PANORAMA MMR DEBATE

Vivian White:
Hi and welcome to Panorama interactive, a live television and internet debate on the combined MMR vaccine following the programme that's just been out on BBC 1.

We've got with us first of all the reporter on that programme Sarah Barclay, she's with us now to deal with your e-mails and your mobile phone text messages to us. And we've got two expert guests who've both very kindly come and we're grateful to them both.

Dr David Elliman, first of all, he's conducted his own review of research on MMR and if I may Dr Elliman I'd like you to introduce yourself by my putting a question to you. Do you support the Government's position on MMR and did you see anything in this programme to change your mind?

David Elliman:
I do think the Government's got the position right and no I haven't seen anything to change my mind.

Vivian White:
What would it have required you to shift on that position?

David Elliman:
I don't think the programme of itself could have done but if they'd said there was scientific evidence that was going to be published that showed something major which was totally contrary to what we had seen already that might have produced some doubts.

Vivian White:
So as far as you're concerned the science points in one direction only and still does?

David Elliman:
It does.

Vivian White:
Our other expert guest is Dr Richard Halvorsen, thank you very much indeed for joining us too. Can I introduce you, if I may, Dr Halvorsen also with a question. What do you think of the Government's position on MMR and in your clinic do you insist that patients have the MMR jab, the combined measles, mumps, rubella vaccine vaccination, or do you give them a choice of having the single vaccines instead and if you do why do you give them that choice?

Richard Halvorsen:
I find the Government's obstinate position on the MMR and its refusal to allow the single vaccines as an alternative very frustrating. I have seen hundreds of parents myself during the last year of which there are tens of thousands in the country who will not give their children the MMR. These are sensible parents who've spent a lot of time researching the issues themselves and they have made the choice that they're not prepared to offer this to their child and they're looking for an alternative because most of these parents do want to immunise their child and they want the single vaccines as an alternative, so I offer the choice. I still offer the MMR vaccine but I offer the single vaccines as an alternative.

Vivian White:
Do you offer the choice because you doubt the safety of MMR or simply because as a matter of principle you respect their choice?

Richard Halvorsen:
Both. I do have genuine concerns about the safety of the MMR. I do not think that the science all points in one direction and there are many interpretations. I've read the same papers that David Elliman has and my conclusions are not the same as his.

Vivian White:
Dr Elliman in the imperfect world in which we live, although you think everybody should take the MMR vaccine for their children, given that, as you can hear, they don't, if you want to reach a sensible level of vaccination wouldn't it be more sensible to encourage people to have the choice on the basis that at least that's going to get people to take the vaccination who are currently not having it all?

David Elliman:
Well I think you're making an assumption that it would mean people got the vaccine who are not having it. If you follow Dr Wakefield's advice then you would string out the vaccinations over a period of five years and we all know that the more complicated you make something the less likely people are to complete it, even if they did it leaves the children susceptible to the diseases during that time and if the children are going to get it they're going to pass it on to other people.

Vivian White:
Ok, we've got lots of e-mails and we'll take them in just a second but last of all just one question to Sarah, who was right in the middle of all this. As the Government's position, Sarah, is so clear that the MMR vaccine is safe and that it should be taken why did you make the programme and did you have any qualms at all about making it?

Sarah Barclay:
I think we would have been very irresponsible if we hadn't made it because this is an issue which is probably one of the most difficult public health dilemmas we have faced for many years and it was a programme on which we had to report objectively what the different sides of the arguments were and I hope we've done that.

Vivian White:
In which case let's start straight from there with our first text message and indeed it is the very first time we've had a mobile phone text message to Panorama, the first one we've transmitted in reply. "My son," says Lois in Llanelli, "was a healthy child until he had his MMR and he's suffered disabilities since. It's not the Government's child, they don't suffer like parents." This is echoing what we heard from parents within the programme. What do you say to that parent? As far as they see the order of events is healthy child, vaccine, unhealthy child - so what do you say back?

David Elliman:
I would say back to them that I sympathise with their problems. As a practising paediatrician I see children with autism and it's something that if we could prevent we would certainly want to do so. But what we have to look is at the overall picture and we know from research that's been conducted on children predominantly born before MMR came out that the commonest time that parents notice that there was something wrong was between their first and second birthday. This is when the MMR is given, so purely by coincidence there are going to be literally hundreds and thousands of cases where there's a close connection in time. That doesn't mean to say that one has caused the other and what we need to do then is do the research which Sarah mentioned in the programme.

