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Rapid Responses: Rapid Responses published:
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But why fear some risks and not others?
- Steve Chaplin (26 September 2003)
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Mr Gummer's Hamburger.
- Ronan O'Driscoll (28 September 2003)
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Because they are not philosophers
- Alan Challoner MA MChS (28 September 2003)
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Making heavy weather of risk
- Steve R Iliffe, Jill Manthorpe (30 September 2003)
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Media has influenced MMR uptake
- Peter J Aquino (1 October 2003)
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Re: Media has influenced MMR uptake
- Alan Challoner MA MChS (1 October 2003)
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Re: Making heavy weather of risk
- Andy M Alaszewski, Tom Horlick-Jones (2 October 2003)
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Re: Media has influenced MMR uptake
- M C Feliciello (2 October 2003)
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compulsion may be the pragmatic response
- Justin Daniels (3 October 2003)
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Re: compulsion may be the pragmatic response
- Alan Challoner MA MChS (3 October 2003)
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Re: compulsion may be the pragmatic response
- GH Hall (4 October 2003)
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Re: compulsion may be the pragmatic response
- M C Feliciello (4 October 2003)
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Communicating risk
- Paul Lynch (5 October 2003)
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Re: compulsion may be the pragmatic response
- L S Lewis (5 October 2003)
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Parents should have the right to choose
- sasha R James (8 October 2003)
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Factors which may shape public perception of risk
- Rosemary J Geller, ST16 3SR (20 October 2003)
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Risk assessment and MMR vaccination: the role of the media and the NHS
- Annette L Wood, Gurjinder Dahel , Suhkdip Johal, Mira Pattni, 4th year Medical students, University of Birmingham (31 October 2003)
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Parents' responses to the risks
- Alan Challoner (18 June 2005)
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Re: Parents' responses to the risks
- John Stone (20 June 2005)
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Steve Chaplin, Medical journalist 21 Alexandra Terrace Hexham NE46 3JH
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Saying that parents can be seen to act in the best interests of their children by refusing MMR vaccine begs the question why they choose to protect them against one risk but not another. Surely, public judgements about risk are influenced by familiarity with the danger, the degree of control people believe they have over the risk, and the benefits that the risky behaviour offers. The contrast between the risks associated with car use and vaccination fits this model well. If protection was uppermost in parents' minds and not influenced by these factors, their choices would clearly be different. Several mothers have asked me about MMR vaccine and autism but not one has mentioned the complications of measles. The media have consistently presented autism as the dominant risk, putting health officials on the defensive and undermining their credibility in the public mind (as Bellamy says, it was already compromised by BSE). The media have led public opinion by misrepresenting the balance of risk in an atmosphere of distrust and anxiety. Competing interests: None declared |
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Ronan O'Driscoll, Consultant Physician Hope Hospital, Salford, M6 8HD
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Mr John Gummer has been ridiculed yet again in today's BMJ because he sought to reassure the public that it was safe for him and his daughter to eat a hamburger in 1990. Ironically, the photograph of the Gummers eating their "dangerous meal" was used to illustrate an article about risk which pointed out that the public will transport their children happily in cars although about 60,000 people have been killed by British cars since 1990 but there have been very few deaths (possibly none) attributable to beef products consumed after Mr Gummer's memorable meal. Surely it is time for journalists and the Medical Establishment to swallow their pride and admit that Mr Gummer was right to swallow his beliefs. Mr Gummer understood how to communicate to the public that we all accept very small risks every day. The BMJ should learn from him instead of laughing at him. But how will the BMJ illustrate its stories about the BSE-vCJD scare in future? How about some colourful photographs of the virologists who predicted hundreds of thousands of deaths from vCJD? Yours Sincerely, Dr Ronan O’Driscoll Consultant Physician Hope Hospital Salford M6 8HD Competing interests: None declared |
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Alan Challoner MA MChS, Retired LL18 5UR
