This section examines the truth about vaccines, their safety and reliability.
It will examine the following topics:
- Why Vaccinate?
- Whooping cough vaccine
- Meningitis C vaccine
- MMR Vaccine
- Human Papilloma Virus (HPV) Vaccine
- Poliomyelitis vaccine
- Influenza vaccine
- Herpes Zoster (Shingles) Vaccine
- Homeopathic Vaccines
- The Anti-vaccine Movement
- Getting the Message Across
- Further Resources
- Site Index
If you wish to go directly to a section, click on the title in the list above. For information about vaccines for COVID-19 and the fight against fake news there, go to COVID-19. What You Need to Know
Fake news and anti-vaccine stories have become far too common. Many of the anti-vax campaigners are conspiracy theorists and in keeping with the fake news agenda, they accuse others of telling lies and fake news. Donald Trump is an excellent example of one who lives in a world of fantasy whilst accusing others of fake news. He is also sympathetic to the anti-vax cause. This section will examine allegations against a number of vaccines along with the truth. It will examine the alternative homeopathic vaccines, the anti-vaccine movement and how to get the truth across to the public and patients.
Quite recently, I saw an article in New Scientist which said that the two most important achievements in public health over the centuries were, first, clean water, and second, vaccinations. I would agree.
Ever since 1Edward Jenner inoculated a boy with material from cowpox (vaccinia) to protect him against smallpox (variola) in 1796, there have been scares and disinformation about vaccines. Misinformation is incorrect information that is usually imparted by mistake and without malice. Disinformation is incorrect information that is intended to mislead. At least that distinction is my definition but the Oxford English Dictionary is more ambivalent. The contemporary cartoonist James Gilray portrayed cows spurting from the bodies of those who were immunised but the procedure became accepted and in 1977 the World Health Organisation was able to announce that smallpox had been completely eradicated from the world. Man is the only species to be affected and so there is no animal reservoir. It is still held in two laboratories, one in the USA and one in Russia and it retains its potential as a biological weapon.2Smallpox as a biological weapon There is pressure to destroy these two final stocks3Nature News but also strong voices to keep them.4Smallpox should be saved (also in Nature)
From James Gilray in 1802, to the present day, absurd claims about vaccines are nothing new. This one shows cows spurting from the bodies of those who have been
Strictly speaking, vaccination means immunisation with vaccinia against smallpox, but it has grown to be synonymous with any immunisation. Immunisation is usually a procedure that is performed on healthy people and therefore it should have a very high level of safety. It is important to emphasise that the diseases that we immunise against are serious and important and any risk of a vaccine must be weighed against the risk of acquiring the disease and the danger associated with that disease.
There are two basic reasons for immunisation. The first is to protect the individual against the disease. The second is to create a society with sufficient immunity that the disease is not endemic. This is called herd immunity and it requires a high uptake of the vaccine.
Eradication of a disease requires a high level of uptake of a highly effective vaccine. Before the MMR vaccine it was customary to immunise only girls against rubella and not before the age of 11 and so there was still a considerable reservoir of rubella in the community. Any pregnant woman who was either unimmunised or who had been unresponsive to the vaccine was at risk. A small number of people will fail to respond to any vaccine, and they will not develop immunity.
Herd immunity is important to cover vulnerable groups:
- Those too young to have been immunised yet.
- Those with genuine reasons for not having had the vaccine such as receiving cancer chemotherapy.
- Those with impairment to their immune system such as congenital immune deficiency states, HIV or malignancies that affect the immune system.
- Those who have had the vaccine but failed to respond.
Sometimes vaccination fails to give complete protection, but it still affords some benefit. In the 1980s, before the MMR vaccine, uptake of measles vaccine was about 50% and so the disease was still endemic. I would sometimes see measles in an immunised child, but it was a mild disease lasting a few days compared with a severe disease of a week to 10 days, often with complications in the unimmunised child. The MMR vaccine was introduced with an uptake of over 90% within 18 months. Notification of measles had run at about 86,000 cases a year with about a dozen deaths. It fell dramatically and deaths ceased.
Most immunisations are given to children, but several are more usual in adults. Annual influenza vaccine is aimed at the elderly and those with chronic conditions although a good case can be made for making it almost universal. A vaccine to protect the elderly against shingles is being introduced. Other vaccines may be for foreign travel. An NHS website offers a comprehensive, up-to-date and accurate source of information on vaccines, disease and immunization in the UK.5Schedule of NHS vaccines
Over the years, vaccine scares have been a common event.
There are four words that help to describe the frequency of a disease and they need explanation.
- An endemic disease is one that is present all the time in a certain area.
- Epidemic means a sudden outbreaks of a disease in a country or region that did not previously have it in that area in that area, or a rapid increase in the number of new cases of a previous existing endemic disease.
- Elimination of a disease means that its numbers are brought down very low. This is not the same as eradication.
- Eradication is when the disease no longer exists as with smallpox and, hopefully polio soon.
Whooping Cough Vaccine
Whooping cough or pertussis is a nasty disease, especially in small children. The whoop is an indrawing of breath at the end of a long and persistent cough. Only smaller children whoop. Older ones do not need to. Tiny ones can be too young to whoop. To hear a short clip of the sound of whooping cough on YouTube, click here
In the late 1970s and early 1980s there was concern about the whooping cough vaccine. Although there was never any degree of certainty that it was associated with brain damage, it was official policy to withhold it from children who may have had a difficult birth or developmental delay and many parents chose to withhold consent. There was no evidence that such children were more susceptible to brain damage from the vaccine but perhaps it reduced the risk of unrelated brain damage being attributed to the vaccine. At one stage uptake was down to 30% with a subsequent epidemic and probably 100 unnecessary deaths.
I have not given a reference for this as it has been archived by the Health Protection Authority and a PubMed search for “pertussis vaccine and brain damage” gives a few papers but there is no abstract. Slightly later, in papers that do have an abstract available, some found the evidence too weak to draw a conclusion either way6Acute encephalopathy and chronic neurological damage after pertussis vaccine whilst others found no evidence to suggest that the vaccine caused brain damage.7American Academy of Pediatrics Committee on Infectious Diseases.
A newer, purer vaccine was introduced, and public confidence rose. This was an acellular vaccine, meaning without cells in it, and it seems more acceptable.8Trials and tribulations of old and new pertussis vaccines Cases of whooping cough are now few and the main concern is decline in immunity as children grow older. Older children are at much lower risk of complications than small babies but the fear is that an older infected child may transmit the disease to a young and unvaccinated baby.
One of my children did not have the whooping cough vaccine although if I had been asked I would have said to give it to her. She had the disease instead and it was very unpleasant. The classical illness can last 4 to 8 weeks.
Coughing can be so severe that subconjunctival
haemorrhage occurs into the white of the eye and other bleeding can occur around the eyes.
Meningitis C Vaccine
Meningitis C, a strain of Neisseria meningitidis or the meningococcus, is the most feared form of meningitis. It has gained particular notoriety for attacking young people in their early days away at university. The symptoms of headache and dislike of light may be attributed to a hangover, but it is a potentially lethal condition.
