GPs call on government to drop MMR

Public trust more important. By Sarah-Kate Templeton Health Editor

THE government has been urged to introduce single vaccines for measles, mumps and rubella in an editorial in the journal of the Royal College of General Practitioners, the professional body for family doctors.

The British Journal of General Practice argues that the government is inconsistent in refusing to offer separate vaccines to parents who fear a link between the MMR inoculation and autism. It also warns that the Department of Health would be responsible for any outbreak of childhood disease due to unvaccinated infants.

The journal also calls for payments to GPs who meet immunisation targets to be scrapped after a survey found that the policy causes patients to distrust their doctor.

Dr David Jewell, editor of the journal, said: 'The report confirms anecdotal evidence that there is a substantial minority of people who would like to make the decision separately for the three diseases and who, if faced with the choice between none and three vaccines, will opt for none. If the immunisation rate were to fall dangerously low then the department would have to bear some of the blame for the resulting harm.

'Beyond this is patients' autonomy. Some parents have clearly signalled their willingness to have their children immunised with one, two or even all three vaccines, provided they can be given separately. The Department of Health's position of simply repeating the evidence and its previous advice fails to respect patients' autonomy, or acknowledge that we all, as both patients and professionals, make important decisions that are only partly based on the best evidence. The DoH, as one arm of government, should try to be consistent about this. It cannot encourage choice in some areas of public policy and discourage it in others.'

The criticism of current vaccination policy will be a major blow to the government which had boasted the support of GPs in refusing to introduce single vaccines.

Fears were raised over the safety of the triple vaccine after a paper published in the Lancet suggested a link between the jab and autism and bowel disease in children. This link has been widely disputed.

The editorial was prompted by the findings of a survey of parents' views published in this month's edition of the journal.

It states: 'Some of these parents recognised that payments to GPs based on achieving immunisation targets represent a major conflict of interest that could compromise their ability to provide impartial information and advice to their patients.

'The DoH may wish to consider whether preserving patients' trust in their doctors has a value that far outweighs the benefit of high MMR immunisation rates.'

The survey, led by Bristol University researchers, states: 'Parents reported unwelcome pressure from professionals to accept immunisation and many had accepted MMR because of this pressure rather than making an informed choice, feeling that it was easier to comply than to refuse.

'All groups emphasised that parents should be able to choose which immunisations, if any, their children received, and they all wanted the single vaccines for measles, mumps, and rubella to be available as an alternative to MMR. Parents felt that the promotion of MMR was partly on considerations of cost and convenience, such as the potential difficulty in tracking individuals for separate immunisations.'

Last week a ruling by the General Medical Council opened the way for Dr Peter Mansfield to continue giving inoculations against measles, mumps, and rubella instead of the MMR triple vaccine.

The GP was reported to the GMC by Worcestershire Health Authority which claimed he was acting contrary to normal medical practice and against the best interests of patients.

Dr Peter Copp, whose private Edinburgh clinic GP Plus has been offering single vaccines, said: 'This editorial is of great significance because it is going to be read by almost every GP. This journal is the defining journal of the Royal College of General Practitioners. It is the academic bible of British GPs. Along with what happened with Dr Mansfield this marks the beginning of a change in attitude to acknowledge that offering an alternative to the MMR is a reasonable and even laudable thing to do.'

Bill Welsh, the grandfather of an autistic child and chair of Action on Autism, added: 'The GMC decision last week confirmed that it is acceptable for parents to have single vaccines. That senior doctors are now calling for 'choice' indicates how out of step the civil servants are on this issue.'

The Scottish Executive last night reiterated that the MMR vaccine has been proven to be safe and there would be no change in vaccination policy.

A spokeswoman added that new information packs on MMR to family health professionals across the country.