Doctors concerned by falling MMR jab rate

A drop of 10 percentage points in the uptake of the second dose of the measles, mumps and rubella (MMR) vaccine for children since 2022 – the lowest level in almost 15 years – has raised concern among health professionals.

Despite Malta’s strong childhood immunisation rate, the Superintendence of Public Health has flagged “warning signs” as 2023 and 2024 data show a clear “dip” in the second-dose uptake.

Malta is among Europe’s highest-rated countries for vaccination uptake. In 2022, around 95 per cent of live births received the MMR 2 vaccine, data from the National Immunisation Schedule shows. But the figure dropped to 85 per cent last year.

To maintain herd immunity, at least 95 per cent uptake for both doses is needed, the superintendence said, explaining that “measles is highly contagious and able to spread fast, meaning that even small immunity gaps can become dangerous”.

It can lead to severe, life-threatening complications, including death.

Health Ministry data on the coverage rates from 2010 to 2024, reported to WHO every year and calculated using live births as the denominator, show that the MMR 1 rates, the first dose of the vaccine, have dropped by one per cent to 94.8 per cent – hovering on the 95-98 per cent of population protection required to avoid outbreaks.

While one dose offers good protection, the second is crucial for boosting immunity in those who respond poorly to the first and in helping to prevent transmission.

MMR2 increases overall protection to near 100 per cent for measles and rubella and about 88 per cent for mumps.

One “underappreciated risk factor”, according to the health authorities, is population mobility, with some non-Maltese families, who begin immunisation in Malta, possibly relocating before the second dose is due.

“This could be the reason for the lower percentage coverage of the second dose,” they said.

“We do chase up parents of children who do not come for the second dose and some non-Maltese are not reachable,” they said, emphasising that “the second dose does matter”.

Officials warned that “Malta’s strong herd immunity (the percentage of protected individuals in a community) is our best defence against outbreaks”.

Vaccine hesitancy

Paediatrician Robert Cassar believes 2025 is already proving “way worse” for childhood vaccination uptake based on what he is seeing in his clinics and says he is increasingly worried about vaccine hesitancy.

He reports more patients insisting on delaying the MMR vaccine until their children are older – around two or three.

“What is bad is that they do it… but late. These parents claim they are not against the vaccine but simply not happy to administer it at the recommended age of one,” Cassar noted.

“This year, I have observed an increasing number of parents asking to skip some vaccines. The most infamous is the MMR but now not only.

“Most of my patients follow advice but an increasing number insist on not having one or more vaccines,” Cassar noted, adding that the number of foreign patients refusing vaccines has always been higher but is increasing.

Delaying is a bad idea

Delaying vaccination is “a very bad idea”, he warned.

The reason the vaccine is given at the age of one is that babies are partially protected through antibodies passed during pregnancy and by the herd immunity, which is very fragile.

If over 95-98 per cent of the population is protected, the community is unlikely to experience outbreaks. But when people insisted on delaying, that percentage could drop below 95 per cent, “leading to trouble” not only for that child but also for others.

Often, parents thought they would just delay the vaccine by around six months but ended up forgetting it altogether, Cassar pointed out, admitting he only gets to see the tip of the iceberg because his patients choose to visit him privately – “those who refuse outright and do not want to discuss immunisation do not go to a paediatrician at all… unless they need certain vaccines for school entry”.

While he is certain parents want the best for their children, and the ones who refuse vaccines genuinely believe they may harm them, he insisted the issue needed to be addressed.

“The problem lies in the very success of these vaccines. Most of the infections targeted in them are now, thankfully, very rare, thanks to vaccination programmes spanning years.

“Today’s parents have never had the illness or seen or heard of cases of children getting very sick or dying from these infections. This makes it easy for them to refuse a vaccine, as they may think it is unlikely that they or their child will get that infection,” Cassar explained.

The Health Ministry has also underscored the “sad reality that some parents blatantly refuse or delay vaccinations, thinking it is in the best interest of their children”.

The rise in misinformation, some general complacency and a decrease in the perceived risk of historically devastating diseases like measles are contributing to increased parental refusal or delays in vaccination, it said.

The main concern with parental vaccine hesitancy and insufficient herd immunity is that unvaccinated individuals can act as virus reservoirs eventually resulting in outbreaks, the ministry said.

Omitting the full story

Social media has played a role in vaccine hesitancy, often omitting the real consequences of contracting measles, the health professionals said.

“Parents are misinformed and willing to allow a child to suffer seriously due to the existence and potential fatality of measles,” Cassar said.

“In the past, it used to be a child dying of an infection that would make parents rush to take a vaccine,” he continued, pointing out that, in the early 1900s, the grandparents or great-grandparents of today’s parents had many children but some did not survive childhood.

But the current generation of parents, not old enough to remember these times and burdened by the availability of misinformation, are less likely to follow recommended vaccination guidelines.

Taking the can for autism

The MMR vaccine remains burdened by a long-debunked claim linking it to autism.

“While we do not know the exact cause of autism – it is likely to be multifactorial, possibly influenced by increasing parental age, diet, air quality, or perhaps some unknown virus in early pregnancy – we do know it is definitely not the vaccine.

“However, autism typically starts in the second year of life and this is when the MMR vaccine is given, making it easy to blame,” he noted.