Letter

Immunisation: there is another view

The sub-text of John Harrington’s report (‘Junk Science’: MMR in the courts, autumn 2003) is that orthodox public health medicine equals true, rational and scientific, whereas objection to mass childhood immunisations (MCI) equals wrong, anti­rational and pre-scientific. This dichotomy is crass and unhelpful if we want an intelligent and democratic debate.

Those objecting to MCI have their own situated rationality, and the scientific evidence to support their case is there to be read.¹ Their rationality is no more nor less compelling than that of any other interest group (for example, the fear and guilt-inducing zealots in the Department of Health and local public health departments).

The rationale for fixed percentage levels of immunisation coverage in variable open systems is questionable.² And there is a prevention paradox: the greater the vaccination coverage and the lower the incidence of a particular infection, the greater the relative iatrogenic risk to which any individual is exposed.³ If MCI is so obviously risk-free, why is there such an international range of policies on vaccine-damage payments? Why do some parents first comply with MCI, then change their minds in the light of their experience?

At the level of public health policy MCI is a small techno-centric tweak on the larger downward trend of infectious disease, the result of improved sanitation and diet, and poverty reduction. How many of us have forgotten what we have known about this simple point for the last twenty years?⁴ MCI can divert our attention from the responsibility of governments to ensure the socio-economic conditions required to minimise the risk of complications from childhood infections. In this context, pressurising doubting parents is arguably amounts to convenient scapegoating and cynical political irresponsibility.

Finally, the offensive notion of ‘herd immunity’ reveals an outdated discourse about animals, not people. From now on, the latter should – and will – express their own legitimate views about health, no matter what ‘experts’ might tell them.