The Meningitis C vaccine was introduced to the UK in November 1999 but in the summer of 2000 the media reported deaths linked to the vaccine. A thorough investigation revealed that of the 12 deaths, seven were from sudden infant death syndrome (SIDS) and the rest were from other fatal infections. None was attributable to the vaccine.
There has been a 75% reduction in confirmed cases of meningitis C in the first target age groups (15-17 years olds and under a year old). Deaths from the infection have also reduced dramatically. Before 1999, about 78 children a year died of the infection. By 2008 it was possible to announce that there had been no deaths from the infection in the past year. It is estimated that meningitis C vaccination has saved 500 lives since 2000 and the pneumococcal vaccine, introduced in 2006, has prevented 470 deaths or serious illness in young children.9Meningitis C deaths cut to zero
The measles, mumps, rubella (MMR) vaccine was introduced in 1988 and within 18 months uptake was 95% and cases of measles and deaths from the disease tumbled. Before then about 12 children a year died from measles. This is in the UK, not malnourished children in Africa. However, a now infamous report was published in The Lancet that purported to show an association between the MMR vaccine and inflammatory bowel disease in children and also autism with developmental regression.10Original Case reports (now retracted) They claimed to have found evidence of the measles vaccine virus in inflammatory bowel disease (usually Crohn’s Disease) of childhood but no one has been able to repeat this finding. The original microscope slides that were said to show evidence of the measles virus in childhood Crohn’s Disease have been reviewed and expert opinion is that there is no evidence of that disease.11I see no convincing evidence of “enterocolitis,” “colitis,” or a “unique disease process”
This publication was based on a mere 12 children and many expressed surprise that The Lancet should bother to publish so small a study. It was not a research paper but “case reports”. The weight given to the findings at a press conference by the authors and the Royal Free Hospital where they worked seemed excessive for such a low level of evidence. Indeed, as this was case reports and not research, it was not really evidence at all. It was just an interesting observation. A Channel 4 Dispatches documentary suggested that both the authors and the hospital were working on an alternative vaccine and the commercial implications of discrediting the present vaccine would be enormous. A libel suit against the Dispatches programme and presenter Brian Deer brought by Andrew Wakefield in November 2004 was dropped in January 2007 with agreement to pay the defendant’s legal costs.12Brian Dere website It has also been revealed that the subjects in the study were not chosen at random but the parents of some had approached Andrew Wakefield with a view to suing the manufacturer of the MMR vaccine. In 2004 all the authors except Andrew Wakefield publicly retracted their findings.13Retraction of an interpretation
It has since transpired that the whole paper is what the BMJ has called “an elaborate fraud”.14Wakefield’s article linking MMR vaccine and autism was fraudulent The time between the administration of the vaccine and the development of the symptoms was nothing like as close as had been suggested. This is perhaps the most notorious case of scientific fraud in recent decades.
The original report did inspire many others to look more closely to see if there was any basis for the allegations. Not a single one has supported the allegations. A study from Denmark looked at not a dozen but more than 537,000 children who had received the MMR vaccine at around 15 months old and they found no increased incidence of autism.15A population-based study of MMR vaccination and autism. This was a retrospective study. Prospective ones are better as shown in the chapter Cohort or Longitudinal and Epidemiological Studies but they take longer to perform.
In 2019, mostly the same team published a prospective national cohort study of more than 650,000 children in Denmark. Again they found that there was no association between the MMR vaccine and autism.16Measles, Mumps, Rubella Vaccination and Autism: A Nationwide Cohort Study. This really ought to be the final nail in the coffin of the anti-MMR campaign but I am sure that evidence will not stop it. I have not seen this paper reported in newspapers or on television. The media love sensation. Reassurance does not interest them.
The rate of diagnosis of autism started to climb around 1980 but the MMR vaccine was not introduced in the UK until 1988. Its introduction made no difference to the rate of climb.17MMR vaccine and the incidence of autism recorded by general practitioners: a time trend analysis If the vaccine was causing autism there should have been a steep rise in the number of cases within a few years of its introduction as uptake reached 95% within 18 months. A more recent review (from the Royal Free Hospital) concluded that the rise was largely, if not wholly due to increased awareness of the disease and willingness to make the diagnosis and certainly not due to any vaccine.18Vaccines and the changing epidemiology of autism Not a single country in the world has withdrawn MMR vaccination because of concerns about safety but in Japan it was stopped because of production difficulties. They were without it for several years. This made no difference to the number of new cases of autism on stopping or re-starting it.19MMR-vaccine and regression in autism spectrum disorders: negative results presented from Japan. A Cochrane systematic review concluded that there was no demonstrable association between the vaccine and Crohn’s disease, ulcerative colitis, autism or aseptic (mumps) meningitis.20Cochrane Systematic Review
The rising incidence or frequency of diagnosis of autism has now levelled off. Most experts attribute most of the rise in diagnosis in the 1980s to greater awareness of autism and greater willingness to make the diagnosis.
Despite the absence of any evidence of danger from the MMR vaccine and the overwhelming evidence of its safety, the uptake of MMR fell to 80% nationally, 70% in London and below 60% in some places. For adequate herd immunity the WHO suggests a figure of 95% uptake. Tony Blair’s government, that had prided itself on “presentation”, had failed to get the public “on message” and the onus was on the primary care teams of GPs, practice nurses and health visitors to present the truth. Unfortunately, not all were as strident as they should have been. Tony Blair’s son, Leo, became of age for the MMR and many were hoping that they would announce that he had received it, giving a personal endorsement from the Prime Minister and his wife. Instead, there was a refusal to say whether he had received it or not, which left most people assuming that he had not but they did not want to say so openly. It transpired later, with his mother’s autobiography, that he had received it but they cited confidentiality as the reason for secrecy. I am sure that the young man was far more embarrassed by his mother’s revelations about his conception than his vaccination status.
It would have been helpful to have had a personal vote of confidence in the MMR vaccine from the Prime Minister and his family. Instead, many people assumed that they had rejected it.
The BBC and ITV must also bear responsibility for insisting on still calling it “the controversial MMR vaccine” long after any controversy had been settled. A typical scenario would be that a distraught mother would say that all she knew was that her child was fine until he had the vaccine and then he started to develop the disease. This is not evidence that the vaccine caused the disease. This was followed by a public health doctor who would say that as far as he could ascertain on the available evidence there was no link between the vaccine and autism. This may be scientifically correct but a far more robust statement was required to convince the public over the heart-rending story.
The public wants certainty, not scientific reticence. Where cases have been examined in detail, there has almost invariably been some evidence of the disease before the vaccine was given. The Daily Mail has run a nonsensical campaign against the vaccine, refusing to acknowledge reality whilst The Times has reported in accordance with the evidence. The Internet is awash with dangerous pseudo-science and garbage about immunisations. It is not just the gullible who need help and advice but even well-educated and intelligent parents from the professions need guidance to find the facts. Nowadays it is not the trendy middle classes who are avoiding the vaccine but the more poorly educated parents.
