The McLellan family of Edinburgh is about to take historic legal action against the Scottish Executive and make a human rights appeal over the combined measles, mumps, rubella vaccination. Alasdair McLellan is five years old but still has not been vaccinated against the three childhood diseases.

Children usually receive an initial MMR jab when they are 12 to 15 months old and then a booster just before they start nursery or primary school, between the ages of three and five years. Alasdair McLellan’s parents do not want him to have the MMR inoculation because they believe that is what caused autism in their elder son, Lewis. They face having to pay one of the handful of private doctors who offer single vaccines. These doctors are under intense pressure not to do so. In fact, in Scotland doctors face legal action if they give single inoculations.

There is a publicly perceived health risk of inflammatory bowel disease and autism developing in children soon after they receive the MMR vaccine. The purported cause of this comes from the measles part of the vaccine. Since the late Nineties, some parents have reacted by not having their children vaccinated at all or by requesting that the three vaccines be administered separately.

In Scotland about 90 per cent of children have been vaccinated, which shows most people here support the childhood vaccination schedules. A growing minority do not, however, and this could pose public health risks (see factfile).

Since 1998 huge studies have been conducted on the occurrence of autism after the administration of the MMR vaccine, including two independent studies - independent in the sense that neither a drug manufacturing company nor government funded them - for which the results were announced at the end of September.

None of these studies has found any evidence on which to base the claim that the MMR vaccine causes autism. Autism occurs at the same rate in unvaccinated as in vaccinated groups of children.

Public health programmes such as childhood vaccination are ideal teaching topics for secondary science and social education because we can all relate to them. Some are even administered at school, such as the tuberculosis (BCG) and meningitis C vaccines.

The Scottish Executive’s 1999 White Paper on health, Towards a Healthier Scotland, recognises the concept of the health promoting school. It involves the Convention of Scottish Local Authorities (COSLA), Learning and Teaching Scotland and the Health Education Board for Scotland, who are to develop health education and promotion in schools.

The National Strategy for School Science also states that LT Scotland will advise on how to enable pupils to cope, as citizens and decision makers, with scientific issues.

Some parents, like the McLellans, still do not believe the evidence that the MMR vaccine does not cause autism and continue to demand single inoculations. So why not give them the option? Why has the Scottish Executive gone to the extent of outlawing single vaccines? Firstly, none of the single vaccines currently manufactur meet UK licensing specifications. Secondly, the Scottish Executive does not want to set a precedent. If single vaccines became available, children would receive them in a staggered way with an interval of months between each jab. In the UK, a delay with the rubella vaccine, for example, would mean that four million children would be susceptible to rubella for another six to 12 months.

The knock-on effect would be that many more pregnant women could be exposed to rubella with the risk of exposing their unborn babies to congenital rubella syndrome. The deformities of this are so severe that a woman diagnosed with it during the first four months of pregnancy is offered termination on medical grounds.

Vaccinations are so successful that we have become complacent about the diseases they control. With the diseases seeming to pose no risk, our attention has shifted to the vaccinations themselves.

That is fine. Accepting scientific developments with blind trust is as bad as rejecting them with emotional reactions based on ignorance.

Our job is to educate pupils to be able to assess critically the achievements, applications and implications of biomedical science. The more people there are involved in decision-making, the more balanced and democratic those decisions will be.

Pamela Maitland lectures at the School of Life Sciences, Napier University, Edinburgh

IDEAS FOR CLASS DISCUSSIONS AND OTHER ACTIVITIES

Consider these questions

* Should people have a choice between being vaccinated or not when so many other lives could be affected?

* Does it pose more of a health risk to outlaw single vaccines than to allow them?

* The perceived risk of the MMR vaccination causing autism is unproved. The increased risk of congenital rubella syndrome after a pregnant woman’s exposure to rubella is proven. If some families believe their human rights are being infringed over the MMR vaccination, what of the human rights of susceptible unborn children?

* What is acceptable risk?

* Why is it important that research studies should be independent, in the sense that a manufacturing company or government did not fund them?

* Viruses cannot grow without hijacking the machinery of living cells (the building blocks of tissues). Many vaccines are developed by growing a particular virus on particular tissues. The viruses are then harvested and treated so that they provoke an immune response without giving the inoculated person the disease.

The measles virus is grown on human cell lines. These cells can be grown indefinitely in the laboratory. The human cell line used for the measles vaccine originally came from the lung tissue of an aborted foetus. The Catholic Church has no ethical problem with this. Do you or your pupils?

Pupil activities

* Look up the definitions of vaccine, vaccination, inoculation, injection, immunity and virus.

* Give a presentation on one of the following diseases: measles, mumps, rubella or, to tie in with the next activity, smallpox.

* Smallpox was eradicated worldwide in 1980 and since then no one has been vaccinated against it. The virus still exists in laboratories in various countries and it is a disease that could be used in biological warfare. Given the current political climate, make a poster of what you think the public should know about smallpox.

Internet references

Health Education Board for Scotland www.hebs.org.uk

Scottish Centre for Infection and Environmental Health www.nhsis.co.ukscieh

World Health Organisation www.who.int

Centre for Disease Control, Atlanta www.cdc.govnipvacsafeconcernsautismautism-mmr.htm

MMR factfile

The MMR vaccination

* The combined measles, mumps, rubella vaccine became available in 1988. The second pre-school dose has been given since 1996. Children get two jabs instead of six.

Before MMR vaccination

* Between 1983 and 1987 there were 25,453 cases of measles and six deaths in Scotland.

* Mumps used to put 100 Scottish children a year in hospital with viral meningitis.

* Between 1980 and 1989 there were 12 cases of congenital rubella births in Scotland.

After MMR vaccination

* The uptake of the vaccine in Scotland reached an all-time high of 95 per cent in 1997.

* There were just three confirmed cases of measles in Scotland in 2000.

* Since 1992 there have been no deaths due to measles in the UK.

* The incidence of mumps has decreased by 90 per cent.

* Between 1990 and 1999 there have been four cases of congenital rubella, and between 1997 and 1998 there were none at all in the UK. There was only one congenital rubella birth in Scotland in 2000. It was linked to an outbreak of rubella at Aberdeen University.

* 1998. The unsubstantiated link of the MMR vaccine to autism means that vaccination uptake in Scotland is slipping close to the NHS’s target of 90 per cent minimum coverage. Below this threshold, outbreaks of measles, mumps and rubella are more likely to occur as the diseases are carried in from abroad.