Focus: Health: An epidemic born of fear

Parents worried about side-effects are refusing to have their babies vaccinated. But will the rest of the nation's children pay the price?

arents queued with their children in the village of Ironville, Derbyshire, last week to receive 20th-century protection against a 19th- century disease. Meningitis has struck nine children in the tiny community over the last three years and, after it claimed the life of eight-year- old Colin Whitehead, almost 300 turned out eager to be the first in Britain (outside clinical trials) to have the new jab against meningitis C, which is officially being introduced in the autumn.

Yet as 20th-century medicine offers new protection, so it has raised a new spectre. In sharp contrast to the parents in Ironville, thousands of mainly middle-class families are refusing vaccination against the once- common childhood illnesses of measles, mumps and rubella (MMR) because of fear that it may do more harm than good. At the root is a growing distrust of scientists and of government, fuelled by the crisis over mad cow disease and CJD and reflected in the continuing row over the safety of GM foods.

As a consequence of this loss of trust, there is the looming threat of a new measles epidemic in 2001 - if vaccination rates continue to fall. According to the Public Health Laboratory Service, 87 per cent of babies are now being given the triple MMR jab by the recommended age of 16 months, compared to the 95 per cent needed to keep the immunity level high enough to prevent an epidemic.

Among five-years-olds starting school this autumn the figure is 94.5 per cent, high enough to be safe, but the fall-off in the vaccination rate among their younger siblings highlights the potentially catastrophic loss of confidence in one of the greatest medical innovations of the century.

One of those to have had doubts is the author and broadcaster Peter Stanford. Like many parents, he was alarmed by reports of a possible link between MMR vaccine and inflammatory bowel disease and autism, which emerged in 1995 and 1998 from his local hospital, the Royal Free, in north London.

The link has since been dismissed by further research, commissioned by the Department of Health and backed by a clutch of eminent scientists, published in June. (An examination of the records of more than 100 children with autism and bowel disease found no link with MMR; a second study of all 498 autistic children born in the North Thames region since 1979 found no increase in the condition after MMR vaccination was introduced in 1988 and no link in the timing of MMR and the onset of autism. No research team anywhere in the world has been able to replicate the Royal Free's findings.) Nevertheless, the reports chimed with parents' deepest fears about the risk of exposing babies' developing immune systems to potentially toxic drugs.

Mr Stanford, whose son Kit is almost three, says: "I read the reports and the thing that struck me was that the evidence, and indeed logic, suggested that introducing three powerful poisons into the body at once didn't seem a good idea. I can see the benefits of inoculation, but to do the three together seemed illogical when you can do them separately."

He asked at his local GP's surgery about separate vaccinations and was greeted with derisive laughter. He persisted and was referred to the vaccination co-ordinator for Camden in north London who arranged an immediate rubella injection but warned that obtaining measles and mumps would be more difficult. The measles vaccine finally arrived nine months later, apparently from France, and the mumps is still awaited.

The supply of single vaccines in Britain, which has been no more than a trickle for the decade since the triple MMR jab was introduced in 1988, dried up completely last year when the manufacturer, Pasteur Merieux, withdrew from the market. There are no plans for any other manufacturer to take its place. According to Jeremy Metters, Deputy Chief Medical Officer, no country in the world that uses the MMR vaccine also provides single vaccines for measles, mumps and rubella. "We believe, along with 33 countries in Europe, the US and others, that MMR is the safest way of protecting children," he says.

The health department is refusing to budge on this issue for two reasons. If the vaccines are separated, the child is left exposed to one or two of the diseases until the course of three is completed. (An interval of a year between each injection was recommended by Andrew Wakefield, chief author of the Royal Free report.) In addition, if parents had to attend with their children three times instead of once for vaccination, there is less likelihood of achieving complete coverage against all three illnesses.

Mr Stanford remains unimpressed. He believes the wool is being pulled over his eyes - and he says the vaccination co-ordinator for Camden told him an interval of two weeks between injections would be long enough to minimise the burden on the baby's immune system. "They are changing their story all the time. They want us all to queue up like sheep in a sheep dip and if you step out of line they will say whatever they like to get you back in line. If they fear an epidemic, why not let people have the vaccines in the way that they want them? It is a classic example of doctors not giving the public what they need. They should stop being so arrogant and get on with it."

For Liam Donaldson, the Government's Chief Medical Officer, the dilemma is acute. If he sticks to the official line, that MMR is the safest way of protecting children, he risks confidence in the vaccination programme ebbing further away and the threat of a measles epidemic increasing. If he relents, and encourages new supplies of single vaccines, he will be condoning the provision of what, in the opinion of most doctors and scientists, is second-rate protection.

The central difficulty is that what is best for the community is not always best for the individual. Vaccination carries some, very small, risks - less than one in a million of a serious adverse reaction. When the risk of illness is high - measles claimed 1,000 lives a year in the 1940s and 90 a year in the 1960s when the first measles vaccine was introduced - it outweighs the risk of vaccination.

But when vaccination rates rise to 95 per cent or more of the population, the benefit for any subsequent individual of getting vaccinated falls sharply since the "herd" immunity of the population will provide sufficient protection. Vaccination programmes thus depend on people acknowledging their social responsibility to contribute to the protection of the wider community.

Some argue that the quid pro quo should be realistic compensation for those who suffer as a result of vaccination, rather than the derisory amounts of up to pounds 30,000 currently paid, which many parents regard as an inadequate sum to give life-long care to a vaccine-damaged child. But the award of six-figure sums in vaccine-damage payments would confirm parents' worst fears about the risks and further undermine confidence in the programme.

The revolt against MMR is an ominous sign of the public loss of trust in government. The middle classes feel dragooned into acting to realise a dimly perceived and ill-understood public good. It is possible that, as in Ironville, only an outbreak of disease, and the casualties that would inevitably accompany it, will rebuild faith in the protective value of the jab.