Mumps, Vaccinations and PHE: This is ‘World-leading’ Britain

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The mumps outbreak across British universities this past winter was headline news. It was an unexpected contagious virus at the start of the year, a hint of the significant medical horror that would soon engulf the world, including our medical system. There were 4,403 reported cases of mumps between October 2019 and March 2020, predominantly affecting young adults, linked to universities and colleges. I interviewed three students who had mumps and set out with a Freedom of Information Request (FOI) to help determine the reasons behind the resurgence of mumps and to emphasise the importance of vaccinations. 

The most recent mumps outbreak was a far-reaching infection, a decade-high spike hitting all English regions, and it now seems like this was the first confirmation of how Britain is not immune at all to any pathological outbreak. Particularly outbreaks that should have been prevented via vaccination. This is the year the world has found out that being a global community sadly also means that we are an international host. But this year could also demonstrate as well, constructively, that when working together as one, we can prevent and curb a future global pandemic. All countries need to be united with the target of full global vaccination, for the coronavirus and all viruses.

In August 2019, Prime Minister Boris Johnson described the problem of vaccine compliance as a “global challenge”. This was when the UK had just lost its WHO status as ‘measles-free’, a sad occasion for the country that invented the vaccine and considers itself a major player in modern medicine.  The MMR vaccine covers Mumps, Measles and Rubella, all three of which are highly infectious, quickly spreading across the unvaccinated. Yet the vaccinated aren’t necessarily safe, as revealed in the student outbreaks of mumps.  People with both the two requested doses of the MMR vaccine can still contract mumps; over a third of the mumps cases were vaccinated individuals, totalling 1,607 people. (39% last quarter of 209 and 36% in the first quarter of 2020). MMR compliance may not make every type of person immune to mumps – this is known as secondary vaccine failure, with some people producing fewer antibodies less quickly, due to weak immune systems – but they do protect the individual by making complications requiring hospitalisation much less likely. 

All three of the people I interviewed maintain that they were fully vaccinated, which is not contradicted by the aforementioned data collected in PHE’s Health Protection Reports. The interviews were all conducted at the end of April, at the same time as the FOI request I started was first approved. This FOI was approved by FOI for NHS England without further adjustment and enquired for more information about the breakdown of mumps cases: numbers by universities affected, native or international student status, severe complications or not, and further data about the West Yorkshire region. 

E, a previous year first-year student at Leeds, is from Switzerland where none of his friends had even heard of the mumps. This is a stark reminder that the UK is only one of seven countries facing this particular surge of old diseases. He understood totally how ‘extremely contagious’ mumps are, but he still, unfortunately, gave mumps to his brother and friend when he returned home. They are recovered and in good health. In Leeds, E was immediately seen by a student medical practice; however, he was told that he would have to wait 10 days for a test due to the strain on testing services from the major mumps outbreak occurring. This was in February 2020, still during the primary outbreak. I saw E’s photographs of himself, undeniably mumps. E suffered from a severe case, and he had to take roughly two weeks off, majorly bedridden. His suspicion is that there is now a new mutated strand of mumps, explaining why he- fully vaccinated, and in general robust health- had such a rough time with the virus.  

credit: vaccinews

All three students had to self-isolate, to protect others on campus. They all said self-isolating during coronavirus was much easier because there was a communal spirit in quarantine, with less fear of being punished socially and academically. 

Public Health England’s latest report revealed that between April and June this year, there were no reported cases of measles and only 112 mumps cases, compared to 3088 mumps cases in the previous quarter. PHE outlined how many factors, induced by COVID-19 will have led to these reduced numbers. Obviously, as measles and mumps are infectious viruses, everyone socially distancing will dramatically cut down the chances of infection, but interestingly the avoided “new trains of transmission” are attributed to the dramatic reduction of air travel. Opening Universities is currently a controversial issue, as it will likely increase the R-rate across towns and cities. However, university has always been a place where being ill on first visit or return is normalised- is it expected. 

We had Freshers Flu, inescapable but manageable. Then the massive increase in mumps, newsworthy but distant for those not infected, and now we are in the new era of coronavirus. There is precedent and insight for coronavirus; policymakers need to remember that mumps was endemic across British Universities and potentially was only stamped out by a lockdown for another virus. 

credit: BBC News

Y, a student from Warwick University, had mumps in the summer of 2019 when they were a first-year. Y coped with painful eating and damaged salivary glands by only eating soft food like porridge and pot noodles. Y was provided with useful information to keep others safe but highlighted to me how difficult it is to avoid others when not showing symptoms. Y is a vaccinated individual who experienced difficulty even eating, then further unfairly had to face a stressful summer now, caused by needless academic inflexibility. Y shared their own experience describing how first they had to pay for a £20 medical certificate as proof for them not sitting the exam. Warwick was not understanding of the fact that Y was confined to their room, blindingly not conducive for any learning, and there was a lengthy back and forth which resulted in Y still having to do “a first time sit in September – with no cap on marks or anything’.  This was an awful lot of stress for a first-year exam that ultimately didn’t count. Unfathomable to myself, whose first year fell off the face of the earth by blanket cancelled exams. 

