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MMR
debate: Quiz the specialists
As
the controversy over the safety of the MMR vaccine rages on, BBC News Online
has brought together protagonists on both sides of the debate to answer your
questions.
Dr Nigel Higson, a GP and chairman of the
UK's Primary Care Virology Group, believes in the safety of the vaccine and
is keen to promote its use.
Jackie Fletcher is the founder of JABS, a
support group for families who believe their children were harmed by the
vaccine.
Transcript
Mr Walton, Bracknell:
My son had the MMR vaccine at 15 months however he was three in September and
has just contracted measles. What is the success rate of the MMR vaccine and
why has he caught measles?
Jackie Fletcher:
As a support group we cannot give information about the actual diseases
themselves - we are a support group for parents who feel their children have
been damaged after vaccines. However, the Department of Health claim that the
success rate of vaccines is 90 per cent. So there may always be 10 per cent
of children although fully vaccinated who may still contract the disease.
Dr. Nigel Higson:
The success rate of a single dose of MMR vaccine is 80 per cent immunity to
measles - so out of ten children who have the vaccine, eight will gain
immunity after one dose. If we give a second dose, that rate goes up to 96
per cent immunity after two doses, which is why we offer a two dose course of
measles, mumps and rubella vaccine as we would do even if we did them
separately.
So why has he caught measles? First of all
it is a question whether it is true measles and he needs to have his
antibodies checked to see if it is, as a lot of things do look like measles.
As the immunisation rate has gone down which means more children in the
community have the measles virus circulating between them then virus levels
go up and children will contract the disease as even if they have the vaccine
their immunity may not be perfect. This is another reason why more people
should be encouraged to have the MMR vaccine.
Germana Kerr, London, UK:
My four year-old son is due to have the second MMR dose shortly. He did not show
any adverse reaction to the first, given at 15 months. I understand that the
booster is given to "catch" those children who may have missed on
the first dose, or those for whom the first dose did not work. How do I know
the first MMR vaccine dose worked for my child? May I not be giving him
something that is not needed, putting him at an unnecessary risk?
Jackie Fletcher:
That is exactly right. Certainly if a child has been given the MMR before,
what a parent could request is a simple blood test to look for antibodies for
measles, mumps and rubella. The family doctor could arrange this and within a
couple weeks would have the results back. From this, parents would have
baseline on which to move forward.
News-Host:
So in your opinion, there is no need to have a second jab if the first one
has been shown to work?
Jackie Fletcher
According to the Department of Health themselves the second one is being
given to try and catch the children who were not immune. So by actually
checking the immunity first, it would determine which children were already
immune and then would not need to be exposed to a second vaccine.
Dr. Nigel Higson:
The only way of determining whether a vaccination has worked is by taking
blood off a child and sending it away for immuno-globulin levels. I believe
it is more traumatic to a child having blood taken than it is to have a
further vaccine. The vaccine is safe - so we don't know without taking blood
whether her child has immunity. Two out of every ten children who have the
vaccine the first time will not gain the necessary immunity, so it is
important that her child does receive the second dose of the MMR vaccine.
Philip Leonard, Doncaster England
Should we not use our common sense and vaccinate, the risk far outweighs the
consequences, statistically speaking. How many people have been killed in the
past with the MMR diseases? We do not want a return of these killers.
Jackie Fletcher:
As a group we are not against vaccines but we want safe vaccines. It is this
combination MMR - the actual putting together of three live viruses that we
are concerned about. We don't want any child damaged by the disease but we
don't want them damaged by the vaccine either.
Dr. Nigel Higson:
They were killers and fortunately many of the generation who are now having
their children vaccinated have themselves had measles vaccines as child and
do not know the terror of measles. Measles is a killer. I know we are talking
about mumps, measles and rubella but let me quote for measles itself: in the
1960s the information I have got here, showed 800,000 people in England and
Wales caught measles each year in the 1960s before the vaccine were
introduced. In 1989 which is a year or two after the introduction of the MMR
vaccine, there were fewer than 20,000 people with noted indications of
measles - so it had dropped dramatically. So I agree we should use our common
sense and get these children vaccinated or else we will see a return of one
of the most rapid killers in the world.
