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Miss Kirkbride : I am grateful to the Speaker for agreeing to this morning's one-and-a-half-hour debate on a topical issue that has become heated during the past few months. I look forward to hearing what the Minister has to say not just on my campaign for single vaccines to be provided by the national health service but on related issues on which the House would like more clarification. No doubt we shall hear a variety of voices from around the Chamber, but the principal point of the debate is to impress on Ministers why they should introduce the right to single vaccinations on the national health service.
Single vaccinations were available under the national health service until the Government came to power in 1997 when the Department of Health changed the guidance and MMR became the only vaccination available against dangerous childhood diseases. It was a fatal mistake to withdraw the right to single vaccinations. The purpose of the exercise is to ensure that the maximum number of children receive important vaccinations against damaging diseases. My purpose in pursuing the campaign is to increase the level of herd immunity, which has fallen to the dangerous level of 85 per cent. and possibly lower. That is not good enough to ensure that we do not have a worrying measles outbreak.
Whatever the Minister says today about restoring public confidence, advertising campaigns and bullying tactics in doctors' surgeriesif we can believe the presswill not persuade parents to do something against their gut instinct. The only way to restore public confidence is to respond to what parents want and 85 per cent. want the right to single vaccinations on the national health service. The Government would be acting in the best interests of children and public healthpregnant women as well as children need to be protected from rubellaif the right to single vaccinations were re-introduced on the NHS.
Dr. Evan Harris (Oxford, West and Abingdon): If the hon. Lady's campaign reduced the level of herd immunity because people abandoned immunisation altogether, would she change her view? Is there anything to be learned from the whooping cough vaccination scare, which led to reduced coverage, higher incidence of the illness and deaths?
Miss Kirkbride : We cannot compare different scares. There is worrying evidence concerning the MMR vaccine. It does not prove a link between MMR and autism, but it gives parents cause for concern. I speak as a parent and for many parents who make difficult decisions on behalf of their children. I examined the
Dr. Harris : I know that the hon. Lady wants to make progress, but this is a key point. If she were persuaded that a change in policy to the one she wants would lead to fewer children being vaccinatednot among the group that may choose single vaccinations, but among those who would simply give up on the whole ideawould she change her view because of the risk of lower coverage resulting in more disease and deaths?
Miss Kirkbride : I do not agree with that hypothesis, so it is difficult to give the hon. Gentleman a relevant answer to his question. If he had been listening, he would know that I believe that the way to boost immunisation levels is to give parents the choice that they want. That is the tenet of my debate so I cannot give him a better answer.
Lynne Jones (Birmingham, Selly Oak): The hon. Lady is right to say that measles, mumps and rubella are dangerous. I feel strongly about this because I almost died as a baby from pneumonia associated with a measles infection. The hon. Lady is raising the matter in an irresponsible way. Of course parents are worriedparents are always worried about possible harm to their childrenbut while a negative can never be proved, the risks associated with not having the MMR vaccination are far greater than the risks of having it.
Miss Kirkbride : The hon. Lady speaks from bitter personal experience, but as parents, we do not consider the risk in the wider context that only a few children are likely to be damaged by the MMR vaccination; we ask whether our child might be damaged. We know that some people believeand we do not know whether they are right or wrongthat their children were damaged by the MMR vaccine and we ask ourselves whether we could bear it if our child were damaged in the same way. That makes the point for allowing parents the choice of single vaccinations. If they were allowed that choice and if the door had not been closed in 1997-98, the position today would be different because we would not have the present crisis in herd immunity.
One of the Government's reasons for not allowing single vaccinations is that they involve six jabs. However, the manufacturers' packets state that single vaccinations provide 98 per cent. effectiveness, while the MMR jab provides up to 90 per cent. effectiveness, so children have to be inoculated twice for MMR, first
The Parliamentary Under-Secretary of State for Health (Yvette Cooper) : Is the hon. Lady aware that the Medicines Control Agency has specifically disputed the claim of 98 per cent. coverage, which is wrong?
Miss Kirkbride : I am aware of what the Medicines Control Agency said and of what the manufacturers state on the packets. Someone is not telling the truth and we must establish who is telling the truth. I am well aware of the point made by the Minister, but we need more clarity instead of the muddled facts that are available at the moment.
Another of the Government's arguments against single vaccinations is the time between each vaccinationit must be at least three months. They say that that is dangerous because more children are liable to get measles in the meantime. That may be true in essence, except that some children are not being vaccinated at all. Given the choice of MMR or nothing, too many parents are choosing nothing. If we compare reality with the Government's comments, we are banging our heads against a brick wall. Parents are told, "If you are not prepared to have MMR, you will have nothing." Ergo, parents are choosing to have nothing, and the risks to the wider community are that much greater. The Minister must let a little daylight into those considerations by accepting life as it is, rather than as she would like it to be.
The Government's rules are one reason why it is more dangerous to proceed on the basis of the single vaccine. Parents can access single vaccinations for their children by having the rubella vaccination, which is licensed in Britain, first. Children are entitled to have it in order to protect unborn children, who may contract rubella.
If the Government changed the rules so that children could have the measles vaccination first, the most dangerous childhood disease would be tackled first. That would mean a longer period of exposure to mumps and rubella, but we must live with life as it really is. Changing the rules would remove a large part of the Government's objections.
Dr. Stephen Ladyman (South Thanet): The hon. Lady raised the issue of rubella and talked about pandering to people's perceptions. Does she realise that one perception in the community is that boys do not need to be immunised against rubella? Given that that is, as she puts it, the reality in the world, how does she expect to get herd immunity to rubella if we provide single vaccines?
Miss Kirkbride : It is a patronising argument used by Labour Membersand it remains to be seen whether it is used by Opposition Membersto claim that parents will not take their children back for the other two inoculations. Parents who want single vaccinations are by definition responsible because they have clearly been thinking about whether that inoculation is right for their children; of course they will go back. I do not know whether the hon. Gentleman has children, but if he does he will remember that they go for a series of inoculations
Ms Drown : I am grateful to the hon. Lady for giving way. She talked earlier about her difficulty, which I understand, as a parent thinking about whether her child might be exposed to a possible side effect of the vaccine. As a parent, however, does she not also consider the risk of her child being exposed to one of those diseases? Is that not a difficult choice that all parents have to make?
