Tuesday, 10 February 2009

MMR - should the UK follow the USA?

Here in the UK we all to often fall into line and copy what happens in the USA - whether it's trends in fashion, music and movies, or whether it's untrammelled use of risky financial instruments and wading into a war with no end - we like nothing less than to ape the Americans, for better or worse it seems.

So why not take on board some lessons for the better? The Guardian today reports on compulsory vaccination as a requirement for school entry in many states the USA (although admittedly "exemptions can be granted for medical, religious or philosophical reasons"). The report shows us that
among the requirements for parents to bring proof of identification when registering, they are, without fail, also asked to bring their child's immunisation record showing they have been vaccinated with MMR. No proof, no place at school.
Simple to replicate here, no? With vaccine uptake still below the level required to reach herd immunity, such measures ought to prevent future outbreaks of measles, mumps and rubella at a time when the former disease is increasingly prevalent - 40% more so last year than in 2007, according to the Health Protection Agency.

Only problem is, in the UK we face one of the most insidious anti-vaccination lobbies, capable of twisting public opinion against established fact faster than you can say 'single jab.'

This is amply demonstrated by the extraordinary kerfuffle over Ben Goldacre's criticism of the LBC Radio broadcast by Jeni Barnett. As I noted in a post last week, the badscience blogosphere rapidly expressed our support of Ben and our distaste at Barnett's scaremongering and down right irresponsibility. Since then, things have gotten a little crazy to say the least. Turns out that the mainstream media is paying attention after all - David Aaronovitch wrote an excellent piece in The Times defending not only Ben's position but tearing apart the entire anti-vaccination lobby. I believe the phrase I'm looking for is 'pwned.'

Back in the virtual world of blogs and such, Le Canard Noir appears to have turned detective and 'found' comments from Jeni's own blog which she apparantley 'lost.' Amongst the myriad comments criticising Jeni's stance are a host of anecdotes from parents claiming their child was 'MMR damaged' (sic), as well as folks linking to whale.to, a surefire way of displaying your lunacy. And somewhat bravely Andrew Wakefiled himself makes an appearance, seemingly offering Jeni a pdf - this blogger assumes he's speaking of this pdf, an apparent refutation of allegations raised by the intrepid investigator Brian Deer in a recent Sunday Times article. To top it all, the legendary Stephen Fry posted a Twitterism (or something like that, I can't keep up with teh internets) exhorting his legions of loyal fans to supoprt Ben in his battle against Barnett and the anti-vaccination corps. So loyal are Fry's fans that they've forced badscience.net into a sort of virtual traffic jam - which in terms of showing just how many people out there accept that MMR is safe can only be a good thing.

Onwards the circus rolls no doubt, whilst policy-makers, in the face of such vehement anti-science rhetoric from print and audio media alike, fail to ensure children are vaccinated against what can be fatal diseases. Meanwhile in the land of the free and of small government (hah...), the CDC reported just 135 measeles cases in 2008 in a country with a population of nearly 300 million - the UK had almost 1400. Go figure.


Warhelmet said...

No, probably not. Compulsory vaccination would turn the anti-vaxxers into martyrs. They would be protesting in the streets, broadcasting 24 hours a day on LBC and the Daily Mail would would be full of nothing else. Certainly, if the current government introduced legislation, it would be seen by certain folks as yet another example of NuLabour authoritarism riding roughshod over what some view as a fundamental civil liberty.

However, there is another way to look at this. Forget the wider public health issues and think about litigation. Could a nursery school that has a child attending who has not had the MMR vaccine for medical reasons, who contracts measles from a child of anti-vaxxers be held cupable in anyway? Actually, that's extremely unlikely because the medical conditions were MMR is contra-indicated are so nasty that they would probably preclude nursery attendance. But, you see my point?

teekblog said...

@ Warhelmet. good point, but this is where things get murky. I am to all intents and purposes a liberal - I believe that one is at liberty to make one's own decisions on a whole load of things. However, there are many things which need to be exempted from the 'choice' and 'civil liberty' argument, and public health is very much one of them. If it's an infringement of your civil liberty to force you to get vaccinated, aren't you violating my civil liberty by exposing me to the risk of disease? which has primacy, your right to make stupid choices or my right to live without the risk of a disease which is easy to eradicate? (btw when I say you, i don't mean you yourself of course ;-))

I see your point about the Daily Fail and the likes of LBC. The way around this is to convince people that vaccination is for the greater good, that it's in society's interests as a whole.

As for litigation, I don't think it would be as big an issue as you say, largely as high vaccine uptake would drastically reduce the number of cases - which is the point! still, I agree that it isn't easy, although if the most litigious society on the planet manages to make vaccines compulsory then why can't we...?!


TriathNanEilean said...

Nice article. I also liked Joanna Walters' piece in the Guardian today (and linked to it on the Bad Science forum).

