Letter: Trials of the HIB vaccine

Sir: Bernard Dixon's profile (Microbe of the Month, 8 February) of the meningitis bacterium Haemophilus influenzae type b (HIB) appropriately pays tribute to 'the companies that have introduced the vaccine' and ends in a journalistic coda, 'it need be a killer no more'.

What the public may not know is that the extent of the HIB problem was not known until the initiative and hard work of microbiologists in Wales and the Oxford region revealed that at least one child in every 600 had a serious illness caused by HIB infection.

Once the extent of the problem had been documented, it was important to ensure that the recently developed HIB vaccine was safe and effective in UK children. This was achieved by the contribution of many in the Oxford region: immunisation co-ordinators, general practitioners, health visitors, practice nurses and, last but not least, the parents and children who participated in controlled trials, which demonstrated that HIB vaccine gives a high level of protection against meningitis.

This work was conducted with private funding, which made it an independent assessment of proposed government policy. Unfortunately, this independence can lead to complications, as we have encountered in the system of payment to GPs for vaccines given in a research study.

We are concerned that the Department of Health has not yet agreed to pay GPs for vaccinations given before October 1992, despite these vaccinations being due sooner or later in any case. This sort of difficulty has serious implications for the very necessary trials of preventive medicine.

It would be pleasing if the inadequacies of public health resources for the prevention of infectious diseases in the UK, highlighted by the experience with HIB, were recognised and appropriate action was taken.

Yours sincerely,

E. RICHARD MOXON, Department of Paediatrics, University of Oxford; RICHARD T. MAYON-WHITE, Consultant Public Health Physician, Oxfordshire Health Authority;

ROBERT BOOY, Department of Paediatrics, University of Oxford

Oxford