HC Deb 07 July 1977 vol 934 cc1578-88

[Motion made, and Question proposed, That this House do now adjourn. —[Mr. Snape.]

10.38 p.m.

Miss Joan Lestor (Eaton and Slough)

My hon. Friend the Member for Ilford, North (Mrs. Miller) has asked to have a few minutes at the end of my speech to contribute towards this debate. I have agreed that she should do so.

The purpose of bringing forward some of the dangers in relation to vaccination against whoopinglcough is geared to what was said in the House by my right hon. Friend the Secretary of State for Social Services when he was dealing with compensation for vaccine-damaged children.

All of us in this House were pleased that the Government saw their way clear to compensating at least those children who had suffered brain damage as a result of vaccination, but I do not think that anyone will ever be able to establish the number of children who suffered such brain damage, simply because vaccination has been used in such a large number of areas and many children have suffered brain damage since 1957, some of it possibly caused by the vaccination and some of it arising from other causes. The whole area of compensation and identifying the cause of brain damage is a difficult one to establish, to say the least.

The most important outcome of my right hon. Friend's deliberations occurred when he said that he had evaluated very thoroughly all the data which had come forward about whooping-cough vaccine and that he had not hesitation in urging parents to have their children vaccinated. He added that, if they did not, the likelihood was that we would have an epidemic of whooping-cough.

I do not know the basis on which those statements could be made. I tabled a Question to my right hon. Friend soon after those statements inquiring about the number of reported cases of alleged vaccine-damaged children which had been sent to the committee set up for this purpose, and what were the results of the committee's examination of those cases. My right hon. Friend replied that a large number of cases had been sent in from various sources, that the committee's examination of them would take a considerable time, and that no conclusions were yet available.

If that is true—and I do not doubt it—I fail to understand why my right hon. Friend could be so categorical in his assertion that the risk of brain damage resulting from vaccination was so slight that he had no hesitation in making the recommendation that he did.

To go on from there, it is clear that the medical profession is itself divided about vaccination. Over many years, there have been schools of thought in the country, including naturepaths, homeopaths and others, with doubts about the wisdom of vaccination. But I am not talking about those people. I am talking about people in orthodox medicine who themselves are arguing, first, about the efficacy of whooping-cough vaccine and, secondly, about the dangers attributed to it.

Therefore, I am in duty bound to ask my hon. Friend what attention has been paid to the assertions which have been made by Professor Gordon Stewart, from Glasgow, and Dr. John Wilson, of Great Ormond Street, who, between them, have sent details to the committee of more than 300 cases of alleged brain-damaged children as a result of the whooping-cough vaccine, none of which has yet been investigated. The same is true of the 180-odd cases which have been sent by the Committee of Brain-Damaged Children in connection with whooping-cough vaccine. What attention has been paid to the research which has been done, especially by the two gentlemen whom I have named, and what weight is given to it?

It is surprising that the Department should publish its findings and be so categorical in its assurances to parents that it is safe to have their children vaccinated against whooping-cough and that we would have an epidemic if they did not, when much of the evidence which has been put forward as the basis for a great many claims for compensation has not been evaluated in any way that I can see.

I am about the last person on earth to want to do anything not to protect children from the worst effects of any disease. But, whichever way one looks at the statistics available, it is clear that before a vaccine against whooping-cough was in common use cases of whooping-cough were declining in number all the time. I would have expected this. Improved standards of public health and sanitation have resulted in a higher standard of living for our society, and we advocate them strongly in order to safeguard people against disease. But I find it hard to establish what part vaccination has played in this process. There is no doubt that whooping-cough was on the decline before the vaccine was in constant use. The number of cases fell dramatically between 1930 and 1957.

Moreover, according to the admittedly small amount of research done on this aspect, 70 per cent of people—mostly children and young adults—who have been found to be introducers of whooping-cough to others had been vaccinated against it. If this is true—and the evidence has been quoted by Professor Stewart and Dr. Wilson—I think that the DHSS has rather overstated its case, to put it mildly, in its claims for the usefulness of vaccine.