Compulsory vaccination is a difficult issue. My liberal leanings against it are just about balanced by the public utility of it. However, then comes the clincher for me: it would be a public relations disaster, for the reasons Warhelmet identifies. It has taken 10 years since Wakefield to begin getting some reason into the debate, and parades of anti-vaccination martyrs would set us back to the start.

So I vote no. And since I won the internet a few weeks ago on another site, that's it decided. I knew that would come in useful.

teekblog said...

@ TriathNanEilean: thanks for the comment. Not sure I buy into the argument about martyrdom for the anti-vaxxers though. Public utility is in my book the foremost argument. Remember, we aren't talking about rounding up members of the JABS forum and sticking needles in their children - if you don't want your child vaccinated then fine, you just can't send them to a state school. With rights and choice (i.e. the right/choice to believe Melanie Phillips over several peer-reviewed studies showing no link between MMR and autism) comes great responsibility (i.e. the responsibility not to make your child a carrier for a deadly disease so as not to infect others).

So fair enough for you to vote no, I understand where you and Warhelmet are coming from, but I really do believe this sits in the same bracket as the ban on smoking in public places - you have the right to do as you please, but you do not have to right to ruin and potentially take the lives of others.

btw TriathNanEilean, you speak of having won the internet on another site - well done, but can we see proof...?! :-)

Warhelmet said...

@Teek - sorry, I didn't word the second bit particularly clearly.

I do not doubt that compulsory vaccination in the States and other places too is primarily motivated by public health concerns.

What I was thinking more of was something like a personal injury lawyer/ambulance chaser going after someone who had consciously decided against vaccination, sends their kid to a measles party, who then infects somebody vulnerable. Anti-vaxxers make a great deal of anecdotal evidence and individual cases.

In the UK, we certainly do have legislation against knowingly infecting another person with certain diseases. AIDS is the example I can think of, but are there others?

I know that measles is a notifiable disease - which is where the stats come from - but I can't see the anti-vaxxers taking their kids to a GP after deliberately having infected their child with measles. Doubtless the real picture is even worse than the figures suggest.

On reflection, if uptake of vaccinations continues to decline, compulsory vaccination may become necessary.

Dr* T said...

I too am extremely apprehensive about any compulsory vaccinations.

Like almost every bust up in the world, the best way to sort it is by education of the public - to promote dialogue, to demonstrate openess, to provide information, to allay fears and to answer questions. This takes time, and when the most vocal group (teh meeeja) refuses to engage or become learned in the field, then suspicion and distrust proliferate.

However, when the Home Secretary (seemingly aged 5) asks her Science Wizards about drugs and then on two occasions does the opposite of what they suggest (cannabis and ecstasy) then the finger of blame for disbelief in science can be pointed to the gubmint.

Warhelmet said...

"Compulsory" is a strong word and behind it is a very strong action. Legislative compulsion is repugnant to most people but we live with social compulsion all the time. And woe betide the dissidents who push in at the front of queues! I noes from teh evil looks if my behaviour is "challenging".

Edjukashun, Edjukashun, Edjukashun.

I think one problems with vaccination denial is that the results of non-vaccination are not visible anymore - which is a testament to the success of vaccination. I have childhood memories of asking why someone had a calliper or a withered arm. I can remember the collection box in the shape of a boy with a calliper on his leg that was in the chemist.

Seeing the effects of polio are part of my memory. I don't remember autism because at the time autistic children would have gone into "homes".

@Dr*T - I do sometimes wonder why we employ public health people & stuff when gubmint isn't prepared to swallow the bitter pill they sometimes serve up. I, for one, will be avoiding equestarian activities.

teekblog said...

@ Dr*T: I agree that the govt and meeja are culpable for engendering suspicion and distrust of science and related policy - the drug classification fiasco is as you say a classic example.

just to clarify - I am not in favour of vaccinations being literally compulsory, I just think they should be made a requirement for entry into state-run schools. Of course we need to be more open and to educate the public, I agree that this is the path to resolving almost all ills - the issue here is that in an ideal level playing field, these measures would be sufficient and yet they aren't. Put it another way - if your child misbehaves big time in class, they lose the right to attend that school - there is a condition attached to the use of public services. all I'm saying is that protecting yourself and others from potentially deadly disease could be made a condition too...

Making MMR and other childhood vaccinations a requirement for entry to state schools is never going to be easy, and may never get off the ground for practical reasons - however sad it is that we've reached this stage though, we ought to keep the option on the table as 'asking' parents to vaccinate, in the force of such militant ignorance, clearly means too many choose not to vaccinate at all.

willson said...

This is a great post. I just had one of the ‘Doh!’ moments and ran back to correct my own site before publishing my comment. You see my own comment form did not match what I’m about to advice. I get less comment than you, so never noticed any problem. I’ve changed it now anyway so here goes.

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