Intended for healthcare professionals

Rapid response to:


Measles: Europe sees record number of cases and 37 deaths so far this year

BMJ 2018; 362 doi: (Published 20 August 2018) Cite this as: BMJ 2018;362:k3596

Rapid Response:

Re: Measles: Europe sees record number of cases and 37 deaths so far this year


I thank Mr Welsh for his response. My correspondence with Mr Stone has been cordial and respectful and he is under no obligation to reply to me. But for me, however much noise there is around potential or actual harms of vaccination, because its success depends on whole population public health approaches (preferably without national borders), what campaigners will rarely commit to is that fundamental question "If you are the chief medical officer, the secretary of state for health, the head of Public Health England, the NHS Medical Director etc etc, what would you do in terms of public policy?" If the answer is "allow each individual to decide on behalf of their own children whether they should be vaccinated at all or which vaccinations they should have or when" - then inevitably vaccination rates will fall as will population in immunity and disease incidence will rise, potentially putting other people's children in harm's way and on occasion one's own.

If the answer is "yes, lets carry on aiming to cover the highest possible % of the population with vaccines but ensure we have rigorous surveillance for potential harms and listen openly to citizens' concerns - just as we should for any medicine or medical intervention, and ensure sufficient funding is put into related research and that manufacturers' Conflict of Interest are all declared openly and transparently" - then that seems fair enough. Although the caveat should be that if the peer reviewed research resulting shows a major weight of evidence for net benefit of vaccination, it shouldn't be dismissed as rigged or partial evidence. Quoting a handful of empirical studies to support the anti-vaccination cause (and hence respecting empirical evidence) but then dismissing evidence which is pro vaccine as partial and biased is intellectually inconsistent.

However, when Mr Welsh says that the "medical hierarchy" should "guarantee that vaccines are safe for all children". It cannot do this. No medical intervention is ever 100% safe and some will always carry significant levels of risk. The whole business of medicine (and population level intervention) involves balancing risks vs benefits, deciding how much risk on each side (from the disease or injury or acute event or infection vs from the treatment options vs non treatment) and balancing individual outcomes, priorities or risks and benefits vs risks or benefits to whole populations. There is no such thing as risk free medical intervention - merely doing all we reasonably can to minimise risk and to maximise the risk vs benefit for populations and individuals.

It would be a promise no-one could keep. And as for the "medical hierarchy", it is the medical footsoldiers in frontline roles who would be dealing daily with Polio, Malaria, TB, Measles, Rubella, Whooping Cough, Cholera, Schistosomiasis, etc, if there had not been major attempts through public health interventions including vaccination to reduce or eradicate them.

One might as well say there was some kind of conspiracy by the "medical hierarchy" to reduce avoidable harms from obesity, smoking, alcohol, hypertension and diabetes to individual patients. Prevention of ill health is and has been a central component of medicine's mission.

Children undergoing vaccination are generally too young to have decision making competency regarding consent to it.

David Oliver

Competing interests: No competing interests

01 September 2018
David Oliver
Consultant Physician