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Taking sides in the vaccine war

25 November 2002

By GRANT FLEMING

 

Choosing not to immunise her two children is a decision that Catharina Fisher does not take lightly.
 

The Hutt Valley mother of two says that when faced with the question of whether to vaccinate or not, she and her husband decided to look further into the matter.

"Once we got into it, there seemed to be a big discrepancy between government information and what our research was telling us."

She says there was little information about possible adverse effects and the research that had been done was funded by the manufacturing drug companies and was very limited in its scope.

However, their decision, says Ms Fisher, means taking greater responsibility for keeping her two children, Kieren, 4, and Annabel, 18 months, healthy. That involves breastfeeding for a long time – till Kieren was two, and still breastfeeding Annabel – not letting the kids get too run down, and providing them with a healthy diet. "We keep away from the high fat and sugar foods."

The Fishers are not alone in their decision. The Health Ministry estimates that 2 to 4 per cent of New Zealand parents choose not to immunise their children for philosophical reasons, and as many as a further 10 per cent waver over the decision to give their children the jab.

In New Zealand, immunisation is offered to babies for hepatitis B, haemophilus influenzae, diptheria, tetanus, whooping cough, polio and measles, mumps and rubella.

Ministry national immunisation manager Clair Mills says that reaching the wavering 10 per cent and another, smaller group who find it difficult to get to a doctor is a priority. She says research shows that if 95 per cent coverage can be achieved, diseases such as measles, which has the power to disable or, in extreme cases, kill, could be wiped out. The ministry estimates that between 85 and 88 per cent of two-year-olds are immunised.

However, Dr Mills says, immunisation is not 100 per cent effective. A small proportion will get these diseases even after immunisation. This, and the fact that they outnumber non-immunised children by about nine to one, accounts for a high proportion of immunised children in disease statistics. But she says it is the children who aren't immunised who often act as carriers, exposing those immunised children. She says that when looking at the effects of a disease outbreak on an entire population, the gains made from immunisation are huge. "If 100 per cent of people were immunised, the diseases would not exist ... next to clean water, this is the most successful health intervention we have."

But Immunisation Awareness Society spokeswoman Sue Claridge says that in the information war the ministry has waged to convince undecided parents, disease risks have been exaggerated and the potential for long-term side-effects ignored.

Ms Claridge says that during the 50 years leading up to the 1940s, when vaccination programmes began, the incidence of communicable diseases had already dropped dramatically because of better sanitation, hygiene, water supplies, housing and nutrition.

"Health authorities attribute the drop to vaccination, but in reality most of it was already happening."

She says that diseases such as scarlet fever have also declined hugely during the past 100 years, despite the absence of a vaccination programme.

Ms Claridge says public health authorities have accepted vaccination on the assumption that it is safe. The common short-term side-effects – swelling, redness, fever and irritability – have been studied and are well known, she says, but there has been no study of long-term health effects.

There is little surveillance of potential adverse effects, such as auto-immune disorders and even death from extreme reactions to immunisation. In many cases of possible adverse reactions, doctors are unwilling to accept immunisation as a causal factor, even if the medical event occurs during the 24 hours after vaccination.

"In many of these cases, it may not be linked to vaccination, but you will never know if there is a pattern if you don't investigate or report it in the first place. We believe that, at the moment, the risks are considerably underplayed by the medical establishment in their effort to reach their aim of high vaccination rates. They are not providing parents with the information to weigh the risks against the benefits."

But, she says, the society also advocates a holistic approach to health if people choose not to immunise. Measures such as long-term breastfeeding, which confers the mother's immunity to the child, and excellent nutrition are essential, she says. "Those things ensure that if a child does get sick, their body has the strength to fight that illness."

Auckland University immunisation researcher Nikki Turner agrees that the monitoring of adverse effects must improve. She says the current passive monitoring system needs to change to one that is more active in collecting data.

"In European countries and the United States, doctors are putting a lot more money into surveillance and better linking of kids' medical records so cause and effect can be established if there is a possible adverse reaction."

Common reactions to vaccines, those experienced by 1 to 10 per cent of people, such as red legs, fever, irritability and even post-vaccination fits, have been well quantified through big studies, she says. But rare adverse reactions, for example, a one-in-a- million probability, are almost impossible to identify because the catchment pool needed to pick up reliable data is too large. "They do large studies on 300,000 or 400,000 kids and they can show there does not appear to be a link, but if it was incredibly rare, if there was some poor individual out there who gets an unusual and rare reaction, you will not pick that up in a very large study . . . for certain issues, the studies have been done, but there are always things we have not considered."

She says that with the measles, mumps and rubella (MMR) vaccine, which some research has linked to autism, there have been big studies that show if there is a link, it is extremely rare.

Dr Turner says there has also been much concern about an international increase in auto-immune conditions – in which the body attacks itself – such as autism and diabetes. But she says that though those conditions relate to the immune system, they are most probably linked to our affluent lifestyle and longer life expectancy.

"You have to look at it and do research case by case. Is there a link between vaccines and diabetes – no. Is there a link between vaccines and autism – it's been found to be extremely unlikely."

Dr Turner is a firm advocate of immunisation. Though there is now a much lower incidence of disease than there was 50 years ago, she says that increased numbers of people travelling, babies being taken out of the home at a younger age and more contact at pre-schools puts children at risk.

However, she says, some vaccines are of more benefit than others. There is a strong case for immunising against measles, which can be very severe. But the case for mumps is much weaker – in very rare cases, it can lead to deafness. And the case for polio is almost non-existent unless you are going to polio endemic areas.

"With coverage, you don't need to get 100 per cent, so they don't have to be religious zealots, but you have to get above 90 per cent and close to 95, but the community can always handle conscientious objectors."

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ALL INFORMATION, DATA, AND MATERIAL CONTAINED, PRESENTED, OR PROVIDED HERE IS FOR GENERAL INFORMATION PURPOSES ONLY AND IS NOT TO BE CONSTRUED AS REFLECTING THE KNOWLEDGE OR OPINIONS OF THE PUBLISHER, AND IS NOT TO BE CONSTRUED OR INTENDED AS PROVIDING MEDICAL OR LEGAL ADVICE.  THE DECISION WHETHER OR NOT TO VACCINATE IS AN IMPORTANT AND COMPLEX ISSUE AND SHOULD BE MADE BY YOU, AND YOU ALONE, IN CONSULTATION WITH YOUR HEALTH CARE PROVIDER.