Vivian White:
It's coincidence not causation - what do you say to that Dr Halvorsen, to Lois in Llanelli?

Richard Halvorsen:
What we're taught to do as doctors is to take a history, we listen to the patients. When parents come in to tell me that something is wrong with their child I have to be pretty damn sure before I contradict that. Here we have thousands of parents with the same story believing that the MMR vaccine has caused their child's autism. They cannot all be mistaken. Secondly, if I can make one more brief point ...

Vivian White:
With respect they could all be mistaken, it could be because it could have been the case that parents had children who regrettably had autism at the same rate before this vaccination existed.

Richard Halvorsen:
My second point was going to answer that.

Vivian White:
I'm sorry.

Richard Halvorsen:
That's quite alright. My second point was going to say - traditionally autism has been a congenital disease, you were born with it, and what David Elliman is saying is that the symptoms are noticed at about the time, for example, during the second year of life. These children are different. They were talking, they were interacting normally, they were maybe potty trained. After the MMR vaccine they lost those skills, that is a totally different thing. It's not noticing that things weren't going right, it's the fact that they were normal and they lost the skills they already had, something must have happened.

Vivian White:
There's pressure to take lots of e-mails but do you want to reply?

David Elliman:
Yes I mean what's called regressive autism has existed for a long time and people have looked at the proportion of regressive autism and if you like typical autism, it hasn't changed. And perhaps the thing we need to concentrate on is rather than looking at individual children, if we take a group of children who've had the MMR, a group of children who haven't and seen how common is autism in those two groups it's the same. Now that suggests that MMR is not linked to autism.

Vivian White:
Ok, let's take our second mobile phone text message to us now because you can of course contact this programme either via the web or via the text number that we put on the screen before. That's from the concerned mother of a one-year-old child who's due to have the MMR jab and this woman writes to say: "Is resistance to three separate jabs only due to lack of cash in the NHS? I, as a parent, would pay any price to protect my children." So is it simply a cheaper all in one, of course it might be that it's cheaper and it's better - let's get that sorted though.

David Elliman:
If autism was caused by MMR, MMR would not be a cheap option. When someone costs a vaccine they don't only cost the ingredients or the time given but the effects of it, both in saving disease and potential side effects.

Vivian White:
So you're saying, with respect to the questioner, the question's irrelevant - it wouldn't be on that basis that the vaccine would have been permitted, it simply isn't done that way?

David Elliman:
That's right, yes.

Richard Halvorsen:
We certainly know that it was introduced into America partly on the grounds of cost, that was one of the considerations.

Vivian White:
We have another question, this mobile text message is anonymous, it's a very straightforward question though, it means we're quite reasonably entitled, I think, to take it. "What about mercury," says the caller, "in MMR?" Now we've had various calls, both before the programme transmitted and now expressing doubts about the ingredients in MMR, let's sort that out, at least perhaps the two of you can agree on that.

David Elliman:
Dead simply one - there is no mercury in it.

Vivian White:
You'd agree with that?

Richard Halvorsen:
Yes nor is there any mercury in any of the single measles, mumps and rubella vaccines.

Vivian White:
Another text message, this one's anonymous: "I think that parents who don't let children have MMR may kill siblings and other babies and this far outweighs the risks of MMR."

Richard Halvorsen:
Well that clearly is the Government's view isn't it, that's right. I would say that ...

Vivian White:
Sarah ended the programme talking about the balance of risk. Even given the case that you put, your basic position at the beginning of the programme, talking about thousands of parents, now I don't have to tell you as a doctor in your clinic you'll also - you also will have parents who occasionally have measles and you'll know exactly what the consequences are. So the question there simply is about the balance of risk. Even if you accepted the connections that you've described what would the balance of risk then be?

