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Q&A: Associate Professor Paul Middleton on falling vaccination rates

Associate Professor Paul MiddletonAs a measles epidemic grips south Wales, Associate Professor Paul Middleton is warning Australians that the same thing could happen here.

The number of measles cases has passed the 1000 mark in the Swansea region in Wales and the 10-18 age group has been the hardest hit. This group would have been eligible for the MMR jab when concerns about the link between the vaccination and autism were raised in the late 1990s in a paper by now-discredited doctor Andrew Wakefield.

We chat to emergency medicine specialist Associate Professor Paul Middleton about the measles outbreak in Wales and the long-term consequences of the drop in vaccination rates in Australia.


Q: What are the circumstances that led to the measles outbreak in Wales? Could this happen in Australia?

The measles outbreak in Wales is the result of a drop in vaccination numbers in the 1990s. Vaccination took a beating in 1990s, when the anti-MMR vaccine hysteria leading many misguided parents to decide not to vaccinate their children. This was caused by a paper published by Andrew Wakefield, subsequently found to be scientifically unsound and the evidence deliberately manipulated to suit his purpose. Andrew Wakefield was also struck off the medical register for his unethical actions.

Because of this paper, a lot people thought the MMR vaccine was unsafe, so they stopped vaccinating their children. There was a 10-15 per cent drop, and now there are 42,000 unvaccinated children in Wales alone. This is what caused the outbreak, affecting more than 900 children.

It’s the same in Australia. With an increasing number of parents having failed to vaccinate their children as infants, we now face the very real possibility of outbreak of measles or another serious virus among older children and teenagers here as well.


Q: What are the long-term consequences of the drop in vaccination rates? 

There are two main consequences, for the individual and for the community. For an individual, there is the long term risk of catching one of these serious diseases, which could result in serious damage, disability and even death.

For the community, the consequence is a loss of herd immunity. If vaccination rates in a community are above 93 per cent, deadly diseases can die out because there aren’t enough hosts to sustain them. This benefits everyone, even those who aren’t vaccinated. When you vaccinate your child, you’re helping to protect your whole community.


Q. What are the dangers of viruses like measles, rubella, mumps and chickenpox if they hit older children/teenagers?

In older children and teenagers, the risk of serious complications can be much worse.

When older children and teenagers catch chickenpox, the same virus can cause shingles, which is a serious and debilitating illness.

The most serious complications for measles are meningitis (inflammation of the brain membrane) and encephalitis (inflammation of the brain). Both of these can lead to brain damage, and can be fatal. A rarer complication of measles is optic neuritis, which can lead to blindness.

The risk of complications is high – 35 per cent of measles cases get 1 or more complications. 1 in 20 children with measles will get pneumonia. 1 in 1000 get encephalitis – which can cause convulsions, deafness, mental retardation and death. 1-2 children in every 1000 who get measles will die.


Q. What are the current stats on vaccination rates in Australia?

A new study, completed in 2011-2012, showed that 77,000 Australian children are not fully vaccinated. There are 32 areas across Australia where 85% of children or less are not fully vaccinated – and 90% is considered the “safe” cut off.

The lowest vaccination rate across all Australian children at age 5 was 84%, in Eastern Sydney. Sadly, the lowest vaccination rate for Aboriginal and Torres Strait Islander children at the same age is much worse – just 70% in North Perth.


Q: What should parents be aware of if they are considering not vaccinating their child?

There are two things parents should be aware of. First, that any possible side effects of vaccinations are much less serious and much less likely than the effects of the diseases that vaccinations protect you against. Secondly, it has been proven that there is no evidence for most supposed side effects that parents are scared of, e.g. autism.

Steve Hamilton, President of the Australian Medical Association, said that people who discourage vaccination and spread fear are putting their communities in danger and harming our children. I agree with him.

Please, make sure your kids are fully vaccinated, to protect them now, and as they grow up.  Sadly, we can’t vaccinate against every single virus, but we can keep you and your family safe from the very worst.



Associate Professor Paul Middleton is an emergency medicine specialist, author of What To Do When Your Child Gets Sick: the Essential Emergency Manual for Parents and Carers. He is also Chair of the NSW branch of the Australian Resuscitation Council and works as a Visiting Medical Officer in emergency departments of major hospitals in NSW and ACT.

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2 comments so far -

  1. I am a mother of three. because i my self and several other family members had bad reactions to some vaccinations i decided to postpone my first born sons immunisations untill he was 1yrs old this way would know what he was alergic to and have the time to make an informed decision as we are in a rural area and contact with other people is limited. he was a healthy boy starting to talk and walking and feeding him self with fingure foods ect, doing all the things a bub can do. but he had a sever reaction to the first lot of vaccinations given to him. We knew there was something seriously wrong but every one kept telling us he’s got a cold but he didn’t have a runny nose or a caugh he was very agitated as if in pain accompanied by a rash and swelling all over the body we had several test done they came back Negative to all of the illnesses. Within two weeks he had regressed to the point he didn’t walk, crawl, talk, feed himself as if he was a newborn again. He didn’t start to talk until he was five, he couldn’t tiolet as much as we tried until he was nearly 5 1/2 and still has several accidents aweek, he has major behavioural issues and repetative behaviours and that’s just the start.

    There are serious side effects and people who are alergic as there is to all medications, the doctors don’t report so they aren’t included in the stats therefore the doctors aren’t aware that these things can actually be side effects. It’s a vicious cycle.

    Quote ” There was a 10-15 per cent drop, and now there are 42,000 unvaccinated children in Wales alone. This is what caused the outbreak, affecting more than 900 children.”
    This is not true vaccination dose not stop out breaks and it sure wont stop your child from getting it or having a bad case of the disease either.

    The best way to prevent is good hygiene, healthy immune systems (eating right) and awareness.

    • Hi, Chris – I’m sorry to hear that your child has suffered, but it’s highly unlikely that his unfortunate disability has anything to do with vaccination. As you know, developmental change doesnt happen overnight.

      I’m afraid you are wrong about vaccination preventing disease – it’s not perfect, but it’s a lot better than relying on even the strongest immune system. Until the 1980’s, perfectly healthy and nourished children with strong immune systems could still die of epiglottitis – caused by HiB – because their air passages could swell and block off – despite the best diet and hygiene. That doesn’t happen any more – because of vaccination.



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