From the New York Times.
================
February 8, 2003

As Vaccination Rates Decline in Ireland, Cases of Measles Soar

By BRIAN LAVERY

 DUBLIN, Feb. 7 - When a British scientist published research five
years ago suggesting a link between autism and a common childhood
measles vaccine, the news caused a wave of fear among parents and a
steep decline in vaccination rates.

 Subsequent studies debunked his findings, and British health
authorities worked hard to make sure that more than 90 percent of
children 12 to 15 months old were vaccinated each year.

 Prime Minister Tony Blair even turned the vaccination of his son into
a news media event.

 Across the Irish Sea, however, public health officials blame latent
fears about the M.M.R. vaccine ? for measles, mumps and rubella ? for
a measles outbreak. The vaccination rate has fallen to 63 percent in
parts of Dublin and 72 percent nationally; the internationally
accepted level for controlling the disease is 95 percent.

 Over six weeks in December and January, the National Disease
Surveillance Center recorded 100 cases of measles. It typically sees
about 30. Its director, Dr. Darina O'Flanagan, issued a national
advisory and sought a meeting with the government health minister to
revise immunization strategies. Now, two weeks later, 100 more cases
have been recorded.

 "I'm seriously worried," Dr. O'Flanagan said in a telephone
interview. Ireland has "topped the list" of European countries with
measles outbreaks in recent years, and "it's not an enviable position
to be in," she said.

 But some Irish doctors say low immunization levels here are a chronic
problem, citing overworked health workers and an outdated system that
makes it hard to track children who need vaccinations.

 "It goes back generations; we've always had an appalling vaccination
rate in Ireland," said Dr. Maurice Gueret, a general practitioner in
Dublin. The widely publicized fear that the M.M.R. vaccine causes
autism is "a convenient way for the health authorities to let
themselves off for the fact that we're very, very bad about
vaccinating our children," he said.

 A measles epidemic last struck Ireland in 2000, when 1,603 children
were infected, 350 were hospitalized and 3 died. The disease has been
all but eliminated in the United States, where only a handful of cases
are reported each year, and those usually are sick people coming into
the country.

 Dr. O'Flanagan met with Micheal Martin, the health minister, on
Thursday to discuss the possible use of American and Australian
strategies, like mandatory immunizations for children before they can
attend elementary school, and increased welfare benefits for
low-income families when their children are vaccinated.

 Officials called for increased education to overcome apathy and
public skepticism about official health services, said Dr. James
Reilly, chairman of the Irish Medical Organization's committee for
general practitioners. High-profile scandals, like one involving blood
products contaminated with H.I.V. and hepatitis C, have tarnished the
health service's reputation in recent years.

 Another part of the problem is that Ireland's regional public health
bodies are large, unwieldy organizations that are also responsible for
a range of social services that deflect resources from purely medical
issues like immunizations. Vaccination records are largely kept on
paper, and regions with computerized systems are incompatible with one
another, making it difficult to follow unvaccinated children when
their families move.