Karen Bradley: Single measles, mumps and rubella (MMR) vaccines to be available through the NHS

Karen Bradley was recently selected for Staffordshire Moorlands.

> Policy summary

Single measles, mumps and rubella (MMR) vaccines to be available through the NHS.  Labour’s policy of forcing the combined MMR vaccine onto parents and doctors puts children at unnecessary risk.

> Explanation of policy

This is not a medical argument, but an argument of principle and responsibility.

To protect their children from measles, parents have three choices;

• a combined MMR vaccine free through the NHS,
• three single vaccines paid for privately or
• not have their children vaccinated. 

Parents’ lack of confidence in MMR means that many are leaving their children unvaccinated – take-up rates declined from 92% in 1995 to 84% in 2002 – leaving them at risk of contracting measles. 

I must declare an interest – I have decided that I do not want my two young sons to have MMR.  Despite the arguments in favour, I do not want to inject them unnecessarily with Rubella before they are 15 months old.  But I can afford to pay for my sons to be vaccinated privately.  Many parents are not so lucky.

Before MMR was introduced in 1988, there was a single measles vaccine, at about 15 months, and then girls had a rubella vaccine at age 11 – I clearly remember standing in line at school to be given mine.  Mumps vaccine was not generally given.  From 1988 to 1999, parents were given the choice of the combined or single vaccines on the NHS.

Then, Labour took away the choice and made MMR the only option.  They said that many parents had failed to give their children all the single vaccines. 

About that time a report was published suggesting a possible link between MMR and autism and Crohn’s disease.  Together with general concern about giving such young babies so many vaccines in one go, this has led to the reduced take up in childhood vaccination.

Watching this reduction, a pragmatic government – one that was not so anxious about losing face – would re-license single vaccines on the NHS.  Instead, Labour has continued, in its authoritarian way, to insist that only MMR can be given and take-up continues to be low.

> Political risks and opportunities

There is little inherently wrong with MMR.  I do not propose that it should no longer be available.  But Labour’s approach is symptomatic of so many of its policies – we know best, people cannot be trusted to make their own decisions, but it won’t affect us because we can afford to buy our way out of the problem. 

Restoring choice would be popular with parents who feel that they are forced into giving their children a vaccine that they don’t really trust.  It would also show that Conservatives trust parents and doctors to decide what is best for their children and patients.

Questions for ConservativeHome readers

• At what age should the single vaccines be administered?  Pre-school?  Or older?  Rubella vaccine was historically given to girls at age 11/12, should it be given at a younger age?  Measles itself is potentially fatal, so all children should be vaccinated against it at 15 months.
• Should boys be given the rubella vaccine at all?  The argument is that as a country we have decided that we want to eradicate rubella completely and this can only be done with a minimum 95% vaccination programme (WHO guidance).  But as rubella is not dangerous to boys, do they need it so soon, or at all??

> Cost

There is an additional cost in the single vaccines compared to the combined one.  But the cost of Labour’s current policy is that children are running the risk of catching potentially fatal measles merely because Labour does not want to lose face.

Comments

[Elvis]

A good piece - we also have the dilemma of whether to trust MMR, and frankly we don't, and it's a risk we are taking.

As Conservatives we should be giving every opportunity for parents to take measured decisions - not insisting on a blanket answer for everyone.

Make no mistake this is a key topic of discussion in our house, and thousands across the country.

[Phil Taylor]

Hysterical luddites who refuse to accept scientific arguments should not be prospective candidates. I am not quite sure why CH even put this proposal forward as it is so wrong.

In Japan autism kept increasing after combined MMR was withdrawn. See:

http://www.newscientist.com/article.ns?id=dn7076

The original Wakefield paper that started the whole scare off has been withdrawn. See:

http://www.newscientist.com/article/dn4743.html

The NHS needs to spend its limited cash on real diseases that kill people not problems that only exist in the heads of middle class silly billies.

[Adrian Owens]

There are also people of many world faiths who have moral objections to MMR, as the rubella component is grown in the cells of an aborted child. This contributes to the low take-up rate.

[dizzy]

Why is this being proposed? No matter how much one tries to dress it up, this all stems from dodgy conclusion extrapolation. The MMR has been being dispensed since the 1970s in the US. This is not about giving parents choice, it's about pandering to flat-earth mentality. Someone will be suggesting we offer homeopathy on the NHS next.

[Mike Christie]

Phil, while I share your concerns, the fact is that the scare generated far more press than the eventual withdrawl of the claims. Right or wrong there are many parents who do not trust the MMR jab, should the NHS be so rigid as to not give them a choice as to how their children are vaccinated? Its not like someone is advocating a choice between MMR and giving children some lucky heather. If there are two effective ways of giving the same protection, why shouldn't parents have the choice. There may be extra cost involved, but if that extra cost means that more children are vaccinated I would think it was worth it.

[William Norton]

It's important to keep separate a number of issues:
(1) is there a link between the MMR vaccine and autism?
I've absolutely no idea; I suspect that on balance there probably isn't.

