Intended for healthcare professionals

Rapid response to:

Feature Public Health

Vaccine disputes

BMJ 2009; 338 doi: (Published 22 June 2009) Cite this as: BMJ 2009;338:b2435

Rapid Response:

A plea for a balanced discussion on immunisation

Any hope for a rational discussion on the benefits and risks of vaccination was not helped by Rebecca Coombes' less than objective critique of what she refers to as the "anti-vaccination lobby".[1] I, too, deplore personal attacks that are made on Paul Offit, David Salisbury or any other enthusiastic proponent of vaccines. But I am also concerned when I hear that those who simply question the value of vaccines, like many of the parents I meet every week in my immunisation clinic, have been patronized and bullied into vaccinating their children by my fellow health professionals.

Any discussion about vaccines is liable to get heated - on both sides of the debate; and that's a great shame because it prevents us from having the open, honest discussion that this important subject demands. Those who speak determinedly in favour of vaccines are just as much to blame as the "anti-vaccination lobby". In the same edition of the BMJ, Iona Heath challenges the benefits of breast screening and the one-sided propaganda that is put out to encourage women to have their mammograms.[2] Many of Dr Health's arguments could equally apply to vaccination. In particular, she quotes David Sackett's description of the arrogance of preventive medicine, of which immunisation must be the pre-eminent example. "Preventive medicine displays all 3 elements of arrogance. First, it is aggressively assertive, pursuing symptomless individuals and telling them what they must do to remain healthy . . . Second, preventive medicine is presumptuous, confident that the interventions it espouses will, on average, do more good than harm to those who accept and adhere to them. Finally, preventive medicine is overbearing, attacking those who question the value of its recommendations." All 3 elements apply to immunisation.

There is an arrogance amongst some doctors that doubters simply need to be told "the facts" to be persuaded of the clear and overwhelming benefits of immunisation. I have spent much time studying "the facts" in the form of published peer-reviewed research papers. These, in general, do demonstrate the benefits of vaccines, but these benefits are usually less than widely claimed, the risks greater than admitted, and the diseases that vaccines aim to prevent often less serious than portrayed.

The disease Ms. Coombes mentions most in her feature is measles, a disease that can be serious and fatal. However, when I was a child, in the 1960s, we all caught measles and certainly did not live in fear of it. A BMJ editorial of 1963, prior to the introduction of the single measles vaccine, whilst asserting the need for the vaccine in underdeveloped countries, stated, "But the need or desire for a vaccine for the general population of Great Britain is much les certain. Measles is now a mild disease, and many parents and doctors may feel that no protection against it is required."[3] It is true that during that period between 50 and 150 people died every year from measles (many of these suffered form chronic health problems, for whom the case for immunisation was stronger), but these figures must be balanced against the evidence that catching measles prevents allergic disease - including asthma, which kills over 1,000 people every year in the UK.[4] The case for vaccination needs to be put in perspective. And why are we immunising the whole population against mumps when a 10-year survey of 2,482 of the most serious cases of mumps (those admitted to hospital), found just five cases of long-term complications - of deafness due to involvement of the eighth cranial nerve? The authors concluded, "It seems clear from the results of this survey that there is little need for general vaccination against mumps."[5] Just as with breast screening, the current public health message is unequivocally in favour of vaccination and never puts the counter argument. Ms Coombes' assertion that JABS is "anti-vaccine" is incorrect. Indeed the JABS web site clearly states this. And yes, the JABS web site does still maintain - correctly - that "some children have and will continue to be damaged by combined and single dose vaccines." If this were not the case, the UK Vaccine Damage Payments Unit would not have paid out 1367 vaccine damage awards between 1978 and 2005. It is an unspoken truth that mass vaccination programmes necessitate sacrificing the few to protect the majority.

Those who question the benefit of mass immunisation are not all irrational non-believers. Most support vaccination but are concerned at - and question the necessity for - the large number of vaccines and the early ages at which these are given. Many have studied the research, only to find - as I have - contradiction and uncertainty. They deserve to be treated with respect and given the opportunity for an open and honest debate.

[1] Coombes R. Vaccine Disputes. BMJ 2009;338:1528-31.

[2] Heath I. It is not wrong to say no. BMJ 2009;338:1534.

[3] Anonymous. Vaccination against measles. BMJ 1963;5360-1.

[4] Rosenlund H et al. Allergic Disease and Atopic Sensitization in Children in Relation to Measles Vaccnation and Measles Infection. Pediatrics 2009;123:771-778.

[5] Anonymous. A retrospective survey of the complications of mumps. Journal of the Royal College of General Practitioners 1974; 24:552-6.

Competing interests: Author of The Truth about Vaccines. Medical Director of BabyJabs children's immunisation service.

Competing interests:

30 June 2009
Richard T Halvorsen