The point of not using single vaccines remains simple. However reasonable a compromise it may seem to be to give single vaccines, the fact is that if you ensure that a child has to come to the doctors more times to recieve vaccines, the greater the chance of missing any given jab and the greater the chance of immunisation not being succesful.

Irrationality like this means that a virus we should easily be able to eradicate - measles - is still around and has killed. If the objections against preventing future deaths come down to doctors receiving free biros and mousemats from drug companies and unfortunate reactions to scientific terms then I believe people need to take a serious look at their beliefs because the only way we are going to get rid of these diseases is if over 95% of those at risk are immunised - any less than that and we make preventable deaths more likely.

Chris, London,

I'd be interested in the source of Gareth's "scientific evidence" that measles provides a safeguard against asthma or eczema, as my father had measles and suffered badly from asthma his whole life. I too had measles and still acquired skin problems. Doesn't seem to have done either of us any good. I'd rather my children have to deal with asthma or eczema, which at least one can get help to control, than measles, which can cause brain damage or kill. I consider it fortunate that the government here showed some sense (a rare event) and requires immunizations for school attendance.

Linda, Albany NY,

So true David!
Minutes of Vaccine Safety Committee in 1988 noted withdrawal of 2 MMR vaccines: one caused a deadly brain inflammation from the Urabe Mumps strain and the other caused neurological complications from the Measles component, yet 7 mths later both were in use here.

One was used on our son and for their deception they scored a ‘hat-trick’!

Our perfectly healthy, happy baby had an immediate and extreme reaction to the MMR vaccine. The high-pitched scream persisted as the Urabe Mumps strain shot his brain to pieces and he lost all his senses as a result, this remains as vivid as the green gunge he discharged and the projectile vomiting that occurred in the instant destruction of his gut from the live Measles virus that poisoned his entire system from within, not forgetting how the Rubella virus attacked his joints and limbs before he lapsed into unconsciousness and was given the last rites.

So Fitzpatrick just doesn't know what he is talking about and as for the VSC!

Elayne, Sevenoaks, Kent

I find this thread of comment terrifying. People rejecting science - this is the demise of civilization.
After medicine has brought our longevity and life quality to unprecedented level, now doctors and scientists are losing authority, like the vicars. Are they to blame? And are they the real losers?
Would you dare to claim that you know better than civil engineers and build a bridge yourself? No? Then why do you think that you know medicine better than a doctor?
Guillaume Mimoun actually says that if a child is diagnosed with a (currently) incurable condition, his parents, being extremely smart and self-educating, are free to "do their own research" and experiment on their child as they wish. Can anybody give me a single example of a condition for which cure or prevention has been found by smart lay people? Those damn doctors and scientists have been doing this job for centuries.

Maya Markova, Sofia, Bulgaria

I am repeateadly amazed by the blinkered views of people who go on suggesting that MMR is somehow unsafe, why should the government supply a seperate vaccine when there is NO evidence that this is the case.

Reputable studies have repeatedly proved that the results of the study that started this fiasco were not reliable. Of course there is a small risk of a bad reaction to an imunisation (as with any medicine that stands a chance of actually working) but this is less than negligable when compared to the risks of not being immunised at all.

As someone commented earlier I can only conclude that we are seeing natural selection in progress in people who believe media scare mongers, snake oil peddlers and people who can only provide anecdotal evidence of their claims.

Do you fools really think that the government are conspiring to damage our children? Gah, noodle monster help me!

Mike Ford, Peterborough,

This reminds me of the doctor who treated me after I had the MMR. My (single) mother kept going to see him as I was ill, but he believed there was no problem; when it became visible it was 'just a viral infection'. During the New Year period I was finally hospitalised; my immune system had collapsed and I became extremely ill.
It took 5 long months and even then it wasn't over. I had to be taught to speak and walk again. My taste buds had changed dramatically making me a very fussy eater. I was later diagnosed with Asperger Syndrome. While I'll never know the cause, the MMR and the way my mum was treated most certainly didn't help.
I’ve read people in the press telling parents to put it on their shopping list along with the school uniform. Anyone who suggests parents treat it with such little thought should be questioning themselves. I don't advocate having the MMR or not, I advocate an informed choice.
Parents have their children and their children only to answer to.

Kay, Plymouth,

Nigel from Abingdon is correct.

