The sharp fall in the take-up of the MMR vaccine is a cautionary tale of our times. The World Health Organisation advises that a 95% take-up rate should be targeted for “herd immunity”.

Britain falls well short, largely because the unfounded scare about the safety of the MMR vaccine behind the sharp reduction in take-up, from 92% in 1996 to 80% in 2004 (though there has since been a smaller reversal).

The consequences have been serious.

2006 saw the first death from measles in Britain for 14 years, while there were . And while the mumps epidemic in the UK in 2005 had more to do with children not being immunised before the introduction of MMR in 1988, a loss of confidence and a lack of take-up would make future occurences more likely.

Next week’s Fabian Review health issue seeks to reopen the public debate about how to raise immunisation rates.

Public intuitions are divided between a belief in collective immunisation and an instinct that parents should decide for themselves. A new Fabian/YouGov health poll asked whether the government should do more to increase the number of children who are immunised. 63% agreed that they should “because immunisation only works if everyone is covered” while 31% opposed this on the grounds that “whatever the experts say, it should be up to families to make this choice”.

The majority view there is an important public policy issues here is also emphasised by the astonishingly striking variations in take-up rate, as low as 11.7 per cent in Westminster yet 91.1 per cent in Chelmsford in 2004/5, with London achieving a rate of only 57.2 per cent against 80.4 per cent in the north-east, as a study of official NHS figures by the Chartered Society of Physiotherapy found.

So what should be done?
Mary Creagh MP makes a number of well-informed proposals in the magazine.(Despite some newspaper reports today, these are proposals being put forward in Fabian Review to inform the public debate, and are not Labour party policy. Creagh is widely respected for her knowledge and campaigning on health issues, was invited by the Prime Minister to chair the party’s manifesto group on public health issues, including inviting MPs and party members to submit ideas, but that is of course not the same as having the final say over policy.

Creagh’s ideas include extending routine vaccinations to include chickenpox and rotavirus (winter vomiting disease) and including children under two in the annual flu vaccination programme. She also proposes making MMR catch-up sessions for five year olds standard in every part of the country before they start school, and asks whether Britain should emulate the US policy where, alongside moves to ensure that low income children are not left unvaccinated, children can only start school where parents provide proof of vaccination (with exemptions on medical or religious grounds).

A BMA spokesman offers the unhelpful kneejerk response that this is ‘Stalinist’. The proposal will be controversial. But the USA - the land of the free - does not see this as an anti-freedom measure. Nor does France.

The BMA has previously recognized this, in setting out a rather more thoughtful policy statement of support for MMR while opposing compulsion. The truth is that much of the devil is in the detail. A BMA study in 2003 sets out how this issue is dealt with in a number of countries. (Full report (PDF)

Its description of the Canadian approach demonstrates how a much greater focus on collective responsibility can be balanced with safeguards for individual conscience:

Immunisation cannot be made mandatory because of the Canadian Constitution. Only three provinces have legislation or regulations under their Health Protection Acts to require proof of immunisation for school entrance. Two provinces require proof for diphtheria, tetanus, polio, measles, mumps, and rubella immunisation and the third requires proof only for measles. Exceptions are permitted in these three provinces on medical or religious grounds and reasons of conscience. Legislation must not be interpreted as to imply compulsory immunisation. Requiring proof of immunisation for school entrance serves two main purposes.

Firstly, parents who have forgotten to have their children properly immunised will be reminded and can rectify the situation. Secondly, parents who do not wish their child to be immunised must actively refuse and sign documents attesting to that fact. Also, all provinces and territories have regulations that allow for the exclusion of unvaccinated children from school during outbreaks of vaccine-preventable diseases.

Seeking to adopt a similar approach could well deal with many of the objections to a ‘compulsory’ scheme, while providing levels of ‘herd immunity’ and so saving children’s lives.

In a separate proposal in Fabian Review, former BMA chairman Sir Sandy Macara floats the idea of linking child benefit to the MMR vaccine. His argument is that such a universal benefit could appropriately be linked to a collective social responsibility. (Attaching such conditions to welfare benefits, such as income support, would be inappropriate).

Calls for better government information are easy to make. There have been very sustained efforts to do this. To date, making clear has not been enough to overturn the effects of a small but sustained misinformation campaign.

It is difficult to see how Dr Andrew Wakefield’s controversial study could have been more thoroughly discredited and debunked. The Lancet admits it should never have published; ten of the thirteen authors published a formal retraction of interpretation. The General Medical Council is currently holding hearings to consider charges of professional misconduct which Wakefield denies, though undeclared conflicts of interest were revealed in a lengthy investigation by Brian Deer. (Wakefield began, and then dropped, legal action against Deer, the Sunday Times and Channel Four over their reporting).

But the damage has been done. As the NHS blog doctor caustically commented, Wakefield’s highly flawed study involving thirteen children produced much much more extensive reporting, and had a much greater influence on public perceptions, than “a more authoritative paper which studied 27,749 children” using robust research methodology for such a study.

And there was no hint of any humble pie from the most prominent media campaigners on this issue, such as Melanie Phillips of the Daily Mail, when the Cochrance Review set out the evidence for the all but universally accepted claim that there is “no credible evidence” of any link between the MMR vaccine and either autism or bowel disease. For Phillips, this was simply proof of the scale of the cover-up.

Indeed, today’s Sunday Express tells us that “many experts say combined jabs can have serious side effects and want parents to be offered single vaccines”.

In fact, every significant medical organisation has signed a statement of support explaining why they support MMR, and why they oppose the proposal for single vaccines on public health grounds. The MMR triple vaccine is supported by the Royal College of Nursing, the Royal College of General Practitioners, the British Medical Association, the Faculty of Public Health Medicine, the Community Practitioners and Health Visitors Association, the Royal College of Paediatrics and Child Health, the Department of Health.

But those so-called experts must compete with the Sunday Express’ own expert source: “leading author Dr Richard Halverson, author of The Truth About Vaccines, who has just opened a Harley Street baby clinic offering parents the choice of single vaccines”. (And his price list shows that he quite probably does very well out of it too). According to Anthony Cox’s blog, Harverson has no peer-referreed publications on this subject, nor any publications beyond his book aimed at a general audience and regular appearances in the Mail and Express. It is interesting too that his information for patients is careful to make no claim that the single jabs are safer than MMR. But that work has already been done by the media misinformation.

In this climate, calls for government to supply better information to parents are fine. But, without greater media responsibility, could they ever be enough? We need a serious public discussion about different options to improve rates of immunization. The proposals we have been put forward might win the argument, or alternatives might be suggested. Doing nothing more should not be an option when children’s lives are at stake.