MMR Vaccination
We now move from hepatitis C to the MMR vaccination. I suggest that, given the time and if the minister and committee members are happy with the suggestion, we get a briefing from the Minister for Health and Community Care and the chief medical officer about the present situation. We can thereafter write to the minister and the CMO with questions based on that briefing and with any other questions that we might have.
We have indicated to the minister our concern about the recent media reports about mercury in vaccines. We had intended to ask questions about that but, because of time constraints, I suggest that we give the minister those questions in writing; however, we require the answers to the questions as quickly as possible.
The committee's report on MMR is now one month short of two years in the making, and the election is looming. I have some serious questions that I wish to pose. I am happy to put them in writing, but only if we have a guaranteed time of response from the minister.
I am sure that the minister is well aware that if we had been able to ask questions today, we would have heard responses immediately, so there is no reason why we should not expect a response within two weeks at the most. Is that acceptable to you, minister?
I have no problem with that. Obviously, the committee is under time constraints. However, the CMO will be happy to give a separate oral briefing on thiomersal, rather than provide something in writing, if the committee would prefer that. The committee must make that decision.
I do not want to say a great deal about the matter because the CMO will say most about the MMR expert group's report. However, I will make two brief points. First, I remind the committee that we accepted the recommendations that were made, pending discussion with UK departments and other bodies, and we issued a more detailed response in October, with which I am sure members are familiar. I do not know whether Mary Scanlon's questions are over and above the scope of that response or whether they seek information on what has happened since. The CMO will cover some of that in his statement.
Secondly, given that people outside the Parliament are particularly interested in the MMR vaccine, I want to repeat my view, which is the view of the Executive as advised by the chief medical officer and the Joint Committee on Vaccination and Immunisation, whose advice we take on such matters.
I am committed to the MMR vaccine with respect to the protection that it gives not just to individual children, but to the population as a whole. That is consistent with what the Health and Community Care Committee said in its report, but it is important to restate it. The wealth of expert opinion throughout the world confirms that there is no proven scientific link between the vaccine and autism.
Those are the only two points that I want to make, so I hand over to the CMO.
I welcome the chief medical officer and the Very Rev Graham Forbes, and thank them for attending. The committee has had a busy session this morning and has run out of time to ask the witnesses questions in situ. However, I am sure that we will pick up on the many points that you will address in briefing us.
Dr Mac Armstrong (Chief Medical Officer for Scotland):
I am grateful for the opportunity to make some opening remarks before responding to questions. I would be happy to follow up any questions in writing, if the committee would prefer me to do so.
MMR remains an important subject, particularly for parents of young children. I intend to say a little about the origins of the strong interest in the subject and what has been done in Scotland to address it. I will also focus on the actions that the Executive and others have taken in response to the recommendations that are set out in the MMR expert group's report.
The combined MMR vaccine was introduced to the UK childhood immunisation programme in 1988. Since about 1998, speculation has surrounded the vaccine as a result of hypothesised connections to inflammatory bowel disease and autism. A minority of parents in Scotland—about one in 10—are declining to have their children immunised by the age of two. There have been calls for a change in policy to allow parents to choose between MMR and single vaccines.
In 2001, the Health and Community Care Committee published a report, which stated:
"On the basis of currently available evidence, there is no proven scientific link between the MMR vaccine and autism or Crohn's disease. The Committee does not recommend any change in the current immunisation programme at this time."
The committee also suggested establishing an expert group to consider the questions that underpin parents' concerns.
The Executive agreed in June 2001 to establish the MMR expert group
"to consider the matters raised by the Health and Community Care Committee relating to immunisation against measles, mumps and rubella, with particular reference to:
a) describing the consequences of pursuing an alternative vaccination policy to MMR;
b) reviewing evidence on the apparent rise in the incidence of autism, taking account of the current work of the Medical Research Council;
c) describing the process of vaccine testing and the monitoring of adverse effects; and
d) in all its work, having regard to the role and remit of the Joint Committee on Vaccination and Immunisation, the Committee on Safety of Medicines and the Medicines Control Agency."