The classic rash of measles. The child is very unwell and complications such as middle ear infection and bronchitis are common. It can be fatal.
There are a number of common questions that are raised about the safety of the MMR vaccine. One is a suggestion that to give three vaccines in one will overload the immature immune system. This is quite a popular one. In everyday life three new antigens in a day is not excessive and there is no evidence of harm from multiple vaccines. The current vaccine schedule now gives a six-in-one vaccine against diphtheria, tetanus, pertussis (whooping cough), polio, hepatitis B and Haemophilus influenzae type b (Hib) at 2,3 and 4 months. This is far more vaccines given simultaneously at a far younger age and there appears to be no problem. The full list of vaccine schedules for children and other is found at the 21NHS Vaccine Schedule website.
The typical swollen parotid salivary glands of mumps. Is can affect the testes but the most feared complication is infection of the brain, or
Another suggestion is that children should obtain their immunity naturally by getting the disease rather than being immunised. This ignores the severity of the disease, the safety or the vaccine and the benefits of herd immunity. There was a time when the commonest cause of death in children who were in remission from leukaemia was measles infection. Nowadays they are given the MMR vaccine without apparent problem. It is the old story that “natural”, whatever that means, is good. It is more natural to die of a serious disease than to have it treated. Should we have relied on “natural immunity” to smallpox?
There has also been a suggestion that autism is due to poisoning from a vaccine preservative called thiomersal that contains a tiny amount of mercury. Thiomersal is not associated with autism, it has been phased out as a vaccine preservative and it was never used in the MMR vaccine.22Mercury, Vaccines, And Autism
Note the opaque lens in both eyes due to cataracts from congenital rubella.
Despite all this there are still people who promote the use of single vaccines rather than the triple and parents who request it. They ask, “If there is any doubt at all could we not use separate vaccines?” There is no reasonable doubt. There is much less data on the safety of single vaccines than the MMR and single vaccines would require six injections instead of two. This takes much longer to achieve full immunity, putting children at risk in the meantime and the need for six injections instead of two will lead to a greater chance of missing one or more by accident or design. This is why the NHS does not offer single vaccines but there are people who prey on the gullible and offer them for a price. False arguments include:
- All the controversy has been about the measles component and it is only a mild childhood illness so I shall miss it. Measles is a very unpleasant and serious disease that often has complications and before the advent of the MMR vaccine about 12 children a year died from measles in this country. That is not a trivial disease.
- My child is a girl and mumps is only a problem for boys. Mumps is an unpleasant illness and the most fearful complication is not orchitis (inflammation of the testes that may lead to infertility) but encephalitis (inflammation of the brain) that affects both sexes equally.
- My child is a boy and rubella is only a problem in pregnancy. Rubella or German measles is a trivial disease except for the matter of serious teratogenesis (abnormality of the baby) if caught in the first 12 to 16 weeks of pregnancy. The baby may have abnormalities of the ear, eye, heart or brain. However, the vaccine is not 100% effective, and so even if there was 100% uptake by girls, there would still be some women of reproductive age who are vulnerable. Therefore both boys and girls must be immunised to eradicate the disease from the community.
In many parts of the country the uptake of the MMR vaccine has now risen to 90% with 95% in places. However, a great deal of damage remains from what is now known as the great MMR hoax.
The proportion of children receiving their first dose of the measles, mumps, and rubella (MMR) vaccine by age two varies across England and for several years the uptake of children’s vaccinations has stubbornly stayed just below the 95% mark, even sinking back a little in some years.23Childhood Vaccination Coverage Statistics
This really is an incredible situation in which a non-existent story, based on overt and proven fraud, has led to such a tragedy of public health with the welfare and lives of so many children being put at risk. It is more than 20 years since the original case reports of the MMR fraud and there is overwhelming evidence of the safety of the vaccine, but not a scrap of evidence against it. Originally the problem was just in the UK but it has now spread abroad with conspiracy theorists in the USA and France convincing gullible parents to withhold vaccination. Leaving children vulnerable to serious and preventable diseases must be seen as child abuse.
Between 2017 and 2018 the number of cases of measles in Europe tripled with 72 deaths.24Measles cases in Europe tripled from 2017 to 2018 In 2019, The Times reported that an outbreak of mumps had hit universities in Ireland.25Outbreak of mumps hits universities A few days later, they reported that doctors are battling measles and conspiracy theories in France.26Doctors battling measles and conspiracy theories in France It is popularist political movements that lead to a lack of trust in politicians which have been blamed for the spread of conspiracy theories but people should trust their doctors instead. They know far more about it than politicians.
The anti-vaccine movement and the spread of lies through media such as Facebook will be considered further in a later section, after examination of a few more vaccines.
Human Papilloma Virus (HPV)
September 2008 saw the introduction of the human papilloma virus vaccine in the UK. The aim was to immunise against the virus that causes cervical cancer. The primary group for immunisation was girls aged 12 and 13. It is effective against only 70% of the strains of virus that cause cervical cancer and so there is no imminent prospect of cervical smears becoming redundant. The immunisation of only girls seemed reminiscent of when rubella vaccine was offered only to girls and so a significant reservoir remained. There has been a call to immunise boys too.27HPV vaccination in the United Kingdom: what about boys? The HPV types 16 and 18 are also apparently responsible for cancer of the penis as well as cervical cancer. However, a cost effectiveness analysis concluded that immunising boys would confer no extra benefit. The reference for this has been archived. Vaccination against hepatitis B and HPV seem to be effective ways of preventing a great many cancers.
Since the introduction of the vaccine there have been further calls for boys to be vaccinated too. It is estimated that 90% of anal cancer is linked to HPV and it has been linked to oropharyngeal cancers.28Anogenital malignancies and premalignancies I am not sure if the HPV is usually spread by sexual contact in such cases. Vaccination of boys too will start in 2019 and 2020.29HPV vaccine to be given to boys in England
There was criticism of the choice of vaccine, as an alternative would also have protected against genital warts. Now there has been a change to a vaccine that does cover many of the viruses that cause genital warts too.30Genital warts and HPV
A pilot study before general release of the vaccine found an uptake of only 70%.31Uptake of first two doses of HPV vaccine by adolescent schoolgirls It was said that the main reason for parents’ refusal of vaccination was insufficient information about the vaccine and its long-term safety. Uptake was significantly lower in schools with a higher proportion of ethnic minority girls or higher proportion of girls entitled to free school meals. It seems strange that the less well-educated parents were more concerned about insufficient information. Few parents mentioned the age for vaccination of their daughters or the vaccine’s effect on adolescent sexual behaviour. Two schools refused to participate on religious grounds, although three other schools of the same religious denomination took part. Some religious groups have opposed the vaccine on the grounds that it encourages sexual promiscuity.32Schools deny girls cervical cancer jabs on religious grounds An Irish Roman Catholic bishop also declared that the vaccine would encourage promiscuity, but he retracted his statement after pressure from colleagues.33Bishop apologises for ‘causing upset’ over HPV vaccine comments saying: ‘I was not fully informed’
The bishop’s argument is absurd. When girls had the rubella vaccine at age 11, they were not expected to breed immediately. Are they suggesting that many teenage girls abstain from sexual activity because they are concerned about future cervical cancer but if they have the vaccine this restraint will be removed? The fact that the vaccine covers just 70% of the responsible viruses leaving the other 30% untouched gives an opportunity to discuss early sex, cancer of the cervix, genital warts and sexually transmitted diseases. Religious extremists never let thought or reason cloud their judgement.