Tim Pilcher, London, UK:
I am a father of two (3 years and 7 weeks) - what are the risks, in
percentage terms, if: (a) We give our youngest MMR: also what are the
potential side effects? ; and (b) We don't: and the possible contraction of
mumps, measles or rubella?
Jackie Fletcher:
That is another reason for looking at the vaccine on an individual basis
because each of the three individual diseases have a different ratio of risk
benefit to the individual child. For example, with rubella it is only
hazardous to someone who is pregnant, so infants are being given the rubella
jab for the sake of the community. Now most parents would be happy to do that
but at the very least they should be aware that the child is being given this
for the community rather than for the individual child's sake.
News-Host:
What about the risk of MMR itself - in percentage terms have you any idea how
many people suffer side-effects?
Jackie Fletcher:
Well certainly the numbers who have contacted the JABS group are very
alarming. We have 1,800 children registered with us believed to have been
affected by this combination measles, mumps, rubella vaccine. These children
were given the vaccine at all ages; some received it for the first time when
they were thirty months or eight or even fifteen years old. According to the
parents, these children have reacted usually within the incubation period of
the vaccine they have been given with symptoms known to the manufacturer - it
is the combination that we have the concerns with.
With the single measles jab, that has got a
much safer track record in Britain; it was used for twenty-one years and we
have got twenty seven children on our books believed to have been affected.
Comparing this with the MMR used for twelve years and having 1,800 believed
to have been affected - something is wrong and needs to be investigated by
the Department of Health.
Dr. Nigel Higson:
Certainly at the age of seven weeks we don't give MMR anyway so I presume he
is talking about when the child is over one year-old. The risks for an
individual depends on the uptake rate in the local community. The significant
side-effects are something like 1 in every 100,000 injections - so it is a
very low risk of significant side-effects. If he lives in an area of high
uptake of vaccination then there is less concern however if everybody takes
the same principle, the rates of vaccination will then go down and the risk
is greater. So it is playing the odds and not knowing what the outcome of the
race is going to be until it has happens.
So we can't give an individual risk
assessment. I would encourage him to have his youngest child vaccinated
against MMR when he is invited to have that done between one year and fifteen
months.
Richard Taylor, Guildford, UK:
Has the incidence of autism increased, decreased or stayed the same since the
MMR was introduced in the UK?
Jackie Fletcher
Certainly the National Autistic Society, the Allergy Induced Autism Society
and many other health professionals have been in touch with us to say that
they are concerned that there is an alarming increase in the number of
children falling into the autistic spectrum. The Department of Health claim
that it is just better diagnosis, but this is something that has developed in
the last twelve years. These same paediatricians, with perhaps twenty or
thirty years experience of examining children, haven't suddenly learnt better
ways to do it - these are experienced consultants who are diagnosing these
children.
Dr. Nigel Higson:
There is no relationship of MMR to autism. I say that bluntly and clearly.
Studies in Sweden and Finland have shown there is certainly no links MMR and
autism. These studies show those children who have been given MMR had less
autism than those children who hadn't had it done. It is like any research
there are many different stories. There is no link between MMR and autism -
full stop. However, autism is a complex range of diseases and what has
happened with autism in the last 30 - 40 years is that there have been a lot
more syndromes recognised which are all classed together as autism. So the
number of children diagnosed with autism has increased because the diagnosis
has been changed.
Chris Greenfield, London, England:
Why are other countries not combining the MMR as we do in the UK? Is the
vaccine safer when administered individually?
Jackie Fletcher
In other European countries and in America the MMR vaccine is the routine
vaccine offered to children. But, if parents don't want it, for any reason,
they can choose the single vaccine if they want. Most health practitioners
are taking the line that it doesn't matter as long as the child is
vaccinated. As to whether the individual vaccine is safer - going from the
track record in Britain, as I mentioned before, the single measles jab was
brought in, in 1967 and used for twenty-one years in the UK - it was the main
vaccine given to babies. We have got twenty-seven children on our books from
that time-frame, so it appears more like a one-in-a-million chance if a child
does have a problem.