As members know, the expert group's report was published on 30 April last year. It takes account of the Medical Research Council's "MRC Review of Autism Research: epidemiology and causes", which was published in December 2001. That review makes it clear that, on the basis of current research evidence, there is no proven scientific link between MMR and autism spectrum disorders. It also says that more research is needed to establish the causes of autism spectrum disorders and to improve diagnosis and treatment. The review report also acknowledged that autism spectrum disorder, as a whole spectrum disorder, is more common than had been appreciated previously.
The review describes vaccine testing and the monitoring of adverse events, noting the circumstances in which single measles and mumps vaccines can be imported into the UK if prescribed by a doctor to meet what are described as the "special needs" of patients. It also described the likely consequences of a range of possible immunisation policies, such as no immunisation, compulsory immunisation, deferral of MMR, a choice between MMR and single vaccines, or of single vaccines' replacing MMR. The report of the expert group concluded that all those possible policies would be less effective in protecting individuals and the population against measles, mumps and rubella.
The report also included 11 specific recommendations that were designed to improve services for people with autism spectrum disorder; encourage research into autism spectrum disorder and inflammatory bowel disease; maintain and enhance expert consideration of that on-going research, and public awareness of the rationale that underpins the development of immunisation policy; and to improve the level and quality of information that is available to parents of children who are due to be immunised.
As the minister has said, the Executive immediately accepted in principle all the recommendations that are relevant to its statutory functions, pending discussion with UK Government departments and other bodies, and publication of a more detailed response. That response was published in October 2002; it established a framework for on-going action by the Scottish Executive health department, the Joint Committee on Vaccination and Immunisation, the Committee on Safety of Medicines, the Medicines Control Agency, and health professionals throughout Scotland.
I will now describe briefly the recommendations that are set out in the MMR expert group's report and the action that is being, has been, or will be taken as a consequence of that report. First, the expert group recommended that the Executive and the Medical Research Council should work together to drive forward and to fund, as appropriate, the full research agenda that is outlined in the final chapter of the "MRC Review of Autism Research: epidemiology and causes". It confirmed in paragraph 240 that parents and other representatives of those who have autism should continue to play a key role in developing research strategies.
The Executive and the Medical Research Council welcomed the expert group's endorsement of the conclusions and recommendations of the MRC's review of autism research. We are developing a joint-funded research programme that is based on the agenda that is outlined in the final chapter of the MRC review, including consideration of the design and evaluation of interventions that are key in areas that currently lack a strong evidence base.
The MRC will continue to maintain its portfolio of high-quality research on autism spectrum disorders through its normal funding schemes, with established autism researchers being able to compete successfully for support alongside all other calls on the MRC's resources. An additional £2.75 million will be used to support proposals that are targeted on the areas that are highlighted by the MRC review as being where research evidence is currently lacking. That total is made up of £2.5 million given specifically to the MRC by the Department of Health in England in February 2002, and a proportional £0.25 million from the chief scientist office of the Scottish Executive health department. That programme will take into account international collaboration in ASD research, which is consistent with the expert group's recommendations that we should also, in pursuing that research agenda, seek to maximise international collaboration.
The expert group also recommended that the Executive consult widely in order to publish a firm timetable for addressing all of the detailed recommendations in the Public Health Institute of Scotland's "Needs Assessment Report on Autistic Spectrum Disorders", which was published in December 2001.
The Executive welcomed the expert group's recommendation in that respect because the PHIS report has a key role to play in shaping the strategic direction of services for people with autism spectrum disorders. We recognise the importance of appropriate services to support individuals who are affected by the disorder, and to support their families and carers. We are now taking that work forward with the PHIS reference group, which was set up in June 2002.
On the important issue of the early diagnosis and management of people with ASD, a health department letter will be issued shortly asking all health boards and local authorities to conduct an audit of current services. That should provide a comprehensive picture and will include reference to existing responsibility for diagnosis and subsequent assessment of need by all those involved.
