The BBC is running with a new scare story about the risk of a measles outbreak because of the lower number of families immunising their children with the combined MMR vaccine. This decline follows reports over a number of years about the combined vaccine causing autism among children whose immune system could not cope with the three vaccines being administered at once.
As the parent of small children, I went through the same agonies over this with my wife, although eventually we decided to immunise both our children. We were quite lucky to live in south west London at the time, where the top expert in this area lived. We even managed to speak to him personally and, though pompous beyond measure, he did reassure us with sound science.
The point for me remains that this current ‘crisis’ is entirely of the government’s own making. There is no earthly reason why the government could not offer individual vaccines as well as the combined MMR jab. The main argument against this was that it would take longer to administer three separate jabs. Well, the fact that the proportion of children being immunised continues to decline over several years completely puts the lie to this grand claim. If the single jab had been offered (i) it would have given parents a choice, which this government purports to want to offer across the health service (ii) the number of non-immunised children would have been limited to the usual religious nutters who deserve everything they get.
There is no sensible reason for not offering the single jab as well as the MMR one. None, nada, zero, nowt.
Thursday, 7 August 2008
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6 comments:
This is a toughie. Firstly I would say that I have no kids so am coming from this from a purely abstract viewpoint.
The argument against single jabs is as you say that it takes longer to administer, therefore it is more likely that children will catch one of the diseases in the interim. It is also more likely that children will not go through with the full course, and this effect may be exaggerated in low-income communities (the papers looking into this effect studied children in inner-city Baltimore). Another reason not to administer single jabs is the associated cost. In fact, until the start of the combined jab, it was not deemed cost effective to immunize extensively against mumps at all.
But what if, as you say, the uptake is low anyway? Should you then cede to demands to give the single jabs to any that want it? This is a big ethical question. The problem is that there is no good evidence that the combined MMR vaccine isn't safe, so why should they offer an alternative? If they do say "well, you can choose" then a) everyone will choose the single jabs (because who is going to risk it) and uptake rates will fall (or rather stay as they are now), b) every Melanie Phillips will come out of the woodwork screaming "Ha, told you, never trust a scientist!" and then c) confidence in government health and science is irreparably damaged. And for what? No change in the uptake and due to no actually scientific evidence whatsoever. I am neither a big fan of the way the NHS is ran nor a big fan of the way the government run anything but in this case I think they were correct. The stuck with the science rather than the hysteria. It sucks that people now suffer again from these diseases but one thing you can never properly do is protect people from there own mistakes. The evidence is vastly weighted in support of MMR, and as you did, you can easily find this out. If people want to believe something else then that is there prerogative but others shouldn't have to pay the price and, as I said, I am glad the government went with the evidence on this one. Also, if they choose to keep MMR as the guidelines, then with time there is a better chance that the uptake will increase again as the hysteria dies away and more detailed study on the aetiology of autism is done. With the single jabs, uptake could stay below the threshold needed for blanket coverage.
The thing is, ideally, this kind of problem should never be in the hands of bureaucrats in the first place. You need a system where people can choose how their own personal health system is administered. If they want to pay more for single jabs, let them. Of course, this doesn't solve the problem for the poor but this is the problem with health care systems worldwide - either have a one-size-fits-all system or admit that, as with most other products, the rich can buy better.
Like I said, it is a toughie.
It is one hell of an issue, which I went through as the parent of young children. The key for me remains that there is no reason why people should not be offered a choice.
If more people opt for a single vaccine, that's fine and only a petulant scientist or government minister would take issue with it.
If even the Prime Minister would not allow his son Leo to have the MMR jab it must be questioned, although as I have said I was persuaded by the science and allowed my kids to have it.
The scientific evidence may well recommend the MMR. But then the scientific evidence was in favour of thalidomide, high dose combined pills and leeches. And when once upon a time a rare doctor listened to the anecdotal evidence of mothers he was vilified for it.
It does not suit the powers to be to listen to mothers. If we question the MMR, or take our children to the doctors when suffering form the effects of the MMR we are patronised and not listened to. The evidence may not even be passed on. The doctors maintain that there are absolutely no side effects of the MMR what so ever. When a few days after the MMR I took my firstborn to the doctor covered head to toe in red spots all the doctor wanted to do was tell me how it was nothing to do with the MMR, even though I had not made that link myself, when I went a week or so later with my firstborn swollen up like humpty dumpty and a temperature in the forties, I was given a lecture that it was nothing to do with the MMR. I had seen enough cases of mumps to know it when I saw it.
Then when there was a measles outbreak we got the news that the MMR was not lifelong protection, and all children needed another vaccine, when there was a mumps outbreak most of the victims had had the MMR.
Off the record I have been told the MMR causes full blown mumps in 1 in 20 children and mild measles in 1 in 50 children. If that is the case and talking with other mums certainly suggests it is at the very least, why are we being lied to? If the govt will not be honest about the risks, why should I trust them to administer any of their vaccines?
I know of a few mums that claim their children suffered serious side effects from the MMR and many that claim ones such as I experienced. Until the medical profession and government enter into a dialogue with parents and acknowledge the concerns I for one will not trust their advice that the MMR is safe.
Well quite...People have to be able to trust medicine for us all to be safe. I am persuaded that MMR is safe but it seems a no-brainer that those with concerns should and could easily be acommodated within the sytem.
If the Prime Minister ill not be honest about not giving his kids MMR, why should we trust the government?
Lucy, it is strange that your doctor would say that the reaction your child had was not due to the vaccinations. A first-year med school student would know the way vaccines work and know that mild symptoms of the vaccinated disease are possible. Rashes and glandular swellings are well known side-effects of the vaccine, and these side-effects can be worse. The figures of 1/20 and 1/50 surprise me but may not be far away from the truth. But I would guess though that these side-effects are the same or similar whether you have the MMR jab or the single jabs.
I would argue with you both that the concerns of parents have been listened to. I would guess now that the MMR vaccine is the most studied vaccine in history. IMHO, the scientific system worked. A possible problem with the MMR vaccine was flagged and then lots of people went away and studied it. They all came back saying that there was no link between autism and MMR.
Science is wrong sometimes, but by its very nature it has an auto-correct function. If a theory is wrong it can quickly get thrown out. Unfortunately sometimes the problem with the theory does not become prevalent until it is fact and residing in a pill or syringe out there in the medical arena.
And please don't forget that science is right an awful lot of the time too.
Two things I would agree with both of you on though. 1) Blair should have come clean about what jabs Leo was getting if he was professing something different. If he didn't have confidence in the science how could he have expected anyone else to? and 2) the system doesn't work. People such as Lucy don't want the MMR vaccine, whether I or a bureaucrat think her fears are real or not shouldn't matter, she should have the choice of what to do with her child. The problem is is that the social system of medicine that we are linked into of the NHS, NICE and QUALYs doesn't allow for any wiggle room. In my view, which is that of a scientist (take that as you will) is that the science is not at fault here. As far as any sensible study shows, MMR is safe regarding causing autism and, AFAIK, is no different in any other side effects from single jabs. Within the current system, the decisions made were the right ones in my opinion.
I think the benefits of taking such vaccines far outweigh the risks, but everyone should be aware that their are risks involved in nearly all medical treatments and procedures and it is up to you, ultimately, to decide whether those risks are worth it, and in that lies the problem with our current system: you are not free to make that kind of choice.
Thanks Andrew, your comments are very interesting. I for one am not looking to blame science for the problems surrounding MMR. To me it is the administrators and politicians who are at fault.
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