Vaccination Panic

Panic sets in as disease dies out

The success of eliminating preventable diseases in the UK has shifted the public’s focus to fears about the vaccination itself, writes Geof Rayner

From The Guardian Society Monday March 18, 2002

“The truth is, people like inoculation. Doctors love it, naturally enough, because it has solved the great economic problem of how to extract fees from people who have nothing the matter with them. And people believe the doctors.”

GB. Shaw, Doctors’ Delusions

George Bernard Shaw explained the spread of vaccination, supported by the law of the day, through reference to the medical profession’s chummy links with government and their interest in moneymaking. Society was engaged in a huge deceit, said Shaw. Not only was vaccination useless but it caused harmful side effects. Furthermore, the clamour for vaccination obscured the causes of disease, to be found in dirt and human distress.

History and evidence have proved Shaw wrong about vaccination, although he was right to question our blind faith in medicine and the increasing use of technical fixes for disease and distress caused by poverty. But what Shaw never understood, and what forms the background to current MMR panic, is this: the more successful public health campaigns are in marginalising disease, the more their success goes unnoticed and their credibility diminished. In the case of measles, mumps and rubella, the very rarity of vaccine-preventable disease in the UK has shifted the public’s focus away from disease prevention to fears about the vaccination itself.

Most parents, and most NHS staff, have never experienced a child choking from whooping cough, because pertussis has been virtually eliminated, along with diphtheria, tetanus, measles, mumps, and rubella – all diseases down at least 95 % compared with 50 years ago. Smallpox and polio have been eliminated among the developed countries.

Contrast the underdeveloped world. The World Health Organisation estimates that around 900,000 children currently die each year from measles alone, while another million or so deaths occur which are entirely preventable through immunisation. The poorest countries of the world, in which many people are denied even basic medical care, would find our questioning of vaccination quite bizarre.

Shaw contracted smallpox following his vaccination and always considered he’d been “medically tricked”. Many parents with autistic children share his conviction that the condition was a direct result of medical treatment. There is no question in their minds that MMR caused their child’s problems.

Today’s vaccination methods are highly targeted and massive studies are used to assess side effects. Nevertheless, virtually no intervention is without risks, although in the case of the MMR vaccine the associated risks, compared with the naturally acquired disease, are tiny.

It is not the known side effects that have given a new lease of life to Shaw’s critique, but rather uncorroborated speculation on a possible link between MMR and autism. But speculation alone can’t account for the panic, and other catalysts might include:

  • BSE/vCJD The revelation of a link between BSE and vCJD after so many assurances caused the stock of government scientists to plummet.
  • Post-deference culture We no longer defer to the inherent superiority of our “betters”, be they people with Oxford accents or those wearing white coats.
  • The decline in collectivism The shift towards individualism means that more people are happy to have a “free ride” from other people’s immunity, thus avoiding the albeit limited risk of side effects.
  • Complementary or alternative medicine There are now more complementary therapists (significant numbers of whom eschew an evidence base to their work) than conventional practitioners. In general, this group is philosophically hostile to mass immunisation.
  • The press “No link shown between MMR and autism” doesn’t make a good headline, even if this fact is stated in the small print. While some press accounts have hinted at a state/pharmaceutical company conspiracy, little attention has been devoted to the moneymaking of private GPs selling single vaccinations.
  • Over-politicisation One TV pundit compared the popular “revolt” over MMR to the Greenham Common anti-nuclear campaigners. The fact that Leo Blair’s parents did not immediately confirm that the little fellow would be vaccinated gave weight to the sneaking thought that while vaccination might be good enough for herds, it did not apply to “top people”.
  • Risk and chance Autism is dreadful and little is known about its causes. On the other hand the national lottery slogan of “it could be you” has acquainted us to the idea that the unlikely is possible. MMR and autism just could be linked.

The Department of Health has developed two lines of response to the press barrage, one being the issuing of “scientific facts” combined with doctorly assurance, and the second being the appeal to their own human interests (ie, doctors are parents themselves). The underlying aim of both strategies is to recreate a relationship of trust that was evidently disappearing. Over time, that may work, but while the focus is on the treatment (MMR vaccine) and not the danger to children, they will remain on weak ground.

It is not that parents should be scared into compliance, but all of us need to move outside the parochialism of most press accounts. Where has been the reportage of the devastation to human lives caused by rubella? Where is coverage of the heartache of third world families whose children are dying of entirely preventable diseases such as measles? Where is the press coverage of the outcry in the US of the shortages of MMR vaccine?

One of the many lessons from the MMR debacle is that all of us need to look to the bigger picture of illness and disease. This may be a contrarian message in an individualistic age, but a new tide of diseases – during the past 20 years, at least 30 new diseases have emerged, for many of which there is no treatment, cure or vaccine – mean that public health can no longer remain invisible.

Trust within the public health system needs to be rebuilt, but not on the old basis of medical paternalism, and even less the private doctor free for all; it must be based on the view that the health of every one of us needs to be linked to the improved health of all us.

Aside from vaccination, even Shaw would have agreed.

Geof Rayner is chair of the UK Public Health Association.