F v F [2013] EWHC 2683 (Fam) – read judgment
The High Court has ruled that two sisters must receive the MMR vaccine against their wishes and the wishes of their mother.
This was an application by the father for a declaration and a specific issue order concerning his daughters both receive the MMR vaccination. This was opposed by their mother.
Background
Following the breakdown of their parents’ marriage, the girls (aged 11 and 15 respectively) lived with their mother, and the father had contact every alternate weekend and half the school holidays. After publication of the now discredited paper published by Dr Andrew Wakefield in the Lancet connecting the MMR vaccine with autism, both parents agreed not to have a booster arranged for the older daughter (who had been inoculated against MMR at birth) and to forego a vaccination for the other daughter completely. After the Lancet retracted the paper, the father became concerned about this decision and in January this year his solicitors wrote to the mother seeking her agreement to the girls being vaccinated, failing which it was indicated he would apply to the court. That agreement was not forthcoming and the father issued this application in April 2013.
Legal framework
The paramount consideration of the court was the welfare of the children. In considering their welfare the court is guided by the matters set out in the welfare checklist in section 1 (3) of the Children Act 1989.
The issue of the MMR vaccination has come before the court on two occasions before. In Re C (Welfare of Children: Immunisation) [2003] 2 FLR 1095 the Court of Appeal dismissed the mother’s appeal against the decision of Sumner J to order her to have her child immunised with the MMR vaccine. At first instance Sumner J had heard from a number of experts in paediatric immunology and infectious diseases and he concluded that the benefits of having the vaccinations outweighed the risks. In the Court of Appeal Thorpe LJ rejected the ‘repeated categorisation of the course of immunisation as non- essential invasive treatment. It is more correctly categorised as preventative healthcare. ‘ (para 22). In LCC v A, B, C and D [2011] EWHC 4033 Theis J, the judge in the instant case, considered the issue of vaccinations in the context of children in care, where there was a dispute between the local authority and the parents as to whether the children should be vaccinated. There she concluded the children in that case should be vaccinated. She cited expert in that case, Dr Ward, who “comprehensively addressed the link between the MMR vaccine and autism and the consequences of getting these diseases”:
‘a. Measles, mumps and rubella are serious infections, each of which carried an appreciable risk of dangerous complications in healthy individuals. Vaccination is the only practical way to prevent an individual from contracting infection, and all the evidence is that it is effective and has a very low level of side effects, which are generally mild and transient……..
d. With due consideration for established contraindications to vaccination in an individual case, it is otherwise in every child’s interest to be protected against measles, mumps and rubella with the MMR vaccine’
The father accepted he could have made this application earlier, i.e. when the Wakefield evidence was discredited and when the children were younger, but said the Swansea outbreak of measles had exacerbated the issue for him, and prompted him to take action. Both parties had the opportunity to adduce expert evidence as to the pros and cons of the vaccine, but they did not take this up. As Theis J pointed out drily, ”The reason why it was not taken up is because from the medical perspective the evidence all points one way.”
The slight twist in this particular story was that one of the daughters is a vegan and part of her objection was based on the content of the vaccine which includes animal based ingredients such as gelatine.
Nevertheless, the judge concluded that it was in the best interests of L and M that they receive the MMR vaccination, and granted a declaration accordingly.
Reasoning behind the decision
The girls had been focussed on the ingredients of the vaccination and had not fully appreciated what might be the ingredients of the medication that would be administered should they fall ill with any of the diseases concerned
They were clearly influenced by their mother’s views
Their lack of maturity meant that they could not understand why their father had changed his mind on this issue
The emotional consequence for the girls of the court making this decision was not a reason for the court to flinch from deciding the issue.
The objections raised by the girls regarding the ingredients of the vaccine had not been balanced against the very clear health risk of getting any of the diseases the vaccine prevents.
Theis J acknowledged that this issue was felt deeply by all the parties concerned,
but now the court has made the decision I have every confidence, that despite their differences, these parents will be able to manage their parental responsibility in such a way that will ensure the strong and secure relationships that exist between each parent and both children will remain in place.
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Filed under: Case summaries, Children, Family, In the news, Medical Tagged: autism, child's best interests, MMR vaccination, Wakefield 
