Having endured months of restrictions on our freedoms to deal with Covid-19, we now face a major health threat entirely of our own making: vaccine hesitancy. Measles – a centuries-old contagious disease which can lead to serious complications – is on the rise. Hospitals in Birmingham are dealing with their biggest outbreak in years. Health experts are warning that, unless more children are vaccinated, more admissions should be expected.

This should worry, but not surprise us. In some areas and groups in London, coverage of the first MMR (measles, mumps and rubella) dose is as low as 69.5 per cent. Approximately 10 per cent of children in the UK are unprotected from measles by the time they start school, with coverage at 12 year lows. The country is well below the 95 per cent required for herd immunity: just 84.5 per cent of people were fully vaccinated last year.

Experts fear that, over time, complacency – and with it, apathy – has crept in. Before the development of a vaccine, there were often hundreds of thousands of cases of measles every year. In 1967, the year before the jab was first introduced, there were around 460,000 suspected cases in the UK, and 99 people died from the disease. In 2020, there was believed to be just one (adult) death.

Herd immunity means that, because a large proportion of the population has been inoculated, an unvaccinated person is at reduced risk of getting the disease. As a result, some parents won’t bother, knowing they can rely on others deciding to vaccinate theirs. We too readily forget that herd immunity is important for individuals who, for health reasons, cannot be immunised or respond less well to vaccines. This is being compromised by ‘free riders’.

But there is more to this story. Scares such as the widely discredited study by disgraced doctor Andrew Wakefield, which wrongly linked the vaccinations to autism in the late-1990s, haven’t helped. Nor will the government’s approach to the Covid-19 jab, which effectively forced, through restriction of movement, young, healthy people to be protected against a disease which presented little personal danger. Setting aside the benefits of reaching the Covid herd immunity threshold, vaccine mandates played into the hands of conspiracy theorists who seek to tarnish all immunisations.

Not all parts of the country are affected equally, but regional variation is less pronounced for the first dose. Why? It may be a demographic issue: some places have a more settled population than, say, London. This has consequences for the accessibility of GPs – which are hardly easy to access even for long-standing residents. It’s not hard to see how vaccinations might be missed.

There is evidence that children from some ethnic groups are less likely to be immunised than others: in London those of an Indian background were more likely to be fully covered than white British children. African and African-Caribbean children were much less likely to be covered. Most major religions do not oppose the idea of vaccination, but certain religious or cultural considerations – such as dietary rules – can shape attitudes and decisions. These are not concerns policymakers can shy away from.

As the incidence of measles increases, there is a risk politicians will, under mounting pressure, reach for the most draconian lever: compulsion. Countries like Australia and Italy have attempted this, requiring proof of measles immunisation for children attending nursery or school. It has not led to 100 per cent coverage but has raised fears over widening inequality and decreased uptake of other vaccines. As it happens, vaccination against smallpox was compulsory in the UK for almost a century from 1853. It prompted the creation of the Anti-Vaccination League, and quickly became a bureaucratic nightmare, as growing numbers sought exemption, many on legitimate grounds. It is highly likely we would face the very same issues were we to experiment with compulsion today.

Instead, we need targeted approaches. Vans on streets in low take-up areas. Pop-up vaccination centres. Better communication through schools, nurseries and religious centres. TV and radio adverts, featuring testimony by well-known actors and politicians from ethnic minorities – as David Lammy (and others) did for the Covid-19 jab.

It won’t be cheap. But it would be affordable if the UK Health Security Agency, which fritters away money telling us to wear more layers and sensible footwear during a cold snap, took its role of preventing the spread of infectious diseases more seriously. When UKHSA was created after Boris Johnson disbanded Public Health England, it had around 2,000 staff members.

It is thanks to vaccination that measles has posed little threat to public health in recent decades. We shouldn’t be fooled into thinking otherwise.