A UK company is visiting Dublin to offer the MMR vaccine in separate doses. But why do the allegations, based on 'spurious science', that the MMR is linked to autism create more fear than the likely prospect of another fatal measles epidemic?
If you are the parent of a baby, it's possibly not the prospect of measles that frightens you. It is the three little letters, MMR, that make you feel anxious and confused.
Nobody would blame you, because the controversy stirred up around the measles mumps and rubella vaccine since 1998 creates anxiety in parents wanting the best health for their children. Yet the rationale of the powerful anti-vaccine lobby is based on "spurious science", asserts Dr Darina O'Flanagan of the National Disease Surveillance Centre.
Parents' worries are being fuelled by media reports about perceived harm resulting from the MMR - and we must say "perceived" because there is absolutely no scientific proof for claims that the MMR is linked to autism, ADHD and bowel disease. The MMR is the safest option for parents, says Dr O'Flanagan, and she has had her own children immunised with the MMR.
Yet some parents are willing to pay €600 per child to Dundalk GP Dr Mary Grehan for a programme of individual vaccination for measles, mumps and rubella. Dr Mary Dunphy of Carrigaline, Co Cork, also gives the vaccines indiv- idually. And 200 Irish families have already signed up to have their 12- to 18-month-olds vaccinated by dh2, a British organisation offering individual vac- cinations in Dublin, from September, at a cost of approximately €375 for the programme.
Paying €600 or even €375 to have your children given the three vaccines individually is pricey - especially when the you can get the MMR in a three-in-one combination vaccine from your local health board or GP for free. So why do some parents go to the expense and inconvenience of paying foe vaccines individually?
The arguments of the anti-MMR lobby can be compelling to parents who have no formal scientific training and may do Internet searches on the MMR. "The 'experts' offering such information may not necessarily be experts, yet they get a lot of media coverage," offers Dr O'Flanagan.
She is "enormously sympathetic" to the emotional need of parents of autistic children to seek and find answers. "If your child has autism or ADHD you are looking for a reason why," says Dr Flanagan. She warns, however, that when parents and the media focus on the wrong reason for autism and Crohn's disease, they are leading down a "blind alley" that could divert funding from research to find the actual cause.
Parents who refuse to have their children immunised are contributing to a frightening increase in measles. Three children have died this summer in a measles epidemic in Italy. Three years ago in Dublin's measles epidemic, three children died. Most likely to die are children aged six-12 months who are exposed to measles in older, unvaccinated children, before they themselves are of the age to be vaccinated.
Among the children infected, some appear to fully recover. Years later, at about the age of six, dormant measles may re-emerge and the children could develop encephalitis, which causes brain damage and death.
To protect children against measles, mumps and rubella, we need to have 95 per cent of children vaccinated. Yet in the Republic, fewer than 80 per cent (between 77 and 79 per cent) are vaccinated. Another epidemic is waiting to happen here.
But this prospect does not seem to create the fear that allegations about the MMR stir up. Why? News media regularly highlight anti-MMR stories. Ken Livingstone, mayor of London, jumped on the anti-MMR bandwagon when he announced that his unborn child would be getting individual vaccines when the time came. Could it be that he was following fashion, rather than looking objectively at the scientific arguments?
Four major studies have refuted any causal relationship between the MMR and autism. Two studies by Dr Andrew Wakefield, which link the MMR to the development of bowel abnormalities leading to autism, are seriously flawed (see Medical Matters column above).
Dr Paul Offit, chief of infectious diseases and director of the Vaccine Education Center at Children's Hospital Philadelphia, reports that home videos of children on their first birthdays, when viewed by experts, show the subtle symptoms of autism long before the MMR has been given. Yes, there seems to be a rise in the diagnosis of autism and other disorders, such as ADHD, on the "autism spectrum". One in 86 primary school children in the UK has autism, compared to one in 2,200 in 1988. But this increase may be due to improved diagnosis, a broadening of diagnostic definitions or to some other factor causing an autism epidemic. The so-called "evidence" that autism is being caused by the MMR just isn't reliable, says Dr O'Flanagan.
