Education And Debate

Concerns about immunisation

BMJ 2000; 320 doi: http://dx.doi.org/10.1136/bmj.320.7229.240 (Published 22 January 2000) Cite this as: BMJ 2000;320:240
  1. Helen Bedford, senior research fellowa,
  2. David Elliman, consultant in community child health (DavidElliman@compuserve.com)b
  1. a Department of Epidemiology and Public Health, Institute of Child Health, London WC1N 1EH
  2. b Department of Child Health, St George's Hospital, London SW17 0QT
  1. Correspondence to: D Elliman

    Immunisation against infectious disease has probably saved more lives than any other public health intervention, apart from the provision of clean water.1 Although other factors were important, it would not have been possible to eradicate smallpox without vaccination; the eradication of wild polio from the western hemisphere is largely due to immunisation; and the immense reductions in Haemophilus influenzae type b infections, diphtheria, whooping cough, and measles are also evidence of the value of immunisation.

    Despite, or perhaps because of, the success of the immunisation programme in the United Kingdom a vocal minority of parents have cast doubt on the wisdom of having their children immunised, particularly with the measles, mumps, and rubella vaccine.2 Not only does this place their own children at risk, but if a significant number of children remain unimmunised it poses a risk to the general population.3 In this article we suggest how health professionals, particularly those within the primary healthcare team, can respond to parents' concerns.

    Summary points

    Immunisation has saved millions of lives

    The routine vaccines are safe

    The eradication of diseases preventable by vaccines throws undue prominence on unconfirmed adverse reactions

    Vaccine scares are common

    Parental concerns should be taken seriously

    Health professionals have a duty to provide accurate information to enable parents to make a truly informed decision about their child's vaccinations

    Methods

    Our approach is based on a number of surveys showing the reasons for non-immunisation,4 5 books,2 6 articles written by those antagonistic to vaccination,7 8 and personal experience of talking to thousands of parents. Information used to respond to parental concerns (box 1) is based on extensive knowledge of both “mainstream” and “fringe” literature.

    Box 1 :Parental objections to immunisation and response to these objections

    The disease is not serious

    Measles can kill healthy children.

    The disease is uncommon

    Diseases such as measles, diphtheria, and polio are common in unimmunised populations and are easily spread worldwide. …

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