A post about Michele Bachmann, a Republican candidate for the 2012 presidential election. Her other views are in keeping with this absurdity. It seems quite clear who really has mental retardation.
An article in June 2019 said that 10 years after the introduction of the HPV vaccine, there was a significant reduction in HPV type 16 and 18 infections, and a significant reductions in diagnoses of anogenital warts in teenagers of both genders and young men and women. In addition, there was a significant 51% reduction in early abnormalities in cervical smears that can proceed to invasive cancer in girls aged 15-19 years and a 31% reduction in women aged 20-24 years. There was also evidence of herd effects among boys and older women, 4 years after the introduction of HPV vaccination.34Population-level impact and herd effects following the introduction of human papillomavirus vaccination programmes
The HPV vaccine story is often different in that it is not always the usual suspects of anti-vaccine campaigners who have opposed it but moralists who want to see those who indulge in sexual activity that they do not approve of, being punished for it. However, as shown above, it has also suffered from the usual suspects too. The time of HPV vaccination is a good opportunity to discuss sexual activity, early sex, promiscuity and sexually transmitted diseases including chlamydia, gonorrhoea, HIV and sexually transmitted cancers. Give them the facts, not ignorance and fear.
Smallpox has now been officially declared to have been eradicated in most of the world. There has been a vast and largely effective campaign worldwide against poliomyelitis, usually abbreviated to polio. It is close to global eradication too but with some recalcitrant areas.
According to the World Health Organisation, “Polio was once a disease feared worldwide, striking suddenly and paralysing mainly children for life. WHO is a partner in the Global Polio Eradication Initiative, the largest private-public partnership for health, which has reduced polio by 99%.” There are just three, and possibly only two countries where it remains. They are Nigeria, Pakistan and Afghanistan but it is hoped that eradication has now been achieved in Nigeria. Polio now survives only among the world’s poorest and most marginalized communities, where it stalks the most vulnerable children.35Polio NHS
Polio affects nerves to the muscles. Here the leg is wasted and as the muscles did not pull so strongly on the affected side during growth in childhood, the leg is shorter. Hence the built-up shoe.
Karachi is the only large city in the world where polio is still endemic. Investigation into the poor uptake of polio vaccine in Karachi found that parental refusal accounted for 74% of failure of uptake.36Parental perceptions surrounding polio There were clusters in both high and low income areas. Reasons given for refusal were lack of knowledge about polio, lack of faith in the vaccine’s effectiveness, misperceptions about vaccine-related adverse events and mistrust. A commonly quoted alleged side-effect is infertility. There is no truth in this but it is an allegation that has been used by the Taliban. All three countries are plagued by Islamic extremists and in Pakistan, polio vaccination teams have been attacked and some have been murdered.37Pakistani Taliban fear polio vaccines are U.S. plot to sterilize them
Since then religious leaders have given their backing to the immunisation campaign. The Taliban had ordered their ban after the CIA recruited a doctor to run a fake vaccination programme in the Pakistani town of Abbottabad, where they hoped he could obtain DNA samples that would help to identify Osama Bin Laden. Bin Laden was killed in May 2011. Polio can emerge again in war-torn and conflict areas.38The recent outbreaks and re-emergence of poliovirus in war and conflict-affected areas. The Pakistani government has appealed to Facebook to remove scores of fake posts that have created panic across the country by claiming that the polio vaccine is fatal to children.39Facebook vaccine scare thwarts drive to eradicate polio Facebook has much to answer for all over the world.
An iron lung from the 1950s. If the respiratory muscles were affected, this machine was required to help the
patient to breathe.
There are two types of polio vaccine. One is an attenuated (weakened) oral vaccine. The other is an injection. Initially the oral form was preferred as it could get into the community and spread resistance to those who had not received it directly. However, in about 1 case in 2.4 million doses the vaccine reverted to wild type and caused vaccine-associated paralytic polio (VAPP). The injection does not appear to have this problem and it has now replaced the oral vaccine in the developed world and now for the endgame in the final endemic areas.40Introduction of Inactivated Poliovirus Vaccine and Trivalent Oral Polio Vaccine/Bivalent Oral Polio Vaccine Switch in the African Region There is a general move with regard to vaccine technologies from whole cell vaccines, whether killed or attenuated (weakened so as not to cause disease) to “rationally designed protein assemblies.” 41From Whole Organisms to Rationally Designed Protein Assemblies.
An example of anti-vaccine propaganda. If the terrible iron lungs were saving lives, they were not reducing the
incidence of polio.
Vaccination did that.
That is why pictures like this are history.
There are three types of wild polio virus, as opposed to the attenuated (weakened) form used in vaccines. They are called WPV1,2 and 3. The WHO certified the eradication of WPV2 in 2015. In October 2019, the independent Global Commission for the Certification of Poliomyelitis Eradication said that WPV3 has been eradicated. Only wild poliovirus type 1 (WPV1) remains, in Afghanistan and Pakistan. No wild poliovirus type 1 has been detected anywhere in Africa since 2016.42Two out of three wild poliovirus strains eradicated According to an article in The Guardian in September 2020, there have been some outbreaks of polio in parts fo Africa where the oral vaccine used has reverted to a pathological form. 43Vaccine-derived polio spreads in Africa after defeat of wild virus Maybe it is time to stop the vaccine in Africa if the disease is eliminated there and the risk of the vaccine exceed the risk of the disease.
Influenza vaccination is safe and effective but for best results it should be repeated annually as the virus mutates slightly each year. However, expert opinion about its efficacy is not universal. A Cochrane review concluded that vaccination of those over 65 years was beneficial.44Vaccines for preventing influenza in the elderly. There is also evidence of benefit in younger people with specific diseases.
Many older people refuse influenza vaccine for spurious reasons. In a British study 44% refused as they were in good health and 25% associated the vaccine with causing illness.45Older peoples’ views related to influenza vaccine Feeling well and anticipation of side effects were the principle reasons for refusal in a Dutch study too.46Why do healthy elderly people fail to comply with influenza vaccination? Expectations need to be real. People say such things as, “You get the flu from the flu vaccine,” and “I had the flu vaccine last year and I still had three colds.” They must be told that a mild reaction is nothing compared with the actual disease and influenza vaccine will not protect against the common cold.
Herpes Zoster (Shingles) Vaccine
I have included a section on this, not because there is an anti-vaccine campaign against it, but because there is often confusion about chicken pox and shingles.