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Most parents do not assess risks or work to utilitarian rules, as philosophers might do. Parents use their experience, knowledge or understanding; and on this they base their fears. It makes sense to me that parents will work out their strategy from the point of view of the worse case scenario as they see it. For many of them, there will be a greater fear of autism or brain damage than there will be of measles. Further, it does not make any sense to these parents that the health department will not allow access to a single vaccination for measles. In practical terms neither rubella nor mumps need be feared too much at all prior to puberty. There is very little evidence to show that children under that age will incur any really serious consequences from not being vaccinated against these two infections. Al least not in comparison to autism and brain damage. Competing interests: Father of vaccine damaged daughter |
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Steve R Iliffe, Reader in General Practice Royal Free & UCL Medical School, London NW3 2PF, Jill Manthorpe
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Why do doctors make such heavy weather of risk? The wide-ranging discussion of risk assessment and communication (BMJ September 27th) tries hard to enlighten the profession yet still slips into patronising patients and oversimplifying issues for doctors. Bellaby tells us that “parents behaviour is not necessarily irrational” (p 727) whilst Alaszewski & Horlick-Jones inform us that “Social context influences the ways that individuals respond to information on risk” (p 730), a proposition that would have been old news to Hippocrates. We suggest that individual behaviours and decisions are almost always reasoned (although sometimes wrong), that patients often have more complex understanding of risk than their doctors, and that the issue is not whether social context influences risk judgement, but exactly how. In our view there are two dimensions to understanding health risks from a citizen’s perspective (1); their estimation and balancing of the probability and impact of any action or inaction, and the individual’s position on a cultural spectrum from conformist to dissenting attitude, itself dependent on a range of influences (2). The examples of parental risk judgements given by Bellaby can be understood easily using a probability/impact model. Driving children to school does expose them to risks of injury or death in road traffic accidents, but the probability of this happening is decreasing as the volume of traffic rises and the serious accident rate falls. The impact of accidents can be reduced by individual action (careful driving), technological innovation (safer cars) and social measures (traffic calming). From a risk perspective the hazards of driving are declining and amenable to intervention. Not so with new variant CJD, which may be improbable but certainly has very high impact, with no possibility of avoidance except by avoiding risky foods. The rumour of a relationship between MMR and autism is sufficient to promote ‘refusenik’ behaviour in a minority of parents, who will still accept the benefits of Hib or meningitis immunisation for their children. They understand that an unlikely event (autism following MMR) still has a profound impact, whilst measles, mumps and even rubella are highly likely to occur in the absence of immunisation but have a low impact because they are perceived as minor illnesses. Minimising an improbable but serious risk by separating the vaccines therefore makes sense, to them. It is this last argument that upsets us professionals, but that may be because we do not understand the second dimension of conformism and dissent. An emerging conception of the fit body emphasises that it is a non-linear system in delicate balance with its environment, with an immune defence that if well brought up will respond flexibly to challenge without need for potentially hazardous crash-courses in training through immunisation (3). This new common sense about health emphasises personal autonomy and responsibility, and resonates with conventional wisdoms about flexibility in personalities, organisations and the economy. We should fear this dissenting view for its potential to marginalize badly brought up bodies and to advocate the survival of the fittest immune system, and not just for the cases of measles encephalitis and congenital rubella syndrome that it may create. The question for professionals and for the BMJ is, what is the alternative common sense? Herd immunity is hardly enticing to those wanting to be outside the herd. Steve Iliffe, Reader in General Practice, Royal Free & UCL Medical School Jill Manthorpe, Professor of Social Work, Kings College London. 1. Iliffe S & Manthorpe J Risk maps and three dimensional models: a rejoinder to Misselbrook & Armstrong Family Practice 2002;19(6):704-7 2. Douglas M, Risk and blame: essays in cultural theory Routledge, London, 1992 3. Martin E Flexible bodies: science and a new culture of health in the US in William S, Gabe J & Calnan M Health, Medicine & Society: key theories, future agendas Routledge,2000, pages 123-145 Competing interests: None declared |
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Peter J Aquino, Research Fellow in Primary Care Newham PCT E13 9PJ