Richard Halvorsen:
We don't know the balance of risks. I think the point with something like - something like a vaccine, the MMR vaccine, is here we have millions of totally healthy children who are having a medical intervention on them and for that to happen we know that it must be as safe and effective as possible. And therefore the onus is in fact not on Dr Wakefield and his colleagues in order to prove absolutely beyond any doubt that there is a link with autism but the onus, once reasonable concerns have been raised, and I believe they have, the onus is on the Government to absolutely prove that it is safe, this is not an intervention that is about to save a dying child.

Vivian White:
With great respect to Dr Halvorsen when I put this question to you Dr Elliman was that a scientific statement in your view that he just made?

David Elliman:
I think he is correct in saying that we are giving vaccines to healthy children, therefore there is an enormous imperative that we make sure they're safe.

Vivian White:
Ok.

David Elliman:
What we now have is a large body of research that in most people's minds proves no link between MMR and autism. We have absolutely no research that has looked at giving measles, mumps and rubella in the way suggested by people like Richard and Dr Wakefield and whether that causes mumps. So on one side we have a lot of evidence of no connection, on the other side we have no evidence. Therefore, following Richard's logic we ought to be going for the MMR.

Vivian White:
We'd already received, before we transmitted the programme, two e-mails which addressed, as it were, both of you head on. The first one came from Mrs K. Fallwell from Coventry who e-mailed us and said that her son was 12 and was given the MMR and he's now autistic. The question that she asks, she doesn't postulate that there must have been a connection she simply asks: "Can Dr Elliman categorically say MMR is a hundred per cent safe?" Can you?

David Elliman:
I cannot but I can't do that for anything - I can't say that the water in front of me is a hundred per cent safe, I am fairly convinced it is and therefore I'll drink it, likewise all the evidence suggests MMR is safe, therefore I would offer it to my children.

Vivian White:
Which logically - logically takes us straight to another e-mail that we received before we'd even got on air from Yvonne Davis from Caerphilly who said: "Until we know MMR's safe then," she said, "the single vaccine should be made available." What do you say to that especially given the answer you just gave?

David Elliman:
Well I would repeat the answer I just gave, in fact there's more research now around the safety of the MMR than there is around giving the three vaccines singly.

Vivian White:
Do you want to make any comment Dr Halvorsen, we'll plough on otherwise happily?

Richard Halvorsen:
No I think it seems to me ridiculous that the Government are so adamant against the single vaccines. The single vaccines have been used - certainly the mumps, the measles and the rubella have been used for much longer than the MMR as a combined vaccine, they are excellent vaccines and they have a very good - very good record, both from the safety and effectiveness. And it's interesting because of course it's not just safety but effectiveness that is so crucial that the public health laboratory services, the Government's own laboratory, they have published data in the last few weeks showing that after a single - the first dose of the MMR - 20 per cent, one in five, children remain unprotected against measles. Now that is a very poor rate. The single vaccine has got much better rates than that. So from the Government's own figures this would suggest that actually the single vaccine is more effective than MMR.

Vivian White:
He's shifted his territory a bit now but let's take that one on Dr Elliman. He's saying now that it's not an effective vaccine, never mind whether it's a dangerous vaccine, it's not an effective vaccine.

David Elliman:
There have been lots of comparisons of MMR and measles vaccine, for example, looking at their efficacy. I have not seen the data that said there's a 20 per cent failure rate from the measles component of the MMR, that has not come out in any of the previous studies and the previous studies have shown no difference between measles singly or MMR combined.

Vivian White:
I think the best thing, given - given that you said that Dr Halvorsen and given that I'm not sure, at this moment - Sarah you can't arbitrate on that one can you? We'll do our best to post on the website ...

Richard Halvorsen:
I've got the paper in my bag and I can show it to you after the programme.

Vivian White:
Ok, the paper - the paper which he refers to we'll post as part of our information - is that ok?

Sarah Barclay:
That's fine.

Vivian White:
... on the website. And Dr Elliman if you want to comment on the paper to the same website then you can.

David Elliman:
I'm happy to do so.

Vivian White:
And that's about as far as we can go on that for the moment. But it was ...

David Elliman:
Can I come back to something though?

Vivian White:
I'm sorry.

David Elliman:
Richard said we have a lot of experience of the single measles vaccine and the single rubella vaccine, we do indeed and what I said was we had no experience of using them in this staged manner. We have experience of using rubella vaccine at 12 months, sorry measles vaccine at 12 months and rubella at 12 years, never bringing them this ...