Both chicken pox and shingles are caused by the herpes zoster virus. It should not be confused with the herpes simplex virus (HSV). Herpes simplex has two types. The HSV1 usually causes cold sores on the face or lips whilst HSV2 is usually responsible for genital herpes which can be very painful and difficult to eradicate. However, sometimes the HSV1 virus affects the genital area and the HSV2 affects the lips. How this apparent reversal may come about, I shall leave to your imagination.
Chicken pox in usually a disease of childhood. It is milder in younger children than older children and can be quite nasty if caught as an adult. Hence, it is not unusual for parents of young children with chicken pox to hold a “chicken pox party” so that all their friends can get infected when still young. Similarly, before vaccination we used to have German measles parties, but the clinical diagnosis of rubella can be unreliable. For both diseases the incubation period is about 18 to 21 days.
Typical rash of shingles on one side only and going from the back, sloping down along the nerve segment.
The chicken pox or herpes zoster virus can lie dormant in the spinal column for decades before breaking out into shingles. This usually affects just one segment on one side of the body, corresponding to the segment of the spinal column involved. It can sometimes break out in the region of the trigeminal nerve on the face with especially nasty consequences if it includes the eye. In older people especially, it may take months or even years for pain after shingles to subside. This is called post-herpetic neuralgia and can be difficult to manage.
Hence the NHS has introduced a herpes zoster vaccine to prevent shingles. At present it is given to people as they reach 70 and 78. When those who have had it at 70 reach 78, this group will be dropped.47NHS Vaccinations Shingles Vaccine
Shingles affecting the face and if it affects the eye, it can scar the cornea and cause blindness. Treatment of this is an emergency.
There is a common misunderstanding about infectivity. Shingles is caused by the virus that has been dormant in the spinal column, often for many decades. It does not result from contact with a child with chicken pox. However, both the chicken pox blisters, more correctly called vesicles, and those from shingles in the early stages, shed virus and so they can spread chicken pox. People whose immunity is suppressed for any reason may be more susceptible to shingles.
This section is replicated in the chapter on Homeopathy.
A later section will examine homeopathy in much more detail, but for now there is the question of homeopathic vaccines. Homeopathy involves serial dilution of the ingredient until there may not be even a single molecule of the original substance left. Homeopathic vaccines exist but are so dilute that they do not elicit an antibody response.48Antibody responses to homeopathic and conventional vaccines The British Homeopathic Association must be commended for taking the responsible line in that it recommends that children should have conventional vaccines.49Vaccinations statement
An online search shows that many homeopathic practitioners follow that line but not all. Some claim that their vaccines are safe, no doubt meaning a low incidence of side-effects but if they do not confer any immunity, that is not safe at all.
Homeopaths prefer the term “nosodes” to vaccines, saying that they do not work in the same way. They admit that they do not seem to stimulate the immune system. To quote one source that recommends it for horses and riders50Homeopathic Nosodes:
“One theory is that nosodes work by creating an artificial disease in the body. Homeopathic medicines may occupy a space, a resonance that the natural disease would occupy should the animal come into contact with the natural disease. If at the time the space is occupied by the nosode, then the disease has no place to settle and reside. If there is no resonance with the patient whatsoever, then it just kind of disappears and nothing much happens. We are putting into the body a very, very dilute substance that really puts a picture into the body, an energetic picture that triggers a healing response. It is sort of like turning a switch with this very dilute energetic substance that says to the body ‘you need to fix this problem.’ With a nosode, what we’re doing is trying to tell the body energetically that it’s capable of dealing with a bug.”
Are you impressed? Before anything is called a theory, it could really do with some evidence to support it. This is pseudoscience at its worst, pretending to offer an explanation that has no basis in the true scientific world of physics, chemistry or biology. It is just supposed to sound convincing to those who know no better. Some of the evidence of efficacy that is promoted is just anecdotal, which, as we have seen before, is of no value. Others are small, underpowered trials of poor methodology. This is the classical scenario for selective publication.
In 2019, senior NHS leaders called for the UK’s largest group of registered homeopaths to have its accreditation revoked amid concerns that some practitioners are spreading misinformation about vaccines. In a letter to the Professional Standards Authority (PSA) for Health and Social Care, the NHS England chief executive and the national medical director expressed “serious concerns” about the possible re-accreditation of the Society of Homeopaths.51Homeopathy should have professional accreditation revoked, NHS leaders urge
The Anti-Vaccine Movement
The anti-vaccine movement promotes dangerously wrong concepts. Deadly Choices: How the Anti-Vaccine Movement Threatens Us All, is a book by Professor Eli Adashi, Professor of Vaccinology and Chief of the Division of Infectious Diseases at the Children’s Hospital of Philadelphia.52(Deadly Choices: How the Anti-Vaccine Movement Threatens Us All by Dr Eli Adashi). He argues that the American anti-vaccine movement started in 1982 when an hour-long television documentary called “DPT: Vaccine Roulette” was broadcast. It showed a series of parents whose children were supposedly well before they had the DTP (Diphtheria, Pertussis or whooping cough, and Tetanus) vaccine. They had withered arms and legs, with spastic limbs, and seizures. They stared vacantly upwards. They had helmets to protect their heads during fits and they were drooling. It was very emotive, but it was wrong. The whooping cough vaccine did not cause permanent brain damage, but the programme had tremendous ramifications. This initiated the idea that vaccines might be doing more harm than good.53Dangers of the Anti-Vaccine Movement
This highly emotional but totally inaccurate portrayal was also typical of the media presentation of the MMR charade. However, these are not the only vaccines that have suffered such misrepresentation. Parents underestimate the real dangers of the diseases that these vaccines prevent. For many years after the medical establishment had decided that there was not a shred of evidence to link the MMR vaccine with autism or bowel disease the BBC and ITV news continued to refer to it as “the controversial MMR vaccine” thereby implying a controversy that did not exist. I feel a sense of déjà vu when television presenters talk about “the controversial technique of fracking”.
It is amazing what people will believe without even looking at the source of the information.
Institutions such as the BBC feel obliged to offer both sides of the argument even when there is really no other side, as with the MMR hoax. The result was an appearance to many viewers that medical and scientific opinion was fairly even divided about the vaccine which was totally untrue. The BBC and ITV are required in law to try to be unbiased in their presentation of the news, but newspapers are under do such constraint. Some newspapers prefer the “shock, horror, cover-up” story to the truth as it is more sensational.
“Popularist” politics involves distrusting governments and the parties they have traditionally represented as well “the establishment”, including doctors and public health officials. It is often accompanied by belief in conspiracy theories. The Internet provided a rich source for people to promote unsubstantiated and often overtly ridiculous ideas, but many people believe them. We have seen that 25% of people seeking medical advice no not note the website and source of this advice. They are no more likely to be discerning with news.
Young people are more sceptical about vaccines.54Young People More Sceptical about Vaccines Perhaps young people are always more sceptical about anything. Perhaps they tend to get more of their information from the Internet, a source far more unreliable and irresponsible than even the worst newspaper. Perhaps they just lack the experience and wisdom to know when something is obviously a fraud. Older people may also remember what the diseases were like before the vaccines. The Russians have been involved in sowing disinformation as they do at any opportunity.55Kremlin spreads lies about MMR jab One of the accounts posted a false story claiming that vaccinations had left three quarters of the children of a Mexican village dead or in hospital. The Kremlin has attempted to sow social discord across the West through social media accounts. They have also spread disinformation on Brexit and the Salisbury nerve-agent poisoning.
