Aug 8, 2019

At the dinner table it is not uncommon to find that someone you know and like is vehemently opposed to routine childhood immunisation. Having worked in this area all my career as a paediatric infectious disease specialist and been a member of every Government immunisation advisory committee for the last 25 years, I have struggled with quite how to respond to anti-vaxxers. Here are some thoughts.

Recent measles outbreaks in the United States, Europe, Indonesia and the Philippines have infected thousands. Despite some people‘s assertions of some that good nutrition and healthy living suffice to protect children, 72 European children died from measles in 2018. There have already been 70 measles deaths in the Philippines in 2019. In Australia, 90 cases of measles have followed unimmunised overseas visitors returning with the infection. I have done a series of promotional interviews for a recent book I have published on immunisations. All the interviewers want to talk about is how we should respond to anti-vaxxers. At my ceramics class, a 14-year-old schoolgirl, unaware of my interest, spontaneously brought up the topic of anti-vaxxers, which is being discussed at her school. Anti-vaxxers crave attention. But their message is a dangerous one. The excellent Sydney Theatre Company production of Mosquitoes (spoiler alert) concerns a woman whose daughter dies tragically from measles when her mother decides, based on ‘Dr Google’, not to give her MMR vaccine.

In 1962, before measles immunisation was available, Roald Dahl’s daughter Olivia caught measles. Roald Dahl wrote:

Olivia, my eldest daughter, caught measles when she was seven years old…..one morning, when she was well on the road to recovery, I was sitting on her bed showing her how to fashion little animals out of coloured pipe-cleaners, and when it came to her turn to make one herself, I noticed that her fingers and her mind were not working together and she couldn’t do anything. ‘Are you feeling all right?’ I asked her. ‘I feel all sleepy’ she said. In an hour she was unconscious. In twelve hours she was dead.

Olivia died from encephalitis, a brain inflammation which occurs in about one in a thousand children who catch measles naturally. In contrast, measles-containing vaccines such as measles-mumps-rubella (MMR) vaccine, cause encephalitis about once in every million doses. Roald Dahl became a staunch advocate for measles vaccine.

To prevent measles spreading when it is introduced into a country, about 92-94% of the population needs to be immunised. This provides so-called ‘herd immunity’: measles will infect 90% of unimmunised people but only about 2% of those who have been immunised. In Australia, 95% of us immunise our children against measles. This means we can proudly boast that there is no endemic measles circulating in Australia. Cases introduced from overseas may infect a few locals, but the disease rapidly dies out because there are not enough unimmunised people to catch and spread it.

Australia achieves this without coercion. I am proud to live in a country that respects choice and does not force people to immunise their children. History tells us that compulsion breeds suspicion and opposition. Edward Jenner’s smallpox vaccine was first introduced around 1800. Some resisted the innovation. English authorities legislated to make it compulsory in the 1850s, only to stimulate riots. A crowd of 80,000 people marched through the streets of Leicester carrying an infant coffin and an effigy of Jenner. The people of Leicester preferred to go to prison rather than give their children the vaccine; immunisation levels in Leicester fell to 3%. The English repealed the law, immunisation levels improved, smallpox receded. Smallpox still killed over 200 million people in the 20th century, yet by 1978 smallpox was eradicated from the world, one of the greatest of all public health achievements.

Most anti-vaxxers love their children but have a different world view from me about the risks and benefits of vaccines. I am older than they are and they have not worked, as I have, in Africa, Asia and Papua New Guinea. They have not seen, as I have, children dying from vaccine-preventable diseases such as measles, tetanus and rabies or seen children permanently paralysed by polio. These forgotten diseases will return if we forget to immunise or get complacent. In Russia in the 1990s, immunisation levels fell after the breakdown of the old Soviet Union, 140,000 children and young adults contracted diphtheria, a disease I have never seen, and 4,000 died.

My response to anti-vaxxers is to try to understand their world view. I try to persuade them, with stories and science, that they are ill advised not to immunise their children. I think they are being selfish, because when we immunise our child we also help protect other children in the community. But luckily, in Australia, we can respect parents’ freedom to decide what is in their child’s best interest. Of course the situation can change. Because of measles outbreaks, parts of the United States and several European countries have introduced or are considering laws compelling measles immunisation or banning unimmunised children from day care, school or public places. The moral justification of such laws is to protect all children against a vaccine-preventable disease by mandating a safe, effective and relatively innocuous intervention.

The Australian public trusts that vaccines are safe and effective. Allowing people to decide about vaccines reinforces public confidence by showing that we trust parents to make wise choices.

David Isaacs is Clinical Professor in paediatric infectious diseases at the Children’s Hospital at Westmead and the University of Sydney. His book ‘Defeating the Ministers of Death: Heroes and villains in the history of immunisation’published by HarperCollins is available in all leading bookstores or on-line from www.booktopia.com.au.

Views expressed in this message are those of the individual sender, and are not necessarily the views of NSW Health or any of its entities.

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