I should like to hear the hon. Lady's policy on when the single vaccines, which include not only rubella, but mumps, should be given. Has she taken medical advice on the gap between vaccinations? Why does she think that her particular view is different from that of the stream of medical organisations that have looked at the evidence in detail?
The hon. Lady raised a number of questions, and I have several concerns that the Government should take seriously. Returning to my previous point, I believe the vaccines to be largely safe. Let me put on record that I believe in the childhood immunisation programme, which has done wonders for childhood mortality in the past 10, 20, 30 and 40 years. It has been a fantastic achievement, and I pay tribute to the medical establishment for having achieved wonderful progress. However, the fact that it has achieved wonderful progress in the past does not make it right about absolutely everything. It does not necessarily make it right about MMR and whether there is a problem in a small spectrum of children. The problem for parents is that they do not know whether their child might be susceptible.
On a wider point, the hon. Lady asked about the gap between vaccinations. Private clinics, which offer those vaccinations, start with the rubella vaccine and give the measles vaccine three months later. I think that there is a longer gap after that to the mumps vaccine. The hon. Member for South Swindon (Ms Drown) seems surprised, but if she knew more about the subject she would know that the measles vaccine is the most virulent, and therefore the one with which we must be most cautious.
Peter Bradley : I do not want to barrack the hon. Lady, but she seeks certainty; I am not sure that there is certainty in life or, for that matter, in science. Can she be certain that the active measles ingredient in the single measles vaccine, rather than MMR in combination, could not be construed or suggested as a cause of autism?
Miss Kirkbride : The simple answer is no. No medical science can be proved absolutely, and that is why we have to offer parents choice. We have to offer them choice because there is no certainty. At the moment, we cannot prove or disprove any of those things. One cannot disprove a negative.
Parents want choice because they believe that as a result of the three live vaccines, which are stronger, more virulent vaccines in MMRall other childhood inoculations are not live vaccineschildren who have a predisposition to be unable to cope with an attack on their immune systems suffer damage to their guts and bowels, which leads to toxins leaking out and damaging their brains. If that is true, and those parents cannot prove it, it is likely that the measles vaccine is responsible. We know that toxins in the brain are a likely cause of autism, but we do not know how and why it occurs.
The Government know that environmental factors are likely to cause autism. I was pleased to learn that there is going to be more research into the causes of autism because we need to know why we appear to be having an epidemic. I would not suggest that MMR is the reason why there has been a massive increase in autism, but the evidence needs to be examined as it raises fears among parents about whether MMR is a contributory factor.
I draw Members' attention to the work of Dr. Andrew Wakefield, and the more recent research by Professor John O'Leary in Dublin. They looked at cases and examined the parents' story. They brought in parents who believe that their child changed on the day on which they had the MMR vaccine. They investigated whether there could be any truth in the parent's belief that having the MMR vaccine caused their child a problem. They examined 91 children whose parents all told the same story that their children had the MMR vaccine, developed an irritable bowel problem and then showed signs of regressive autism, which is such a dreadful thing to see in one's child. They found measles
That does not prove anything, but it does give me, as a parent, cause for concern. The Minister and the medical establishment seem to have closed ears when it comes to that subject. They want to discredit Dr. Andrew Wakefield, who has been driven out of the Royal Free hospital and is now working in America. Other people have raised the same concerns, and we need to look at the matter.
Mr. Andrew Lansley (South Cambridgeshire): Before my hon. Friend concludes, will she consider scientific studies that have examined each hypothesis presented by Andrew Wakefield, and have found no evidence to support them? Will she consider the Finnish study, which is a randomised, placebo-controlled, double-blind study that provides no evidence to support his conclusions? Has she spoken to those on the Medical Research Council panel, as I have done in my constituency, who listened to Andrew Wakefield, but who found no evidence to support his hypotheses?
Miss Kirkbride : I am sorry to disagree with my hon. Friend in answering his concerns. Andrew Wakefield is not alone in raising the matter; doctors in America and Dublin have questioned whether there is a cause for concern. I have not spoken to the MRC panel, but I would be interested to hear my hon. Friend's remarks should he be lucky enough to catch your eye, Mr. Deputy Speaker.
I am grateful that my hon. Friend raised the Finnish study, which looked at 1 million children and claimed that there was no link between MMR and autism. The problem is that it found not a single case of autism, which, in 1 million children, is statistically inconceivable. I am greatly concerned about the veracity of the study and its conclusions. The affliction of autism is so great in our society that to find not a single case is most unlikely; according to the most recent figures the incidence is six in 10,000, so there is likely to be a case of autism in 1 million children.
Another problem with the Government's statistics relates to the Japanese experience, which the Prime Minister raised on the Floor of the House. I am sad to say that when Ministers refer to such a case, it makes one wonder what they have to hide. The Japanese experience is wholly different from that portrayed by Ministers. Japan had a genuine problem with the mumps componentthe urabe strainof MMR, which was causing encephalitis and killing children. That rogue strain was not used elsewhere, so there is no comparison to be made with the strains of MMR used elsewhere in the world. The Japanese Government covered up the problem for a long time, and then introduced single vaccines having withdrawn the MMR vaccine. In those circumstances, it is hardly surprising that the Japanese public said that they would not accept any vaccine because they no longer trusted the Government.
There is a case to be made for single vaccinations. I was grateful to learn a few weeks ago that the Government are to spend more moneyan extra £2.5 millionon looking at the causes of autism. That money is welcome. Will the Minister clarify whether any of the money will be used to consider the findings of Dr. Andrew Wakefield and Professor John O'Leary, and to address the issue that is causing public concern? Speculation in the newspapers has been that the ostracism of Dr. Andrew Wakefield will not continue and that greater dialogue may be achieved between him and the Department of Health. That would be welcome, and would give parents less reason for concern.