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Editor May I first commend Bellaby's well written and researched article. However i do think that the influence of the media has been very much under-represented. The media (both television and newspapers) have a huge role to play in people's thinking on medical issues, in fact many patients would argue that they are more likely to trust the media than their local GP regarding the MMR controversy. With regards to coverage of the MMR debate it is surprising how much coverage it has been given compared when compared to more pressing conditions such as smoking and obesity although this is not to trivialise the MMR issue in any way. On reflection the media's reporting on MMR should have been a lot better and this undoubtably has helped in reducing the uptake. Many GPs including myself have lamented at the number of times patients have refused the MMR jab for their children before even having discussed this with their GP. It would be interesting to calculate the coverage of the many reports that have refuted MMR and autism link against the very few that have supported it. I suspect there would be more coverage for the latter which may prove after all the bad news really does sell. Dr Peter Aquino Competing interests: None declared |
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Alan Challoner MA MChS, Retired LL18 5UR
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As a research fellow, I wonder what research Dr Aquino did before he made the suggestion that, “(the) Media has influenced MMR uptake”? The implications from the title and contents of his contribution are that at least the media has not done enough to persuade parents to use the MMR vaccinations for their children, or at worst it has contributed to a decline in the uptake. In a short time it is not possible to access all recent reports. However I have accessed 52 of the most recent publications by the BBC on its website. Each has a 96% relevancy to the topic. Of those, there were only two ‘negative’ reports. (4%) One considered a poll, for the National Consumer Council, which suggested that recent governments of both parties had, “kept people in the dark”, “manipulated” or even “ignored” concerns. (19/10/2002) The other was, “London Mayor Ken Livingstone has advised parents not to give their children the controversial MMR triple vaccine.” (03/07/2002). Of the remainder: 32 (62%) positively reported the government/health department policy. 8 (15%) were connected with court cases. 5 (10%) were connected to reports on the single vaccine situation. 5 (10%) were connected with research issues or GP financial issues. Competing interests: Father of vaccine damaged daughter |
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Andy M Alaszewski, professor of health studies CHSS, University of Kent, Canterbury, CT2 7NF, Tom Horlick-Jones
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While we read with interest Iliffe and Manthorpe’s comments on our risk communication article, we do feel that they rather missed the point. Governments and medical practitioners should take into account social context but for a variety of reasons they tend not to. While it is possible to advocate a specific approach to or definition of risk, it is important to recognise that risk is defined and used in different ways. In the medical and health care literature risk tends to be treated as the probability of objective and measurable harm and the discourse is phrased in terms of the ‘risk of’ specified adverse health events assessed in terms of mortality and morbidity. This involves the identification of factors associated with such events within populations, ‘risk factors’ or personal characteristics that make individuals ‘at risk’ (see for example the BMA’s influential guide to risk )(1). A keyword search of the National Library of Medicine’s database PubMed in 2002 using ‘risk’ identified 482,260 publications of which nearly half (211,148) were also identified using ‘risk factors’ as a key word. These publications were mainly concerned with factors that affected the incidence of specific clinical conditions, for example ‘Diabetes mellitus a risk for osteoporosis? (2) or ‘Hypoglycemia risk reduction in type 1 diabetes’(3) . However it was possible to identify ‘risk in’ health care, in which the emphasis is on the social processes which shape and influence health outcomes. These processes include ‘risk communication’, ‘risk perception’ and ‘risk management’. The keywords ‘risk perception’ for example identified 347 articles which focussed on the ways in which specific health risks were perceived, as in ‘Risk perception and psychological strain in women with a family history of breast cancer’ (4) or ‘Perception of risk of vaccine adverse events: a historical perspective’ (5) . Risk means different things to different people. These meanings are linked both to the symbolic associations of risk and the variety of perspectives which individuals and groups use in making sense of risk (6) . Social researchers have drawn attention not only to contested nature of risk but also the ways in which the experience of risk offers many attractions to individuals: it can provide opportunities for excitement, challenge and personal fulfilment (7) . One of the few studies to explore the ways in which risk is conceptualised in health and social care settings (8) examined alternative definitions associated with the