http://www.bmj.com/cgi/content/full/321/7253/108#resp1
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Letters
Concerns about immunisation
Breast
feeding should be promoted
Is
vaccination cause célèbre or bête noire?
Facts
are not enough
Authors'
reply
Breast feeding should be promoted
Bedford
and Elliman make some important statements about immunisation.1
Certainly, millions of lives have been saved. Smallpox has been
eradicated, and polio should be eradicated soon. But are routine
vaccines safe? Four months after the Centers for Disease Control and
Prevention in the United States recommended that all babies should
receive three doses of the rotavirus vaccine, the use of this
vaccine was being indefinitely suspended after reports of over
100 cases of intussusception and two deaths resulting from its
use.2
The manufacturer voluntarily withdrew the vaccine.
In July 1999 the US Public Health Service and the American Academy of
Pediatrics asked vaccine manufacturers to eliminate the preservative
mercury from vaccines because of concern about its cumulative
effects.3
Babies who receive the 15 recommended vaccines in the first six
months of their lives have a cumulative mercury exposure that
exceeds limits set by the Environmental Protection Agency. What is
the impact when, by the age of 5 years, children have received
over two dozen doses of vaccines containing mercury and other toxins?
Some scientists say that the massive polio immunisation campaign in Zaire
and other African countries in the 1950s accelerated the spread of
HIV.4
The aerosol vaccine was grown in monkey kidney tissue; that same
species of monkey carries a simian immune deficiency virus. The
places where the vaccine was administered are the epicentre of the
AIDS epidemic. Was the vaccine the vector that carried the immune
deficiency virus to humans? The answers to this most important
question are inconclusive and controversial.
It costs millions to develop, research, and market a vaccine. Wouldn't it
make more sense to spend that money to protect, promote, and support
breast feeding for every baby? There is much evidence that breast
feeding reduces the incidence and severity of rotavirus, respiratory
syncytial virus, and otitis media, without side effects.5
There can be conflict when economic and political interests enter the realm
of public health. We have seen how important information about
safety has been hidden to protect profit; the tobacco industry lawsuits
are an illustration. We have seen it when the sons and daughters of
the mothers who were given diethylstilbestrol showed up seriously
ill a generation later, and when infants whose mothers were given
thalidomide were born deformed. How long must a clinical trial be to
ensure safety? One generation? Two? More?
Nikki Lee
Center for Breastfeeding, 8 Jan Sebastian Way, Number 13, Sandwich,
MA 02563, USA
Competing interests: None declared
|
1. |
Bedford H, Elliman D. Concerns about immunisation. BMJ
2000; 320: 240-243 |
|
2. |
CDC. Withdrawal of rotavirus vaccine recommendation. JAMA
1999; 282: 2113-2114 |
|
3. |
Miller JL. Elimination of thimerosal from vaccines set as
goal. Am J Health Syst Pharm 1999 Aug 15; 56: 1589 |
|
4. |
Stricker RB, Elswood BF. Polio vaccines and the origin of
AIDS: an update. Med Hypotheses 1997; 48: 193 |
|
5. |
Grover M, Giouzeppos O, Schnagl RD, May JT. Effect of
human milk prostaglandins and lactoferrin and respiratory syncytial virus and
rotavirus. Acta Paediatr 1997; 86: 315-316 |
Is vaccination
cause célèbre or bête noire?
Bedford
and Elliman discuss some of the concerns about immunisation.1 The
Faculty of Homoeopathy speaks for a medically qualified minority.
The more numerous medically unqualified homoeopaths belong to the
Society of Homoeopaths, the Institute of Complementary Medicine, or
the Homoeopathic Medical Association, totalling some 2000 practitioners.
None of these bodies supports vaccination. The Society of
Homoeopaths, in a leaflet, encouraged parents to seek advice about
it. Currently the Homoeopathic Medical Association has no policy on
vaccination. The Institute of Complementary Medicine, which has a register
of "classical homoeopaths," opposes vaccination.