It's not sufficient to simply announce that MMR causes autism. Neither is it sufficient to rely on the words of one person in deciding if there is a link. Get a load of children who will not be given the MMR jab (Group A) and get the same number who will (Group B) and have all assessed by qualified paediatricians before and after administering the jab. (Or not, depending on the group) Then, for each group, compare the number of children whose development regressed. If more children in the MMR group developed Autism than the other group, and the difference is great enough (One or two is neither here nor there) then you conclude MMR causes autism. Otherwise, you don't.

However, there have aready been studies asking if MMR causes autism. The answer is 'no'. Trouble is, some people choose to ignore this, and instead choose to believe that MMR causes autism, falling back on assertions that the lack of evidence in their favour is proof of a cover-up.

Clive O Trent, Guildford, Surrey, UK

Dear Angmoh of Clerkenwell,

I have no objection to anyone showing their qualifications. I'm just realistic enough not to think I'm any more likely to be listened to because of them, except by those who agree with me anyway. Dr Fitzpatrick doesn't seem to have learned that lesson yet.

Michael W Stone BA FBIS, Peterborough, UK

With regard to the comments suggesting separate vaccines are the solution.

1. There is no scientific evidence that single vaccines are safer than MMR.

2. Allowing the supply of single vaccines, against all scientific advice, would be a tacit admission that there is a problem with MMR vaccine. It would be seized upon by anti-vaccinators worldwide - with knock effects on other populations even more likely to lose large amounts of children from measles.

MMR vaccine is not linked to autism. Those that consider it is, are at odds with all scientific evidence, and engaged in a conspiracy fueled political campaign that is endangering other people's children.

Anthony Cox, Birmingham,

It is truly frightening and bewildering to "insiders" that the MMR-autism link gets so much play despite a scientific consensus to the contrary. This consensus probably exceeds the level that agrees climate change is real. If there is an epidemic in Britain, a handful of children will die, a significant number will suffer brain damage and every GP will be roundly criticized for not having warned loudly enough. Patients who educate themselves are desirable because they can be engaged in their own health rather than be passive recipients of care. People learn better that way, but learning also means making mistakes. In the US, one of the problems health reformers refuse to acknowledge is that as long as physicians know more than patients about health care matters, a consumer-driven health care system is not realistic. Physicians will have to develop better methods for informing and educating patients but this takes time and is not reimbursed, so don't expect it it soon.

Zagreus Ammon, CLARKSBURG, Maryland

Thank you, Dr. Fitzpatrick. Some of these responses show a lack of understanding of the issues around public health. Public health isn't to be dealt with in the same way as health issues that are less obviously public, like whether or not a woman should take hormones during menopause or choosing whether or not a mole should be removed. There are health choices that are right to be kept private and there are things where we all need to listen to the educated people who are studying the problem of keeping epidemics under control. Just as a disease can wipe out a flock of birds or sheep, diseases can rage through communities and ones that seem so mild in some people's memories can kill. Smallpox became a childhood disease in Spain, after it had killed many people over a few generations. The Spaniards took their childhood smallpox to South America and it decimated the natives. Measles can do the same thing if left alone.

Ms. Clark, Davis, CA, USA

Natural selection indeed. The only sad thing here is that it's the children who are suffering due to the stupidity and "I know more than someone who's spent his entire life studying science because I read it in the Daily mail" attitude of some parents.
Single vaccines were avalible through private healthcare, the NHS being social healthcare should not have to offer unecessary choice for the benifit of the ignorant, especially if money spent on unecessary choice could be spent on saving lives.

Justin, Portsmouth,

"What Dr Fitzpatrick objects to is simply the latest chapter in the long story of "The death of deference".
[....]
"Michael W Stone, BA FBIS, Peterborough, UK"

You are so right M.W. Stone BA FBIS - I too hate it when people throw their qualifications about simply in order to boost their prestige.

Angmoh, Clerkenwell, UK

"Of course, the simplest way to scotch the mistaken belief of a link between autism and MMR would be to commission a study: group A gets MMR, group B gets separate vaccinations. Do this for a suitable period and then compare the autism rates."

Already been done - in both the UK and Japan, the vacination rates have fallen significantly (in Japan they withdrew the vaccine in the face of the scaremongering). The result? A lot more measles; just as much autism.