Moreover, one thing stands out very clearly. I can find no recorded case of a child who has had whooping-cough suffering any brain damage. But there are many cases of children who have been vaccinated suffering from brain damage. Whether vaccination against whooping-cough is as effective as the DHSS and others argue is open to doubt.

I am basing my argument not so much on that as on the large number of cases in which people working in this field have done their own research and sifted through the cases available to them and have put forward the results to the committee dealing with the efficacy of vaccination and immunisation. Without examination of those cases the DHSS has advocated that parents should get their children immunised against whooping-cough. Moreover, it has asserted that if they do not do so there is likely to be an epidemic. I am not aware of any evidence of this. There does not seem to be any great correlation between the rise and fall in vaccination and the incidence of whooping-cough. As I have pointed out, there was a steady decline in the disease before the vaccine was in general use. That is explained as much by improvements in health and living standards as by anything else.

My final point is that there seems to be a great deal of doubt, on the evidence produced, that babies and toddlers are effectively vaccinated against whooping-cough, yet they are the most likely to get it. Evidence bears that out. The efficacy of vaccinating babies under six months and young children has been found not to be as great, even in orthodox medicine, as in other groups. The dangers to young babies are considerable, yet we still continue to vaccinate them.

Is it wise for the Government, who at least have had the courage and wisdom to accept partial responsibility, because of their advocacy of vaccination for whooping-cough and to pay compensation to the parents of children where it is established that this is the cause of damage, to be so outspoken and without caution in their statements that the danger is minimal and the need for vaccination is as great as it is. Without examining the large number of cases brought to their attention, they have said that the number of children identified as having brain damage is small, and the risk is small.

10.50 p.m.

Mrs. Millie Miller (Ilford, North)

I support my hon. Friend in her submissions to the Minister, and I should like to expand the information she has given the House relating to the decline in the incidence of virulent diseases in the last century without the aid of complex vaccines and other forms of medication. The combined death rate, from 1860 to 1965, for scarlet fever, diphtheria and whooping-cough in children up to 15 shows that nearly 90 per cent. of the total decline in the death rate over that period had occurred before the introduction of immunisation and vaccine programmes.

My hon. Friend has already said that improved health standards and better housing and stability of population has eased the situation. Certainly relief from poverty has done a great deal towards assisting the position, with the aid of the medical profession.

Many are worried about the record of mishaps through the administration of so-called protective measures. Many cases resulting from the administration of whooping-cough vaccine have been reported in recent years. People are turn- ing away in their tens of thousands from orthodox medicine treatment, including many young mothers who are afraid to subject their children to vaccination and immunisation processes because of the danger of complications.

I know, from personal experience in recent months, the effects on me as a result of the side effects of drugs administered to me by one of our main hospitals. Those side effects were devastating and I have suffered greatly from them. I have joined the ranks of those who want to warn the Minister of the dangers of advocating chemo-therapy in any form without a most searching investigation into the question whether it is as effective or as safe as he has maintained.

The Government should take into account the growing views of the public in this direction. They should make available facilities for those who wish to choose different methods of achieving and maintaining health. To take a case reported in the Press recently, I wonder whether the Government are being fair to those who believe in the efficacy of acupuncture, an non-orthodox treatment, in not registering those who practise it. For the past five years the Acupuncture Association has pressed for registration, but it has not been successful in achieving it.

There are other non-orthodox treatments that are also not yet accepted by the Government and that I believe should be available to people under the National Health Service. Therefore, those who have turned away from treatment for very good reasons, flowing from the side effects and damage of many of the modern technological medicines, should be as entitled to be treated by their chosen methods as are those who are able to pay for them. I plead with the Government to consider this matter and to take into consideration the worrying figures given by my hon. Friend.

10.48 p.m.

The Under-Secretary of State for Health and Social Security (Mr. Eric Deakins)

I am grateful to my hon, Friend the Member for Eton and Slough (Miss Lestor) for providing this further opportunity in the debate tonight to reassure Members on both sides of the House, the medical and nursing profession, and, above all, the public at large, about the weight of medical opinion in favour of vaccination against whooping-cough.