Homoeopaths' views derive more from leading writers than professional
bodies. James Compton Burnett discovered vaccine damage in the
1880s, and Stuart Close denounces all mass treatments as fundamentally
unholistic. Harris Coulter, a historian, blames vaccination for
mental illness, crime, and social deviance. A prominent Dutch
homoeopath describes "post vaccination syndrome," and he
claims that potentised vaccines can cure this syndrome and act prophylactically
against many infections. This claim was confirmed by Margery Grace
Blackie, the Queen's former physician.2
Martin Miles, a London homoeopath, extends Coulter's views, claiming that
vaccination causes cancer, meningitis, arthritis, constitutional
weaknesses and neurological damage, and increases the level of mucus
in the body. A leading homoeopath, George Vithoulkas, thinks that
vaccination ignores the susceptibility of individual patients, is
fundamentally unhomoeopathic, and leads to the degeneration of whole
populations' health. None of them supports vaccination: the original
article and the faculty stand alone. From about 1903 until the
1970s, even the faculty endorsed an approach that regarded bacteria
as harmless scavengers and opposed vaccination. 2 3
The data presented by Bedford and Elliman do not conclusively show that
vaccination caused the decline of infectious diseases. Diphtheria,
tuberculosis, and pertussis were virtually extinct before vaccines
were introduced. American and British data show similar patterns.
More likely causes are improved water supply, sanitation, adequate
food supply, and birth control. Many were declining before the
immunisation programmes began.4 I
therefore remain unconvinced and agree with Stacey's assessment that
the decline of many infectious diseases is or was as much due to
improved sanitation as to anything elseincluding
immunisations.5
Peter Morrell
Department of Sociology, Staffordshire University, Stoke-on-Trent ST4 2DE peter.morrell@tesco.net
|
1. |
Bedford H, Elliman D. Concerns about immunisation. BMJ
2000; 320: 240-243 |
|
2. |
Winston J. The faces of homeopathy: a history of the
first 200 years. Wellington, New Zealand: Great Auk Publishing,
1999. |
|
3. |
Miles M. Homeopathy and human evolution. London:
Winter Press, 1992. |
|
4. |
Leavitt J, Numbers R. Sickness and health in America.
Madison, WI: University of Wisconsin, 1978. |
|
5. |
Stacey M. The sociology of health and healing.
London: Unwin, 1988. |
Competing interests:
None declared.
Facts are not
enough
Bedford
and Elliman provide a useful summary of the main evidence supporting the safety
and effectiveness of vaccines.1
They suggest that their evidence based refutations of erroneous beliefs
commonly expressed by immunisation defaulters are useful in
dispelling their concerns. This assumes that those who express these
beliefs are simply mistaken and when exposed to counter-arguments will
realise this.
Although we believe that it will always be important for scientists and
health professionals to refute misleading information, there is
little empirical support for the hope that decision making about
vaccination is based on "facts" alone. In their research on
cognitive processes in vaccination decision making, Meszaros et al
showed that when parents opposed to the vaccine for diphtheria, tuberculosis,
and pertussis were presented with factual information about risks
and benefits they became more committed to their antipathetic position.
This response was moderated by underlying values about death and
chronic disability.2
Our own research on antivaccination press reportage has shown that manifest
claims about vaccines being dangerous and ineffective tend to be
located under a canopy of more general discourses about cover up and
conspiracy, manipulation by venal private enterprise interests,
governments with totalitarian agendas, and the back to nature idyll.3 We
argue that what generates the appeal of antivaccination claims is
underlying reference to these wider issues. We are now undertaking
qualitative research with parents and immunisation providers in an
attempt to explore the nature of the appeal of both
anti-immunisation rhetoric and reassurances by providers. Although
this work is incomplete, we have been impressed by how frequently
parents in focus group discussions are adamant that they want to be
given the "facts" but demonstrate minimal retention of
these when exposed to television items containing pro-immunisation
and anti-immunisation claims. What is retained and discussed and
prompts strong responses from participants are images of children
who have allegedly been damaged by vaccines. In other words, the
facts have little potency when competing with the very emotive news
stories found in the media.
Any attempt at refuting or deflating the persuasive power of vaccination arguments
must address the potential gut level appeal at which
anti-immunisation rhetoric tends to operate. What we have learnt
about immunisation science will be of no public value ultimately if
we ignore key lessons from health communication science.
