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.

The worries I have are in regard to Condé Nast’s GQ, which is edited by one Dylan Jones. In 2006 GQ featured David Cameron on its front cover, a rather surprising departure from the disrobed Hollywood sirens who usually adorn it. There is nothing necessarily wrong in the leader of the Conservatives starring on a magazine cover, I guess, but as a subscriber to GQ (a valentine’s day present), I have noticed the distinguishable stench of political bias throughout the magazine of late. (more…)

• The IPPR challenges a union \ left-wing shibboleth in highlighting that at least some of the problems we see in education can be attributed to poor teachers. “[I]n the last ten years teachers’ pay has improved and the number of people choosing teaching as a career has increased. But teaching is still not attracting the very best graduates and poor performing teachers are not being dealt with effectively”
• They also carry an worthwhile report on the complexity of UK migration numbers - half of those who’ve arrived from new EU members since May ‘04 have now left but I think the Daily Mail missed that story.
• “New Labour is now dead” - according to Compass who, to be fair, have been trying to administer last rights since about 1998. Last Thursday’s results have boosted their confidence somewhat - “The strategy that saw the Party continually triangulate interests and concerns, tacking endlessly to the right, doing what the Tories would do only doing it first, fixating on a mythical middle England and denying that free market policies are having a damaging effect on society is now finished”
• Also on Compass Hilary Wainwright takes a pop at the impact triangulation has on traditional supporters and one of their regular ‘thinkpieces’ tackles ‘Capitalism and Social Recession’.
  Anthony Painter also did a write-up on LC after a Compass event here.
• The Social Market Foundation have an interesting piece on individual behavioural change and the challenges policymakers face in linking that with broader cultural changes.
• CentreForum have a great (and timely) piece on whether Liberal Democrats and Conservatives can co-operate. David Cameron and Nick Clegg are “two declared liberals [who] share a vision of a new, ‘post-bureaucratic’ politics in which power is devolved, not just from central to local government, but from government at all levels to individuals, families and communities”

This seems to be his main tactic - either lie about what your party believes in, ignore anything your party may have believed in the past, or preferably believe nothing at all.
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Will it last? I fear that Boris Johnson’s critics are already repeating the mistake they made during the campaign, as I argue in a New Statesman column on the Mayoral race fallout.

Gleefully anticipating a gaffe-filled mayoralty that will wreck David Cameron’s project helps Johnson to set expectations very low. Johnson benefits as much as Ronald Reagan or George W Bush ever did from being seriously “misunderestimated”. Which other candidate would have got away with floundering and being roughly £100m out on their sums for buses in the televised mayoral debates?

But if he merely remembers to put his trousers on every morning and get to work, Johnson’s mayoralty will be acclaimed as a triumph. But the real test must be the same any other mayor would face: delivery. That - with Johnson presented as a hands-off “chairman of the board” - is truly a test of the Cameron project”.

Rather than expecting a total fiasco, we should be scrutinising what the Tory modernisers want to do with power.

Perhaps the (conservative) answer will be not very much at all.

Anthony Painter - Thinks Hillary should manage her climb-down carefully, for the benefit of Obama and the Democratic Party. Interesting position, and one which lends itself nicely to the idea, floated by Mike Smithson, that Obama may pay-off Clinton’s campaign debts.
David Brooks - Arguing that the Tories’ greater emphasis on society may prove to be the road to salvation for a struggling Republican Party.
BBC Magazine - A Surrey based company is this month to launch the National Staff Dismissal Register, a business service that will monitor employee dismissals and allow prospective employers to check against the register for alleged accusations - proven or not… Several major employers have signed up.
Remembering the Ability in Disability - Kudos to the BBC, which now offers subtitles on 100% of its programming.
Dave Cole - Boris, by banning alcohol on the tube, has not only indulged in the worse sort of un-enforcable gesture politics, he has proven himself a hypocrite. (more…)

We are increasingly aware of the public consequences of private decisions – but where do we draw the line? These are the questions posed by The Politics of Public Behaviour, published by Demos today.

The liberal case against intervention from government in these issues is easy to make.

Libertarians argue that it instrumentalises citizens, reducing politics to the achievement of goals established not by people themselves, but by a small governing elite who believe they know best.
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Today, we publish 24 reasons for 24 weeks, as part of our own campaign to fight for women’s rights to abortion.
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westmonster - From that most industrious governmental department, The Office for Placating the Daily Mail, comes Labour’s latest muddled U-Turn: smoking pot is again a heinous and terrible crime, which may result in 14 years in a PlayStation-adorned redbrick gulag.
Obsolete - Unsurprisingly, septicisle is similarly unimpressed with the drug’s reclassification.
Love and Garbage - It seems that those high flying Labour egg-heads, weren’t the bee’s knees after all.
tygerland - Where I convey my exasperation at being forced to watch Hillary flush more of her fading credibility down the toilet.
Karl Rove - Bush’s former chief strategist observes the race and concludes it’s over for Hillary. He also agrees with me, that McCain is the best candidate to beat Obama.
Political Betting - Suggests that with Hillary’s debts rocketing, Obama may simply pay her off.
UPDATE: Missed this, Robin Lustig makes a prediction. Brave man!
Alix Mortimer - At tea-time with Clegg, Alix finds that Cameron really is a vacuous “PR tosser”.

