Immunisation

Weighing up the risk

No decision is risk-free and everything in life carries some level of risk. When parents make the decision about immunisations for their child, they need to weigh up whether the risk of their child catching the diseases and having complications is greater than the risk of potential reactions to the immunisation.

The overwhelming majority of parents believe in immunisation for their children. We have however included here the views of a few parents who do not believe immunisation is right for their own child based on their personal beliefs. Their views represent a small proportion of the population.

In order to make an informed judgment about risk, parents need to be sure that facts which are used to weigh up the risk are based on reliable, scientific evidence and there is now a mass of this information available (see 'Information for making decisions').

It is important to know that you are comparing like with like. For instance, comparing the chance of your child developing inflammation of the brain (encephalitis) as a rare complication of measles (1 in 1,000 cases of infected children - Encephalitis Society 2014) and the chance of developing encephalitis as a complication of MMR (less than 1 child in a million).

Parents need to weigh up the risk of potential side effects of the immunisation versus the risk...

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You know, a lot of them will say, 'There are no side effects'. Well, there are side effects, those are actually noted by the pharmaceutical companies who manufacture these vaccines. So you can't say the vaccines have no side effects. There are risks with everything and you have to weigh up, 'Are you happy that the risk of that vaccination and the possible side effects were better for your child than the risk of maybe not having the vaccination and catching that disease naturally'. And that's ultimately what you have to weigh up and I don't think the government really give that view. I think they've just been very black and white about it.

Deciding that the risk of their child getting the disease was greater
Parents who decided that the risk of their child getting the disease was greater than the side effects from the immunisation took several things in to consideration:

They reviewed the suggestion a link between inflammatory bowel disease, autism and MMR and decided that ithere was not enough evidence, that it was one study based on a biased sample, with tentative findings, where there might have been a conflict of interest, now discredited by most of the team that produced it and by the editor of the Lancet who published the study findings.
They believed the media had exaggerated the risk attached to the immunisation.

Decided it was a safer gamble to give her son the MMR vaccine than to not have him immunised.

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It's really difficult, really difficult. And our son was quite, I don't want to say normal, but, you know, you look at sort of their landmarks that they're supposed to reach at certain ages and he hit those quite easily. And by the end of the research and the agonising then we took a gamble, because there is a risk attached to the triple vaccine. But just like there's a risk attached to the immunisations I gave him at 3 months. But it seemed to be easier to give him the injection than not to give him it. And we were, I don't know, I can't even say we were prepared to take the consequences. It felt a safer gamble than it did at the start. And now, having given the triple vaccine, he goes to nursery and he'll start school in a couple of years. And it seems like the right decision.

Didn't believe MMR caused autism and believed immunisations could protect her child from...

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I know that they can be life-threatening. So that's why I think, you know, it is important for me as a mother to protect my baby if I can, as much as I can. Because I know some mothers, I've heard from my friend and family that they do complain that the babies cry, you know, they've got probably a rash or something, I don't know. But you just have to weigh the situation as I said. It's what's more important.

Because I don't really think, me personally, I don't really think a vaccination is linked to autism really. Because it's usually, you really notice it after a year. So I think parents get a bit confused that they think, because MMR is given at that same age as well, so they just link it with that vaccination. But, because with my friend, she had a brother that had autism. And he was born premature and he's got autism. But it's not because of the MMR, it's just something that you're born with. But you don't actually, I mean you don't really notice the autism until they're 1 years old, because that's when they walk and they talk, isn't it? They, that's when you actually notice all these things. So I think, I wouldn't really link MMR with autism because I don't, and there's no, really any studies to say that it is linked to that or the side-effects to that. I don't think it is.

Believed the risk of the diseases and complications of the disease to be a greater risk than the...

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I was also aware, and my husband too, of the controversy raised here about the MMR. I always thought, sorry to say so, that that was rubbish. And I think later on that was confirmed. Now the evidence shows that that study reporting MMR association with autism and IBD is completely wrong. Even if it was so, the incidence of autism and inflammatory bowel disease in children who have been vaccinated with MMR was far, far lower than the consequences, the, the possible consequences of.... for not having received the immunisation and having had the infection. Measles is one of the most immunosuppressive viruses around and when a child gets measles his whole immune system is affected. So they can get any infection. In my country they often die of bronchopneumonia. And it's just terribly sad to see a child die because he wasn't given the immunisation in time. So you can have much worse consequences for not having the vaccine than for having it.

