Immunisation and the anti-immunisation movement

Smallpox continued to kill millions in the 20th century but vaccination programs gradually and predictably eliminated it region by region. The last death of a naturally-acquired case was in 1977 in Somalia. In 1978, there was a laboratory-acquired UK fatality. Smallpox’s final victim was the professor running the responsible laboratory. He committed suicide.

Another immunisation success is the virtual elimination of polio. Many of my older patients caught the virus during their childhood in the 1940s and 1950s.

While I excised a skin cancer recently, one man with a withered arm asserted his view of anti-immunisers. He thinks they are insane because he personally witnessed a huge fall in polio infections with widespread immunisation. He is still upset that the immunisation became available a few months too late to prevent his disability.

Polio vaccine did in time, however, suffer a cost-benefit dilemma. The commonly-used Sabin oral vaccine uses a weakened, live polio virus which carries in the vicinity of a one in 2.5 million risk of causing polio. This was used in Australia for decades and eventually, perhaps for years, the tiny risk of the immunisation was greater than the even tinier risk of naturally-occurring disease. Australia has now switched to a more expensive injectable vaccine with no associated risk of causing polio.

There have been many other obvious immunisation successes. For instance, early in my medical career, epiglottitis was a much-feared presentation to emergency departments. Just examining a child’s throat could kill them. Epiglottitis suddenly became rare after a vaccine was introduced in the 1990s.

In 2007, I spoke on ABC Radio National about the influence of drug companies over doctors. This included passing comments about possible downsides to the heavy marketing of Gardasil, a human papilloma virus vaccine.

My views were not controversial from a scientific standpoint. Nonetheless, my university’s administrators felt I should apologise to the manufacturers lest it taint a commercial arrangement. This fanned public suspicion that there is something horribly wrong about the cosy relationship between many universities and drug companies.

After my situation became public, the ensuing 15 minutes of fame encouraged a few anti-immunisers to contact me. I could have been the darling of a thousand websites but I told them immunisations had been of great benefit to mankind.

I was also contacted by 60 Minutes. My major concern with Gardasil is its cost effectiveness. The producer’s major concern was side effects, preferably lethal ones. She seemed less interested in quality-adjusted life years or the finite nature of public health budgets.

I said many immunisations carry roughly a one-in-a-million chance of killing the recipient, so a dozen deaths from 20 or 30 million immunisations might be tragic but was not necessarily news. I think they canned the story.

I often tell patients that immunisations probably carry about a one-in-a-million chance of severely injuring or killing them. This means health bureaucrats might kill people by recommending millions of immunisations but I cannot recall any patients refusing a vaccine solely on this basis.

I earlier noted the comment that, “A special place should be reserved in hell for the people who want to kill or maim children by preventing them from receiving vaccinations”. I think this misrepresents the vast majority of anti-immunisers. Most hold sincere concerns that immunisations are not worth the risks. There are good reasons why this view might be stupid - and I have outlined a few - but it need not be malicious.