risk of supporting vulnerable adults in the community. The dominant conception of risk which was shared by professionals, users and carers, emphasised hazard or danger-oriented dimension of risk. However other defintions. These included recognition of uncertainty and possible positive outcomes that either had to be balanced against negative outcomes or were themselves a product of empowering individuals to take risks. As Eldridge (9) points out, an area of central importance in risk research is to explore which and whose definitions of risk are accepted in different contexts. Jaeger et al (10) have argued that there is a need to take into account different forms of rationality exhibited by agents in different real-world risk-related contexts. The 1992 Royal Society report (11) utilised the concept of ‘social framing’ as a framework for exploring the often radically contrasting views of ‘expert’ and ‘lay’ groups concerning specific risk issues. Alternative approaches to risk issues can be understood in terms of the ‘framing’ of (often unarticulated) assumptions, expectations and norms, which are shared by a given social group (12) . In this way, the existence of implicit assumptions entailed in the production of specific risk evaluations are taken into account, as is the relevance of wider issues and concerns in which the ‘risk object’ (13) is embedded. (1) THE BRITISH MEDICAL ASSOCIATION (1990) The BMA Guide to Living with Risk, Harmondsworth, Penguin. (2) LEIDIG-BRUCKNER, G. AND ZIEGLER, R. (2001) Diabetes mellitus a risk for osteoporosis? Exp Clin Endocrinol Diabetes, 109 (Suppl 2), S493- S514. (3) CRYER, P. E. (2001) Hypoglycemia risk reduction in type 1 diabetes, Exp Clin Endocrinol Diabetes, 109 (Suppl 2), S412-S423. (4) NEISE, C., RAUCHFUSS, M., PAEPKE, S. ET AL (2001) Risk perception and psychological strain in women with a family history of breast cancer’, Onkologie, 24, 470-475. (5) SPIER, R. E. (2001) Perceptions of risk of vaccine adverse events: a historical perspective, Vaccine, 20, Suppl 1, S78-S84. (6) PETTS, J., HORLICK-JONES, T. and MURDOCK, G. (2001) Social Amplification of Risk: the Media and the Public Contract Research Report 329/2001 HSE Books, Sudbury. (7) LUPTON, D (1999) Risk, London, Routledge. LUPTON, D. AND TULLOCH, J. (2002) Life would be pretty dull without risk: voluntary risk-taking and its pleasures, Health, Risk and Society, 4, pp. 113-124. (8) ALASZEWSKI, A., ALASZEWSKI, H., AYER, S. & MANTHORPE, J. (2000) Managing Risk in Community Practice, Edinburgh, Balliere Tindall. (9) ELDRIDGE, J. (1999) Risk, society and the media: now you see it, now you don’t, in: G. Philo (ed.) Message received: Glasgow Media Group research 1993-1998, Harlow, Longman. (10) JAEGER, C. C., RENN, O., ROSA, E. A. ET AL (2001) Risk, Uncertainty and Rational Action, London, Earthscan. (11) THE ROYAL SOCIETY STUDY GROUP (Ed.)(1992) Risk, Analysis, Perception and Management, Report of a Royal Society Study Group, London, The Royal Society. (12) WYNNE, B. (1982) Rationality and Ritual: the Windscale Inquiry and Nuclear Decisions in Britain, Chalfont St Giles Bucks, The British Society for the History of Science. (13) HILGARTNER, S. (1992) The social construction of risk objects, in: SHORT, J. and CLARK, L. (Eds.) Organizations, Uncertainties and Risks, Boulder Colo., Westview, pp.39-53. Competing interests: None declared |
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M C Feliciello, Parent Leeds
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I would suggest that media reporting such as this latest piece on the BBC website 01/10/03 http://news.bbc.co.uk/1/hi/health/3155538.stm only serves to restate the current beliefs of both the Pro-vaccine health department and the deeply held suspicions of some parents without offering conclusion to the debate. The potential for open examination of the issue and all current evidence appears to have been temporarily quashed with the withdrawal of legal aid to those families pursuing a claim against the manufacturers of the MMR Vaccine as reported. Surely that method of silencing the dissenting voices would enhance parental concern rather than damping down inconvenient individual cases? What is overlooked in examing the communication of risk with regard to the MMR is the ability of parents to talk amongst themselves and perhaps give weight to the evidence presented by their associations within their immediate kinship and and friendship networks. This method of risk communication is far more effective and powerful than anything the Dept.of Health or peer reviewed journal could hope to achieve as it is based on a level of personal trust and transparency of motive. Competing interests: None declared |
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Justin Daniels, paediatric registrar Whittington Hospital, London N19
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Bellaby asserts that compulsion will not increase the take-up of the mumps, measles and rubella (mmr) vaccine. Compulsion is the norm in the United States where a child is not admitted to school without vaccinations. In the UK there were similar concerns about the seatbelt legislation in the 1980s - these worries proved unfounded. The case for non-vaccination is not rational - yet many doctors spend considerable periods of time trying to repond to it with rational arguement, often without success. If we believe we have a public health duty to increase vaccination take-up and prevent childhood deaths from measles then we may have no choice but to use legislation. Competing interests: None declared |
