§ 1.57 a.m.
§ Mr. Jack Ashley (Stoke-on-Trent, South)
This debate is being held for three reasons. The first is that the whole immunisation programme is being jeopardised by the refusal of my right hon. Friend the Secretary of State to respond to grave public disquiet about compensation for vaccine-damaged children, and the conflict of medical experts about the whooping cough vaccine. The second is that the case for compensation needs to be pressed, in view of my right hon. Friend's defiance of parliamentary opinion and overwhelming public support. The third is that my right hon. Friend's statement that the gains of whooping-cough vaccine outweigh the risks has now been shown in parliamentary answers and other sources of information to be completely without foundation.
It is a matter of deep regret to me that my right hon. Friend's response to the parents and their supporters like myself has been to go on television and accuse them of damaging the immunisation scheme, whereas he is responsible for the 1130 damage. I am also sorry that he chose to reply to me by making a personal attack, accusing me of arrogance. I notice that he has run away tonight and sent one of his junior Ministers. The House will draw its own conclusions.
I lose no sleep over his accusations, but I must tell the House two things in his absence. He has seriously misjudged the people he is dealing with. If he believes that he can gag them by smears or personal insults he has made a grave miscalculation. Those involved in this campaign have endlessly repeated their support for the immunisation programme generally, with reservations about whooping cough, and they have acted with dignity and restraint. Making provocative attacks upon them will in no way deter them from seeking compensation and an independent inquiry. If anything, it will have the reverse effect. My right hon. Friend's failure to learn that lesson is a grave reflection on his political judgment.
Secondly, the Secretary of State is directly and personally responsible for damaging the immunisation scheme as a whole by failing to respond to the widely supported call for compensation, and to the serious conflict within the medical profession about whooping-cough vaccine, He is crying in the wilderness, asking people to support the immunisation programme while they are anxious about these two basic issues, and the anxiety of many people spills over into a confused rejection of all immunisation. He should therefore reconsider his refusal and take immediate action, giving a commitment to compensation, and order an independent inquiry.
In addition, my right hon. Friend should work in close consultation with my right hon. Friends the Secretaries of State for Education and Science and the Environment to set up a working party and co-ordinate all its efforts. He should make a special appeal to all doctors, urging them actively to recommend immunisation, particularly against diptheria and tetanus, and even more particularly against poliomyelitis, and to display departmental publicity posters in every surgery.
The Department of Education and Science should notify the parents of every schoolchild of the need for immunisation and the benefits to be derived from 1131 it. In conjunction with the local medical officers of health it should arrange for those children who were not immunised at the normal pre-school age, and whose parents agree, to be immunised in schools.
On the question of compensation, the Government have a clear and over-riding moral responsibility to pay the children who are severely damaged, because they are vaccinated primarily for the benefit of others who are too young to be vaccinated themselves. The main benefit is to the community at large, yet all the risk is to the individual.
The Secretary of State's intention to await the Pearson Commission report on civil liability is merely a delaying tactic, because he is not seriously going to reject parliamentary and public opinion in the unlikely event of Pearson's recommending against compensation for these children.
I know that the Secretary of State argues that the Government encourage other procedures, such as dental treatment, which can cause damage, and says that he must also consider these cases. It is rather a pathetic excuse for inaction, because it completely disregards the fact that children have dental treatment for their own benefit, whereas, as I have explained, they are vaccinated primarily for the social good, and the benefit of others.
I am also aware of the other limp excuse that is made to avoid payment of compensation—that to do so would create an anomaly. But anomalies abound already. If there is to be complete equality, there must be no differential benefit for any handicapped people—no industrial injuries scheme, no pneumoconiosis scheme, no occupational sickness scheme, no earnings-related benefits and no criminal injuries compensation scheme. Only when the Secretary of State abolishes them can he legitimately advance the excuse about anomalies.
