1. Cash payments to parents for completing immunisations at 6 months and four years.
2. Cash bonuses to doctors for improving their immunisation uptake
3. Monitoring immunisation targets and having immunisation days
4. Attempted eradication of measles
5. Schools refusing to take un-immunised children

While this worked well in Australia, one has to consider the composition of parents un-vacccinated children. They come in two types.

1. Parents who are genuinely concerned that vaccination is dangerous
2. Parents who couldn’t be arsed to vaccinate their kids.

I postulate that Australia had a great deal of parents in the second category. Unfortunately, I suspect New Zealand has a far smaller portion of parents in category 2 and a much higher spread of parents in category 1. Parents in category 1 are not going to be moved by any financial incentive (seen as “we’ll give you this small amount of money, if you let us poison your children”). They will not be persuaded by GPs with a vested financial interest, nor by nurses with a gung-ho “vaccinate anything that moves” attitude. Schools refusing to take children will just see these parents move their children to private schools or to a home-schooling environment (where, frankly, they will be unlikely to catch the childhood diseases they are not immunised against!). In short, New Zealand is unlikely to see the massive improvement Australia saw and the increase expenditure will be largely wasted.

Note: I have no hard data to support my conclusion, just my general experience. But it would be very advisable for the MoH to run a survey to determine the mix of parents who decline to immunise their children before copying Australia’s effort.

I also have deep concerns about the ethical nature of banning children from creche, primary and secondary schooling on the basis of their immunisation status. That goes for threatening to cut benefits as well. To me, it seems incredibly stupid to seriously harm children’s education and deepen their poverty levels in order to force people to have their children immunised. The consequence will be that those who opt out for conscientious reasons will suffer these harms, since they sincerely believe their children’s health will be seriously harmed by vaccination. These methods are therefore, in my opinion, completely inappropriate, regardless of the numbers of parents in the first category above.

You wouldn’t approve of a doctor who gave a person (of sound mind) an injection against their will. Why should we approve a government that tries the same thing?

Related posts:

1. Attack of the Vaccine Nazis
2. Ethical Jab?
3. Gardasil Update

The study was seized upon by the anti-vaccination groups, despite its deep inadequacies, and used to promote unreasonable fear of the vaccination process. Long-time readers of this blog will know that I am not a fan of the drive to indiscriminately vaccinate children against every known disease. It seems to me that this is likely to be a counterproductive policy in the long run because each addition to the armamentarium of needle-weilding nurses meets with more and more parental resistance. After all, it is a traumatic experience having your child vaccinated. At some point (which we may have already reached) parents are just going to say “forget it” and ignore vaccination entirely. Of course articles like the above study simply reinforce this tendency.

I can’t see that the belated withdrawal of the study is really going to make any difference to this situation. At this stage, the withdrawal merely intensifies the suspicions of parents (look, they’re suppressing the truth) who increasingly tend to see the myriad of vaccines as just a ploy of vaccine manufacturers to make money. Given the combination of trauma and fear-driven conspiracy theory, it is a wonder that any parent has their child vaccinated!

I see a fair number of parents who opt out of the vaccination program. I usually try to (gently) persuade them to have the DTP, Polio and HiB courses. All of these diseases (Diphtheria, Tetanus, Pertussis, Polio and Haemophilus Influenza B) have appreciable mortality and are worthwhile having your child protected against. Thereafter, the benefit of vaccines compared to their cost becomes more and more dubious. Judging by the almost hysterical reaction of the public health department, one would have thought the recent measles “epidemic” – that did not actually happen – was an outbreak of ebola virus. Families who had not vaccinated their kids were being treated like some sort of plague factory. Measles is very unpleasant but not really a great deal more dangerous than seasonal flu, so some sense of proportion would have been helpful.

While the Lancet’s response to a poorly written article was “too little, too late”, the vaccination program could well be characterised as “too much, too soon”.

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1. Cough or Cry
2. Stupid Question of the Week
3. Attack of the Vaccine Nazis

What is interesting is that 17% of physicians who answered this survey think it is ethical to refuse to see a child whose parents have chosen not to vaccinate (this has remained stable at around 17% for the past 500 or so votes). I find this quite bizarre. How many doctors would refuse to see a smoker because they won’t stop smoking? Or an obese person because the won’t stop eating? Or a diabetic because they are non-compliant with their medication? In my experience it is virtually unheard of for a doctor to remove a patient from his practice for unhealthy behavior. And this unhealthy behavior is entirely volitional – they choose to do this to themselves.

