The warning comes as the HSE begins a catch-up vaccination programme, following an increase in confirmed measles case in the country since the beginning of February and similar to what is also reported across Europe and the UK. The catch-up programme is prioritising delivery to key groups, including children, young adults and healthcare workers.

Ms O’Brien said catch-up efforts now were ‘really critical’ as 60m children missed their doses during the pandemic. "It is now a race between whether the catch-up activities can happen quickly enough or whether the outbreaks continue to scale."

The risk of a widespread measles outbreak will increase significantly in the coming weeks with increased travel over the Easter break. The key question at this critical juncture is whether pharmacies should be added to the arsenal of GPs and countrywide walk-in vaccination clinics to facilitate high uptake of the MMR vaccine before transmission rates exponentially rise.

Representatives of the pharmacy industry certainly think so. Chair of the Irish Pharmacy Union (IPU) Pharmacy Contractor’s Committee Kathy Maher said in February that the availability of the vaccine in pharmacies would increase uptake due to its accessibility.

"The MMR provides the best way to minimise the risks of contracting or spreading measles. Recent data has shown that vaccination rates have fallen in recent years. 

Pharmacists are now experienced vaccinators and have been playing an important role in combatting flu and covid for many years. It is time to add measles, through the MMR to the list of vaccinations in local pharmacies. The Covid pandemic demonstrated that pharmacists can play an important role in administering vaccines. Patients value the convenient locations and long opening hours of Irish pharmacies; this asset should be utilised in the new fight against measles.

The pharmacies have a point. With a steady trickle of confirmed measles cases in the last two months, this trickle could quickly become a river in the coming weeks.

Measles danger zones for holiday- makers over Easter include: England, Austria, Cyprus, Greece, France, Poland, Portugal, Lithuania and the Netherlands. Meanwhile, Romania has reported over 7,000 cases including a number of deaths in unvaccinated children. Cases are also rising in the US.

The IPU reiterate that there is recent legislation in place that allows pharmacy-based measles vaccinations.

"Pharmacies are now also connected to the national vaccination recording system which will ensure that GPs and other healthcare providers can access up to date vaccine records for each patient," Ms Maher added.

Healthcare leaders in the UK agree. Alarmingly, UK Health Security Agency (HAS) data shows that almost 3.5m children aged under 16 are unprotected from measles. It was suggested in January that pharmacists can play an essential role in increasing MMR uptake across communities to prevent large measles outbreaks.

House of Commons health and social care committee chairman Steve Brine is in favour of using community pharmacy for MMR vaccinations and suggested the same during a debate on measles towards the end of January.

Policy manager at the UK National Pharmacy Association (NPA) Helga Mangion agrees. Speaking to Pharmacy Business, she said pharmacies are a natural setting to offer an expanded vaccine programme both for MMR and other common vaccinations. 

They enjoy high levels of trust, have huge amounts of expertise, are close to the communities they serve and are ideally placed to ease waiting times for GP surgeries.

On March 21, the NHS announced that a small number of pharmacies in the North West Region are the first in the country to pilot administration of the MMR vaccine, while supporting a national recall of under-vaccinated children.

NHS England-North West public health regional deputy head Tricia Spedding said that measles is a highly infectious disease with the potential for life changing complications including blindness, deafness and swelling of the brain.

"By offering the MMR vaccine in pharmacies to children who missed one or both doses, we are hoping to make it easier and more convenient for parents to get their children protected."

The pilot will run through 28 participating pharmacies in the North West covering Lancashire, South Cumbria, Cheshire and Merseyside. The scheme will be further rolled out to a small number of pharmacies in Greater Manchester in the near future.

Parents of 5 to 11-year-olds who are overdue one or both doses of MMR will be able to just walk in, with no appointment needed, although there may be a short wait if the pharmacist is busy. GPs will also be able to refer patients for MMR vaccination in a pharmacy.

Michael Ball, a pharmacist clinician at Broadway Pharmacy in Preston, Lancashire, which is involved in the pilot initiative, said: "Offering MMR vaccines at community pharmacies provides patients with the chance to access services withing their local community at a convenient time, enhancing susceptibility and ultimately increasing vaccination rates.

The role of community pharmacists is rapidly evolving in response to changes in healthcare delivery, technology and patient needs. Pharmacists are increasingly recognised as integral members of the healthcare team with expanded clinical responsibilities and a greater focus on patient-centred care.

French health authorities have been slow to embrace pharmacy- based vaccination but in the last year have dramatically expanded the role of pharmacists in providing almost all vaccines recommended for the general population. Trained pharmacists are now permitted to prescribe and administer vaccines to children 11 years and older against diphtheria, tetanus, polio, flu, covid-19, measles, mumps, rubella, HPV and varicella. Immunocompromised people must still go their treating physician for ‘live attenuated vaccines’ (which consist of attenuated viruses or bacteria) such as measles, mumps and rubella, varicella or BCG vaccine.

The benefits of pharmacy-administered vaccination is becoming increasingly apparent with emerging evidence that pharmacists in Ireland are reaching adults who might not otherwise have been vaccinated. Irish pharmacists have, since 2016, been permitted to vaccinate against pneumococcal disease and shingles. Uptake of these vaccines is much lower than for flu but the Irish Pharmacy Union expects greater engagement by pharmacists in the years to come.

"There is a consolidated trend towards regulatory environments that support a broader role for pharmacists in vaccination, including the authority to administer a range of vaccines to various age groups and target populations," reported Gonçalo Sousa Pinto, lead for practice development and transformation at the International Pharmaceutical Federation, talking to Vaccines Today (2022).

It seems community pharmacists could become a growing part of efforts to both address vaccine hesitancy and improve vaccination rates. At this critical point — when the country is under threat of a significant surge in measles cases over the coming months — is it time to reconsider the role of pharmacists in their ability to ameliorate this threat?

• Dr Catherine Conlon is a public health doctor in Cork and former director of human health and nutrition, safefood