As for the difficulties of implementing a scheme, six countries already have compensation schemes for vaccine-damaged children and have managed to overcome the difficulties. Naturally, each foreign Government scheme varies according to local conditions, history and attitudes, despite the common underlying principle that compensation should be paid to the victims of vaccine damage. The criteria 1132 is uniform, but the Danish attitude is interesting. They say that definite proof is not needed and that a reasonable presumption of a casual connection between vaccination and damage would suffice.
Regarding the need for an independent inquiry into the whooping-cough vaccine, my right hon. Friend the Secretary of State made great play, in the Adjournment debate on 17th February, of the advice of the experts, accusing me of insisting that "the medical experts" were wrong. The Secretary of State made the following false statement about me in that debate:by insisting that he is right and that the medical experts are wrong he is creating serious dangers for children whose health and lives may be put at stake."—[Official Report, 17th February 1977; Vol. 926, c. 886.]The Secretary of State knows full well that I was not maintaining that "the medical experts" were wrong. Medical experts are not confined to those serving on the Joint Committee on Vaccination and Immunisation. Some eminent experts take a different view from those who do serve on that Committee. I was contending that there was a conflict between the medical experts and that that was one of the reasons why we needed an independent inquiry. I now invite the Secretary of State to make a public retraction of the false statement that he made to the House of Commons.
The Secretary of State maintains that there is no need for an independent inquiry, and says that he and the joint committee are convinced that the gains from the whooping-cough vaccine outweigh the risks. There are, he says, only two children a year seriously brain damaged by the vaccine whereas four children a year suffer brain damage from whooping-cough itself. These are interesting figures, backed by the full authority of the Department and advanced to support the continuation of a vaccination programme affecting millions of children. When they are challenged, the Secretary of State merely abuses those who dare put questions, and refuses to hold an inquiry.
Let us look first at the Secretary of State's claim that there are only two cases of brain damage per year from the vaccine. They are based, according to the Minister's own admission, on doctors' reports of adverse reactions, made to the 1133 Committee on Safety of Medicines. Yet the Secretary of State has also admitted that the majority of adverse reactions are not reported. The shamefaced phrase, reluctantly dragged out of him, was that these figures "could be on the low side". He can say that again.
If most cases of vaccine damage are not reported by the doctors, how can the Minister still maintain that there are only two cases a year of vaccine brain damage when the figures are based on these inaccurate returns? His Department has already publicly admitted that its information is insufficient to make reliable estimates. It is an Alice-in-Wonderland situation.
The Minister's argument is therefore demolished at the outset, before one has even begun to consider the views of the other "medical experts". One of them, Professor Gordon Stewart, of Glasgow University, maintains from his own experience that there are eight cases of vaccine brain damage a year. He says that that is a minimum figure. Let us compare that with the figure of two put forward by the joint committee and the Minister, based on their admittedly inadequate data.
The Secretary of State quoted a couple of newspapers in the Adjournment debate because they supported him—carefully omitting to mention those that opposed him. I wonder whether he saw the comprehensive and well-informed article in The Sunday Times on Sunday.
He will have seen from the article that the Committee on Safety of Medicines warns of naive interpretations of its data and says that people should ensure that any interpretations placed on the figures should be clearly stated to be their own. not those of the committee, and that the answers to many questions require a search of original reports. The Secretary of State did not make it clear in the Adjournment debate that the interpretation on these figures was not that of the Committee on Safety but his own. Perhaps he would care to explain that to the House. He may also like to comment on the fact that no search of the original reports of complications of whooping-cough vaccination has been made by this committee.
A further demolition charge has been put under the Secretary of State by the 1134 Chairman of the Joint Committee on Safety of Medicines, Sir Eric Scowen. Perhaps that is another reason for the absence of the Secretary of State tonight, after his speech in the Adjournment debate was challenged. Commenting on the reports of adverse reactions to drugs, Sir Eric said that usually 10 per cent. or 15 per cent. of the cases were reported to the committee, but it was impossible to say whether the same would happen with a vaccine. He added the significant and ominous comment:I don't know why the Secretary of State gave a figure for adverse effect of whooping cough vaccine. I would not have given one. The data are not sufficently reliable.The Secretary of State has not merely got a weak case. He has got no case, and he should withdraw.