Yet 17% of physicians see nothing wrong, apparently, with not seeing a child because his/her parents have made what they consider to be a healthy choice. That strike me as a very peculiar double standard. Do they somehow think that not immunising children is some form of child abuse? That is the only reason I can think of for refusing to see a child. Even that is a bit of a stretch. The last thing an “abused” child needs is to be abandoned by his/her doctor.

While it is probably not unethical in a medico-legal sense to refuse to see a child for being un-immunised, it certainly seems entirely unreasonable. The un-immunised child will be at risk of developing certain severe childhood diseases and is therefore more in need of a physician than ever. It is highly unlikely that this negative attitude will cause parents to rethink their position on immunisation. In my experience, a rational discussion with parents is possible, if you treat their opinion with respect and are prepared to counter their arguments with facts. I have managed to persuade many parents to have at least the DTP and polio series and the HiB series, as I consider these essential vaccines, due to the dangerous nature of the diseases they prevent. If I cannot persuade parents, I abide by their decision without rancor.

Last time I checked, the hippocratic oath contains the words “To keep the good of the patient as the highest priority.” I do not see how discriminating against them based on their immune status achieves this.

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1. Attack of the Vaccine Nazis
2. Incentives
3. Too Little, Too Late

The insurance companies are arguing (quite rightly, in my opinion) that if the government wishes to rush a half-tested vaccine into use, then they should bear the risk. Some insurers seem to be prepared to accept the risk if the doctor documents that he has told the patient that the vaccine is untested and experimental. Expect the uptake of the vaccine under those circumstances to be very low.

I would seriously advise any doctor to get a written waiver from each patient they give the vaccine to, detailing exactly what the patient has been told. This will be my advice to the group practice I am currently working in, as well.

It is now clear from the epidemiological data that the swine flu is no more dangerous than the normal seasonal influenza, and possibly less so, as it does not appear to be as dangerous to the elderly. For this reason, it makes no sense at all to attempt to push a swine flu vaccine without adequately testing it first, particularly in Australia and New Zealand where we are coming to the end of the flu season. There is now plenty of time to test the vaccine properly and include it with next year’s seasonal vaccine. The need for untested vaccine is simply not there. Even in the US and Britain, there is still probably enough time to adequately trial the vaccine in time for the winter flu season.

The headlong rush to get a mass vaccination program up and running without the standard safeguards is chillingly reminiscent of the previous swine flu epidemic in 1975, where more people became seriously ill from the vaccine than from the influenza virus. The department of public health need to curb their enthusiasm for mass vaccination and step back and take a good look at this. There appears to be no pressing reason to rush blindly ahead and put patients and doctors at risk.

The vaccine companies, who have made massive investment in the production of the vaccine, will attempt to pressurise the government to go ahead with a nonsensical mass vaccination program. Ryall should resist the temptation to be seen to be “doing something”.

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Superficially, this might seem like a logical thing to do, until you recall that 33% of partially immunised kids and 10-15% of “fully” (two dose) immunised kids will also catch measles. It therefore makes absolutely no sense whatsoever to keep non-immunised children from school, if you are going to allow immunised contacts free access. As it is, the practice of keeping children home for a fortnight is a fairly dubious one, unless you also insist that the child and his/her entire family stay out of contact with everyone during this time. Also Measles can take up to 21 days to incubate and is not infectious until 1-2 days before the rash appears. It is also vastly more infectious than the flu, making isolation futile.

One has to assume that this is simply another way of pressurizing families into having their kids immunised.

The irony of advocating a compulsory assault of a child with a needle “for their own good” while simultaneously objecting to the use of smacking for corrective purposes has apparently escaped these people.

Make no mistake here. I think the measles vaccine is a worthwhile addition to our immunisation schedule. It is the least benign of the childhood diseases and the vaccine works well, with few side effects. The dark myth of autism from the vaccine has now been dispensed with by a number of excellent clinical trials. It is mildly annoying that the measles vaccine is packaged with mumps and rubella, both very benign childhood diseases (Rubella should be given separately to girls when they are older). There is some evidence that the immunity developed from having a benign childhood disease is much better than the immunity acquired by vaccination. Childhood diseases like chicken pox and mumps are far more serious in adults than in children. It may therefore be better to catch these diseases in childhood, rather than be immunised for them. Note that I do not include measles in this.

Having said all that, I think that immunisation for measles should still be a choice. Coercive methods are unwarranted and have no place in a modern society. If we cannot persuade people the immunise their children because it is the logical thing to do, we have no business trying to bully them into it by restricting their children’s education of the flimsiest of grounds.

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2. Stupid Question of the Week
3. Cough or Cry