Vivian White:
Ok, that's a fair point. The programme - the programme gives in effect Dr Wakefield's preferred alternative to the present procedure, which is indeed what you're recommending to your present patients. Dr Wakefield is very hard on what he thinks are the connections, the causation is being argued, but the connections between an event, namely the vaccine, and autism afterwards. But where is the equivalent research on having the three single vaccines, which you're prepared, you say, to let your patients have, partly for reasons of democratic choice and partly because you argue that they might be right and it might be safer, where's the equivalent research on the three stage vaccines?

Richard Halvorsen:
The research - of course the research hasn't been done giving the vaccines at all - lots of different particular stages ...

Vivian White:
But that's the point he's making, he's saying - if you're saying it's safer, if you're saying the alternative is safer is the onus at that point on you - he says it's safe. If you're proposing but saying it's safer shouldn't you have tested your alternative?

Richard Halvorsen:
No because what I am trying to do I am trying to ensure that the uptake of measles vaccine continues. Here we have a catastrophic drop off in uptake and therefore I am offering it as an alternative that people will accept, bearing in mind the concerns about the MMR vaccine.

Vivian White:
I'll try that tack on Dr Elliman again because I know he has another part of the answer which he hasn't yet given. Ok, let's pretend that you didn't mind - let's pretend that you didn't mind so much about people having what you think is the best, namely MMR, but you simply were - but you were aiming as someone concerned about public health - and I'll put the question again that I put earlier - to the highest possible level of vaccination. Now Sarah reported in the programme that in some parts of the country the level of actual vaccination, not the level you would wish, is so low that we don't have in quotes "statistically speaking" a vaccinated population. In other words isn't it the case here that the best is the enemy of the good, that you would do better to live with his advice, even if you don't like it, to get to where you want to get to?

David Elliman:
Well I think there are a number of things that we need to add in perhaps then. I think what you're alluding to is that there are a number of parents who don't get their children immunised at 12 or 13 months because perhaps their child is unwell, because they have other things to do and that certainly applies to a lot of the people I see in central London and inner cities. The other thing of course is if one says ok let's go for the single vaccines, if I was someone out there I would say well does that mean they've got doubts then and I have no reason to believe that more people would go for it. I can see, just as Pat Troop said on the programme, that it might cause more doubts and less people would go for the vaccine.

Vivian White:
So you think ...

David Elliman:
If you wanted to follow Richard's logical line the only thing we're interested in is increasing uptake then you would go down the line of compulsion which I don't believe in.

Vivian White:
But do you think the reason, if there's low uptake, isn't to do with - isn't mostly to do with concern about MMR it's simply because people are rather bad at getting their children vaccinated anyway?

David Elliman:
I think it varies depending upon where you are in the country. Out in the leafy suburbs it may well be, if you like, positive objectors, where I live it's a mixture of factors.

Vivian White:
Sarah you don't have to come in but you're sat here, it's your programme, they've been fighting over it, do you want to moderate, come in here, or do you just want to - shall we just go on with the scrap - it's up to you?

Sarah Barclay:
I think all I'd like to say at this point is that - I think we've reached a fairly good defining moment in the whole debate because we do have this cluster of measles cases in South London now and I think ...

Vivian White:
As has been noisily reported over the weekend, not surprisingly.

Sarah Barclay:
Indeed, but I think this is perhaps a moment at which people can really begin to realise what the choice is that they're making. One of the cases who had measles ended up in intensive care and that's not to say at all that people shouldn't be having choice.

Vivian White:
Your programme started off with a measles disaster, if you like, with - showing what happens with measles.

Sarah Barclay:
And I think what this now will show parents is what actually that choice is all about and the balance of risks that's involved.

Vivian White:
While I'm just listening to all this but if it's making the choice easier I must have been in the wrong room. Dr Natasha Campbell McBride e-mailed us from Cambridge before we even got on air and said: "I'm a medical doctor and I firmly believe that vaccines like MMR act as a trigger to children who are already immuno- compromised." Which is not dissimilar to what the argument is that Dr Wakefield puts forward because one of his cases is that one of the risk populations is children who are in that situation. She says we should screen children for immunodeficiency before giving vaccinations. Now let's try that on you Dr Elliman. Even if you think it's safe what's the objection to that?

