[e-drug] Worries about acceptance of MMR

[Peter Copp <petercopp@gpplus.co.uk>]

E-drug: Worries about acceptance of MMR
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[We need to keep in mind that E-drug's main purpose is to support
developing countries, and MMR is not one of the EPI vaccines in
most of them. However, Peter asks for international assistance from
E-druggers. Isn't that great? HH]


Dear E-druggers,

I ask for international help for Scotland.

Despite a concerted effort to reassure parents of the safety of
combined Measles-Mumps-Rubella vaccination, there are a large
contingent of parents in this country who refuse to vaccinate at all
with this product (available in the UK as Priorix or MMR-2).

A large number ARE prepared to vaccinate using mono-component
equivalents and over the past 3-4 years, I have vaccinated several
thousand children this way with complete courses. This has been a
small but important contribution to overall 'herd-immunity'.

There is little anyone can do about those who are steadfast in their
opinion other than 're-educate' at every opportunity and in addition,
the threat of Measles and Mumps outbreaks in the UK (a situation we
now unfortunately face) may prompt some into action.

There is no problem with the availability of Measles and Rubella
vaccines but the story regarding Mumps is a puzzling one to say the
least. Merck closed down their production of Mumpsvax in the USA
about two years ago without any satisfactory explanation and as far
as I am aware the situation remains unchanged.

I was able to find existing product scattered around middle and
eastern Europe up until recently and import this via the Medicines
Control Agency.

Despite being fully informed of the shortages and uncertainties,
parents continue to register for moncomponent vaccines and we
ensure that this decision is reviewed carefully before proceeding with
any vaccination.

However, we are now faced with a growing number of children who
are waiting for monocomponent Mumps vaccine (the Jeryl-Lynn strain
being the one of choice). This number now stands at about 600. We
are also aware that across the whole of the UK this number becomes
thousands as there are many other Private and NHS GPs (and
nurses) who are prepared to vaccinate this way.

Our responsible approach is to do everything possible to ensure that
each vaccination course is completed. However, for many, this could
be well into the future.

However, the 'future' may be too far away for some of these children
who may sustain Mumps meningitis or sub-fertility in the interim.

I therefore appeal to any members of the international pharmaceutical
community to determine whether they can advise of any residual
stock available (wherever they are) and in addition, whether they can
shed any light on the lack of new mono-component Mumps vaccine
production?

We located a possibility with the Pavivac (Jeryl-Lynn) product from
Sevapharma in the Czech Republic. Despite assurances from our
regulatory bodies here in the UK that they would assess any
safety/efficacy issues last year, nothing was done about this until I
interceded last month and the MHRA have finally made contact with
Sevapharma to launch an independent laboratory assessment of their
product. This could take many months (and there is much scope for a
smokescreen).

I wholeheartedly agree with the commitment to promote combined
MMR but any attempt to 'manipulate' other options is unreasonable
and is highly likely to have an unwelcome rebound effect in the eyes
of the general public here in the UK.

This is simply a societal reality and we (allied healthcare
professionals) must take our heads out of the sand and be prepared
to be flexible for this determined, vocal minority.  The fact of the
matter is that the majority of those whose current option is to do
absolutely nothing about MMR vaccination are much more likely to
come forward for combined vaccine if and when these other
individuals can go about their business quietly and exercise their right
to choose (and pay) without the associated conflict which spills into
the media.

If we applied the same regulatory approach/argument to other
medicines, we would only be able to choose one ACE inhibitor, one
macrolide, one COX-2 NSAID etc etc

Single vaccines do not achieve licensed status because there is
another solitary acceptable option readily available (combined MMR).
Unfortunately, this remains unacceptable to many potential recipients,
despite the evidence-base available.

Any help to secure further supplies would be tremendously welcome.

Peter

Peter A J Copp
MBChB MRCGP DCCH DRCOG DFFP DFOM DPCRheum
Private GP and Occupational Health Medical Advisor
Medical and Managing Director
GP-Plus (Edinburgh) Ltd
https://www.gpplus.com
e-mail: petercopp@gpplus.co.uk

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