MMR Vaccination
The next item of business is a debate on motion S1M-1624, in the name of Tommy Sheridan, on the national health service. There is one amendment to the motion.
On a point of order, Presiding Officer. Can you indicate how many back-bench members it will be possible to call in the debate?
I hope to call as many as I can. Obviously, that will be dictated largely by the amount of time that each member takes and more names are appearing on my screen as I speak. To be honest, it is almost impossible to predict how many members I will be able to call. I will monitor the situation and try to call as many as I can.
During nine years as a councillor and two as an MSP, I can say without fear of contradiction that the most heart-rending and frustrating cases to present at my various surgeries have been those of the mothers and fathers of children who, the parents said, had hitherto been normal but who had developed autistic spectrum disorder, along with Crohn's disease and other bowel irregularities. The number of cases has risen markedly over the past 10 years and, almost without exception, those parents believe that there has been a causal link between the MMR triple vaccine and the development of autism.
I will be absolutely honest: I do not know for sure whether there is a causal link between the MMR triple vaccine and the development of autism. However, in the midst of so little research into autism, and so little understanding of it—especially of the reasons behind its markedly increased incidence over the past 10 years—who can really be sure that there is no causal link? Who can really be definitive? Who can say, hand on heart, that the MMR triple vaccine is totally unrelated to autistic spectrum disorder?
The argument is not black and white. It involves fears, misunderstandings, instincts and much healthy scepticism. Make no mistake: the motion is not against vaccination. Vaccination against measles, mumps and rubella must be promoted and encouraged across the whole of Scotland. The motion simply asks for the return of single vaccines for at least a five-year period, during which time proper, reliable and extensive research into autism and the causes of its increased incidence can be produced.
If the MMR triple vaccine is not responsible for the increased incidence of autism, the reasonable and legitimate question from an increasing number of parents will be: "What is?"
I am not saying that the triple vaccine should be replaced by single vaccines. I am saying that single vaccines should be an alternative. There should be a choice. Many parents will continue to choose the triple vaccine for their children and they should have that choice. However, the choice of single vaccines, so readily available in the countries that are mentioned in the Executive's amendment, should also be available here.
A report from the Committee on Safety of Medicines concluded in June 1999 that the MMR vaccine is safe, yet buried away in the middle of the report, it said:
"We could not prove or refute a connection between MMR and autism."
No wonder there is so much confusion and fear.
I move,
That the Parliament notes the increasing concern expressed by parents and many in the medical profession across Scotland regarding the triple MMR vaccination for measles, mumps and rubella and agrees, in the interest of addressing this serious public concern and in order to maximise choice for worried parents in relation to these important vaccinations, to allow immediately single vaccinations across the National Health Service in Scotland for at least a five year period, during which a detailed study of autistic spectrum disorder should take place and its incidence throughout Scotland should be closely monitored.
It is regrettable that Tommy Sheridan has brought forward the motion in this manner today. We must be mindful of the public health implications of anything that we say on the subject and we would be well advised to pay heed to the overwhelming weight of medical opinion in this country and throughout the world.
Some members may have seen today's press release, which deplored Tommy Sheridan's proposal, from the Royal College of Nursing, the Royal College of General Practitioners, the British Medical Association, the Faculty of Public Health Medicine, the Royal College of Physicians and the Royal College of Paediatrics and Child Health. As John Garner, chairman of the BMA in Scotland says, there is
"a very clear link between low rates for vaccination uptake, increased incidence of life-threatening complications from measles and the use of separate vaccines. Parents who wish to exercise the precautionary principle should arrange for their children to receive the MMR vaccination."
On the alleged link between MMR and autism and inflammatory bowel disease, the fact is that vigorous scrutiny by a number of independent expert groups has established that the evidence does not support any such association. Both the Joint Committee on Vaccination and Immunisation and the Committee on Safety of Medicines, which advise UK health ministers on those issues, are unequivocal that, on the scientific evidence available, there is no causal link of that kind.
Will the minister give way?
As I say, it is regrettable that the subject has been brought up in a 30-minute debate. I have three minutes, so I am forbidden by the nature of the debate from taking interventions.