There is still a risk from the single
vaccine and parents should ask their health practitioner for full details of
the manufacturer's information - not the glossy printed pamphlets but the
contents of the vaccines and the contra-indications. In fact in hindsight
some of the families of the twenty-seven children affected have discovered
there were medical reasons why the child should not even have been offered
the single vaccine. Parents should have the choice.
Dr. Nigel Higson:
Firstly, the majority of developed countries in the world who can afford
vaccination now use MMR primarily for vaccination against measles, mumps and
rubella. It has been used for approximately twenty years in the USA, fifteen
years or so in the UK and in Canada and the last ten to fifteen years in most
of the European countries, New Zealand, - I don't know for sure but also most
of the Far East as well. There are a considerable number of children
vaccinated throughout the world every year with MMR vaccines. In France,
where a lot of children are now being given the single dose measles vaccine,
they give single dose measles at eight months and then they give two further
doses of MMR after a year and at three years. So in fact some of the countries
that parents are saying only use single dose vaccine - yes, they might use a
single dose vaccine but they do use MMR as well. MMR is trusted and is used
widely throughout the western world.
Secondly, is the vaccine safe when
administered individually? The simple answer to that is - no it is not. If I
give a child a vaccination I am assaulting that child with a needle; I am
putting the needle through the skin into the subcutaneous tissue - every time
I put an injection into it, there is a potential for tissue damage. So the
more combination vaccines I can use, the less damage and less distress there
is to that child. So they are not safer when administered individually and as
far as these links with any other disease, there is no link at all.
News-Host:
What about the level of immunisation that the individual vaccine offers in
comparison to the triple vaccine rather than the fact that it means the child
has to have more injections?
Dr. Nigel Higson:
The combined vaccine MMR offers greater immunity because they potentiate each
other by giving measles, mumps, and rubella at the same time, the body
undergoes an immunological response which gives more immunity than if given
individually. If it were given individually we would perhaps get 70 per cent
immunity from the measles vaccine whereas when given the MMR we get 80 per
cent.
News-Host:
Are there statistics available to show that where the individual vaccines are
used more disease is prevalent?
Dr. Nigel Higson:
Not in the UK. Certainly not in the USA or most of Europe. If you are going
to get statistics like that, based on current available vaccines, you are
probably looking at the Third World, which makes research very difficult. So
I don't think there are statistics easily available on that.
News-Host:
I think again it was Dr David Salisbury who made the point, that the
individual vaccines for measles, mumps and rubella have to be given fairly
widely spaced apart and during that time a child would not be protected
whereas when they have the triple vaccine they are protected immediately for
all three conditions.
Jackie Fletcher:
On that point again it is down to looking at the individual diseases. Measles
is something that all children could do with being protected against and
parents should have the choice of a single vaccine. The families coming to us
who want to vaccinate their children are calling for the measles vaccine -
that is one that perhaps should be considered first as it the most serious of
the three diseases. Rubella is of no consequence to anyone not at risk of
being pregnant, so if it was last on the list, the child itself is not being
exposed to any greater danger. By all means educate females of child-bearing
age to make sure that they are immune to rubella before they plan a pregnancy
but it could be last on the list so far as the child is concerned. Mumps - it
can also be a single vaccine - it usually has been seen as a more of a
problem for teenage boys so if it was second on the list, I cannot see how
you are exposing an individual child to any greater degree of danger.
Kyle MacRae, Glasgow, UK:
Is the current MMR programme merely a mass nation-wide experiment that will,
by accident or design, determine the safety of otherwise of this vaccine?
Jackie Fletcher:
We know from the research that we have been doing that the pre-license trials
conducted by the public health laboratories in the UK, only lasted twenty-one
days. This is wholly inadequate for three live viruses together. World-wide -
we have only been able to find a four week period which again seems to be
inadequate.
