Intended for healthcare professionals

Rapid response to:

Letters Case for mandatory vaccination

Debating the future of mandatory vaccination

BMJ 2017; 358 doi: (Published 07 September 2017) Cite this as: BMJ 2017;358:j4100

Rapid Response:

Re: Debating the future of mandatory vaccination

With all respect to Emma Cave and the BMJ [1] it is one thing to call for a debate, and another thing to allow one: there were thirteen other letters originally posted in Rapid Responses along with hers - admittedly four were mine but making vaccination compulsory is politically drastic step - so perhaps there ought to be a range of opinion.

It is worth bearing in mind that harm can eventuate from drastic measures, even without forced vaccination. Back in 2009 the swine flu "emergency" scarcely justified itself. While the Chief Medical Officer, Sir Liam Donaldson, feared that 65,000 might die [3] nothing like this ever happened. By December 2009 NHS Choices reported there had been 138 deaths [4]:

"Swine flu is less lethal than feared, according to reports on the BBC News. The website quotes research led by Sir Liam Donaldson, the chief medical officer, which found that only 0.026% of those infected with swine flu have died."

It is unclear whether there is any evidence that any deaths were prevented from the rapidly developed vaccines but it is widely accepted that the GSK version Pandemrix was associated with narcolepsy [5]. It is also likely that such measures could lead to the distortion of policy. During the swine flu episode a GP, Peter Lush, wrote to this journal [6]:

"I am An Inner City GP in England, in the past 3 or 4 weeks I have been seeing patient(s) with what I suspect is H1N1 'swine flu', I am treating some of these cases with antiviral medication. The numbers of people that I diagnose will go toward making up the numbers of the UK flu epidemic numbers. But I am not allowed to take swabs on even a proportion of the cases. So that even in retrospect I will not be able to see if my diagnoses are correct. The computer saying 'rubbish in, rubbish out' comes to mind when assessing the UK statistics. Incidentally the numbers of patients with fever, myalgia and what I take to be 'swine flu' went down last week as compared to the week before. I await the late Autumn and winter with interest."

Before the swine flu episode Sir Liam was apparently equally convinced of the certainty of a coming deadly avian flew pandemic [7]:

"He told the BBC's Sunday AM show it would probably kill about 50,000 people in the UK, but the epicentre of any new strain was likely to be in East Asia. ..The UK has so far stockpiled 2.5m doses of anti-viral drugs - and may restrict travel if there is an outbreak."

Equally, Sir Liam also confirmed in Rapid Responses in December 2009 in spite of the hyping of influenza risk that in the previous four year only 131 people had died in England and Wales "with an underlying cause of influenza" [8]. From my own experience last autumn I was prevented from getting an urgent blood test at my local surgery because the nurses were booked up with flu jab appointments.

Again, with measles - despite the alleged baleful influence of Andrew Wakefield - there have only been four deaths from contracting the disease in the United Kingdom since 1992 [9] during which period perhaps thirteen million people will have died from all known causes, so perhaps the risk is about as low it gets (since everyone dies anyway).

In providing services and the useful deployment of resources, alarmism may not always be helpful. Nor will making an limitlessly expanding vaccine programme compulsory lead to trust.

[1] Emma Cave, 'Debating the future of mandatory vaccination', the British Medical Journal, 7 September 2017
[2] Rapid Responses to Tom Moberly, 'UK doctors re-examine case for mandatory vaccination',
[3] The Guardian, 'Swine flu could kill 65,000 in UK, warns chief medical officer', 16 July 2009,
[4] NHS Choices, 'Swine flu deaths examined, 11 December 2009',
[5] Trogstad et al, ' Narcolepsy and hypersomnia in Norwegian children and young adults following the influenza A(H1N1) 2009 pandemic', Vaccine. 2017 Apr 4;35(15):1879-1885. doi: 10.1016/j.vaccine.2017.02.053. Epub 2017 Mar 13.
[6] Peter Lush, 'diagnosis of 'swine flu'' , 17 August 2009,
[7] BBC News 'Bird flu pandemic 'will hit UK' ',
[8] Donaldson et al, 'Author's response' 24 December 2009,
[9] See explanatory note beneath table. Public Health England, 'Measles deaths by age group 1980-2016',

Competing interests: No competing interests

10 September 2017
John Stone
UK Editor