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Apr 30 2013

The recent MMR outbreak – what do we really know about the choices parents have made?

There are now over 850 cases of people infected with measles in southwest Wales and one linked death. It is reported that 330,000 children aged 10-16 years old remain unvaccinated and the Department of Health have launched a massive vaccination drive.

The Times are reporting ‘one million children may not have received the full course of the MMR vaccine, in large part because of discredited fears it leads to autism’ and other news outlets are making the same foregone conclusion that the unvaccinated teenagers are the result of informed decision-making by their parents who weighed up the Andrew Wakefield ‘evidence’ published in 1998 and decided they didn’t want to take any possible risk with their children.
It would seem to be an obvious connection to make. Back in 1998 there was a monumental exercise in scare-mongering with newspapers, TV and radio catapulting Wakefield’s scientific paper published in a specialist journal into every family’s home. It is thought that the impact of his supposed findings have extended for years, even despite Wakefield subsequently being struck off by the General Medical Council for misconduct.

It does seem to be an obvious connection to make that the parents were swayed by the autism-link arguments are opted not to have their children vaccinated.We wonder though whether this assumption has been put to the test by actually asking the families involved?

Our work for the NHS and health charities on a broad range of issues reveals time and time again the high levels of apathy that people have about making conscious decisions to maintain or promote their health. Despite the overwhelming case for eating fruit and vegetables, reducing alcohol intake, stopping smoking, attending screening and the list goes on, people regularly do nothing to adopt the behaviours that are recommended by the evidence. In part this can be because they develop ways to dispute the macro, population-level statistics which are the basis for much government guidance.  For every official recommendation some people point to their own micro ‘evidence’ to disprove what they are being told, such as their 90 year old lifelong smoking grandfather, or burger and chip eating mother who has no problems with her heart not diabetes. So it could well be the case that for some people, the evidence for vaccination is not meaningful enough to overcome their apathy.

It might be the case that for some of the parents they don’t believe in the benefits of vaccination in general, rather than just MMR specifically? Given past vaccination programmes have been so successful at almost eradicating certain diseases, people may have become complacent and even disbelieving that their children is at a genuine risk,  or that the impact of the disease is really so catastrophic. So do we know how many of the teenagers without the MMR vaccine have also not received protection for other diseases such as polio, diphtheria, tetanus, whopping cough, meningitis C? For it may be that for some parents feel the benefits of vaccination are too low.It’s possible too that we could be overlooking a host of real practical problems that some parents may experience in getting their children vaccination, such as not being able to reach the clinic or keep their appointment because of transport issues, work commitments, or other illness at that time.

There could too be demographic characteristics, beyond their age cohort, that link these young people and their vaccination behaviour and attitudes. Are there revealing patterns to where are they are in the country, or their income level, or educational attainment of the family that might this help to explain the attitudes and behaviour that have prevented vaccination?
So is it the case that this cohort of parents with young children in the late 1990s and early 2000s have been influenced solely by the the Wakefield MMR and autism debate? Taking a deeper look and unlocking the motivators and barriers to taking up particular health behaviours is complex, but ultimately absolutely essential.  We urge the health officials behind the current MMR vaccination drive to ensure they are truly reaching parents and young people with messages that will speak to how they are seeing the issue.