Measles resurgence – Expert Reaction

Four cases of measles have been confirmed in Canterbury this week, and one case in Auckland.

The Ministry of Health has sent out an advisory reminding travellers to make sure they are immunised against measles following outbreaks overseas in the Philippines and in parts of Europe.

Since 2012, all cases of measles in New Zealand came from travellers bringing the disease from overseas.

The SMC asked experts to comment on the resurgence – please feel free to use these comments in your reporting. 

Nikki Turner, Director of the Immunisation Advisory Centre (IMAC) and Associate Professor in the Division of General Practice and Primary Health Care, University of Auckland, comments:

“There has been a flurry of news reporting increasing measles outbreaks both internationally and locally. What is going on? The science behind measles control is really clear: If you have high enough immunisation rates you eliminate measles. Measles is a nasty disease with a highly effective remedy, the science is straightforward.

“So, why can’t we eradicate measles? There is a lot of international commentary on the damage from ‘vaccine hesitancy’ (fear and mistrust leading to declining vaccines). Some, but not all, European countries are finding growing anti-immunisation sentiment, magnified by ‘fake news’ in social media.  Vaccine hesitancy arises from lack of trust – we have a world where currently there is less institutional trust, increasing equity gaps and power-imbalances.

“However, mistrust is only one piece of the puzzle. In New Zealand, we have actually eliminated measles, any new case starts from an import. If it spreads it is because that case is in contact with someone who is not immune.

“Most cases are occurring in young adults who were unaware they were not completely immunised when they were young. This is the legacy of a system that historically was not so effective at offering services, changed schedules often and does not have a national register for those who missed out.

“There was some added effect from some vaccine hesitancy in the 1990s arising from the myth that arose from a mistaken belief in association with childhood autism.

“We need a great deal more attention on how to translate effective science into effective public health service delivery. Public health messages are embedded in institutional trust and these can easily be eroded. Furthermore, we need to build and nurture social trust – requiring a system that offers quality provision and communication.

“Vaccine-preventable disease is a tricky product to sell at times – the absence of disease is forgotten until it reappears. The simple public health message for New Zealanders is: don’t forget to check your immunisation status. If in doubt, it is safe to revaccinate.

Conflicts of interest: I chair the World Health Organization SAGE subcommittee for measles and rubella elimination.