I would be grateful if the Minister would clarify, openly and honestly, Government plans for the MMRVmeasles, mumps, rubella and chicken poxvaccine to be included in a quadruple jab. When I asked recently, I was told that there were no such plans, but I have seen newspaper speculation that scope may exist for introducing a quadruple jab. If we are to deal straight with parents, we should know whether the Department of Health genuinely has such plans. We need clarity and certainty about what is being considered and what has been ruled out.
Will the Minister comment on allegations in newspapersI do not know whether they are truethat the reason for the removal of the availability of single vaccinations on the national health service and the introduction of the MMR jab was that the patent on single vaccines was running out? Does the same reason apply to the prospect of introducing MMRV, and the MMR patent? Is that why the new quadruple jab is being introduced? I hope that that is not true, but it has surfaced in newspapers so people would like clarification.
Another allegation that has surfaced in newspapers is that doctors are dropping children from their lists if parents refuse to let them have the MMR jab. Does the Minister have any reason to believe that? If it is true, can she clarify the attitude of the Department of Health towards such doctors, who would be behaving disgracefully by not allowing parents the right to choose what is best for their children?
Lynne Jones : Does the hon. Lady think that parents would conclude that separate jabs would be best for their children if equal prominence were given to the adverse effects associated with not having the triple vaccine as that given to the unquantified and probably unassociated effects of autism?
Miss Kirkbride : The hon. Lady makes a relevant point. However, hon. Members who disagree with me have a problem with the difference between the desirability of achieving wider public health goals and the inevitable feelings that parents have towards their children; they want to do the best for them, and are not
Miss Kirkbride : No. If parents believe that MMR is a problem, but do not have access to single vaccinations, they will make a choice between having MMR with its potential link to autism, or not having it and accepting that their child may get measles. The hon. Lady's experience may be different, but I had measles, as did my brother, sister, mother and father. We have all had it, and for most people the experience is not life-threatening. However, it is for some children, which is why the public health argument is more important. We need to protect those children who are likely to be damaged by measles, which is why we want more parents to give their children measles mumps and rubella vaccinations. However, when one considers one's own child, the considerations are slightly different from those surrounding the wider public health. Labour Members must bear in mind that difference in attitude.
I shall comment on the Prime Minister's refusal to say whether his young child has had the MMR vaccine. It was not an issue of privacy. All parents talk about whether their child is having the MMR vaccine; it is no big deal and much like asking which school a child will attendit is part of the common currency of conversation between parents. It is also relevant to point out that when there was concern about the whooping cough vaccine, Prince Charles made it known that his children had had the DPTdiphtheria, pertussis and tetanusvaccine to prevent whooping cough. The Queen also let it be known that Prince Charles and Princess Anne had had the polio vaccine when concern arose about that. The Prime Minister therefore stands somewhat accused of causing the problem.
If we are to believe the story in The Independent at the beginning of February, the Prime Minister had not given his child the MMR vaccine when I asked my question. That is surprising because children are called for vaccination after they are a year old; little Leo was a good 18 months, if not older, by that time. I do not believe that this is a privacy issue, and it is a shame that the Prime Minister sought to make it one. That has not helped his Government's policy on the matter. I know that the Minister and other hon. Members will accuse me of undermining public confidence, but such accusations are wrong and false. The Minister has undermined public confidence by not allowing public choice. Choice is fundamental to people's lives and they are entitled to have it.
We pay for the national health service. Research has left queries in some people's minds about MMR, and rightly or wronglywe all hope that the research is wrongthey will be swayed by it. No amount of bullying by the Minister's Department and officials will make any difference to public attitude. People want choice and it is about time that the Government gave it them.
Peter Bradley (The Wrekin): Thank you, Mr. Deputy Speaker. I shall do my best to be brief. It is my susceptibility not to measles but to high blood pressure that has put me at risk in recent weeks. Nothing has enraged me morethe hon. Member for Bromsgrove (Miss Kirkbride) has done nothing to diminish my outrageamong what passes for news in this place than the so-called controversy about MMR.
What makes this issue different from others, and the reason that I am angry not just as a politician, a Government supporter and a Member of Parliament trying to represent the best interests of my constituents, but above all as a parent desperate to protect my children and those of others from killer diseases, is that this is a matter not so much about choiceas the hon. Lady suggestedas about public health. I believe that, in this important case, some elements of the press and some Opposition Members have lost sight of their responsibilities as shapers of public opinion and the public agenda. They ought to know, if they do not already, that their actions and words in this place and elsewhere have consequences. It is a shame that others might be asked to pay the price for their irresponsibility.
I understand parents' anxieties. We live in an age in which we demand certainty but cannot have it; in which we want to live risk-free lives but cannot do so; in which we expect definitive advice from the experts whom we then distrust, and against whom we reserve the right to litigate when they get it wrong; and in which we are too often unprepared to take decisions for ourselves, or to take responsibility for those decisions when we do. In such circumstances, it is crucial that information on life-and-death issuesthat is what we are discussingsuch as MMR should be objective, balanced and, far as possible, politics-free.
That has not been the case in the debate. In the face of overwhelming evidence that MMR is safe and that the alternatives are less so, some papers have sensationalised the largely refuted research of just one doctor, and some Opposition Members, I regret to say, have jumped on the bandwagon. Together, they have sought to make political capital out of a public health issue. By design or default, they have collectively undermined confidence in MMR, contributed to a reduction in its uptake and thereby placed children at risk from the diseases that MMR had all but eradicated since its introduction into this country in 1988. The Public Health Laboratory Service now warns of an epidemic among four-year-olds beginning school, as mine will be after Easter.
What are the facts? I shall abridge them because I am sure that others better qualified will spend more time on them in the debate, but 90 countries, 35 of them in Europe, pursue a policy of MMR vaccination. They include all members of the European Union, Australia, New Zealand and the United States, where some states do not accept admissions to schools of children who have not had MMR and other vaccinations. No country recommends three single vaccines in preference to MMR and 500 million doses have been issued since 1972.
The studies that have been referred to in the United Kingdom, the United States, Sweden and Finland have found no proven link between MMR and autism or Crohn's disease. The British Medical Association, the Royal College of Nursing, the Royal College of General Practitioners, the Royal College of Paediatrics and Child Health, the Community Practitioners and Health Visitors Association, the Faculty of Public Health Medicine, the Royal College of Midwives, Unison, Sense, the Royal Pharmaceutical Society, the Public Health Laboratory Service, the Medicines Control Agency and the Department of Health have all advised that MMR is safe.
