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Good morning. Not too long ago, the UK was really good at beating measles. In 2017, the World Health Organisation declared that the the disease had been eliminated for the first time in the UK, after no indigenous cases had been recorded in three years.

Now, measles is back. Already this year there have been more than 500 confirmed cases in England, the majority in young children.

On Sunday it was announced that a child who contracted measles had died at Liverpool’s Alder Hey hospital, which had seen an additional 17 cases since the beginning of June. What makes this case more tragic is that healthcare professionals say no child should lose its life to this disease in the UK. The MMR vaccine, offered to all children across the country, gives 97% protection against becoming infected with measles, mumps and rubella.

Yet as measles cases not just here but across the world see a surge, vaccination rates are plunging. Much of the blame has fallen on anti-vax conspiracy theories, which rehash the debunked links between the MMR vaccine and autism and tell parents that vaccines are akin to injecting their children with poison. But according to healthcare professionals, many other factors are also at play, and dealing with the complex reasons why parents aren’t getting their children the jab is becoming increasingly urgent.

For today’s newsletter I talked to Dr Elizabeth Whittaker, the clinical lead for paediatric infectious diseases at Imperial College healthcare NHS trust, about why vaccine levels are falling and what can be done to reverse this decline.

Five big stories

1. Middle East crisis | At least 20 Palestinians have been killed in a crush at a food distribution site in southern Gaza run by the US-backed Gaza Humanitarian Foundation, after guards used teargas or pepper spray on hungry crowds arriving at the centre.

2. UK politics | Conservative former ministers have “serious questions to answer” over the secret scheme to resettle Afghan nationals named in a data breach under the previous government, Keir Starmer has said.

3. Labour | Four Labour MPs have had the whip removed for repeatedly breaching discipline, with three others demoted, in an effort to assert control over the party. The Guardian understands that the four are Rachael Maskell, Neil Duncan-Jordan, Brian Leishman and Chris Hinchliff.

4. US politics | Donald Trump has dismissed a secretive inquiry into the sex offender Jeffrey Epstein as “boring” and of interest only to “bad people”, but said he backed the release of any “credible” files.

5. UK news | The Prevent anti-terrorism scheme missed chances to protect the public from the attacker who assassinated the MP Sir David Amess, and from the youth who murdered three young girls at a Southport dance class, an official report has found.

In depth: ‘None of us have any lived experience of how devastating these infections can be’

Just a few decades ago, the likelihood of a child dying from measles in a UK hospital would have seemed remote, if not almost impossible. Yet Dr Elizabeth Whittaker said that the disease’s resurgence has almost been a foregone conclusion as vaccination rates have steadily fallen over the past 10 years.

To ensure herd immunity against measles, where enough people are protected to prevent the virus spreading, vaccination rates must hit 95%. The current rate across England is 84%.

“Measles has never been eradicated in any part of the world and if a country drops below that 95% herd immunity threshold then the disease will return,” said Whittaker.

“I think a huge part of the problem is that we have been so good at preventing measles, none of us really have any lived experience of understanding how devastating these infections can be.”

How fast is measles spreading in the UK?

According to NHS data, there have been 529 confirmed cases in England so far this year, with 68% occurring in children under the age of 10.

The disease is highly infectious and airborne. In the past few years, outbreaks have occurred around the country, with the West Midlands experiencing cases at their highest level since the mid-1990s.

The uptick in measles cases comes as no surprise to infectious disease experts such as Whittaker, considering that figures from NHS England show that 3.4 million children under the age of 16 years have not been fully immunised with the MMR vaccine.

The UK’s rising measles rates are part of a global upward trend. Measles cases in the US and Europe are at their highest levels in 33 years and 25 years respectively.

Why are parents not getting their children vaccinated?

Whittaker said that while there has certainly been a barrage of misinformation and conspiracy theories around the MMR vaccine – and vaccines in general – in recent years, she believes that this is only part of the story.

“Of course there is some vaccine hesitancy out there, but the bigger lesson here – and it’s a good one because this is much easier to tackle – is that access is a massive issue,” she said.