The evidence to support the safety of MMR is much greater than that for the single vaccines. MMR vaccines have been through a licensing process that requires safety and effectiveness to be carefully reviewed before a licence is granted. Nor is there any evidence that single vaccines are more effective. There is every reason to expect that they are less so.
The MMR vaccine is now used in more than 30 European countries as well as in the USA, Canada, Australia and New Zealand. Since its introduction, more than 250 million doses have been administered, with dramatic reductions in the incidence of the three diseases and in the deaths caused by measles. The World Health Organisation regards MMR as
"a highly effective vaccine which has such an outstanding safety record".
I cannot speak in detail about the recent Finnish study, but some members will know that, when MMR was introduced in 1982, the Finns set up a countrywide surveillance system specifically to identify serious adverse effects associated with it. By the end of 1996—and 3 million doses delivered to 1.8 million individuals later—the authors concluded that
"no cases of autism were associated with MMR during this 14 year follow-up".
Tommy Sheridan calls for research. That is precisely what is happening now in the Medical Research Council. We are funding a major study, with the UK Government, into the causes of autism. The Executive recognises the real concerns of parents. Parents are bound to be confused when conflicting reports appear in the media. That is why we regard it as important that parents are provided with the best possible advice on MMR and single antigen vaccines. We are determined that they will get that.
I urge members to support the amendment in my name and to oppose Tommy Sheridan's motion.
I move amendment S1M-1624.1, to leave out from "the increasing" to end and insert:
"that the MMR vaccine commands the support of all the major health organisations in the UK, that it is recommended by the World Health Organisation, that it is used in over 30 European countries, as well as in the USA, Canada, Australia and New Zealand and that the two UK independent expert committees, the Joint Committee on Vaccination and Immunisation and the Committee on Safety of Medicines, remain unequivocal that, on the scientific evidence available, there is no causal link between MMR vaccine and autism; further notes that there is in progress a major study funded by the Medical Research Council into the causes of autism, and agrees that, in the best interests of all Scottish children, there is a need to present to concerned parents the facts about MMR and single antigen vaccines in an objective, accurate and responsible way."
The issue is complex and it is impossible to do it justice in a half-hour debate.
There is no evidence of a link between the MMR vaccine and autism but, equally, there is no evidence that such a link does not exist. Therefore, politicians must act responsibly and do or say nothing to increase parents' concerns. However, responsible behaviour by politicians also means that we must respond to the reality that an increasing number of parents are concerned about the MMR vaccine and nothing that we say or do this morning will change that or convince them that there is no danger. We should remember that following the BSE crisis there is public scepticism about Government assurances.
Whether we think parents' concerns are justified or not, they are real. The danger is that, deprived of any other option, some parents are choosing not to have children vaccinated, leading to a possible increase in the incidence of measles, which none of us wants. So my question to the Deputy Minister for Health and Community Care is, is giving people the choice of the single vaccine not the answer? It may well be that the absence of that choice and the perceived intransigence of the Government are helping to fuel public fears.
The Executive amendment notes that most European countries, the USA and others recommend the MMR vaccine. That is true, but the amendment does not mention that in many of those countries the single vaccine is also licensed, so those parents are given a choice that parents here do not have. Why do we not do the same? There are concerns about the time lag and about whether parents will take children to be vaccinated on three separate occasions, but we should not forget that many of the parents who would opt for the single vaccine are at present opting not to have their children vaccinated.
We do not need dogmatism from the Government, we need pragmatism. That would mean recognising the concerns, even if it does not mean accepting their basis. James Kennedy of the RCN, in the press release that the Deputy Minister for Health and Community Care referred to, said:
"It is vital that parents do not feel dictated to."
Parents are being dictated to. They should be given the choice that they want to help calm current fears while independent research is carried out—I stress the word independent—in which parents and the public will have confidence.
I am disappointed that the Health and Community Care Committee report on the MMR vaccine, which is in mid-progress, has not yet been referred to. Because that report is incomplete, the timing of the debate is discourteous. The committee's principal spokesman on the issue is Mary Scanlon and I do not want to jeopardise her report by saying too much. If we want to reintroduce confidence in the system, the debate should have been delayed until a considered Executive response to the committee's report was available.
