The Pharmaceutical Journal
Vol 268 No 7195 p568-572
27 April 2002

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Letters to the Editor

Childhood vaccination

MMR research is imperative

From Mrs K. E. M. Coull, MRPharmS

Dr Jim Smith, asserts that the MMR vaccine is safe and effective (PJ, 6 April, p466). I am sure that this is so for most children but, for some, it appears not to be safe and to have devastating consequences. The Department of Health has recently spent £3m on a national MMR-safety campaign. Now it needs to spend money on investigating why certain children are susceptible to the MMR vaccine.

If a person is allergic to penicillin then a general practitioner will prescribe an alternative antibiotic; perhaps one less effective than penicillin, but necessary given the severity of the side effects suffered by the patient after penicillin-ingestion. Surely then, it makes sense to offer an alternative to the MMR vaccine.

Until thorough research is carried out, parents will continue to lose confidence in the MMR vaccine, and also be subjected to unnecessary worry. This issue will not go away, and it is imperative that it is properly addressed immediately.

Kate Coull
Abergele, Clwyd

A social responsibility

From Mr A. Cox, MRPharmS

In her letter (PJ, 30 March, p432), Juanita Westbury raises the concept of concordance in relation to vaccination policies and accuses the Department of Health of having a regressive attitude at odds with moves towards more concordant relationships in medicine taking.

Margaret Thatcher once declared: "There's no such thing as society. There are individual men and women and there are families." Although not referring to vaccination policies, the oft-quoted comment illustrates the rise of individualism between the 1950s and 1990s. Although now a modern virtue, giving people freedom of choice, individualism can lead to people putting personal freedom ahead of any responsibilities to others. This is also coupled to a loss of wider social cohesion and a loss of trust in authority. Poor performance of "authorities", such as occurred with bovine spongiform encephalitis, reinforces such views. The current MMR debate is taking place in such an environment.

Concordance was born of a desire to help patients with problems with medicine taking. At its heart is an agreement reached after negotiation between a patient and a health care professional that respects the beliefs and wishes of the patient in deciding when, how and if medicines should be taken. The primacy of the patient's decisions is considered paramount in the process.

However, the control of infectious diseases occurs with communities and populations, and it is simplistic to apply an individual-centred model of bio-ethical reasoning, such as concordance, to vaccination policies. Some may argue that individuals and respect for their individual autonomy may still have a role, but the benefit and risk of vaccination should be seen in relation to societal and individualistic perspectives. An individual may decide that refusal of vaccination is in their interests, so long as enough of the population is vaccinated to achieve "herd immun-ity". Although this decision may seem a rational course of action for the individual, is it a morally justifiable decision given the risk the individual person brings upon the wider society and community within which they live? Vaccination can be considered a social responsibility.

The decision of a patient not to use a medicine usually has little direct effect on the health of other individuals, but the denial of vaccination puts others at risk. Some of those at risk will not have had the opportunity to obtain vaccination, for example, small infants below the age of vaccination will be at risk.

The Department of Health's policy towards MMR is based on current scientific advice. If the Government were to ignore scientific advice this would be a truly regressive step. There is evidence that the provision of single vaccines may reduce uptake, thereby increasing the prevalence of measles. In addition some polls already show concerns are not limited to MMR, with 4 per cent of parents with young children not wishing to inoculate their children against mumps, measles or rub-ella by either single vaccines or use of MMR. Changing government policy for short-term political gain, rather than because of scientific evidence, would be seen by some as a tacit admission that a link between autism and measles vaccine exists, when no evidence supports such a risk.

Partnership is needed with parents and the public in putting across the safety and importance of the MMR vaccine, but the consideration of NHS provision of single vaccines needs to be seen as a public health issue.

Anthony Cox
Teaching Fellow
Pharmacy Practice Group,
Aston University, Birmingham

Pharmacists entitled to their own opinions

From Mr B. W. Knox, MRPharmS

Dr Jim Smith states that MMR vaccine is safe (PJ, 6 April, p466). Well he would, being an employee of the Department of Health — nothing scientific about that.

Pharmacists should be able to form their own opinions on the merits of this vaccine and to expect them to slavishly follow directives from the Government is insulting.

After all, community pharmacists are not even part of the supply chain.

Brian Knox
Harrogate, North Yorkshire

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