Todays Irish Times/MRBI poll on the MMR controversy gives some interesting insights and poses some fundamental questions about our national childhood immunisation programme.
The discrepancy between those willing to vaccinate and those who have vaccinated with MMR needs further investigation. With 78 per cent of those questioned in the Dublin area happy to immunise, why do the latest National Disease Surveillance Centre figures on vaccine uptake show only a level of 59 per cent in the Eastern Regional Health Authority (ERHA) catchment area? Even allowing for some slippage between intent and action, this is a large discrepancy. Does it reflect a failure to deliver an adequate service on the part of certain health authorities? How else can one explain a 28 per cent discrepancy between MMR uptake in the ERHA and the levels achieved by the top performing health authority, the South Eastern Health Board?
There is some evidence that the administration of vaccine programmes is less than it might be. Poor co-operation between general practitioners and public health nurses, poor record keeping and tracking by some health boards, an inadequate reminder system to parents and the lack of a seamless information transfer between primary care and public health departments are just some of the likely causes for the low vaccination uptake.
While payment levels to general practitioners are adequate, there is a problem in achieving prompt payment from some health authorities in the State. It is not unknown for payments to take up to two years after vaccination. Even for the most motivated health care professional, such painfully slow payments cause disenchantment and are a likely disincentive to the operation of a more effective scheme.
Another important issue addressed by the poll is that of single measles vaccination in the face of growing fears of a link between MMR and autism. While the scientific evidence is overwhelming against such a link, the fear is firmly implanted in the public mind. With 72 per cent of those not in favour of MMR willing to give a single measles vaccine, the issue of consumer choice must be addressed by the Government. It also flies in the face of modern medical practice to force a patient into a specific treatment. People act in their best interests when given a choice between a number of healthcare options.
The question of selling the MMR vaccination message has also been inadequately addressed by the Department of Health and others. Contrast the sharp drop in MMR vaccination rates - 13 per cent in 2 years - with the success of the recently introduced Meningitis C vaccination programme. Backed by an effective media campaign and an open approach to potential side effects , the Meningitis C rates have increased by 6 per cent between the 2nd and 3rd quarters of 2001.
While France and other European countries have not experienced a loss in public confidence in MMR, the vaccine controversy is largely a creature of the UK and the Republic. Childhood immunisation is one of the most effective means of ensuring a nation's good health. It is time the MMR failure was tackled vigorously, using a broad mixture of imagination, good administration and a commitment to do better.