Making a pig’s ear of the vaccination debate

People are right to be sceptical about the swine-flu scare, but it is telling – and worrying – that they focus their scepticism on swine-flu jabs.

In the climate of fear that has been promoted around the swine flu pandemic, the mass vaccination campaign getting underway in the UK this week is heading for trouble.

Healthcare workers in contact with patients in hospitals and surgeries have been designated a priority to receive the swine flu vaccine. Yet early soundings reveal a high degree of scepticism that is likely to lead to a substantial rate of refusal – inevitably undermining public confidence in the vaccine.

A poll conducted by the Nursing Times in August suggested that 31 per cent of nurses would reject the swine flu vaccine – a proportion that had increased to 47 per cent by October (1). Over the same period the proportion of nurses indicating that they would have the vaccine declined from over a third to less than a quarter. A propaganda barrage from the health authorities aiming to put moral pressure on National Health Service staff to receive the vaccine seems unlikely to boost uptake significantly. The lack of confidence in the vaccine among nurses and doctors will do little to reassure their anxious patients.

It is unfortunate that legitimate scepticism about the scaremongering around swine flu has come to focus on the vaccine, which is only a slightly modified version of the familiar seasonal flu vaccine. The swine flu vaccine is likely to be as effective as this vaccine (which is to say that it offers a degree of protection against one of the viruses that may cause respiratory infections over the winter months) and it is no more likely to cause serious adverse effects (which are very rare with these widely used vaccines). But healthcare workers – and the wider public – have already seen the first wave of swine flu cases. They know that in the vast majority of cases this is a fairly mild illness, often milder than seasonal flu, and they have seen that the doomsday scenarios projected in recent months have already been falsified by events.

Healthcare workers are well aware of the ways in which reports of the numbers of cases of swine flu have been inflated by unreliable helpline telephone diagnoses. They have been appalled at the politically motivated distribution of vast quantities of the marginally effective Tamiflu to many people with mild symptoms. They are not convinced by the publicity given to a small number of extreme cases that these confirm a significant risk to the wider population. Refusing the swine flu vaccine is set to become a gesture of defiance over the conduct of the pandemic scare among health workers and, more widely, an expression of public cynicism and distrust of the government.

The swine flu vaccine campaign is a gift to anti-vaccine activists, who now anticipate an upsurge in popularity. Claims of a link between vaccines and autism and efforts to discredit the HPV vaccine against cervical cancer have already given previously marginal anti-vaccination campaigns a growing public influence. These groups of disaffected scientists, cranks and conspiracy theorists are now trying to revive old vaccine scares in relation to swine flu. One issue is the use in one of the vaccines available in the UK (Pandemrix, made by GSK) of the mercury-based preservative thiomersal, which has been linked to autism by US campaigners. Though this association has been universally discredited, it is still advanced by the promoters of junk science and quack therapists who flourish around autism-parent campaigns (2).

Another issue is the use of squalene, a naturally occurring substance commercially extracted from fish oil, as an adjuvant to enhance the effectiveness of the vaccine in provoking an immunological response. Though squalene was blamed by anti-vaccine campaigners for causing the ‘Gulf War Syndrome’ reported by veterans of the invasion of Kuwait in 1990-91, subsequent investigations revealed that it was not included in the vaccines given to combatants (3). It has, however, been included in seasonal flu vaccines given to more than 20million people in Europe since 1997 and has not been linked to any particular adverse reaction.

Another popular theme among anti-vaccination activists is the supposed risk of Guillain-Barre syndrome, a debilitating neurological condition which was associated with what has become known as the ‘swine flu fiasco’ of 1976. Following a single case of swine flu at an army base in New Jersey, US health officials declared a pandemic emergency and President Gerald Ford launched a nationwide vaccination programme. As things turned out there was no swine flu epidemic but 500 people became ill with Guillain-Barre syndrome, apparently as a result of an immunological reaction to the vaccine, and 25 died, leading to compensation claims amounting to $100million. But Guillain-Barre has never been recognised as an adverse effect of the seasonal flu vaccine, which has merely been tweaked to produce the current swine flu vaccine.

