HC Deb 19 November 2003 vol 413 cc923-32

Motion made, and Question proposed, That this House do now adjourn.—[Joan Ryan.]

2.18 am
Norman Baker (Lewes)

Nineteen hours ago I was attending a breakfast meeting in Newhaven to discuss infrastructure works in my constituency. It seems a long time ago.

The measles, mumps and rubella vaccine is a difficult subject, but it is extremely important for my constituents. I do not profess to be an expert on the matter but I shall do my best to represent constituents who have presented me with a compelling set of circumstances that I feel obliged to raise on their behalf in this debate. I do so with the full support and encouragement of my constituent, Isabella Thomas, on behalf of her children Michael and Terry. I hope that the Under-Secretary has received from my office information giving the history of events.

My constituent has four sons. The two older boys both caught measles during the first years of their life when the single vaccine against measles was not offered. They are both fine. However, the two younger boys both received the MMR vaccine and suffered severe reactions that dramatically changed their lives. Michael suffered mild asthma and breathing problems after his third diphtheria, tetanus and pertussis and polio vaccinations, but was developing normally before he was given the MMR vaccine at 14 months.

Within hours of the MMR vaccination, Michael developed high-pitched screaming and a high fever. According to my constituent, he was like a wild animal; he screamed when anyone touched him and cried day and night. He has been diagnosed with regressive autism and has an obsessive-compulsive disorder. He suffers from auditory hallucinations, increased clumsiness, chronic bowel disease, temperature control problems, severe headaches, loss of memory, breathing problems and rashes. Last year, he was unable to attend school very much due to his health problems. At present, he does not go to school, as no school can meet his needs. It is clear from a psychological report compiled this year that his condition is deteriorating. Medical test results have found the measles virus, consistent with the vaccine strain, in damaged tissue in Michael's bowel and in his blood.

Michael's younger brother Terry also suffered minor reactions to his DTP and polio vaccinations. He was prone to febrile convulsions, but otherwise he developed normally. He walked at 10 months and his development milestones were satisfactory according to his health visitor at the time.

As Michael had had such a severe reaction to the MMR vaccine, his mother was worried about giving Terry the same injection. However, under intense pressure, and after medical advice, she duly had Terry vaccinated. During the night after the vaccination, Terry suffered a fit and within a week he developed excessive temperature swings and loss of skills. Before the vaccination, he was potty trained, but he regressed the very next day. Within two weeks he began to suffer from constipation and chronic diarrhoea. Within a month he appeared clumsy and walked into doors. He stopped talking and would become completely silent. He no longer indulged in pretend play. He now suffers from fits, jaundice when ill, chronic bowel disease, very high fevers, rashes, regressive autism and excessive thirst. His medical test results show that he, too, has the measles virus, consistent with the vaccine strain, in the damaged tissue in his bowel.

As I said earlier, I do not pretend to be an expert in these matters. I merely consider the evidence as a layperson. The Minister may be able to give me some explanations but none has yet been forthcoming from the medical profession. Given the circumstantial evidence, the conclusions that my constituent has reached are hardly surprising.

My only previous involvement in the topic of vaccines was when I raised questions about bovine material in vaccines during an Adjournment debate in this place on 28 March 2000. I was concerned that the use of such material, which could be a transmitter of CreutzfeldtJakob disease, was allowed in vaccines years after it should have been withdrawn. Subsequently, the Government admitted that in a statement. In fact, although it was thought that the risk of the disease was greater from injections than from food, action was taken on food as a transmission route but not on vaccines. Sometimes, when there are questions about the safety of vaccines, Governments, of whatever party, have the wholly laudable intention of not damaging confidence in vaccines generally, which are obviously useful for society, and are reluctant to admit that there may be a problem under certain conditions. That idea came to my mind as a result of that debate on bovine vaccines three years ago.

I need to know how these conditions developed in Michael and Terry. How can they be explained if they are not an adverse reaction to MMR? Should some other medical explanation be forthcoming? The injections were two years apart and the adverse reactions began immediately after the vaccine was administered, so the circumstantial evidence is quite strong.

My constituent, in a letter to me, says: I wanted to keep my children safe from disease and I trusted the system. I thought the system would be structured to protect my children as individuals. I have been naive. The system is structured to protect itself. That is her view on the matter, and I hope that the Minister's response will go some way to reassure her and make her feel better about the situation in which she and her children now find themselves.

