Strategies to improve vaccination uptake rates

Epidemiological studies have failed to document an association between autism and the measles, mumps and rubella (MMR) vaccine, and the biological mechanisms that may underlie such an association are ill-defined. There is overwhelming scientific evidence that there is no causal link between the MMR triple vaccine and autism. The MMR debate has focused on the pattern of incidence in cases of autism and autism spectrum disorders (ASD) in an attempt to examine Dr. Wakefields’s claims (as per his highly controversial 1998 Lancet paper) and to determine if there is indeed a link between ASD and the MMR vaccine. What is clear is that there has been an increase in the incidence of measles since the fall in MMR uptake rates. We have lost herd immunity for this disease and measles is once again endemic in the UK.

A Commissioning Support for London (CSL) survey (2009) found that socio-economic status influences uptake of MMR with low uptake in both high and low socio-economic groups. It is unclear how health care professionals view MMR because they are professionally bound to follow the healthcare edict but may experience conflicts of interest as parents. A Japanese study in 2005 showed that despite withdrawal from the MMR vaccination programme, autism rates and ASD continued to rise. Moreover, the study showed that the incidence was higher in children born before 1992 when the vaccination was introduced. This destroys any possible causative link between the use of the vaccine and autism. To date, there is no established or proven cause of autism, which is a complex neurodevelopmental disorder.

Single vaccines (though only available privately now) has been considered but does not seem a sensible, feasible or safer alternative. Compulsory vaccination has been proposed but remains controversial, not least of which it does not get the backing of the medical profession. Therefore this proposal is not deliverable and could be counterproductive.

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Primary Health Care 2011; 21(2): 16-21

Primary Health Care Journal is a Royal College of Nursing (RCN) publication.