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Alan Challoner MA MChS, Retired LL18 5UR
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If legislation is used to compel vaccination then there will need to be parallel legislation to improve the awards under the Vaccine Damage Payments Act 1979. Currently the maximum award is a one-off payment of £100,000. My daughter has received this, but it bears no comparison to the costs of her care. The staff costs alone amount to £50,000 pa. Competing interests: Father of vaccine damaged daughter |
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GH Hall, Retired Physician EX1 2HW
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Compulsion rather than rational argument? Now we see the true colours of the MMR zealots. Until we are allowed data on the safety testing of these vaccines the rational thing to do is to wait until we are. Competing interests: None declared |
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M C Feliciello, parent Leeds
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The introduction of compulsory use of a seat belt belt in the UK is an interesting comparison to make in support of the suggestion of compulsory vaccination as an method of achieving herd immunity. Even with a well fitted, self adjusting seatbelt, one size does not fit all, hence the use of baby & booster seats etc to avoid damage from the seatbelt per se and maximise it's benefits. I wonder, would Justin Daniels advocate a similar "tailoring" of his proposal regarding compulsory vaccination policy based on appropriate screening of individual suitability and family health history? MCF Competing interests: In favour of the use of appropriately fitted & tested seatbelts in all road vehicles........ |
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Paul Lynch, N/A Swansea
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Please read this ? http://www.mercola.com/2003/oct/1/mass_vaccination.htm Competing interests: None declared |
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L S Lewis, GP Newport, Pembrokeshire, SA42 0TJ
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Justin suggests in the mildest tones what would be a major change in British doctor-patient relations. Firstly, it is not true that vaccination is compulsory in the USA. Rather, admission to public schools without vaccination certification is disallowed. But parents are allowed not to have their children vaccinated. I do not want to vaccinate a child, whilst her parents are held in temporary police custody. Parents (all those I have known) do try to make the right choice for their children given their experience, knowledge, fears and concerns. I well remember 25 years ago, having to take my baby daughter for vaccination, because I was embarking for a new job in Nigeria. My tiny daughter needed to have BCG, Triple Vacc, etc all in a 'crash course'. I agonised about other risks too - but we decided to give her a Measles vaccine ( single measles vacc was available then ! ), but after much heart-searching !! And who holds the child while the jabs are given ? How many needles can you stick in your child ? It is an emotional business, I can tell you - I held her while my wife looked away. Justin's analogy seems reasonable - the Law requires the wearing of seatbelts, designed only to protect that individual, not 'society' - so why not pass a Law to vaccinate children ? Yet many individuals object to seat belts in principle, and many simply ignore the Law ( I am not 'immune' ! ). Policemen respond according to their mood , or the Chief Constable's need for convictions 'targets'. I am regularly asked for 'Seat-Belt exemption' certificates - sometimes for the most bizarre of reasons. We in the UK can achieve high immunisation rates, AND a reasonably tolerant liberal approach to 'parental rights'. All we need to do is listen to concerns, try to persuade - and OFFER SINGLE VACCINES where parents persist in refusing MMR. How do I know this ? Because it is exactly what we did with triple DPT vaccine through the dark years of the 'Pertussis and Brain Damage' debate - when mass refusal to accept Pertussis vaccine led to a major upsurge in Whooping cough morbidity and mortality. But after due discussion we would give DT vacc and not add Diphtheria and Tetanus epidemics to our problems! But Dr Pat Troop and the Public Health establishment have taken on a Stalinist policy... how times change ! Competing interests: doing good vs. avoiding harm |
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sasha R James, student and carer Cornerstone Community Care AB11
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Whether the risk of Autism from the MMR vaccine is perceived as being miniscule or not, parents should have the final say on what foreign live viruses are injected into their babies, is it too much to ask that those who would prefer single vaccines not be denied them? Autism devastates families and is an extremely difficult, demanding and stressful thing to live with, no matter how loved the child with the condition is. I have seen many children who, prior to this vaccine, were developing normally and afterwards deteriorated severely. Science may have many answers, but it cannot explain everything. Why are some children clearly affected so badly by this vaccine while others are not? Until we know, there should be single vaccines available. Competing interests: I work as a carer to autistic children |