(2) is a single MMR vaccine likely to be more effective than several separate vaccines for each disease?
Yes. No question.

(3) are there effective separate vaccines available to replace the MMR?
Not sure. The way the system works is that New Labour didn't exactly ban separate vaccines, more that they've only licensed the MMR. Presumably however if it became known that the NHS had reversed this policy and would now licence separate vaccines, someone out there with a pharma company will meet the gap in the market. Lord Drayson of Bung?

(4) notwithstanding the preceding, is there is a significant degree of distrust of MMR?.
Undoubtedly.

This is one of those difficult areas where Nanny really does know best, but not enough people believe her any more (and she's bungled it). You don't have to accept all the new age hysteria to agree that if a large number of people withdraw their children from MMR, even if they are quite wrong, then it means MMR isn't working and it's more sensible to make alternative provision.

A policy that the NHS should re-licence separate vaccines - whilst explicitly refusing to endorse the autism claims and instead based on 'consumer reluctance' is sensible, defensible and attractive.

[TaxCutter]

Parents, who pay for the NHS in taxes, should have the responsibility and choice of what vaccines their kids get.

[NigelC]

I will vote for this one as it delivers choice to parents (irrespective of scientific arguments.)
We are for choice aren't we?

[Mark Fulford]

The flat world Luddite accusations are very amusing. If you think that science can never be wrong, you’re not much of a scientist.

After a year or so of agonising, and on the basis of the Japanese findings, we decided that MMR was the safest option for our children. It was a big decision so I was very unimpressed when the nurse got quite pocky that a) we had left it a bit late and b) we didn’t want her to give our children two other booster jabs at the same time. To me, it summed up the disregard of parents in government health policy.

If only on a pragmatic basis, a definite Yes to this proposal.

[Phil Taylor]

Choice is all very well but is incompatible with the NHS and the notion of services free at the point of delivery.

The NHS concept requires that we are prepared to accept that the best will not always be available, merely the most cost-effective when viewed against a range of other priorities. If we want the best cancer drugs that give only marginal increases in life span in return for £10Ks, if we want single vaccines that is fine but these demands will destroy the NHS as we will end up taxing at economically unacceptable levels, including raping the poor, so that the middle classes can belly ache their way to gold-plated treatments.

The NHS depends on us all accepting small sacrifices so that the greater good can prevail. By all means go to a US model where the wealthy get the very best but the middle orders worry about health costs and the poor simply get the minimum but you cannot have it all.

Believe me the single vaccine crowd will not like the alternative.

[dizzy]

"The flat world Luddite accusations are very amusing. If you think that science can never be wrong, youre not much of a scientist."
=========

What an absurd thing to say. No one suggested that. The fact is though that the entire MMR question arose from baseless extrapolation which has been shown as such. To then have a policy which effectively panders to that piosition but mask it in the language of "choice" is jsut silly.

[James Cleverly]

I have to say that I completely disagree with this.

The worry about take up rates is an important issue and needs to be addressed but rather than pandering to unscientific fears we have a responsibility to move the debate onto a much more logical level.

People are worried about autism because of a discredited report and ignoring the very real risks associated with the delay in administering the vaccines that results from the single vaccine option. A proposal like this undermines our medical professionals and that is an option I cannot subscribe to.

Parental choice is important but ill informed choice is no choice at all.

PS both my sons have had the combined vaccine.

[Mike Christie]

The problem here is one of trust, the people simply don't trust the government and health professionals who are telling them MMR is safe. Until that trust can be restored, surely the best option is to make the seperate vaccines available. It is easy for people to spout off about luddites and ignorance, but the simple facts are that there was a huge media frenzy about this which sparked a real fear in parents about MMR. To simply brush that away as being ignorance is somewhat insulting to parents who are just trying to do the best for their children. The link between MMR and autism may finally have been completely discredited, but the seeds of doubt have been sown a log time ago in people's minds and it will take time for them to regain their trust.

In that time, is it not only right that the NHS, recognising the real fear that these reports have caused, make alternatives available, while at the same time launching a vigorous campaign to re-assure people about MMR.

When it comes to drugs, people can be scpetical, thinking that they are being pressured into taking the drug that is the cheapest and most convenient option for the NHS, rather than what is best for them.

The real solution is to fundamentally change the way health services are provided in the UK of course :-)

[William Norton]

Dizzy/James Cleverly: agreed the anti-MMR crowd are nutters, but you have to remember WHY the NHS exists and offers vaccines. The objective is to vaccinate as many as possible, and if insisting on only MMR induces a material number of parents to avoid vaccination then the objective isn't being met. Stamping your foot and enforcing MMR and only MMR is a bit like someone who refuses to win if it would mean winning for the 'wrong' reasons.

Would it salve your conscience if the policy avoided 'endorsing' the anti-MMR crowd by providing a choice + an incentive to plump for MMR e.g. a Mothercare voucher for £10 or whatever?

