Johnjoe McFadden
Monday January 21, 2002
The Guardian
Save the Children Fund last week accused a major vaccine programme of
putting pharmaceutical industry profits above the needs of children. A
doctor was forced to resign last month from a London medical school post
because of his anti-establishment views on the potential dangers of measles
vaccine. As a scientist trying to develop new vaccines, I could be forgiven
for self-doubt. Are vaccines all that they are cracked up to be?
The answer to that is that those millions of doses of vaccine annually
jabbed into the arms of children are a needle-thin line protecting humanity
from disease. Their greatest triumph has been the elimination of smallpox,
which once killed millions and scarred the survivors. If you've ever
wondered why milkmaids were so often shown in landscape paintings, it is
because their faces were unscarred - as Edward Jenner surmised, their
tendency to catch the milder cowpox protected them from smallpox. Jenner
developed his cowpox vaccine over 200 years ago, but the disease wasn't
conquered until the massive vaccination campaigns of the 20th century.
Smallpox has not been the only conquest. Anyone who has travelled in
Africa or India has been shocked by child beggars dragging polio-ravaged
limbs. Do you remember pictures of wards of people gazing out of rows of
iron lungs? Those patients weren't in hospital for treatment; they were
trapped in those machines for life after polio paralysed their respiratory
systems. Polio has been nearly defeated. The World Health Organisation's
heroic efforts are now tackling the last redoubts of the disease, delivering
the heat-sensitive vaccine by camel in Sudan, bicycle in India and boat in
Cambodia and Vietnam.
True, all infectious diseases were not eliminated, even in the West, in
the 20th century. Meningitis, caused by the Hib and MenC bacteria, annually
killed hundreds of children in the UK into the 1990s. In 1992 the Hib
vaccine was introduced and since then Hib disease has almost disappeared.
The UK was the first country to introduce the MenC vaccine in 1999; there
was a big reduction of MenC disease in 2000.
There are downsides to all health interventions, including vaccines.
Vaccination may have kept you free of measles in childhood, but if you are
unlucky enough to contract measles as an adult, it is likely to be more
severe. We should remember why measles, mumps or rubella are diseases of
childhood in places where they are still common: because infectious agents
generally infect children soon after birth. If those children survive, they
became immune. For most infections, disease is the best vaccine. But that
immunity comes at a huge cost, as children that don't quickly develop
immunity will die.
In the UK, vaccinating children is like voting. A single vote, or a
single vaccination, is rarely going make any difference. If everyone else's
children are vaccinated, herd immunity will ensure that deadly bacteria or
viruses cannot circulate. A few people can then afford to be "conscientious
objectors", because the vaccination of the majority will keep disease at
bay. But as with voting, if everyone stops, the system collapses. Measles,
mumps, rubella or diphtheria haven't gone away. They are still among us,
ready to break out if we let our defences down. A recent outbreak of measles
in the Netherlands was triggered by low rates of vaccination: 2,961 children
were infected and most recovered. But three died. If too many of us refuse
to have our children vaccinated, then parents will soon be discussing
epidemics that are far more deadly than nits.
If vaccine-preventable diseases take hold again in the UK, the well-fed
children of Guardian readers will not suffer the worst. Measles has a 10%
mortality rate among in the malnourished. But pointing to social deprivation
as the cause of disease doesn't save lives. Vaccines do. And they are one of
the cheapest ways to do it.
· Johnjoe McFadden is professor of molecular genetics at the
University of Surrey.
Email: j.mcfadden@surrey.ac.uk