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David Oliver: Vaccination sceptics are immune to debate

BMJ 2019; 365 doi: (Published 22 May 2019) Cite this as: BMJ 2019;365:l2244

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Re: David Oliver: Vaccination sceptics are immune to debate


I thank Professor Goldenberg and Dr Cunningham for their considered responses.

I was careful to cite and endorse arguments made by other commentators that our focus should be constructive engagement with the vaccine-hesitant to understand and overcome their fears and understand their concerns – albeit with the aim of increasing or restoring previous rates of vaccine uptake.

I have not argued for compulsory vaccination enforceable by law and although some people do advocate for this, I have never done so. Certainly in the UK context, it is not true that trust in medicine is low. In fact, nurses and doctors routinely top large structured survey tables of the most trusted professions and the National Health Service is repeatedly found to be the service making those surveyed proud to be British. This may be something to do with the nature of the health service being universally funded, needs based and free at the point of need.

Nor have I stated that anti-vaccination activists are “stupid”. My experience reading many postings on line is that many of them appear ferociously intelligent, albeit in some cases coming from other scientific backgrounds than public health, immunology, infectious diseases or paediatrics. Their writings are often densely, forensically, if selectively referenced with papers or quotes supportive of their cause.

The thrust of my column was to describe the playbook of tactics used by some of the more extreme activists to dispute any position taken by individual experts or expert bodies. I am neither and nor am I a member of the “vaccine community”.

However, I am profoundly interested in public policy which can prevent disease, whether communicable or not, and do so not just in wealthy first world countries, as well as in the considerable gains over the past 70 or 80 years in the prevention of infectious diseases and their complications and ensuring that we don’t return to the days of outbreaks and pandemics which vaccines can help to prevent.

I am concerned more broadly with the current animus against experts. They may not always get it right but they are our best chance of doing so. Whether it’s economic forecasts on the costs of leaving Europe, major civic construction projects, or public health, I’d tend to go with the people who are highly trained, seasoned and active in the field, who have devoted their working lives to it and are conversant with the current evidence base and its constraints.

I have no problem with the notion of Clinical Trials or high quality implementation studies, epidemiological and health services research on vaccination programmes; I am also realistic enough to know that this is hard to achieve for well established mass vaccination programmes.

Questions for me include
1. How much evidence and expert consensus do we need to prove that well established vaccination programmes are effective in preventing disease and that falling uptake is linked to higher infection rates?
2. What would those campaigning against vaccination want to see instead of our current programmes?
3. Are they pleased to see rates falling?
4. Would they prefer pro-vaccine bodies to stop pushing back and trying to reverse the trend?
5. What public policy solutions would they prefer instead of the status quo?

Meanwhile I haven’t been convinced that the WHO, the UN, UNICEF or national governmental public health bodies are wrong and the campaigners are right.

David Oliver

Competing interests: No competing interests

24 May 2019
David Oliver
Consultant Physician