Where, then, did this controversy come from? There was no new research at the beginning of December, no new evidence to launch the story into the headlines. Someone in a newsroom on a slow day just decided to turn up the heat under a trusted old potboilerthis is not the first time that the controversy has hit the newspapers. There is nothing like a health scare story to bide the press over a slack couple of weeks, not least because, as the hon. Lady conceded, there is no certainty in science. We can spend days, if not weeks, wringing our hands and agonising over what is true and what is not true, what is fact and what is not fact, what is trustworthy advice and what is a conspiracy of silence.
I make one crucial point about press responsibility. It was not what was said about MMR that caused the problem. The fact that the issue had been raised at all precipitated the controversy and, inevitably, parents' anxiety. A Daily Mail headline on 13 December said, "High rate of autism increases fears about jab". There was no report of new evidence, new research or a new study but simply "fears about jab". No attempt was made to link MMR with autism or the identification of autism. Three days later, Lauren Booth, writing in the same newspaper, said that
Peter Bradley : Some newspapers had an almost dismissive attitude to truth, facts and standards of objective reporting. The Sunday Telegraph on 9 December, referring to a Department of Health report not yet published, headlined its story, "Studies fail to disprove autism link to MMR jab". Three days later, the headline in its sister paper The Daily Telegraph was, "Autism and MMR link not proven, say experts". By that time, the damage was done.
We then had, as the hon. Lady mentioned, the case of Leo and the relentless crusade of the Daily Mail and other newspapers against an 18-month-old infant. It is as if all the medical evidence to which I have referred should be put aside and the only authority in this crucial public health issue be the man whom the Daily Mail most despisesthe Prime Minister. On 23 December, Amanda Craig headlined her article in The Sunday Times, "Privacy be damned, Mr. Blair, parents are afraid."
Who is responsible for that fear and anxiety, and the risk under which they place parents and their children? I suggest that some elements of the press and some hon. Members search their consciences. There have been so many scoops about the incidence of Leo's jabsthe hon. Lady referred to some of themthat the poor child must feel like a pin cushion, if not a political football.
The press has not been the only example of the exercise of freedom without responsibility. The story has been politicised by the press and by some Opposition Members alike. I tabled an early-day motion on MMR on 13 February, which I hoped would be an all-party one. The first signatory was a Conservative, the hon. Member for Esher and Walton (Mr. Taylor). I pay tribute to his courage because so far he is the only Conservative MP to have signed it.
The hon. Member for Bromsgrove said much about choice, which is one of her party's favourite issues. The issue is not about choice but about public health. We have responsibilities to each other in our communities, and the issue goes beyond party political doctrine. We know the risks of single jabs, and we know that we must balance the relative risks of MMR, such as they may be, with the known risks of improper immunisation. Some influential people in the newspapers and in this place have exercised their choice, but they have put children at risk thereby. I deplore that and find it deeply depressing.
I shall finish with an anecdote. A researcher for one of the more influential Radio 4 news programmes phoned me not long ago and asked me to comment on a Standards and Privileges Committee report that I had not seennor had the researcherabout my hon. Friend the Member for Leicester, East (Mr. Vaz). When I declined, the researcher asked me whether I knew of anyone who "hated Keith Vaz" and who would comment. The question was chillingly but refreshingly
Mr. Andrew Lansley (South Cambridgeshire): I shall be briefer than the hon. Member for The Wrekin (Peter Bradley). I should hate to be seen as sharing any of his views. I shall make my own arguments and not share any of his, which will ring hollow with the pharmaceutical industry, given the occasions on which he has attacked it.
I understand the points made by my hon. Friend the Member for Bromsgrove (Miss Kirkbride). However, I have considerable concern about one of them. I believe that previously she had not argued against the effectiveness of the MMR vaccine but had accepted that it was effective for its purpose. I am glad to see that she is nodding, because I would like to put that question to one side. The vaccine is effective: one has only to consider the reduction in measles, mumps and rubella in the population as a consequence of the introduction of the vaccine in 1998 to agree that it is effective for its purpose. The question that all hon. Members and I wrestle with is, what should be our response to concerns that are expressed by parents in our constituencies? What response should we give, not as scientists but as Members of Parliament?
I come from a constituency in which the worth of science is taken to heart, and I have the opportunity to speak to people in my own constituency who have undertaken research in precisely the area that we are discussing. I am convinced that the situation is not like others in which people have doubted the value of science. If one includes the word "Government" as an adjective to describe the scientists, it is even worse. Government scientists and medical advisers are not operating on the basis of supposition or presenting a hypothesis about the effectiveness of MMR or even a hypothesis about the lack of a link between MMR, inflammatory bowel disease and autism. They are working on the basis of substantiated trials and research that sought specifically to identify such a link but did not find one. As such, my conclusion is that a responsible public policy would proceed with, and sustain, MMR as a safe vaccine without proven side effects that question its safety.
The issue that the Government must contend withperhaps the Minister might consider this briefly, even if he does not refer to it in detailis that there must come a point at which parents' concerns about MMR reduce compliance with it to the extent that it is not a viable policy. I do not think that we have reached that point in my area, and I shall certainly continue to do everything that I can to sustain the take-up of MMR.
However, the hon. Member for The Wrekin is wrong: the issue is raised with me, as a Member of Parliament, expressly on the basis of choice. Although the great majority are opting for MMR, a small number of
That raises a serious issue. How ethical is one's choice if others, by virtue of the choices that they make, provide protection for one's children? The Government would move to difficult ground if they were to decide that, as a matter of public policy, we should make choice available. Such choice may mean that some people gain protection because of the right choices of others or, alternatively, it may lead to a much worse public health outcome. It has been clearly proven many times around the worldit is not a matter of patronising peoplethat asking parents to comply with six rather than two inoculations for three separate diseases leads to lower compliance than has been the case with the MMR.
