[bpsdb] Guest post by British doctor DeeTee. See more by DeeTee here.
If it isn’t enough that Wales is witnessing its biggest outbreak of measles for several decades (courtesy of rampant antivaccination propaganda that resulted in very low levels of MMR vaccine coverage), now we have to endure the spectre of an English company setting up shop in the epicentre of the epidemic in order to make money from worried parents by flogging them single measles jabs.
To recap: As of Tuesday, 207 cases of measles had been reported in Wales, with 26 children being admitted to hospital and several ending up in intensive care with life-threatening complications. There have fortunately been no deaths yet, but that is probably a testament to the good care these kids have had in ITU. I just hope none have had measles encephalitis or any other complication that will cause long-term damage.
MMR vaccination levels in Wales have been low ever since the late 1990s when Andrew Wakefield announced a speculative (and subsequently disproved) link between MMR and autism and urged parents to use single measles vaccines. This was not helped by anti-MMR campaigns in the local press. Quite horrifyingly, full MMR uptake rates have recently been reported to be as low as 15% in some schools. The result of this decline in herd immunity has been to create a vulnerable population that is highly susceptible to measles, and it comes as no surprise that there are now outbreaks in several parts of the country.
The response by the National Public Health Service for Wales has been to implement and publicise an MMR catch-up programme, and it sent letters throughout the region to encourage parents to get their children immunised. On the 12th May this was covered by the local media, including “This is South Wales” which is the website covering three local papers. On the response section to the article, I noted one comment from a “Deborah” in Herefordshire. This is what she said on the 15th May:
I have run a single vaccine clinic for the past eight years and I am prepared to bring the clinic to Llanelli to vaccinate with single vaccines. With the current outbreak we are prepared to bring the price of measles to £40 please contact if we are able to help with this Debby
deborah, Herefordshire
On the 22nd May someone called “Dixon” responded:
Deborah, you just stay in Herefordshire will you. We don't need your sort here.
Dixon, Cardiff
Unfortunately it looks like Deborah did not take Dixon’s sound advice. Not content with touting for business and using the media to get some free advertising, she has proceeded to set up her clinic as planned.
“Deborah” would appear to be none other than Debbie Ryding, owner of a Hereford-based company called Desumo, which generates a profit from selling unlicensed single vaccines. Presumably not being one to miss an opportunity, she has leapt at the chance to sell her wares in Llanelli, except the initial bargain price of £40 for a measles jab as mentioned in her online comment now seems to have crept up to £45. Whatever the market will bear I guess…. Do I hear £50? (Perhaps we can look forward to see her on a future edition of “The Apprentice”?)
Desumo’s actions have been branded “unethical” by Dr Marion Evans, head of communicable disease control at the National Public Health Service for Wales, and I wholly concur. All we can do is hope that an application for approval for a clinic on 30th May is refused by the Health Inspectorate in Wales.
So what do “Desumo” actually offer? Well, they mention MMR shots on their website (as they are probably legally obliged to do) but as these are available free from one’s local GP, they don’t say much else, except to provide a few links to websites highlighting concerns about it. Desumo promote the freedom of individual vaccines for measles, mumps and rubella, but this comes at a price.
According to the website the vaccines alone would cost a whopping £570 for all 3 diseases. But what would be the overall cost of getting vaccinated? It appears that there is an upfront payment of £100 for “registration” and the first appointment. It’s not clear how much subsequent appointments cost, but even if they were free, the minimum outlay to fully vaccinate a child would be £670. I’m just surprised they haven’t priced their package at £699.99, to make people imagine they are getting a real bargain.
It would appear that Desumo think parents might find the price of their vaccines “to high”[sic], hence the “reduced” currently rate on offer to panicky Welsh parents. Or perhaps they realise they are aiming at a different market in Wales than the chattering classes of rural Herefordshire. Still, considering their single measles vaccines appear to be manufactured in India at a cost of pennies rather than pounds**, the profit margin seems to be considerable.
I fail to understand the appeal single vaccines have for parents. Costs aside, they entail far more inconvenience, they are required to be “spaced out” (Wakefield actually suggested as long as 12 months) and therefore risk big gaps appearing in the immunisation schedule that make children more vulnerable to disease, the chances of fully completing a schedule of six jabs as opposed to two is low, there is no logical reason to imagine single vaccines have less risk (in fact the risk of allergic reactions may actually be higher), and protection from single measles vaccine is known to be less effective than the protection from MMR.
