By Jeremy Laurance
A British High Court judge ordered two girls aged four and 10 to have the MMR immunisation against the wishes of their mothers.
In a dispute between two sets of estranged parents, Mr Justice Sumner ruled in favour of the absent fathers, who wanted their daughters to be given MMR and other vaccinations.
It is thought to be the first time the courts have become involved in the MMR controversy, which has raged for five years.
Campaigners claim the triple vaccination - for measles, mumps and rubella - can cause bowel disease and autism.
The judge said it was in the "best interests" of the children to have the vaccination. But he stressed he was making his ruling only because the parents disagreed and it should not be seen as a general approval of immunisation for children.
The verdict came as family doctors attending the British Medical Association's annual conference of GPs attacked the target payment system for MMR vaccines and called on the UK's Chief Medical Officers, including England's Sir Liam Donaldson, to resign.
GPs condemned the government's "lamentable failure" to persuade the public about the safety of the jab.
The two separate court cases were brought by the fathers of the children, who are not married to the mothers but who have "parental responsibility".
They said their daughters needed the protection of the vaccine. But the mothers said immunisation involved unacceptable risks and there was good reason for their anxiety.
MMR has been the subject of fierce dispute since a small group of doctors published a paper in The Lancet in 1998 claiming it was a potential cause of bowel disease and autism. Although the claims have never been proved, and subsequent investigations have failed to find a link, vaccination rates have fallen.
Campaigners are preparing to bring a class action, due to start in April 2004, when 2 000 parents who blame MMR for causing autism and other disorders in their children will sue the manufacturers.
The judge said parents had the right to refuse medical advice to have their children immunised, but the parents were in dispute. "This decision should not be seen as a general approval of immunisation for children. It does not mean that at another hearing a different decision might not be reached on the facts of that case," he said.
Neither of the girls has had any of the routine childhood immunisations. In addition to MMR, the judge ordered that the girls, who cannot be named, should also receive vaccinations against diphtheria, polio, tetanus and meningitis.
One of the mothers was never immunised herself and said she came to no harm and did not believe her daughter would come to harm. She said it was wrong to impose immunisation on her.
For the other mother, immunisation represented what she said was the "total rejection" of her holistic approach to life. She also claimed that the court application by the father was motivated by a wish to control her by using the legal system.
Even if the court decided it was in the girls' best interests, the mothers said immunisation should be voluntary and it was not right to impose it against the wishes of a caring parent.
The judge said the court recognised the importance of the bond between the child and the parent with whom he or she lived. But he added: "It does not give that parent greater rights. It does mean that the court will take care to safeguard and preserve that bond in the best interests of the child."
The older of the two children was against vaccination with MMR but the judge said her views were "influenced by her mother's unreasoning and rigid approach" and could be discounted because her mother had accepted the court's decision. The other child was too young to have her wishes taken into account.
The judge said he had reached two clear decisions. "Firstly, the medical evidence I have accepted is both clear and persuasive. Secondly, the impact on the mothers and their care of their daughters, whilst of great importance... is not in either case of such potential impact as should in the children's best interests deter me from the decision to which I have otherwise reached."
Doctors attending the BMA GPs conference criticised the payment system for vaccinations under which they are penalised financially if they fall short of immunisation targets. They claimed it had added to parental mistrust of GPs who recommended MMR.
The conference agreed MMR was safe and the best way to protect children but said it was indefensible to refuse to allow separate jabs, given the public concern over the issue.