Leading Article: The NHS must respect the wishes of patients

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The Independent Culture
IT IS reassuring that two important new studies find no evidence to link the triple child vaccination, MMR, either to autism or to Crohn's disease, a chronic bowel condition. Since the mumps, measles and rubella vaccines were combined in 1988, there has been an erosion of the public confidence on which a successful vaccination programme depends.

Philosophically, vaccination embodies an awkward contradiction between individual and collective interests. As Yossarian said in Catch-22, it was right that some air crews had to risk their lives in bombing missions in the Second World War, but why did it have to be him? Likewise, it is a good thing that most people are vaccinated; illnesses such as mumps, measles and rubella are now virtually unknown. But an individual gains nothing by being vaccinated, so long as 90 per cent of our fellow citizens are. And if there is any doubt about the safety of vaccines, then vaccination rates start to fall sharply, as they have recently. It is only when rates are low that self-interest kicks in again. In the last measles epidemic there were some 15-20 deaths; so parents will feel that whatever tiny risk there may be in being vaccinated is justified for their children.

The role of the Government and the medical profession is to provide information and moral persuasion, but in the end it must be for patients to decide on any treatment. In this case that means parents deciding whether to get their children vaccinated and - if so - against what. This is where the real scandal of MMR lies: the Government will not let people have the three vaccines separately. It is simpler and cheaper, and may be in children's best interests, to have all three vaccines at once. It is not possible to prove a negative, though it now seems less likely that it causes harm. But it is not an unreasonable view that they should be administered separately in order to spread the impact. Nor is it unreasonable to take the view that one, two or all of them are unnecessary. Ministers and doctors may regard that view as selfish or foolhardy, depending on the level of vaccination in the general population, but, equally, parents could be justified in treating reassurances with scepticism.

In 1995 the last government responded to the findings of a possible link between MMR vaccine and serious illnesses by insisting that the health of the population was best served by the triple vaccine. For "technical" reasons separate vaccines were no longer available. That forced parents with any doubts to refuse to have their children vaccinated at all. It is time for the medical profession, and Frank Dobson, to accept that it will take more than yesterday's research to begin to restore public confidence - and that more people will be vaccinated if the three jabs are offered separately. Mr Dobson must recognise that we are moving away from a society in which professionals dictate to consumers. The test for the NHS is whether it will allow patients' wishes to be respected.

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