Their anti-vaccine message has had some success with reported cases of measles in Europe numbering 41,000 up to August in 2018 with at least 37 deaths. This repudiates the message that measles is a trivial illness. In Britain 828 cases of measles had been laboratory-confirmed up to August in 2018, compared with 274 cases in the whole of the previous year, representing a serious setback for public health.56Vaccine fears blamed as measles cases hit record high in Europe In 2019 the head of the NHS blamed online fake news for the falling uptake of the MMR vaccine whilst the number of cases of measles tripled.57Anti-vaccine fake news causing decline in take-up and rise in measles says NHS chief
The UK’s Advertising Standards Authority (ASA) has banned a Facebook advertisement paid for by a US based antivaccination campaign group, saying that it should not appear again.58Anti-vaccination campaign’s advert banned for claiming all vaccines can kill children The advertisement was posted for Stop Mandatory Vaccination, founded by Larry Cook, a Los Angeles based author and “natural living” advocate. It stated, “Parents, not only can any vaccine given at any age kill your child, but if this unthinkable tragedy does occur, doctors will dismiss it as ‘sudden infant death syndrome’ (SIDS).”
Once again, with “natural living” we come across this abused word “natural”. They want children to get their immunity “naturally” as they did before vaccines, and many died getting it. The whole idea of vaccines, whether an inactivated toxin or a live attenuated organism, is that it gives immunity much more safely than does the natural organism that causes the disease.
In Pennsylvania, a doctors’ surgery posted a Facebook video urging parents to get their children the HPV vaccine. Soon there were 10,000 vicious comments along the lines of “vaccines kill” on the site. With the help of researchers from Pittsburgh University, the doctors found that only five of these replies came from Pennsylvania. The others came from all over the world as part of a co-ordinated attack. 59Anti-vaxxers are spreading a virus that just won’t die I suspect that many were “bots” or robots that are not even humans but programmes to spread such lies.
People can make absurd statements that are patently untrue and yet others will believe them. They seem to be eager to believe the ridiculous. To take the lyrics from an Andrew Lloyd Webber song from Whistle Down the Wind:
No matter what they tell us,
No matter what they do,
No matter what they teach us,
What we believe is true.
Joseph Goebbels who was Adolf Hitler’s minister of propaganda is credited with saying that if a lie is told often enough it will be believed although this may have been an extension of “Das grosse luge” or the big lie that Hitler expounds in his book Mein Kampf. The distortion of truth is a common feature of the rule of despots and it features strongly in George Orwell’s 1984.
Here is a tweet from a man who believes that his fantasies are the truth. Not only is the statement false, but even if it were true, we have seen that association and causation are not the same.
The basis of fake news is an appeal to emotion rather than reason.
At the beginning of his presidency, Donald Trump was promising an investigation into the many alleged ill-effects of vaccines but nothing has materialised. Perhaps he has realised that he would have to appoint the most discreditable committee to get the outcome that he desires.
Another of Donald Trump’s tweets, from 2012 said, “Massive combined inoculations to small children is the cause for big increase in autism.” By April 2019 he was telling the American people to “Get your shots” as an epidemic of measles spread across the USA. It is good to know that even Donald Trump can be brought round to reason, but it took an epidemic to do so.
Measles was declared eliminated in the USA in 2000 but it had been reported in ten states by February in 2019 with clusters in New York, Washington State, Texas and Illinois. Doctors and public health officials struggled to counter the unsubstantiated stories told by “anti-vaxxers”. A local doctor said, “Nobody is there to tell the stories of people who are alive and not disabled by vaccine-preventable illness.”60States confront anti‑vaxxers amid measles outbreak.
Getting the Message Across
It is said that doctors are generally held in high esteem. People trust and believe them. So why should so many reject the advice of their doctors in favour of misinformation or even intentional disinformation? New medicines are usually greeted with enthusiasm but not new vaccines. The benefits of medicines are usually swiftly obvious. Preventative medicines such as vaccines do not make people feel better. Why do so many people prefer the conspiracy theories of the anti-vaccination movement to the rationale of science?
GK Chesterton wrote, “When men choose not to believe in God, they do not thereafter believe in nothing, they then become capable of believing in anything.” The same applies when people cease to believe in doctors, politicians or the mainstream media.
We believe in open democracy, but governments have to have state secrets. Perhaps it is a greater awareness of this and some of the “dark arts” of war and confrontation that have led people to embrace conspiracy theories. They are not recent. In the USA the deaths of both President Kennedy and Marilyn Monroe raised theories about the CIA in the 1960s. The theories expounded by The Daily Express about the death of Princess Diana are too preposterous for a Dan Brown novel. Do people really believe that governments instruct doctors and academics to cover up the dangers of vaccines and they all supinely obey?
The undermining of public confidence in the MMR vaccine had considerable implications. Many parents were unnecessarily concerned, many children suffered a nasty disease unnecessarily and a few even died. This was child abuse on a massive scale.
In 1995 the veteran reporter John Lawton, speaking to the American Association of Broadcast Journalists said, “The irony of the Information Age is that it has given new respectability to uninformed opinion.”61(Crichton M, in Airframe, 1997.) This must be fought and the truth must be heard and believed. Experts no longer command respect. Instead reverence is given to celebrity endorsement. Junk science is embraced62Sense About Science whilst experts are dismissed as Government stooges. The problem is that people are uncritical of what they read because they do not know how to ask the right questions. Hopefully this website will equip the reader to be better able to do that. Perhaps people embrace conspiracy theories because they are more exciting than a reasoned appraisal. Faith in the statements of the British Government suffered a severe reverse when the “dodgy dossier” that was the justification for the second Iraq War became public.
There is also the problem of the media, whether television, radio, newspapers or magazines. The people who edit them do not understand science, but they do appreciate that controversy is news whilst reassurance is not. It is in their interest to create a story. Facebook is a company with the ability to have enormous influence and responsibility with regard to public health but instead they permit dangerous groups to promote their messages unhindered. Anti-vaccination groups can target people deemed by the networks’ algorithms to be interested in the topic. After an outcry in the United States Facebook removed the ability to target people interested in “vaccine controversies” but still allows “informed consent” to be targeted, which is a term used by some anti-vaccination groups.63Facebook ‘must block false claims’ on vaccines. Other countries need to take similar action and Facebook needs to take some responsibility.
Nothing seems too absurd for the conspiracy theorists who never let common sense get in the way. These advertisements are found not only in the USA but of Facebook and other social media too.
Think about how you might test the hypothesis that vaccines do, or do not work. If they work I would expect to find the following to be true:
- After the introduction of the vaccine, the incidence of the disease starts to decline. The degree of decline will be dependent on the uptake of the vaccine.
- If the uptake of the vaccine falls, the disease may make a resurgence.