The existence of clinics like Desumo is an anathema to me. They would argue they are merely responding to parental concerns, are offering choice and are helping protect those who might not have been vaccinated anyway. I do not really believe this, any more than I believe in a drug dealer’s altruism when he says he is selling cocaine because without it people might use heroin. And when I see them ambulance-chasing to capitalise on the situation in Wales, when the anti-MMR mindset behind single vaccine clinics is one of the main reasons there is an outbreak in the first place, I feel sick.
----------------------------------------
** The Desumo questions page says their single measles vax is from SII (India) which must be this one. They don't quote the price, but I know from the time I worked in Africa that measles vax was pretty cheap. I can't find a source price for SII's vaccine (I've emailed them to ask), but the WHO does say that "It costs less than one US dollar to immunize a child against measles."
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This is a guest post by British doctor DeeTee.
http://layscience.net/trackback/579
Is MMR safe for everyone?
If it's not quite safe for every British kid, which British kid isn't it quite safe for?
Answers on a post card please to our very own Dr TeeHee.
Lol, how's the job going Celtic? Heard you had a spot of bother... ;o)
Martin is the editor of layscience.net.
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@ CelticLeopard
It's impossible to prove it's safe for everyone, but thats true of everything anyone ever consumes. The autism claims have been thoroughly discredited, and there are no other claims against it.
Even if there are real risks that it may harm people at a rate so low it has gone undetected so far, these risks are outweighed by the large benefits it brings in terms of immunity, as we are seeing now with the sad case in Wales.
Still on the old surgical spirits then Struthers?
But what else can you do now you've got so much time on your hands?
Like I said, MMR seems to be safer than the individual vaccines in terms of reactions (which makes sense, doesn't it - after all you only need 2 shots full of "nasty toxins" as opposed to 6).
Some good news - it looks like Desumo have failed to get approval in time to hold a clinic on Saturday in Llanelli. They plan to bus people over the border to their Herefordshire clinic instead!
http://www.thisissouthwales.co.uk/news/Private-measles-clinic-axed/artic...
DeeTee, would you direct me to the evidence you used to back up your claim that "protection from single measles vaccine is known to be less effective than the protection from MMR"?
Ditto for your claim that single vaccines are required to be "spaced out" any more than MMR. I realize that you quoted Wakefield to justify this claim, but I don't consider him to be a reliable source.
Finally, what is the evidence to back up your claim that the risk of allergic reaction may be higher for single measles jabs as opposed to MMR?
I ask these questions not because I necessarily disbelieve you but that this being a science blog specializing in mocking fact-free pseudoscientific claims, I think you need to provide links or quotes to back up your assertions. (Yes, Martin, I know it's not my blog, but I'm just giving my opinion. Feel free to differ.)
You say, "And when I see them ambulance-chasing to capitalise on the situation in Wales, when the anti-MMR mindset behind single vaccine clinics is one of the main reasons there is an outbreak in the first place, I feel sick."
What are the other main reasons? You don't say, but here's one: If the NHS offered the choice of single measles vaccines, the rate of measles infection can reasonably be expected to be lower than at present, and Debbie wouldn't be "ambulance chasing". Does that also make you feel sick?
At the end of the day, if the public, misguided or not, has concerns about a vaccination programme and there is a reasonable alternative, then that alternative should be made available. The solution to the problem of the public's ignorance on the actual facts is patient, widespread education on the issue. Eventually, with nothing to back up the public's concerns, the convenience of a couple of MMR jabs as opposed to six individual jabs will win the day. As it is, by failing to readily provide individual jabs, the NHS is making the situation worse than if they did provide them. The irony is that this failure to give the public choice actually fuels their suspicion. After all, it's not as if mainstream science isn't ever influenced by funding considerations, is it?
DeeTee, I asked (01:45) "Finally, what is the evidence to back up your claim that the risk of allergic reaction may be higher for single measles jabs as opposed to MMR?"
I see you'd already clarified that in your letter at 22:56. Fair enough.
What an outrageous thing for Carl to say,
"After all, it's not as if mainstream science isn't ever influenced by funding considerations, is it?"
You naughty pro-vaccineer, Carl! Now, with his trusty shield of British fairplay barely poking above the parapet, DeeTee will strike you down with his simple sword of truth. TeeHee.
