The Australian
Edition 1 MON 18 FEB 2002 Page 011
British parents are reacting badly to a triple vaccine,
reports Tracy Sutherland in Brussels
WHO should they trust? This is the agonising dilemma
facing parents in Britain who must decide whether to allow doctors to
administer the controversial MMR (measles, mumps and rubella) vaccine to their
children. In principle, vaccinating a
child against debilitating and potentially life-threatening diseases makes
sense to most parents, who judge the dangers posed by the diseases outweigh the
known risks associated with many vaccines.
But amid furious debate in Britain over claims (so far
unproven) by a medical researcher and thousands of families, that MMR may be
linked to autism and bowel disease in children, parents have been trapped in an
atmosphere of escalating hysteria.
Amid claims and counterclaims, which have headlined
television and newspapers across Britain in recent weeks, confused and
frightened parents are being forced to make their own judgments about the
validity of the information at hand.
And despite repeated assurances by the British Government
and medical establishment that the MMR, which is used in 90 countries including
Australia, is safe, increasingly it seems parents simply don’t believe it. For the British public, this is familiar
territory. Images of Conservative agriculture minister John Gummer feeding his
daughter Cordelia a beefburger before the cameras in 1990 in an attempt to
reassure a worried public that British beef did not cause mad-cow disease
(BSE), remains stark in many minds.
Mistrust climaxed recently over Prime Minister Tony Blair’s
initial refusal to say whether his 20-month-old son Leo has had the MMR. Blair
has since said that the MMR is safe enough for Leo to take—the closest he’s
come to admitting Leo has had the jab.
“[The BSE debate] sowed the seeds of whether we trust [the
government] on anything ever again,” says Jonathan Harris, a Birmingham father
in the West Midlands who blames the vaccine for autism in two of his six
children. “They said BSE wasn’t a big
issue, that you couldn’t catch it from a beefburger—they’ve been proved wrong.”
Harris and his wife Kay now devote most of their time to
caring for their two autistic boys Thomas, 11, and Oliver, 7. Both were normal
two-year-olds, according to their parents, before they received their MMR jabs,
but their behaviour quickly deteriorated following the injections. Oliver’s case is starkest: within a week of
having his MMR in 1996, a bright, attentive little boy who was very social and
inquisitive, deteriorated into a tantrum-throwing introverted child who will
not make eye contact or interact with other people and rocks himself on the
floor. Two years is the age when autism
is commonly diagnosed, but the Harris family insists there were no causes for
concern before the MMR and blood tests found no genetic predisposition to the
illness. The couple’s two older children (who were born before the MMR was
introduced) and two younger children (who have not been vaccinated) are not
autistic. Three thousand families with
similar stories are registered with British parent support groups.
The MMR, a single vaccine combining three live viruses,
was introduced in Britain in 1988 and is administered to 15-month-old babies.
Previously, the vaccines were given singly.
The protection it offers is important: in one in 100,000
cases, measles can cause brain illness and death. Mumps can lead to sterility
in adult males, while rubella in early pregnancy can cause birth defects. A 95 per cent vaccination rate is needed to
prevent a measles outbreak. However,
publication in 1998 of a paper in the medical journal The Lancet by consultant
gastroenterologist Andrew Wakefield and the debate it prompted, is eating into
that figure.
Wakefield and his colleagues from the Royal Free Hospital
in London raised the possibility of a link between MMR and regressive autism in
a handful of children they had seen with a chronic, possibly new form of bowel
disease. Wakefield suggested that the
three vaccines may overload some children’s immune systems and should instead
be given singly at yearly intervals—a hypothesis many in the scientific
community say he had no grounds for making based on the Lancet paper.
Wakefield’s associated claim—which points to the measles
component of the MMR as being the suspect ingredient—is that he has found
measles in the gut of the autistic children he has treated.
Many scientists disputed the findings and Wakefield has
since left the Royal Free Hospital. “All the published research in medical peer-reviewed
journals has shown no link between the MMR and autism or the inflammatory bowel
disease—this includes Dr Wakefield’s work,” insists George Kassianos,
immunisation spokesman for the Royal College of General Practitioners.
John O’Leary, professor with the department of pathology
at Coombe Women’s hospital in Dublin, tested tissue samples supplied to him by
Wakefield’s team and released the results two weeks ago.
