Andrew Wakefield - MMR

[ladywotlunches]

I'm so angry that the media are giving yet more airtime to Andrew Wakefield, the guy that did the original 'research' into the MMR vaccine, and has since been struck off by the GMC.

The guy has been discredited, his research was found to be fundamentally flawed, and no link has ever been proven between the vaccine and autism. All he is doing now is promoting his book. So why do the media insist on letting him speak? No matter how many times they clarify "the position" by stating that its been proved to be safe etc etc, just by having him saying his stuff, casts seeds of doubts into parents minds yet again.

To any parents about to go and get the jab, PLEASE don't take any notice of him, and instead listen to the fact that the media have to tell you every time its safe. Of course its emotional getting any kind of jab for your child, but it could be so much worse for them to get Measles.

[taper]

Agreed. Who's giving him more coverage? The Daily Mail's role in this lunacy is worse if anything than Wakefiled's

[ladywotlunches]

Well (hangs head in shame) "Lorraine" was on while I was having my breakfast and baby was asleep :)

[Moos]

Well said, o lunching one.

Bad Science, not that I'd pay ?14 for a bib but it's funny...

[ladywotlunches]

Moos Wrote:

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> Well said, o lunching one.

>

> Bad Science, not that I'd pay ?14 for a bib but

> it's funny...

Brilliant!

[Curmudgeon]

There is no such thing as a 100% safe vaccine that is safe for 100% of the population

There would be no furore and higher uptake if the whole fiasco had been handled differently by the government and they had offered parents the choice.

And my children had MMR.

[taper]

What choice? Single jabs? Not as effective

[Saffron]

taper Wrote:

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> What choice? Single jabs? Not as effective

From where is this derived? Just curious. I'm not aware of any immunological data presenting single v multiple injections as any different. When I looked into it (a few years ago, I admit), the reason I found single jabs not widely available was that they are not cost effective.

[plimsoul]

this was in the guardian the other day

http://www.guardian.co.uk/lifeandstyle/2010/oct/11/vaccination-fears-developing-world-deaths

not to fan flames of previous threads (plus i didn't fully read the article) but it's interesting...

[fearnpw1]

Ladywotlunches - I agree wholeheartedly.

[Saila]

fearnpw1 Wrote:

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> Ladywotlunches - I agree wholehearted

Me too!

[Jamma]

Single jabs aren't as effective because people tend to miss appointments and not get the whole course. That's the evidence

[Curmudgeon]

Jamma Wrote:

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> Single jabs aren't as effective because people

> tend to miss appointments and not get the whole

> course. That's the evidence

I think you're mixing up evidence with spin

[Curmudgeon]

I have no issue with MMR and no allegiance to Wakefield but I hate this confusion of medical research and spin doctoring.

There is a vaccine damage compensation act (I think it ws 1979 in UK IIRC)

There are cases of children being damaged by vaccines, including MMR and receiving compensation in UK, US and elsewhere

There are some children who are more susceptible to vaccine damage than others

Multiple vaccinations are offered because of cost benefit this does not mean they are the best route for all

Vaccinations do not confer the lifelong immunity that many people seem to assume

[taper]

On the single jab issue, I take my view from this brief by the estimable Sense about Science -

http://www.senseaboutscience.org.uk/pdf/MMRPolicyBriefing.pdf

So not spin. Key section reprinted here:

"It has been be argued that even if the Government believes MMR to be safe, they should provide single vaccines as an alternative because then more children would be vaccinated. However,there is absolutely no evidence to support the suggestion that allowing single vaccines would lead to a greater uptake of MMR, and a significant amount of evidence to show that it would have the opposite effect. Single vaccines would be less effective than MMR and there is no evidence

that they would be safer. Sense believes that it is unethical to promote six invasive procedures instead of two without sound scientific support, and when there is evidence that such a strategy would have negative effects. Problems associated with single jabs include: Delays - these would be an inescapable part of a single vaccine strategy. More children

would be left unprotected for longer, with more opportunity for dangerous diseases to spread.

Missed appointments - over 11 million GP and over 5 million practice nurse appointments are missed every year.15 Single vaccines would require six appointments instead of two: this would be bound to cause more missed appointments and reduced protection against disease.

Not taking up rubella vaccination - parents may opt not to vaccinate their children,particularly their sons, against rubella. This would lead to increased risk to pregnant women.Unvaccinated boys can catch rubella and go on to infect pregnant women, including their own mothers. This is exactly what happened before MMR was introduced.

Lastly, offering single vaccines could reduce confidence in the vaccination programme, which could lead to reduced uptake, putting more people at risk.Given that there is no evidence that single vaccines have any advantages over combined

vaccines and plenty of evidence of the risks, Sense believes that it would be a mistake to offer them.

[EDmummy]

Spin? Not sure about that but the BUPA health information website states the following reasons for the questions of single jab effectiveness.

- Children would need three times as many injections (six in total), which is more unpleasant because of the pain from each jab and six episodes of possible side-effects.

- It could mean that fewer children have all the necessary vaccinations, increasing the levels of measles, mumps and rubella in the UK.

- There may be more delay before being completely vaccinated, leaving children at risk of infection from the diseases for longer.

- Single vaccines aren't licensed in the UK, and have not passed the UK's safety and effectiveness testing.

Certainly point two is proven by disease modeling. I didn't know the final point before I found this information.

[Senor Chevalier]

I haven't read the whole article, but the excerpt seems to relate to the population healthcare economy as a whole rather than the effect on individual patients. The main advantages cited are in relation to improved take-up rate, prevention of cherry-picking of some but not all of the vaccines, fewer appointments to miss etc. I see no clear comparison of the efficacy of a correctly administered combined vaccine versus the individual vaccine program (perhaps it is elsewhere in the article).

