Some Reflections on Peter Hitchens's Reflections on Measles and MMR

[My comments on Peter Hitchen's piece in bold.]

I’m asked for my thoughts on the measles outbreak in Swansea. I’m not sure quite why, as most readers here will know my views on the MMR controversy.

I've not been asked for my thoughts on Arsène Wenger, but most of my readers will know my views on him: he should hire Wayne Rooney to play in goal for Spurs. My readers will also know that I know about as much about football as Peter Hitchens knows about science.

Perhaps there’s some intended suggestion that I am in some way responsible for this outbreak, which is also being attributed by some to a long-ago local newspaper campaign against the MMR vaccination. The local newspaper, I should add, says that it covered the controversy fairly, which I have no reason to doubt. I was interested to hear its current editor rather aggressively and righteously questioned on the subject by a BBC presenter the other day.

I think the suggestion is that all ill-informed journalists who've reported irresponsibly on MMR bear some responsibility for the current outbreak.

Longstanding readers will know that I was myself mysteriously targeted, some years ago, by a skilful anonymous letter writer who faked a letter from a mother claiming that her child’s terrible illness was my fault. As it turned out, the woman whose identity the fraud had stolen (and whom I eventually traced) confirmed that no such thing had taken place. Nor, of course, had she written the letter sent to me with her signature faked upon it. The address from which the letter was sent was also a fake, though a very clever and carefully-planned fake which I only uncovered by going to visit it personally, a step the fraud did not think I would take.

The elaborate faking of the letter, the invention of a real-seeming address, the use of an actual name, have always seemed to me quite sinister and unpleasant. And it is things like this, rather than the science of the matter, which have continued to make me question the behaviour of those who petulantly insisted that the MMR injection was the only option for worried parents. I am still astonished that the supposedly beloved National Health Service, every inch of which is paid for by the public, treats the parents of children in this high-handed way. If it is the people’s service, a national benefit, surely its loyalty is above all to those who use it? Is the state our servant or our master?

The fake letter is indeed sinister and unpleasant but was almost certainly the action of a particular individual whose motives we can only guess at. It has no bearing whatsoever on the question on the validity of the National Health Service position that the MMR injection was the only option. The state is our servant, but the mechanisms for providing instructions to our servant are necessarily quite complex and highly regulated. An individual or a group of individuals can't simply demand that the state do whatever barmy thing they've just thought of. I consider myself fortunate to live in a country where this is the case.

If it is our servant, it should sympathise with our fears. Yet, while public money could not, apparently, be used for single jabs, it could be used to pay generous bonuses to doctors who increased the uptake of MMR, and it could be used for propaganda campaigns telling parents that all was well. Yet the Chief Minister of the government which used tax money for these purposes refused to reveal if his own small child had been given the MMR which his ministers and civil servants were vigorously pressing on everyone else.

Depends what you mean by "sympathize". I sympathize with people who hear voices telling them that they have been chosen for a special purpose in life. I don't share their delusions or base my policy towards such people on their delusions. (NB I am NOT saying here that MMR opponents are psychotic. I am saying that their fears have no basis in reality.)

Another of the authorities’ tactics has been to over-rate the importance of immunisation. They suggest wrongly that the main defence against measles is immunisation, when (see below) history shows that it was general improvements in public health, especially in nutrition, housing and the availability of clean water, which reduced the numbers of measles deaths from thousands to a tiny few, before any vaccine was brought into use. Linked with this is a tendency to exaggerate the dangers of measles. In rare cases, measles can without doubt be very damaging. But in most cases it is not. And the rare measles deaths which take place in the modern era tend to involve patients who are already gravely ill or otherwise vulnerable for separate reasons (such as chemotherapy making immunisation impossible).

Ceteris paribus, general improvements in public health do reduce death rates from measles dramatically. Immunization reduces measles rates dramatically. In addition to death, measles causes: pneumonia, deafness, brain damage, blindness and lots of other health problems. Immunization (properly implemented) reduces death rates to zero.