Autism is a very rare occurrence. Probably we are seeing a bit more of it because now we are diagnosing it more. It was completely unknown thirty years ago. Nowadays there are more criteria and more knowledge so we are diagnosing it more. It's not that it's just out there increasing now. It is just that we are now seeing it. The same happened with the cancer. Before, people said, 'Oh, no, nobody died of cancer fifty years ago'. It's just that we didn't diagnose it. People still died of it. But people said, 'Oh, they just died of something'. And, and it's the same with autism and, and inflammatory bowel disease. They happened coincidentally to start being diagnosed about the same time as MMR was starting to be applied, and also they tend to be diagnosed at about the age when the MMR is administered. So it's coincidental. But there is absolutely no evidence, and there have been lots of studies done with a lot of children that proved that there is no connection. It's just totally coincidental.

Believes the media misrepresented the level of risk associated with MMR.

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Again I think because I'm in research I always treat media representation of health results with quite large scepticism [laughs]. So the media like to get hold of this idea, this difference between absolute risk and relative risk they deliberately play on that. It was like when the pill scare came out and they said, you know, that the risk of thrombo-embolism was, the relative risk was, I don't know what it was, it was about twice or something if, it, on this pill rather than that pill, but they didn't say that the absolute risk was still tiny and actually still smaller than it would be if you were pregnant. And what happened was that all these women got pregnant as a result. So that whole representation of risk they deliberately play about with that.

And I always find whenever you read anything that you know anything vaguely about in the papers you always realise how many sort of [laughs] how biased it is or that it's coming from a certain angle and certain things aren't ' So I'm not so swayed by stuff in the media.

I think I'm quite lucky at having access to research papers and if I read something in a much more I don't know, reliable, if that's fair, source, then I would be more worried. But even then studies are funded but that's what swung it for me about the MMR was that this guy had a serious conflict of interest. You know, he was representing the parents of children with autism and you can see how it happens. Somebody stakes their career on making a certain point and they get a certain reputation and they can't really back down. So, I think knowing that, knowing that background, that piece of information in itself was enough for me to really dismiss, I think [laughs]. Although I mean it's funny because you have a rational head and then you have your sort of mother head on and so it's not that I got him immunised and didn't worry about it. It was still, I was still looking for signs of [laughs] withdrawing from the world and not wanting affection enough to... which is ridiculous, I knew it was ridiculous but you still sort of do that, you still kind of watch afterwards to see if he's changed. But there was absolutely no sign of that.

Thought there was not sufficient evidence to not give her daughter MMR.

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Thought there was not sufficient evidence to not give her daughter MMR.

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I discovered through reading up on, on this issue that if you choose to have a single immunisation programme you have to have six separate jabs instead of the two that you have for the MMR. And obviously if the time in-between having the jabs, these six jabs, your child isn't protected. So it's, it's again heightening the risk of catching one of these diseases and of your child maybe passing the disease on to a pregnant mother, whatever in the case of rubella.

The fact that MMR is done so worldwide, used so worldwide I think over a hundred countries have used it since it was introduced in '88 I believe, suggests that if there really was such a massive problem they would have pulled it off straight away, the Government would have taken it off the shelf straight away because I can't, you know, I can't believe that they would put, you know, the nation's children at risk that seriously. I think that if I had read different, a number of different reports suggesting that the evidence they'd come up with was, was very clearly, you know, in favour of getting rid of the MMR I would have thought again. But because it was just this one gentleman's report and the fact that I believe I read as well that after the Lancet published the report they suggested that he had conflict of interest because he was at the same time looking into the whatever it was the MMR vaccine influence on these, some children that were autistic. It, it does make you think, 'Mmm maybe, I don't, I don't think I'm going to pay too much attention to it. I think that the thousands, well, millions of children that are immunised against it that are actually okay.' I think it's the way forward for me and my baby basically. That was how I reached the decision for us.

They considered the risk of other side effects to be very small and not high enough to warrant not giving their child the immunisation.
They assessed the chances of their child getting a disease where they lived. For example, if they lived in an area where many people didn't immunise, or if there had been outbreaks of measles or mumps in their neighbourhood, the chance of their child getting one of these diseases was increased.

When there was a measles outbreak in her daughter's nursery she was relieved to have finally...

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And then the next day when I found out and I'd gone to pick her up from the nursery and they said, 'Has my daughter had MMR injection?' and I said, 'Yes, actually she's had it two days ago' they were a bit like, 'Okay, well...'. I think you needed to allow 48 hours or something for the injection to actually kick in, I think. So there was a slight concern about that, but I was also very relieved that, you know, she'd had the injection and the chance of her contracting measles was probably fairly diminished from that. So I was incredibly relieved and quite sort of freaked out that I had actually sort of made the decision and suddenly, because if I hadn't have had her, you know, immunised I would have been really, really panicking.