I note the 'three jabs rather than one' lobby is out in force: Why should the separate vacinations be provided through government hospitals and clinics? There is no evidence to show they are more or less risky at all. The government is rightly avoiding blowing our taxes on subsidizing stupidity.*

*Except for the Royal Homeopathic Hospital, where they do.

Roger Braintree, London,

Nigel and Neil,
I'm afraid that this work has already been done - Yokohama prefecture in Japan stopped using MMR and switched to single vaccines during the 1993. They have seen no subsequent fall in the number of cases of autism (in fact, along with the rest of the world, these have continued to increase). This has been well reported in the scientific literature and I believe even made it through to the newspapers in this country (the original paper was published in 2005).

Clearly no one actually cares about the evidence.

Michael, London,

What Dr Fitzpatrick objects to is simply the latest chapter in the long story of "The death of deference".

All the professions have been losing prestige over the years. Clergymen were already a joke in my boyhood, 50 years ago, and lawyers became suspect not long after. Teachers did somewhat better, but by the 1980s one was reported as complaining about having "joined a profession and retired from a trade", a change symbolised by the virtual disappearence of the word "schoolmaster".

The medical profession has retained its status longer than the rest, but it was only a matter of time. Now,this inexorable process has reached doctors as well. Sorry, Michael, but people today won't take dictation from you any more than from the vicar.

Michael W Stone, BA FBIS, Peterborough, UK

What really gets me is how this general practitioner (like many in the field of medicine) takes a position denouncing patients that educate themselves.

When a patient or patient body is chronically afflicted with a disease or a condition for which a doctor is UNABLE TO CURE, it behooves the afflicted to seek other means of relief; even it means doing your own research.

Ideally (I hope to think) people in the business of healing want to heal people but at the end of the day, regardless of the outcome, doctors get paid. In the end, that's exactly what the medical profession has turned into; a business...

It may seem "way out there in left field" as to a link between MMR and Autism but until the so called "experts" figure out exactly whats going on, I find no reason why thinking out of the box is in any way, shape or form wrong.

To Dr. Fitzpatrick: Get back to the lab and do some R&D if you care so much...

Guillaume Mimoun, New York, USA

You may well be right about MMR however, my experience is that doctors do not always inform us of risks and do not treat us holistically. I am currently taking an anti-cancer drug which hundreds of women on the net say is ruining their quality of life. Neither oncologists or GPs will comment on the issues. After a long discussion with my young, newly qualified orthopaedic specialist she finally admitted that there were 'problems' with the drug and she had other patients suffering from its side effects. Until doctors treat us as individuals who have some intelligence and want to be involved in our treatment, more and more people will be sceptic about 'established sources of authority'.

Margaret Shephard, Rodilhan, France

Parents are far more worried about a child having autism than catching measles.

This never seems to be addressed in any articles discussing MMR.

James, Manchester,

As a GP you must see autistic children with bowel disorders, perhaps like my GP you explain that a bowel movement once a week is normal, or perhaps you prescribe and adult dose of movical on a repeat prescription (a drug that should not be used for more than 2 weeks and not at all if bowel disease is suspected) .
you could always refer them on to a gastroenteritis who will do anything to avoid investigating the root cause.

I know that measles is a painful disease i had it as a child, I was not vaccinated as my sister had Asthma and it was considered to risky for us, now it just seems that this herd immunity target is the prime concern. perhaps we should be stopping people with live measles entering the country as this is what the stats appear to show.
google this ""GSK at centre of Russian vaccine scandal"
and i would like to see you comment on it

martin, london,

As a parent of a boy that has autism, I can only point to the evidence as I see it personally. Pre MMR he was displaying normal development, immediately after the MMR he suffered high fever, and following this his development visibly slowed.

He also suffered chronic digestive problems culminating at the age of 11, when he was unable to hold down anything including water. He was admitted to hospital, placed on a feeding drip and we, after carrying out our own investigations placed him on a dairy-free and wheat-free diet, supplemented by strong pro-biotics which together with a year of care solved his dietary problems. Unfortunately there is no "cure" for a learning disability which in our opinion occured due to the breakdown of the gut lining.

sonny, london,

The single biggest blow to the credibility of the MMR jab was the refusal of Tony and Cherie Blair to confirm or deny that it was given to their son Leo. The immediate, and understandable, conclusion drawn from their silence was that they did not, and therefore if the PM didn't trust it then there must be something in the claims for a link. If Leo did have the MMR jab, the Blairs should have said so at once and effectively endorsed the treatment. To have failed to do so sent a very clear message to the public, the eventual results of which are as Dr Fitzpatrick describes here.