Given the possibility, also discussed below, that a small minority of patients may react badly to any vaccination, this is an important point in calculating risks.

It has actually occurred to all the stupid scientists who work in the field that medical interventions have risks and benefits and that we need to be sure about where the balance lies before rolling out national programmes. Sometimes, as with some types of cancer screening, it is very difficult to decide exactly where the balance lies and the debate continues. In the case of MMR, however, it is perfectly clear where the balance lies. The benefits far exceed any possible risk.

Before quoting my January 2001 article, I should make a historic point. It was written when the dispute over the safety of the MMR was already in full swing and had not been resolved. I doubt very much if it influenced even one person in deciding whether to give their child the MMR or not. It certainly was not intended to do so. Many parents had already declined the MMR and were unconvinced by official assurances of its safety. They may have been mistaken in this view, but their fears were reasonable at the time.

In March 1998 The Medical Research Council concluded there was no evidence showing a link between the MMR jab and bowel disease or autism. In April 1998, a 14-year Finnish study found no danger associated with the MMR vaccine. In 1999 Research published in the Lancet from the Royal Free Hospital, where Wakefield did his research, found no evidence or an MMR - autism link. The "dispute over the safety of the MMR" was in full swing in the pages of the Daily Mail and other newspapers, but anyone who knew what they were talking about was insisting that the MMR vaccine was safe.

An experienced doctor’s public doubts about the vaccine had been considered so significant by medical journalists and news outlets that a controversy had by then continued for three years (though, as I show below, it goes back even further than that). This is not itself unreasonable. Medical treatments can go wrong. Vaccines can have problems. Should reporters or media suppress such worries? Surely the default position, in a free society, is to publicise them. What if they had been justified, but suppressed?

When one maverick is saying one thing and almost the entire scientific establishment are saying another, then reporters have a responsibility not to suppress anything but to report the maverick views in their proper context. Now that Wakefield has been so thoroughly discredited, there is no excuse whatsoever for journalist reporting his views as though they had any remaining credibility - especially when doing so may result in death or injury to children.

As a parent myself, I sympathised then, and sympathise now with those parents who were worried. It is a very heavy responsibility to authorise an injection, in the fear that it may unpredictably do permanent and irreversible damage. The chance may be very small. The authorities may be saying that it does not exist. But if it is your child, you won’t necessarily be convinced by such words. Any parent will know this. Many non-parents will simply not understand.

So why not find out the facts and use your power as a journalist to help them understand?

I say now what I said at the time and have always said. If the true aim of the authorities was the maximum possible level of immunity, they should have authorised single jabs on the NHS while the controversy was still continuing. My view is that events show that , if maximum immunity was their true aim, they went about it in a very odd way. The predictable ( and predicted) effects of what they did were – as we now know – a significant number of children who were never immunised.

Single jabs are less effective, cause more distress to the children, have far fewer data on their safety, and result in far more missed appointments. Even more importantly, if the authorities had authorized single jabs, this would have given the impression that there were real doubts about the safety of MMR. It is unethical to offer a treatment which has less evidence of safety when a better product with much more robust evidence of safety is available. Moreover, given all the considerations described, it is more than likely that the provision of single jabs would have resulted in fewer children being protected.

It seems to me that what they wanted above all was to get their way. The fact that this involved a number of parents refusing the MMR, could perhaps be blamed not on their inflexibility, but on the wicked media. QED.

It is outrageous to suggest that the medical and scientific establishment had any other considerations in mind than the best way of protecting children.

The current events in Swansea and elsewhere were entirely predictable 12 years ago, and I predicted them. Exhortation and official reassurance were never going to work. A significant minority of parents would not let their children have the MMR, but would unhesitatingly have given them single jabs. Had this happened, there would now be no Swansea measles outbreak, or it would be much smaller (no injection has a 100% success rate, even when given twice, as the MMR is).