There must come a point at which it would be right to make the single vaccine available, but we have not yet reached it. It is responsible of the Government to sustain MMR, and it is responsible of me, as a Member of Parliament, to encourage parents in my constituency to accept it. It is incumbent on all of us to debate these concerns; however, if science points to a conclusive position in support of the MMR vaccine, we have a responsibility to reflect that in what we say and do.
Dr. Stephen Ladyman (South Thanet): I will also try to be brief. I believe that I can safely say that, during my work for the all-party parliamentary group on autism, I have met, and discussed the issue with, all the leading experts in this country, corresponded with many of the leading experts around the world, read the vast majority of the research on the subject and given the matter considerable thought. We are not dealing with an open-and-shut case. I would not pretend for one second that we are, because that is not the nature of science. However, I could take hon. Members through the list of evidence that indicates that MMR is the right policy but, as it would probably take much longer than a one-and-a-half-hour Adjournment debate to do so, I shall touch briefly on only a few studies, ones at which hon. Members who have raised the question should take a long, hard look.
One is the Finnish study, rightly challenged by the hon. Member for Bromsgrove (Miss Kirkbride). It is only a small piece of the picture, but it provides strong evidence that MMR is safe. There are other studies, such as the one by James Kaye, which was reported in the British Medical Journal last year. It included a time trend analysis that looked for a correlation between the increase in autism and immunisation rates. It found that the levels of autism increased four times in the population during a period when the levels of immunisation with MMR were constant; there was no correlation between MMR and autism. In 1999, The Lancet published a study by Brent Taylor et al, which showed no evidence of temporal clustering in the north-east Thames region.
The process of science is to set up a hypothesis and test it. It is like building a big jigsaw puzzle: one has a small piece of the jigsaw in the corner and tries to find another piece that will fit. The question that one tries to answer is whether the pieces fit together. Sometimes the answer is yes, sometimes it is no. One cannot predict the shape of the next piece, the piece after that, or the full picture, simply because the answer is occasionally yes. Each study is only a small part of the total package. One cannot criticise individual studies for not being a total answer to the question.
I bring the attention of Opposition Members to two types of study that have produced strong evidence against MMR being the causal agent for most cases of autism. Research was carried out on thalidomide, examining the relationship between thalidomide damage and autism. A strong correlation was shown during the tragic experience of thalidomide. We know that thalidomide acted in the first three months of embryological development. There is strong circumstantial evidence that whatever causes autism happens during those first three months.
Other scientists have been looking for metabolic markers of autism. In the United States, several scientists believe that they have identified potential chemical markers that are present in babies shortly after birth and are a strong indication that that baby is going to develop autism later in life. Those scientists have described the chemical markers as the smoking gun that points to the development of autism. If the chemical markers are there immediately after birth, that child will have autism. Nothing will happen later in that child's life to trigger autism: he or she already has it, but it will take time to develop.
Those are important parts of the total evidence, but no one part is the complete picture. I acknowledge that, based on the evidence of Wakefield and others, a very, very small sub-group of children may get autism as a result of MMR. That cannot be disproved, but it is a long way from being proven. That sub-group consists of a tiny proportion, which did not show up even in the large studies that have been undertaken.
Dr. Ladyman : Based on Andrew Wakefield's research, if the effect is there at all, it is caused by the measles component. There is no reason to say that a measles vaccination would be any more or less safe than MMR.
However, Andrew Wakefield's research can be explained by other means. The findings of measles virus markers can be explained in some children on the basis of the immunological memory that one would expect immunised children to have. I can tell the hon. Member for Bromsgrove that many of Andrew Wakefield's co-workers do not agree that there is a link with MMR. I have discussed that with them, and they believe that there are other, equally valid, explanations for his findings, distinct from the one the hon. Lady advances.
Even if we accepted that there was, in a small number of cases, a risk of a link between MMR and autism, I put to the hon. Lady the argument of herd immunity. Herd immunity is, as she knows, the phenomenon whereby one creates resistance to an epidemic throughout a whole community. If an infectious agent of a disease passes it on to another person who is susceptible to that disease, the level of the infection in the community is maintained. If the disease is passed on to more than one person, the level of infection increases towards epidemic proportions. If a high proportion of people are immunised against a disease, the whole population is partially protected. The 10 per cent. of the child population who have an injection but do not develop immunity are protected by herd immunity. When the hon. Member for Bromsgrove makes the choice not to immunise her child, she does not make it just for herself, but for my child also. She is taking away my choice in the matter: my child will lose herd immunity because she made a personal choice. [Interruption.] I shall not give way: the Deputy Speaker has ordered against it.
There is no such thing as choice in matters of public health. Whether we like it or not, we have to weigh the balance of the risks, consider the evidence and take a public health decision for the whole population. On that basis, I say that the Government have struck the right balance and made the right decision. It is inappropriate for the hon. Lady to suggest that we would maintain herd immunity with a single choice immunisation programme. She still questions my analysis, but most parents of boys do not believe that they need the rubella injection, so boys would not receive it under a single choice system. Most parents of daughters do not believe that they need the mumps injection, so girls would not receive it under a single choice system. In both cases, we would lose herd immunity if the single vaccination approach were adopted.
We have the experience of the pertussis events, where we exchanged a multiple injection for a single choice system. We found that the level of immunisation went from 80 to 30 per cent. That is the reality we shall have to deal with if we adopt single vaccines. We would lose herd immunity, and the hon. Member for Bromsgrove, by making a choice for her child, would damage the children of everybody else in this country.
Dr. Evan Harris (Oxford, West and Abingdon): Let me start by saying that I do not think that the hon. Member for Bromsgrove (Miss Kirkbride) is being irresponsible. If she were open-minded, that would be a responsible attitude: I hope that she is. I do not think one should blame Back-Bench politicians for raising concerns on behalf of themselves and their constituents. That is, after all, what this place is for. It is more consistent for her to express doubts about the safety or effectiveness of MMR than for people to profess that they have no doubts about the safety of MMR and call for single vaccination. Conservative Front Benchers have done that, despite knowing that the evidence suggests that that would damage public health. There are people in my party, whom I respect, who take the view of the hon. Lady. I do not think that her scepticism about MMR is unique to her party, but the position of Conservative Front Benchers is harder to sustain.