The Conservative party is concerned that public debate has led to such a lack of confidence that there is now a serious threat to public health. It is not good enough to rely on the small amount of scientific evidence. The Executive must take active measures to reassure people or to solve the problem pragmatically. My experience with syndromes or conditions in the armed forces, such as gulf war syndrome or post-traumatic stress disorder, is that the medical profession can be far too hesitant about addressing the circumstantial evidence, at least until it stares it in the face. There is considerable fear in the community that there is a link between autism and the MMR vaccine. The legal case in England brought by 500 parents shows that parents are acting on that concern.
It is always good to hear a socialist such as Tommy Sheridan arguing for choice. Why has the Executive made this such an issue? Why are we not allowed to make a choice? As Nicola Sturgeon said, the Executive's amendment says that MMR is used across the west, but so is the single vaccine. I am sure that that was a deliberate omission by the Executive. Why is the Executive risking knocking public confidence, at the expense of public health in Scotland? The ideal proportion of immunised people to ensure minimal risk of disease is 95 per cent. Because of the recent concerns about autism and MMR, vaccinations in Scotland have dropped below that level. The pragmatic solution is to rebuild public confidence by offering parents a choice.
We will support the Executive's amendment because we believe that, until things are proved one way or the other, a constant is best. However, before doing so we seek assurances. The first is that the present MMR programme will be reviewed while the MRC study is being completed, and that once the study is completed the Executive will take measures to offer more choice. The second is that the Executive will act if the report of the Health and Community Care Committee comes down on one side or the other of the argument. That is a test of the Executive—will it take the Health and Community Care Committee's report seriously?
The debate is far too short, but it raises again the concerns that were expressed in the member's debate introduced by Lloyd Quinan some weeks ago. That debate was well supported, showing the concern of MSPs from all parties and our wish to ensure that a clear message goes out to parents that a good uptake of the vaccination is essential. Measles, mumps and rubella have serious dangers. In the 1987 outbreak of measles, 16 children died. Mumps used to be the leading cause of viral meningitis in under-15s. Rubella can affect the unborn child in dreadful ways.
Ben Wallace mentioned the report from the Health and Community Care Committee. I will reserve my position until I see the work undertaken by Mary Scanlon, who sends her apologies. She is attending her mother's funeral. She said that she was happy for members to be told that; conscientious as ever, she would otherwise have taken part in the debate. Mary has been working on a wide-ranging report, which the committee expected to have by now, but we hope to have it within the next two weeks. I hope that the Parliament will have the opportunity to debate the issue again once that report has been digested by the Health and Community Care Committee and by the Executive.
There are two main concerns. the first is the safety of the MMR vaccine. I am not an expert—I cannot say whether it is safe. Most of the medical evidence, as we have heard today, suggests that it is, but we cannot be 100 per cent certain. There is also the evidence from Andrew Wakefield at the Royal Free Hospital and School of Medicine in London. Most important, there is heart-breaking anecdotal evidence from parents who believe they have seen a causal link between the MMR vaccine and autism in their children. We do not know whether the alarming rate of increase in autism is due to increased diagnosis or to that link. That is why I welcome the MRC research on autism.
The second concern, which is where we politicians come in, is about the efficacy of the vaccination programme. We cannot just blindly say that we think that something is right, so we will not listen to parents' concerns. Parents have no choice at the moment. While I agree with much of what was said in the press release by the RCN, the BMA in Scotland and others, I take issue with the paragraph saying that
"Parents should be encouraged to discuss any concerns they have regarding the vaccination with their GP, practice nurse or health visitor who will be able to provide detailed information allowing the parent to make an informed choice."
What is the choice? It is MMR or no vaccination at all. Is that a real choice? I am looking forward to our report setting out a range of options. The single vaccine is not necessarily the panacea that some people believe—it is untested, untried and brings problems of its own. I will wait until our report comes out before taking a final position on the matter. It is a complex issue and one to which Parliament must return when we have a little more than three minutes each in which to discuss it.