- The majority, but not all, of the who acquire the disease have not been vaccinated. Not all who have been vaccinated will be immune as some fail to respond and this is one reason for achieving a high uptake. Thus, if there is a 90% uptake of a vaccine, the ratio of vaccinated to unvaccinated in the community is 9:1. If the unvaccinated represent 95% of those who get the disease, that is a ratio of 19:1. Hence, we may assume that vaccination reduces the risk of acquiring it by a factor of 9 x 19 or 171-fold. That is not complete protection but it is a very impressive one.
The data seem to be very much in keeping with the proposition that vaccines do work and very much against the theory that they actually make children more susceptible to the disease. This applies to all vaccines with the eradication of smallpox, the imminent eradication of polio, the reduction in the number of babies born with rubella syndrome, measles, diphtheria, a reduction in abnormal smears that may precede cancer of the cervix and much more. With a free press and a democratic political system, why would doctors, administrators, politicians, statisticians and journalists want to perpetrate the alleged lies? Where is the evidence to back these idiotic claims?
An extensive, international study was performed by the Welcome Trust.64Wellcome Global Monitor 2018 It found that trust in vaccines, doctors, scientists, and governments was very low in France and countries of the former USSR, especially Ukraine. In Western Europe, for example, only 59% think that vaccines are safe, but on the other hand 77% say they are effective.65Chapter 5: Attitudes to vaccines If they are ineffective, as nearly a quarter seem to suggest, how has smallpox been eradicated, and polio should soon follow it? Before the MMR vaccine there were many thousands of cases of measles in the UK each year and about a dozen deaths. With the uptake of the vaccine high, cases tumbled and deaths ceased but as uptake has fallen, annual cases have risen. After the breakdown of the Soviet Union in the early 1990s, and with it the breakdown of systematic immunisations, there was a resurgence of diphtheria, a nasty disease that had not been seen for many decades.
The World Health Organisation (WHO) has cited vaccine refusal or delay in countries where vaccination is available, as one of the top 10 threats to world health in 2019.66WHO Top 10 threats to global health in 2019 If we are to tackle vaccine refusal we must understand what makes otherwise rational parents refuse it. There have been a number of studies from a number of countries and a Cochrane review too.67Parents’ and informal caregivers’ views and experiences of communication about routine childhood vaccination
Much of the burden of this will fall on the general practice team. For children, the issue of immunisations is usually discussed by the health visitor at an early stage. This must be enthusiastic and not ambivalent. Any reservations must be identified and addressed. If the health visitor is unable to convince the parents, they should be asked to arrange an appointment with the doctor. Communication should aim to be understanding and not condescending, but it must be framed in terms that parents will understand. Many people have a poor grasp of language and an even poorer grasp of biology. Communicating risk and percentages can be very difficult when talking to people of limited numeracy.
In 2019, a report by the National Audit Office saaid that recent problems of poor vaccine uptake date back to 2013 when NHS England took over responsibility for the vaccination system from the former primary care trusts. It has failed to set out what it expects practices to do. They found “limited evidence” of anti-vaccination messages on social media having an impact. They claimed that NHS inefficiency rather than anti-vaxx campaigners are responsible for shortfalls in childhood vaccine rates.68NHS urged to improve child vaccination rates However, NHS England published its own review of vaccination policy, insisting that anti-vaxx messages were having an impact. NHS England says primary care networks will be able to offer access to evening and weekend appointments. A similar policy is prepared for screening, such as cervical smears. I find it sad that people have to be offered evening and weekend appointments as they are unable to take responsibility for their own and their children’s health without it. Perhaps I am wrong and the onus lies with employers who are unwilling to let employers have time off for such matters. Thee are important matters for personal and public health and they must not be ignored.
- Public Health England
The main English resource on diseases, vaccines and much more in public health
- The History of Vaccines. College of Physicians of Philadelphia.
An American site that gives an overview of many vaccines.
- Cultural Perspectives on Vaccination. College of Physicians of Philadelphia.
Another interesting article from the same source.
- How the case against the MMR vaccine was fixed. Brian Dere. BMJ 2011;342:c5347[full text]
Brian Deer exposes the bogus data behind claims that launched a worldwide scare over the measles, mumps, and rubella vaccine, and reveals how the appearance of a link with autism was manufactured at a London medical school
- Understanding Opposition to Vaccines
American sight giving an interesting insight
- NHS Vaccination schedule.
- Welcome Global Monitor 2018. Chapter 5. Attitudes to vaccines
The Wellcome Global Monitor is the world’s largest study into how people around the world think and feel about science and major health challenges. It surveys over 140,000 people from more than 140 countries.
- Edward Jenner 1749-1823. whonamedit.com
- Henderson DA, Inglesby TV, Bartlett JG, et al Smallpox as a biological weapon: medical and public health management. Working Group on Civilian Biodefense. JAMA. 1999 Jun 9;281(22):2127-37.
- WHO to decide fate of smallpox stocks [full text] News. Nature. 13th May2011
- Smallpox should be saved. Nature,469,265. 20th January 2011.
- NHS Vaccination Schedules from children to the elderly
- Cowan LD, Griffin MR, Howson CP, Katz M, Johnston RB Jr, Shaywitz BA, Fineberg HV. Acute encephalopathy and chronic neurological damage after pertussis vaccine. Vaccine. 1993 Nov;11(14):1371-9.
- American Academy of Pediatrics Committee on Infectious Diseases. The relationship between pertussis vaccine and central nervous system sequelae: continuing assessment. Pediatrics. 1996 Feb;97(2):279-81
- Cherry JD. Pertussis: the trials and tribulations of old and new pertussis vaccines. Vaccine. 1992;10(14):1033-8.
- Meningitis C deaths cut to zero. BBC News 20th Aril 2008
- Wakefield AJ, Murch SH, Anthony A, et al. Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. Lancet. 1998 Feb 28;351(9103):637-41. The original case reports- now retracted
- Tormey WP. Commentary: I see no convincing evidence of “enterocolitis,” “colitis,” or a “unique disease process” BMJ 22 November 2011.
- Brian Deer. Meaning of a programme: what Channel 4’s Dispatches said about MMR scare doctor.
- Murch SH, Anthony A, Casson DH, et al; Retraction of an interpretation.;Lancet 2004 Mar 6;363(9411):750.
- Godlee F. Wakefield’s article linking MMR vaccine and autism was fraudulent. BMJ 2011;342:c7452.
- Madsen KM, Hviid A, Vestergaard M, et al. A population-based study of measles, mumps and rubella vaccination and autism. New England Journal of Medicine 2002 347: 1477-1482. [full text]
- Hviid A, Hansen JV, Frisch M, Melbye M. Measles, Mumps, Rubella Vaccination and Autism: A Nationwide Cohort Study. Ann Intern Med. Annals of Internal Medicine 5th March 2019.
- Kaye JA, del Mar Melero-Montes M, Jick H. Mumps, measles, and rubella vaccine and the incidence of autism recorded by general practitioners: a time trend analysis. BMJ. 2001 Feb 24;322(7284):460-3.
