The Pharmaceutical Journal
Vol 268 No 7189 p360-364
16 March 2002

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Letters to the Editor

MMR vaccination (2 letters)

Public still needs to be convinced about safety

From Mr P. E. G. Shattock, MRPharmS

Your report (PJ, 2 March, p280) that the Department of Health is asking pharmacists to encourage patients to accept the combined measles, mumps and rubella (MMR) vaccine demonstrates, once again, a total failure on the part of the Department of Health to convince the public about the safety of this product. The implication, included in your report, that doubts about safety are being promulgated by parents purely to add weight to their legal claims is unworthy but typical of the Department's approach.

The Department continues to promote the deceit that the whole scientific basis for linkage rest upon the original 12 cases described by Wakefield.¹ It totally ignores the further 150 similar cases described by Furlano et al.² The finding of the genetic material (RNA) from measles virus in the intestines of 75 of 91 of these children has been publicised although formal publication is awaited³ as has the finding of measles RNA in blood.⁴ Additionally, antibodies to the measles virus have been detected in a proportion of children with autism⁵ (which may be associated with brain auto-antibodies). The Department argues that all of these findings may have resulted from wild measles but, according to the parents, these children have not had measles except through the attenuated strains in the MMR vaccine.

Dr David Salisbury points out, correctly, that measles virus is extremely immunosuppressive and that giving the vaccines separately could mean that the child has a suppressed immune system when the other vaccines are given sequentially. Strangely, he feels this principle does not apply when the vaccines are given in combination.

The Royal Pharmaceutical Society suggests that pharmacists are well placed to offer information and support to parents who are concerned about vaccinations. I would agree and would suggest that pharmacists follow the advice of Simon Whitaker (PJ, 2 March, p288) who, in his article on quack remedies quotes our Code of Ethics which requires that pharmacists should not recommend any therapy "where they have any reason to doubt its safety or quality".

If pharmacists have studied all the evidence, rather than merely read the Department's information sheets and still believe that this vaccine is safe, they can recommend it with a clear conscience. If they have not done that, such an action would be difficult to justify.

Paul Shattock
Autism Research Unit,
University of Sunderland

Putting patients' trust in jeopardy

From Mrs A. Morant, MRPharmS

As community pharmacists, we are asked by the Department of Health to support its line on MMR vaccination. Furthermore, the article "Pharmacists asked to spread positive message about MMR vaccine by DoH", (PJ, 2 March, p280) concludes with a statement that the Royal Pharmaceutical Society "continues to support the position held by the Department" and adds that pharmacists are well placed to offer information and support to parents and can "reassure" parents about the safety of MMR.

A tailpiece to the article refers us to the internet for further information. I have visited the site quoted and read the 50 or so pages of "information" much of which, unfortunately, reads like hurriedly cobbled together hype aimed at promoting a weak case. To cite one example, while one document states that MMR vaccination has been in use for nearly 30 years in the United States there is no reference to the increase in autism over a number of years. I feel that I need reassurances that there is no correlation between the two, before I can endorse MMR in any way. After all, giving three live viruses at the same time to an infant with an undeveloped immune system might not be such a good thing.

I encourage all pharmacists to read this article carefully, even if they do not study the information on the internet. They will see that the DoH opposition to the single vaccines is because "it would give credibility to the shadow of doubt being cast over MMR".

Community pharmacists are trusted by the public. Over the years we, as a result of professionalism and regard for the interests of our customers, have become regarded as a source of reliable advice and information. Now the DoH wants us to wave the flag and promote MMR vaccination. This is all very well as long as MMR is safe. How can we do it if there is any degree of doubt?

Why should we, who have no part in the administration of MMR, be required to back it, except for the fact that the public trusts us? Furthermore, what immunity from legal action will the DoH give pharmacists (let alone parents and children) in the event of anything going wrong?

In addition, will there be an opt-out for those of us who do not have blind faith in the MMR, like there is for Roman Catholic pharmacists and contraception?

These are all fundamental issues. The Government and the DoH recognise the trust that the public have in the profession without which GP surgeries and hospital accident and emergency departments would grind to a halt due to overload.

No one involved in health care can afford to put this trust in jeopardy.

Annette Morant
Edgware,
Middlesex

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