Almost certainly untrue - see above.

Here I will reproduce the very first thing I recall writing on the subject, and the earliest of my writings about it that I can find in any archive, which was in the Mail on Sunday on 28th January 2001. It was published under the headline ‘ Is it Really Our Duty to risk our children’s lives with this Jab?’, and it followed Anthony Blair’s refusal to say if he planned to let his small son Leo have the injection, at the height of the controversy over its safety. It read ‘Many mothers would die to save their children's lives, and many would kill anyone who threatened their young with danger. But now they are being asked to risk their own offspring for the sake of others. You may be worried about your own child, say the authorities, but your fears are groundless and actually rather selfish. Be responsible. Overcome them. Trust us, for we know better. This is an astonishing piece of State bossiness in an age that has seen a catalogue of mistakes, panics and mysteries in the world of disease and medicine.

They were not being asked to risk their own offspring for the sake of others. They were being asked to vaccinate their own offspring for the sake of their own offspring. Yes, the world is complicated and some people do know better than you (or me) about all sorts of things. There is, of course, no absolute guarantee than any particular expert in something is right but science is a collaborative enterprise that produces a consensus reflecting the best evidence we have at any particular time. Even then the consensus MAY be wrong, but it's the best source of information there is. The alternative - listening to people who don't know what they are talking about and just make stuff up - is much worse.

They told us thalidomide was safe.

It is - for the person taking it. Unfortunately they didn't test drugs properly for effects on developing embryos in those days. Now they do.

They said that we would all get AIDS.

No they didn't. They said that you risk getting AIDS if you have unprotected sex. You do.

Official advice on avoiding cot death switched from 'babies must lie on their fronts' to 'babies must lie on their backs' with barely an apology.

Yes. Because science - unlike your immutable prejudices - is based on evidence. When new evidence comes in, science changes to reflect that new evidence. That's why science gets better and better all the time whereas stuff people just make up or think doesn't.

The wise person responds with deep caution to the words 'Trust me, I'm a doctor', and with even more caution to the words 'Trust us, we're the Government'.

The wise person either becomes an expert him/herself or puts his trust in the the current expert consensus. The fool places his/her trust on something s/he read in the newspaper.

The same authorities who refuse even to consider that there might be a risk from the Mumps, Measles and Rubella (MMR) vaccine have embarked on a massacre of cattle, and on slaughter and hygiene regulations which have crippled the entire beef industry, when there is still no actual proof that eating BSE-infected meat leads to CJD.

We don't "prove" things in science - you can only do that in maths or logic. We gather evidence and develop well supported theories. There is overwhelming evidence that eating BSE-infected meat leads to vCJD - though vCJD is (mercifully) relatively rare.

But they demand conclusive proof of danger before they will even entertain doubts about MMR. They shout 'bad science' at Andrew Wakefield, the consultant who has persistently raised questions about MMR. Yet nearly half the health professionals questioned by the British Medical Journal say they have concerns about children being given the second of the two required MMR jabs. Surely they, with their long and careful training and education, can recognise 'bad science' when they see it? And what about Tony Blair, who refuses to say if he will follow his own Government's advice when little Leo comes up for his first MMR any day now? If it's so wonderfully safe, why not give a lead to us all?

Yep. Blair's behaviour was indefensible - only valid point in this entire diatribe.

This weekend the triple vaccine is being urged on every parent of small children through a £3million propaganda campaign, mounted at our expense in breezy defiance of unproved but frightening suggestions that MMR could be behind a sudden increase in childhood autism. Most GPs back the Government line, though this may have something to do with the fact that doctors can increase their annual income by £860 if they achieve a 70 per cent take-up of the jab, and by £2,580 if they can reach 90 per cent.