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Rosemary J Geller, Director of Health Strategy Shropshire and Staffordshire Strategic Health Authority, Mellor House, Corporation Street, Stafford,, ST16 3SR
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EDITOR--Thank you for devoting an issue of the BMJ to the important topic of communication and public perception of risk. As a Public Health Physician, whose daily thoughts are shaped by probability, other statistical methods and epidemiology, I have long pondered and puzzled over the apparent dissonance between statistical and public interpretation of risk. Not just the unknown mass public, but even my friends and family. In fact those avoiding or declining minimum risk activities and health interventions are more frequently from the sector of society which is apparently better informed and more highly educated, as pointed out by Bellaby1 in relation to the drop in MMR uptake post Wakefield’s claim in 1998.2 Bellaby takes us through the complexities of how scientific findings and probability are transformed in the public’s mind, via politicians and the media, into perceptions, beliefs and actions. In general, I agree with the points he makes. However, three thoughts occurred to me which I feel need further consideration: Bellaby argues that in a post-war democracy, like Britain, compulsion cannot work and concordance through two-way communication (presumably with each person on an individual basis) is the only way forward. This is time -consuming. Whilst concordance is preferable, there is one example where arguably compulsion worked well: seat belt legislation. Post introduction in 1988, this compulsory health measure for all vehicle drivers and passengers, did not generate riots or failed compliance.3 The rate of fatalities and serious accidents has not substantially increased since, despite a huge increase in traffic-miles travelled.4 I acknowledge the contribution of better car design, road engineering and slower speeds in urban areas due to congestion.5 There is another factor which could influence reaction to risk, that is whether the risk is within an individual’s control or imposed upon them. Risk imposed by others may be less acceptable. In the three examples covered by Bellamy, the injuries sustained by children as passengers, presumably largely driven by their parents, could be perceived by parents as under their own control and their responsibility. Measles, mumps, and rubella (MMR) vaccination is imposed by the health service and by the Government. Variant Creutzfeldt-Jakob disease (vCJD) could be perceived as being imposed by the agriculture and food industries. Two risks, which I like to compare, are those of death from smoking and air travel. The statistics tell us that air travel is incredibly safe and that tobacco smoking is not. I suggest that not many disasters hit the headlines or produce more public fear than a plane crash and yet approximately 340 jumbo jets would have to crash in one year to equal the toll from smoking in the UK. I argue that those who smoke feel that smoking is under their personal control and the fate of an aircraft in flight is not. This example brings me to my third point, the media and hence the public, seem more interested and frightened by unusual and immediate events. Smoking is an every day occurrence plane crashes are not. Smoking takes many years to kill, a plane crash happens in a matter of hours after take off. So in addition to Bellamy’s well-made points, I would add the suggestion that the above points are worthy of further research both as to whether they are relevant to the public’s assessment and perception of risk and how the findings can help the implementation of effective Public Health programmes, through better communication, in today’s Britain. References 1. Bellaby P. Communication and miscommunication of risk: understanding UK parents’ attitudes to combined MMR vaccination. BMJ 2003;327:725-728. 2. Wakefield A, Murch S, Anthony A, Linnell J, Casson D, Malik B, Dhillon A, harvey P, Walker-Smith J. Ileal-lymphoid hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Lancet 1998 Feb 28; 351 (9103):637-41. 3. Mackay M. Seat belt legislation on Britain. J Trauma 1987 Jul; 27(7):759-62. 4. MacCarthy M. The Benefit of seat belt legislation in UK. J Epidemiology Community Health. 1989 Sep; 43(3):218-22. 5. Crandall CS, Olson LM, Sklar DP. Mortality reduction with air bag and seat belt use in head-on passenger car collisions. Am J Epidemiol. 2001 1;153(3):219-24 Dr. Rosemary J. Geller
NB the views expressed here are those of the author and do not necessarily represent the views or policies of Shropshire and Staffordshire Health Authority. Competing interests: None declared |
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Annette L Wood, CCDC Birmingham and Solihull Health Protection Unit, 142 Hagley Road, Birmingham B16 9PA, Gurjinder Dahel , Suhkdip Johal, Mira Pattni, 4th year Medical students, University of Birmingham
