Doctors still advocating triple vaccine

DOCTORS’ leaders have rejected the idea of compulsory immunisation for children in the UK but stressed that the controversial triple vaccine was the most effective way to immunise children against measles, mumps and rubella.

The British Medical Association (BMA), which is holding its annual conference this week, published a report yesterday on childhood immunisation. It called on doctors and health workers to stress to parents that vaccination is the safest and most effective way to protect children from infectious disease.

The report, "Childhood immunisations: a guide for healthcare professionals", acknowledges that there will always be some concern about vaccines but that those recommended in the UK are safe and their use is "for the greater good of individuals and society".

The report looked at the issue of whether parents should have a choice of vaccine, for example single doses instead of the triple MMR jab, but concluded that the triple vaccine was the best.

Dr Vivienne Nathanson, head of science and ethics at the BMA, said: "One of the biggest problems of the single vaccine is that children are left vulnerable for much longer as it takes more time to complete the course and you have some children who do not complete the course at all. We also do not know how effective a single vaccination is so there are scientific problems as well as completion problems. These are both significant reasons not to introduce it."

She added that the problem of introducing it would also be that people would regard the single vaccine as equal to the triple vaccine, which she stressed was not the case, and that it was not reasonable to offer an alternative that was "less good or less safe".

Dr Nathanson added: "The BMA has published this report to help doctors talk to their patients about the benefits of childhood immunisation.

"At the end of the day it is up to parents to balance the risks and benefits of vaccination. In our view the benefits are immense.

"We live in a world of increased international travel that has the potential to spread disease rapidly between countries and continents; we saw this happen so vividly with the spread of SARS. Surely it makes sense for parents to protect their children from potentially fatal diseases when they can do so."

Parents first became worried about MMR after a paper in the Lancet in 1998 speculated about a possible link between the jab and autism and bowel disease.

The BMA report pointed out that the paper did not prove any link and only one of the 13 authors suggested that MMR should be given as separate injections one year apart.

Dr Ian Bogle, chairman of the BMA, said: "We have looked carefully at the issue of compulsory vaccination and it is true that some countries do operate immunisation programmes where there is some degree of compulsion.

"However, the BMA does not think this would be right for the United Kingdom. The doctor-patient relationship is based on trust, choice and openness and we think introducing compulsory vaccination may be harmful to this."

The MMR jab was introduced in 1988, but following concerns the uptake in Scotland has dropped from 94.1 per cent in 1997 to 86.1 per cent last March. Since the MMR vaccine was introduced the number of deaths from acute measles fell from an average of 14 per year to only four deaths between 1998 and 1996.

However, because coverage required for population immunity for measles is 92 to 95 per cent there is concern about the likelihood of a measles epidemic.

The BMA’s report urges parents to be cautious when trying to find information about the jab.

It advises them to decide if a site is trustworthy by asking themselves whether the content is highly emotive, whether conspiratorial claims are made and whether it refers to privately published material. The BMA states that if the answer is yes to any of these questions then the site may not be presenting unbiased and substantiated advice.

Doctors have also expressed concerns about target payments for GPs should they vaccinate a certain percentage of children within their practice because some parents may feel that they lack impartiality in recommending it.

Dr Bogle also said yesterday that government-led targets in general were detrimental to patient care.

He added that instead of focusing on targets for the time it takes for a patient to be seen more emphasis should be given to the patients who had the greatest clinical need.

He added that patients who may have the greatest clinical need but had not been waiting the longest were suffering.

A spokesman for the Scottish Executive said: "Patients’ needs are paramount when delivering health care in Scotland. Targets have an important part to play in measuring the success of services but they do not take priority over patient care."