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Feature Communicable Disease

UK doctors re-examine case for mandatory vaccination

BMJ 2017; 358 doi: https://doi.org/10.1136/bmj.j3414 (Published 18 July 2017) Cite this as: BMJ 2017;358:j3414

Re: UK doctors re-examine case for mandatory vaccination

I read with concern Tom Moberly's report that the British Medical Association is trying to open a debate about mandating vaccines in the United Kingdom [1] having already made a number of relevant observations under an earlier article [2]. Most fundamentally, I would urge the medical establishment to exercise a little humility when today's scientific orthodoxy could so easily in retrospect become tomorrow's horrific misjudgement. It does not help when we see all vaccine critics dismissed by the Guardian newspaper or, by CEO of Gavi, in the Spectator in abusive terms as "anti-vaxxers" [3, 4], when it is far from clear that every issue in vaccine safety has been resolved - or that we can even begin to assess the risks while denying a respectful hearing to patients or their families, which pre-empts both evidence and argument in an inappropriate way. In my experience the most vociferous vaccine critics hitherto have not so much been people with an ideological objection to vaccination as people who had had their children vaccinated and regretted it. Such indiscriminate (scorched earth) strategies scarcely command the moral high ground.

Moreover, disregarding the highly intolerant atmosphere which is being generated in some quarters it is not evident that even if the science involved could approach the level of being definitive that it is anywhere near that at present. For example, three successive reports by Cochrane on the safety of MMR have declared [5,6,7]:

"The design and reporting of safety outcomes in MMR vaccine studies, both pre- and post-marketing, are largely inadequate."

which would indicate that the science has never been done (and some might consider it a bit late now). I also note the current complaint to the European Ombudsman regarding HPV vaccines and the European Medicines authority from Nordic Cochrane [8,9]. Though HPV vaccines may or may not be mandated the complaint partly relates to the uncertain science surrounding aluminium adjuvants which are also used in scheduled infant vaccines such as Infanrix Hexa [10], Prevenar [11] and Bexsero [12]. Yet this science is being publicly promoted as if infallible. There are surely lessons here from history. Meanwhile, it is far from apparent that Dr Farah Jameel who proposed the motion at the BMA had the remotest idea of these shortcomings [1].

Nor is it immediately obvious that the threat from infectious diseases has increased in any degree to justify such an abrupt change in policy (and in a way which could antagonise people presently much more well disposed to the vaccine programme than I might be myself). A greater problem which presently demands attention from health officials is the steep, unexplained rise in neurological disorders such as autism, which even now seem to be gathering dramatic momentum [13, 14, 15].

[1] Tom Moberly, 'UK doctors re-examine case for mandatory vaccination', BMJ 2017; 358 doi: https://doi.org/10.1136/bmj.j3414 (Published 18 July 2017)
[2] Rapid Responses to Peter Doshi, 'US government website for collecting adverse events after vaccination is inaccessible to most users', http://www.bmj.com/content/357/bmj.j2449/rapid-responses
[3] Editorial: 'The Guardian view on vaccination: a matter of public health' , The Guardian 7 July 2017, https://www.theguardian.com/commentisfree/2017/jul/07/the-guardian-view-...
[4] Seth Berkley, 'Anti-vaxxers have embraced social media; we paying for fake news with real lives' Spectator Health 28 June 2017, https://health.spectator.co.uk/anti-vaxxers-have-embraced-social-media-w...
[5] Jefferson T, Price D, Demicheli V, Bianco E, 'Unintended events following immunization with MMR: a systematic review' 2003 https://www.ncbi.nlm.nih.gov/pubmed/12922131
[6] Demicheli V, Jefferson T, Rivetti A, Price D., 'Vaccines for measles, mumps and rubella in children', 2005 https://www.ncbi.nlm.nih.gov/pubmed/16235361
[7] Demicheli V, Rivetti A, Debalini MG, Di Pietrantonj C, ''Vaccines for measles, mumps and rubella in children', 2012.
[8] Stephane Foucart , http://www.lemonde.fr/planete/article/2016/12/09/papillomavirus-les-auto...
[9] Gøtzsche P, Jørgensen K, Jefferson J, Auken M , Brinth L,  'Complaint to the European ombudsman over maladministration at the European Medicines Agency (EMA) in relation to the safety of the HPV vaccines', http://nordic.cochrane.org/sites/nordic.cochrane.org/files/public/upload...
[10] http://ca.gsk.com/media/537989/infanrix-hexa.pdf
[11] https://www.medicines.org.uk/emc/medicine/22689#COMPOSITION
[12 ]http://www.medicines.org.uk/emc/medicine/28407/SPC/Bexsero+Meningococcal...
[13] Helen McArdle, 'Call for investigation as 20 young Scots a day are rejected fro mental health care', Sunday Herald 20 December 2016, http://www.heraldscotland.com/news/14975962.Call_for_investigation_as_20...
[14] Brett Campbell, 'Autism assessment list now at crisis level, says MLA', 22 December 2016, http://www.belfasttelegraph.co.uk/news/northern-ireland/autism-assessmen...
[15] Jane Dreaper, 'Autism diagnoses 'could be reduced under NHS plan'', BBC News 27 May 2017, http://www.bbc.co.uk/news/health-40058482

Competing interests: No competing interests

22 July 2017
John Stone
UK Editor
AgeofAutism.com
London N22