A year ago, there wasn’t the collective anxiety about thousands of people being close together on campus. Y commented that mumps being ‘prevented beyond the vaccine is kind of impossible.’  A vaccine ideally should be enough in itself to protect us against the virus it is targeted at. There is no chance for the MMR vaccine to work when its second dose’s uptake is at an abysmal 86.4% average for England 2018/2019, far below the 95% target set by WHO. I asked all three students their thoughts on vaccinations and if they should be made compulsory. They were not unanimous in their views. E and Y both agreed with introducing compulsory vaccinations, citing their misfortune. Y was concerned to have given it to others and pointed out that their friends were worried themselves that they had contracted mumps, despite displaying no symptoms. Y believes that media coverage could help solve the issue of the MMR vaccine, along with education and generating more efficient health care user responses:

“I do find that people who haven’t been vaccinated are increasing the risk for those of us who have been…. but are still susceptible because of the inefficacy.”

For X, the period spent self- isolating for mumps transitioned into being on quarantine during the Coronavirus crisis. A very long time. X, a second-year student in Leeds, fortunately didn’t have as severe a case, instead facing mostly swelling and general discomfort. Isolating with mumps before lockdown ‘definitely made me more prepared to spend time with myself and at home’, X commented. I asked X also about the UK government perhaps now, after coronavirus, being more willing to make vaccinations compulsory, with policies like state-school children having to have their jabs. X said that it could be a “personal decision to choose not to have these vaccinations” and is hesitant to think the coronavirus will change those who “consciously choose to not have vaccinations.” X continued:

 “I don’t necessarily think people should be forced to have vaccinations, simply on the basis that it can have many moral implications such as undermining their right to choice…but [it] can be recommended to them.”

Credit: bbc iplayer/ Prime Minister’s Questions 9/9/2020

X’s opinion on not undermining freedom is not uncommon, and their mention of recommendation instead of mandating is straight out of the NHS and public sphere discourse. In modern times, there has been a consensus that policies regarding public life must only be implemented through encouragement. This liberal thinking has been criticised for being insufficient as the strain on the NHS grows and grows, exacerbated by the public’s poor lifestyle choices. Do we always need to have choices presented to us, even for our jabs?  

It is also wrong to put the onus onto the individual – similar with Climate Change – when it is the political underfunding and cuts to other services buttressed in through austerity. Coronavirus has exposed how unbelievably powerful central government can be in an emergency state, how unrestricted, insular and unaccountable the people who make these integral decisions are.  The once contemporary ‘third way’ approach to health policy- an irresistible combination of nudge theory and public relations- seems half-hearted in a time of substantial governmental restrictions.

On April 29TH, NHS England accepted the freedom of information request, and I was told that it would be answered in twenty working days. On May 29th it was formally delayed without any general time estimate in a generic email. The FOI system should guarantee that both journalists and members of the public are kept informed, in a system that is transparent and fair. With no useful information given when I rang, I extended my right to complain, filing a concerns report to the Information Commissioner’s Office (ICO). Then it was going between NHS England and the ICO – you know morale has become when low when Hard Day’s Night was the comforting, catchy hit played on hold. The ICO said I’d be given a reply within three months, becoming ten working days from August 5th. Then it was a standard email response with another delay. At the same time, I found out my FOI Case Officer’s name, quite casually in conversation with NHS England, and eventually, T was reached. Through another person, T told me to contact PHE instead as his recommendation, with much apologies.

credit: nursing times

PHE sent the shortest and most confusing email to my explanatory request, so, unsure, I rang to check if my data request met their criteria. Soon into my further twenty-day wait, the government decided to reorganise Public Health England. On the 3rd September, the FOI met a dead end with PHE “not holding the information in the way you had requested’. PHE did direct me to previous reports that I had read. 

PHE’s sudden reorganisation was lambasted at a time when government ministers were on the firing line. Major administrative change is a risky move for this time; a distraction and a political decision. PHE is only 7 years old, so to now divide it into two new bodies was going to be highly unpopular. It smacks of desperation by the current government who have been adept at devolving power. Expert at passing on blame and responsibility. Top civil servant in the building Jonathan Slate was sacked for the A Levels Results Scandal, instead of a minister. The most senior Civil Servant, Mark Sedwill, stepped down in June after reported ‘clashes’ with Dominic Cummings. Sedwill’s replacement Simon Case is widely seen as a political appointment, perfect for executing Cumming’s vision of a new Civil Service.  It’s like the Thick of It, but towards the end when the party in power is in its last days; barren. 

credit: science|business

The public gets short shrift too for governmental blunders. Matt Hancock is like a confusing nightmare pointing his privileged finger at us for going to get tested. The “25% we estimate” amount of users, selfishly popping in for a test who are non-positive. I don’t believe for a second that masses of people go for tests, cognizant that they wouldn’t have had any chance to catch coronavirus but wanting to check anyway. I believe in the goodness of people. This automatic, flippant response by the Health Secretary betrays a deep-rooted arrogance by those currently in power. They shirk responsibility and go on to blame travel companies for testing deficiencies when the government was so keen on air travel to pick up again. 