Celtic Leopard, DeeTee won't strike me down, as you put it, for the simple reason that I have no personal investment in my positions. If DeeTee can elucidate his arguments so that I no longer have concerns, then good for him. However, as matters now stand, I believe that the NHS should provide the measles vaccine for those who refuse the MMR. Better something than nothing at all! Also it will stop opportunists from profiting from the situation, which DeeTee finds so upsetting.
Oh dear Carl!
"However, as matters now stand, I believe that the NHS should provide the measles vaccine for those who refuse the MMR. Better something than nothing at all! Also it will stop opportunists from profiting from the situation, which DeeTee finds so upsetting."
You are a naive little bunny, Carl. And DeeTee eats little bunnies for breakfast. TeeHee.
CelticLeopard, I'm well aware that you're nothing but a troll, but if you're trying to stir the pot I'm afraid I'm going to disappoint you. You see, although I take issue with DeeTee's lack of support for his allegations as well as with his broad conclusion, I nevertheless take it as a given that unlike yourself, DeeTee is an honorable person trying to come to terms with a vexatious problem, which is exactly what I am trying to do, too.
Now, go back under your bridge or wherever, and quit bothering people who have real ideas to discuss.
@Carl:
I can't speak for DeeTee, but for me the argument against your suggestion is pretty well illustrated by what happened in the U.S. back in 2001. The CDC decided that although there was no evidence that the small levels of mercury and thimerosal in vaccines caused any problems, they would remove or reduce them anyway, for the same sort of reasons you give above. The problem was that as soon as the government announced this, for many parents it simply confirmed that the problem was actually real. Far from encouraging more vaccinations, it caused more fear and uncertainty. (Good post by Orac here reviewing a paper on this in PLoS - http://scienceblogs.com/insolence/2009/05/the_anti-vaccine_movement_is_i...)
Or if you want a more directly related example, Japan withdrew an older version of the MMR vaccine in 1993 (for more genuine concerns), and replaced it with single vaccines. Since then, they have continued to have problems with measles outbreaks, and something like eighty children died in the period 1992 - 1997 (compared to zero in the UK). In 2000 alone, there were 200,000 cases of Measles in Japan, and 88 deaths. (http://www.smh.com.au/news/world/japanese-measles-epidemic-brings-campus...)
And that's pretty much what I think would happen if the NHS were to introduce single jabs. Rather than being seen as a helpful move, I can imagine that a lot of papers and pressure groups would simply take it as confirmation that MMR was dangerous all along, and confidence in vaccines and the NHS in general would simply erode further.
On a wider, more philosophical point, I also think it sets a potentially very dangerous precedent. If health officials are forced to change treatment policy and promote less effective treatments because of what was essentially a campaign by a handful of tabloid newspapers, then where does that leave future public health policy?
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"DeeTee is an honorable person"?
Eh? LOL! TeeHee, teehee!
Cock Robbins boils silly bunnies too,
"On a wider, more philosophical point, I also think it sets a potentially very dangerous precedent."
DeeTee would larf out loud at the boiling of a bunny. TeeHee.
Where to start?
Orac says, “To this day, this is one of the most spectacular examples of the law of unintended consequences that I've ever seen, and I can't believe that anyone would think that a line like ‘the current levels of thimerosal will not hurt children, but reducing those levels will make safe vaccines even safer’ [as stated by the American Academy of Pediatrics] would do anything other than what it did: spark a panic.”
Well, no kidding! One shouldn’t draw conclusions about the results of a sensible education campaign based on the consequences of such a thoughtless statement!
Orac also says, “I also don't like the attitude behind this [PLoS Biology] article that regular people can't understand science.”
I quite agree. The key word here is “can’t”. IMO every student should have the principles of science drummed into him from an early age. The fact that so few people understand the principles of science is a failure of education, not a lack of intellect. After all, these principles are not, in and of themselves, difficult to grasp. If this were done, scientists’ normal caution would no longer “come across to the public as waffling or weaseling.”
The situation in Japan is quite different. For instance, the SMH article to which you linked states,
"The Asahi Shimbun newspaper, citing unidentified experts, said a previous decline in the number of measles outbreaks may have lessened the efficacy of childhood vaccinations among the students, as exposure to the virus strengthens their effect.”
and,
“In Japan, however, the government bowed to strong public pressure in 1994 by repealing laws that made childhood immunisations mandatory. In 2000 there were an estimated 200,000 cases of measles and 88 deaths.”
and,
“It was only last April that the National Institute of Infectious Diseases introduced a double vaccination program [a vaccination with a follow-up booster shot]. But it would take at least a decade before the results of that could be seen, predicted Tatsuo Kato, president at the National Centre for Child Health and Development.”