My right hon Friend the Secretary of State, on 24th June, announced the publication of the Report of the Joint Committee on Vaccination and Immunisation on this subject and its issue to all doctors and nurses involved. The committee's review of the benefits and risks of vaccination was carried out at his specific request because he was deeply sympathetic to the concern that had been expressed. I think the House will agree that the committee has responded with admirable speed and thoroughness. It makes it clear that while it will continue to review the position with the utmost care, it unanimously recommends the continued use of whooping-cough vaccine. I trust that hon. Members will welcome this conclusion, based as it is on a very thorough examination of the wealth of data available to the committee.

My right hon. Friend has expressed the fullest confidence in the committee, and I should like to reaffirm this—at the same time expressing the hope that we can now concentrate on the vital task of rebuilding public confidence in whooping-cough vaccination and the vaccination programme generally, and so increasing the level of uptake, which has fallen to dangerously low levels in the case of some vaccines.

First, however, I should like to stress the weight of expertise within the joint committee itself. The committee was set up in 1962 by the Central and Scottish Health Services to advise Health Ministers on all medical aspects of vaccination and immunisation". It continually reviews the use of existing vaccines and considers the possible application of new vaccines. For example, it introduced measles and rubella vaccination on a national scale in 1968 and 1970, respectively, and in 1971 it recommended that routine smallpox vaccination was no longer necessary. Its membership, which is drawn widely from the whole of the United Kingdom, includes medical and scientific experts from every branch of medicine concerned with immunisation—hospital medicine, including paediatrics; microbiology; epidemiology; immunology; community medicine; and general practice.

Miss Joan Lestor

Will the Minister tell me why the committee recommended that vaccination against smallpox was no longer necessary?

Mr. Deakins

With respect, I have little time left to answer the points made in the debate. I shall write to my hon. Friend with an explanation and if my hon. Friend the Member for Ilford, North (Mrs. Miller) is interested I shall write to her also.

The committee is thus in the best possible position not only to study all the available data from this and other countries but to know from personal experience the relative benefits and risks of vaccination. The detailed discussion of the protective efficacy of whooping-cough vaccine, which is mentioned in Chapter II, is based on the numerous studies that have been carried out here and in America. It will leave doubts in few minds about the effectiveness of the vaccine. I recommend those interested to read that section of the report in particular.

The report goes on to discuss, fully and fairly, the arguments put forward by opponents of whooping-cough vaccination, including those mentioned by my hon. Friend the Member for Eton and Slough. The committee acknowledges that a degree of risk is involved in any vaccination but it points out that interpretation of data in this field is extremely complex, and, in its view, in offering opinions opponents of the vaccine have not always taken into account all relevant factors and data. For instance, the association of alleged neurological damage with whooping-cough vaccine has been based on retrospective study of information, some dating back a number of years.

It is agreed by most research experts that it is often difficult to collect and examine sufficient trustworthy data from past cases and to determine whether a disability was due to vaccination or to some other cause. It has to be borne in mind that convulsions leading to neurological damage occur spontaneously and that in a few cases such convulsions will occur at or about the time of vaccination. In other words, there is an ever-present danger of making an association where the damage is in fact coincidental. The joint committee considers that retrospective information of (his kind provides no basis for a decision to withdraw protection that is generally agreed to be effective from what is known still to be a dangerous disease in young children. But the committee emphasises it is not fully content with the adequacy of the information available and it has set up studies in order to supply more reliable data on this aspect. It will continue to review the position in the light of new evidence. Of course, I can assure my hon. Friends that should the committee report further to the Secretary of State, and should there be any alteration in existing policy, my right hon. Friend will take appropriate action.

It has also been claimed that the decline in whooping-cough following the introduction of vaccination on a national scale in 1957 has been due to improved socioeconomic standards. However, examination of the decline in the incidence of whooping-cough over a longer period than has been carried out by those opposed to the vaccination—and I take note of the suggestions made by my hon. Friends— indicates that the fall in whooping-cough subsequent to the introduction of vaccination was marked.