- Taylor B. Vaccines and the changing epidemiology of autism. Child Care Health Dev. 2006 Sep;32(5):511-9.
- Uchiyama T, Kurosawa M, Inaba Y. MMR-vaccine and regression in autism spectrum disorders: negative results presented from Japan. J Autism Dev Disord. 2007 Feb;37(2):210-7.
- Demicheli V, Jefferson T, Rivetti A, Price D. Vaccines for measles, mumps and rubella in children. Cochrane Database of Systematic Reviews 2005, Issue 4. Art. No.: CD004407. DOI: 10.1002/14651858.CD004407.pub2. October 2005
- NHS Vaccine Schedule.
- Baker JP. Mercury, Vaccines, And Autism: One Controversy, Three Histories. Am J Public Health. 2008 Jan 2
- NHS Digital. Childhood Vaccination Coverage Statistics, England, 2016-17
- Thornton J. Measles cases in Europe tripled from 2017 to 2018. BMJ 2019;364:l634
- Outbreak of mumps hits universities. The Times 27th February 2019.
- Doctors battling measles and conspiracy theories in France. The Times 2nd March 2019.
- Kubba T. Human papillomavirus vaccination in the United Kingdom: what about boys? Reprod Health Matters. 2008 Nov;16(32):97-103 vaccination in the United Kingdom: what about boys?
- Kutlubay Z, Engin B, Zara T Tüzün Y. Anogenital malignancies and premalignancies: facts and controversies. Clin Dermatol. 2013 Jul-Aug;31(4):362-73.
- HPV vaccine to be given to boys in England.
- Genital warts and human papillomavirus: guidance, data and analysis.
- Brabin L, Roberts SA, Stretch R, Baxter D, Chambers G, Kitchener H, McCann R. Uptake of first two doses of human papillomavirus vaccine by adolescent schoolgirls in Manchester: prospective cohort study. BMJ. 2008 May 10;336(7652):1056-8. Epub 2008 Apr 24. [full text]
- Schools deny girls cervical cancer jabs on religious grounds. The Guardian 18th July 2012.
- Bishop apologises for ‘causing upset’ over HPV vaccine comments saying: ‘I was not fully informed’Irish Eamainer 2nd October 2017
- Drolet M, Bénard É, Pérez N, Brisson M; HPV Vaccination Impact Study Group. Population-level impact and herd effects following the introduction of human papillomavirus vaccination programmes: updated systematic review and meta-analysis. Lancet. 2019 Jun 26. pii: S0140-6736(19)30298-3.
- Polio NHS.
- Khowaja AR, Khan SA, Nizam N, Omer SB, Zaidi A. Parental perceptions surrounding polio and self-reported non-participation in polio supplementary immunization activities in Karachi, Pakistan: a mixed methods study. Bull World Health Organ. 2012 Nov 1;90(11):822-30. [full text]
- Al Arabia News. Pakistani Taliban fear polio vaccines are U.S. plot to sterilize them. 2nd November 2013.
- Akil M, Ahmad HA. The recent outbreaks and re-emergence of poliovirus in war and conflict-affected areas. Int J Infect Dis. 2016 Aug; 49: 40–46.
- Facebook vaccine scare thwarts drive to eradicate polio. The Times 13 May 2019
- Tevi-Benissan C, Okeibunor J, Maufras du Châtellier G, Assefa A, Nsiari-Muzenyi Biey J, Cheikh D et al. Introduction of Inactivated Poliovirus Vaccine and Trivalent Oral Polio Vaccine/Bivalent Oral Polio Vaccine Switch in the African Region J Infect Dis. 2017 Jul 1; 216(Suppl 1): S66–S75.
- Karch CP, Burkhard C. Vaccine Technologies: From Whole Organisms to Rationally Designed Protein Assemblies. Biochem Pharmacol. 2016 Nov 15; 120: 1–14
- Two out of three wild poliovirus strains eradicated. World Health Organisation 24 October 2019
- Vaccine-derived polio spreads in Africa after defeat of wild virus. The Guardian. 2 September 2020.
- Rivetti D, Jefferson T, Thomas R, Rudin M, Rivetti A, Di Pietrantonj C, Demicheli V. Vaccines for preventing influenza in the elderly. Cochrane Database of Systematic Reviews 2006, Issue 3. Art. No.: CD004876.
- Mangtani P, Breeze E, Stirling S, Hanciles S, Kovats S, Fletcher A. Cross-sectional survey of older peoples’ views related to influenza vaccine uptake. BMC Public Health. 2006 Oct 11;6:249.
- van Essen GA, Kuyvenhoven MM, de Melker RA. Why do healthy elderly people fail to comply with influenza vaccination? Age Ageing. 1997 Jul;26(4):275-9.
- NHS Vaccinations. Shingles vaccine.
- Loeb M , Russell ML, Neupane B, Thanabalan V, Sing P, Newton J, et al. A randomized, blinded, placebo-controlled trial comparing antibody responses to homeopathic and conventional vaccines in university students. Vaccine Volume 36, Issue 48, 19 November 2018, Pages 7423-7429.
- British Homeopathic Association. Vaccinations Statement 2013.
- Holistic Horse. Interative care for horse and rider.Homeopathic Nosodes: Vaccination Alternative?
- Homeopathy should have professional accreditation revoked, NHS leaders urge. BMJ 2019;367:l6248
- Deadly Choices: How the Anti-Vaccine Movement Threatens Us All by Dr Eli Adashi. New York: Basic Books 2011.
- Paul Offit on the Dangers of the Anti-Vaccine Movement. Medscape. 27th April 2011
- Young People More Sceptical about Vaccines. The Times. 23rd October 2018
- Kremlin spreads lies about MMR jab. The Times 24th August 2018.
- Vaccine fears blamed as measles cases hit record high in Europe. The Times 20th August 2018
- Anti-vaccine ‘fake news’ causing decline in take-up and rise in measles, NHS chief says. Sky News 1st March 2019.
- Anti-vaccination campaign’s advert banned for claiming all vaccines can kill children. The Independent. 7th November 2018
- Anti-vaxxers are spreading a virus that just won’t die. Sarah Baxter. The Sunday Times. 31 March 2019.
- Cited by Crichton M, 1997. Airframe, published by Arrow Books (Quotation in preface).
- States confront anti‑vaxxers amid measles outbreak. The Times 27 February 2019.
- Sense About Science Website.
- Facebook ‘must block false claims’ on vaccines. The Times 2 March 2019
- Welcome Global Monitor 2018
- Welcome Global Monitor 2018. Chapter 5. Attitudes to vaccines
- World Health Organisation. Top 10 threats to world health 2019.
- Ames HM, Glenton C, Lewin S. Parents’ and informal caregivers’ views and experiences of communication about routine childhood vaccination: a synthesis of qualitative evidence. Cochrane Database Syst Rev. 2017 Feb 7;2:CD011787.[full text]
- NHS urged to improve child vaccination rates. Practice Index 29 October 2019
This website is now completed, although I shall continue to do updates. The following list shows the sections or chapters. Just click on the topic in blue to go to that part of the site.