We move to the open debate. Members have no more than three minutes each.
Tommy Sheridan opened the debate by saying that he does not know whether there is a causal link between MMR and autism—that goes for most members, if not all. However, we know that there are parental fears. We have all met parents who have real concerns. No matter how many reassurances are given by the Government, the BMA or anyone else, a sizeable minority of parents will decide not to give their children the MMR vaccine.
We must accept that over the years there has been growing public scepticism about Government reassurances. Rightly or wrongly, people no longer accept everything that the Government or the medical profession says. What can we do? We must accept that the result is that some parents will choose not to vaccinate their children. That is the worst possible outcome and puts children in real danger. Margaret Smith made an important point. The BMA press release talks about "informed choice", yet people are being offered no choice. What is the choice? It is our responsibility to take a pragmatic approach to the matter. In those cases where parents are refusing MMR, we should consider offering a single vaccine—measles in the first instance, followed by mumps and rubella after the required period.
The problem will not go away. Parents will not change their minds on the vaccine. I look forward to the report of the Health and Community Care Committee, which is likely to be both informative and useful. However, at the end of the day, we will have to come to a decision. We should offer parents the choice that they require and deserve. I hope that we can reach a point where we agree on that.
Some of what I was going to say has already been said, but I will emphasise some points. We have already had a member's debate, initiated by Lloyd Quinan, which raised many of the concerns about the MMR vaccine. I am sorry that I missed that debate.
Debating this motion when the Health and Community Care Committee is on the point of receiving its report is almost a discourtesy to the Parliament because it bounces us into making decisions. I will vote against the motion, although I will keep an open mind on the Health and Community Care Committee report. I look forward to discussing the issue once I have been able to consider all the evidence. I say that as someone who has read much of the evidence and many of the studies.
The first challenge to the vaccine is that it is not safe. Dr Wakefield recently attacked the vaccine as unsafe and suggested that it had been inappropriately licensed. That is invalid for two reasons. First, as Malcolm Chisholm mentioned, the number of doses that has been used across the world demonstrates that there are no real safety fears. Secondly, there are the results of the initial Finnish twin study, published in 1986, which met the strictest scientific criteria. The study was unique and classical—it was a placebo-controlled, double-blind twin study and demonstrated the vaccine to be safe.
Not only is the vaccine safe, evidence published last year by the Finns in the Journal of the American Medical Association demonstrated positive benefits. The Finns were also considering another theory, which is held there and which was suggested here by a doctor—I am sorry to say—in an article in the Daily Record not so long ago: that measles is not that bad because it somehow helps the immune system. That is complete and utter rubbish. The Finnish study shows that the levels of asthma, eczema and allergic rhinitis in children who receive MMR is reduced by between 32 and 67 per cent when compared with those who have had measles. That was a substantial study showing that the MMR triple vaccine has benefited the prevention of those diseases. I hope that we will be able to demonstrate that in Scotland, too.
There is no doubt that the individual measles vaccine was an effective vaccine. However, the level of measles in Scotland did not drop until the introduction of the triple vaccine. It was not until the mid-1990s that vaccination levels meant that the appropriate reductions in infection were achieved.
Will the member give way?
I am sorry, but I do not have time.
The member has 30 seconds left.
As Margaret Smith said, measles causes death and disability, mumps causes significant disability and brain damage, and rubella causes serious problems for unborn children. Even if the link were to be proved, the situation is not simple. As I said, I will keep an open mind until we receive the Health and Community Care Committee report. I look forward to seeing the evidence from the Dáil, the Irish Parliament, which is discussing the same issue. My last comment—
Very briefly, Dr Simpson.
It is my last comment. In Japan, when the MMR vaccine was withdrawn, within a short time, there was a significant measles outbreak. The message must go out that no link has been proven. On that basis, the MMR vaccine should be promoted to the greatest possible extent.
As Dr Richard Simpson well knows, the Japanese equivalent of the British Medical Association has said that the measles outbreak is a direct result of the lack of uptake of MMR and the failure of the Japanese Government to instruct immediate access to single vaccines. The gap period created the measles epidemic.
