9.5 What went wrong with MMR?
Bellaby, P. (2003) ‘Communication and miscommunication of risk: understanding UK parents' attitudes to combined MMR vaccination’, British Medical Journal, 327, 27 September 2003, pp. 725–28. Reproduced by permission from the BMJ Publishing Group; Mary Evans Picture Library Ltd; P A Photos.
The extent of people's willingness to conform to public health programmes in Britain was and remains considerable. From the Introduction of the MMR vaccination in 1988 until the scare broke in 1998, levels of take up had been high, rising to 92% in 1997, sufficient to achieve population immunity. One estimate based on surveys to date is that take up fell by only 8.6% from 1995 to 2001.17
In 1988, at the start of the MMR campaign, take up was higher in affluent areas-a familiar pattern in Britain and North America.18, 19 Up to 1997, the affluent pattern of take up spread to less affluent areas.20 All the more remarkable then, that, from 1998, take up decreased first in affluent areas and more so than in deprived areas. Even when parents decided for MMR vaccination, a study based on focus groups among the public indicated widespread misgivings.21 A survey of health professionals who provided vaccination for children suggested that parents’ unease rubbed off on the professionals.22
The vicissitudes of the MMR campaign show that “mass communication” is mediated or filtered in different ways, through the diverse groups that comprise society and through hierarchies, including the medical profession. It should be no surprise that the same message conveys different meanings to different people.
The conduct of the media may have contributed to the miscommunication of risk,23 but it would be a mistake to suppose that the media led the public. Parents were predisposed to act in what seemed to them to be the interests of their children. The response of “the establishment” confirmed for some their suspicions that inconvenient truths would be covered up. The handling of the earlier BSE crisis lent support to this view. In the case of MMR vaccination, the chief medical officer would not meet parents’ concerns half way by sanctioning access to single disease vaccinations. The grounds for refusal were reasonable enough: the six administrations required in all (measles, mumps, and rubella, each twice) would increase the likelihood that vaccinations would not be completed. In the United States children under 18 months old are now given protection against 11 childhood diseases, which requires some 15–19 doses of vaccine, and this has driven healthcare managers to seek ways of reducing infant distress and so making the process more acceptable to parents.24, 25 After 1998, many UK parents would probably interpret the chief medical officer's argument as insulting, both to their conviction that they were acting in their children's interests and to their competence as responsible parents to ensure that individual vaccination courses were completed.
In spite of appearances to the contrary, one can argue that parents have behaved rationally, not only with respect to MMR vaccination, but also in relation to vCJD and road transport crashes. The case evokes cultural and social context rather than “economic man.” True, as the economic man argument suggests, parents who refuse vaccination may “free ride” on the compliance of the majority in order to secure the benefit of herd immunity for their child. But, taken together, responses to the three risks we have reviewed suggest that parents are acting conscientiously as norms dictate, not selfishly. They act in what they perceive to be the interests of their children. If there seems to be any risk to their child, responsible parents will avoid it. Thus, they avoid beef products, and they question the safety of the MMR vaccination. Even though taking children to school and elsewhere by car may have unintended consequences for their health and safety, it is interpreted as a way of protecting them from greater dangers on the streets from other road users and abduction by strangers.26