The thing with vaccine programs is the need to balance the needs of the individual versus the population. It is classic game theory: every vaccine bears some risk and as long as every one else takes the vaccine then the disease won't spread so you don't need to, but if enough opt out then the disease may spread and so you are at risk if you don't take it.

Anyway overall, I agree that utilitarianism should prevail and that, on balance, the MMR combination vaccine should be the one offered - people clearly can't be trusted to behave for the good of society when it comes to sticking pointy things in their children!

As Curmudgeon notes this may not prove to be the best thing for all people but parents would have no way of knowing in advance and if there were adverse consequences would simply blame themsleves for the choice they made - another good reason to take this decision out of their hands.

Of course if a parent has a child who reacts badly, then consideration should be given to allowing a different approach for future siblings.

[Saffron]

taper Wrote:

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> Single vaccines would be less

> effective than MMR and there is no evidence

> that they would be safer.

It's the wording that's misleading. When one speaks of effect pharmacologically, it is important to distinguish between efficacy and patient compliance. Just because patient compliance is low does not mean single immunizations are less effective pharmacologically.

Also, just because it is true that compliance could very well be low, and multiple injections are more invasive than single injections, does not negate the fact that single injections are not cost effective to pharmaceutical companies.

I have no problem with the MMR, but I do think it's worth debating openly. As for the compliance argument, just for the sake of argument, this principle can be turned on its head. For example, if single injections were avaialble, parents who now opt out of the combined MMR, could have to opportunity to opt in to any single injection; thus increasing uptake in this group.

[Saila]

'Single vaccines are not cost effective to pharmaceutical companies'

How are single vaccines not cost effective to pharma companies?

Don't they sell them to customers such as the nhs? A sale's a sale?

Do u mean single vaccines wouldn't be cost effective to *government or the nhs* as they'd have 3x appointments and therefore higher administrative costs etc?

If it's the same company making the single and mmr vaccines and they charge more for mmr than single, then I could understand if u were being suspect about their intentions. Are they made by the same company do u know? Otherwise I don't understand how its not 'cost effective'

[Senor Chevalier]

Pretty sure Taper meant not cost effective to those procuring it. Clearly Pharma Cos will sell wherever there is a market. Let's not nitpick - the bigger point is the the lack of proper clinical comparison and the misleading missives that blur this fact. Saffron is spot on on this.

[Saila]

Senor Chevalier Wrote:

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> Pretty sure Taper meant not cost effective to

> those procuring it. Clearly Pharma Cos will sell

> wherever there is a market. Let's not nitpick -

> the bigger point is the the lack of proper

> clinical comparison and the misleading missives

> that blur this fact. Saffron is spot on on this.

i'm just not sure this is nitpicking - sweeping statements and aportioning blame to a whole industry that i'm not sure had anything to do with this fiasco is misleading too

There's one villain in all this and that's andrew wakefield imo (and possibly the Daily Mail et al)

[Saffron]

Single vaccines are less cost effective to pharmaceutical companies b/c they have a high production value, but low return. That is b/c they have to be individually produced and packed, which costs more than combined production and packaging. However, very few are sold, as the combined MMR is the current product of choice. So the cost-analysis doesn't work out in favour of single vaccine production in this case.

As for efficacy of single v combined, both single and combined preparations would have been legally required to be tested as such in animal models before entering the market for human use. If safety and efficacy cannot be demonstrated in animals to an acceptable level, the products cannot enter the commercial market.

And finally, Saila, I totally agree... the real idiot here is Andrew Wakefield, making the whole scientific community look bad. What a jerk.

[taper]

By effective, I meant in helping to ensure that immunisation levels were up to those necessary for herd immunity.

[Saila]

Single vaccines are less cost effective to pharmaceutical companies b/c they have a high production value, but low return....

now i am nitpicking.. and i can't believe i'm doing this (on my day off) this has just annoyed me, i'm not sure why.

I think it's because everyone loves to bash pharmaceutical companies. It's sociably unacceptable not to. they really were not at fault here and it's not whether a vaccine is more or less cost effective. It's whether a vaccine is more or less profitable that impacts the choices around manuacturing a product. If the margins are negative, they wont do it. They're not a charity. However if the margins are positive, chances are they will go out and sell it.

i've done a little research (sorry)

sanofi (rubella & measles) and merck (mumps) make the single vaccines, glaxo, merck and sanofi make the mmr vaccine.

the government would have drawn up a contract most likely with *one* of those companies to supply the mmr. They will fight for that contract but they dont' try and 'push' the single one over the mmr one. They'll see what the government wants and apply for that contract... urgh.. sorry about this

One of Europe's most successful pharma companies Roche, invested in R&D and discovered a breast cancer drug called Herceptin. They charge a huge amount for that drug to make a return on teh $2bn it cost to discover it. In just 9 years time it will go generic and we will have a cheap and highly effective drug that can actually cure HER2 +ve breast cancer. How can we knock this system? It's working.. drugs are being discovered and people are being cured.

The public would never of course be happy or grateful that these companies had in fact investing, year over year, in the research and development to discover a safe and effective treatment for loads of diseases incl cancer/diabetes etc etc. Yes their motive is to generate a return but at least they're generating a return from trying to make people better. Tobacco companies make profits by directly killing people. None of their profits go into research or helping their victims, and they really are victims in my view, most likely a portion of their profits goes to pay off litigation costs.

Why is it that pharma companies are such an easy target over say tobacco companies?

rant rant.. separate thread.. sorry sorry

ps i don't work for a pharmaceuticals company and never have

[James Barber]

I think way back when the MMR controversy broke Mercury was used in the MMR preservative formulation used in the UK. It isn't anymore but I can't say I'd like the idea of any child being injected with any amount of Mercury.