http://bmj.com/cgi/content/full/323/7324/1304#resp3

Should decision on vaccination be best for you or us?

EDITORAlthough I agree with Majeed that Dr Peter Mansfield's referral to the General Medical Council seems inappropriate, this may prompt more debate around the important issue of whether it is reasonable to legislate for the rights of the community over the rights of the individual as regards vaccination for measles, mumps, and rubella.¹

The argument seems to be that we know that combined measles, mumps, and rubella vaccine is safe and effective (anyone who takes the time to assess the extensive literature should be able to persuade themselves of this fact) and that single vaccines may reduce adherence to the full course and show no advantage. The community therefore loses out as a result of an individual's decision, by a reduction in herd immunity and an increased chance of an epidemic. The Department of Health therefore thinks that single vaccines should not be offered on the NHS, and there is now a question as to whether this is defensible medical practice.

Other individual choices (such as aspirin or warfarin in stroke prevention) are allowed as these are not seen to affect the community directly, although they might result in a notable burden for those caring for the increased numbers of people with strokes that this would create.

The Department of Health banks on the fact that more people would take up the option of receiving single vaccines if they were available than would refuse all vaccinations if the former were not available. Although this may seem sensible from a public health and community perspective, it is sometimes difficult to communicate the lack of individual choice in this matter in the consulting room. Shouldn't we, in this age of "patient centred" medicine, trust patients to make decisions for their own children? This would mean the cost of a potential epidemic with each media scare, but give parents the freedom, responsibility, and ownership of such a decision.

Alex Manning, general practitioner. 
Burwell Surgery, Burwell, Cambridgeshire CB5 0AE alex.sam@virgin.net

ALL INFORMATION, DATA, AND MATERIAL CONTAINED, PRESENTED, OR PROVIDED HERE IS FOR GENERAL INFORMATION PURPOSES ONLY AND IS NOT TO BE CONSTRUED AS REFLECTING THE KNOWLEDGE OR OPINIONS OF THE PUBLISHER, AND IS NOT TO BE CONSTRUED OR INTENDED AS PROVIDING MEDICAL OR LEGAL ADVICE.  THE DECISION WHETHER OR NOT TO VACCINATE IS AN IMPORTANT AND COMPLEX ISSUE AND SHOULD BE MADE BY YOU, AND YOU ALONE, IN CONSULTATION WITH YOUR HEALTH CARE PROVIDER.