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Rapid response to:

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

Rapid Response:

Vaccine anti-science and hearsay evidence have taken a firm hold

John P.A.Ioannidis introduced the notion of "evidence-based hearsay" determining the use of medical treatments. (1)

The "safety of vaccines" can be considered as hearsay as it does not have a proper evidence base. In contrast to scrutiny of medication (pharmacovigilance), proper vaccinevigilance does not exist. Proper and consistent research into long term side-effects from vaccines does not exist. (2)

As a result, do we now have endemics of (chronic) non-communicable disease (NCD) with mortality and morbidity greater than that from vaccine prevented (acute) infectious diseases in the well nourished and hygienic societies? (3)

To further illustrate the lack of vaccinevigilance, take hormone replacement therapy (HRT), aspirin and statins: proper debates have been able to inform patients' (and doctors') opinions.

Instead, ideology leads (non-informed) debates on vaccines and not evidence based medicine (EBM).
In Italy, compulsory vaccination is supported with slogans like: "vaccination is not an opinion".

Reading Tom Moberly's description of the BMA meeting, the motion at the meeting "to make childhood vaccination mandatory" seemed to be based on an emotional repulsion of "anti-vaxxers" by un-informed doctors.

Regulatory bodies (e.g. for doctors) however suggest that health professionals should help patients to come to an informed decision, through a process called shared decision making (SDM). As such, when the issue "mandatory" comes on the scene and relating "mandatory" to each and every person in the land, it is surprising to see that word used by doctors.

Still, emotions can even be more easily influenced in members of parliament and people in worldwide health organizations, as these people, due to their background and lack of EBM training, have even less defence against the lobbying prowess of the pharmaceutical industries. (4, 5)

Vaccines are big business as each and every person on the planet is a customer, in contrast to e.g. HRT, aspirin and statins.(6) Several hundred vaccines are in development. (4)
Furthermore, vaccine immunity wanes and boosters are needed which provides for returning customers.

Tom Morberly's report on the BMA meeting exemplifies that ideology maintains the vaccine panacea dogma, as a spokeswoman told him that the BMA would "consider producing a summary of previous work on vaccination policies". In other words, the BMA is condoning ideology based on "previous work" and lack of research into vaccine side-effects?

However, the NIHR (7) reports on a Cochrane review that showed that: "parents want more balanced information on risks and benefits in advance of vaccinations" (8)
But in fact, the NIHR immediately hijacks this Cochrane review by concluding with ideology rather than the reviewers conclusions: "The review findings support immunisation guidance from NICE, PHE and the Royal College of Nursing. Further research is needed to understand the decisions of groups highlighted in NICE guidance, such as homeless families, non-English speaking parents and teenage parents." This blatant hijack needs a formal apology to David Sackett (9), Cochrane and the public from the responsible individuals or is this acceptable vaccine EBM behaviour?

If acceptable, the new WHO president Dr Adhanom Ghebreyesus needs to remain vigilant or might see the increase in burden of disease due to morbidity and mortality with the introduction of vaccines in countries with no or low vaccination rates due to (unscrutinized) NCD endemics that now affect the developed, highly vaccinated world.

John Ioannidis calls for keeping the EBM course and throwing the pirates overboard. (10)
The question is, does his call include vaccinevigilance, and will epidemiologists hear and act on his call?

1 Ioannidis, John PA. Does evidence-based hearsay determine the use of medical treatments?. Diss. Stanford University, 2017. http://www.sciencedirect.com/science/article/pii/S0277953617300849

2 Havinga W. Re: Is the timing of recommended childhood vaccines evidence based? RR BMJ 29 February 2016 http://www.bmj.com/content/352/bmj.i867/rr-7

3 Havinga W. EBM and vaccines #AskforEvidence. RR BMJ 5 January 2014 http://www.bmj.com/content/348/bmj.g22/rr/680259

4 ABPI news release. World Immunisation Week: Parliamentarians highlight value of vaccines to UK. 28 April 2016 http://www.abpi.org.uk/media-centre/newsreleases/2016/Pages/World-Immuni... (accessed on 22 July 2017)

5 Havinga W. Not red flags but red carpet treatment for vaccination guidelines. RR BMJ 28 September 2013 http://www.bmj.com/content/347/bmj.f5535/rr/664108

6 Bioportfolio. Reports http://www.bioportfolio.com/vaccines/reports (accessed on 22 July 2017)

7 NIHR Signal. Parents want more balanced information on risks and benefits in advance of vaccinations. (accessed on 22 July 2017) https://discover.dc.nihr.ac.uk/portal/article/4000684/parents-want-more-...

8 Ames, Heather MR, Claire Glenton, and Simon Lewin. "Parents' and informal caregivers' views and experiences of communication about routine childhood vaccination: a synthesis of qualitative evidence." The Cochrane Library(2017). http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD011787.pub2/full#C...

9 Ioannidis, John PA. "Evidence-based medicine has been hijacked: a report to David Sackett." Journal of clinical epidemiology 73 (2016): 82-86. http://www.jclinepi.com/article/S0895-4356(16)00147-5/fulltext

10 Ioannidis, John PA. "Hijacked evidence-based medicine: stay the course and throw the pirates overboard." Journal of Clinical Epidemiology 84 (2017): 11-13. http://www.sciencedirect.com/science/article/pii/S0895435617301440

Competing interests: No competing interests

24 July 2017
Wouter Havinga
locum GP
NHS
GL6 6JL