Parents are not immune to reason

There is risk in vaccination, just as there is risk every time we strap our child into a car. It is by trying to suppress every whisper of risk that the immunisation programme damages itself.
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The Independent Online

How odd it is that a programme that overwhelmingly exists to promote our communal well being has become so susceptible to hints of sinister undertones. The latest ripple of controversy over the National Immunisation Programme, this time in the form of worries over the new meningitis C (MenC) vaccination, swelled quickly into a flood of doubt.

How odd it is that a programme that overwhelmingly exists to promote our communal well being has become so susceptible to hints of sinister undertones. The latest ripple of controversy over the National Immunisation Programme, this time in the form of worries over the new meningitis C (MenC) vaccination, swelled quickly into a flood of doubt.

Not long ago the introduction of the vaccine had been a godsend. The MenC jab did not offer parents complete deliverance from the terrible fear of meningitis, which has us rolling glasses over every pimple until our children are old enough to tell us to stop it. But it did mean the strain most likely to strike babies and under-fives, and most likely to be fatal, was no longer a worry. My son, almost three, had his immunisation two weeks ago. He displayed no side effects.

Now I know that his experience was unlike that of 16,000 others, who have reported adverse reactions of various kinds, including severe headaches, fits and blackouts. This is apparently a much larger incidence of adverse reactions than has ever been reported with other vaccines. I also know that among these adverse reactions there were 11 deaths, all reported to the Medicines Control Agency, and none made public by the Government.

Predictably, they are public now anyway. Eleven coincidences, two among cases who had existing heart conditions, six deaths due to sudden infant death syndrome, one from a convulsion 10 days after a vaccination, and two of septicaemia meningicoccal, group B meningitis, a "completely different disease".

The publicity generated by one of these last deaths, that of the teenager Keith MacGregor, prompted Una Robb to make public that her son, Christopher, had collapsed after receiving his injection at school and was treated for three days in hospital for symptons of meningitis. He has made a full recovery, but his mother was asked by an operator on a 24-hour helpline run by the National Meningitis Trust to keep quiet because her revelations could needlessly damage the immunisation programme.

Understandable perhaps - except that pressure groups are now suggesting that research in America has found grounds to suggest that the vaccine encourages a new-variant meningitis strain to form, and that a three-year study is under way at Oxford to assess the risk of the antimeningitis C vaccine promoting the emergence of the B strain.

Furthermore, medical professionals have suggested that research so far has looked at side effects for a very limited period. Suddenly, the fact that this is the first country to introduce a national immunisation programme for Meningitis C looks over-eager rather than ground-breaking.

The ease with which suspicion can be fostered certainly emerges from the ongoing controversy over the Bacillus Calmette-Guerin injection, or MMR. This combined vaccine against measles, mumps and rubella has prompted 2,000 parents in this country to fight for compensation for children who they believe have been damaged by MMR, many of them claiming a link between the vaccination and autism or Crohn's disease. Again pressure groups make much of scant evidence, yet it is also true that there is scant evidence to suggest the very idea of such links is preposterous.

The most telling fact used to promote suspicion of MMR is that it is banned in Japan. In 1995, 93 per cent of children were being presented for immunisation. Last year, it was only 87 per cent. There had been a growing tendency among well-informed parents to request instead a stand-alone inoculation for measles, which is the most dangerous of the three illnesses combated by the MMR. Last year, imports of MMR were banned by the Government.

Again my son is among those who have received the MMR vaccine. Again he had no side effects at all. His experience of the National Immunisation Programme has been complete. There is no vaccination available which he has not had. I believe that the risks involved in immunisations are far fewer than those involved in catching these illnesses. I don't, however, believe that there are no risks involved when vaccinating children. What I think is wrong with successive official attitudes to the immunisation programme is that there is no room for my view, or any other view which suggests anything except total benevolence and utter lack of risk when partaking in this programme.

More than £25m has been set aside to finance the MenC programme and more than 13 million doses have already been given. This has led to a cut in cases and deaths of 70 per cent. Essentially, that means that around 105 people who would have died of the illness over that past year are, instead, perfectly well. Many others who may have suffered brain damage, or lost limbs, have also been saved. However, the fact remains that Meningitis C is a rare disease.

Surely the fact that so much energy and so much money has been spent on saving this many lives indicates a society that values its members enormously, and one in which compassionate decisions are being made by compassionate people. So why do we find it so easy to distrust these decisions that are made for us? Why do inoculation programmes increasingly make us uneasy?

I think it is almost wholly to do with the way in which the public dialogue is conducted. Just as these latest doubts trickled out against the wishes of the Government and of interested parties - as if parents were not the most interested parties of all - so it has been with the entire programme.

We are asked simply to accept that this is all for our own good. Facts, figures and speculation will just confuse us, make us less malleable to the demands of those who know better than us. Instead, this information comes to us anyway, and the way in which it does causes us more doubt and suspicion than it would if it were discussed with us openly and honestly.

The most dreadful consequence of this official insistence that everything is always all right is the history of the Vaccine Damage Payment Scheme. The fact that such an institution exists is in itself rather a contradiction to the official line that no vaccine ever damaged anyone. More than aware of its own paradox, the Vaccine Damage Payment Scheme has always been tremendously wary of accepting liability, and vastly chary about providing compensation when it has to.

Set up by Labour in 1979, it started out by undertaking to offer £10,000 to families whose children were brain damaged by vaccines by 80 per cent or more. In 1985 the sum was raised to £20,000, and in 1991 to £30,000. In its lifetime the scheme has had 4,217 claims made against it. For these, 416 received payment immediately while 482 received payment on appeal. The rest were rejected. Needless to say, the scheme has never accepted liability for any claim involving MMR.

In June, after a two-year review, the Vaccine Damage Payment Scheme was overhauled, and £60m was set aside to be made in payments. The punitive threshold of 80 per cent brain damage was reduced to 60 per cent and the six-year limit on claims was removed. This may not be perfect, but it is certainly a great improvement.

However, we will not be treated like grown-ups by those who run the National Immunisation Programme until it is admitted to us that nothing is utterly certain, that things can and do go wrong and that while the programme is for the common good, we will always be informed of any development which may be of relevance to the decisions we take in caring for our children's health.

There is risk in vaccination, just as there is risk every time we strap our child into a car. It is by trying to suppress every whisper of risk that the immunisation programme damages itself. If it acted in a more upfront manner, these scares would not have the potency that they do when, inevitably, they reach the public domain.

* d.orr@independent.co.uk

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