The president of the Australian Medical Association, Dr Michael Gannon, says it has been disappointing to see a growing “demonisation of pharmaceutical companies” by the anti-vaccination movement in an attempt to promote distrust of proven medicines.
Gannon made the comments in response to the NSW health department recommending reforms that, if implemented, would see parents of high-school students compelled to provide details of their child’s vaccination status, and give public health officers the power to exclude unvaccinated children from high schools during disease outbreaks.
This policy already applies to children in childcare and primary school, but may be extended under the Public Health Act to apply to high schools. A bill reflecting the recommended changes will be drafted and considered by the parliament in 2017.
Gannon told Guardian Australia he supported the changes, which would see unvaccinated children banned from childcare and school for up to two weeks if they come into contact with a child suffering a vaccine-preventable disease — even if they aren’t sick themselves.
“I’m reluctant to make the comparison between anti-vaxxers and climate change deniers, but it almost seems if you can shout louder than the careful, temperate advice from medical professionals and scientists you might get support for your non-scientific views,” he said.
A report from the NSW Child Death Review Team, published on Tuesday, found that in the decade to 2014, 23 child deaths may have been prevented had the children been vaccinated.
Gannon said he believed there was a growing distrust of the medical profession and of big pharma which may be fuelling the anti-vaccination movement.
“Let’s be clear that the pharmaceutical industry is not without sin,” he said.
“But it is disappointing to hear this demonisation of vaccinations as a result of this distrust, and overall the pharmaceutical industry improves and saves tens of millions of lives, without exaggeration, each day.
“The processes by which vaccines get approved and by which the relevant commonwealth government departments decide which medicines to spend tens of millions of taxpayers’ dollars on is very careful, and has to be.
“Vaccines approved have to represent value for money and have to be safe. The idea that big pharma rolls into town and that their latest idea gets approved without scrutiny is ludicrous.”
He said vaccines and their safety were continuously scrutinised and reviewed at a level that “many other things in the community aren’t”.
The director of communicable diseases for NSW Health, Dr Vicky Sheppeard, said that in recent years the incidence of some diseases preventable by vaccine, such as measles, had been higher in high-school-age children than in younger children.
“All recent measles outbreaks in NSW have tended to affect high-school children rather than primary-school children,” she said.
“Since then, catch-up measles vaccination has been offered in all NSW high schools, further reducing the risk of outbreaks occurring in this setting.”
Your main concerns when you attend a festival might include any of the following: how will I identify my tent at 5am? Is glamping worth it? Will Este from Haim do bassface?
But one thing you should not have to worry about is: will I get measles?
Public Health England has confirmed a significant number of infections linked to music festivals and other large public events. There have been reports of 38 suspected measles cases at events in June and July alone. Glastonbury had 16 cases, with seven cases reported from the NASS festival near Bristol; six at the Triplicity festival in north Devon; three at Tewkesbury medieval festival; two at Nozstock: the Hidden Valley in Herefordshire; two at Noisily in Leicester; one at the Secret Garden Party near Huntingdon; and one at Yeovil Show.
In all, 234 cases have been confirmed between January and June, compared with 54 for the same period last year.
Why is this happening now? One possibility is that the Wakefield generation has come of age. The fraudulent study by Andrew Wakefield that incorrectly linked the MMR vaccine and autism was published 18 years ago. Although later discredited (with Wakefield being struck off the medical register), the rate of vaccination against measles plummeted after the study’s appearance in The Lancet. There were 56 cases of measles the year before its publication in England and Wales; by 2008 there were 1,370.
Many parents of the Wakefield era chose not to vaccinate their children and were understandably swayed by breathless media coverage, inconsistent messages from health providers, and apparent validation of Wakefield’s findings by the scientific community; it took The Lancet 12 years to retract the publication. If you were the parent of a toddler in those years, what would you have done?
Now, those unvaccinated children have grown up. They go to festivals. The virus is so contagious that if one person has it, 90% of those in close contact will also become infected if they are not immune themselves. And so Public Health England has urged teenagers and adults to check with their GP if they have been vaccinated and to receive two doses of the MMR vaccine if required.
The Wakefield-era children also grew up to account for most of the 1,219 measles cases in the Swansea measles epidemic in 2012, in which one person died. Although some recovered quickly from fever, conjunctivitis and a rash, others suffered more significant complications. According to the US Centers for Disease Control and Prevention, one or two out of every 1,000 children who become infected with measles will die from respiratory and neurologic sequelae including blindness, seizures and encephalitis. Since 2006, there have been three deaths from measles in England and Wales.
This historical legacy is compounded by anti-vax sentiment that has become more visible in recent years, albeit not necessarily more widespread. The consequences of this movement travel beyond forums and Facebook posts. It is easy to imagine it to be as infectious as the virus itself, but I think there is a more nuanced subtext, too.
Measles arrived at Disneyland, California with one case in December 2014. Within four months, there were 145 confirmed cases in seven states and three countries, all linked to Disneyland. The authors of an analysis in JAMA Pediatrics journal said the outbreak was directly associated with substandard vaccination compliance: “The ongoing measles outbreak linked to the Disneyland Resort in Anaheim, California, shines a glaring spotlight on our nation’s growing anti-vaccination movement and the prevalence of vaccination-hesitant parents.”
Vaccination is more than a personal choice; the inaction of others can affect even vaccinated children and adults
Vaccination is more than a personal choice; the inaction of others can affect even vaccinated children and adults. Community vaccination helps to halt the spread of the virus and thus protects the wider population. The sum is greater than its parts. But here’s what is crucial. Each outbreak is different, there are nuances to each one, and not all can be attributed simplistically to a groundswell of anti-vax sentiment. Swansea is definitely not California.
For example, early 2014 cases were linked to unvaccinated travellers returning home who had acquired the virus abroad (an outbreak in the Philippines was an important factor) and then infected others in communities with lower vaccination rates. Despite the concerns expressed in pockets of unvaccinated residents, there is no nationwide loss of confidence in vaccines. Sometimes it’s a case of missed doctors’ appointments or single vaccines refused rather than staunch dissent. And vaccine refusal does not correlate with a lack of knowledge. Moral outrage is too easy.
Julie Leask, an associate professor at Sydney University’s school of public health, provides level-headed discussion on this topic: “To be committed to the science of immunisation ideally comes with a commitment to the science of immunisation behaviour. Media often present this problem as refusal to vaccinate. But the evidence is clear and it’s more complex: under-vaccination is broadly about a lack of acceptance and a lack of opportunity to vaccinate fully or on time. It’s not just the haves, but the have-nots who don’t fully vaccinate.
“A typical measles outbreak will reveal this. There will be children whose parents refused vaccination; children whose parents were unwittingly not up to date for lack of access; affordability or awareness; adults and travellers who didn’t get a needed booster; and babies who are too young to be vaccinated.”
So although “festival measles” seems to largely fit with the coming of age of the Wakefield generation and more particularly a broader anti-vax narrative, it is too simplistic to conclude that this is applicable to all. But it does provide an opportune moment to discuss issues around vaccination, to strengthen public health infrastructure to deliver effective programmes, and to ensure there is never even the possibility of a Wakefield generation occurring again.
Related: Measles warning to young people at festivals after series of outbreaks