She said a recent report from the Royal College of Paediatrics and Child Health (RCPCH) found that there was a reasonably good uptake in early childhood vaccines when women were on maternity leave and in close contact with healthcare professionals, but then this tailed off by the time children should be getting their first MMR jab at 12 months. This declined even further by the time the second jab was due at three to five years.

“It’s things like parents working zero-hours contracts who can’t afford the day off, or vaccines only being offered on certain times of the week, or a lack of transport or not being able to navigate the GP practice appointment system,” said Whittaker. “So the key thing to tackle is increased flexibility on how, where and when these vaccines are being offered.”

How have cuts to NHS services contributed?

Another barrier to access is the way that information about the vaccine is being disseminated.

“Trusted individuals like midwives who are in contact with new mothers are replaced often by people who families don’t know,” said Whittaker. “Before you’d have a family doctor, now you see a different GP every time you go into the surgery. Health visitor resourcing is inadequate, so this means that trusted touch points between the health system and new parents have been lost.”

Without access to the information and the vaccine, anti-vax messaging can move into this vacuum and become the dominant narrative.

“We’ve had parents reporting that they were never worried about vaccines, but that since all the doubt and conspiracy theories that took hold about the Covid vaccine, they’re now questioning the credibility and safety of all vaccines, including the MMR,” said Whittaker.

“For a lot of women having a baby or being on your own with multiple small children is a very isolating experience and exposure to misinformation online isn’t counteracted by contact with a trusted healthcare professional.”

What can be done to reverse this?

Whittaker said that there has to be an awareness that “what works for us in north London may not work in Liverpool. We can make the systems as good as possible, but we need to provide solutions that are specific to the local population.”

She points to a project she has recently visited in west London run in partnership with a local community group called Why Did Nobody Ask Us?, which attempts to work with parents from diverse backgrounds to understand the reasons underpinning slow vaccine take-up in their communities.

“We know Black African women have the lowest uptake of vaccines but nobody is really asking why,” she said. “We need to listen to parents because their answers are probably the most crucial tool we have in tackling declining vaccination rates. Information has to be disseminated in as many ways and languages as possible.”

Whittaker is also optimistic about other developments taking place, such as rolling out vaccination appointments and reminders through the NHS app.

Yet what is clear is that there needs to be a massive and rapid investment into prioritising child health across the NHS. She sees the decline in vaccines as a manifestation of “a real neglect of children’s health across the board and it’s something that has to change if we’re going to reverse this trend”.

What will happen if measles continues to spread?

Whittaker said that if measles begins to spread and vaccinations levels continue to fall, the health system is likely to come under increasing strain.

“Measles comes with a huge health risk. Not only can children get really ill from the disease but they have a high risk of secondary bacterial infections,” she said. “This all places a huge burden on an already overstretched system and means health care could be diverted from other children who desperately need it and comes at a significant economic cost.”

Often the first time the hospitals come into contact with an infected child, “they present with symptoms that aren’t obviously measles and have sat in a waiting room and interacted with multiple other children and adults”.

This means that when children do come back with all the visible signs of the disease, “we then need to go back and contact trace everyone they might have been in contact with who could then be spreading infection through their community. It’s a huge job and not one that we’re currently prepared for.”

She points out that this is a disease that could swiftly get out of hand if vaccination levels remain low. “Unless we tackle this now, we’ve got a very big problem coming down the line.”

What else we’ve been reading

• This interview with Janet Street-Porter by the Guardian’s Simon Hattenstone made me howl with laughter. A feature that shows them both at their best. Aamna

• As someone who remains traumatised by It, I’m not sure I’ll make it through this whole list of the greatest Stephen King TV hits and misses but I’ll certainly give some of these a go. Annie

• Trump’s decision to launch a politically waged trade war against Brazil in defense of Jair Bolsonaro has spectacularly backfired, writes Tom Phillips. Aamna

• Very powerful reportage from Minatullah Alobaidi for the excellent New Lines magazine on the resurgence of Iraq’s child brides as women’s rights around the world continue to crumble. Annie

• If, like me, you’re terrible at keeping up with life’s admin, check out these useful tips from administrators. Aamna

Sport

Cricket | Deepti Sharma tallied 62 as the tourists chased down their hosts, India winning by four wickets despite an error-strewn spell with the bat. 1st women’s ODI: India, 262-6, beat England, 258-6, by four wickets.

