Children are being immunised but others are being turned away. Two additional batches of vaccine have been ordered to cope with demand. One batch is weeks away from arriving, the second is months away.

All of this was potentially avoidable, according to scientists, if recommendations for catch-up campaigns had been acted on.

“We were predicting that there would be outbreaks of measles in New Zealand and we had been requesting for several years that we needed a national campaign to close the gap. So this is not unexpected,” said Immunisation Advisory Centre director Dr Nikki Turner.

The Ministry of Health told Newsroom last week its current focus was on ending the outbreak and ensuring children were immunised as usual to prevent gaps in the future.

Yesterday, after further questions, it did not confirm a catch-up campaign was planned but said it had not been ruled out: "MoH is currently working through a range of strategies and we hope to make announcements in the coming months."

Immunisation gaps in teens and young adults. Data Source: ESR

The only way to stop an outbreak is to make sure enough people are immune to the virus, either by having had measles or getting immunised.

“I would expect that the Ministry of Health needs to have a national strategy to respond to closing these immunity gaps or we will continue to see measles. I will be extremely disappointed if we do not plan for a national strategy,” said Turner.

New Zealand has now had more cases of measles this year than the United States. Along with the United Kingdom and Australia, the US has warned citizens planning to travel to New Zealand of the risk.

“New Zealand is now exporting our disease to other countries. I particularly worry for the Pacific Islands … I would say this is shameful for New Zealand,” said Turner.

She said it would be a “miracle” if New Zealand did not lose its status of having eliminated measles. 

“It's a reputational impact. New Zealand had said to the world we can control measles and now we've shown we can't.”

To achieve what’s referred to as herd immunity - where enough of the population is immune to stop it being passed to those who are too young to be immunised or are immunocompromised - around 95 percent of people need to be vaccinated. 

For those aged 20 to 29 there is sketchy data around about vaccination. At one point only about 50 to 60 percent were fully vaccinated. People aged 30 to 49 are also likely to have only had one dose of the MMR vaccine. Two doses are required for the best immunity. 

This could equate to up to 1.3 million people, although the actual number is likely to be lower as some may have caught up with vaccination during outbreaks. The National Immunisation Register was only set up in 2005, so accurate data before then is unknown. 

Not enough vaccine to meet outbreak demand

Victoria University of Wellington’s faculty of health dean Professor Gregor Coster said the current situation was avoidable and had been predicted.

Coster has previously been deputy chair of Pharmac, the agency responsible for ordering vaccines. 

He said an increase in global cases of measles during 2018 should have been a sign an outbreak was likely.

“We should, at that stage, act fairly quickly to ensure we have sufficient measles vaccinations available.”

The MMR vaccine has been rationed twice due to shortages this year. Pharmac told Newsroom last week historical data was used to estimate how many doses of vaccine to buy, although global outbreaks are factored in. Normally around 12,500 doses of vaccine are required per month.

The decision to order 170,000 additional doses was made by Pharmac. Newsroom asked how this number was calculated but the Ministry of Health did not answer the question. 

However, it was confirmed vaccine shortages were not due to a lack of funding.

Coster said it was difficult to estimate the number of vaccines required, obtain them and then ensure they were used before expiring. 

"We simply can't hold large stocks of a vaccine just in case an epidemic comes along. That's wasteful."

He prefers a preventative, rather than knee-jerk, approach but doesn’t think it’s possible to target the whole country at once.

“There’s simply not enough vaccine available. My proposal is that we start in South Auckland where the need is the greatest and where there is more overcrowding than in other parts of the country.”

There have been 1282 cases of measles in Auckland so far this year with 864 of those cases in the Counties Manukau DHB.

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