Next we should examine the other figure that the Secretary of State so confidently deployed in the Adjournment debate, which is that four children a year were damaged from whooping cough itself. It has been admitted, as I suspected. that this is a departmental figure, based on the paper of Miller and Fletcher, published on 17th January 1976, which studied the severity of 8,000 cases of whooping cough—that is, half of the average of 16,000 cases of whooping cough a year. That report supposedly found two cases of brain damage in the 8,000 cases—ergo, there must be four cases a year in the average 16,000 cases of whooping cough each year, said the DHSS.
Unfortunately, the Secretary of State omitted to tell the House that one of the cases was of doubtful origin because the 1-year-old child had recovered from whooping cough five weeks earlier. Unfortunately, the Minister had also omitted to tell the House that both of these children recovered.
In addition to these vital factors, a statistician has said that it is statistically doubtful to draw very precise conclusions from figures such as these because the incidence is so low.
So in fact there is no convincing case for arguing that there are four cases of severe brain damage per year from whooping cough. It is on this astoundingly flimsy foundation that the whole of the whooping-cough vaccination scheme, involving millions of children, has been sustained. It is a sad and sorry policy, 1135 which will be irretrievably damaging to all those concerned.
The Secretary of State should recognise the validity of these arguments and not simply brush them aside. They torpedo his case, which is already waterlogged and listing very heavily. Any attempt to salvage the wreckage of such a discredited policy will only damage him and his Department further. Hon. Members on both sides of the House have unanimously criticised the Secretary of State, and public opinion is against him.
The charges against the Secretary of State are very serious, and I have no pleasure at all in making them. They are that he has made a false statement in the House. abused people who challenged him, hidden relevant facts in the dispute, used figures of vaccine damage that are inaccurate, quoted figures of whooping cough damage that are unfounded, claimed that the gains from whooping-cough vaccine outweigh the risks on scandalously inadequate data, refused to accept a reasoned request for compensation, and defied parliamentary opinion. In the process he has damaged the whole immunisation programme, which is vital to the lives and health of our children.
I appeal to my right hon. Friend to think again, to stop assuming that those who challenge him are necessarily hostile to him. He must know by now that we will never be browbeaten, that all those Back Benchers who unanimously criticised him on 8th February are as anxious as he is, but that they will not be ridden over roughshod by any Minister, however eminent. They are prepared to show that the House of Commons is more powerful than any Minister. My hon. Friend should also recognise that if he is willing to compensate the families and institute the independent inquiry into whooping-cough vaccine, Back Benchers of this House will be the first to thank him and express their warm appreciation.
§ 2.22 a.m.
§ Mrs. Jill Knight (Birmingham, Edgbaston)
I want to make three brief points. There is no doubt that the hon. Member for Stoke-on-Trent, South (Mr. Ashley) is quite correct in what he says about the problem that has arisen over the Department of Health's figures. The figures are in question, and there appears 1136 to be a dispute between the Department on the one hand and the Committee on the Safety of Medicines and the joint committee on the other.
I also read The Sunday Times article to which reference has been made, and I shall quote from it very briefly:Other experts are now questioning the Department's vaccination policy on the grounds that the benefits no longer outweigh the risks of the vaccination itself.In the light of that, should parents still be advised to continue with whooping cough vaccinations for their children?
Secondly, I am gravely worried about the way in which publication may have spread a real reluctance in the minds of parents to have their children vaccinated at all. It is extremely important to state loudly and frequently that every other vaccine is safe and that children should be vaccinated for their own safety against other diseases that exist and threaten children.