The simple fact about the Finnish study is that 187 children were tracked—not the number of doses that were administered during that time. The figures are misleading. It is true that a certain number of doses was administered during the period of the study, but the study itself followed only 187 children.
Whether there is a link between the MMR vaccine and autism cannot be proved one way or the other. There is a simple reason for that: we do not know what causes autism in the first place. To talk about a causal link or lack of one is to hold a discussion on an irrational premise, because we do not understand what causes the syndrome. I am standing here to say that I have received correspondence from people in every constituency in the country expressing concern and telling me that there is a network of people who have decided, because of their fear, not to take up the MMR vaccine. If we want to prevent a measles outbreak, we must give access to the single vaccine, as of today. I appeal to Labour members to support the motion on the basis of the precautionary principle. That is what the people want—Richard Simpson knows that, as do I. I urge members to confirm that today at 5 o'clock.
Although the Executive deplores the circumstances of today's debate, we are keen to have detailed discussion on the subject. That is why the Executive has invited Professor Michael Langman, chair of the Joint Committee on Vaccination and Immunisation, to a meeting in Edinburgh next Tuesday morning. We have invited both the Health and Community Care Committee and the cross-party group on autistic spectrum disorders to attend, as well as health professionals. That will be a helpful opportunity to learn at first hand why the independent experts are in favour of MMR and against the single vaccine approach.
Offering single vaccines as an option is not the simple solution it is represented to be. Dr Wakefield—to whom both Margaret Smith and Dr Simpson referred—has suggested there should be a 12-month gap between the three vaccinations. However, there is not a shred of evidence to inform that advice. For 12 or 24 months, the child concerned would be exposed to infection by mumps, measles or rubella, which can result in death or serious illness. The potential consequences are not confined to that one child but, importantly, may affect any other unprotected child or adult with whom that child is in contact.
Lloyd Quinan refers to the precautionary principle, but there is nothing precautionary about the unnecessary exposure of infants to potentially serious infections. Children having to have three vaccinations, rather than one, would suffer increased trauma at 12 to 18 months of age, and would require three booster doses, instead of one, at three and a half to five years of age.
Nicola Sturgeon asked for choice, but there would be enormous difficulties in presenting a single vaccine option to parents. I remind members that 93 per cent of parents in Scotland take the MMR option for their children, and that most of them have been supportive of that particular vaccine. Providing an alternative would immediately place a question mark against MMR. Far from being reassured, parents would be utterly confused by being offered a choice, and children would be put at unnecessary risk.
We must ensure that parents are given the best possible advice and information about MMR and single antigen vaccines. That precise point was made by James Kennedy of the RCN, to whom Nicola Sturgeon referred.
We have a responsibility to present the facts in a responsible, measured way. That is what the Executive will continue to do. The key point is that MMR is a proven measure and there is no basis for linking it to autism. I therefore ask members to support the amendment.
The minister finished his speech with a statement which I hope he will reconsider. He said that there is no basis for linking the MMR vaccine to autism. The minister admitted that there is not enough research on or understanding of autism to rule out the link with the MMR vaccine. MMR may not be a causal factor, but there is simply not the evidence to rule it out.
I disagree with the minister's statement that parents would somehow be over-confused if they had a choice between vaccines. The rest of Europe does not have a problem providing that choice. The minister says that it will not be simple to provide it. No one in the chamber is saying it would; nor is anyone saying that this is a black and white issue. It is difficult and it will cause continued debate, but if we have confidence in the triple vaccine, surely that should not be a barrier to allowing parental choice on the matter of single vaccines.
I will welcome the Health and Community Care Committee report when it is issued. I had hoped that it would be available by now, as originally it was going to be available by today. Over a year ago, I gave a number of parents a commitment that I would use part of the once-a-year opportunity given to the Scottish Socialist Party to raise issues to debate MMR vaccination. That is why it is raised today, in a time scale which is not of my choosing. Although the minister commented that various organisations had condemned me for raising the issue, he failed to mention parents. The voices of parents are saying quite clearly that they want choice.