I could find nothing in the article that either stated or implied that there was any linkage between making measles only vaccines available in addition to MMR, and an increase in measles. If I overlooked something, perhaps you could point it out.
You say, “If health officials are forced to change treatment policy and promote less effective treatments because of what was essentially a campaign by a handful of tabloid newspapers, then where does that leave future public health policy?”
Believe me when I tell you that the anti-vaccine movement is far more than “a handful of tabloid newspapers.” Rather, it’s a worldwide, multi-faceted movement. And far from “promoting” less effective treatments, I specifically stressed that there should be “patient, widespread education on the issue.” As the Orac article to which you linked implied, that is ultimately the only way to counter the constant barrage of anti-vaccine propaganda.
Finally, calling the single vaccines “less effective” is a bit of a red herring. After all, the recipients would by and large be the very children who currently are not being vaccinated at all!
Martin @ 09:45 A further point on your comment, "On a wider, more philosophical point, I also think it sets a potentially very dangerous precedent."
Actually, the precedent was set long ago as for instance with alternatives to blood transfusions for Jehovah's Witnesses, even when from a medical standpoint, the patient would clearly be better off with the transfusion. Nevertheless, without such accommodations, many Jehovah's Witnesses would refuse even life-saving surgery, just as many children will remain unvaccinated because the NHS refuses to provide an alternative to the MMR vaccine.
Seems to me as if public policy is rather muddled on the principle at stake, which is, simply stated, if it saves lives and needless suffering, it's good. Any suggestion that public policy shouldn't yield on this issue even if it saves lives and suffering vis-a-vis the current situation (as it likely would unless it's thoroughly bungled) is simply untenable.
The problem with both of your points is that you're working on the assumption that single jabs would result in more kids being vaccinated, and that there would be no effect on lives of the principle I defended.
The point of referring to the CDC and Japan problems wasn't so much to argue that the exact same thing would happen here, but to point out that these are the two main attempts to do what you've described, and both have failed to produce any benefit. In short what I'm saying is that there's no evidence at all to support your assumption that single jabs would increase take-up, some evidence to suggest that they won't, and plenty of examples of unintended consequences following on from such attempts.
You also assert thart the people taking up the single jabs would be previous unvaccinated kids, but again that's an unevidenced assumption. It's equally possible that unvaccinated kids could continue to stay away from vaccines, and that in fact people moving on to single vaccines could be parents who currently consent to MMR.
Finally you say: "Any suggestion that public policy shouldn't yield on this issue even if it saves lives and suffering vis-a-vis the current situation is simply untenable." But again, these ignores the fact that any change of public policy that results in a less effective solution will ultimately cost lives.
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Well, Martin, I still don't see any evidence to support your arguments. The fact is that you drew unwarranted conclusions from the SMH article, and I could find only one attempt to do as I propose (not two) in the links you provided. And even that single (US) attempt was badly bungled from the get-go. Despite this, rather than giving up, according to your link they've embarked upon an aggressive, if belated education programme.
As for who would actually take advantage of a free single vaccine programme in addition to the current free MMR vaccine, neither of us actually have data on that. I certainly wouldn't make a definitive decision without polling and perhaps a pilot project, but Martin, DeeTee's blog is merely crying the blues. What does he propose to do about the current untenable situation? You too, for that matter.
It seems to me that you're both rejecting a possible remedy as out of hand without any data to back up your position. Why?
"DeeTee, would you direct me to the evidence you used to back up your claim that "protection from single measles vaccine is known to be less effective than the protection from MMR"?"
Protection can be defined in various ways. If one uses a simple measure of specific measles antibody levels generated there may be little to choose between measles vaccine or MMR. There may be some evidence that the Edmonston-Zagreb strain of measles used in some MMR vaccines is less immunogenic than Schwarz strain. The virus used in most monovalent measles vaccines such as the Indian SII used by Desumo is the Edmonston-Zagreb strain.