Thirdly, the Minister will have seen the reports about the recent outbreak of polio and the scare in the Wigan area. There were long queues for vaccination yesterday and on Saturday. But vaccinations were available only between 9.30 a.m. and 4.30 p.m., although special supplies of the vaccine were rushed to the area to deal with the situation. Children who were still waiting with their parents in the queue at 4.30 p.m. were refused vaccination, because no more were undertaken after that hour. I hope that the Minister will look again at these points and do what he can to avoid a recurrence of what is happening at Wigan.
§ 2.24 p.m.
§ The Under-Secretary of State for Health and Social Security (Mr. Eric Deakins)
I know how deeply concerned many Members on both sides of the House arc about the matter that my hon. Friend the Member for Stoke-on-Trent, South (Mr. Ashley) has raised in the House tonight. I should like to assure him that I feel no less deeply about this problem than he does. My right hon. Friend has expressed his deep sympathy with the small minority of children who are the unfortunate victims of vaccine damage, and with the wish of their parents for compensation, and on 8th February he made a statement that will be familiar to the House. The matter was the subject of an Adjournment debate on 17th 1137 February. My right hon. Friend dealt with the matter on the Adjournment, and I must tell my hon. Friend that it is very rare for a Cabinet Minister to deal with a subject on the Adjournment. Indeed, in my seven years membership of the House I cannot recall another example, although I might have missed one.
I think it regrettable that in this very important discussion that is going on in the House and outside my hon. Friend has chosen to make this a personal matter with my right hon. Friend the Secretary of State. At the end of that debate my hon. Friend expressed his dissatisfaction with my right hon. Friend's reply. He had himself made an impassioned attack on the continued use of whooping-cough vaccine, and was disappointed in my right hon. Friend's continued stand, on behalf of the Government, that the question of compensation for vaccine-damaged children must await the report of the Royal Commission on Civil Liability and Compensation.
As my right hon. Friend explained, the case for these children cannot be considered in isolation. There is a larger group of children who are similarly damaged by the diseases against which vaccination is offered, and there are many other categories of handicapped children for whom a case can also be made. Is it seriously suggested that we should create one privileged group of handicapped at the expense of all the others? What will the parents of the unprivileged children think of that? As my right hon. Friend explained, all need to be considered together before conclusions can be reached. That is why we feel that there is no sensible alternative to awaiting the report of the Royal Commission. That must remain the position.
As hon. Members will be aware, the Government are advised on immunisation by the Joint Committee on Vaccination and Immunisation. The joint committee continually reviews the uses of existing vaccines and considers the introduction of new vaccines. At the present time, it recommends routine vaccination against diphtheria, tetanus, whooping cough, poliomyelitis, measles, tuberculosis and rubella. The success of the immunisation campaign can be measured by the virtual eradication of such diseases as diphtheria and poliomyelitis. Whooping cough vaccine is also 1138 very effective, and studies have shown that it has a protection rate of 70 per cent. to 80 per cent.—much the same as polio vaccination. But the committee is not wedded to any particular vaccine; it has no axe to grind. Its decisions are based on the balance of medical advantage. For example, smallpox vaccination was dropped when its dangers exceeded its benefits. I believe that the House as a whole shares my right hon. Friend's confidence in the members of the joint committee. There is no dispute between my right hon. Friend and the joint committee.
I hope, too, that hon. Members will share my right hon. Friend's concern and that of the medical profession at the alarming drop of 25 per cent. to 30 per cent. in the number of vaccinations for diptheria, tetanus and poliomyelitis over the last three years and the even steeper fall of nearly 60 per cent. in whooping-cough vaccinations. If the result of current publicity is to continue to lower the uptake of vaccinations in this way, there could be a serious increase in the diseases that they are designed to prevent. That way disaster lies, and we must do all we can to stop it happening.
Unfortunately, as honourable Members are well aware, no immunising procedure is entirely free from risk. Adverse reactions are, however, exceedingly uncommon. Some of these risks can be avoided by recognising contra-indications and exercising care in administering vaccines. Precise estimates of the degree of risk are difficult to make.