David Elliman:
Well, what - you would have to start by saying what do you actually mean by immuno-compromised because I think, with respect to this doctor, she's probably using the term loosely, this isn't a medical condition that we would normally recognise where people get lots of infections but some way very sensitive to the MMR I think.

Vivian White:
Whether it helps or doesn't, just to be clear, this person is going to publish her position in February's edition of the Autism File, I don't know whether that to you - that's a journal concerned with autism, whether, from your point of view, that satisfies you or not as to her status I don't know, I can only report that to you.

David Elliman:
If you look at the risk factors that Dr Wakefield has now produced you would cover an enormous percentage of children because he talked about antibiotics, colds, the sort of things that most children are normally going through.

Sarah Barclay:
About 20 per cent apparently.

David Elliman:
Thank you, yes. So a large proportion of children and there is no reason, I would say again, to suggest that there is any link with the vaccine because I go back to the original studies - if you take a group of children who've had MMR and a group of children who haven't, irrespective of anything else, there is no difference between the two. If you were going to screen all these children, I presume she means you would do blood tests on all the children, now that's cruel - having a blood test done is much more traumatic than having an injection, I can tell you because it's something that I stopped doing some years ago because I've lost the expertise to do it in young children, but any child who's been through it, you ask their parent, they will say they'd prefer to have a jab which is over in 30 seconds to having a blood test. Because then what are you going to do, most of those children are going to go on and have the jab as well, so they're actually going to get an extra needle stuck in them for no good scientific reason.

Vivian White:
Right, which I can only say to Dr Natasha Campbell McBride from Cambridge you've heard Dr Elliman's answer, which is it's bad enough if you - the process of having a needle stuck in a small young arm dragging out the blood is from your point of view itself something you'd prefer not to gratuitously and you're afraid that she's proposing something which would be gratuitous. What do you think Dr Halvorsen?

Richard Halvorsen:
Certainly if we could do that to prevent cases of autism it would be a very small price to pay. But I agree quite interestingly and surprisingly here with David Elliman in that we don't have enough evidence of what these susceptible children might be, yes the hypothesis is that the MMR triggers autism in these susceptible people but not even - but nothing like enough is known to be able to do that.

Vivian White:
A sort of triumph at this point, about 20 minutes in, Dr Natasha Campbell McBride has forced - encouraged an agreement between the two - our two expert guests to the immense relief of our reporter. But a similar question has been raised in a text message from Paul who says: "I'm extremely worried," he puts the same thing the other way round, as a parent, "I'm extremely worried about my son who's about to receive the MMR." And this is why: "He's had a bad start in life and his mum has diabetes, is there an alternative?" So alright, real patient coming to your clinic and we can hear what the parent is saying - my son, seems to me, for one reason or another, to be in an at risk category - does that mean he's in an at risk category in connection with this vaccination?

David Elliman:
No.

Vivian White:
Ok.

Richard Halvorsen:
Yes maybe and there is a very good alternative, that is the single vaccines which I would discuss the pros and cons with this - with the parents and if they wanted to go ahead with that I'd be very happy to offer it to them.

David Elliman:
But Richard has no evidence at all that the MMR leads to diabetes or if it does that giving it separately makes any difference.

Richard Halvorsen:
I didn't suggest it. I didn't suggest for a minute that diabetes - that it would lead to diabetes. I'm sorry you misunderstood me. It is possible that diabetes and other autoimmune type problems may - may be a risk factor for having autism triggered by the MMR.

David Elliman:
Substitute autism for diabetes.

Richard Halvorsen:
This is hypothetical, so it's clearly - I fully accept that. But this is what Dr Andrew Wakefield has postulated and I know you don't agree with that but that's what we're looking at.

Vivian White:
Aren't there an awful lot of hypothetical things that would lead you not to do things because there might be risks in your clinic? Once I hear the word hypothesis, rather than proof, I'm led to ask you that question.

Richard Halvorsen:
Again it reminds me of the question that Sarah Barclay asked Andy Wakefield, you asked him, you said you hadn't got proof ...

Vivian White:
That's right, yes.

