Measles, mumps and rubella (MMR) vaccine
February 2006
The BMA:
- supports the triple MMR vaccine as the safest and most
effective means of protecting children against measles, mumps
and rubella;
- rejects calls for compulsory childhood immunisation, and
- supports the abolition of the immunisation target payments
system without financially penalising GPs.
Two million children in the world die every year from
vaccine-preventable diseases. Immunisation programmes have probably
saved more lives than any other public health intervention apart
from the provision of clean water.
Independent research has found no link between the childhood MMR
vaccination and either autism or Crohn’s disease (a chronic
inflammatory bowel disease). This should encourage parents to follow
the advice of their family doctor and have their children immunised
with the triple dose vaccine.
Measles, mumps and rubella can be serious diseases with potentially
fatal consequences. Using single dose vaccines would leave children
exposed to the risk of infection for longer periods.
A colossal amount of work has been done by GPs and their primary
health care teams to convince parents of the value of vaccination.
MMR is an extremely safe vaccine and has been used worldwide for
nearly 30 years. Over 500 million doses have been used in over 90
countries.
Go to reference 1
The MMR vaccine was introduced in the UK in 1988.
By protecting their own children, parents are also protecting other
people’s children from the serious health risks associated with the
illnesses of measles, mumps and rubella.
Vaccination levels for MMR fell following adverse publicity in 1998
after the publication of a paper suggesting an association with the
MMR vaccine and autism and inflammatory bowel disease. Dr Andrew
Wakefield suggested that if there was a link between MMR and these
conditions, the risk might be avoided by giving three separate doses
one year apart.
No independent studies, however, have been able to find any
evidence of a link between the MMR vaccine and autism or bowel
disease.
Latest figures on uptake
Immunisation levels for MMR had been falling every quarter since
April 2002. For the cohort of children reaching their second
birthday In 2004-05, 81% had been immunised against measles, mumps
and rubella with the combined MMR vaccine, slightly higher than the
80% uptake in 2003-04, but well below the peak coverage of 92%
achieved in 1995-96. At a local level 290 Primary Care
Oraganisations reported uptake less than 90%, including 206 with
uptake below 85%. Only 12 reported a uptake of over 90%.
Go to reference 2
Uptake is below the 95 per cent level recommended by the World
Health Organisation to prevent outbreaks of disease. Coverage
required for population immunity for measles is 92 to 95 per cent.
According to the Health Protection Agency, no country in the world
recommends giving the MMR vaccine as three separate injections.
There is a real danger that we will see measles, mumps and rubella
recurring in the population. To prevent this, parents should follow
the advice of their GP and have their children immunised.
Compulsory immunisation
The BMA’s annual conference in July 2002 rejected a call for
compulsory childhood immunisation. The BMA subsequently published a
report '
Childhood
immunisation: a guide for healthcare professionals - go there now'
on the merits and drawbacks of introducing a programme of compulsory
immunisation in the UK.
The report looked very carefully at the issue of compulsory
vaccination and it is true that some countries do operate
immunisation programmes where there is some degree of compulsion.
However, the BMA does not think this would be right for the United
Kingdom.
It is far preferable to inform and educate parents about the
overwhelming benefits of vaccination, not only for their children,
but for society in general. The doctor-patient relationship is based
on trust, choice and openness and we think introducing compulsory
vaccination may be harmful to this.
The BMA continues to believe that the safest way of protecting
children from the potentially serious illnesses, measles, mumps and
rubella, is the triple dose MMR immunisation. single vaccines are
not the solution as this would leave children unprotected for
extended periods and raise the likelihood of epidemics.
Immunisation target payments
The BMA's general practitioners’ committee calls for the abolition
of the immunisation target payments system without financially
penalising GPs. The reasons for this are as follows:
- the current controversy over the safety of the MMR vaccine,
and the government's inability to adequately address it, has
exposed the target payments system as unworkable;
- the target payments system has a detrimental effect on the
doctor/patient relationship resulting from the perceived link
between medical advice and pecuniary interest;
- it has a negative impact on vaccination levels;
- it does not take into account parental choice;
- it does not recognise 'informed refusal'.
Facts and figures
- Infectious disease remain a major cause of mortality
world-wide, accounting for 17 million deaths annually in the
developing world and 500,000 deaths in the industrialised world.
- Before the introduction of the diphtheria vaccine in 1939,
around 45,000 suspected cases were recorded annually in the UK
with over 2,000 deaths. In 1957, only 37 cases were recorded
with 6 deaths.
- The dangers posed by a fall in immunisation cover are real.
Fears in Japan that the whooping cough vaccine was unsafe lead
to a mere 10 per cent coverage of 2 year olds in 1976 - in 1979
the country suffered a major epidemic with more than 13,000
cases and 41 deaths.
- Since the MMR vaccine was introduced in the UK in 1988 the
number of suspected cases of measles has fallen from between
50,000 and 100,000 cases per year to less than 10,000. The
number of deaths from acute measles has also fallen from an
average of 13 per year to only 4 deaths between 1988 and 1996.
- Several countries (Barbados, the Czech Republic, Canada,
USA, Belgium, Singapore, France, India, Kuwait) have some form
of compulsory immunisation, either in general of for entrance to
nursery/school.
For further information, please contact the parliamentary unit:
Address: BMA House, Tavistock Square, London WC1H 9JP
Tel: 020 7383 6223/6520
Fax: 020 7383 6830
Email here to:
parliamentaryunit@bma.org.uk
- NHS Immunisation Information 2006, Health Protection Agency
- NHS Immunisation Statistics, England: 2004-05, Department of
Health