Experts on autism agree that treatment of autistic children should be begun early. They advise that children with autism do not respond best to conventional medical treatment or to a simple medical model of illness but, rather, to a long-term combination of health and educational inputs. The "national initiative on autism: screening and assessment", which is a combined initiative that was established jointly by the Royal College of Paediatrics and Child Health, the Faculty of Child and Adolescent Psychiatry and the Royal College of Psychiatrists, with the support of the National Autistic Society and the UK all-party parliamentary group on autism, is examining issues around screening, diagnosis and early interventions on autism. We support and contribute to that work.
On integrated services, the Executive is committed to reform and improvement across a range of services, notably in health. As the committee will appreciate, much work is already under way and the Executive wants sustainable and long-term improvements in the range and quality of services for those who are affected by autism spectrum disorders in Scotland, working in partnership with local service providers and users.
In that respect, autism spectrum disorders are already included in the work that is being done to implement the initiatives in the document, "The same as you?", which was part of a national review for people with learning difficulties. Its aim is the same as that which is set out in the PHIS report, which is to ensure that services are co-ordinated and seamless.
In relation to people with learning disabilities and autism spectrum disorders, local authorities have been allocated change funds worth £36 million over the three years to 2003-04 and £16 million in each year thereafter. The Executive's view, which is consistent with the PHIS report, is that early priorities for services should include early assessment, integrated joint planning for resources and management, involving people with ASD and their families or representatives in service development, and the development of a coherent approach to training and work force development. We will work to secure those aims.
On training, professional awareness of autism is improving. Of course, there is more to do in relation to raising awareness and improving expertise. The National Autistic Society and the Scottish Society for Autism are already involved in general awareness training for education and health authorities. The Executive will continue to encourage that. NHS Education for Scotland—the special health board that was established to oversee the education, training and development of all professional staff in the NHS in Scotland—is about to establish a steering group to scope and develop multi-disciplinary training at a variety of levels.
Information is the key to service planning for individuals, localities and the whole country. Local statutory authorities are responsible for ensuring that they have sufficient knowledge of local needs and priorities to inform the pattern of services in their area. The MRC's review of research provides as a background an authoritative overview of the current state of knowledge about the prevalence and incidence of autism. However, we are considering carefully how we can improve data collection on autism.
I am conscious of the time, and that the Very Reverend Graham Forbes is with you; I want to bring him in and ask him whether he is happy with the progress that has been made to date. Is there much more of your briefing statement?
In anticipation of your questions, we have attempted to go through all the recommendations and to try to give you as much information as possible about the work—
If we can have the rest of your statement in writing, that will allow me to bring in the Very Reverend Graham Forbes, who has travelled to be with us. It would be nice to hear from him and to thank him for the work he has done through the expert group on MMR. Would that be okay?
I am happy with that.
Are you happy with the progress that has been made as a result of the work that has been done by you and the rest of the expert group?
The Very Rev Graham Forbes (MMR Expert Group):
Unlike distinguished parliamentarians, I have had sight of what Dr Mac Armstrong was going to say. One of the good things about it is that a positive response is being made to all the things that the group said we wished would happen. The critical thing for the committee is to ensure that Dr Armstrong and the minister are hauled back now and again so that the matter does not remain on the headline-grabbing agenda—"MMR this" and "MMR that" and so on. One of the sobering aspects of the 12 months in which I lived with the project was my discovery that there are 7,000 children in Scotland today who have ASD. There are also probably 30,000 adults who have it, but where are they? We know where only some of them are. Dr Armstrong alluded earlier to conducting the audit. That sort of activity is absolutely essential and if we can continue it, genuine progress can be made. I give a warm welcome to the fact that action is now being taken. My advice to the committee is not to ease up on the pressure.
I thank you for you attendance and I thank the CMO and the minister for theirs. It has been an interesting meeting.
Meeting continued in private until 13:00.