However, in real life there is more to protection than mere antibody levels; and the true test of protection is whether children are protected against infection. In the UK, monovalent measles was introduced in the 1960s, quickly reducing the incidence of measles, but only down to a base level of around 100 thousand cases per year on average, with 10-20 deaths annually. The year MMR was introduced (1988) there were 86000 cases of measles and 16 deaths. Immunogenic the vaccine may have been, but in practice it didn’t achieve what we have come to expect from an effective vaccine. Within 5 years, MMR had reduced the incidence of measles to less than 10,000 per year, with a corresponding drop in acute deaths to nearly nothing. In my book that equates with better protection, and a return to the incidence seen pre 1988.
"Ditto for your claim that single vaccines are required to be "spaced out" any more than MMR. I realize that you quoted Wakefield to justify this claim, but I don't consider him to be a reliable source."
The conventional advice is that vaccines should be spaced out by at least 6 weeks between doses. Wakefield did suggest 12 months, and I mentioned that because many some vaccine schedules suggest this should be how it is done. With even 6 weeks between individual components of the MMR vaccines there will be a gap during which there is increased susceptibility. I have seen no evidence that this has had great impact in practice, but with herd immunity still high and relatively little measles about, it would be difficult to judge the impact of different schedules. If measles is highly prevalent, a case controlled study could be done to determine this. I think it is sensible to avoid gaps if possible – why take the risk?
"Finally, what is the evidence to back up your claim that the risk of allergic reaction may be higher for single measles jabs as opposed to MMR?"
There is the issue of 3x as many injections, each with constituents capable of provoking reactions, be they minor febrile reactions or anaphylaxis. When one of the arguments of the anti-MMR lobby is that there are “too many toxins” and “too many injections overloading the immune system” it does seem perverse for them to recommend kids get 6 injections rather than 3.
Suspicion that single vaccines cause more reactions is not purely theoretical; there is evidence that the incidence of severe allergy may be higher. The anaphylaxis rate with MMR is reported to be 14 per million doses. But the rate with single vaccines has been estimated to be 189 per million for measles, and 224 for rubella. So a child having separate measles and rubella jabs could have a combined anaphylaxis risk of up to 413 per million doses, which is 30 times higher than with MMR alone (though there may be a degree of overlap). I could not comfortably advise parents to get vaccines that might be 15-30 times more risky than the conventional alternative, but it appears that doctors servicing the single vaccine clinics have no problems with this. Looking at the websites of some of the “single vaccine” clinics, I see none that mention the higher risks of anaphylaxis. Perhaps they remain blissfully unaware of it (which is no excuse) or perhaps if they do they conveniently fail to mention it, which hardly qualifies as fully informed consent.
You suggest that if single vaccines are promoted and made available that this might allay concerns and that not giving people a choice fuels their suspicions. I disagree. The MMR is of proven safety and efficacy, and we should be encouraging people to just get on with it. Single vaccines are not a “reasonable alternative”, and it is only a small and misguided minority who want them. Making them available would merely exacerbate suspicions about MMR. I am mindful of the situation in the USA where thimerosal was removed from vaccines, not because of any evidence it caused harm, but to try and convince people that vaccines were as safe as possible. But instead of allaying fears, it had the opposite effect, with people assuming thimerosal must have been causing damage (something the antivaccine lobby actively encouraged), and confidence in vaccines took a heavy blow.
If the DoH caved in to unreasonable pressure from the small but vocal minority of parents who wish to have single vaccines when there is not a jot of evidence they are better than MMR, this would send out entirely the wrong message and confidence in MMR might plummet. The only reason a small minority of people have been saying they want single MMR is because of the scare-mongering put out by the antivaxers about MMR.
Carl, Japan withdrew MMR vaccine, it did not run MMR and single vaccines in parallel. The only choice was single vaccines for children, and the epidemics occured against a background of a monovalent immunisation programme.
TeeHee wibbled,
"Single vaccines are not a “reasonable alternative”, and it is only a small and misguided minority who want them."
Carl, you've been boiled! I told you DeeTee was a bunny boiler.
If there is one person here whose eyes are swivelling, I would have thought it was Celtic Leotard, not exactly surprisingly. DeeTee seems to have answered Carl's questions with total courtesy.
I am interested to see if Carl is convinced.
Incidentally, the pricing seems to be fairly typical for single-vaccine operations. I just checked one Harley St (and elsewhere) set-up I came across online and they quoted:
£ 50 "registration" + (6 x £ 95 for six shots) = £ 620
As DeeTee says, a nice little racket seeing as you get MMR for free from the GP...
