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Vaccination uptake: access is still biggest barrier, experts warn

BMJ 2019; 366 doi: (Published 17 September 2019) Cite this as: BMJ 2019;366:l5576

Rapid Response:

Re: The Boiling Frog Principle: patient safety and vaccines

I am grateful to Allan Cunningham [1]. To illustrate the point last year the European Parliament press room reported [2]:

"MEPs say it is unjustifiable that the cost of a full vaccines package for one child is 68 times more expensive in 2014 compared to 2001."

while failing to note how much the schedule expanded. Off the top of my head we have had added to the UK childhood schedule since 2014 influenza vaccines, Meningitis B vaccine, Hepatitis B vaccine, HPV vaccine for boys. The MEPs' calculation may also not have included vaccines in pregnancy (influenza, DTaP). It is likely that cost of vaccinating a single child has escalated by now well beyond IO0 times since 2001. Whatever you think of Andrew Wakefield he surely put a finger on a raw industry nerve when he questioned the triple vaccine MMR in 1998. What would happen if people continued to think they could pick and choose?

The European Parliament did also express some caution:

"MEPs stress that increased transparency in evaluating vaccines and their adjuvants, in the funding of independent research programmes and the possible side-effects of vaccines would contribute to restoring confidence in vaccination.

" They point out that researchers must declare any conflict of interest. Those subject to a conflict of interest should be excluded from evaluation panels. The confidentiality of deliberations of the European Medicines Agency’s (EMA) evaluation panel should also be lifted, and scientific and clinical data be made public."

Nevertheless we may wonder how much governmental and institutional progress has been made in regard to these pious concerns in the intervening months (now exactly a year and a half ago).

[1] Allan S Cunningham, 'The Boiling Frog Principle: patient safety and vaccines', 19 September 2019,

[2] 'Health Committee MEPs warn against dropping vaccination rates', European Parliament Press Room 20 march 2018,

Competing interests: No competing interests

20 September 2019
John Stone
UK Editor
London N22