I know that the Minister is not responsible for the legal system and therefore cannot say much about that, but my constituent is in a difficult situation. Her anxiety and stress has been exacerbated by a change to the legal aid funding of the class action. Her sons were awarded legal aid to pursue their case for compensation through the courts, but after several years of legal aid, on 1 October, just six months before the test cases were due to go before the High Court in April 2004, legal aid was stopped. Unless a judicial review requires the Legal Services Commission to revise its decision, it will be extremely difficult for her and many other parents to fight the case that they have progressed so far. Purely from the point of view of the use of public funds, it seems rather excessive and bizarre to have expended so much public money up to a particular point, only to pull the rug. There is a question mark in my mind about that.

My constituent believes, rightly or wrongly, that the reactions that have been caused in her children and which have led to these, it seems, permanent conditions are a result of MMR. She holds that view very strongly and communicates it to those in the health service. She feels that because she holds that view, her children are effectively being denied effective treatment to deal with their conditions until such time as she is prepared to deny that MMR is the cause. That may be a misconception on her part, but that is what she believes.

Whatever else comes out of this, I hope very much that we can find a way of providing effective treatment to help those children, because their mother sincerely believes they have been effectively abandoned in many ways by the health service as a consequence of the situation that has arisen and as a consequence of the huge controversy surrounding MMR in the medical profession and society at large. No doctor, it seems, wants to be associated with cases that may be MMRrelated—or at least are in the mother's view—in case somehow there is a problem from their perspective, so the children are effectively denied medical treatment that would help them.

I want to leave plenty of time for the Minister to reply so I will not speak for much longer. My constituent says that she thinks that the Department of Health has failed in its duty of care for her children. In a letter to me, she raises a number of points about the pre-introductory MMR trials, which she believes were inadequate in that they failed to follow up adverse reactions for more than just a few weeks. She says that it took the Department four years to identify and withdraw two of the three original MMR brands that had been introduced into the UK vaccination programme in 1988". I do not know whether that is true. She refers to the two brands Pluserix and Immravax, which she says were withdrawn in September 1992 because they contained a mumps strain that was apparently suspected of causing mumps meningitis. If the Minister has advice on that, I should be interested to hear it.

Is it possible, I ask the Minister, that there was an earlier strain of MMR that was, in her view, less satisfactory than the ones being used now? Would that be an explanation of the situation in which my constituent finds herself? In the opinion of the Department of Health, is there a difference in the safety of different strains or is it the Minister's view that they are all equally safe, as the Government maintain they are?

My constituent says that the vaccine policy makers failed by providing an inefficient monitoring system for adverse events following vaccination. To justify her position on that, she quotes a sentence published in The Lanceton 4 March 1995: There is an urgent need to find more reliable methods of adverse event surveillance. Lastly, my constituent also believes that the Government's senior vaccine officers failed to investigate the children believed to have been damaged. She says that a full list of children then affected was presented to the then Health Minister, the chief medical officer and the principal medical officer during a one-hour meeting in 1997, when the Government were asked to instigate a scientific investigation of the children believed to have been damaged. Such an investigation would have been useful. Is the Minister aware of that meeting? If so, is she able to tell me what progress there has been as a result of the meeting?

I freely admit that, as the Minister will understand, I am not an expert in health matters—my expertise, such as it is, is in environmental matters—but my constituent is extremely distressed. She has two children whose lives have been changed for the worse—it seems, permanently. There is at least a casual link in her mind between the conditions that the children now have and the administration of the MMR vaccine.

The Minister will know just how difficult it is for parents to decide whether vaccinating their children is the right thing to do. There are risks in vaccinating and in not vaccinating. It is a very difficult decision, and my constituent feels that the medical profession encouraged her to take the wrong decision for her children. I hope that the Minister can deal constructively and sympathetically with my constituent's case and give some reassurances that I can take back to her.

2.30 am
The Parliamentary Under-Secretary of State for Health (Miss Melanie Johnson)

I congratulate the hon. Member for Lewes (Norman Baker) on securing this debate on his constituent and the MMR issue. Many other hon. Members and I care greatly about the health and safety of children. Many of us, as parents, well understand the difficulties of deciding whether to have children vaccinated and, indeed, the concerns that any parent must have about the health of their child.

Of course, autism can have a devastating impact on children and their families, and it is only natural that the parents of autistic children want to find out what has caused their child's condition, but it has proved difficult to find such a cause. The Department of Health has already asked the Medical Research Council to consider the evidence. The MRC produced a clear and authoritative picture of what scientific research has revealed about the occurrence and causes of autistic spectrum disorders. The MRC report clearly reflected the current state of knowledge. Like other authorities, the MRC identified a strong genetic component in the causation of autism.

