Measles infections are on the rise, due partly to falling vaccination rates — and because of their work, healthcare workers and those around them are particularly vulnerable. In a new Frontiers in Public Health article, Nikki Heinze and her colleagues talk to healthcare workers in a London hospital to understand the factors that encourage or discourage measles vaccination. In this editorial, Heinze explores those factors, and calls for action to improve immunity screening, raise awareness, and support healthcare workers who want to be vaccinated.

by Nikki Heinze

In recent years, measles has made a resurgence globally. In England, 2024 saw the highest number of confirmed measles cases since 2012, resulting in the declaration of a national incident. One reason for this is falling vaccination rates, prompted — to some extent — by the success of established measles vaccination programmes, which has reduced public awareness of the contagiousness and potentially serious complications of measles.

Measles is often erroneously thought to be a childhood disease. Yet approximately one-third of the 2,911 cases confirmed in England in 2024, and six of the seven measles-related deaths since 2000, were in adults. Healthcare workers are at the frontline of outbreak containment and patient care. Their occupational exposure means they are at higher risk of catching measles than the general population. However, studies across Europe have shown that concerning proportions of healthcare workers are not immune to measles, meaning they are more susceptible to infection and could spread the virus among vulnerable patient populations. Our article explored barriers and motivators to measles vaccination among a group of 23 female healthcare workers at a London hospital.

Raising the profile of measles vaccination

The interviews showed that knowledge of measles and measles vaccination was generally low, due to a lack of personal or professional experience with measles, which did not feature prominently in participants’ healthcare training. A lack of awareness of the symptoms, contagiousness, and potential complications of measles can delay the diagnosis of infected patients and lower the perceived need for vaccination. Those who are hesitant may also choose not to be vaccinated, due to the low perceived risk of being exposed to measles and the notion that it is a childhood disease that their body will be able to fight.

A now-discredited article published in 1998 that linked the combined measles, mumps and rubella (MMR) vaccine to autism also remains present in the minds of some healthcare workers. Almost half of the interviewees spontaneously referred to autism, although only a small number gave this as a reason for not being vaccinated or not vaccinating their children.

In addition, there is a considerable proportion of healthcare workers who do not know their measles vaccination status (ten of the 23 participants in our study). This is not surprising, considering that measles forms part of the childhood vaccination schedule and few adults will remember receiving their childhood vaccines, meaning they rely on their parents, GP or hospital occupational health department for up-to-date vaccination records. Access may be especially difficult if healthcare workers have emigrated from their country of birth. Unsurprisingly, the idea of an app or platform where healthcare workers could easily access and manage their vaccination records was popular.

Ensuring healthcare workers are aware of their vaccination status, providing them with better training, engaging them in discussions about the risks of measles, and, importantly, the safety and effectiveness of the MMR vaccine may help to increase awareness and alleviate concerns, and is therefore an important public health priority.

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Strengthening vaccine screening

Many hospitals, including the one in our study, screen for measles vaccination as part of their pre-employment screening. This often relies on self-report or the transfer of records, but the. application of screening protocols can be inconsistent and record-keeping poor. Several participants did not recall if measles formed part of their screening or described it as a tick box exercise. There was greater awareness of hepatitis B vaccination, partly because this requires regular boosters.

Prior research found that only 48 of 104 hospital trusts in England recorded their staff’s MMR vaccination status on a central database and 16 recorded staff eligibility for the MMR vaccine. Patient-facing healthcare workers who cannot confirm prior measles infection or vaccination with at least one dose tend to be offered vaccination with or without prior immunity testing.

Placing more emphasis on measles vaccination alongside regular educational and awareness campaigns underlines a hospital’s commitment to, and thus emphasises the importance of, measles vaccination. While expanding immunity testing to all healthcare workers may not be financially and logistically practical for many trusts, screening protocols should ensure all patient-facing staff, including those who move from non-patient-facing to patient-facing roles within a trust, are screened and accurate records of staff vaccinations are kept.

Reframing vaccination as patient care

Healthcare workers with an uncertain vaccination status were generally positive about measles vaccination, but suggested that having to find out their status and make time for vaccination appointments constituted a barrier because of their time constraints. Several interviewees routinely prioritized patient care over what they considered personal chores. Using prompts and reminders, reframing measles vaccination as a means to protect vulnerable patients and the wider community, and action from employers to make it easier for busy healthcare workers to take time to get vaccinated would further underline the importance of measles vaccination and may help those who want to be vaccinated.

Healthcare workers are at the frontline of our defence against resurging diseases such as measles, and it is vital that they are protected. However, if we want them to prioritize measles vaccination, hospitals and other healthcare facilities should continue to campaign for improved vaccination uptake. Improving screening processes in hospitals and holding regular educational campaigns can help to raise awareness of the risks of measles and the benefits of vaccination, and serve as a nudge for those who are unsure.

About the author

Nikki Heinze is a Research Fellow in the Institute of Psychiatry, Psychology & Neuroscience at King’s College London. Her previous research has encompassed well-being, inequality and disability.

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