The use of a small "outbreak" of rubella (German measles) to three adults in Malta as an example to argue the importance of vaccination was perhaps not the most compelling choice (Saving About Three Million Lives A Year, April 24). Most people with rubella are not very ill, do not need any treatment and soon make a full recovery. Indeed no symptoms may occur and this is called a "sub-clinical infection". However, if contracted by pregnant women without immunity, the baby is at risk of rubella congenital syndrome and a pandemic in the US in 1964-1965 led to 0.3 per cent of pregnancies resulting in miscarriage or rubella congential syndrome.

Seeking to avoid any future rubella congenital syndrome is a noble aim but the method of achieving this via herd immunity through blanket vaccination needs examination since every vaccination carries a tiny risk of complications. The first question is why not just immunise women of child bearing age and save infant boys the needless injection?

Unfortunately the vaccine does not guarantee immunity and so some pregnant women can still catch rubella from the male population. This is the reason that before 1995 in the UK, all girls aged 10-14 were offered immunisation, but since then boys have been included.

The moral case for blanket rubella vaccination is, therefore, complicated. As a parent do you want your infant boy to take the minute risk of complications from a rubella vaccine for the potential benefit of an unknown woman who has not herself been immunised or has not been educated that she must have herself checked for immunity before she starts having children?