Matt Hancocks’ tenure as Health Secretary also highlights the interventionist wing within the Conservatives. A year ago, Hancock said he “would rule nothing out” referring to compulsory vaccinations on the BBC Radio 4’s Today Programme. That may have been mere posturing, to differentiate himself in the party. However, now with the new, controversial ‘rule of six’ measure, restrictions on the unvaccinated don’t seem such a world away.

For instance, advising unvaccinated school children to remain in a bubble or conduct online learning would once have been an unimaginable proposition, but seems less draconian in the current climate, considering how the pandemic has brought the country to a standstill for so long.

https://amp.theguardian.com/society/2019/sep/29/government-seriously-considering-compulsory-vaccinations-matt-hancock

credit: the telegraph

On the 9th September, PHE Press Office responded with their statement. Dr Vanessa Saliba, Consultant Epidemiologist at Public Health England, said that it is “never too late to catch up” with getting your two MMR doses and advised students to contact their GP to “get up to date as soon as possible.” Also, a twofold explanation for the rise in mumps cases in 2019/2020 was given. First, we are the ‘Wakefield Cohorts’ born around the millennium, now of age. Second, “about half of the cases will have had MMR in the past”. The email explained that MMR is “very good” at protecting young children, but then, at early adulthood, this immunity wanes, meaning that even in highly vaccinated communities, the vaccinated can still contract mumps.  

They have “no specific evidence to suggest international students are more at risk of mumps”, or information to detail how many of the mumps cases were by native or international students. PHE didn’t respond to my questions about vaccinations being made compulsory for students, regarding the possibility of a potential coronavirus vaccine being found. The current national vaccinations policy was made clear:

“Vaccinations are not compulsory in the UK; we operate a system of informed consent.”

9th September. ‘Ill-chosen words’. Boris Johnson is in Parliament talking about the Head of Trace and Test’s critical comments about the system. Johnson pointedly repeatedly calling it “NHS Test and Trace”, to Starmer to make it about Labour criticising the “heroic” NHS. This pandering is meaningless. Call it the “NHS mumps outbreak”, call it the “NHS vaccination failure”. Hide behind those three letters Prime Minister. There are three letters for you and your colleagues who have been the biggest obstacles for public health bodies. OUT. Get out. Leave! Resign! Own up to the chronic underinvestment in public services that mean that, now in a crisis, our country, in particular, is ill-prepared. Politicians seem to be interfering with public health bodies to hide their gross incapacity to lead. 

Mumps is a critical issue. A preventable outbreak, so it should be swiftly dealt with so we can focus on the unknown virus. In my opinion, so many of the individuals contracting mumps after being vaccinated proves that herd immunity has to be so high that it might as well be compulsory. Even when the vast majority of people stick to lockdown measures, spikes of infections still occur. Even when the vast majority of people vaccinate their children with MMR, these vaccinated children still suffer as adults from the few people who don’t vaccinate. It could be a term off school; it could be, in rare cases, severe brain infections. 

credit: bbc news/ getty images

At this moment, the state is constrained to just promoting public policy regarding vaccinations meaning that for now, the United Kingdom will not be turning away unvaccinated children in their schools. Whole cities can be closed overnight, but there is still “informed consent” for vaccinations. There hasn’t been informed consent for coronavirus restrictions..Parliament is an afterthought for the inner cabinet. The nation has had a change of attitude and, whether they like it or not, the current government has shifted Britain’s health system away from nudge economics, encouragement and soft policies.

The world waits for a coronavirus vaccine. Mumps was the precursor to our new world of vital healthcare. It may not have generated the political drive for mass vaccinations. Still, it displayed how everyone of us needs to be vaccinated in our interconnected, diverse and lively country, to protect the herd completely. Britain choosing to eliminate coronavirus and compliance with the longed-for vaccine will make us reframe the consequences of our choices in medicine. Choices that don’t undermine our freedom but allow us to get back to our lives again.

Further resources about Mumps can be found below:

https://campaignresources.phe.gov.uk/resources/campaigns/94/resources/5075

https://www.nhs.uk/conditions/mumps/

header credit: The Scientist Magazine