HC Deb 26 May 1978 vol 950 cc2009-22

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

4.0 p.m.

Miss Joan Lestor (Eton and Slough)

My debate follows well from the subject raised by my hon. Friend the Member for Stoke-on-Trent, South (Mr. Ashley). Last July the Minister and I met on a similar occasion. Following that debate he wrote a letter to me about whooping cough vaccine. I had asked him during the debate why smallpox vaccination was no longer advocated as a routine measure for young children in this country. The Minister promised that he would let me have the answer in a letter. Two weeks later he wrote to me and said that smallpox vaccination was no longer advocated as a routine measure because the incidence of smallpox abroad had declined and that therefore the risk of a child contracting it in this country was now less. He said that it was felt that the risk of damage from the vaccination was more dangerous than the likelihood of small- pox. That is true, and has been for a long time.

I wish to find some common ground with my hon. Friend before I begin the main thrust of my argument. I am sure that my hon. Friend would agree that in all these illnesses, whatever the efficacy of the protection might have been, good health, sanitation and improved environmental circumstances have contributed as much, if not more, to the erosion of these infections than has any form of vaccination.

It is common for the Department of Health and Social Security to say that since the vaccination was introduced among young children in the 1950s, whooping cough has declined, but whooping cough was declining in this country long before vaccination was introduced. An examination of the figures at the turn of the century proves that. Instances of whooping cough have risen and fallen over the years, but they have never been as great as they were when the disease was at its peak at the turn of the century, although there have been epidemics.

I take issue with my hon. Friend and shall continue to do so until I at least am satisfied, because whatever one's views might be about vaccines in general, the anxiety about the whooping cough vaccine and the way in which the situation has been handled by the DHSS is militating against the use of many other protective vaccines for young children.

My hon. Friend is not a doctor. His colleagues are not doctors, neither am I. Ministers rely for their conclusions on advice and judgments given to them by advisers under the Committee on Safety of Medicine.

When the medical profession disagrees as profoundly as it does on the question of whooping cough vaccine any layman or woman has a right to go to other sections of the medical profession and ask them their opinion. Is what such people say being evaluated properly? Those who first questioned thalidomide were told that they were foolish, that there was no evidence, and that it should be ignored. A time will come when, just as we see contraceptive pill after contraceptive pill withdrawn because of new dangers associated with it, other drugs will be withdrawn. A few people stand out and say "I am not satisfied. I am not happy", and one must take note of them.

For most of my information, but not all, I shall quote Professor Gordon Stewart, of Glasgow—who is well known to the Department—and Dr. John Wilson, of Great Ormond Street. It is well known that cases of whooping cough have been declining for a long time.

I wish my hon. Friend to establish an important matter. We were told that there would be an epidemic of whooping cough and that unless there was a massive campaign of vaccination of children against it all hell would break loose. We were told that there would be a devastating epidemic. We have had epidemics before to a greater or lesser extent. The most important consideration, however, is the number of children who, having been vaccinated, were among the increasing number of cases in certain parts of the country subsequently to suffer from whooping cough. The evidence to that effect is mounting to considerable proportions. Again, I refer my hon. Friend to the work that has been done by Professor Gordon Stewart in this respect.

I believe that the evidence will ultimately show that children who are vaccinated against whooping cough suffer from it far less severely. In the early days of vaccination, doctors, believing that vaccination gave total protection, were not notifying cases of whooping cough. I hope that the Department is checking the research which has shown that recent cases of whooping cough have occurred among children who were vaccinated against the complaint. Large numbers of children—Professor Gordon Stewart puts the figure at 70 per cent.—who were found to be carrying whooping cough had been vaccinated against it. In addition to the dangers, therefore, there is doubt about the efficacy of the vaccine.

Much was made by the Department and my hon. Friend the Minister about the possibility of an epidemic and about the need for a campaign. In spite of the advice that the campaign should be delayed, he took the view that it should go ahead. He said that children who had been damaged by the vaccination would be compensated, and that the risk from the vaccination was so minimal and the risk from whooping cough so great that it was better to have children vaccinated.

It is interesting to note, however, that the incidence of measles, rubella, and influenza, as well as other children's illnesses against which protection can be given, have all increased. Has the DHSS done it work to check whether the increased incidence of these complaints has occurred among children who were vaccinated? If that is so, why pick out just whooping cough, particularly when we know some of the dangers associated with the vaccine?