They didn't want these diseases returning in the population and if there were epidemics they believed the risk of catching the disease would be higher for their child.
They didn't want their child to be ill when it could prevented.

Believed the risk of a side effect from MMR was small and she didn't want her son to be ill when...

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I saw him as a very minimal risk and I probably really did think [child noise] Yeah, I think he was at, I think by the end of it I believed that he was at negligible risk from the MMR itself. Obviously he could still be autistic. That could still happen. And what, if you look at, that to manifest itself but I felt that it was so small that I didn't want to, for him to miss out on the benefits of the immunisation for it.

Measles and mumps, has...?

Well they can be serious if a boy gets the mumps he could become infertile, which is serious. And they, they are serious illnesses. They are not very often fatal but it's horrible having a sick child. A young, sick child it's just dreadful and I wouldn't relish looking, you know, I don't want to go through that at all. There's worse things that he can suffer with but, yeah, I'd like him to not have to go through something like that.

So how do you feel about the decision you made?

Oh, I feel comfortable with it.

They considered it better to have a short-term risk from a reaction to the vaccine than a long-term risk through childhood of their child not being protected from the diseases.
They were concerned that the health care their child might need if they had a complication from measles would not be available.

Deciding that MMR was less risk than single vaccines
Parents who decided that MMR was less of a risk than single vaccines considered the following:

Single vaccines were unlicensed in the UK.
They were only available in private clinics and they couldn't be sure how trustworthy the clinic was.
There would be opportunity for unscrupulous people to set up clinics for single vaccines to take advantage of parents' concerns.
Because they were unlicensed they were possibly less reliable and could give less immunity than MMR.

Deciding that single vaccines were less risk than MMR.
One parent we interviewed who decided that single vaccines were a safer option than MMR personally believed that if there was a small but potential risk that her daughter would get a reaction to the MMR, she didn't want to take that risk. She believed that if the vaccines were imported from America or France the risk of them being unsafe was lower. The MMR vaccine also comes from abroad. She also personally believed that going to a clinic in Harley Street would be less risky.

Chose a clinic in Harley Street to give her daughter single vaccines because she thought it would...

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And I eventually found places that, that, that could do, it but again it's finding information about those people and if they're, what the service is like. Hence why I saw Harley Street, thinking, 'Well, okay, you can have really shoddy doctors on Harley Street but, hey, on the whole they're going to be okay'. As opposed to someone suggesting, another website suggesting East Finchley, thinking, 'Well, Harley Street is a street of doctors. I think I'd better go there' [laugh]. So this, it is difficult.

It's difficult to know who to trust.

Who to trust. There's no kind of information of, of recommendations of who to go to. It really, it's really difficult.

Deciding that the risk of side effects from the immunisation was greater
A very small number of parents who decided that the risk of potential side effects from the immunisation was greater than the risk of their child getting the disease took several things in to consideration:

They personally believed that while these diseases could be unpleasant, they were not particularly serious unless a child developed complications. About 1 in 15 children with measles have complications which include ear infections, pneumonia and fits (NHS 2015). They personally believed the chance of a complication occurring to be quite low, so they decided to take a chance that if their child caught the diseases, they wouldn't develop a complication and they would be able to nurse them through the illness (see 'Parents' views of the diseases').
They personally believed that the media and the health authorities portrayed these diseases as more serious than they actually were. Before immunisation was introduced, most people who have measles and mumps did not suffer serious complications. However, 1 in 15 children with measles had complications including earache, pneumonia and fits (NHS 2015). 1 in 1,000 had inflammation of the brain (encephalitis), (Encephalitis Society 2014). When these rates are applied to the whole population, the complications of measles and mumps caused a serious number of hospital admissions and long-term disability.
They believed that it was better to have the disease than be immunised against it and it helped to build up the immune system. Gaining immunity from actually having the disease involves the risk of a child developing a complication.
A few of these parents personally believed that building up their child's immune system, through diet and homeopathy, was better than having immunisations. The protection against measles, mumps and the other vaccine-preventable diseases comes from have antibodies (immunity) which is specific for each disease. This specific protection can be produced only if the immune system is stimulated by the vaccine or the natural infection. General measures to strengthen the immune system do not give the protection against the disease and its complications. While it is true that a child with an underlying health condition is more likely to have complications and/or die from measles, healthy children can be very ill too. Allowing them to catch the diseases means that they run the risk of complications.

Feels more comfortable with the risk that their children may catch measles than immunising against it.