A more appropriate historical parallel is with the smallpox bioterrorism scare launched by President George W Bush in December 2002. At a time of heightened national anxieties following the 11 September 2001 attacks on the World Trade Center and other targets, US authorities raised the spectre of biological attack using the smallpox virus (though there was no evidence that such an attack was imminent, or even feasible). Bush announced a programme to vaccinate 10million ‘frontline’ public service workers, including police and health staff, with the smallpox vaccine (which had not been used since smallpox had been declared extinct 30 years earlier). But few believed that smallpox was a real threat and, though the politicians succeeded in bullying the public health authorities into endorsing the programme, fewer than 40,000 of the eligible staff came forward to have the vaccine and within a year the whole campaign sputtered out.

According to journalist Arthur Allen in his authoritative study of vaccination and anti-vaccination campaigns in the US, in the smallpox scare ‘the Bush administration had seemingly distorted the truth and manipulated public fears to achieve its goals’ (4). As an advocate of the benefits of immunisation, Allen regretted the effect of the smallpox bioterrorism vaccine programme in undermining public trust for health authorities and in damaging the reputation of vaccination. He noted that this episode contributed to a shift in popular attitudes towards immunisation from the prevailing enthusiasm of the postwar years (resulting from the success of vaccination against polio, smallpox and other diseases) to the more ambivalent climate that now prevails (as a result of the vaccine/autism and other scares).

The distortion of truth and the manipulation of public fears are key features of the official promotion of the swine flu pandemic. The very concept of a pandemic, which formerly required ‘large numbers of deaths and illness’ as well as intercontinental dissemination, was changed to allow the World Health Organisation to raise the global profile of the relatively mild H1N1 swine flu outbreak (5). Health authorities have presented worst case scenarios as realistic projections, basing ‘pandemic planning’ on the anticipation of a rerun of the catastrophic 1918 pandemic. But as Peter Doshi observes, ‘strategies that anticipate only “type 1” epidemics [those that cause severe infections among many people, as in 1918] carry the risk of doing more harm than they prevent when epidemiologically limited and clinically mild epidemics or pandemics occur’ (6).

Who benefits from the swine flu scare? No doubt the pharmaceutical companies making vaccines and anti-viral drugs have made substantial profits, nurturing familiar theories about conspiracies among Big Pharma, the government and the media. But for society as a whole the costs are high – in terms of the disruption of economic activity and employment, of the education system, of people’s lives. The scare has also been disruptive of primary healthcare, leading to an upsurge in telephone and surgery consultations – mostly by people with minor symptoms but high levels of anxiety. But the most damaging aspect is likely to be the further corrosion of trust in medical authority. In relation to the swine flu vaccine, which can be expected to result in an unprecedented wave of adverse reactions (enthusiastically anticipated by the anti-vaccine campaigns and their associated lawyers), the outcome may well be a wider loss of confidence in vaccination, with unfortunate consequences for childhood immunisation programmes.

Dr Michael Fitzpatrick is the author most recently of Defeating Autism: A Damaging Delusion, published by Routledge (buy this book from Amazon(UK). He is speaking in the debate Is the NHS institutionally ageist? at the Battle of Ideas festival on Sunday 1 November 2009.

(1) Swine flu fears grow as NHS staff shun vaccine, Guardian, 11 October 2009

(2) Defeating Autism: A Damaging Delusion, by Dr Michael Fitzpatrick, Routledge 2009

(3) Squalene-based adjuvants in vaccines, WHO

(4) Vaccine: the controversial story of medicine’s greatest lifesaver, by Arthur Allen, Norton (New York), 2007

(5)  ‘How should we plan for pandemics?’, by Peter Doshi, British Medical Journal 2009; 339:b3471

(6) ‘How should we plan for pandemics?’, by Peter Doshi, British Medical Journal 2009; 339:b3471

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