Parents should have the final word on MMR

By Sarah Crompton
(Filed: 20/06/2003)
 

There is a measles outbreak in my son's school. In itself, that does not seem particularly frightening. Like most adults, I had measles as a child, and regarded it as a rite of childhood, like the first day at school and the first swimming lesson: something to be got through and overcome.

But since the introduction of the triple MMR vaccination against measles, mumps and rubella in this country in 1988, the incidence of the illness had been steadily declining. Now, however, it is re-emerging and that is attributable to one factor: loss of public confidence in the MMR jab. The fact that the Department of Health knows this and yet is doing nothing to remedy it, except shouting ever louder that the MMR jab is completely safe, seems nothing short of scandalous.

I don't pretend to be a medical expert. For all I know, the MMR jab may be without risk. I recognise that doctors around the world recommend and use it. But in 1998, a small study by a team at the Royal Free Hospital in London suggested that there might be a link between the MMR vaccine - or the measles component of it - and autism and inflammatory bowel disease.

That study came out at exactly the time I was due to have my eldest son vaccinated. I looked at him, studied its findings and knew that I would never forgive myself if, by any remote chance, he developed autism after being vaccinated. I would never know whether there was a link. I could not bring myself to risk it. The same hesitation, and indeed the same calculation, applied when it came to my second child three years later. He did not have MMR either.

Such deliberations, going on across the country, must account for the fact that MMR immunisation rates have fallen to around 81 per cent - and down to 72 per cent in London. At the same time, the number of measles cases reported has risen significantly from 100 in 2000 to 314 last year. There will undoubtedly be more this year as the trend continues.

If you accept, as the public health authorities want us to do, that measles is a potential killer, then this is a cause for concern. But what makes me furious is that it need not be this way. Just as you don't have to be against vaccination to have a lingering, residual doubt about MMR, so the choice is not simply between MMR or outbreaks of measles, mumps and rubella. There is a third way, to use a much-favoured phrase: single vaccines.

MMR is the recommended vaccine in most countries but - and here is the critical difference with the NHS - if parents choose not to have the triple jab, then separate, single inoculations are relatively easily available. In this country, this course of action is theoretically possible. But it is difficult to pursue. Parents have to take the time and trouble to find private clinics that are willing to give single vaccines. This is the course I have taken with my sons, but it is also expensive - between £60 and £140 for each jab.

GPs, on the other hand, are encouraged to give MMR with bonuses for the percentages of children they vaccinate - and discouraged from being able to give single jabs if that is what the parents want.

Doctors are increasingly concerned by this. A conference last week claimed that this system was adding to parental distrust of GPs who recommended MMR. While agreeing that MMR was safe and the best way to protect children, the meeting concluded that it was indefensible to refuse to allow separate jabs, given the public concern.

What is at stake is parents' freedom to choose what is best for their children. Of course, we do not know more than the medical profession, but we do have to live with the consequences of any decision we make about our children's health. The responsibilities are ours - and we should have some rights.

However, the structure and instincts of the NHS always place the benefits to the entire population (which demands total vaccination coverage) over and above the rights of the individual in any given case (which may demand single vaccinations). Average outcome becomes more important than individual satisfaction.

I understand why this happens. I recognise that the danger of single vaccines is that children are left unprotected against illness for longer and that it is administratively much more complicated. I understand, too, that issues of public health are never simple. One only had to read the recent High Court judgment that MMR was in two girls' "best interests", thus going against the wishes of their mothers while backing their estranged fathers, to realise that even parents do not always agree about the right treatment for their offspring.

However, the Government has to live in the real world. Vaccination has never been compulsory in this country. For programmes to be effective, they rely on an atmosphere of belief and trust.

In the current climate, with a significant minority of parents anxious about MMR and with measles creeping back into the population, the Government's intransigence on single vaccinations is counter-productive. The Department of Health website quotes an article from the journal of the Royal College of Paediatrics and Child Health that states: "While the final decision rests with the parents, the evidence of the safety and efficacy of MMR vaccine is so overwhelmingly conclusive that health professionals should have no hesitation in recommending its use."

Well, that's fair enough. The health professionals have recommended the MMR, but the final decision is ours as parents. It seems to me that it would now be a perfectly reasonable position for the Government to adopt to say: we believe the triple jab is absolutely safe, but if you really, totally refuse to have it administered to your child, then we will offer you a programme of single vaccinations - administered through your GP and carefully controlled, whatever the expense and administrative difficulties that may involve.

This would enable the health services to push up vaccination rates to effective levels once again, while still acknowledging an element of parental choice. It would stop the spread of measles and would protect children.

No doubt the Chief Medical Officer would see this as a climbdown. I would applaud it as a bold step that would both protect the general good - and let parents have some say in the treatment of their children.

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