Intended for healthcare professionals

Rapid response to:

Primary Care Ethical debate

Vaccination against mumps, measles, and rubella: is there a case for deepening the debate?How safe is MMR vaccine?Validity of the evidenceDealing with uncertaintyGP's response

BMJ 2001; 323 doi: (Published 13 October 2001) Cite this as: BMJ 2001;323:838

Rapid Response:

Why not allow single measles vaccine?

The controversy surrounding MMR won’t go away. The title of the
series of articles poses the question “is there a case for deepening the
debate?”1 I believe there is. Many of us are not in a position to
evaluate critically all the evidence presented and are further confused to
find that well-qualified experts stand in both camps of the debate.

From the infant’s perspective immunisation against measles seems the
most pressing, as infection carries a small risk of serious and even fatal
complications. Mumps and rubella are far less serious for the infant and
my understanding is that the only scientific argument for immunising
infants against these two diseases is to establish a good herd immunity,
which will benefit society and reduce infections of non-immune older
children and adults where sequelae of mumps and rubella can be more
serious. (I can also see the practical and economic reason for providing
an immunisation against more than one disease in a single vaccine.) But
should the benefit to society take precedence over possible risks to an
individual? My understanding of the Wakefield hypothesis is that in a
very small number of children the triple vaccine may precipitate Crohn’s
disease or autism.

What I find puzzling is the adamant refusal of the authorities to
facilitate the availability of the single measles vaccine, to the point
that the Department of Health has banned its use within the NHS. How does
this fit with the growing acceptance of patient autonomy and patient
choice? It is now enshrined in case law that a pregnant women can, for
rational or irrational reasons, refuse treatment even if that refusal
fatally jeopardises her unborn child. I suggest that the medical
profession should support a parent's wish for single dose vaccine, however
irrational the establishment might view that wish. In addition there are
some parents who are opposed to the rubella component of MMR, on the
grounds of conscience because of its manufacture on cell lines extracted
from an aborted fetus, but who would still wish their child to be
immunised using single vaccines available in other countries. I find the
arguments against use of single vaccines on grounds of safety and efficacy
weak and difficult to accept, particularly when other countries with
equivalent medical and ethical standards make them freely available.

Yours sincerely

Dr Michael Jarmulowicz FRCPath MBBS

1. Ethical debate: Vaccination against mumps, measles, and rubella:
is there a case for deepening the debate? BMJ 2001;323:838.

Competing interests: No competing interests

15 October 2001
Michael Jarmulowicz
Consultant Histopathologist
Royal Free Hospital, London