The pressure is strong. If you don't let us immunise your child, says the Government, you could help cause an epidemic of measles. And don't imagine that measles is just a few spots. This is a serious disease which can kill. The Department of Health speaks of the 'devastating brain-destroying impact of measles in young children', known as SSPE, which sometimes accompanies measles.

Yet it is the devastating brain-destroying impact of autism which is so worrying for the parent who hovers at the surgery door, wondering whether to submit a cheerful, healthy toddler to MMR.

There is no proof that MMR causes or has ever caused autism, or the severe bowel disorder Crohn's disease which can lead to brain damage.

Again, "proof" is not a relevant concept here. There is no credible evidence that MMR causes or has ever caused autism, or the severe bowel disorder Crohn's disease and there is overwhelming evidence that MMR does NOT cause autism, or Crohn's disease.

But both of these afflictions have become more common since the triple MMR was introduced in 1988,

A questionable claim, but one that is irrelevant given the detailed and large scale epidemiological investigations which have been carried out.

and they have brought unutterable misery to many families. Heartbroken parents speak of how they have 'lost' their children even though they are still alive. Toddlers who were alert, responsive, full of laughter and recognition, suddenly went quiet, and retreated into an unknown world where they are no longer the people they were or might have become.

It is indeed terrible when such a thing happens to a toddler, but the terribleness of it is irrelevant to whether this terrible thing was caused by MMR.

Imagine wondering for the rest of your life whether you were to blame for such a thing happening to your own child. You cannot know, but you will always suspect. Because the decision on whether to inject or not was yours alone, this would be far worse than coping with the random, unpredictable ravages of a disease. It is an awful choice, and those who must take it need not propaganda, but help.

But why would any parent wonder such a thing unless that parent had been misled by a dishonest doctor and credulous journalists who insist on spreading that doctor's lies?

Why do they not get help?

Why do journalists not give them the help they need - accurate easy-to-understand facts.

Why do parents have to take this decision at all? The alleged autism risk is linked entirely to the joint use of the three vaccines in one go.

A false and thoroughly discredited allegation.

If there is a connection it is possibly because three viruses at once overload the child's small frame.

No! Again, scientists consider such possibilities, and they understand how the immune system works. Three attenuated viruses at once do not overload a child's small frame.

While we find out for certain, why not let worried parents have single vaccines, spread over time?

See above.

The official answer to this is astonishingly thin. Parents are told that huge studies - especially a recent one in Finland - have shown no link between MMR and autism. But the Finnish study, it turns out, was not really looking for any such link so it is no great surprise that it did not find one.

Do you mean this study? "No evidence for measles, mumps, and rubella vaccine-associated inflammatory bowel disease or autism in a 14-year prospective study." (PMID:9643797) Peltola H, Patja A, Leinikki P, Valle M, Davidkin I, Paunio M Lancet [1998, 351(9112):1327-1328]?

Asked to explain its rigid refusal to leave a loophole for worried mothers and fathers, the Health Department brusquely proclaims: 'The Government recommends the use of MMR because the evidence is that combined MMR is better for children than separate vaccines. There is evidence that separating the vaccines puts children unnecessarily at risk of diseases that have serious complications. Recommendations on MMR vaccines are categorically not based on financial considerations, nor do they aim to deny parental choice. We cannot offer parents the choice of an unsafe and unproved option when a safer and more effective vaccine exists. The Department must make recommendations based on the best scientific evidence and the advice of experts and this is that MMR is the safest way to protect children against these diseases. For this fundamental reason we cannot support the use of single dose vaccines.' Dr Jayne Donegan, a sceptical London GP, says the official position about this is confused and self-defeating. The reason for the current panic is that fears of MMR have led to a severe drop in the take-up, down to levels of 75 per cent, which are not enough to insure against an epidemic. If this is so, she points out, then the urgent task is to get as many children immunised against measles as possible. By making the single measles vaccine available easily in this country, the Government could get levels back up to 90 per cent. Even with a six-month gap between jabs, toddlers could then be immunised against the more distant dangers of rubella and mumps within less than two years.

