The young Muslim father who answered the door of the big detached house in the heart of Birmingham‘s Sparkbrook district did not wish to give his name but was happy to speak about the measles outbreak in the city. The crucial question: did his son, who goes to the local primary school, get the MMR jab? ‘Neither I nor my wife would allow him to have it on religious grounds,’ he replied politely and without hesitation.
The measles jab contains traces of pork, he explained, which is unacceptable to some Muslims. The fact that there is a non-porcine, or halal, vaccine available is an option he did not wish to consider. ‘The vaccine has been associated with pig matter and that is enough for us to have refused it,’ he said.
His decision, mirrored by other Muslims in the city, is one of the reasons Birmingham is at the epicentre of the measles crisis that has been declared a ‘national incident’ because of the growing public health risk it poses.
The problem is encapsulated, in microcosm, here in this ordinary residential area near the Sparkbrook Community Health Centre.
We heard the same story at most of the addresses where someone was at home and willing to be interviewed. The occupant of the red-brick semi next door, for example, told us his niece had not been vaccinated for the same reason.
‘We are Muslims and as such we will not allow it,’ he said.
Ditto three other families in the area, including a school dinner lady whose three children, all under 12, have not been immunised.
‘Basically, it’s the ingredients of the vaccine,’ she said. She was not aware of the alternative halal version and her husband was against vaccines in any case. ‘We don’t believe in any vaccines,’ he said.
There were other explanations given for the vaccine mistrust in this corner of Britain’s second city.
One mother in the same area, in her mid-30s, said: ‘The Covid vaccinations were b******* and this one is too. I won’t be inflicting it on my child.’
Financial economics graduate Adam Khan, the only resident who agreed to be named, said his wife, an NHS nurse, is pregnant with their second child. Neither will be vaccinated over fears of a link to autism, the legacy of a discredited 1998 study by disgraced doctor Andrew Wakefield.
‘Until I have more information, it’s just too big a risk as far as I am concerned’, said Mr Khan. ‘My wife agrees.’
Nine families within a 100-yard radius or so in Sparkbrook, home to more than 20,000 Muslims, said their children had not been given the measles jab, while six said they had.
This is not meant as a criticism, just a statement of fact, which reflects the scale of the predicament in Birmingham, where there are over 340,000 Muslims overall (the majority British Pakistani or of Pakistani heritage).
Professor Dame Jenny Harries, chief executive of the UK Health Security Agency (UKHSA), admitted on BBC Radio 4’s Today show after visiting Birmingham last week that a campaign was under way to make members of the Muslim community aware of the ‘availability and effectiveness’ of the non-porcine vaccine (Priorix) to boost take-up.
But is political correctness, to avoid offending cultural sensitivities, already diluting the message? There are a few reasons to be a little suspicious.
UKHSA issued a press release about ‘a national incident’ being declared last Friday, the very day Prof Harries was in Birmingham.
‘Dame Jenny,’ it says in the first few paragraphs, ‘has expressed concern that unless more urgent action is taken we are likely to see the measles virus spreading rapidly in other areas.’
But of the Muslim community, or the availability of the non-porcine vaccine, there is no mention.
The ‘pockets of low immunisation’ Prof Harries referred to (when pressed) on Radio 4 included Sparkbrook (and Small Heath, another densely-populated Muslim district), a health official, who asked not to be identified, confirmed.
But UKHSA will not say so officially. The agency has declined to name any of the neighbourhoods in question. Wouldn’t families – apart from anyone else – with babies under one year old, who are too young to be vaccinated, benefit from that information?
There is one other thing to mention here. The escalating measles outbreak brought Health Secretary Victoria Atkins to Birmingham last Thursday when she visited a GP’s surgery.
We learned about the trip the day before. But no one in the UK Health Security Agency, the Department of Health and Social Care, the NHS or Birmingham City Council could say which GP she would be meeting or in which neighbourhood.
‘There is no press,’ we were finally informed by someone in ‘Comms’ at the DHSC. There might be a very good reason for this, but many might think it odd that at a time when a campaign has been launched to boost take-up of the MMR vaccine – especially among Muslims – there was not a peep from the Health Secretary when she was in Birmingham.
As the health official we spoke to pointed out: ‘It’s a challenge for us. There is still fear among some in the Muslim community that the vaccine contains pig matter. Of course a non-porcine version of the MMR jab is available, but the message has not always got through effectively enough.’
No one should need reminding of the shortcomings involved in tiptoeing around the truth to avoid offending cultural sensitivities, if indeed that is what is happening.
The Rochdale and Rotherham grooming scandals – where fear of accusations of racism enabled Asian male gangs to operate with impunity – are still fresh in the memory, after all.