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Mother' And actually I don't have a fear of, you know, every year since our son has been born there has been, 'There's going to be a major measles epidemic'. Well, in reality I think there's measles epidemics every three, two to three years anyway, and obviously, you know, it depends on the seriousness of that. But the kind of scaremongering that goes on just actually really frustrates, makes me more cross and, and more determined in some ways that parents should have more information. Because it does feel like scaremongering every year when they say there's going to be a, an epidemic. And, yes, we have a risk that both our son and daughter could catch natural measles. But actually I feel far more comfortable with that and dealing with that than, than actually vaccinating them against it.

Why is that? Why do you feel comfortable with the measles?

Father' Because I think partly, I had measles as a child and it I think it was far more common then. But now the media has portrayed it as a deadly killer disease, which, okay, it can be, there can be complications that cause horrific problems for children, but it's a childhood disease that, it's not like smallpox. It was something that used to exist and it's been a nicety that people are vaccinated and it's helped obviously with some children who have the complications. But it's always portrayed now as a deadly killer, which I'm not sure is the whole truth.

And I, and I think part of it is, when I was a child everyone got mumps, you know. You, it was, I certainly had it. And all I remember is my father keeping out of the way, you know, when I had it. And it was just something all the kids had.

Mother' And I think there is, there is an element that it, again we believe that having some of these illnesses actually builds the immune system, which protects against other illnesses as you get older. The, you know, the immune system needs to be challenged. You know, it's the same theory about you mustn't have your house too clean and, you know, people who have animals for example, dogs, cats, you know, children seem to have fewer allergies because they, you know, they are exposed to some of these things. And I kind of feel the same way about, about some of these illnesses, you know. Having chickenpox is, is fine. It's a, an illness and children's bodies need to develop and go through these things to actually build their immune system against perhaps more serious illnesses as they get older.

Father' It's why their immune systems are there.

They considered the benefits of immunisation and were unhappy that they didn't give 100 per cent protection.
They were unhappy with the ingredients in vaccines and they personally believed that the chance that these might cause a reaction in their child was a riskier option.

Her personal belief is that the risk of the diseases were less than the potential risks of...

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It's very hard and, and some days I do still worry, you know, it still crosses my mind and I, and I hope that I've made the right decision. But certainly some of the literature that I'd read seemed to, be quite dismissive of the fact that the immunisations actually give sufficient cover for a child anyway, and in fact in some circumstances there have been outbreaks of some of the diseases even where there's been a very high take-up of the immunisation. And that actually went quite a long way to me making my decision because I felt that I wasn't happy with the children having the injections if there really wasn't going to be any cover provided anyway. And no one could really categorically tell me that, that it would actually help them and, and keep them safe from the problems.

So weighing up the risk, that was quite a big factor in the fact, you know, understanding that perhaps they weren't going to be covered anyway and, and perhaps only minimally. I also spoke to as many people as possible. And my mother was quite a good source because I have elder brothers and sisters and the immunisations weren't available when they were children, and she nursed them both through measles and mumps. And she felt that whilst it was distressing in some ways and they were very poorly, you know, she managed, she managed to keep it under control and she was able to nurse them through. And I felt confident that I give my children a good diet, we eat organic food when we can and we have lots of fresh air. And also we use homeopathic remedies and I felt confident that my homeopath would be able to help us prevent and perhaps nurse through any of these illnesses should they arise. So that's how I assessed the risk in the end.

Her second child is autistic and though she feels she should immunise her younger children she...

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And it's not something, it's not a decision I've made lightly. I haven't sat here and gone, 'Oh, that's it. I'm not having any more'. I have thought it over and thought it over and discussed it with my husband and we've talked and talked and talked and talked. And what do you do? You're just so afraid for your child. That when you're not dealing with, any of the individual illnesses on a day-to-day basis, so really and truly they don't really kind of come into your mind. You're just thinking about what you are dealing with. And when it's not like 'Well, everybody has got polio or everybody has got that and they're really going to catch it' you don't, it's not logical I know on one side of the coin, but the other side of the coin in my head it is. I don't see those illnesses so I'm not having to deal with that. I'm seeing the consequences of the effect of an vaccination, and I see that every day. You know, when you wake up in the morning the full effect of what's happened is there. And when you go to bed at night the full effect is there. And then when he wakes up three, four and five times a night screaming his heart out you, there's no escaping the problems that, you know, have arisen from doing what is deemed as best. So it's, it's really difficult. It's not, I wouldn't wish my worst enemy to be in the position that I have to be in when, when it comes to the children being, having their jabs. It's, it's hard, it really is hard.

Last reviewed October 2015.
Last updated July 2013

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