Presentation (CTI)

OBJECTIVES: MMR vaccination coverage in England has continued to decline since the COVID-19 pandemic, increasing population vulnerability to measles outbreaks. Building on previous work in MMR1 coverage among 2-year-olds, this study expands the analysis to MMR2 among 5-year-olds, where declines have been even greater, to estimate the NHS economic burden across both cohorts and compare this with the cost of catch-up vaccination.
METHODS: The model was expanded to capture a second age cohort, estimating excess unvaccinated children and resulting excess cases under outbreak conditions, accounting for case severity and catch-up vaccination costs. Direct NHS costs included case management and vaccination; indirect costs captured caregiver productivity losses. Costs were projected over five years (2026 to 2031), and sourced from NHS, PSSRU, BNF, and ONS data.
RESULTS: Since the pandemic, MMR1 coverage at 2 years fell by 1.7%, and MMR2 coverage at 5 years fell by 3.1%. This corresponds to 10,711 additional unvaccinated 2-year-olds and 20,442 unvaccinated 5-year-olds, totalling 31,153. Assuming a 41% attack rate, this could result in 12,773 additional measles cases. NHS treatment costs were estimated at £1.35 million for the MMR1 cohort and £2.57 million for the MMR2 cohort, with caregiver productivity losses of £1.36 million and £2.61 million respectively, totaling £7.89 million combined. Vaccinating these children is estimated to cost £1.11 million, a net saving of £6.78 million. Given geographical heterogeneity, local-level impacts were also explored. If current decline rates continue, projected direct costs total £150.39 million between 2026 and 2031.
CONCLUSIONS: These findings show MMR coverage decline extends beyond first dose uptake, with second dose completion falling faster, contributing to higher NHS costs and school-based outbreak risk. Catch-up vaccination remains a cost-effective strategy across both cohorts, with targeted campaigns prioritizing school-age children given the higher associated costs and outbreak risk, supporting efforts to prevent avoidable NHS costs and disease burden.