Monday, 12 October 2009

Was MMR panic really about Iraq?

Harry's Place has a remarkable quote from Ben Goldacre, apparently from a radio show he was appearing on. Refering to parental resistance to vaccination campaigns, he said:

It’s kind of an act of protest on which people can take a stand. When the MMR scare really kicked off in the UK in 2002, it was shortly after we were sort of going off to wars that were very, very unpopular. And I think in some respects people might have felt, well, there’s nothing I can do to stop my country bombing but I can take a stand on vaccines. It almost becomes a kind of poetic response to unrelated problems.

HP's Gene thinks that "linking the MMR scare to the wars in Afghanistan and Iraq is a huge - and politically suspect - stretch." It's certainly striking, and I doubt Goldacre has any evidence to back it up. Indeed, it smacks of the "bad science" Goldacre is famous for campaigning against. To suggest that conscious bloody-mindedness lies explains some parents' refusal to accept official advice is plainly ludicrous. Things are much simpler than that: parents are naturally concerned for their children, and if they've read that the MMR vaccine is associated with autism, or the Cervarix vaccine with instant death, then they are being entirely rational if they take fright. That doesn't mean that the reports that influenced them were balanced or evidentially-sound, of course, merely that they are available.

Similarly, there is no particular reason why parents should believe the bland reassurances of officialdom simply because they are official. The tragic death of Natalie Morton within a couple of hours of her injection was, we are assured, entirely unrelated to it. She had an undetected tumour. Fair enough: she was probably not long for the world. But it is stretching credibility to claim, as government scientists did, that her receiving the immunisation had no effect whatever in at least precipitating her end. It is not anti-science or paranoid to suggest that it may have been a trigger event. By refusing even to allow this obvious possibility - presumably for fear that it would "undermine confidence" - the authorities look shifty and unconvincing. It is natural for people who are in no position themselves to assess the facts to suspect that the experts are hiding something.

Moreover, where mass vaccination campaigns are concerned there is a tension between public good and private interest. Immunisation, to be effective, requires that the vast majority of the population have the jab: otherwise, the disease being targeted will remain a public nuisance. Yet immunisation is not risk-free to the individual undergoing it. Even the NHS admits that "no vaccine is totally without side effects"; and although it rightly goes on to argue that "the risk of complications with the natural infections is very much greater than the risk of a serious adverse reaction following the vaccine", such consequences will only arise if the individual actually contracts the infection. In a population as a whole, the cost-benefit analysis will almost always favour immunisation. For an individual, on the other hand, the same analysis may well favour resistance to the jab. Simply put, this is because if everyone else has been protected, the risk of contracting the disease (which may have side-effects) will be minimal, whereas the risk of having the jab (which may have side-effects) is 100%.

If I can be sure that everyone else in the population is protected, and thus the disease has effectively been eliminated from the population, then I can best protect myself by not being immunised and so avoiding any side-effects from the vaccine. The trouble begins when a significant proportion of the population begins to reason in this way - for then the programme of eradicating the disease becomes more difficult or goes into reverse. It is thus in the interest of the state's medical authorities to minimise the dangers associated with any particular vaccine and to exaggerate the dangers associated with the disease.

To take the most notorious case, there is almost no net benefit to a small male child in being immunised against rubella, though rather more in being immunised specifically against measles. As for mumps, the best time for such protection would be around the age of ten. MMR - even accepting (and I do) that the link with autism was unfounded - is a case of public health protection more than it is one of protection for individuals. Surviving a bout of measles, for example, was until a generation or two ago a childhood rite of passage. For some, tragically, the disease led to blindness or even death, but most got over it. Rubella, or german measles, is (except in pregnant women) an even milder disease - which is why before the advent of MMR the inoculation was offered only to girls. (Incidentally, that fact didn't produce campaigns in the Mail claiming that it encouraged teenage pregnancy or underage sex.)

A course of individual injections would arguably serve individuals better, or at least as well, as MMR. Yet the language used by government medics and their supporters in respect of MMR-resistance is little short of apocalyptic. They make measles sound worse than bubonic plague. They put obstacles in the path of parents seeking individual vaccinations, even though the population can adequately be protected through the use of single jabs. There is a false note to some of this propaganda, however well-intentioned. It is therefore not surprising that it produced a backlash, in which inaccurate claims about the danger of the vaccine mingled with broader conspiracy theories and an entirely reasonable suspicion that the government may not be an objective source of information.

If there is a connection between opposition to the Iraq War and (less widespread) resistance to vaccination campaigns then it is to be found here. It is a resistance not born of anger and frustration (as a "poetic response" to other things, as Goldacre suggests) but rather reflects a generalised scepticism about official advice. In both cases, the government is guilty of a form of misdirection. It used "weapons of mass destruction" as a pretext for a war fought for other reasons, and it used scaremongering about measles to combat the scaremongering about MMR, rather than coming clean and admitting that there exist perfectly viable alternatives to the triple jab which informed parents should be free to choose. In both cases, there were hidden agendas. The coincidence Goldacre referred to can be explained quite simply. The Iraq war, its justification and its aftermath, brought government lying into sharp relief. People have always mistrusted their politicians, of course; what changed with Iraq was that supposedly independent and non-political parts of government were implicated in official mendacity. Trust, once lost, is difficult to recover. As the shepherd boy in the fable discovered, people who falsely cry "Wolf!" run the danger of being disbelieved even when they are telling the truth.

So there's no need to assume that refusing to give your child the MMR jab is simply a way of sticking it to the Man. Nevertheless, though his example is badly chosen, I think Goldacre may be onto something. In some parts of the world, opposition to US foreign policy has been expressed in campaigns against Britney Spears, Hollywood films or Macdonalds as symbols of cultural imperialism or moral pollution. Scepticism about vaccination drives in Africa does seem to be bound up with opposition to the exploitation by Western companies of countries' natural resources. And closer to home, reluctance to take on board scientific findings about climate change may be linked to the suspicion that businesses stand to profit disproportionately from renewable power-generation or energy-saving schemes.

More broadly, there's a pervasive sense of disenfranchisement, and with it mutual mistrust between government and the people. Power has moved from elected representatives as decision-making has been centralised, delegated to quangos or subsumed by the largely undemocratic set-up in Brussels. I was struck the other day by Robert Harris's comment, while promoting his new novel about Cicero, that the Roman Republic was a much more authentic and vibrant democracy than modern Britain. Obviously it had its flaws - it excluded women, slaves, non-citizens and, to a large extent, anyone who wasn't rich - but the leading figures were considerably more accountable (and thus precarious) than are the cushioned leaders of today. It was also, like all proper democracies, unstable and was eventually replaced by an authoritarian system in which the people gave up political influence in exchange for bread and circuses. Something similar may be happening before our eyes. It certainly feels like that much of the time, and it's only human nature to want to kick against the pricks. Especially the pricks who rule over us at the moment.