[Londoner]

I agree with Phil Taylor, Dizzy and others that this would be a very silly policy for the Party to put forward, especially now the scientific doubts have largely been refuted. I have two young children and they both had MMR without hesitation.

Those who say it is choice should consider the two possible reactions to such an announcement from a major political party. Either it might reignite the controversy ("they must know something we don't") thereby leading to even lower take-up or would lead to (in my view) justified accusations of populist pandering to ignorance.

On a practical level, it is doubtful to me whether single vaccines would increase the numbers protected against all three, as the organisation involved in keeping many more appointments would mean many children ending up with only some of the jabs. [I also thought that at least one of the vaccines is not available separately in nearly as effective a form (although I accept that if the NHS were prepared to sponsor it, one might emerge).]

The whole concept of the NHS is that there has to be prioritisation in return for the free service. It is not a difficult judgement not to spend money on something which all informed opinion believes would actually be less effective. If people want to waste their own money, fine.

Incidentally, the fact that the Blairs refused to say about young Leo, to me indicates that Cherie refused him having it (mothers wishes tend to prevail), which, bearing in mind her new-age style gurus etc, gives me increased confidence that it is right to have the MMR. The best thing Cameron could do would be to announce that his new young baby will have the MMR and that he hopes others will follow the example to get the compliance level up. As well as potentially doing some good, he would gain credit with the medical profession, which would not go amiss.

[Justin Hinchcliffe]

I cannot understand why this is proposal is being given 'air time' by ConservativeHome. Did Karen Bradley make her MMR views known at the selection meetings? My partner is a doctor and a close friend works at the Lancet (the magazine which first published the 'link' between autism and the combined MMR vaccine - and later disowned the author!), so I do know a little about the subject. What is Ms. Bradley's profession - is she a doctor or scientist? Karen Bradley has certainly made me re-think my support for the A-List...

[Justin Hinchcliffe]

"Karen worked in the CCHQ Policy Unit before the last election..." Crikey!

[TomTom]

Who is going to manufacture these single vaccines when production is geared to MMR ?

Who is going to punish parents who fail to get all the single innoculations up to date without which they are inefficacious ?

Why shouldn't these people pay a premium. The NHS is not about consumer choice - there is not enough budget for that.

This is ludicrous and all because Dr Andrew Wakefield wanted to make a fast buck by selling his quack remedies - the media played a cynical game in selling his false thesis without exposing his false evidence and business scheming

[malcolm]

No not a chance until a reputable scientific study suggests otherwise.We should be looking at ways of reducing expenditure on drugs for the NHS rather than needlessly increasing it.
Having said that ,the arrogant manner in which some politicians and leading members of the medical behaved when this scare first blew up ensured that the take up rate has declined.Both should remember that the age of deference is over.

[TaxCutter]

Would you really trust either the current government or the NHS to make the right choice for your own kids?

[Adrian Owens]

There are plenty of proven single vaccines available, although there would be a timelag while production is ramped up.

William Norton, your contributions are usually well-made. To call all people who object to the MMR vaccines nutters, is gratuitously offensive to the many people who have ethical objections to a vaccine produced from the cells of an aborted child.

If people want more information on this it is readily available and I'll post weblinks.

[Mark Fulford]

If we’re going to start rejecting candidates who (arguably) hold a belief that isn’t backed by science, what are we going to do with all those MPs who claim a religion? MPs are supposed to be representative. It’s patently obvious that there are many lesser mortals who have fears about MMR and their viewpoint deserves representation too.

[Londoner]

May I repeat the earlier request that voting figures (or % and relative "turn-outs") are given on these policies at the end of each day? If they were, this one hopefully might receive the lowest vote in favour so far...

At least, now more people (the editor?) are back from holiday, could the site please respond to this suggestion from several sources?

[Justin Hinchcliffe]

Andrian, if the baby is already dead then I cannot see why we cannot his cells to prevent other children from dying. Natrually, I would prefer it if the baby wasn't aborted as I'm a member of RtL.

[Opinicus]

As a doctor, I have to say that the controversy over MMR is not sorted. MMR is very, very safe but it is not completely safe (almost nothing in medicine is). If a parent wants single vaccines to cover, perhaps needlessly, against this small risk then I see no problem in them having them. The vaccines are manufactured abroad and would be readily available if the government hadn't banned their import.

This is a matter of choice and respect for patients. They may be wrong but the collapse in vaccination rates is wholly due to the smarmy, arrogance of my academic colleagues, who have been far too long away from real patients and must realise that they have a duty to explain.

This is just the sort of smart, voter centred, niche marketed policy that any half decent opposition should be coming up with to berate the government every other day. The scandal is that none of our MPs was arguing for it when it was topical two years ago. The sort of prissy, self righteous response above shows why we are and are likely to remain in opposition.

PS I know 90% certainly that Leo never had his MMR, which makes the hypocrisy of the government well nigh unbearable, given the damage they have caused to public confidence in vaccination policy in this country.