And she asks: 'Why is it safer to give them together?' It is true, she says, that the old Berna-Rubini single mumps vaccine had a poor record. But there is no reason why the new and effective Jerryl Lyn mumps immunisation could not be given on its own. However, you cannot readily get it here except as part of the MMR.

See above.

The Department's fierce statement that the single-vaccine alternative is 'unsafe and unproved' does not seem to be founded on much, and an unkind person might well suspect that this assertion was 'bad science'.

There are far fewer data about the safety of the single-vaccine. This is good science.

Dr Donegan used to be an enthusiast for vaccinations of all kinds, but experience has turned her into a doubter. She believes that the medical establishment is in the grip of an intolerant orthodoxy that will not listen to questioning voices.

But does she have any real evidence for her doubts or any support from the rest of her profession concerning her opinions about "the medical establishment"?

'They think that people who question the vaccine are socially irresponsible. If I say anything critical about vaccines it's as if I were saying that God was dead.' Certainly an act of faith is required. The claims of an MMR risk have not been proved, but nor have they been disproved. There is no reason for either side to be certain, and every reason to be cautious, especially if the future of a tiny child is in your hands. Yet the use of emotional strong-arm tactics comes just as much - if not more - from the pro-injection lobby as it does from the antis.

See "proof" and "overwhelming evidence" above.

Are their scares valid? The MMR enthusiasts make much of recent measles epidemics in Ireland and the Netherlands which involved several thousand children. Dr Donegan says measles is indeed deadly if it attacks badly nourished children living in dirty conditions, or if it affects those who are already seriously ill. She says most health improvements, even the ones credited to vaccination, are really due to the march of civilisation. In an advanced country with clean food and water, fresh fruit and vegetables readily available, and modern, spacious housing, she believes measles is unlikely to be fatal for healthy youngsters.

What Dr Donegan believes is irrelevant. There is ample statistical evidence about how many otherwise healthy children are likely to die or become disabled in a measles outbreak.

Normal, fit people can suffer severely or even die from measles, but such deaths are rare. The Netherlands recently suffered an epidemic in the country's rural 'Bible Belt', where vaccination of all kinds is frowned upon. There were three deaths among the 3,300 who caught the disease. One two-year-old had underlying heart problems, but the two other victims, a three-year-old and a 17-year-old, died from measles complications.

And those three children would be alive today if their parents had vaccinated their children.

The two measles deaths in Ireland's epidemic last year suggest that Dr Donegan has a point. One of the victims was a 12-month-old baby girl from a very poor family living in grim conditions on a large Dublin housing estate and was, incredibly for a European capital in the year 2000, malnourished. The other was also exceptional and seriously ill before he contracted measles. He was a two-year-old with a severe malformation of the throat which linked his windpipe with his oesophagus and who had to be fed by a tube let into his stomach.

And those two children would be alive today if their parents had vaccinated their children.

The Irish epidemic also revealed another unsettling fact for the 'MMR at all costs' lobby. At least ten per cent of those who developed measles had been given the MMR jab. One in ten is a pretty high failure rate for a treatment that is being pressed on the public as a great social duty.

The failure rate is less than one percent for children who get both MMR jabs. Even if it were lower, herd immunity would protect the unprotected children.

And it is that idea of social duty which really lies at the heart of this argument. The lofty view that 'the health of the people is the highest law' seems to have shoved aside all other thoughts. The authorities, who take more than a third of our income in taxes, are not delivering very much that is good or laudable in return, as the NHS decays into Third World conditions.

Have you ever visited the Third World?