The Government have demonstrated their commitment to finding out more about the causes of autism by allocating a further £2.5 million to the MRC to help it to take forward the recommendations of the report. However, we know that some parents genuinely believe that their children's lives have been damaged by the MMR vaccine. Clearly, the hon. Gentleman's constituency is one of them. Of course, they want to know what has affected their child. However, I have to reassure the hon. Gentleman and others that all the scientific research from around the world comes to the same conclusion: there is no credible evidence linking MMR and autism. That may not be a comforting conclusion for parents who believe that their child's autism was somehow triggered by MMR, but I cannot ignore the evidence and the scientific advice that we have received from around the world.

Perhaps I can put the introduction of the MMR vaccine in the UK into context. The MMR vaccine underwent a thorough licensing programme and a review was carried out in 2001, which was prompted by concerns raised by Andrew Wakefield in a publication in 2000. The Committee on Safety of Medicines concluded that standard procedures were followed and that MMR vaccines were licensed on the basis of satisfactory standards of safety, quality and efficacy.

Pre-licensing trials are normally not large enough to detect rare adverse reactions. That is why procedures are in place to monitor vaccine safety after licensing. Therefore the retrospective call for the original MMR clinical trials carried out in the 1970s and 1980s to be able to detect an increase in autism postulated in the 1990s is not sensible or justified. None of the studies carried out subsequently, however, has provided any support whatsoever for the claims that either bowel disease or autism is associated with the MMR vaccine.

The hon. Gentleman touched on the withdrawal of the MMR vaccines containing the urabe strain of mumps vaccine in 1992. The identification of this issue four years after the introduction of the vaccines is not proof that the clinical trials were inadequate. When the Department of Health became aware of the existence of a potential safety issue with that vaccine strain, it immediately asked the Public Health Laboratory Service to instigate detailed monitoring of possible vaccine-associated cases of aseptic meningitis. Initially, some 28 vaccine-associated cases were identified, which were all in recipients of MMR vaccines containing the urabe mumps strain. This indicated a risk of one case of aseptic meningitis in 11,000 vaccinees. As soon as those data were available in 1992, an alternative vaccine became available which did not have that level of risk and was equally effective. The vaccines were replaced in September 1992. Very rare adverse reactions sometimes cannot be identified until a vaccine is used in a wider population, which is precisely why we have the monitoring arrangements that we do.

To turn to the monitoring arrangements—the yellow card scheme—I cannot go into all the detail in the time available to me, but as soon as the strain was identified, vaccines were withdrawn. That demonstrates clearly that if we identify a problem, we are able to act and respond—[Interruption.]I cannot hear what the hon. Member for Epping Forest (Mrs. Laing) is saying from a sedentary position. If I could, I might be able to respond.

A number of studies cannot find any difference between the rate of autism in children receiving MMR and in those who do not receive it. Other studies have found no sudden increase in autism associated with the introduction of the MMR vaccine in the UK in 1988, no difference in the age of diagnosis between MMR-immunised and un-immunised children, no difference in the MMR immunisation rates between those children with autism and the general population, and no link between the timing of MMR and the onset of autism.

Norman Baker

One thing that I did not mention was some staggering figures on the incidence of autism in the United States, which tend to suggest, taking all the states on average, that there has been an overall increase of 870 per cent. between 1992 and 2002—from 12,000 cases to 118,000 cases in just 10 years. Has the Department of Health made any studies as to what the reasons might be for that gigantic increase in the US? Has that been investigated at all?

Miss Johnson

Obviously, I am not responsible for health care in the US, although I appreciate that its experience may be relevant to ours. In the UK, vaccinations are not compulsory but voluntary. I do not have an analysis with me this evening of the US figures that the hon. Gentleman has quoted, and I cannot therefore comment on their validity or on what the scientific community has said about them.

It is not just this country that has come to this conclusion about MMR—a huge number of countries around the world that use the vaccines have done so, as has the World Health Organisation, which states that MMR has an outstanding safety record". The hon. Gentleman will have heard the recent views from Dr. Murch, who was one of the authors of the original papers that triggered the MMR debate. His words speak for themselves: No other vaccine has ever been studied in such depth and the evidence for its overall safety is comprehensive…There is now unequivocal evidence that MMR is not a risk factor for autism. He was one of the authors of the original report. He continues: This statement is not spin or medical conspiracy, but reflects an unprecedented volume of medical study on a worldwide basis. I now turn to the question of measles virus in samples from autistic children, which the hon. Gentleman also raised. Some parents of children with autism have chosen to have samples of blood and tissue analysed privately. The hon. Gentleman referred to the fact that, in some cases, the measles virus consistent with the vaccine strain has been found in blood and other samples taken from the child. The detection of that has become the focus of much attention over recent months.

