Dr Muiris Houston , Medical Correspondent, looks at the results of an Irish Times/MRBI poll on people's attitudes to the MMR vaccine and finds their intentions don't tally with practice
The Irish Times decided to include a number of questions on the MMR vaccine in its latest opinion poll because of growing public concern about a possible link between the vaccine and the development of autism.
This concern has been reflected in steadily decreasing immunisation rates throughout the State and a growing demand for separate vaccines instead of their joint administration within a single MMR shot.
What is MMR? It is shorthand for measles, mumps and rubella [German measles] vaccine, which is given to infants at 12 to 15 months and repeated at age five to six years.
MMR was introduced in 1985, primarily in response to growing concerns about the high number of measles cases - an annual peak of 10,000 was recorded here - and the risk of death and disability which the infection posed.
Rubella and mumps, although potentially less devastating, pose a significant public health risk, and the Republic followed an international trend in introducing a single vaccine against all three diseases. A minimum uptake of 95 per cent of the target population is required if national immunisation is to succeed.
What do the poll results show and how does this compare with the most recent report from the National Disease Surveillance Centre \ on the uptake of the MMR vaccine?
Overall, 78 per cent of people, asked "If you had a child who was due to be given the MMR vaccine, would you or would you not bring him for vaccination?" said they would bring the child forward.
This compares with the latest figures from the NDSC, which show that only 70 per cent of children aged 24 months have received the MMR shot.
Significantly, 17 per cent of people are either in doubt about what to do or have already made up their mind not to immunise a child.
These figures do not vary significantly across age groups, the urban/rural divide or social class.
The figure for Dublin respondents was also 78 per cent, yet only 59 per cent of infants within the ERHA area have got the vaccine. In contrast, the South Eastern Health Board has achieved 87 per cent immunisation rates for MMR, according to uptake figures for the third quarter of 2001.
People in social class ABC1 are more sure of their option not to vaccinate; 11 per cent are set against vaccination , as against 6 per cent in a lower socioeconomic group.
However, more people in social group F are confused about the situation, as reflected in the 12 per cent who don't know what to do.
The poll question, "What is the main reason for your decision [not to vaccinate]?" was deliberately left open-ended; people were not prompted into a reason for their decision.
Eighteen per cent of those questionein poll d said that " a risk of autism" was the reason.
A further 20 per cent labelled medical reasons/too many side-effects, while 14 per cent would prefer if the vaccines were given one at a time.
Media reports were mentioned as the reason by 7 per cent of respondents.
Looking more closely at those who gave autism as their reason not to vaccinate, this was commonest in the 25-34 age group. And fear of autism was greatest - at 27 per cent - among people in the highest socioeconomic groups.
Seventy-two per cent of those not in favour of a joint MMR vaccine would give their children a single measles shot. A further 15 per cent are unsure.
There was no appreciable difference across age or social class among those who would prefer the single vaccine option.
So what conclusions can we draw from the poll? First, the actual uptake of MMR is lower than people's intention to vaccinate [70 per cent v 78 per cent]. About one in five of us is confused about what to do; it is likely that a number of people who are sure about their intentions in a theoretical situation will either change their minds or postpone a decision when faced with a real-life choice.
But the discrepancy between people's actions and their intentions also raises the possibility that they are experiencing difficulty accessing vaccination. Is there a problem with the availability of MMR vaccine, its distribution and delivery?
Are we motivating our primary healthcare professionals and making it easy for them to vaccinate? There is some evidence that general practitioners are being paid up to two years late for vaccinating children - hardly a good motivator in a climate of dropping immunisation rates.
How does the South Eastern Health Board maintain MMR vaccination rates of 87 per cent? Is it time to give this health board a lead role in bringing other health authorities up to speed by replicating its methods nationally?
And while there is no scientific evidence for a single measles vaccine, there is clearly a consumer demand for this option. Despite the many sound scientific reasons against its introduction, it may be that by offering an option to parents, the "heat" will be taken out of the issue; overall immunisation rates may then begin a welcome climb to the level required if we are to avoid the human suffering associated with a dreaded measles epidemic.