Feature

Opposition is sadly myth-led

Michael Corr sets out the case in favour of routine childhood vaccination

The debate over childhood immunisation, reawakened by the measles/rubella campaign of November 1994, is at heart a question of information. Is the information on immunisation accurate? Is information being withheld? As the organisation charged with informing the public about childhood immunisations, the Health Education Authority is clearly involved in this debate.

Though few parents and even fewer health professionals would subscribe to the view that immunisation is a bad idea, there are some voices calling into question the very need for immunisation. For the sake of putting the argument on the table once again, it is probably worth quoting two examples to establish the benefits of mass immunisation programmes.

Whooping cough once infected over 100,000 children every year. The death rate was one per thousand cases overall, and higher among infants below one year. When uptake of the vaccination reached 80 per cent in 1973 there were fewer than 2,500 cases. Public confidence in the safety of the vaccine then faltered and uptake fell to around 30 per cent. Two substantial epidemics followed, in 1977-9 and 1981-3, both recording over 100,000 cases, before vaccination rates were restored.

In 1923 there were 6,638 deaths from measles in the UK. After the introduction of the first measles vaccine in 1968 the average number of deaths fell to around 13 per year. Today only one in a million children in the Western world dies of measles, but many still die in developing countries. Operation Safeguard immunised 7 million schoolchildren in the UK, and without this campaign it is almost certain that there would have been a measles epidemic similar to that of 1987, with up to 200,000 cases of measles and about 50 deaths. Instead of increasing over the winter months, notifications of measles dwindled and the epidemic was averted (see chart).

It is important that those with doubts do not become non-immunisers because of a lack of information. Fears that side effects from vaccinations are more common and more serious than they actually are, need to be addressed to avoid scenarios such as the whooping cough example above. Parents must have clear information about the possible side effects and reassured that, for example, no children vaccinated in Operation Safeguard have suffered any permanent damage attributable to the vaccine. Unpleasant as the side effects can be, they very rarely cause any permanent damage to the child. In the case of measles, however, complications are observed in one in fifteen cases. Even taking all vaccines together, the risks from vaccination are tiny compared to the risks from the diseases themselves.

We must make it clear to parents that information adverse reactions is not in any way being suppressed. An adverse reaction in a child can be extremely distressing to parents, especially if they have not been told what to expect. The feeling may then arise that information was withheld. The problem is that there is a fine line between providing enough information and overstating the incidence and severity of adverse reactions. Some health professionals, lacking confidence in their own knowledge, may remain silent, unwittingly transferring their uncertainty to the parents.

Many of the questions posed by the correspondent in issue 21 of healthmatters can be easily dealt with. In fact, many have their origins in research which is now discredited, but the myths persist. Figures are quoted from old studies of vaccines which were superseded many years ago. Other findings are grossly exaggerated or selectively quoted. For example, the fact that cases of measles occur in vaccinated children should not be surprising, since the vast majority of children have been vaccinated in recent years. Vaccines do not confer 100 per cent immunity—the first dose of measles vaccine is effective in 90 per cent of children. What is important is the actual number of cases of measles, which is tiny compared to those that would occur in an unimmunised population.

The HEA supplies a range of leaflets informing parents about immunisation. Some of the leaflets have been criticised for being too simplistic and not providing enough information. In recent years parents have become much more confident in asking for information and the HEA accepts that its literature must change to reflect that. We will be publishing new editions of the leaflets later this year which will answer more of parents’ questions.

We also plan to publish a book for health professionals which will address all the major issues identified by our research with parents and professionals. It will equip practice nurses, health visitors and GPs with the information that parents are most likely to want, including possible side effects, homeopathy and ‘alternatives’ and the safety of immunisations.

The HEA has nothing to hide. We want the total confidence of groups like JABS and The Informed Parent, because we are all concerned first and foremost with the welfare of children. We have to put the evidence across so that there is no doubt that immunisation is the safest way to reduce the risk of the serious infectious diseases which have killed so many children in the past.