Richard Halvorsen:
Why should you be doing this. And I've thought about that - why am I offering it? There is no absolute proof that the MMR causes autism, I fully accept that, but what there is - there is enough uncertainty, there are enough unanswered questions - why has autism increased ten fold, why are several thousand people saying that it has happened to their child, why is measles being found in the gut of so many children with autism?

Vivian White:
No causation he said - I'm sorry I'm saying it for you - Dr Elliman?

David Elliman:
Can I - this may sound facetious but medicine has moved on from solely acting on anecdote and our own individual experience because it can be misleading. There used to be an era when people were treated by cupping, by bleeding and undoubtedly lots and lots of them got better but they would have done otherwise. And we've moved on from that era to examining our practice and basing it not on our personal experience but a broad scientific basis - so-called evidence based. Now if we go back to an era of saying I know some children where this has happened to them, no there isn't any scientific evidence but my experience is, and there's a lot of people's experience, I worry about the way medicine would be going if we followed that.

Vivian White:
You were looking at me but you were addressing him - I mean he's saying that your pre-scientific, or at least your pre-modern, in the previous answer that you gave, that just by saying there's a lot of it about isn't scientific - doesn't give us causation.

Richard Halvorsen:
Science gets things wrong and experts certainly get it wrong as we've seen in the past. What I am doing is I am looking at all the things I see and I hear and that includes the scientific papers. Let's just look at the scientific papers for a bit. There are a lot of scientific papers that the Government claim shows that MMR does not trigger autism, well most of them do no such thing. Worryingly one important paper for example was paid for by the drug company that makes the MMR, another paper in its introduction said - in its introduction - the purpose of the paper was to reassure parents about the MMR ...

Vivian White:
Hang on - come on ...

Richard Halvorsen:
This is not science, this is not science.

Vivian White:
Come on - come on now - come on. Wouldn't you want the drug company that makes - you can't have it both ways. If you think there may be risks in something wouldn't you want the drug company that makes it to carry out research? You can't then say look they've carried out research - it's a shocking business, it's the drug company that made the vaccine that did it.

Richard Halvorsen:
Can you be sure that a drug company's research is independent research? The drug company has a duty ...

Vivian White:
That's what peer review's about isn't it? I'm sorry.

David Elliman:
Yes you've taken the words out of my mouth. The whole idea of producing a scientific paper is as far as possible what you've done, how you've done it and the results are presented in an overt manner so that someone else can examine it. I think going down the ..

Vivian White:
... to believe that - is it nonsense - I mean should I apologise - should I apologise - is it the case that the drug companies who sponsor research are always looking for the answer that suits them? Perhaps I'm just ...

David Elliman:
That would be an oversimplification. Now obviously someone who's had a vested interest you want to be absolutely certain that they haven't cooked the books, if you like, but I defy you to find anybody who hasn't a vested interest. Richard gets paid for giving the single vaccines.

Vivian White:
Sarah you've been wanting to come in.

Sarah Barclay:
I was just going to say that I think one of the problems in this whole debate is the way that the Government has tackled the information campaign that it is giving to parents. The fact is that they may be right or there may be a group of children who are affected but nobody believes the advertising - it's seen to be propaganda and not only that it's seen to be paternalistic, the parents don't like being told what is best for their children. And I find it difficult to understand at times what the Government strategy has been in the way that it has set out to persuade parents that they're right.

Vivian White:
Anybody going to comment on that?

Richard Halvorsen:
I agree with you, I'm hearing this from parents who are coming to see me all the time asking about the single vaccines, they're telling me that they feel that they're being bullied, that the Government's being paternalistic and they just - they just don't trust them, they're too certain is what they're saying.

Sarah Barclay:
But of course what gets lost in all that is truth.

David Elliman:
I again to surprise people I partially agree with Richard here. I think what you saw in terms of the television advertising I don't think is appropriate at all. But what's ...

Vivian White:
So you think to address parents in terms of there being lions and tigers out there in the jungle - if I don't get my child - I couldn't believe that but you two seem quite familiar with all that stuff.

David Elliman:
I don't think that sort of thing is appropriate but what the Government has taken on board is that parents who are questioning this do not need a glossy leaflet that says the Government says this. So they have produced fact sheets which not only say this is what we think but give the basis for that and the scientific papers ...