Edward Morgan, Southampton,

"Herd immunity"? No-one who regards my child as a member of a herd will be allowed near him with a needle!

Ian, Sheffield,

The MMR is yet another vaccine in an ever growing list - perhaps it is not the MMR but the number of vaccines that the infant is subjected to in a very short period that results in conditions such as autism in susceptible individuals. Please Doctor don't be so righteous - how often have the drug companies been wrong in recent years? Unfortunately all too often and the results have been ugly. A greater humility is required of the medical profession and greater honest research by the pharmaceuticals - just remember thalidomide

hana, kuala lumpur, malaysia

I'm sure you are right that there is no link between MMR and autism.

For whatever reason, distrust of government a likely candidate, parents decided ot to have the injection. The government refused the single vaccination. We now have a measles outbreak.

If the single vaccine had been made available this wouldn't have happened. It happened because of the governments, and some health professionals attitude that you use what I say or have nothing at all.

Robert , Camberley, Surrey

Bravo for the parents in the UK! At least you pay attention to what's going on and ask questions etc.
here in the US, the "home of the brave" sheeple, we keep lining up for our dose of poison with no questions asked. It seems the uptake for the MMR in the UK hasn't met the requirement to maintain "herd immunity" for almost 10 years. And you have an "epidemic" of 150 cases of measles where 6% of these were sent to hospital? Wow, I thought half the people would be dead in the streets by now. And the 6% in hospital may have other health conditions that make the virus worse for them. It would be hard to imagine none of these children having asthma etc.
And how many of these were vaccinated but didn't obtain immunity? That's always a possibility. But you don't hear health officals talking much about how poorly the vaccines work, not to mention all the toxins in them. I'd much rather take my chances for the illness than the vaccine.

DG Davis, Va Beach, USA

Of course, the simplest way to scotch the mistaken belief of a link between autism and MMR would be to commission a study: group A gets MMR, group B gets separate vaccinations. Do this for a suitable period and then compare the autism rates. Seems such a simple solution to the problem - one wonders why nobody seems to have thought of it? Yes, this would pander to public misconceptions etc etc, but the bottom line is that confidence in MMR is far too low and not rising fast enough. This should provide a cure for every aspect of this problem....unless there really is something to hide!

nigel, abingdon,

Absolutely. But then who other than the media, including the Times, bears responsibility for hyping up health scares and miracle cures, and for that matter allegations of cover up and spin generally?

julian, london,

As Stevie Wonder so presciently sang: When you believe in things that you don't understand, Then you suffer, Superstition ain't the way. Good quote, and can be applied to orthodox medicine as well. I work with Doctors and if I had a dollar (Canadian) for every time they answer a question in regard to the mechanism of many medications with an "I don't know, we don't know", I'd be doing quite well thank you. I suspect 100 years from now our ancestors will look back in horror at what vaccinations did to us in the long term. It wasn't that long ago we treated Schizophrenics with "Insulin Shock Therapy". We could compile an extensive list of such instances.

Colan Mitchell, toronto, Canada

All that this colleague has had to say on the scientific aspects of MMR immunisation hangs together. However there are parents who would have had their children given the separate measles vaccine ( however irrational Fitzpatrick argues) but instead dodged the MMR. it might have been better to have gone along with that to keep up the measles protection. Some parents probably feel that there is an arrogance about the health establishment which forgets that thye population is made up of individual people.

Dr J Findlater, Carnforth,

What we are never given in regard to outbreaks of measles is a breakdown of how many of the total number of cases have been among the vaccinated and how many of the total among the non vaccinated.

Raw total numbers have no significance in and of themselves.

Jerome Whitney, London, England

Nigel. You are correct that this might give a robust answer to your question. The study would take around 7-10 years and It would cost 10s or millions of pounds. It would be of questionable ethics. I for one wouldn't consent my child to enter such a study. I wouldn't want the 50% chance of him being randomised to the separate vaccines, as the MMR has already been shown to be safe and effective.

Imagine this ...the study results come out and show there is no link and guess what? The Daily Mail publishes an editorial stating that the results are flawed and one of the doctors involved in the trial once received a post-it pad from the one of the vaccine companies. So nobody believes the results.