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We were interested in articles in recent issues of this journal about risk communication and media reporting of measles, mumps, rubella (MMR) vaccination1, 2. The role of the media and concerns about the motives of the National Health Service (NHS) are key to how parents perceive risk and benefit. We used a questionnaire to assess the awareness and attitudes of 61 parents in three large general practices in Birmingham, whose children would be eligible for MMR vaccine in the future. Nearly all were aware of the particular issues with the vaccine: 72% were aware of the alleged link between autism and the combined vaccine and a further 15% were aware of a controversy but not the exact nature. The outcome is 44% of parents stated the controversy had made it less likely their child would be vaccinated. Ten percent of all parents stated their child would not be vaccinated with the combined MMR vaccine. Reassuringly, Health Care Providers are still a powerful source of advice: 40% of parents regarded the Health Visitor as the most influential determinant in their decision. However, 55% gave the media (television, newspapers) as the most helpful when making a decision about MMR vaccination. This mirrors Trevor Jackson’s review on the role of the media, ‘that what people knew usually corresponded with those aspects of a story that received most persistent coverage’ 3. Thus the extent of the coverage has left parents wondering whether there can be smoke with no fire. The way in which aspects of the safety of the MMR vaccine have been dealt with by the media has left parents suspicious of health services and a feeling that they are not provided with adequate levels of information required to make decisions. Media coverage has succeeded in tarnishing the reputation of the combined MMR vaccine and also had a detrimental effect upon the relationship between parents and the health service. Consequently, parents are less willing to place the safety of their child’s health with an organisation they feel has hidden agendas. Gurjinder Dahel, Suhkdip Johal, Mira Pattni, 4th year medical students, University of Birmingham. Dr Annette Wood, CCDC, Birmingham and Solihull Health Protection Unit References 1. Berger A. The Third Degree. MMR: Can You Decide? BMJ 2003; 327:628. 2. Bellaby P. Communication and miscommunication of risk: understanding UK parents’ attitudes to combined MMR vaccination. BMJ 2003; 327: 725-728. 3. Jackson T. MMR: more scrutiny, please. BMJ 2003; 326:1272. Competing interests: None declared |
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Alan Challoner, Retired LL18 5UR
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It seems to me that the comparisons being made in ‘Parents responses to the risks’ do not involve risks of the same order. Parents can take care or otherwise when they are driving, but they cannot control the behaviour of other road users. If public transport is being used then there is very little control that either parent or child can exert positively. With regard to vCJD, parents can be concerned but in practice I believe that they do not see the current risk of contracting this condition to be great and, of course, there is no way of telling if any particular action will produce a reaction. When it comes to the MMR vaccine, the order changes in as much that it is not the vaccine that may be at fault but that it might be their child who may be susceptible to adverse reactions. The factor that produces the risk reaction is that the parents have no way of knowing if there child is a reactor or not. So it is in reality a sort of Russian roulette in reverse. Not, will my child find the bullet, but will my child’s system fire the gun. The real motivator to decline vaccination is the potential ‘guilt factor’ that enters the equation. It is the parent and not the child who makes the decision whether or not to vaccinate. Those who have had children who are brain damaged by vaccination know only too well how heavy this burden is to carry. Unfortunately it is not a factor that is considered by epidemiologists, vaccinating doctors and researchers who tell us that, “authorities ought to act in the interests of the child”. What has not been thought through here is the possibility that if a vaccination was imposed by dint of law, who would be responsible if the child was adversely affected by the vaccination? If the answer is that the matter is covered by the Vaccine Damage Payments Act 1979, then think again. No mother would willingly bargain their child’s life and wellbeing for the rest of its life in payment of £100,000. Competing interests: Father of a vaccine damaged daughter. |
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John Stone, none London N22
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Alan Challoner makes an interesting point. There has not been much political enthusiasm for compulsory vaccination in the UK. Perhaps the vaccine lobby recognise the importance of gaining parental complicity, (although they are unlikely to have adequate information on which to make a judgement). Remove the complicity and parents will come to regard adverse reactions with far more scepticism. On its own this would I should think make very little difference to the issue of compensation, since the culture of denial would continue unabated. Competing interests: Autistic son |
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