That in rare cases there can be an association of neurological complications with the administration of whooping-cough vaccine has been accepted for some years. Normally these are mild, but occasionally they can be severe. The booklet "Immunisation against Infectious Diseases", which was drawn up by the joint committee and published in 1972, draws attention to this and emphasises the need to exclude from vaccination any child with a history of, or a tendency to, neurological defects. It is the degree of risk of adverse reactions over which opinion is divided—though the bulk of medical opinion agrees with the joint committee. The booklet's advice has been repeated in the guidance recently issued by the Chief Medical Officer on contraindications to vaccination.

Present evidence is however, inadequate to assess the incidence of these rare complications. Much more evidence will need to be obtained before it is possible to determine satisfactorily the relationship between vaccination and neurological damage. Two main studies, recommended by the joint committee and supported by the Department, are under way.

First, the Department of Community Medicine of the Middlesex Hospital is undertaking a national survey of encephalopathy between the ages of six months and 3 years. This is to investigate all cases of serious neurological damage occurring from 1st July 1976 in children of the appropriate age range and is being supported by paediatricians in hospitals throughout the United Kingdom. In addition, the Public Health Laboratory Service is undertaking in the North West Thames Region, a survey of all adverse reactions to all childhood vaccinations. Doctors are being encouraged to report every reaction, however small.

As for past cases of damage alleged to be due to vaccination, my hon. Friend will be aware that the Committee on Safety of Medicines is currently in the process of studying cases collected in recent years by the Association of Parents of Vaccine-damaged Children. At the same time, the Department is encouraging and supporting research aimed at improving whooping-cough vaccine and eliminating neurotoxic elements while retaining its protective efficacy.

My remarks would not be complete without drawing attention to my right hon. Friend's announcement in the House on 14th June. In this, he indicated the Government's acceptance in principle that there should be a scheme of payments for the benefit of those who are seriously damaged as a result of vaccination recommended by a public health authority. This applies to existing as well as new cases. We were able to make this decision in the light of the conclusion reached by the Royal Commission on Civil Liability and Compensation and conveyed in correspondence with the Prime Minister. We felt that it would be right to make this clear commitment in the exceptional circumstances of vaccine damage and we hope that it will be of great relief to the parents concerned.

As we do not yet know the details of the recommendations that the Royal Commission will be making, the detailed provisions of the scheme cannot yet be settled, but its report is expected later this year and we shall lose no time in considering its recommendations and working out a scheme. The setting up of the scheme and arrangements for the submission for financial assistance will be given publicity in due course.

Meanwhile, we are doing all we can under the present law to ease the heavy burden of families in the rare cases where serious ill-effects result. A wide range of services and benefits is available under the National Health Service, personal social services, the social security system and the Family Fund, which was extended in 1974 to help families in which there is a severely handicapped child. We are doing our best to draw the attention of all parents who may be concerned on the assistance these provide.

To conclude, I stress that the committee rejects the view that the balance of benefits and risks of immunisation can be decided in terms of the number of neurological complications resulting from the disease and from immunisation. All the burdens of illness, the complications and the deaths from whooping-cough have to be taken into account, and not just the children who may have had brain damage. The committee supports the continued use of pertussis vaccine and, while it does not recommend selective immunisation for particular social groups, it emphasises that protection is specially necessary for children in large families.

My right hon. Friend and I hope that the report will provide the reassurance needed to restore confidence in the vaccination procedures currently recommended. The whole vaccination programme has suffered in recent years from the controversy surrounding whooping-cough vaccine. In the case of some vaccinations there has been a reduction to dangerously low levels, which could lead to serious outbreaks of infectious disease. We intend to do all we can to restore the level of uptake that will provide adequate protection to the children of this country. It is their due.

My hon. Friend the Member for Ilfora, North raised a number of points connected with non-orthodox medicine. I shall consider what she said and remind her that there was a recent Adjournment debate on homoeopathic medicine. I recommend her to read it, if she has not done so already. In half an hour that debate exposed many of these issues.

We have not yet had an Adjournment debate on acupuncture, but I have the feeling that one may be coming along in due course. I shall be writing to both my hon. Friends on the other matter that was raised earlier.

Question put and agreed to.

Adjourned accordingly at six minutes past Eleven o'clock.