The 20th anniversary of the introduction of the combined MMR vaccine in the UK should be an occasion for celebration.
In 1988, the year that measles, mumps, rubella (MMR) was added to the childhood immunisation programme, 16 children died of measles in the UK. This was higher than the annual average of deaths from measles in the 1980s. Working as a GP in East London in those days, I recall seeing cases of mumps and measles every year. I particularly remember my first cases of the congenital rubella syndrome, two severely handicapped adults whose mothers had been pregnant during the world-wide rubella epidemic of the mid-1960s.
Twenty years later mumps and measles are mercifully rare and congenital rubella has effectively been eradicated. It is true that there have been outbreaks of mumps and measles in recent years – there were 300 cases of measles in Hackney in 2007 – and there have been two deaths in England, the first since 1992. These followed a decade of unfounded negative publicity about the safety of the vaccine, which in turn had a detrimental effect on immunisation rates. The cases serve to underline the importance of the MMR catch-up programme, so ensuring that all children are properly protected against these diseases.
But it is also important to recognise the achievement of the past two decades. Just as the post-war immunisation campaigns triumphed over diphtheria, whooping cough, tetanus and polio, so MMR has succeeded in drastically reducing the toll of human suffering caused by measles, mumps and rubella.
Of all the prejudices promoted by anti-vaccination campaigners the notion that measles is a relatively benign disease of childhood is the one that most infuriates any doctor who has ever treated a child with measles. In 1911, in London alone, 3,000 children died of measles. In 1941, more children – more than 1,000 – were killed by measles than by German bombs. Through the years of my childhood in the 1950s and 1960s, an average of more than 100 children died from measles every year.
Recent outbreaks of measles in prosperous Western countries – Italy, Holland, Ireland – confirm that measles remains highly contagious and commonly causes pneumonia and encephalitis. If 5,000 children are affected, at least one will die. Children whose immune system is compromised by some other condition are particularly dependent on the protection afforded by a high level of community uptake of the vaccine.
Even in healthy children, measles is a particularly severe respiratory infection, producing a high fever, a hacking cough, streaming eyes, sore throat, and the characteristic rash. In recent measles outbreaks, about 10% of cases have ended up in hospital, some in intensive care.
MMR has become a victim of its own success. Now that memories of these diseases have receded, for some, anxieties over the safety of the vaccine – no matter how ill-founded – exceed fears of epidemics. These sceptics are distrustful of the wealth of scientific evidence, accumulated over decades in many different countries, supporting both the efficacy and the safety of MMR. What is even more extraordinary is that some people, while expressing scepticism towards scientific authorities, put their faith in the junk science of the anti-vaccination campaigners.
Michael Fitzpatrick is a GP in Hackney and author of MMR and Autism: What Parents Need To Know, Routledge 2004
This article is published in the 23 October issue of Community Care magzine under the heading Vaccination has saved lives so why are the sceptics so vocal?