Our approach is based on several principles. We believe in sceptical scrutiny of the Government. I am dubious about almost all Government policies, including those in the arena of public health. They have failed on tobacco advertising and delayed and dallied on sexual health strategy. However, after careful scrutiny, we are prepared to back the Government's policy on childhood vaccinations. An approach that we commend to other parties is one of evidence-based policy making. It is hard for an Opposition party to sustain a position that Government should take a view contrary to that recommended by its expert medical and scientific advice. The Conservative party has to defend its view.
One must avoid bandwagon politics while being sensitive to parental concerns, which Conservative Front Benchers have not managed. I recognise that there are genuine parental concerns: I have never told any of my concerned constituents to have the MMR because I say so. I have always told them to talk to their GPs: it is more sensible for people to have a discussion with a doctor or health care professional than with a newspaper editor or a politician. We must be realistic about media behaviour. I agree in broad terms with the hon. Member for The Wrekin (Peter Bradley). Sadly, a story titled "MMR Proved Safe" would merit fewer column inches than "Health Scare on Immunisation". We therefore have to be careful about that.
On reading the evidenceI initially considered it with scepticismmy position is that MMR is safe and the most effective way to protect children from serious diseases. I criticise those who take a different view on some of the issues for being blasé about those diseases. Dr. Carol Vorderman, whom I had previously respected and, dare I say, admired, stated in The Independent that the vaccination
The hon. Member for Bromsgrove said that we were concerned about such a full-frontal attack on the immune system, and that we knew or suspected that toxins in the brain were responsible for autism. I would be interested to know whom she meant by "we". Such an approach, with a pseudo-scientific justification for genuine concerns, takes people down an unhelpful avenue. It is almost certain to be a blind avenue unless the approach is based on scientific evidence. It does a disservice to autism, which is a devastating illness that is worrying in its incidence and prevalence. I am concerned that the focus on MMR will detract from other more fruitful and long overdue research into the disease.
Issues have been raised about general practitioners suspending patients from their lists to achieve immunisation targets. Will the Minister now abandon the immunisation target payments for GPs? They corrupt the system, are a conspiracy theorist's paradise and pollute the doctor-patient relationship. How can one have an open approachhow can patients believe that they are to be given independent advice from their GPswhen the spectre of financial incentive hangs over consultations? The Government did not introduce the policy, and they would do well to remove it.
Similarly, it is wholly unacceptable for GPs to remove or suspend patients from their lists to gain immunisation target payments. While those payments exist, there will always be worry about that. I urge the General Medical Council and primary care trusts, the bodies that control the conduct and contracts of GPs, to clamp down severely on any suggestion that even temporary suspensions with no treatment implications have taken place to remove patients from lists.
It is appropriate to speak about the Prime Minister and his son. I have absolute sympathy with Leo Blair and limited sympathy with the Prime Minister. Politicians must be careful about parading their children in any circumstances and then claiming privacy. I urge all hon. Members to withdraw the subject of their children from the debate, and to stick to the facts and their opinions. Where would it end if practice in relation to our children were to become important in terms of the subject of public health? If there were a contraceptive pill scare, would people be asked what their spouses or young daughters used? I do not think that we want to go down such a path, and I cannot see the ethical difference between the two subjects.
Dr. Andrew Murrison (Westbury): Does the hon. Gentleman agree that he is being a little hysterical, and that it is incumbent on the Prime Minister to show leadership in this country, as abroad? Had the Prime Minister done so on whether his son had been immunised, we might not face a measles epidemic on the scale that we do.
Dr. Harris : I asked people who are concerned about MMR whether their views would change if they knew that Leo Blair had had the vaccination, and the answer was that they would not. A change is worth making only if it will change one's practice, as I learned from my work in medicine. There is a fatal flaw. When Leo Blair was rumoured to have been vaccinated, the shadow Health Secretary said:
The Government have some difficulty on single vaccines and choice, but my view on the subject echoes that of the hon. Member for South Cambridgeshire (Mr. Lansley). They are right to accept that if MMR is the safest and most effective way to protect people from serious diseases in childhood, it is not appropriate to offer on the national health service something that is known to be less effective and could be less safe. Would that be appropriate in the name of choice? I hope that the NHS does not generally offer treatments that we know are dangerous to children simply because patients want the choice. Indeed, we should not offer a treatment that we know is in the worst interests of patients simply because they want it, and there is no ethical duty to do so.
When I suggested that to the hon. Member for Bromsgrove, she said that the situation was hypothetical. Her whole case is predicated merely on the hypothesis of a link between MMR and autism. At best, it seems inconsistent for her to refuse to engage with hypothetical questions when challenged.
The hon. Lady said that one could not apply the lessons of one vaccination to another when I pointed out that coverage fell by a further 30 per cent. when single vaccinations were offered during a whooping cough scare, and that there were thousands of cases and more than 70 deaths from the disease. However, the hon. Member for Woodspring (Dr. Fox) stated in a Conservative press release on 3 March 2001:
Mr. Wiggin : I was concerned by the hon. Gentleman's comment that coverage had already fallen. In my constituency in Herefordshire, there has been a 6 per cent. fall in coverage, from 93 to 87 per cent. We are debating not whether MMR is good or bad, but whether we can give people a choice. While coverage continues to fall, lives will be put at risk.
Dr. Harris : That is a fair point, and one that I can answer. The lessons of history advise us that to switch to something that the Government know to be less effective and possibly less safethere is less evidence of its safetywould make levels fall further. That would expose more children. It would affect not only the children of parents who would currently give their children MMR, as they would lose faith and not vaccinate, but put at risk the babies of parents who still supported MMR but whose children were too young to be vaccinated.
I would not go so far as the hon. Member for South Thanet (Dr. Ladyman), who said that there was no free choice in public health. It is more reasonable to say that there are limits on choice in public health, and that we should strike a balance. Those on the Conservative Front Bench must explain how the Opposition can be the first in history to urge the Government not only to ignore all their medical and scientific advice, but to go against it. If the then Government had done so on BSE, we would be in an even worse situation than we are in relation to that disease.