They are anxious to prove to us that they are still benevolent and good: the abolition and defeat of diseases is one of the few ways they now have of doing so. They have made a calculation which leaves no room for doubt and they think we are obliged to help them. Luckily for us, they cannot - yet - make us vaccinate our young. I bet they wish they could, but in the meantime they are forcing the parents of Britain into a deeply unpleasant and completely needless dilemma which may have the opposite effect to the one they intend. If there is a measles epidemic in this country, the rigid minds of the Health Department will have to share the blame for it. ‘

That statement is so perverse, I hardly know how to respond. There is a measles epidemic in this country. It was caused by the rigid minds of one idiot doctor and dozens of idiot journalists.

I still think that, given the state of knowledge when this was written, this is a reasonable summary of the case. I was the only journalist to track the measles deaths in Dublin and find out the true circumstances from the Irish authorities. This would have been impossible in Britain, where my requests for such information on a measles death was brusquely refused, on the spurious grounds of patient confidentiality. I never sought to identify anyone so that cannot be the reason. It is useful to recall that Andrew Wakefield’s original paper in ‘The Lancet’, suggesting that the MMR (introduced in 1988) might have risks, had been published in February 1998, almost three years before I wrote the article. The concerns about the safety of the MMR had already taken hold in the public mind long before I ever uttered a public word about it.

But by the time you wrote, the fears over MMR had already been put to rest. You could (and should) have uttered your public words in favour of vaccination.

In fact, they go back further than the famous press conference which began the controversy. Using an electronic library database, I found that fears over the MMR being linked with autism and bowel disease were raised in newspaper reports in March 1994, January 1996, November 1996, June 1997 and July 1997. In 1992, two of the original MMR vaccines had been withdrawn because of a separate concern over the safety of the mumps component.

Yep. That's what we do if, despite our best efforts, we later discover that vaccines are dangerous or do more harm than good.

I am not going to attempt to go into the rights and wrongs of this controversy now. I can only say that it seemed to me that some legitimate concerns had been raised, and that parents were entitled to be worried. Some personal experiences of mine have made me worry about all claims of total safety for vaccines.

No scientist would ever claim total safety for anything. Your personal experiences are irrelevant. The safety of vaccines is established by the large scale collection of evidence.

Nor is it just personal experience, nor the ghastly experience of Heather Edwards and her son Joshua, which I have often written about, and which haunts me to this day (Joshua had severe reactions after *both* his MMR injections, suffering both regressive autism and grave bowel problems. No, this doesn't prove anything. But it is surely worrying).

What's worrying is that a supposedly intelligent journalist can commit such an obvious case of the post hoc ergo propter hoc fallacy. I am very sorry about Joshua, but the epidemiological evidence clearly establishes that he did not develop his conditions as a result of his jabs.

As I noted in July 2007, ‘ I am hugely grateful to Vivienne Parry, a member of the Joint Committee on Vaccination and Immunisation, which advises the Government on the controversial MMR injection, for finally explaining the true attitude of the authorities: “There's a small risk with all vaccines,” she says. “No one has ever said that any vaccine is completely without side-effects.” “But we have to decide whether the benefits outweigh the risks. If we had measles, it would kill lots of children. If you have a vaccine, it will damage some children, but a very small number.” ‘ As I wrote then: ’It's not really true about measles, a rather minor risk to a healthy child in an advanced country. But what a refreshing change this candour is from the woodenheaded assertions by the medical establishment that the MMR jab is proven to be completely safe.’ The problem here is that governments may regard the ‘small number’ who are damaged as unimportant. But the individuals who are personally and directly affected see it in a very different way.

See above. The benefits of MMR vastly outweigh any risk - for each individual child as well as for the child population as a whole.

I don’t think I have ever met or communicated directly with Andrew Wakefield, though I have corresponded with many people, whose children suffered from bowel complaints and regressive autism, who did meet him and who had and continue to have a high opinion of him as a doctor and a man. I note that many modern accounts of the controversy describe his actions as ‘fraudulent’ or ‘false’ or as a ‘hoax’, suggesting a deliberate attempt to deceive. I don’t personally think this is fair.