I’m much more sceptical about Obama than many people I know (including many around here). In practice, I don’t think he’ll be as progressive as is wished or assumed, nor Clinton as regressive as her campaign has sometimes sounded. Andrew Stephen in the New Statesman is right:
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First to Cruddas’ contribution. He counselled that the Conservatives have changed, not just in terms of style but in terms of philosophy as well and Labour underestimates that at its peril. Moreover, and anyone who followed the London Mayoral elections can vouch for this, they have adopted a new emotionalism to their political language. Labour’s language by contrast is managerial and aloof.
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A few years later, my partner and baby daughter were abducted outside my house. (more…)

rhetorically speaking.. - Fisking Nadine Dorries’ “twenty reasons for twenty weeks”
EarthPal - A take on the abortion issue that isn’t distorted by politics.
NHS Blog Doctor - Dr. Crippin takes a professional position, and decides that 20-weeks (with provisions for extenuating circumstances) would probably be a good idea.
OurKingdom - Fighting money-grabbing councils is easy when you press-gang David Cameron in the butchers.
Anthony Painter - Writing for Labour Outlook, Painter asks: “What can Labour learn from the Democratic primaries?”
Finally… Are the Republicans really waging a “war on science?” Michael Gerson argues not, but Crooked Timber’s John Quiggin takes him to task.

If you’re still looking for something to read, Justin has an eclectic basket of links he has picked for you.

First, a bit of background.
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She and a claimed ‘coalition of 200′ MPs are calling for a reduction in the time limit on legal abortion from 24 to 20 weeks, despite a lack of evidence that fetuses can survive outside the womb before that point and despite the fact that most women are against further reductions in the time limit.
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Purnell will declare today that Labour can still beat the Tories in the fight against poverty because it is willing to stump up the money and is committed to tax credits.

“Both their goal and their policies are just aspirations,” Purnell will say. Mocking the Conservatives’ approach, he will say: “It would be nice to reduce child poverty. It would be nice to put more money into the working tax credit. But nice isn’t good enough. Until they pass the test of hardening their commitment and costing their policy, they cannot claim to be committed to ending child poverty.”

Ah, yes, child poverty. It’s strange how this government’s modest redistribution, so modest that it may have lifted some children out of poverty but has done nothing whatsoever to alter overall inequality, only gets mentioned when the going gets really tough. It screams of desperation, of someone begging their lover not to walk out the door, bumbling, “but, but, look at all we’ve done for the poor kids!”

In any case, Labour’s pledge to end child poverty is just as much an aspiration as the Conservatives’ policy announcements are: it’s simply unattainable and completely unrealistic without far more targeted help being provided, and Labour doesn’t have either the will or the funds to do it with. The less said about tax credits, the most hopeless and over-egged panacea of all time, the better.
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Jock Coats - A beautifully written personal narrative of Jock’s recent candidacy in Oxford. Some interesting political ideas, too.
Spy Blog - A reports has legitimised fears that CCTV cameras aren’t the great panacea for street crime. So exactly why are we the most watched nation on Earth?
Cassilis - Liam Murray’s debut blogosphere review showcases an eclectic choice of stories and a soothing and informed delivery.
Ann Black - Over at Labour Outlook, Ann asks: What’s next for Labour?
The Daily (Maybe) - “The real anti-fascist work is in creating social solidarity. To repair a society where we have communities with no sense of community. To present a positive alternative and to, put simply, make people happier.”
John Angliss - Also over at t’ (Maybe), a guest post discusses the politics of Guernsey, where there are no political parties, and therefore, no whips! (more…)

Now I have always thought that the ‘no-platform’ approach is wrong. To deny the far-right a voice is to give them a status that they do not deserve.
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Tim Worstall - South-East Asia’s rice-producing countries are considering creating an Opec-style cartel to control prices. Demand = Power.
Earthpal - On a similar note, EP is outraged at the international agribusinesses that are making gargantuan profits from rocketing food prices.
EU Referendum - Don’t blame growing demand in China and India for the food crisis, blame Biofuel and the CAP.
minority report - If Boris is serious about crime, he needs to tackle “anti-social behaviour and marginal crimes”. There are no big fixes, only little ones.
John Band - The first test for Boris will be whether he sacks Ken’s successful appointments, such as transport commissioner Peter Hendy and London Underground MD Tim O’Toole. Will BoJo resort to petty partisanship?
Question That - Ken was constantly berated by the Standard, but who’ll keep Boris in check? Also, say hello to Boris Watch.
The Poor Mouth - Jams reports on the battle for the right to call oneself a Lesbian from Lesbos.
Indigo Jo Blogs - Mad Mel has penned another slavishly pro-Isreal piece in The Spectator. IJB finds almost all her points infuriating.