It is wrong to use the state health system to obstruct individual choice

Click to follow
The Independent Online

The Prime Minister and his chief medical adviser, Sir Liam Donaldson, have disastrously mishandled the issue of vaccination. They have failed to understand the psychology of public confidence. They simply cannot see that the more they insist that people should have the triple vaccine, and the more they try to prevent them having separate doses, the less people believe their assurances that the triple jab is safe.

This error arises out of a more fundamental philosophical prejudice, which is the denial of choice. The evidence suggests that the combined measles, mumps and rubella vaccine is safe, in the ordinary sense of that word, and the hypothesis that the combination contributes to autism has little evidence to support it and much to disprove it. The number of children diagnosed with autism was rising before the triple vaccine was brought in, continued to rise at the same rate during the two years in which it was introduced, and went on rising afterwards.

Yet, if parents believe that there is a risk, it is wrong in principle as well as counter-productive in practice to use the state health system to obstruct their choice.

It is simply no use politicians and the medical profession complaining that the issue has been misrepresented in parts of the press. It is true that the theoretical risk from combining the vaccines has attracted more attention than the known risks from the illnesses themselves, and from measles in particular. That may have created the impression among some parents that having the triple vaccine is dangerous whereas not having it is safe. The measles outbreaks in London over the past week ought to have rebalanced that perception. We have now been forcefully reminded that measles was not only a middle-class childhood excuse to have time off school and read a lot of books, but a serious illness that used to kill an average of 13 children a year.

It is also true that if there is a risk from the triple vaccine, it is more likely to come from the measles element of the combined vaccine than from the fact that it is delivered with two other vaccines. Andrew Wakefield's discovery of the measles virus in the gut of children suffering a bowel disorder linked to autism could implicate the separate measles vaccine – and indeed measles itself – as well as the triple vaccine. There is, therefore, no risk-free option for the parents of young children.

Had Tony Blair and Sir Liam not been so instinctively hostile to the notion that people should be allowed to choose for themselves even if they make choices that seem unwise, they would not have ended up with worst of all possible worlds. The result of their giving people a choice between the triple jab and nothing has been that too many people have opted for nothing. The Government should have said, and could say now: "The single vaccines are not as good, but if you want them you may have them – the important thing is to have your child vaccinated."

It did not, because it feared that such permission would undermine confidence in the triple vaccine. That allegedly happened in the scare about the whooping-cough vaccine in the 1970s: it was offered separately, take-up fell, 70 children died and the scare was subsequently shown to be unfounded. That argument is unconvincing. Confidence in the MMR vaccine is already undermined and is more, not less, likely to be restored if the distracting issue of coercion is removed.

The refusal to license the separate measles vaccine; the bullying by some GPs of their patients; the posture of aggressive defiance in the face of parents' sincere concerns – all these are compounding the problem. If ministers and doctors do not trust people to make their own decisions, they cannot be surprised if that lack of trust is reciprocated.