However, Muslims are not the only demographic in Birmingham causing concern for health officials, it should be stressed.
Arrivals from Eastern Europe – the city is home to more than 7,000 Romanians – with historic memories of state-enforced vaccinations are also understood to be part of the problem.
‘It would be wrong and misleading to lump the problem onto any one specific community,’ said Rob Pocock, the city council’s cabinet member for health and social care, who is leading the fight against the outbreak.
‘It’s a multitude of different factors. That’s why it’s so hard to manage. This battle needs to be fought on a very broad front and it’s vital we don’t get stuck down any particular side alley.’
The measles outbreak, the most serious since the 1990s, is spreading rapidly. Confirmed cases in the West Midlands have now risen from 216 to 276, with more than 100 further probable cases, and the vast majority (80 per cent) are from Birmingham, according to the latest figures obtained by the MoS.
The citywide vaccination rate for children aged five who have had both MMR doses is 74.5, which means that some neighbourhoods have fallen below 70 per cent, far below the 95 per cent recommended to gain herd immunity.
Failing to vaccinate your child has been compared to driving a car without a seat belt. Measles can sometimes lead to hospitalisation, deafness, meningitis, even death. It can spread rapidly through an unvaccinated community because it has an R (reproduction) number of between 12-18, meaning each person with measles will, on average, infect between 12 and 18 other people. The R number for Covid, by contrast, is 1-2.
Up to seven children with measles are now turning up at Birmingham Children’s Hospital every day, compared to a ‘trickle’ not so long ago, doctors say. The most common complications are ear infections, pneumonia and severe diarrhoea, which may lead to dehydration.
‘We are aware of the lower rates of uptake among the Muslim community due to concerns around vaccines made with gelatine from pork,’ said GP Dr Ben Sinclair. ‘Birmingham celebrates a diverse range of ethnic minority groups, for whom accessing NHS services may be more challenging. Communication of health messages may come via trusted friends in the community and so rumours and misinformation can abound.
‘These groups often distrust mainstream media and Government announcements.’
Nevertheless, many will be wondering: why Birmingham? Why is the situation there so much worse than other towns and cities with large ethnic minorities?
There are believed to be a number of systemic reasons for the dramatic spike in measles in the city.
‘Part of the problem seems to be among the more recent immigrants, primarily from Somalia and Yemen,’ explained a Muslim mother of two young children, whose grandparents moved to Britain from Pakistan.
‘They’ve arrived in the last three or four years, so they don’t have the older generations brought up here who can educate them on how serious measles is. As a result they don’t necessarily understand the importance of immunisation against measles and their kids are not being vaccinated. Then they go to school and it spreads. It is a very worrying time for the community.’
In fact, there is a 10,000-strong Somali contingent in Sparkbrook and Small Heath.
Many of the children attend a primary school which, like other educational establishments, was warned about the measles outbreak in a newsletter over Christmas.
Worryingly, GPs serving such ethnic communities are particularly stretched. In parts of inner-city Birmingham, they are so thinly spread it is practically impossible to see a doctor, even if you want to get your child vaccinated. Health chiefs say the number of patients per fully qualified GP should never exceed 1,800. Yet NHS data shows the ratio is sometimes much higher at surgeries in Birmingham.
A Department of Health and Social Care spokesman said: Public health teams have been working tirelessly across the West Midlands to try and control the outbreak, but vaccination rates in some areas remain very low, so there is a risk it could continue to spread if more people do not take up the jab. We’re also appealing to communities where there is low uptake to pass on the message to those who are not coming forward.’
History teacher Qasia Farooq, 23, lives in the area. ‘We have two doctors in the family so we have complete trust in the jab and we understand why it is a duty to have our children immunised against measles,’ he said.
‘However, I realise there is a lack of trust in the vaccination in our community, possibly made worse since Covid, and that is a danger.’
His sentiments were shared by his neighbour Shiraz Ali, 45, a supervisor at a local security firm. He said his two-year-old son Zayyan was vaccinated six months ago but acknowledged: ‘Many people have fears over this vaccination, which suggests the message about the halal version is not getting through to people yet.
‘It needs more publicity to make everyone aware there is a non-porcine jab available. I’ve never even heard mention of it at my mosque. Perhaps the imams could be doing more to spread the word.
‘Schools are sending parents emails, but people don’t seem to be responding. Maybe they don’t yet realise the importance. This needs to be taken more seriously.’
Which surely means, at the very least, not ‘tiptoeing’ around when there are difficult issues that need to be addressed.
Additional reporting: Tim Stewart and Mark Branagan