Intended for healthcare professionals

Education And Debate

Concerns about immunisation

BMJ 2000; 320 doi: (Published 22 January 2000) Cite this as: BMJ 2000;320:240

Re: A concern about ethics


Subra Vemulpad makes two main points:

1. " often do parents 'routinely' receive this information from
the immunisation providers? When parents take their
children for immunisations, consent is implied. However, does it not
fall short of 'informed' consent?" [1]

2. "Such a practice provides ammunition to the anti-immunisation
camps' rhetoric." [1]

I think Dr Vemulpad misses the point slightly about those who are
opposed to routine vaccinations of children. Parents do
not receive the 'full picture' on this issue because clinicians are
polarised, most being trained to believe that vaccines are
safe and harmless and confer immunity to the child. I deliberately
use the word 'believe' because it is a fair statement.

Second, it cannot therefore be construed as 'informed consent' as it
is informed from only the one side: a pro-vaccine side.

Regarding the second point, 'providing ammunition' is correct in the
sense that by denying parents the full picture, clinicians
are placing weapons into the hands of those opposed to routine
vaccinations. However, the use of the word 'rhetoric' is a
tad one-sided. One could equally accuse pro-vaccinators of using
rhetoric in everything they say about how wonderful and
necessary vaccines are. Rhetoric is used to bolster a belief, while
evidence is used to support a rational contention ['fact'?].

There is a difference there. Obviously people vary in their claims,
on any subject, regarding the words 'belief' and 'rationality' or between 'rhetoric' and 'evidence', and these terms
do shade into one another on most issues.

However, pro-vaccine rhetoric falls on deaf ears to those who are
ideologically opposed to vaccination, not because it is
'rhetoric' or that it denies 'informed consent', but chiefly because
they are downright opposed to vaccinations.

The main arguments against the routine use of vaccines, have been
'done to death' here before, but in brief they include the
following notions:

* that the human organism has its own healing agent or defence
mechanism that in most of us can successfully fight off

* that through succumbing to childhood infections, the defence
mechanism is empowered rather than damaged;

* that the introduction of 'foreign germs' into the organism is seen
by some as a form of 'blood poisoning';

* there are religious arguments against it;

* that the vaccines often do not successfully confer the immunity
their promoters claim;

* that the damaging consequences can be and in some cases are

* that by using vaccines we are depleting the innate power of the
defence mechanism [by doing its job for it and making it lazy?
- an argument equally applicable to antibiotics];

* that any form of mass applied therapy, must, by its very nature, be
unsuited to the individual symptoms or constitutions of
each child;

* that vaccine damage can be cured using homeopathic vaccines;

* finally, that many childhood infections had already declined
massively, due to improved diet and hygiene, before a single
vaccine was introduced. Many also regard vaccinations as an unnecessary
medical fad, for example those against Tetanus.

These are the main arguments coming from the lips of the opposers. Additionally, it is claimed by many [but not all] homeopaths that
homeopathic vaccines are effective in conferring immunity,
and that childhood infections treated homeopathically are minor
medical matters of little serious concern. Obviously, these views are dependent upon gaining clinical experience of a type which
is not mainstream to most clinicians, and must be
judged accordingly.

To take a truly neutral view of this matter, therefore, we must say
that the evidence is finely balanced; the 'evidence' in
favour of vaccination is just about as mixed as that for homeopathy.
One finds 'rhetoric' and 'beliefs' sitting side by side with
'facts' and evidence on both sides of the divide. Ultimately, parents
tend to be most concerned with the risks to their child,
and as risks are low, they tolerate vaccinations, whether they
instinctively agree with them or not. I think that is a fair
account of the matter.


[1] BMJ letter, Subra Vemulpad, A Concern About Ethics, 31 July 2000

Competing interests: No competing interests

04 August 2000
Peter Morrell
Hon Research Associate, History of Medicine
Staffordshire University