Figures have been published from time to time showing the risk of death from whooping cough. The group most at risk from whooping cough always has been babies and young children. The few deaths that have occurred in the current outbreak of whooping cough have been of young babies. The reason is that young babies cannot be protected against whooping cough. Babies can be vaccinated against whooping cough only between the ages of nine and 12 months, and therefore babies outside that age range are at risk from whooping cough, whether there is a programme of vaccination or not.

Even before vaccination was introduced, young babies died more frequently from whooping cough than did older children. It is an illness that proves fatal in very young children. We now know, therefore, that babies cannot be protected against whooping cough. Even so, the Department is considering reducing the age for vaccination in order to concentrate the efficacy of the vaccine into a shorter period of weeks or months. If that is so, the DHSS must proceed with care. It may cover itself by saying that children at risk should not be vaccinated, but how on earth does one establish whether a young baby is at risk?

I do not believe that the Department can ever establish the common factors among the children who were damaged as a result of the vaccine to enable it to determine which group of children is at risk. That is because there were no common factors. Many children who suffered damage from the vaccine had not been thought to be at risk. Just what is the area of risk? What were the common factors among the children who were at risk? What were the common factors among those who suffered brain damage as a result of the vaccine? If we do not know what these common factors were, how can we say which children are at risk?

There is talk about bringing down the age in order to concertina this thing in to protect young children, but if children who have been vaccinated are getting whooping cough—I think that the evidence that has been presented is overwhelming—the likelihood of offering greater protection to babies seems very suspect.

Secondly, and, of course, more importantly, if—I do not know this—the DHSS decides that it would not be sensible to bring down the age of vaccination for young children, they will continue to be at risk, and they have the biggest risk of death from whooping cough. It has always been the argument about death from whooping cough that has been the main thrust of the argument for vaccinating children. But young babies have always been at risk in relation to the older children in the family.

Professor Gordon Stewart says that the vaccine is fairly ineffective and that this fact has been hidden because doctors believed that children were not getting whooping cough because they had been vaccinated. It is interesting that the baby in the family has often had whooping cough and no one has known where the baby has got it from, because the rest of the family have been protected. But if Professor Gordon Stewart's argument is correct, that it merely lessened the symptoms but they still got the disease, of course babies were still getting whooping cough. There is little that one can do about that, with or without vaccine.

I put another point to my hon. Friend. Has the extent of the damage to the vaccine-damaged children been quantified in any way? People talk about brain damage, but we know of cases of paralysis, of various types of mental defects, of continuous screaming, and of other minor effects resulting from the vaccine which have also been reported to the Committee on Safety of Medicines.

Among the things that I should like to ask my hon. Friend is the question whether the chairman of the Committee on Safety of Medicines has given his blessing to the campaign now going ahead for the vaccination of children. Has he given his support to the advocacy to parents that they should have their children vaccinated? If so, I believe that he and the Department are being very negligent in not taking into account and answering the constant arguments that are being put forward by Professor Gordon Stewart and others. To my mind, they have not been answered. Until they are answered, I believe that a large number of parents in Britain will hesitate not only about this vaccine but about many others. Until these points are answered, the whole case about preventive medicines and preventive inoculations, and about various other things, is very much at risk.

In conclusion, I say to my hon. Friend that I do not believe that anything that has happened since the first warning signs about whooping cough vaccine were given has wiped the slate clean, as it were. There are doubts about the efficacy of the vaccine. There are certainly doubts about the way in which one will protect those at the greatest risk—babies—without subjecting them to even greater risks. Thirdly, there are very strong doubts indeed that the risks from the vaccine are now not greater than the risks from the effects of whooping cough.

It was on those grounds that the smallpox vaccine was certainly discouraged in this country, and I believe that it is on those grounds that the vaccination of children againset whooping cough should also be discouraged.

4.13 p.m.

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

First, I should like to say how grateful I am to my hon. Friend the Member for Eton and Slough (Miss Lestor) for offering me this further opportunity of allaying public fears about the dangers of whooping cough vaccine. As my hon. Friend mentioned, she had previously raised this subject in an Adjournment debate on 7th July last year. That was just after publication of the report on whooping cough vaccination by the Joint Committee on Vaccination and Immunisation. Much has happened since then. I hope that what I have to say now will put the matter into perspective.