Golf | The R&A says it has held a “really good discussion” with Donald Trump’s family over the thorny issue of when their Turnberry course might stage the Open again.

Cycling | In a chaotic climax to stage 11 of the Tour de France in Toulouse, Tadej Pogacar crashed at speed before remounting to finish, an anti-Israel protester ran on to the finish line, and the Norwegian Jonas Abrahamsen took his first Grand Tour stage win, for Uno-X.

The front pages

As the age-old proverb rightly states, “You are what you eat.” Our diet largely influences our health and well-being. A balanced diet lays the foundation for healthy living and disease prevention. However, a ‘one-size-fits-all’ approach may not work, given the biological, cultural, socioeconomic, and lifestyle differences. Moreover, gender and age can dramatically influence dietary preferences. Many studies have explored dietary diversity and how often certain foods are consumed. However, little is known about how dietary patterns, food choices, and combinations vary with age and gender.

To bridge this gap, Professor Katsumi Iizuka from the Department of Clinical Nutrition, Faculty of Medicine, Fujita Health University, Japan, and his team sought to analyze dietary patterns among young and middle-aged Japanese individuals. Explaining why this is important, Prof. Iizuka says, “Being aware of the gender- and age-specific differences in dietary patterns and diversity can lead to individualized nutritional improvement for each age and gender group.” Their findings were published in Volume 17, Issue 13 of the Nutrients journal on July 2, 2025.

The researchers analyzed the anonymized responses from a dietary survey obtained during health checkups of 2,743 Fujita Health University employees. The respondents were stratified into four age groups: 20–29, 30–39, 40–49, and 50–59 years.

The Food Intake Frequency Questionnaire was used to assess their weekly consumption frequency of 10 different foods, including meat, fish, eggs, dairy products, soy, green vegetables, seaweed, fruits, potatoes, and oil; the frequency of drinking sugar-sweetened coffee and tea; and the frequency of consuming soft sweets, colas, other soft drinks, and alcohol.

Previous studies utilized diversity indices to evaluate food intake. However, these scores do not adequately reflect dietary patterns or combinations. In this study, the researchers applied previously unexplored statistical techniques that are commonly used in ecology to examine microbial diversity. They assessed ‘alpha diversity,’ or the diversity in a single group, and ‘beta diversity,’ or the diversity across different groups. Further, they performed multivariate analysis to incorporate age and gender variations.

The analysis revealed that the intake frequency of the individual food items did not vary greatly between male and female respondents, except that women consumed fruits more frequently than men. On grouping the participants by age and sex, the researchers noted significantly different dietary patterns influenced by the intake of meat, fish, eggs, fruits, seaweed, dairy products, vegetables, and potatoes. Women had more diverse dietary patterns compared to men. Further, younger men were least likely and older women were most likely to follow a meat- or egg-centered dietary pattern with fruits and dairy products. On the flip side, older men preferred a fish- and fat-centered traditional Japanese diet, while younger women leaned toward plant-based foods, including fruits, vegetables, and potatoes. Notably, the differences between male and female dietary patterns became smaller with age, suggesting a shift in dietary preferences.

Interestingly, dietary diversity and the intake of beneficial foods, including fruits, seaweed, and dairy products, increased with age for both men and women. The researchers suggest that this increase may be because of generational gaps between adults in their 20s and those in their 40s. While middle-aged individuals often live with their families, younger adults tend to live alone, which may affect their food intake and choices. Healthy food choices at a young age can significantly impact future health. Therefore, including micronutrient-rich foods like fruits, seaweed, and dairy products at staff cafeterias and workplaces can help improve their intake by younger adults.

Overall, these findings provide novel insights into how dietary patterns differ by age and gender. These results can further be extended to understand how dietary variations impact gut health and microbiota and the occurrence of diseases like obesity, diabetes, heart disease, and cancer. Additionally, understanding dietary variations can help nutritionists provide tailored guidance to address individual deficiencies.

“By eating fiber-rich foods and fermented products from a young age, it is possible to reduce the risk of developing heart diseases and cancer. Visualizing differences in dietary patterns across generations can improve the general public’s understanding of dietary balance and diversity,” Prof. Iizuka concludes.