Dr. Nigel Higson:
This is obviously a conspiracy theory. No it is not a mass nation-wide
experiment. It is a mass, nation-wide attempt to decrease and eradicate a
major killer - being measles as well as decreasing the incidence of mumps and
rubella syndrome. So it is not an experiment - the vaccine has been proven in
twenty years or more of use in the USA, fifteen years in the UK and in many
other countries, to be a safe vaccine which is effective in controlling these
diseases.
Steve Bow, Bradford, UK:
The official line seems to be that there is no proven link between MMR and
autism or Crohn's Disease. Whether there is a proven link or not is not the
point as far as I am concerned, as the parent of a child who now of the age
to receive MMR, I want the choice of having the vaccines administered
separately. I am currently being denied this choice - why is that?
Jackie Fletcher:
Whether the Department of Health like it or not, there is a question mark
over the safety of the triple vaccine. Six hundred Legal Aid certificates
have been awarded to parents to pursue a case through the courts to determine
the safety or not of the MMR vaccine. So while the jury is out, parents
should have the right to choose single vaccines.
Dr. Nigel Higson:
The UK is not a society whereby things are inflicted upon us or our children
so that the state benefits. There is a community benefit to everybody having
the vaccination because it stops the spread of disease. There is an argument
to say that if enough people don't have their children vaccinated, they are
therefore putting their neighbours' children at risk and their neighbours
might sue them for spreading disease. Now that is a very complex legal
argument which has never been tested.
So should we have single vaccines? I
personally believe in the MMR, as do the majority of doctors in the UK and
certainly so does the Department of Health. It is a safe vaccine. However, I
have patients who prefer to have the single vaccine and they have gone
elsewhere to have this done. I believe that the UK should licence single
vaccines for specialist-centre use only. It should not be an easy option. It
should be an option that is only available at certain areas in the UK which
have to be referred on by the GP or paediatrician at the local hospital for
consideration of vaccination. The reason I say this is because our aim is to
decrease measles and I would rather give a child a single vaccine of measles
if they really refused MMR than not given anything at all.
Mike Dunn, Sussex, UK:
Is it ethical for doctors to be paid a bonus for each child they vaccinate?
Jackie Fletcher
Certainly from JABS' point of view, we do wonder whether this questions the
integrity of the vaccine decision. I would feel happier if they gave a bonus
for every adverse reaction that was reported by the parents.
Dr. Nigel Higson:
We are not paid for individual child vaccination. We used to be paid a bonus
for each child, we are not paid that anymore. We are paid to achieve a
community target. In other words, within my own practice, if we achieve a
target of 70 per cent of our children receiving vaccines, we receive a
payment, if we achieve a target of 90 per cent, we get a higher payment. So
there is a bonus for working that bit harder to try to get the children
vaccinated. The Department of Health felt that by giving an incentive system
to GPs they would achieve a better health status for the UK than they would
by the previous method.
Suzanna Cardash, London, UK
Is there any concern over the single dose measles or mumps vaccines? Are
they, too, linked with Crohn's, autism or other disabilities?
Jackie Fletcher
All vaccines carry a risk and the risk benefit will be different for each
particular vaccine. What we suggest to parents is that they get as much
accurate information on the childhood diseases, which they can get at any
library and asking for copies of medical textbooks from the early sixties
prior to the vaccines coming out in 1967 onwards. That would give them
accurate information on the diseases. They could also request a copy of the
drug manufacturer's information on any vaccine - even the single - from their
GP or any chemist. That information will tell you the contents of the
vaccine, when not to give it and the side-effects that drug companies have
encountered when introducing the product.
Dr. Nigel Higson:
The MMR is not linked to Crohn's, autism or any other disabilities. There is
no research that I know of that has compared the single antigen vaccine of
measles, or mumps or rubella. This is something which has been a point of
concern in Wakefield's original study where he raised these queries - so no,
there is no research showing there is any link of the individual vaccine to
any other disease, specifically not Crohn's, autism or other disabilities.
Similarly, there is no concern about MMR being linked to any of these
diseases or conditions.
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