I also agree with my hon. Friend that neither of us is an expert in this field. We are laymen on these issues, like most hon. Members. The Government have to be advised by experts, and my hon. Friend is also, naturally, following one or two particular experts. When experts disagree, it is often difficult for the layman to see his or her way clearly. I accept that criticism. Nevertheless, that does not relieve the Government of the duty of making a decision in the public interest on the basis of the advice they are given. I shall come to that matter shortly.

I appreciate that my hon. Friend is especially concerned that we have had an informational vaccination campaign while the Committee on Safety of Medicines is still considering a large number of cases of possible vaccine damage submitted by the Association of Parents of Vaccine Damaged Children. But, as the chief medical and chief nursing officers explained, in their letter of 28th February which announced it, the campaign set out to publicise in some detail the facts about vaccination—both the benefits and risks including those about whooping cough—and not to promote it. The campaign also reflected the findings of the recent report by the Parliamentary Commissioner for Administration which emphasised the need to keep the public informed of risks, however small they might be in terms of numbers.

My hon. Friend will recollect that the Parliamentary Commissioner had no criticism of the Department's arrangements for the issue of guidance to doctors who, he recognised, have the responsibility of advising parents about benefits and risks of vaccination. But he felt that the Department should have seen earlier the need to alert parents to the risks. This has been done in leaflets published since 1975. The most recent leaflet is particularly detailed.

The need for measures to improve the uptake of vaccinations has been underlined by recent events.

I now wish to deal with one of my hon. Friend's criticisms. On various occasions my right hon. Friend the Secretary of State has uttered warnings about the danger of a serious outbreak of whooping cough—what my hon. Friend called warnings of an epidemic. These fears have been realised. There have been a number of outbreaks in recent years, but last winter the total of notifications exceeded the figure for any year since 1971. There were 26,600 notifications in the last quarter of 1977 and the first quarter of 1978, compared with a figure of 2,400 in the same six-months period the previous winter. There were six deaths in comparison with one for the winter of 1976–77.

How far the outbreak has been due to the lowered uptake of vaccination is difficult to say, but the fact that the uptake dropped from 79 per cent in 1970 to 38 per cent. in 1976 and around 39 per cent. in 1977 clearly has some bearing on the figures I have quoted.

Miss Joan Lestor

I do not dispute by hon. Friend's figures. I appreciate that the outbreaks of whooping cough have ebbed and flowed over the years. I could pick on any year. The facts are that since the turn of the century whooping cough has been on the decline. My hon. Friend says that he does not know about the efficacy of the whoping cough vaccine. That is precisely my point. I hope he will say what monitoring has taken place of the number of cases where chilren have been vaccinated.

Mr. Deakins

If my hon. Friend will allow me to do so, I shall come to that point in the course of my remarks. At the moment I am dealing with facts rather than suppositions as to whether we have had an epidemic. In the opinion of the Department, we have had what can only be described as a serious outbreak. I do not know whether that ranks as a serious epidemic, but it is serious enough to warrant great public concern.

Mr. Jack Ashley (Stoke-on-Trent, South)

Will the Minister confirm that the increase is at the top of the cycle? There is a four-year cycle which must be taken into account. Did my hon. Friend hear his hon. Friend the Minister of State in the previous debate mention the German experience? I have never heard a more irrelevant or unimpressive argument. If, however, the Department can quote the German experience in the previous debate, why cannot I quote evidence from the German Department of Health that the authorities there have dropped whooping cough vaccinations, apart from special cases, and that there has been no increase in the incidence of whooping cough? Why cannot we take account of the German experience?

Mr. Deakins

I am interested to hear about the German experience in this matter. We need not only to examine the experience in Germany but to look to the other industrial countries also to see whether we can learn from their experience. I shall consider the point made by my hon. Friend. He said that there is a cycle to be considered. I do not regard an increase from a figure of just under 2,500 to 26,500 as being part of a cycle. It is a quantitative jump. I do not believe that one can refer to the epidemic of the past winter as part of a normal cycle. I think that it is something much more serious, and we should not underestimate its importance.

