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Views And Reviews

New guidance from the GMC: what constitutes meaningful dialogue?

BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m3933 (Published 12 October 2020) Cite this as: BMJ 2020;371:m3933

Rapid Response:

Re: New guidance from the GMC: what constitutes meaningful dialogue? (Coercive atmosphere over vaccination)

Dear Editor

I express concern about the coercive atmosphere being generated over vaccination in this Covid episode which surely infringes the legal right to informed consent of the citizen, having previously remarked here on the repeated comments of the Prime Minister (who is not a medical authority) [1,2].

I have, for example, been forwarded a standard letter to parents who have not signed the consent by ‘School Immunisation Team - Hertfordshire (Vaccination U.K.)’ which has prevented the team from vaccinating a child with nasal flu spray. The letter takes no account of the parental right to refuse. It reads:

“Vaccination UK are coming back to the school for a second visit. Please complete the consent form attached to the school office so we can make sure you child is not missed again...”

This ignores all reasons a parent might have for refusing (for instance issues of health which Vaccination UK are not aware of). At the top we read “Make sure you protect you child against Flu and protect against Pandemics”, but this is problematic since the benefits are by no means straightforward. At the the EMC site we read [3].

“Vaccine recipients should be informed that Fluenz Tetra is an attenuated live virus vaccine and has the potential for transmission to immunocompromised contacts. Vaccine recipients should attempt to avoid, whenever possible, close association with severely immunocompromised individuals (e.g. bone marrow transplant recipients requiring isolation) for 1-2 weeks following vaccination. Peak incidence of vaccine virus recovery occurred 2-3 days post-vaccination in Fluenz clinical studies. In circumstances where contact with severely immunocompromised individuals is unavoidable, the potential risk of transmission of the influenza vaccine virus should be weighed against the risk of acquiring and transmitting wild-type influenza virus.”

Yet this important information is not (perhaps no longer?) in the Patient Information Leaflet [4] even if this is provided: possibly even immunocompromised children at the school might be exposed.

There are a host of complex ethical issues here and it is not clear that the approach of Vaccination UK meets these, while the lack of courtesy is truly disturbing. It is also surely completely out of line with the Montgomery ruling and the new GMC guidelines [5,6]. Moreover, the PIL withholds important information which would seem to invalidate the possibility of informed consent anyway.

[1] John Stone, ‘ Re: New guidance from the GMC: what constitutes meaningful dialogue? Vaccines are a matter of individual autonomy too’, 20 October 2020, https://www.bmj.com/content/371/bmj.m3933/rr-0

[2] John Stone, ‘Regarding the Use of the Term “Anti-Vaxxer”’, 27 August 2020, https://www.bmj.com/content/370/bmj.m3099/rr-5

[3] https://www.medicines.org.uk/emc/medicine/29112

[4] https://www.medicines.org.uk/emc/files/pil.3296.pdf

[5] Noel Thomas, ‘ Re: New guidance from the GMC: what constitutes meaningful dialogue?’ , 4 November 2020, https://www.bmj.com/content/371/bmj.m3933/rr-9

[6] Daniel Sokol, ‘ New guidance from the GMC: what constitutes meaningful dialogue?, BMJ 2020; 371 doi: https://doi.org/10.1136/bmj.m3933 (Published 12 October 2020)

Competing interests: AgeofAutism.com, an on-line daily journal, concerns itself with the potential environmental sources for the proliferation of autism, neurological impairment, immune dysfunction and chronic disease. I receive no payment as UK Editor

13 November 2020
John Stone
UK Editor
AgeofAutism.com
London N22