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21/08/2014

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Should children be barred from pre-school if they haven’t had the MMR vaccine?

Dear Richard,

We’re both family doctors, and we both have our patients’ best interests at heart.

There are a very few children on my list of patients who must not be given the MMR vaccine. Not as a result of parental choice, but for valid medical reasons. But these children are at risk of serious illness through no fault of their own, because the parents of other children, who could and should receive the vaccine, fail to have them immunised.

I know you’ll be familiar with the concept of ‘herd immunity’, where such a high percentage of the population is immune to a disease that it cannot spread through the community. As measles is so virulent - each victim/sufferer in turn infects a dozen unvaccinated children - we would need to achieve immunisation rates of at least 90 per cent to have any chance of finally eradicating the illness.

We’ve only ever achieved that once, with mandatory smallpox vaccination. Smallpox is now officially ‘extinct’.

So, what would you say to a compulsory pre-school MMR vaccination programme? MMR is perfectly safe, remarkably effective and could consign a potentially fatal childhood disease to the waste paper basket of history where it belongs.

‘No education without immunisation.’

How about it?

Best wishes,

Martyn

Dear Martyn,

You propose that all children should be compulsorily given the triple MMR vaccine (presumably forcibly if necessary), in complete disregard of whether their parents wish this or not. There have to be overwhelming reasons to force a medical intervention on anyone against their, or their parents', will.

You state that the MMR vaccine is ‘perfectly safe’. But no drug or vaccine is completely safe. We know convulsions occur more frequently after the MMR vaccine than after any vaccine used routinely in the UK. It is well documented that the vaccine causes convulsions in 1 in 750 of recipients, all of whom are then at greater risk of convulsions later in life. The vaccine also causes the potentially life-threatening bleeding disorder ITP in a further 1 in 25,000.

Only last year a boy was awarded compensation by the UK Vaccine Damage Payment Unit (VDPU) after the MMR vaccine caused him to suffer brain damage. Indeed, between 1988 and 2000, the vaccine damage payment unit awarded compensation to 12 children who were severely damaged by the MMR vaccine.

This hardly makes the vaccine ‘perfectly safe’ Martyn, you must admit? There needs to be a public health emergency – which there clearly isn't – to impose any vaccine on unwilling recipients.

Best wishes,

Richard

Dear Richard,

You hold 'em down, I'll get the jabs. You misunderstand me for comic effect. Making MMR compulsory would not result in universal vaccination: experience in the United States has shown that. Families of Klingon-speaking whack jobs in the Boondocks will contrive to side-step the program on 'religious' grounds, but it would establish immunisation as the norm and establish sufficient herd immunity to protect the innocents.

 

I'm actually surprised that so few children have febrile convulsions following vaccination. MMR contains a live, though weakened, strain of the virus quite capable of inducing a mild fever. Statistically, some of those children will go on to have a convulsion. Consider what effect the wild, untamed, virus might have.

 

However, febrile convulsions are entirely benign. I'm pleased that you avoided using the term epilepsy, as we both know there's no connection between the two.

 

I sincerely hope we aren't going to take decisions about public health policy based on the outcomes of compensation cases in the courts. M'learned friends may be learned in matters of law, but in medicine? Two words: ‘Whiplash claims’.

 

Measles is potentially fatal. Vaccination is safe and effective. Accepting the status quo should no longer be an option.

 

Best wishes,

Martyn

Dear Martyn,

You misunderstand how vaccine damage awards are made. Lawyers are not involved and they are not heard in the courts; the awards are made by doctors on behalf of the government.

I agree with you that measles can kill, but this is a rare event nowadays, occurring in 1 in 5,000 cases, and probably less than 1 in 10,000 of healthy children catching the illness. You may not be as old as I am to remember, but when I was young we all caught measles and certainly didn't live in fear of it.

When there was a debate amongst doctors about the introduction of the (single) measles vaccine in the 1960s – and believe me there was a debate – there was an article written in the British Medical Journal questioning the necessity of introducing a vaccine against a ‘trivial illness’. How times have changed!

I am not arguing against measles vaccination, or even against vaccinating with the MMR, but simply against compulsory vaccination. There have been just two deaths in the UK from measles in the last ten years – and none from either rubella or mumps which never, or hardly ever, kill. Why the sudden need for enforced vaccination, Martyn?

Best wishes,

Richard

Dear Richard,

We didn’t worry about measles as kids because, compared to the other frightening things knocking around the playground (poliomyelitis and the dinner ladies in particular) it seemed insignificant.

But even then, it wasn’t. The BMJ reported after the 1963 epidemic that one case in fifteen had suffered a complication, most commonly a ‘severe affectation of the respiratory tract’. The outbreak had affected half a million children in England and Wales and was described with classic British understatement as ‘mild’.

Things have changed, you say, and they have. Measles now disproportionally affects the disabled and immunosuppressed, the very children who cannot receive the MMR vaccine. As a result the US Center for Disease Control reported a complication rate of one in three and death rates of one in five hundred cases as recently as 2002.

Vaccination made polio a thing of the past in the UK and measles is no longer endemic in the USA as a result of their ‘compulsory’ immunisation policy.

We’ve barely touched on rubella. It doesn’t kill, but why should our unborn children run the risk of congenital blindness and deafness when it could be so easily prevented?

Enough is enough, Richard, enough is enough.

Best wishes,

Martyn

Dear Martyn,

We didn’t worry about measles because it was rarely serious. ‘A severe affectation of the respiratory tract’ is a chest infection to you and me; unpleasant, most certainly, but rarely life-threatening.

Babies born disabled as a result of their mothers catching rubella during pregnancy is indeed a terrible affliction. However, there have only been 10 cases of babies born with congenital rubella syndrome this century in the UK. The current immunisation programme is doing a very good job without resorting to compulsion.

So there we have it. Your case for compulsory – rather than voluntary – immunisation rests on the occurrence in the UK over the last 10 years of 2 deaths and a handful of chest infections from measles, 10 babies born disabled from congenital rubella and probably no more than a few days in bed from mumps.

Things would have to be a great deal worse than that to force vaccines onto all children, regardless of their parents’ wishes. And how do you think British parents would react? They would resent being forced to give MMR, the most controversial vaccine of the last 30 years, to their children and the probable backlash would be a fall, not a rise, in vaccine uptake rates.

Best wishes,

Richard

Dr Martyn Lobley
Dr Martyn Lobley is an NHS GP and medical journalist working at Thamesmead Medical Associates
Dr Richard Halvorsen
Dr Richard Halvorsen is the Medical Director of the children's immunisation service BabyJabs, and the author of The Truth about Vaccines (Gibson Square, 2007)
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