Do we need to reboot the Australian experience of vaccination policy?

And we should be looking at what other nations with excellent health outcomes are doing. Denmark has less vaccinations on its schedule than Australia. They have a very strong record of controlling infectious disease, and do not experience the high incidence of broad spectrum neurological and immune dysfunctions Australia suffers from. There is no doubt that Denmark does very well on health issues, and yet presumably someone following the Danish vaccination schedule would be considered not compliant with the Australian schedule.

We also have to question what is actually driving the current media campaign, and whether the apparent concern over vaccination rates is justified. Associate Professor Julie Leask, and Research Fellow Hal Willaby, (School of Public Health), both from the University of Sydney, suggested in an opinion piece in 'The Conversation', that elements of the media were hystericising the issue, and trading in stereotypes. They risked polarising the community, when the reality was that vaccination rates generally remained high. They proposed a more conciliatory approach and suggested that some families who are not up to date may already be struggling with a lack of access or practical support, and penalising them will only create further disadvantage.  And is the current rate of 'Conscientious Objections' (CO) really a threat to the theory of 'herd immunity'? An opinion piece on the Australian Medical Association website states,

"First, you don't need everyone to be immune to prevent an epidemic occurring. If 90 per cent or more are immune, they create sufficient fire breaks to prevent the easy transfer of most infectious diseases. So, good levels of public health could be maintained even if the CO rate climbed substantially – which it is not likely to do in real terms." 

The Cochrane Collaboration has established a reputation for independent assessment of medical products and procedures. They have played an integral role in the establishment of the 'All Trials' initiative, and continue to hold pharmaceutical companies accountable.

A recent study from US Public Citizen found that, since 1991, there have been 239 legal settlements, totaling $30.2 billion in federal and state penalties, levied against US pharmaceutical companies. There's a real laundry list of crimes, but defrauding the government, hiding drug safety information, and hawking drugs for purposes beyond which they are approved are the main ones. Drug companies have pledged to change, signed 'corporate integrity agreements' and indicated that they want to move on, promising a better future. We can be hopeful, but we also have to be realistic. Paying huge fines for illegal activity is one thing, but will they be still playing the eminence game? Will they continue to fund their own experts and do research that goes through a selective reporting of 'the evidence'? Sadly, that's probably going to be the case so you must immunise yourself: keep asking questions and questioning answers.

In America the Centre for Disease Control has come under fire for blurring the lines between regulation and marketing. The Huffington Post alleges they massively inflated flu morbidity figures, then "….. unabashedly decided to create a mass market for the flu vaccine by enlisting the media into panicking the public. An obedient and unquestioning media obliged by hyping the numbers, and 10 years later it is obliging still". This isn't America, but we do take many of our cues from the American experience, and their multi nationals reach deep into our market. What we can learn from this is the need to insulate regulatory bodies from pharmaceutical marketing. This point is strongly underscored by an article in the 'Journal of Law, Medicine and Ethics', entitled "Institutional Corruption of Pharmaceuticals and the Myth of Safe and Effective Drugs' which alleges that the medical evidence base has been massively compromised since at least 1966. The "…..proportion of new products with clinical advantages seems to have moved from about 1 in 8 down to 1 in 12, while the proportion with serious harms has gone up from 1 in 5 towards 1 in 3 as the number of drugs given priority status increases......"  Whilst there is mounting consciousness of the extent of the problem overseas, here in Australia it seems to be business as usual for the most part.

Writing in the journal of the Association of American Physicians and Surgeons, Marilyn Singleton asked us to question whether we can always trust Evidence Based Medicine. She states that "…reporting bias is systemic in medical literature. A 2012 Cochrane independent review found that company-sponsored trials were more likely to report favorable efficacy results compared with non-industry sponsored studies. Even in academic studies positive results are more likely to be published. A 2009 analysis of 18 surveys by multiple authors found 34 percent of researchers admitted to "questionable research practices." Instead of blindly accepting that research is bone fide and regulatory bodies are vigilant and unbiased, she suggests that "government intervention in medicine can be harmful to your health. Rigid rules and restrictive drug formularies are advanced based on consensus, leaving no room for individualized treatments. We want physicians whom we can trust to be open, honest critical thinkers, not "providers" who are government puppets". Once again these are sentiments which we could afford to apply to the Australian context. It is a basic tenet of medical ethics that patients are treated individually and not according to some 'one size fits' all approach, because human physiology has huge variances, and we need healthcare professionals who support this and question the basis of their knowledge and beliefs.

Returning to the original question, does the Australian experience of vaccination adhere to global best practice, and do we have the policy and regulatory framework to ensure this? There can be no under estimating the positive contribution Western medicine has made. Part of supporting its continued viability is working tirelessly to ensure it is insulated from pharmaceutical marketing and media driven policy. Our policy makers need to support 'All Trials' as a step towards this, and the adoption of Peter Collignon's eminently sensible proposals would also be a positive development.. In the meanwhile Australian consumers might perhaps take the Cochrane Collaboration's advice – "immunise yourself: keep asking questions and questioning answers."