Vivian White:
So besides the sort of safari tactic - showing lions and tigers in the jungle - they've actually got rather cooler material I can pick up in the surgery too?

David Elliman:
That's right, that you could pick up in the surgery, the health visitor would give you, that you could go away and read and if you didn't believe it you could go and look up the scientific paper that it's based upon.

Vivian White:
Dr Halvorsen, not surprisingly someone has asked the question which I should have asked you rather than biting you the way that I did when you talked about the pharmaceutical company which was conducting research on MMR themselves, which company, asks our texter, which pharmaceutical company conducted the MMR clinical trials? Because you suggested that the company that makes the vaccine conducting clinical trials was itself less than ideal.

Richard Halvorsen:
Yes it's a less than ideal situation. I'm not suggesting, and I want to make sure that therefore that paper is necessarily invalid but clearly ...

Vivian White:
Right, less than ideal was the phrase I used - which company?

Richard Halvorsen:
Now I think ...

David Elliman:
I think it was MSD but I'm not certain.

Vivian White:
Alright, we think it was MSD, we're not absolutely sure texter.

David Elliman:
Can I say there is a difficulty here: if the drug companies are non-U in terms of funding people will say well if the Government funds it you know they would say that won't they, so who on earth is going to fund it because these studies are very, very expensive if done properly.

Vivian White:
I'm not exactly sure what you call someone, by the way, who contacts a programme via text, e-mailer I can just about manage, texter sounds a bit clumsy but if there are any better suggestions do text us or e-mail us in. Nick Middleton from Newton Abbot e-mailed us just before we went on air saying: "If Tony Blair won't say which vaccination his child had then he's assuming it wasn't MMR, what does he know ..." well let's deal with one question at a time, he then goes on to say: "What does he know that he's not telling?" Well we can't read his mind so first of all do either of you find any implications at all and which implications in Mr Blair not saying what he did in the case of his own children - Dr Elliman first of all?

David Elliman:
I think it's a very difficult situation as to whether or not he should tell, I don't think one can draw any conclusions. What may reassure people is that before there seemed to have been a clamp down on ministers saying anything Yvette Cooper who is actually the minister responsible for the immunisation campaign had already said that her child had had the MMR and she should know if anybody.

Vivian White:
I see, so the Minister of Health - the Minister of Health will say and that, as it were, somehow outranks the Prime Minister ...

David Elliman:
Well she's got the information, she's responsible for the programme, she's more likely to have the detailed information than he is.

Vivian White:
Because the second part of the e-mail says what does he know that he's not telling? And so what you're saying is the person who's in a position to know everything - Yvette Cooper - says it's ok, so that's - she's a sort of super answer. What did you think about Mr Blair's reluctance, apparent reluctance, to say what he's doing in the case of his own family - did you think - well if it was a patient of mine I'd be jolly glad to respect their confidentiality or has that principle now gone by the board after recent events at the Whittington?

Richard Halvorsen:
It certainly hasn't gone by the board and of course on the one hand I fully respect his right not to let anybody have any information about his family's health and I accept that entirely. But this is such a controversial issue that wouldn't it have helped Dr Elliman here in his campaign to encourage people to have the MMR if he had just stood up and said - Yes Leo's had it - but he unfortunately he hasn't said that.

Vivian White:
Is that a - is that a when did you stop beating your wife position regarding Mr Blair?

David Elliman:
I think it's very difficult. I don't know, I honestly don't know how many people would be convinced by what would be, if you like, a PR exercise. There was a PR exercise over BSE with John Gummer feeding his child a hamburger, that rebounded badly. So I'm not sure how good ...

Vivian White:
Well it rebounded badly ...

David Elliman:
If he came out ...

Vivian White:
It rebounded badly because it subsequently turned out it was dangerous, not because he gave his child ...

David Elliman:
But because of that - because of that would people now believe someone who did exactly that?

Vivian White:
Oh I see what you mean - oh that's quite sophisticated, you're saying that the moment that Tony Blair recommends it instinctively we think something's awful about to happen. Sarah I see you want to come in at that point.

