Official data published this week revealed that uptake of the measles, mumps and rubella (MMR) vaccine among children in England fell to a 15-year low. At the same time, the Government announced that from next January, the chickenpox vaccine (varicella) will be offered to all children in England for the first time.
Varicella will be administered along with MMR to create a combined MMRV vaccine. The question is whether such a strategy could lead to a further reduction in take-up.
In general, chickenpox infection represents a much smaller risk to children than, say, measles. As a result, the varicella vaccination is unlikely to be seen as a priority for most parents. Some will consider the potential side effects and conclude that they do not want their children to have this vaccine at all.
Many parents are already wary of the MMR vaccine for various reasons, ranging from moral objections to the use of cell lines derived from aborted foetuses, to concerns about the safety of administering combined vaccines.
There is indeed evidence that MMRV can increase the risk of febrile seizures among infants relative to the MMR on its own. The JCVI statement on childhood varicella notes that the absolute risk from combining the vaccines is low (about one additional seizure for every 2,300 vaccinations) but here is the problem: trust in messaging around vaccinations has been severely undermined by the unethical way Covid vaccines were promoted.
In 2021, the Government introduced draconian policies such as mandates and vaccine passports aimed at pressuring young people to get vaccinated. And they followed up by rolling out the vaccine to schoolchildren, despite the evidence that for most young people, the risks from vaccination almost certainly outweighed any plausible benefit. Unethical as they were, such policies may have increased vaccination take-up in the short run, but the consequence was that a significant proportion of the population no longer trusts official reassurances on vaccine safety.
This loss of trust may well mean that the rollout of the chickenpox vaccine results in a further reduction in uptake of the combined vaccine. If this is indeed the unintended consequence of the latest policy, the public health response will be critical.
One possibility is that officials will decide to ramp up pressure on parents to get their children vaccinated and encourage politicians to crack down on online “misinformation”. We might even see renewed calls for childhood vaccines to be made mandatory. If officials take that route, the result will of course be an even greater erosion of trust.
An alternative approach would be to try to rebuild trust by increasing transparency about vaccine side effects and providing parents with more choice and options. This might include trying to accommodate parents who, for whatever reason, want some but not all of the four vaccines for their children, by offering the alternative of single doses.
Trusting parents to make the best decisions for their children should not be a radical concept. The problem is that such an approach would require public health officials (and indeed politicians) to learn from their failures during Covid. From the evidence we have so far, we should perhaps not hold our breath.