This is a great article. The new religion is conspiracy - people would rather believe the conspiracy and the more evidence presented to refute the conspiracy, the more the appealing the conspiracy becomes - and like all religions it belies all reason (Am I sounding like Dr Dawkins?!)

Neil, Vancouver,

I'm not so interested in MMR vs. autism. But I am interested in the cost/benefit ratio of vaccinations more generally. This is never thoroughly examined. The medical profession, including Dr Fitzpatrick presumably, conclude that if there is a vaccination for a disease, then you vaccinate, end of story. I think this is foolhardy and cowardly. Can we never accept a single death from a disease? For measles, it is very rare for death to result. Even in the old pre-vacc. days, there were at most 100 deaths a year, it would be far less now in these days of better nursing/medical care. There is scientific evidence that exposure to measles provides good protection against asthma and, to some degree, against eczema. There's a whole load of things to be put into this cost/benefit analysis for vaccinations (allergies etc) and it's never been done.

Gareth, Brighton,

Measles kills about one in a thousand. If these outbreaks take hold we will see not one but several death this autumn. And everybody, the tabloid press in front, will be lamenting. But nobody will be held accountable for the blood they will have on their hands. You can kill and go unpunished in this country by simply spreading fairy tales and falsehoods.

Ed Zuiderwijk, Cambridge, UK

So, the children of people stupid enough to listen to snake oil salesmen will have a lower probability of reaching adult age and reproducing. Sounds like natural selection to me.

Eugenio, London, UK

The government precipitated the MMR panic when it decided to forcibly remove parental choice over vaccination in 1998 by withdrawing the option of seperate vaccines on the NHS and simultaneously blocking import licenses for measles-only vaccines to the private market. The reason? Not to prevent measles - parents would have lined up for the single-dose measles vaccine, if available. The real reason was to salvage a campaign to vaccinate all boys against German measles, and all girls against mumps, to protect the unvaccinated (ie, the people taking the risk of vaccination would receive no direct benefit). The fact that the NHS had committed to buying gallons of MMR vaccine must also have been a factor. In the end, who cares for a vaccine-damaged child? Not the government, or the doctors. Pathetic as Dr. Fitzpatrick may consider them, parents are the ultimate buck-carriers on this one, and were poorly served by a patronising medical establishment.

Delilah, Maryland, USA

Thee are several problems here. Firstly the cause or causes of autism are unknown so a vaccine induced encephalitis remains a possibility. Secondly a rare idiosyncratic reaction to the vaccine is possible. Thirdly when a condition is rare (autism) statistical analysis cannot rule out the possiblity of such reactions in the individual case. Fourthly an adverse reaction to the vaccine which is noted by the mother is going to be separated for a number of years from the onset of autism, and so reliable records in this regard may be absent. None of the above precludes the desirability of this vaccination which is broadly supported by statistical analysis - but perhaps the choice of individual vaccinations or combined (MMR) should be left to the parents. It must be emphasised that statistical analysis never gives information about the individual - only a specific population.

the choice of individual or comined ccinations remains a reasonable compromise

David, Manchester, UK

With measles epidemic becoming a realistic threat,
(1).NHS
a. Accept the fears of some parents in regard to triple MMR (caused by some medical professionals and publications) and allow separate measles vaccination.
b.Call influential anti-immunisation formal bodies of supplementary medicine to take an unequivocal stand. Very few for example know that the official Royal London Hospital of Homeopathy position is “ we recommend that parents vaccinate their children against measles. We do not encourage the use of homeopathy as an alternative to immunization” .
Parents consider
a.the risk-to-benefit balance for child’s immunisation. Measles, highly contagious, has acute effects; some dangerous particularly in sick children. Later developing subacute sclerosing panenccephalitis (a dreadful disease) caused by an altered form measles virus, is a small but realistic risk.
b. social responsibility of non-immunised children affecting others (including pregnant women and babies).

C Panayiotopoulos, London , London

when mmr first came out there was a faiure by the regulaters which allowed the drug companies to use a component of the vaccine when it was allready proven to cause autism and had been banned in both america and japan.
this was used for a full 3 years and then quietly changed.
this has been admitted by the b.m.a. and has been reporeted in journels.
why should the public trust any dr.when they get frebies off the drug companies to promote there drugs.

david, liverpool, england