In discussing the risks of vaccination, which is what the debate is about, we must not forget the dangers of the disease. I know that my hon. Friend the Member for Eton and Slough feels that the dangers have been overestimated, but we have to go by what the joint committee said in its report last June, in chapter IV: It cannot be emphasised too strongly that the risk to children from pertussis is not the occurrence of so many cases of a particular complication, including encephalitis, but the total effects of the disease, the toll of prolonged morbidity, the requirements for admission to hospital of one in 10 affected children, the severity of illness and the occasional death. As my hon. Friend will recall, the joint committee's report was issued to all doctors and nurses involved with vaccination. The members of the joint committe are, of course, experts in this field, and they are in the best possible position to offer advice. They continually review the use of existing vaccines and the introduction of new vaccines, and they have the advantage of regular use of information from the Committee on Safety of Medicines on the safety and efficacy of particular vaccines.

The joint committee's report discussed in great detail the protection given by whooping cough vaccine, based on numerous studies carried out here and abroad, and discussed in the fullest possible way the arguments put forward by the opponents of whooping cough vaccination.

The joint committee was well aware of Professor Gordon Stewart's claim that whooping cough vaccination not only gave little protection—a point reinforced by my hon. Friend—but also was the cause of many cases of severe brain damage, and it was aware of his view that it should therefore no longer be recommended for routine use, which, I think, is what both my hon. Friends the Members for Eton and Slough and for Stoke-on-Trent, South (Mr. Ashley) are advocating.

Nevertheless, the joint committee rejected Professor Stewart's evidence and does not accept his view about the use of this vaccine. Indeed, it considered that the benefits of vaccination against whooping cough outweighed any risk, and, as my right hon. Friend the Secretary of State informed the House on 7th February this year, it confirmed its full support for the continued use of the vaccine for basic immunisation.

My hon. Friend the Member for Eton and Slough asked about the position of the chairman of the joint committee. Since the passage is rather too long to quote now, I refer her to column 1212 of Hansard for 7th February this year, when my right hon. Friend gave an Oral Answer and subsequently supplied information, circulated in Hansard, about three questions which he had put to the Joint Committee on Vaccination and Immunisation and asked for comments. Also in that passage in Hansard there are the joint committee's replies.

May I say, in response to my hon. Friend's question, in response to the request to look at the publicity material and so forth, that the joint committee commented on the factual material about the benefits and risks of the vaccines used for routine immunisation of young children proposed to be used in the forthcoming publicity, and these comments were taken into account in revising the material. The joint committee did not say "You should not go ahead with a campaign of information about vaccination", and it was on that basis that we felt quite confident that we were doing our duty to citizens, and particularly to children, in publicising the information in the way we did.

Of course, we all accept that there is some degree of risk in any vaccination, as in any other form of medical treatment, but, as the joint committee pointed out—I think that my hon. Friend agrees with this—the interpretation of data in this field is extremely complex. It is particularly difficult to collect and study trustworthy data from past cases in order to determine whether a disability is due to vaccination or some other cause. I think that my hon. Friend made this point in the Adjournment debate last year.

Convulsions leading to neurological damage occur spontaneously, and they can occur at or about the time that routine vaccinations are carried out in childhood. Clearly, this can easily lead to a false association of damage with vaccination where in fact there may be only coincidence.

The report emphasises the dangers arising from the disease in young children, which can lead to death or permanent damage. At the same time, the committee recognises the inadequacy of the information at its disposal—there is no doubt about that—and it has, of course, set up studies, which have been referred to elsewhere, in order to obtain more reliable data on the incidence of serious adverse reactions.

I come now to the Committee on Safety of Medicines. As my right hon. Friend indicated in a Written Answer of 21st November last year, that committee, which examines evidence on the safety and efficacy of all types of medicines, is at present considering a large number of cases of possible vaccine damage submitted by the Association of Parents of Vaccine Damaged Children. The committee is examining the evidence, at my hon. Friend's specific request, through its sub-committee on adverse reactions and two advisory panels.

Professor Gordon Stewart of Glasgow University and Dr. John Wilson of Great Ormond Street are both on the advisory panel concerned with the collection of data on adverse reactions to pertussis vaccine. There is, therefore, no danger of their views being ignored or underestimated by the Committee on Safety of Medicines. The study is likely to be a lengthy process, and it is obviously too early for the committee to report any conclusions at this stage.