...provided Celtic, JABS, Andy Wakefield, Melanie Phillips and and the Daily Mail haven't scared you senseless, of course.
The decerebrate newt is back,
"DeeTee seems to have answered Carl's questions with total courtesy."
All hail the brainless newt, so help me God!
"...so help me God!"
Appeal to authority.
Bound to fail. no-one can help you I'm afraid.
Incidentally, Dr Struthers, when you see parents in your surgery... Oops, sorry, I mean when you used to see parents, did you tell them to get single vaccines rather than MMR as was the GP practice policy?
Serious question. Care to answer?
DT @ 17:46
No argument here, DeeTee. It was Martin who tried to link the Japanese experience to what I'm proposing, as here:
Martin on Fri, 05/29/2009 - 12:01:
The point of referring to the CDC and Japan problems wasn't so much to argue that the exact same thing would happen here, but to point out that these are the two main attempts to do what you've described, [My emphasis] and both have failed to produce any benefit.
Here's an excerpt from a 2002 BBC article on the Japanese experience:
http://news.bbc.co.uk/1/hi/world/asia-pacific/1808316.stm
They stopped using the MMR vaccine in 1993 and reverted to three separate injections for measles, mumps and rubella.
Japan's Health Ministry said more than 100 people died from measles over the next six years, while there were no deaths in the UK.
But a spokesman said even more had died from the disease during the period when MMR was being used. [My emphasis]
He said the withdrawal of the triple vaccine had had no impact.
Deadly epidemics of measles are far more common in Japan than the UK. The ministry says that is because children are often vaccinated much later.
Japanese officials say they have no record of a connection between MMR and autism.
I should point out that the Japanese withdrew their early MMR vaccine because of public pressure due largely to serious side-effects which are no longer an issue in the current MMR vaccine. I believe they simultaneously made the single vaccine replacements non-compulsory, unlike the previous MMR vaccine.
In short, it's just bad science to insist there is some sort of parallel between what I'm proposing and the Japanese experience.
DT on Fri, 05/29/2009 - 17:11
Hi DeeTee - I appreciate your response.
”I think it is sensible to avoid gaps if possible – why take the risk?
Well, I personally wouldn’t take the hypothetical risk, but the target people are those that have been convinced that MMR is anathema, and thus don’t get their children immunized at all!
If a survey and perhaps a pilot study shows that offering single vaccines to those who have concerns over MMR vaccines (but not “promoting” them, as both Martin and yourself seem to believe is what I’m calling for) likely wouldn’t increase the number of immunizations, then by all means forget it. I’m just suggesting something that might alleviate the problem, provided it’s handled properly, with a concomitant education programme both from the government and doctors such as yourself (including providing pro/con type hand-outs for MD’s to offer their patients, challenging the tabloids in letters and blogs, etc. etc.). Also, as I mentioned in a previous comment, every student should have the fundamentals of science drummed into him/her.
DeeTee, I appreciate the links and elucidations. I do think it’s important to lead by example, and you do make some good points. Nevertheless, my concern remains that perhaps an underlying fear of being seen to “give in” to the dark side, as it were, may be preventing you from exploring all possibilities to alleviate the problem. As things now stand, matters seem to be spiraling out of control and you’ve offered nothing to address it.
Anecdote makes bad science: DeeTee knows that.
"... Oops, sorry, I mean when you used to see parents, did you tell them to get single vaccines rather than MMR as was the GP practice policy?"
And I know that Dr TeeHee does not make an appealing authority on science, medicine or anything else for that matter.
Carl, I agree the Japan situation is not a suitable comparative situation to what might happen in the UK if single vaccines would become available. Nevertheless, they show the problems in that country when MMR has had bad press, single vaccines are introduced but not made mandatory, and poor health governance and a Department of Health seemingly uninterested in what happens to its own citizens.
Reassurances from a spinning Govt. minister about the situation hardly counts as hard evidence. All he quoted was mortality in the year before MMR was stopped, and the few years afterwards. He also appears to have said MMR vaccine uptake was 68%, so mortality during the MMR era probably reflected poor uptake rather than poor vaccine efficacy, and I expect the vast majority of measles cases and deaths would be in the unimmunised.
