[We already have them--private schools! The BMA is just the trade union for vaccinators. You wonder where these journalists are going to hide when Wakefield is publicly vindicated and Vaccine autism is exposed. See: [2009 June] It is committing professional suicide to be anti-vaccine! by Christina England ]
Although subsequent studies have repeatedly confirmed that there is no more evidence for such a connection than there is, say, between toad contact and warts, agonised, emoticon-strewn discussions about the jab are a regular theme on mummy websites that did not exist in 1998, when Wakefield struck.
Today, an absence of corroboration for Wakefield's study only leaves room for other doubts and rumours. Some mothers maintain that a "cocktail" of agents is too much for "a little body" to cope with or reassure one another that measles is not all that big a deal. Defiant mummies, whom one pictures at the helm of their 4x4s, trailing clouds of particulates and rubella, declare that they don't care what anyone thinks about their lifestyle choice. It's not their fault if their unvaccinated children should chance to infect babies, pregnant women or anyone with a weakened immune system. For those with consciences, there are always doubts to be shared about "big pharma", even when its approach to measles coincides with that of the World Health Organisation.
Understandably, this resistance has exhausted the patience of Sir Sandy Macara, former chairman of the BMA. "Our attempts to persuade people have failed," he said last week, explaining why he has submitted a proposal for mandatary vaccination for debate at the forthcoming BMA conference. "The suggestion," he says, "is that we ought to consider making a link which would make it compulsory for children to be immunised if they are to receive the benefit of a free education from the state."
While many taxpayers might wonder where Sir Sandy got the idea that state education costs them nothing, his proposal certainly has its attractions. If parental avoidance of the jab continues, some people will be left permanently disabled. Last year, a boy of 17 died of measles in Yorkshire. More than 260 people have now been affected in a series of recent outbreaks in Wales, where immunisation has dipped beneath 95%, the level required for herd immunity. The disease is spreading when it should, like diphtheria and polio, have been purged from these shores.
Still, given the current fashion for persuasion, à la Thaler and Sunstein's Nudge, you wonder about Macara's marked preference for stick over carrot. Wouldn't his officious approach merely increase resistance among parents who already suspect that doctors are motivated, at best, by cold pragmatism, at worst, by a desire to bump up their salaries with zillions of jab bounties? Moreover, if we are going to start finger-wagging, it is worth remembering that this scare originated not among hysterical parents, but among Macara's former colleagues, in the medical school attached to the NHS's Royal Free Hospital in north London.
In February 1998, it was not some ignorant, tabloid rag that featured Wakefield's now utterly discredited study, but that respected medical journal, the Lancet. Looking back, as one of thousands of parents whose introduction to Dr Wakefield coincided, almost exactly, with the MMR call-up, I wonder if it was so idiotic, in the circumstances, to have kept postponing the moment of vaccination. Considering that the Lancet paper also came with the endorsement of a Royal Free press release. Wakefield's paper found, according to the Royal Free: "... that in a number of cases the onset of behavioural symptoms was associated with MMR vaccination."
I don't recall the "attempts to persuade people", as Macara calls them, being very strenuous. Doctors just said you'd be stupid not to ignore other stupid doctors. In 2001, with several big MMR studies yet to deliver reassurance, the public was sufficiently unpersuaded to want to know whether the Blairs had vaccinated their youngest son. This information was doughtily withheld until Mrs Blair revealed in her recent autobiography that she did give Leo the MMR jab: "... not least because it's irresponsible not to." Why didn't she and the prime minister say so at the time, since it's also irresponsible not to spare children suffering? It was more important to spite the Daily Mail
"I was adamant," she explains, "that I would not give the press chapter and verse. They had no right and it would set a bad precedent." You can understand it, can't you? Tell people stuff like that and, next thing you know, they're asking you about your contraceptive equipment.
Not until many non-vaccinations later, in 2004, did the Lancet admit that the Wakefield paper was "fatally flawed". At the same time, 10 of its doctor authors carefully retracted its "interpretation" of a possible link between autism and MMR. This followed Sunday Times journalist Brian Deer's demolition of Wakefield's methodology and his shocking discovery that the doctor had not disclosed two glaring conflicts of interest. Before recommending single vaccines to parents on the back of the Lancet paper, Wakefield had patented a single measles vaccine. The GMC has yet to conclude its investigation into his alleged misconduct.
If Wakefield's story is too lengthy to stand alone as an MMR persuader, there must be other ways, short of compulsion, of increasing MMR uptake. What, given that neither science nor guilt trips will do the trick, would convince doubting mothers that they are MMR kinds of people? Boden vouchers? A chance to see Jude Law in Hamlet? Or maybe single vaccines, if it kept them happy? Since many parents see vaccination as a form of self-expression as opposed to an instrument for protecting public health, perhaps reassurance should be offered in their own language. It's too late to argue that customer caprice has no place in the NHS. Not when patients experiencing childbirth, say, or low back pain, find themselves offered a range of consumer choices instead of a standard, rational minimum.
Maybe that's another reason so many parents are outraged by a system of mandatory child vaccination that, with reasonable opt-out clauses, maintains herd immunity everywhere from the US to Jamaica. It would probably work here if Barack Obama went on mumsnet. Failing that, I can only suggest that vaccine-dodgers have their principles fully tested, but in a really non-authoritarian way.
If the government invited schools to decide their own vaccine policies, this would show exemplary commitment to localism. Given that vaccinators predominate, even in Islington, most schools would probably support the MMR as a condition of enrolment, leaving dodgers to send their children to schools tolerant of the unjabbed, where their diverse immune systems can be challenged in a truly diseased environment. Admittedly, these MMR-free academies may be unfair on the children. But so, when they could have been eradicated, are measles epidemics.