Indeed, I should make it plain that when my right hon. Friend consulted the chairmen of the two committees concerned, both of them pointed out that there will be serious difficulties in drawing firm conclusions about the degree of risk now associated with whooping cough vaccine from the Committee on Safety of Medicines' study of the material, even when it is completed. Some of the cases go back many years, and, apart from the difficulty of distinguishing between coincidental brain damage and that associated with vaccination, the vaccine used in a proportion of cases has been superseded. Undoubtedly, the quality of whooping cough vaccine has been improved over the years, and research to this end, financed by my Department, is continuing. My hon. Friend referred to some of these difficulties in the Adjournment debate last year.

Now we have the national childhood encephalopathy study which has been in progress since 1976. This may give a more reliable assessment of risk. It is a study of current cases of neurological damage reported by paediatricians from which cases of vaccine damage may be distinguished. My right hon. Friend will be keeping in close touch with both committees to see that whatever new information emerges will be used to give the medical and nursing profession any advice that appears useful.

I hope that what I have said puts this matter in perspective. We are certainly not seeking to hide anything. Perhaps I can now briefly allude, although my hon. Friends will, of course, be well aware of it, to my right hon. Friend's statement on 9th May on payments for those seriously damaged by vaccination.

Miss Joan Lestor

I know that my hon. Friend wants to be fair, and I do not think that he is being dishonest. But what interests me is that I have all the figures here, given to me by his Department, for the number of notified whooping cough cases. What interests me is that my hon. Friend picks a year to contrast with this year to show that there is this tremendous difference. He quotes 2,000 cases. I could go right through the years and quote other figures—for example, 58,000 cases in 1960. The point I am making remains the same. All that he has said so far is really that we do not know.

If my hon. Friend says that in 1970 there were 2,000 cases—I believe that was the year—I have a figure of 2,000 cases for 1973 and just over 2,000 for the year before. He says that now there is this big increase. But throughout the whole period from 1947 it has ebbed and flowed, even when vaccination was at its height. This is the point that I am making. All my hon. Friend has said today, however, is that the Department still does not know. The thrust of my argument is that, if we do not know, what right have we to say to parents "Go ahead"?

Mr. Deakins

I disagree with my hon. Friend about the figures. The figures I quoted were for two successive years, not for 1970. If, in fact, there is a cycle—let us assume for a moment that there is—we still have a duty, if we believe in the efficacy of the vaccine, to warn parents about the dangers of an epidemic and to get their children vaccinated.

But I do not want to finish without reminding my hon. Friends of the scheme for payments. I shall not go into detail because my right hon. Friend made a full statement on 9th May. We hope that this scheme, which will give a lump sum of £10,000, tax-free, in respect of those who have, since 5th July 1948, been severely damaged by routine vaccination in the United Kingdom, will do something to help quickly and be of benefit to the small minority who have suffered for the general good of the community. Meanwhile, of course, the Government are studying urgently the other and wider recommendations of the Royal Commission on Civil Liability and Compensation for Personal Injury.

What my hon. Friends and I have said in the debate underlines the need for a sense of responsibility in all of us who put to public debate the issue of vaccination against infectious disease. It is right in any democracy to raise and discuss issues of this kind which affect so many families of ordinary people, but we should not ignore the dangers of arousing needless and unjustifiable fears which may defeat the object we are all trying to achieve—the health of the nation's children.

There has in recent years been a marked fall in the uptake of all forms of routine immunisation. We are fortunate to have two expert committees—the Committee on Safety of Medicines and the Joint Committee on Vaccination and Immunisation—which constantly monitor both the vaccines employed in public policy programmes and the diseases they are intended to prevent, and keep the balance of risks and benefits constantly under review.

That, after all, is all that even experts can do, let alone laymen like ourselves. Let us, therefore, lend all the support we can to re-establishing confidence in our immunisation programmes and to restoring the levels of protection we achieved for our children in earlier years.

Question put and agreed to.

Adjourned accordingly at twenty-nine minutes past Four o'clock till Tuesday 6th June, pursuant to the Order of the House of 24th May.