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MMR experts call for action on Autism
30/04/2002
The MMR Expert Group report, published today, calls for a step-up in ongoing research into the causes of autism and Crohn's disease, and improved services for those affected.
The Group's chairman, the Very Reverend Graham Forbes, Provost of St Mary's Cathedral in Edinburgh, said they had carefully appraised current scientific evidence and concluded that it did not support a hypothesised link between the MMR vaccine and autism.
However, he added that the controversy over MMR had clouded the fact that many more people were affected by autism than traditionally thought, and that a research strategy should be a top priority to better understand the statistics.
Rev Forbes said:
"Our report was handed over to Health Minister Malcolm Chisholm last week, and I am delighted that he has agreed to make it widely available. That decision is consistent with open and inclusive approach adopted by the group. I am grateful to the many organisations and individuals - particularly parents - who contributed.
"Much of the interest in our work relates to MMR. Parents in Scotland are confused as they hear claim and counter-claim in the media. We trust that our report will help. We share a common interest in the health and well being of all people in Scotland, especially our children.
"The Health and Community Care Committee stated last year that the current scientific evidence does not support the hypothesised link between the MMR vaccine and autism. So too did the Medical Research Council. The Expert Group reached the same conclusion on the basis of careful appraisal of the current scientific evidence.
"I appreciate that for some, our views and indeed the views of other independent bodies, will not be the end of the matter. I do not believe that is what our group was set up for. However, we as a group are convinced that the controversy over MMR has clouded an even more important issue - the increasing number of families striving to cope with the challenge of supporting and bringing up an autistic child.
"There is clear scientific evidence that autistic spectrum disorder affects many more people than has generally been recognised - approximately 60 per 10,000 - or around 30,000 people in Scotland. A recent report published by the Public Health Institute of Scotland identified a need for significantly improved services for people with ASD. We endorse that, and we have urged the Scottish Executive to act to improve the range and quality of services provided to, and for, children with autism and their families.
"This must be a top priority but it must be matched with renewed drive to get behind the statistics to find out why the prevalence of ASD is higher than has traditionally been thought. We welcome the Medical Research Council's plans to pursue further research into the causes of autism and Crohn's disease. The Scottish Executive must work in partnership with the MRC and ensure that gaps in research are addressed - in Scotland, within the UK, and in collaboration around the world.
"Our report also describes the consequences of pursuing an alternative vaccination policy to MMR - which is what we were asked to do. It also recommends that the Scottish Executive should take steps to improve the quality and accuracy of information about MMR to be given to parents prior to immunisation of their children."
The Health and Community Care Committee's 8th Report (2001) stated that "on the basis of currently available evidence, there is no proven scientific link between the measles, mumps and rubella vaccine and autism or Crohn's disease and therefore the Committee has no reason to doubt the safety of the MMR vaccine. The Committee does not recommend any change in the current immunisation programme at this time." The Committee also suggested that an Expert Group should be established to consider a range of related questions.
The Expert Group has made 11 recommendations:
1) The Scottish Executive and the Medical Research Council should drive forward and fund the full research agenda outlined in the final chapter of the MRC Review of Autism Research (paragraph 2.40)
2) The Scottish Executive and the Medical Research Council should, in pursuing that research agenda, maximise international collaboration (paragraph 2.41)
3) The Scottish Executive should consult widely, in order to publish a firm timetable for addressing all of the detailed recommendations set out in the PHIS Autistic Spectrum Disorders Needs Assessment Report (paragraph 2.48 and 2.49), and in particular those relating to the
- Development and implementation of improved evidence based approaches to the diagnosis and management of ASDs
- Integrated joint planning, delivery and review of related health, education and social care services, for children, parents and adults, in which context people with autism, or parents and other representatives of those with autism, should have a role
- Need for a more coherent and systematic approach to training health, education and social care professionals, better and in appropriate numbers
- Development of a database of people with ASD in Scotland
4) The Scottish Executive and the Medical Research Council should drive forward and fund further research into inflammatory bowel disorders in children (paragraph 3.16)
5) The Medicines Control Agency should continue to improve monitoring of vaccine safety (paragraph 4.18)
6) The Scottish Executive should ensure that (paragraph 4.35):
- All vaccination records relating to individual patients should include details of the name and batch number of the vaccine administered
- A national lifelong vaccination record is developed, to allow identification of the immunisation status of an individual throughout the health
- NHS Boards put in place adequate quality assurance mechanisms to ensure accuracy and completeness of recording of vaccination data
7) The Committee on Safety of Medicines and the Joint Committee on Vaccination and Immunisation should, taking account of ongoing and future research into the causes of IBD and autism, continue to keep vaccination contraindications under review (paragraph 5.25).
8) The Joint Committee on Vaccination and Immunisation should (paragraph 5.29):
- develop and publish core principles for immunisation policy to provide a clear framework against which future policy options might be assessed in a transparent manner; and
- continue to publish the conclusion of its regular reviews of the scientific evidence relating to the safety and efficacy of MMR.
9) Health Ministers should urgently implement existing plans to appoint members, to the Joint Committee on Vaccination and Immunisation and the Committee on Safety of Medicines, who are non-medical experts and/or members of the general public (paragraph 5.31);
10) The Scottish Executive should improve the information available to parents whose children are due to be immunised against measles, mumps and rubella (paragraphs 5.21 and 5.32), by:
- Ensuring that all parents receive basic factual information with the invitation to bring their child for vaccination
- Ensuring that parents know that they should discuss related questions with their GP or health visitor in order to make an informed choice about vaccination
- evaluating and developing the MMR discussion pack
- Requiring NHS Boards to put in place systematic arrangements for providing further advice to parents who have concerns
11) The Scottish Executive should ensure that appropriate resources are provided to allow the Scottish Centre for Infection and Environmental Health to carry forward research with the aim of developing mathematical models, which might help demonstrate the range of possible outcomes, for the population as a whole, arising out of immunisation decisions made by individual parents (paragraph 5.47).
The Expert Group was established by the Executive in August 2001 "to consider the matters raised by the Health and Community Care Committee (HCCC) relating to immunisation against measles, mumps and rubella, with particular reference to":
a) describing the consequences of pursuing an alternative vaccination policy to MMR
b) reviewing evidence on the apparent rise in the incidence of autism, taking account of the current work of the Medical Research Council (MRC)
c) describing the process of vaccine testing and the monitoring of adverse effects
d) in all its work, having regard to the role and remit of the Joint Committee on Vaccination and Immunisation, the Committee on Safety of Medicines and the Medicines Control Agency