Focus: Health: An epidemic born of fear ( Independent on Sunday )
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Parents queued with their children in the village of Ironville, Derbyshire,
last week to receive 20th-century protection against a 19th- century
disease. Meningitis has struck nine children in the tiny community over the
last three years and, after itclaimed the life of eight-year- old Colin
Whitehead, almost 300 turned out eager to be the first in Britain (outside
clinical trials) to have the new jab against meningitis C, which is
officially being introduced in the autumn.

Yet as 20th-century medicine offers new protection, so it has raised a new
spectre. In sharp contrast to the parents in Ironville, thousands of mainly
middle-class families are refusing vaccination against the once- common
childhood illnesses of measles,mumps and rubella (MMR) because of fear that
it may do more harm than good. At the root is a growing distrust of
scientists and of government, fuelled by the crisis over mad cow disease and
CJD and reflected in the continuing row over the safety of GMfoods.

As a consequence of this loss of trust, there is the looming threat of a new
measles epidemic in 2001 - if vaccination rates continue to fall (emphasis added). According
to the Public Health Laboratory Service, 87 per cent of babies are now being
given the triple MMR jabby the recommended age of 16 months, compared to the
95 per cent needed to keep the immunity level high enough to prevent an
epidemic.

Among five-years-olds starting school this autumn the figure is 94.5 per
cent, high enough to be safe, but the fall-off in the vaccination rate among
their younger siblings highlights the potentially catastrophic loss of
confidence in one of the greatestmedical innovations of the century.

One of those to have had doubts is the author and broadcaster Peter
Stanford. Like many parents, he was alarmed by reports of a possible link
between MMR vaccine and inflammatory bowel disease and autism, which emerged
in 1995 and 1998 from his localhospital, the Royal Free, in north London.

The link has since been dismissed by further research, commissioned by the
Department of Health and backed by a clutch of eminent scientists, published
in June. (An examination of the records of more than 100 children with
autism and bowel disease foundno link with MMR; a second study of all 498
autistic children born in the North Thames region since 1979 found no
increase in the condition after MMR vaccination was introduced in 1988 and
no link in the timing of MMR and the onset of autism. No researchteam
anywhere in the world has been able to replicate the Royal Free's findings.)
Nevertheless, the reports chimed with parents' deepest fears about the risk
of exposing babies' developing immune systems to potentially toxic drugs.

Mr Stanford, whose son Kit is almost three, says: "I read the reports and
the thing that struck me was that the evidence, and indeed logic, suggested
that introducing three powerful poisons into the body at once didn't seem a
good idea. I can see thebenefits of inoculation, but to do the three
together seemed illogical when you can do them separately."

He asked at his local GP's surgery about separate vaccinations and was
greeted with derisive laughter. He persisted and was referred to the
vaccination co-ordinator for Camden in north London who arranged an
immediate rubella injection but warned thatobtaining measles and mumps would
be more difficult. The measles vaccine finally arrived nine months later,
apparently from France, and the mumps is still awaited.

The supply of single vaccines in Britain, which has been no more than a
trickle for the decade since the triple MMR jab was introduced in 1988,
dried up completely last year when the manufacturer, Pasteur Merieux,
withdrew from the market. There are noplans for any other manufacturer to
take its place. According to Jeremy Metters, Deputy Chief Medical Officer,
no country in the world that uses the MMR vaccine also provides single
vaccines for measles, mumps and rubella. "We believe, along with 33countries
in Europe, the US and others, that MMR is the safest way of protecting
children," he says.

The health department is refusing to budge on this issue for two reasons. If
the vaccines are separated, the child is left exposed to one or two of the
diseases until the course of three is completed. (An interval of a year
between each injection wasrecommended by Andrew Wakefield, chief author of
the Royal Free report.) In addition, if parents had to attend with their
children three times instead of once for vaccination, there is less
likelihood of achieving complete coverage against all threeillnesses.

Mr Stanford remains unimpressed. He believes the wool is being pulled over
his eyes - and he says the vaccination co-ordinator for Camden told him an
interval of two weeks between injections would be long enough to minimise
the burden on the baby'simmune system. "They are changing their story all
the time. They want us all to queue up like sheep in a sheep dip and if you
step out of line they will say whatever they like to get you back in line.
If they fear an epidemic, why not let people have thevaccines in the way
that they want them? It is a classic example of doctors not giving the
public what they need. They should stop being so arrogant and get on with
it."

For Liam Donaldson, the Government's Chief Medical Officer, the dilemma is
acute. If he sticks to the official line, that MMR is the safest way of
protecting children, he risks confidence in the vaccination programme ebbing
further away and the threat ofa measles epidemic increasing. If he relents,
and encourages new supplies of single vaccines, he will be condoning the
provision of what, in the opinion of most doctors and scientists, is
second-rate protection.

The central difficulty is that what is best for the community is not always
best for the individual. Vaccination carries some, very small, risks - less
than one in a million of a serious adverse reaction. When the risk of
illness is high - measlesclaimed 1,000 lives a year in the 1940s and 90 a
year in the 1960s when the first measles vaccine was introduced - it
outweighs the risk of vaccination.

But when vaccination rates rise to 95 per cent or more of the population,
the benefit for any subsequent individual of getting vaccinated falls
sharply since the "herd" immunity of the population will provide sufficient
protection. Vaccination programmesthus depend on people acknowledging their
social responsibility to contribute to the protection of the wider
community.

Some argue that the quid pro quo should be realistic compensation for those
who suffer as a result of vaccination, rather than the derisory amounts of
up to pounds 30,000 currently paid, which many parents regard as an
inadequate sum to give life-longcare to a vaccine-damaged child. But the
award of six-figure sums in vaccine-damage payments would confirm parents'
worst fears about the risks and further undermine confidence in the
programme.

The revolt against MMR is an ominous sign of the public loss of trust in
government. The middle classes feel dragooned into acting to realise a dimly
perceived and ill-understood public good. It is possible that, as in
Ironville, only an outbreak ofdisease, and the casualties that would
inevitably accompany it, will rebuild faith in the protective value of the
jab.

©1999 Newspaper Publishing P.L.C.

Jeremy Laurance Health Editor, Focus: Health: An epidemic born of fear. ,
Independent on Sunday, 08-22-1999, pp 16.