Yet parents may be completely convinced by this evidence. Mairead Hilliard, of the Irish Colitis and Crohn's Support Group, puts enormous voluntary effort into informally counselling parents of affected children. She says that nine out of 10 parents she hears from have children who, before receiving the MMR, had allergies such as asthma and eczema, and/or mothers with auto-immune conditions such as arthritis. She is convinced that a weak immune system predisposes children to developing Crohn's or autism as a result of the MMR.
She passionately believes that Dr Wakefield's work is being ignored by the the majority of doctors because it doesn't suit the vested interests of mainstream medicine and the pharmaceutical industry to accept Dr Wakefield's ideas.
Cecelia Young, a parent of a child who developed high-pitched screaming and fever and lapsed into a coma within three days of receiving the MMR, refuses to accept hospital doctors' explanation that the illness was caused by an unnamed virus. She has intensively researched the MMR/autism link on the Internet and is convinced that intestinal problems, caused by the MMR, led to her child's developing autism. A special gluten- and casein-free diet has alleviated many of her child's autistic symptoms, proving in her mind that bowel problems are to blame.
Hilliard and Young are representative of a growing group of parents who are not opposed to vaccination, but do believe that vaccines should be given individually. If the reasoning behind individual vaccination is based on "spurious science", then why are so many intelligent parents siding with Dr Wakefield, instead of trusting their own GPs' advice?
There could be a philosophical issue at the basis of this. A distrust of multinational pharmaceutical companies and the mainstream medical profession could be coming from a feeling that we are out of control of our lives.
Whatever the reason for parents' refusal to have their children immunised with the MMR vaccine, the fact is that their choice could result in a measles epidemic. The bottom line is that we need to immunise 95 per cent of Irish children against measles. So if parents are fearful of the MMR - for whatever reason - shouldn't we stop arguing about why they are afraid, and simply offer them the single vaccines?
'I can see the logic in that argument," says Dr O'Flanagan, "but the difficulty is that there is no scientific basis to show any benefit in giving single vaccines. The second issue is that parents have a right to choose, but you have to weigh that right against the right of children to be protected."
With dh2, the individual vaccination may take four or more appointments, and if your child does have a reaction, the people who gave the vaccination will be back in the UK when this happens. Countering this criticism, Kathryn Dermford of dh2 says that the doctor and paediatric nurses who administer the vaccines screen children before vaccination, so that adverse reactions areunheard of. Dermford says that dh2's screening looks for auto-immune diseases in the mother, as well as allergies such as asthma and eczema in the child. Such children should not be vaccinated, dh2 asserts.
Dr O'Flanagan counters with the point that there is no scientific basis for believing that allergies and auto-immune conditions in mother and child make a child vulnerable to harm from the MMR. For this reason, the list of contraindications in the leaflet provided to doctors with the vaccine does not list allergies.
The MMR also brings up a difficult ethical issue for parents. You'll hear parents say, "my child hasn't had the MMR and he's perfectly healthy. He got measles and now he's fine". Or, you might hear them say "my children didn't have the MMR and none of us got measles".
There are two points to be answered here. First, it's true that most children who get measles suffer no ill-effects. However, one in 2,500 die. And one in 200 children who get measles suffer febrile convulsions (see chart below).
Even so, the likelihood that your unvaccinated child will get measles, mumps or rubella and then be seriously affected is low. So that leaves you, the parents, with an ethical choice. Most children who die in measles epidemics are aged six to 12 months. They are too young to have been vaccinated. So when you vaccinate your child aged 12 to 15 months, you are protecting not just your own child. You are also protecting younger, more vulnerable children.
It's ironic that in an age when parents distrust pharmaceutical companies and mainstream medicine on the grounds that these groups make decisions based on vested interests, some parents have no problem being selfish about their own children by not getting them vaccinated, at the possible cost of the lives of others.
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