Chanda Cooper-Warren: Immunisation is a question of science, not faith

COMMENT

Every mother and father who has welcomed a baby into the world understands the immediate desire to do what is best for their child, and immunisation is one of the first important health issues parents must confront.

With the birth of our first child in 1999, my husband and I began understanding the debate. In forming our opinions we did our own research, and since then have had another child and remain interested in this public health issue.

The pro-immunisation position is that immunisations are one of the greatest achievements of medicine and have spared millions of people from devastating diseases. The anti-immunisation position is that it is an unreliable and extremely risky way of preventing childhood disease, a worldwide conspiracy, rife with side-effects.

For most parents, immunisation is not a battle between two legitimate sides of an argument; it is fundamentally a 'Them vs Us' debate - you immunise or you don't.

We found the best way to judge those positions was simply to look at the differences between the way they each presented and verified their claims. Like most things in life, just because you believe something, doesn't make it so.

What made the difference for me, as a mother, in my reading was deciding to make a distinction between scientific evidence and individual opinion. I tried to understand where both sides were coming from, and value any attitude and claim which resulted from a critical and informed review of the evidence.

There has to be a starting point from which to frame any argument, and my starting point was science. Simple. A medical issue should be judged by science. There is no other valid alternative, at least not if you want to understand the facts.

If I was going to accept any claim by either party, then the claim had to be scientifically valid, and up to date, in other words relying on scientific data (for example, large, controlled studies published in respected scientific journals).

The studies that the World Health Organisation and medical community take seriously are those that include double blind trials, are peer reviewed and prepared by medical experts such as epidemiologists. I was happy to put my faith in this rigorous kind of analysis.

Fear of immunisation is not unusual, nor unreasonable, and it is from this fear that arguments against immunisation accumulate much of their power. World history shows that fear is the single most effective motivator to act or not act.

My friends who don't immunise present compelling arguments that are largely driven by fear. When I listened to or read the information they gave me I became concerned and fearful, yet instinctively I wanted to know what sort of science they were basing their claims on.

The arguments are usually based on either a rejection of evidence supporting immunisation, or are based on alternative views of health and health care, while ignoring or distorting scientific studies. There are two excellent examples of this.

Recently, the Herald has reported on research which has contradicted the findings of Dr Andrew Wakefield, a British gastroenterologist and lead author of a 1998 paper that suggested there may be a relation between the MMR vaccine and autism.

This single claim gathered enormous publicity, and was used in every single anti-immunisation argument, providing another chance for the immunisation campaigners to frighten parents away from protecting their children against preventable diseases.

It was reported the year before our son was born, and was used relentlessly as an example of why not to immunise him. Who in their right mind, wants to impose a risk of autism on a healthy child?

Since then, ten of Wakefield's co-authors have published a formal retraction of the suggestion of a link in the medical journal, the Lancet (March 2004) and they have strongly dissociated themselves from the idea that the vaccine is in any way related to autism.

Dr Wakefield is also under investigation for alleged failure to declare a financial interest when he submitted his research for publication, as he failed to mention he was paid £50,000 towards research for a legal action by parents claiming the MMR vaccine had harmed their children.

The retraction was great news, but I wonder how many parents declined to immunise because of his unfounded claims. By now, their views are probably firmly entrenched and their positions impossible to change, especially if their children rarely get sick, which simply reinforces the wisdom of their decision.

The second example concerns one of the most public opponents of immunisation, Viera Scheibner. She prepared a report, which is widely circulated among anti-immunisation campaigners and was given to me on two separate occasions by those wanting to influence my decision. The document is terrifying. if you don't understand the basis of her claims.

After reading the report I decided to find out about her validity. I found that Scheibner was awarded the silver spoon award by the Skeptics Society of Australia which said she uses doubtful science and science methodologies. "She uses vast numbers of quotes from a number of sources, taking isolated snippets of information which support her contention but does not cite the tenor of the article or the context in which the quote is included."

The society describes her high profile anti-immunisation campaign, which promotes new age and conspiracy mythology and owes little to scientific methodologies or research, and poses a serious threat to the health of Australian children.

I was fortunate to have the time to check her claims, but someone who does not have the time to check the scientific references could certainly be impressed.

Reading about this continual focus on elaborate conspiracy theories, with attempts to blame immunisation for all kinds of social and medical ills, was staggering. The conspirators are deeply suspicious of science and modern medicine and repeatedly make evidence-free claims that doctors conspire with the government and drug companies to promote vaccines as safe and effective.

Which of course raises the question of why governments would want to promote anything that costs them millions of dollars each year, and why scientists, researchers, and the medical community, who are notoriously jealous of their academic reasoning, should voluntarily conspire not to reveal their research outcomes.

I stopped engaging in these arguments years ago.

If you're having an argument with somebody about something they have deep beliefs about, those views are not going to change simply with the presentation of facts. Quite the opposite; the more facts that are presented, the more opposed they become. Once reputations are staked, any discussion of the scientific evidence is almost impossible to acknowledge, regardless of the sources.

Like any medical intervention there are risks. No medical procedure, including immunisation is 100 per cent effective or 100 per cent safe for every person. This cannot, however, be validly used as an argument against immunisation, just as the occasional tragic outcome from surgery is not a valid argument for stopping surgery. Immunisation remains the only tested means of protection against vaccine-preventable diseases.

Although the arguments about safety will continue to rage, the most compelling statistic is the difference in infant mortality rates between countries which provide immunisations and those that don't. Immunisation has repeatedly been demonstrated to be one of the most effective medical interventions we have to prevent disease, and it is estimated to save 3 million lives a year throughout the world.

I will leave the last word to measles. Measles is one of the most severe and infectious diseases of childhood and is virtually universal among un-immunised children in all countries. Eventually, 99.9 per cent of people who have not been immunised will contract measles, and 90 per cent will do so before the age of 20.

Among un-immunised people, measles was the eighth leading cause of death throughout the world in 1990, ahead of road traffic accidents and lung cancer.

There is no need to be defensive about immunisation. World history, and recent local events, prove that vaccine-preventable diseases are severe. Immunisation prevents them.

* Chanda Cooper-Warren is an Auckland mother