§ Mr. Ashley
I have no quarrel with my hon. Friend. My quarrel is with the Secretary of State. However, on the question of damaging the immunisation programme, would my hon. Friend care to reply to the points that I have made? I have contended that the Secretary of State has damaged the programme, because people are anxious about whooping-cough vaccine and are worried about the conflicting expert advice. Therefore, we need a public inquiry.
People are worried about the lack of compensation, so we need compensation. Unless and until the Secretary of State does something on these matters, people will worry about the immunisation programme generally.
1139 I have now put forward a comprehensive programme for improving the programme, involving consultations between Departments. I appreciate my hon. Friend's problems, but could he not depart from his brief for a moment and comment on these points?
§ Mr. Deakins
I shall be coming, case by case, to the points made by my hon. Friend on the general principles. At the moment, I am trying to illustrate the areas of risk.
It is often very difficult to determine whether a disability has been caused by an immunising procedure, and this means that it is impossible to say with certainty what the precise risk is. Illnesses and disabilities reported as adverse reactions may often have another explanation. For whooping-cough, the figure of one case of brain damage—or, to use the technical terms, "encephalopathy" or "encephalitis"—in 300,000 children vaccinated, has been quoted. As my right hon. Friend has explained, this was never intended as a precise estimate. It was produced to counter unsubstantiated claims that the risk was as high as one in 5,000 or one in 10,000. It was designed to show the order of magnitude of the risk involved. As for the nature of the "brain damage" referred to, this may be either permanent or temporary. My right hon. Friend is advised by the joint committee that, in any case, the risk is a good deal lower than that from the disease.
The joint committee consists of independent experts. There can be no case for an independent inquiry into independent experts. The experts may disagree, but my right hon. Friend has to be guided by the official advisory committee set up to advise Ministers impartially on these matters.
My hon. Friend has repeated his previous criticisms and has mentioned the evidence provided by Professor Stewart of Glasgow University. I understand that the joint committee's Sub-Committee on Complications considered further information from Professor Stewart last week and asked him to provide more details, so that the conclusions that he has drawn may be evaluated. This is an important step, because I agree that the experts 1140 should get together and reach some sort of joint conclusion on the basis of the statistics.
As my right hon. Friend said, a continuing study in the North-West Thames Region has shown that out of 80,000 vaccinations containing a whooping-cough component there has not been a single case of brain damage, and I should like to add to what he said in the light of further reports in medical journals which are of great interest in this connection.
A letter in the British Medical Journal of 26th February this year, from Dr. N. R. Grist, a member of the joint committee, reports that a survey of encephalitis among patients discharged from hospital in Scotland in the two-year period 1968–9 revealed not one case of brain damage due to whooping-cough vaccination. No such cases have been encountered in the Glasgow area by the two senior infectious diseases physicians with a combined experience of 60 years. A further letter in the Lancet of 19th February 1977, from Dr. T. S. Wilson, another member of the joint committee, reports that during the period 1961–75 about 180,000 children in Glasgow received immunisation against whooping-cough and no case of severe brain damage directly attributable to whooping-cough vaccine is known to the agencies concerned with assessment. The evidence of these various surveys is backed up by a survey in Denmark reported in The Times of 23rd February this year, which brings out the very point that the joint committee has stressed—that convulsions resulting in brain damage occur naturally at the ages at which vaccination is offered, and which concludes that any casual connection between whooping-cough immunisation and such convulsions seem very unlikely.
It is essential that there should be the most careful regard to contra-indications to vaccination. Much advice has been issued in the past, especially in the booklet "Immunisation against Infectious Disease", reprinted in 1972. This booklet is now in course of revision, and to make sure that the latest information is available to doctors and nurses involved in vaccination a detailed schedule of contra-indications is being prepared for circulation later this month. Similarly, to make sure that the public are aware of the benefits and risks of vaccination, we wish to help doctors and nurses in their 1141 task of providing information and discussing issues with parents. We have asked the Health Education Council to provide a new and detailed leaflet for them to give to parents.