Julie-Anne Leask
Simon Chapman
Penelope Hawe
Department of Public Health and Community Medicine, University of Sydney,
Sydney NSW, Australia
|
1. |
Bedford H, Elliman D. Concerns about immunisation. BMJ
2000; 320: 240-243 |
|
2. |
Meszaros JR, Asch DA, Baron J, Hershey JC, Kunreuther H,
Schwartz-Buzaglo J. Cognitive processes and the decisions of some parents to
forego pertussis vaccination for their children. J Clin Epidemiol
1996; 49: 697-703 |
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3. |
Leask J-A, Chapman S. `An attempt to swindle nature':
press anti-immunisation reportage, 1993-1997. Aust N Z J Public Health
1998; 22: 17-26 |
Competing interests: Dr
Leask and Professor Chapman have been reimbursed for attending a conference and
have received funds for research from CSL Vaccines.
Authors' reply
We
welcome the interest taken in our article as we believe immunisation to be very
important. Lee concedes that vaccines have been an important health
initiative but questions their safety. She rightly points out that
rotavirus vaccine was withdrawn after being in use in the United
States for less than a year. This is in fact an excellent example of
how closely the safety of vaccines is monitored. As soon as there
was serious suspicion of a problem, the vaccine was suspended from
use and an extensive investigation conducted. When the results of
this were announced, the vaccine was permanently withdrawn.1
Lee also cites other examples of the possible side effects of vaccines.
There is no evidence that anyone has come to harm from the mercury
in vaccines, but it seems reasonable to eliminate any potential
risk, however small. For this reason, many governments have urged
vaccine manufacturers to eliminate mercury from vaccines as soon as
is practicable. There is no convincing scientific evidence that
polio vaccines in Africa had anything to do with the origin or
spread of AIDS.
Morrell points out that many homoeopaths advise their clients to avoid
conventional vaccines. We were trying to make the point that the
common assumption that homoeopathy and orthodox immunisation are
incompatible is a myth, a view by which we stand. We do not claim
that the only explanation for the fall in the incidence of many diseases
is the introduction of vaccination. There is, however, overwhelming
evidence of the efficacy of vaccines, both from trials conducted
before their widespread introduction and from experience of groups
who remain unimmunised when most of the population has accepted
vaccine. Outbreaks of disease among communities that reject
immunisation have caused not only disease but also death, most
recently in an epidemic of measles in the Netherlands.2
Leask et al make a fair point, which we accept. There are many interrelated
factors that determine whether or not children are immunised.
Parents' attitudes to the safety and efficacy of vaccines and the
severity of disease are among the most important determinants of
vaccine uptake.3
We need to look no further for evidence of this than the recent
decline in uptake of measles, mumps, and rubella vaccine in the
United Kingdom, which has followed much publicised claims that the
vaccine is linked with autism. Although we recognise that knowledge
alone does not change behaviour, there are many myths circulating
about immunisation and infectious diseases, and without accurate information
it is not possible to make a fully informed decision. The other
aspects mentioned by Leask et al are more intangible and may reflect
the empathy between parent and professional.4 Even
that relationship will be influenced in turn by an individual's
wider perceptions of governments and industry.
Helen Bedford
Department of Epidemiology and Public Health, Institute of Child Health, London
WC1N 1EH
David Elliman
St George's Hospital, London SW17 0QT
|
1. |
Centers for Disease Control and Prevention. Withdrawal of
rotavirus vaccine. http://www.cdc.gov/epo/mmwr/preview/mmwrhtml/mm4843a5.htm
(accessed 18 February 2000). |
|
2. |
Communicable Disease Surveillance Centre. Outbreaks of
measles in communities with low vaccine coverage. Commun Dis Rep CDR
Weekly 2000; 10: 29 |
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3. |
Peckham C, Bedford H, Senturia Y, Ades A. National
immunisation study: factors influencing immunisation uptake in childhood.
Horsham: Action Research, 1989. |
|
4. |
Harrington PM, Woodman C, Shannon WF. Low immunisation
uptake: is the process the problem? J Epidemiol Community Health 2000;
54: 394-400 |
Competing interests: Dr
Bedford and Dr Elliman have both been sponsored to attend and speak at
educational meetings and have conducted research funded by
manufacturers of vaccines.
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Rapid Response responses to
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Response responses
'Gut appeal'
Subra Vemulpad, Lecturer , Macquarie
University, Sydney
bmj.com, 25 Oct 2000 [Response]
Other related articles in BMJ:
EDUCATION AND DEBATE
Concerns about immunisation.
Helen Bedford and David Elliman
BMJ 2000 320: 240-243.
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