2.10 MMR
The MMR vaccine was licensed in the UK in 1988, it is routinely administered to children at 13 months of age together with a pre school booster. However, recent challenges have been made to the orthodox view regarding its safety, provoked mainly by the study of Wakefield, Mursch and Anthony (1998) which described inflammatory bowel disorders in twelve children with autism, and suggested this phenomenon could be linked to the MMR vaccine as the measles virus had been found in the intestines of all twelve children. As a result the MMR vaccine has received widespread attention in the popular press.
Bedford and Elliman (2002) argue this has made the public both more aware and less informed and the result has been a drop in vaccine uptake. The problem poses serious threats for the Government immunisation programme as compliance with this vaccine has fallen drastically from 91 per cent. in 1994-5 (Department of Health statistics, 2000-1) to only 84 per cent. in the first quarter of 2002 (Public Health Laboratory Service, 2002).
The Government continues to resist widespread demands from the public for single vaccines to be made available on the NHS and is attempting to regain public confidence in the MMR vaccine by publishing the findings of various studies on its website to refute a link between the vaccine and autism/bowel disease.
The Government wants these studies to state that MMR does not cause autism, this is how it is reported in the media. Retrospective cohort studies do not demonstrate causality. These studies simply were unable to demonstrate a link, it can be interpreted that it is less likely however it does not mean a link does not exist. As Nicholson the editor of the Journal Medical Ethics stated in 2002, it is much “easier to deny that MMR causes side effects if you do not look for them”. He goes on to state that if they were found it would be very expensive for the Government. Hence the complete lack of interest among government officials in trying to replicate Andrew Wakefield’s work on MMR and autism. Evidence of long term side effects would make it difficult for the vaccine manufacturers to defend.
Researchers on both sides of the debate are looking for absolute truths and there are few absolutes in health because every individual is genetically different. MacDonald (1999) states that pivotal to the developmental of the scientific approach is what we call “reductionism”. Much of scientific research has progressed by focusing on as few variables as possible in the topics being investigated, ideally just two, so that one can be measured (a dependent variable) while the other (an independent variable) can be experimented with. He went on to say “once medicine applied reductionist thinking to illness, progress in the definition and eradication of disease served to separate biomedicine from health and to focus it on illness”. Epidemiological studies examining this phenomenon must consider so many confounders that any conclusion will always be open to question.
Japan was the first country to withdrew the MMR “Urabe” vaccine in 1992 after it was shown to cause aseptic meningitis in children. The MMR vaccine was replaced by a safer “Jerry Lynn” vaccine but Japan has refused to use it, choosing single vaccines instead. A study by Nokes and Andersen (1991) concluded that the Urabe vaccine had greater efficacy than the safer alternative and that it may not always be in the interest of the community to use the vaccine with the lowest complication rate.
A highly complex and fiercely contested debate surrounds the MMR vaccine and has raised questions about the ‘mass childhood immunisation’ policy (Cave, 2001). Consequently, there is a need to consider vaccine refusal more fully, as parents continue to challenge 'expert opinion' regarding the safety of this vaccine.