We are advised by another group of experts, mentioned by my hon. Friend, the Committee on Safety of Medicines, in relation to the safety, quality and efficacy of vaccines, as of other medicinal products. In addition, the Committee on Review of Medicines is undertaking a systematic examination of immunological products, including whooping-cough vaccine. Information about adverse reactions, which my hon. Friend has criticised, relies mainly on a system whereby all doctors, dentists and manufacturers have been asked to report any cases where use of a product may have harmed a patient. Comprehensive reporting cannot be expected under any system that requires the voluntary co-operation of so many people. But we are satisfied that valuable information is being obtained. About 150 reports of suspected adverse reactions to vaccines of all types are received each year.
The Joint Committee on Vaccination and Immunisation also has the benefit of studies of adverse reactions carried out by the Public Health Laboratory Service, the Medical Research Council, and other bodies. To supplement our knowledge of vaccine damage, research studies are in progress. The main study is being carried out under the aegis of the Middlesex Hospital, with the co-operation of the British Paediatric Association and is looking at all children aged 2 months to 3 years with serious neurological illness. Its aim will be to establish the incidence of vaccine damage.
The question of compensation is a difficult one. While any vaccination programme is carried out for the common benefit of society, its primary purpose is to protect individuals, and the fact that there is a risk involved makes it no different from many other medical procedures. Clearly, the implications of compensation for the ill-effects of vaccination, where there is no question of negligence, are very wide. As I have said, it raises the question whether we should similarly compensate those who are damaged by infectious diseases.
§ Mr. Ashley
This is a myth. It is basic to the whole argument. Children are at risk from whooping-cough up to the age of 1, especially at six months. That is when they are most at risk. The triple whooping-cough injection is not now given until children are 1 year old, and they are vaccinated to protect younger children, not themselves. When children are vaccinated they are past the time when they are at the greatest risk. They are vaccinated for the social good, for the protection of younger children, not to protect themselves. I do not see how my hon. Friend can dispute this fact.
§ Mr. Deakins
I am not disputing that the immunisation programme is for the benefit of society, but it is possible for children over 1 to get whooping-cough. I know this, because when I was a child my brother had whooping-cough at the age of 5. I did not catch it, although I was slightly older.
§ Mr. Deakins
I accept my hon. Friend's implied criticism. The issue of compensation raises the question whether we should similarly compensate those who are damaged by infectious diseases. Moreover, it is by no means easy to decide whether disability is due to a particular procedure, or what the right level of compensation for different disabilities should be. That is why the claims of vaccine-damaged children cannot be considered in isolation, and why it would be wrong to pre-empt the Royal Commission's Report.
Meanwhile, as my hon. Friend knows, we are doing all we can under the present law to ease the heavy burdens of families in the rare cases where serious ill effects result. A wide range of services and benefits is freely available under the National Health Service, the personal social services, the social security system and the Family Fund, which was extended in 1974 to help all types of families in which there is a severely handicapped child.
I hope that what I have said tonight will reassure parents—this is very important—about both the safety and the efficacy of whooping cough vaccine. I would urge them to see their own doctor or the clinic doctor to discuss the question 1143 of vaccination for their child if they have not already done so.
In conclusion, I echo my right hon. Friend's remarks, quoting Sir Charles Stuart-Harris, the Chairman of the Joint Committee on Vaccination and Immunisation. There is, as I know my hon. Friend recognises, a real danger of a rise in the incidence of whooping cough and of other infectious diseases if the current seriously reduced rates of acceptance of vaccination are not increased. Parents must face up to the dangers that must result if their children are not vaccinated against whooping cough, diphtheria, tetanus and polio. All these diseases remain a real threat to health, and certainly far greater than the risks of vaccination.