Andrew Wakefield's dishonesty has been established beyond any reasonable doubt.

Another doctor ( I won’t name her in case it brings extra trouble to her) who dared to sympathise with worried parents, and whom I believe to be a fine and ethical professional, was also dragged before the General Medical Council for daring to give evidence on behalf of such worried parents. I am glad to say that she was cleared, but not until after she had been put through a professional and emotional ordeal which would have crushed many people.

One of the things which always made me sympathise with the worried parents was the intolerant fury of the pro-MMR campaign, which to this day exaggerates the dangers of measles. The prevalence and dangers of this disease (grave among malnourished people without access to clean water) had already fallen precipitately before the first vaccine was introduced in 1968. Annual Measles deaths in in England and Wales ranged between about 9,000 a year and 12,000 a year before the First World War, rose to a peak of nearly 17,000 in the harshest period of the war (during, and perhaps caused by, the now-forgotten severe food shortages of that period) , fell after the war, at one stage to fewer than 3,000, then rising again to nearly 6,000 before beginning a long, jagged fall to around 100, a level reached in the mid-1950s 13 years before the introduction of any vaccine at all. During the first 60 years of the century, its victims fell from more than 300 deaths per year per million to about two per million. (Older figures show a far higher death rate in the 1840s – 700 per year per million; and again in the 1880s – 600 per year per million. There is a data gap in the 1890s In the five years immediately before the first vaccine, deaths were as follows : 1962:39; 1963:166; 1964:73; 1965:115; 1966:80; 1967:99; 1968:51. To give an indication of the range of possible variations in those times, deaths in 1956 were at 30, while the previous year there had been 176 and in 1957 there were 96, and in 1958, 49. The width of the variation did narrow after 1968, but not vastly. Nor can we be sure that the vaccine was responsible, or wholly responsible, for the subsequent continuing fall in the number of deaths to zero or very near zero, which has been maintained since then. General standards of housing, nutrition and public health were all continuing to rise in that period, which saw the final removal of some of the worst slums. Deaths in subsequent years fell even lower, falling to 6 in 1979. This is obviously an advance. But a) it is really quite small compared with the changes wrought by better nutrition, housing conditions and hygiene achieved in the previous 60 years. And b) it is very hard to say whether it is attributable to the vaccine, or to the continuing improvements in public health which had already had so much effect.

This line of argument makes no sense whatsoever. Yes deaths were reduced by better living conditions. Now we have better living conditions, the only way to reduce deaths further is by vaccination. It is not hard to say what is attributable to the vaccine. Epidemiologists do this for a living. The vaccine (properly deployed) prevents people getting measles at all. If nobody gets measles, nobody dies from or is disabled by measles. The only argument for not vaccinating would be if vaccination caused more harm than good. It doesn't.

Let us all hope and pray that there are no deaths or serious illness as a result of the current measles outbreak.

Indeed! At least, if there is death or serious illness, those of us in the "intolerant orthodoxy" will at least be able to sleep at night knowing we did our best. Will you?

As always, the subject is illuminated more by thought and facts than by dogma and emotion, though it is, in my view, kind to respect the fears of others, and foolish to ignore them.

Even when the fears of others are based on dogma and emotion?

If you want accurate information about medical science and the sorry tale of Dr Wakefield and the MMR scare, I can only suggest that you stop reading the Daily Mail and start reading Bad Science by Ben Goldacre.

PS I've just been taken to task on twitter for not citing references (other than Ben's book above). I really wanted to avoid rehearsing debates about the detailed scientific evidence because those debates have all been had and the outcome is clear. I wanted to restrict myself to the question of how the advice was derived from the science and how science works. I have, however, alluded to factual evidence concerning the merits of MMR versus single vaccines. If you dispute any of my claims, I would direct you to Public Health England: Why is MMR preferable to single vaccines?. If you don't accept what they have to say then you'll have to start reading the primary literature.