Sarah Barclay:
I do think that the most difficult thing now is to restore any kind of confidence. I think once trust, for whatever reason, has been destroyed it's terribly difficult to get it back and all the information campaigns in the world will not banish the fear that a parent might have once it's been put there.

Vivian White:
Now we've been talking about campaigns and choice ...

Sarah Barclay:
I think David Elliman wants to come back in there.

David Elliman:
I think Sarah is dead right, it is very, very simple to destroy confidence, it's very difficult to build it up again and we saw this with pertussis, almost 30 years ago now, where almost exactly the same scenario - some well intentioned clinicians saw some children who were brain damaged, who had had whooping cough vaccine, put two and two together and got five and a half ...

Vivian White:
And were they wrong?

David Elliman:
They were wrong and in fact ...

Vivian White:
Do you accept they were wrong Dr Halvorsen in that particular case, historically?

Richard Halvorsen:
I haven't studied those enough to be able to comment.

Vivian White:
Ok, fair enough.

David Elliman:
And as a result of that the immunisation rates went down, between 70 and 100 children died from whooping cough who needn't have done and it took about 15 years to get back up to the immunisation rates that there were beforehand and it's almost exactly analogous.

Vivian White:
We had e-mails before we went on air, one particular came from a woman who e- mailed us from the USA and she was talking about mandatory vaccination. Now that's raised by a text message we've just received from someone who says, it doesn't give his name, but it seems to me that it's perfectly reasonable that we take this: "My son is soon to get his MMR jab I believe there could be a risk. I don't want to take that risk." I'm sorry that's obviously in this case from the mother because the texter says: "My husband is unsure. Could we be forced, at a later date, by the Government?" Ok, if you're sure it's safe is that the logic of your policy, never mind whether you think the ads with lions and tigers are a bit extreme, if you're quite sure what you're doing is in the interests of public health is there a moral right to make sure people have the jab?

David Elliman:
Personally I don't think there is a moral right to enforce something. What I do think I have a moral obligation to do is advise the best treatment and give the best treatment, I don't have a moral obligation to give second best treatment. And I don't have the obligation to force people to do what I want them to do.

Vivian White:
Have there been any forced vaccinations in this country - is it ever done? I mean we know that parents are meant to have these vaccinations, is that a matter of law, is it a matter of guidance, what's the legal status of these vaccinations? No one knows?

David Elliman:
From something like 1850 to 1948 smallpox vaccination was compulsory in this country - that is the only vaccination that has ever been compulsory, there are none that are compulsory currently.

Richard Halvorsen:
I agree entirely with what Dr David Elliman has said, again I'm delighted to say, in that I also feel obliged to give the best advice that I see. Of course doctors have never agreed completely on things so it should be no surprise that there is some disagreement now.

Vivian White:
And last of all we have an e-mail directly addressing Dr Wakefield from someone who says that Dr Wakefield's past research has shown equal disregard to proper scientific procedure, his data on measles and irritable bowel syndrome is unrepeatable, in other words, presumably what they mean is, unreliable.

David Elliman:
What they mean is not irritable bowel but inflammatory bowel and what I think he's referring to is some research that they did some years ago now looking for the virus in inflammatory bowel disease and then when they used a different method they didn't find it, other people in the world didn't find it either. I think that's what he's referring to.

Richard Halvorsen:
From what I know of Dr Andrew Wakefield he's an extremely conscientious scientist and likes to do everything scientifically, that's why he speaks very rarely to journalists, he wants to do things through the scientific mould and he has published negative papers as well as positive papers supporting his argument.

Vivian White:
I'd like to thank you all very much indeed. I'd like to especially thank you for the two moments when the two of you agreed during this programme ...

David Elliman:
Three I think.

Vivian White:
And for that fourth moment when you agreed that there were three moments. Sarah thank you very much indeed for coming straight after transmission and thank you very much indeed for all the e-mails and for the text messages which are still pouring in - all those of course can be posted and will be posted on the website and the address is: www.bbc.co.uk/panorama - but I'm sure you know that. And if you saw part of this transmission but not all of it as soon as we're done the whole thing will be there recorded on the website and if you press the red button on satellite digital you can see it all again and again right through the night. Panorama's back next week on BBC 1 at 10.15 but now from all of us and from me, Vivian White, thank you very much for joining us and goodnight.