Scientists found measles virus in the intestinal tissue of
more than 80 per cent of the children with developmental disorders who had an
unusual form of bowel disease, and in just 7 per cent of those without it. The scientists are at pains to point out
that they were not looking at the MMR vaccine. They have found fragments of
measles virus, but do not know whether the virus is the same strain as that used
in the vaccine. However, they concede the findings raise many questions.
With too many questions and not enough answers for many
parents’ liking, the national average for the MMR vaccine is now 84.2 per cent,
prompting concerns of a measles epidemic. Earlier this month authorities
reported an outbreak in south London, where take-up rates have fallen to as low
as 65 per cent.
In Australia, even in the early 1990s, the estimated
immunisation cover sat at only about 60 per cent to 70 per cent. At the end of
last year, however, following a federal government campaign to boost the rate
and tackle the national epidemic of measles (one of the biggest immunisation
programs since the mass polio vaccination programs of the 1950s), it is 90.44
per cent. Some hospital surveys put it
closer to 95 per cent. Former federal
health minister Michael Wooldridge made improving the immunisation rate a top
priority. The Government developed the Immunise Australia seven-point plan.
This included incentives for GPs to become involved in immunisation; increased
maternity benefits linked to immunisation; and encouraged those who received
childcare assistance to immunise their children. About 1.3 million children
were immunised. As one federal Health Department official says: “Do you think
we would do that if we suspected there was even a slight problem with the
vaccine?” The Australian Government estimates 17,500 cases were prevented by
the measles campaign. Cases of measles have decreased from 4915 cases in 1994
to only 110 cases in 2000. There have been outbreaks among unimmunised children
where the illness was brought back from overseas travel. There have also been
whooping cough resurgences.
Any hopes in Britain that concerns of a measles epidemic
will push parents into giving their children the MMR appear misplaced, as the
demand for single-dose vaccines increases—with the backing of the Conservative Opposition.
Health officials argue single-dose vaccines will lead to
delays and failure to take boosters, leaving thousands unprotected. Blair advised parents to stop listening to
media scaremongering on the MMR issue, but there is little sign that people are
listening. If anything, distrust seems to be growing. “This won’t go away,
because there are genuine issues and genuine concerns, with genuine science
behind it,” warns Richard Halvorsen, a London general practitioner who is
offering single-dose vaccines.
“I think it’ll be another BSE.”
MUCH of the UK debate over the MMR vaccine is being
fuelled by the effect of mad cow disease (BSE) on the nation’s psyche, says
Peter McIntyre, deputy director of the National Centre for Immunisation
Research at the Children’s Hospital at Westmead in Sydney.
“Ever since BSE the idea has been promoted in the UK that
the government is not telling people everything they should know,” he says. “However,
there is no conspiracy with the vaccine. When you look at all the evidence of
studies done in large groups of autistic children the theory that vaccination
caused their autism does not bear out at all.” McIntyre says much of the
continuing doubt over the vaccine stems from the fact that many parents
discover their children are autistic at about the same age their children are
vaccinated. “The time parents first notice symptoms of autism tends to be the
second year of life, around the time of the MMR vaccine.”
Compounding the confusion is the fact that the definition
of autism has been expanded in recent years so more cases are being diagnosed
than ever before. The new term “autism spectrum disorders” is broader and
includes developmental problems that were not traditionally labelled as autism
in the past.
Autism is not documented in Australia because it is not a
notifiable disease and does not require hospital admission. McIntyre says that while it is not surprising
these two facts make parents of autistic children keen to blame the vaccine, no
scientific study has been able to do so. “There is so little evidence it could
be said there is little justification for further study of whether there is a
causal effect any more.”
Lobby group the Australian Vaccination Network says
governments all over the world have “abridged or denied the right” to free
choice when it comes to vaccinations. The network urges parents to investigate
with an open mind before agreeing to vaccination and says it is a parent’s
right to choose “what’s best for their child”.
In response to the controversy in Britain, the network
says families should have the choice of single vaccines rather than the
three-in-one and that the Australian government and the Australian Medical
Association should scrap the policy of incentives for doctors who meet
vaccination targets.
Caption: Inoculation against alarm: Tony Blair, inset,
says the newly
controversial MMR vaccine is safe for his 20-month-old
son, Leo
Illus: Photo
Section: FEATURES
Type: Feature
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