We are short of time today because the Government have not had a debate on MMR in their own time. If they are keen to reassure people, perhaps they should give up some of their own time rather than dealing with the matter at the fag-end of a debate initiated by a private Member.
The comments made by the hon. Member for Oxford, West and Abingdon (Dr. Harris) were, as usual, extraordinary. I am sure that the Government will be enormously relieved that the Liberals are supporting them on MMR, although, apparently, half the hon. Gentleman's party are notbut that is the usual situation. This is nothing to do with bandwagons. There has been more jumping on bandwagons in Liberal party circles than at the OK corral. It is a matter of public confidence and that is what we should be concerned with. We are all concerned with our children's health and we have a dual responsibility both as parents and as representatives of our constituents.
Let me repeat that the Conservative party remains absolutely confident that MMR is the safest form of vaccination available. It is not 100 per cent. safenothing isbut we think that it is the most effective way of vaccinating and protecting our children. However, we are not the ones who need convincing. People have lost confidence and in parts of London, in particular, the vaccination rates have fallen below 70 per cent.
I ask the Minister to give us the latest, up-to-date figures. She keeps telling us that the figure is only 84, 85 or 86 per cent. In a written answer to me yesterday she was unable to give the last quarter figures for 2001. The Government are basing their pronouncements on last September's figures, and a lot has happened since then.
I welcome the study performed by the Royal Free and University College medical school in London, with the Public Health Laboratory Service, which has been publicised by the British Medical Journal. The study followed 473 children with autism born between 1979 and 1998 and found that the proportion who showed decline in intellectual performance at the onset of autism was no higher after the introduction of MMR in 1988 than before. The study concluded:
I welcome the extra £2.5 million going into autism research. I speak as vice-chairman of the all-party group on autism, of which the hon. Member for South Thanet (Dr. Ladyman) is chairman. He made some interesting comments about chemical markers that may affect the onset of autism before birth. However, we do not know for sure, and the public are increasingly sceptical about pronouncements from Ministers and from medical officers acting under instructions from Ministers. The vaccination rate has been falling and continues to fall.
This debate is about choice. The choice between MMR and no vaccine at all is not a choice. It is certainly not a choice that I recommend to any of my constituents, because measles is not a soft optionit is a killer. Getting rubella during pregnancy can lead to deafness, blindness and heart defects. We need more publicity about the deadly effects of catching those diseases, as well as mumps. The lack of confidence has been growing for months.
The hon. Member for The Wrekin (Peter Bradley) thinks that the Conservatives, in cahoots with Lauren Booth, the sister-in-law of the Prime Minister, have cooked up the controversy, as if people had not lost confidence until the Conservatives and Lauren Booth started saying things. Coming from a Labour Member, the suggestion that the Conservatives are using Leo as a political football really takes the biscuit.
For all those reasons my hon. Friend the Member for Woodspring (Dr. Fox), the shadow Secretary of State for Health, took the right decision earlier this month in saying that, because of the alarming fall in vaccination rates, the Government should now make the choice of single jabs available to those parents who refused MMR for their children.
People have been losing confidence. We have all heard anecdotes. We have all been rung up by constituents who say that they are scared stiff about the prospect of MMR. One of my constituentsMrs. Lewis from Worthingwas quoted in the local paper two weeks ago. She said:
She is dead right and she must take some of the blame for that. A poll conducted by ICM for The Guardian two weeks ago showed that 75 per cent. of people want the Government to provide free separate jabs. Only 73 per cent. of those with young children would choose MMR and 19 per cent. were so worried that they were prepared to pay for separate injections themselves. Only 20 per cent. said that they trust advice from politicians and officials "a lot". Some 47 per cent. trust such advice "a little" and 30 per cent. disregard it altogether. Unsurprisingly, only 6 per cent. trust "a lot" what journalists have to say, so the Government cannot pin all the blame on what people read in the papers.
A poll published in The Telegraph on 9 February said that four out of 10 parents with small childrenthis is contrary to the claims of the hon. Member for Oxford, West and Abingdonsaid that the Prime Minister's equivocation about his son's treatment had dented their confidence in MMR. What has been the Government's response? Apparently, they are going to launch an advertising campaign. We would like to see the evidence of its effectiveness, because Roger Hayward, the chairman of the Public Relations Standards Council, warned that such a campaign could backfire. He told the "Today" programme:
The Government need to do some research. Are they monitoring who is giving those jabs? A private clinic in Lincolnshire said that it received 10,000 calls a day inquiring about single jabs. Are the Government monitoring charges? We are now hearing stories of people paying anything from £240 to £560 for a set of three single jabs in different parts of the country. Such people are voting with their feet and paying out of their own pocket because they do not trust the advice that the Government have been giving. Are we monitoring those health authorities taking action against individual GPs who want to give single jabs?
I have also been told that the waiting time for single jabs is going up because of the lack of vaccines. Those are all questions that the Government cannot ignore, because many thousands of parents are opting for that course of action because, for them, MMR or nothing is not a choice. That is what the debate is about.
It was irresponsible of the chief medical officer to say that taking a single jab was like playing Russian roulette. That undermines enormously the confidence of those many thousands of parents who have taken the desperate action of getting single jabs for their children. The debate is not about the Prime Minister and the Government proving that they are right and that the wicked Tories are wrong. It is about treating the genuine fears of ordinary parents with respect and giving them a choice rather than no choice. Concerned parents have now been added to the ranks of "wreckers". However much the Minister may disagree with them, they have genuine fears and are exercising their power to opt out if they see fit. The Government urgently need to restore confidence; until they can take every step to increase coverage, they should offer choice.
The Parliamentary Under-Secretary of State for Health (Yvette Cooper) : I congratulate the hon. Member for Bromsgrove (Miss Kirkbride) on securing this debate. MMR is an extremely important issue which affects the lives of our children even before they are born, and I know that she feels strongly about it. However, I deeply regret the climate in which the debate is taking place and the opportunism that has been shown by some Opposition Members in discussing something that is so important to our children's health.
In the limited time available, I want to deal as fully as possible with the serious issues that have been raised: the safety of MMR, the worth of separate vaccines and the question whether government policy should change.