Monovalent vaccine rates apparently improved over the subsequent years to nearly 95% (yet mortality was "no different" - what do you conclude from that?). And he is also ignoring the huge epidemics that hit Japan in the early 2000s.
http://www.cdc.gov/mmwr/preview/mmwrhtml/mm5738a5.htm
"Measles outbreaks occurred each year in Japan during 1999--2003 and involved both children and adults (Figure 1). The largest outbreak occurred in 2001, when the number of measles cases among children aged <15 years was estimated at 265,000."
Quater of a million cases in one year? That hardly sounds like a ringing endorsement for single measles vaccine to me.
I don't know how to best counteract the call for single vaccines. Estimates put their demand at 5%, so it is a small minority. All we can do is keep plugging away at telling people that MMR does not cause autism, and to hope the media take their responsibilities more seriously than they have in the past.
DT, 5% demand for single vaccines is indeed a small minority. I must admit that without any evidence at hand, I thought it would have been larger, so perhaps on balance offering the single vaccines would do more harm than good.
Yes, you do need to keep plugging away. Perhaps a more organized pushback would be in order, with challenges to faulty newspaper articles, demands for corrections, etc.
It's all-too-easy also for reporters and editors to draw false conclusions, for they're almost never experts on the subjects they report. That's one area where bloggers such as yourself have a huge advantage. Indeed, you might want to consider shopping blogs such as this around to the MSM. You never know!
At the end of the day, one does have to sympathize with the public and media, who are rightly suspicious of the pharmaceutical industry, with its conflicts of interest in research funding and too-cozy relationship with government regulatory bodies. (Google or Google Scholar pharmaceutical conflicts interest, for countless examples.)
Anyway, good discussion, DT. I enjoyed it.
Thanks Carl. You have made some good points and given me cause for some reflection/reappraisal/reassesment, which is always a good thing.
Dr TeeHee is humbled. Good for you Carl ... and well done ... for humbling that great British doctor of vaccinology.
But Dr TeeHee arrogantly stated,
"All we can do is keep plugging away at telling people that MMR does not cause autism ..."
Is it possible Carl that you could get TeeHee to show some humility and humbly admit that it is possible that MMR might be the trigger to an autistic spectrum disorder in a small subset of genetically vulnerable children? Go for it mate ... you can bring the mighty down ... and boil a bumbling bunny too, for tea.
Love to take you up, mate. After all boiled bunny sounds so um, appetizing! Unfortunately, I'm just not clever enough to be able to explain away articles such as this:
http://openlearn.open.ac.uk/mod/resource/view.php?id=296922
Say, why don't you give it a go, Dr. CL?
Sad to say, 47 parents seem to have taken up Desumo's offer of single measles jabs and bused their children out of Wales to get the jab.
http://news.bbc.co.uk/1/hi/wales/8074338.stm
Does that mean 47 children? 47 families? Who knows, but it is a retrograde step in relation to educating these parents about MMR safety and efficacy. All I can say is that at least they want their kids immunised somehow, but not with MMR.
This would indicate that they were of the "MMR vaccination is dangerous" persuasion, rather than "I was too busy to bring David in for his booster" school of thinking.
I guess it is a small victory in the battle for science and rationality that they finally had a Damascene conversion and realised the potential seriousness of measles, and now decide they don't want their own kids to catch it.
But perhaps as I write... someone in Wales is organising a measles party? I wouln't put it past them.
Nice contrib DT & worthwhile discussion; nice to see sensible arguing on teh tubes and this subject for once, cheers Carl (mjr - perhaps you could edit out the purile interludes though? Cyber: deja vu, don't you ever get deeply bored of this FFS).
Yeah... I'm very, very reluctant to censor comments on this blog on principle, but in the case of this guy it's just puerile nonsense, which is actually quite sad. If he continues in this manner, and fails to make at least some sort of coherent point, I'll act on it.
Martin is the editor of layscience.net.
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Yes, I'm strongly anti-censorship, too, but it would hardly be censorship if you removed comments that failed to make a coherent point -- indeed not even a coherent sentence in many cases.
Nevertheless, they show the problems in that country when MMR has had bad press, History degree - single vaccines are introduced but not made mandatory, and poor health governance and a Department of Health seemingly uninterested in what happens to its own citizens.Journalism degree
I guess it is a small victory in the battle for Affordable degree science and rationality that they finally had a Damascene conversion and realised the potential seriousness of measles, and now decide they don't want their own kids to catch it.Online Universities | Distance learning
Great post, luckily in Europe the ambulance chasers are still few and far between but I don't see this carrying on into the future.
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