There is only one laboratory of which we are aware that claims to find measles virus in tissue samples from autistic children. However, the head of that laboratory in Dublin, Professor O'Leary, issued a press statement last year because he was concerned about the way in which certain newspapers had reported the results of his work. He said that the newspaper reports were misleading, erroneous, and are causing unnecessary concern among parents. He added: I and my research team have consistently advocated the use of immunisation and the use of MMR to protect the nation's children from measles, mumps and rubella. Much evidence has been put into court about parallel testing of blood and other samples both by Professor O'Leary and other experts advising the court. The results of those investigations need to be put into the public domain, so that everyone, including the parents involved in the court cases, can see all the evidence and not just selected parts of it. We need to be careful about accepting just part of the story.

The hon. Gentleman might also like to know about the test results of the recent court case taken against the manufacturers of MMR. He will be aware that three test specimens were claimed to have proved positive when tested by the laboratory on behalf of the claimants, and this became the centre of attention in a number of media stories claiming that Dr. Wakefield believed this to be the strongest evidence yet linking MMR to autism. However, the hon. Gentleman will also be interested to know that the results of the analysis of the same samples carried out by other expert laboratories were that no measles virus could be detected in the samples. I am not sure how the stories were run in the newspapers, but they probably did not serve the public's best interest. Scientists and the responsible media need to look at the evidence dispassionately, both for and against a theory, and not risk the idea that they suppress results.

On legal aid, it is important to understand the process that has led to the decision by the Legal Services Commission to withdraw funding for the MMR litigation. After all the evidence from both claimants and defendants was put into court, I understand that the Legal Services Commission took the view that there was insufficient evidence to proceed with any prospect of success for the claimants. This decision was appealed by the claimants' lawyers and it was reviewed by the funding review committee of the LSC. The committee is an independent body made up of solicitors and barristers from private practice, including a Queen's counsel with expertise in this sort of litigation. The decision to withhold further funding was supported on appeal.

We should not forget that the LSC had already made an investment, which the hon. Gentleman mentioned, of £15 million in this case. Despite this investment, medical research had not proved a link between the MMR vaccine and autistic spectrum disorders and no link had been proven by any other medical authority. I also think that it is important to note that the LSC has said that, on further consideration, it regrets embarking on funding the scientific studies that have contributed to the £15 million costs.

It is important to ensure that this £15 million investment of legal aid does not go to waste. I am sure that hon. Members will agree that it is imperative that experts look at this evidence, as they have with all evidence on MMR over the years, to reassure themselves that no evidence of a link has been overlooked. We also have the evidence about the view of the claimants' chances in court.

Mrs. Eleanor Laing (Epping Forest)

Will the Minister ensure that the money that the taxpayer has spent so far does not go to waste? It appears that the research that has so far been carried out has been to no avail, simply because it does not appear suitable to take forward the court case. Will she assure the House that taxpayers' money that has gone into the research on the possible link between MMR and autism will not be put to waste, but will be followed up so that we can finally reach a conclusion on this question?

Miss Johnson

The hon. Lady makes a good point, and I was saying that we hope that the money will not go to waste. I understand that most, if not all, of the expenditure is incurred by claimants, so much of the expenditure is effectively their property. They have the ability to put the information into the public domain, so the main onus does not rest with the Government.

I turn to the examination of cause regarding autism children. Detailed information about more than 200 children was obtained from families, GPs and specialists who look after children. Experts reviewed more than 100 cases of autism and bowel disease in children, but they could find no syndrome that made those children different from any others with autism. They found no evidence to implicate the vaccine or to give any cause for concern about its safety. It is worth pointing out that only one parent admitted that their child's symptoms had appeared before the MMR jab. However, there were written records from health professionals showing that there were concerns about nearly 40 per cent. of children's development before they received the MMR jab.

Exactly the same thing was seen in a study done by Professor Taylor, because there was clear evidence that some parents had originally acknowledged that their children had problems before the MMR jab but later said that the symptoms had appeared after it. That is not to say that parents do not tell the truth. It shows how fraught the situation can be, how difficult it must be for parents to deal with it, and how difficult it can be to assess evidence before and after such a jab.

Many scientific studies have failed to demonstrate a causal link between MMR vaccine and autism or bowel disease. The Committee on Safety of Medicines has considered the safety of MMR vaccines on numerous occasions and its conclusion remains that available evidence does not support an association between MMR vaccine and autism or bowel disease. Therefore the identification of at-risk groups is neither relevant nor feasible and the hypothesis that there is a connection does not hold

I am not sure how much time I have left, but I shall say a little about vaccinations in Japan. Japan does not use MMR vaccine, but that is because it cannot produce a vaccine with a mumps component that does not carry the risk of mumps meningitis. Japan uses single—

The motion having been made after Seven o'clock, and the debate having continued for half an hour, MR. DEPUTY SPEAKER adjourned the House without Question put, pursuant to the Standing Order.

Adjourned at twelve minutes to Three o'clock.