Concern has been raised about whether MMR causes autism. As my hon. Friend the Member for The Wrekin (Peter Bradley) has said, it is used in 90 countries. It is recommended not only by the Government, but by a series of independent bodies including the Royal College of Paediatrics and Child Health, the Royal College of Nursing, the Royal College of General Practitioners and many of their counterparts in other countries, as well as the World Health Organisation and independent bodies around the world. In this country, the Committee on Safety of Medicines and the Joint Committee on Vaccination and Immunisation have reviewed all the evidence concerning autism. The Medical Research Council has now reviewed MMR, bowel disease and autism three times. All the organisations that I have mentioned have stated their full support for the present policy and for the overwhelming conclusion that there is no link between MMR and autism.
In the United States, the American Academy of Paediatrics and the Institute of Medicine have also undertaken huge reviews of MMR and have come to the same conclusions. All the expert bodies have been very clear and their advice has been strong: plenty of evidence shows that there is no link between MMR and autism and we should continue with a programme offering MMR, not separate vaccines.
My hon. Friend the Member for South Thanet (Dr. Ladyman) gave examples of evidence. I should like to highlight further examples of the research that medical experts tell us is so important. For a start, a study of all children in the North Thames area found no impact on levels of autism when MMR was introduced. In 1988-89, most under-fives were vaccinated with the MMR jab. Before 1988 there was no MMR jab; after, it was almost universal. Was there a step increase in autism? No, there was not. No impact on the level of autism could be found, because it had been increasing before 1988, and it continued to do so after 1988. Other studies, both here and abroad, have found similar things.
In addition, there is evidence of regressive autism not having been affected by the introduction of MMR in 1988. Many individual cases have been studied. In 1998, the Committee on Safety of Medicines set up an independent group of experts to examine 110 cases, looking at reports from the families, the GPs, and the specialists looking after the children whose parents feared that their autism might have been brought on by MMR. The written records of nearly 40 per cent. of the children showed that health professionals had already had concerns about their development before they had MMR and nothing in those detailed investigations implicated the MMR vaccine.
The hon. Member for Bromsgrove raised the issue of Dr. Wakefield's research and the recent research statements that he has made. Independent experts have serious doubts about the validity of Dr. Wakefield's methods and his results, as well as about the design of the study. For example, Dr. Bellini, head of the measles laboratory at the Centres for Disease Control and Prevention in Atlanta in the United States, said that there was
None of the research by Dr. Wakefield implicates MMR. The latest study does not even mention whether the children studied had had an MMR jab, a single measles jab or any jab at allor had had measles.
On Radio 5 earlier this month, Dr. Wakefield said that some of the children in his study had had the single vaccine and that the virus was present there. That is one of the key issues that the chief medical officer raised in his letter to Dr. Wakefield, in order to try to ensure that the statements made receive proper academic and public scrutiny. The evidence on MMR is clear. Experts advise us that there is plenty of research that finds no link between MMR and autism.
The hon. Member for Bromsgrove is pushing the view that single jabs are somehow less risky and represent a precautionary approach. All parents want to do what is safest for their children; they want to take the fewest risks. There is no evidence that single jabs are less risky or less likely to cause autism or anything else. Parents have been misled.
Mr. George Osborne (Tatton): If a parent decides, however irrationally, not to give his child the MMR vaccine, would the Minister recommend that that parent arrange for the child to have three vaccinations or for it to have none at all, leaving the child unprotected?
Yvette Cooper : The clear recommendation of all medical experts in the field is that parents should arrange for the MMR jab. Parents are being misled by statements like that made by the hon. Member for Bromsgrove, about the protection afforded by single jabs, and are led to believe that the single jabs are somehow less risky. That has arisen due to the hon. Lady's confusion over technicalities, which I shall be happy to write to her about. However, she is wrong and is misleading parents as a result. There is extensive evidence about the problems and the risks that would be posed by introducing single vaccines on the NHS.
Yvette Cooper : No, I do not have time. The hon. Member for Oxford, West and Abingdon (Dr. Harris) clearly stated the problems involved in introducing six separate vaccines. Recent research in Chester has suggested that two thirds of children currently going for separate jabs do not complete their courses. The advice that we have received is clear: coverage would fall if we introduced separate jabs, not only because people would be less likely to complete the course but because children would be unprotected between injectionsDr. Wakefield recommended having a year between themand because of the impact on confidence of introducing separate jabs.
The hon. Member for Oxford, West and Abingdon mentioned the impact of introducing separate jabs for whooping cough in response to similar anxieties. That led to substantially lower coverage and lower coverage of all other vaccines also. In that case, many thousands were admitted to hospital and around 100 died. The clear conclusion from the medical experts is that introducing separate jabs would make things worse. It would lead to lower coverage than at present, not higher, and would leave many more children exposed to deadly diseases. That would mean more cases of measles and of mumps, more pregnant women exposed to rubella and, ultimately, more children dying as a result.
I do not see how any Government could responsibly listen to all that medical adviceknowing that if we introduced separate jabs we would put the health and lives of more children at riskand choose to ignore it because it was politically easy to do. Of course it is politically the easy thing to do, but it is morally the wrong thing to do. The advice to us is clear. I do not see how we could look those parents in the face, either. Parents are deeply concerned because they want to do the right thing for their children. Opposition Members are asking us to implement a policy that would put children across the country at risk. What do they say to the royal colleges, to the nation's top children's doctors, to all the medical experts who have told us that that would put the lives of more children at risk? It would be deeply irresponsible to do so. Those on the official Opposition Front Bench hide behind all kinds of weasel words, saying that they have only just called for single jabs and that that is only because the levels of coverage are falling.
Last year, the hon. Member for Woodspring (Dr. Fox) said that his party would introduce separate jabs if coverage did not rise. At the time, a parent said, "Well, I saw that Conservative on telly saying that we should have single jabs. He's a doctor; he should know." Yes, he should know. He should know better and he should listen to the medical experts and medical bodies that are advising us that to do that would put children's lives at risk. Parents want information. They have a right to information and they want their questions answered. We must find more ways to give them answers to their questions. We do not want to put their children's lives at risk.