Health: Why child vaccines may be a shot in the dark: Doubts are being expressed about the virtues of mass immunisation programmes, reports Tessa Thomas

A RECORD 91 per cent of babies were immunised against whooping cough and 93 per cent against measles in the last quarter of 1992, according to government statistics published last week. As a 15 to 20 per cent increase on 1989, that is a big step forward in child health care. Or is it?

With the number of vaccinations on the national programme rising, some health professionals and parents are beginning to question the virtues of mass routine vaccination. According to Andrew Lockie, a GP and homeopath, 'The questions now being asked are: is it wise to introduce live

viruses into the body, and could they compromise the immune

system?'

The national immunisation programme that has been in operation since the Fifties has dramatically reduced the number of cases of fatal and crippling childhood diseases and its merits have been widely accepted. But Dr Lockie believes that the relatively rare cases of serious adverse reaction point to something else which is also worrying. He thinks that the adverse-reaction cases - reports last September told of illness suffered by recipients of the measles, mumps and rubella vaccine and led to a decision by the Department of Health to stop using two makes of vaccine - are a reflection of more widespread reactions, which are mild but long- term and go unreported.

'It's evident that immunisation causes some mischief, but no one knows for how long and to what extent. What is clear to me is that I now see a lot of children who have suffered a series of minor ailments, such as ear infections and allergies, since being immunised,' Dr Lockie says.

Even supporters of immunisation acknowledge the limitations of current knowledge. The children's charity Action Research was founded on ground-breaking research into polio immunisation. Yet its director, Anne Luther, says: 'The long-term consequences of vaccination remain unproven one way or the other. As yet it's difficult to know how chronic symptoms can be quantified.'

Meanwhile, infants are being vaccinated at an ever younger age. The diphtheria, tetanus and whooping cough (DTP) vaccination, which until the end of 1989 was given between three and eleven months, is now given between two and four months. 'In a perfect world we would have vaccines that needed only one dose and could be given immediately after birth,' says David Salisbury, principal medical officer at the Department of Health.

The department has adopted the principle of 'herd immunity' in which the aim is to eradicate specific diseases among all groups, regardless of their vulnerability. Baby boys are therefore immunised against rubella. While the disease is trivial in children, in pregnant women it causes miscarriage and a wide range of abnormalities in the foetus. The less rubella there is in the 'herd', the less chance there is of a vulnerable pregnant woman being infected.

Last October, yet another child immunisation programme was launched, using the Hib vaccine to provide protection against meningitis. But some are now asking: how well can an immature immune system cope with the flood of foreign substances? A study carried out in 1991 at Oxford University showed that babies vaccinated younger had fewer antibodies against tetanus and diphtheria because the protective antibodies from the mother inhibited a full response by the infant to the vaccine. The reaction of the vaccine manufacturers has been to start developing a measles vaccine that will work independently of the mother's antibodies.

It is already clear that the new GP contracts, under which a doctor's pay increases in line with the percentage of patients in the practice who are vaccinated, has meant more pressure on parents to take their children for immunisation.

In the US, where critical voices are much more common, children are legally required to provide proof of immunity before starting school - even for those illnesses they have apparently already had. It is argued that as childhood illnesses can be misdiagnosed, it is better to be safe than sorry.

Much of the research into the long-term effects of childhood vaccination has been carried out in the US, and some of the most radical findings have been collated by What Doctors Don't Tell You, a British newsletter that brings together unpublicised medical information, in its new Vaccination Handbook. Its American editor, Lynne McTaggart, claims: 'The bottom line is that we don't know how effective or safe many vaccinations are. Quite apart from their many unacceptable side-effects, the level of immunity they provide is often unacceptably low.'

Studies at the Centers for Disease Control in Atlanta, Georgia, have shown that the new Hib vaccine, (which is used in the UK), is 74 per cent effective - a 10 per cent improvement on the old Hib vaccine, but still not as high as many people would expect.

Ms McTaggart also says the duration of immunity is of particular concern. Studies from the Children's Hospital in Vancouver, carried out by Aubrey Tingle, a paediatric immunologist, suggest that the rubella vaccination can last as little as five years. This has been confirmed by an Italian study, also reported in the Lancet, showing that 10 per cent of young women who had been vaccinated against rubella were infected during an outbreak by a 'wild strain' of the virus five years after their immunisation.

After numerous cases in which the 'live' oral polio vaccination was found to have caused the disease, the American government is considering reintroducing the inactivated injectable version. In the UK, the Department of Health advocates the live version on the basis that it deactivates any wild polio virus that reaches the gut, preventing it being excreted into the community, thus conferring community protection. The injectable vaccine acts only on the bloodstream, protecting the individual but not breaking the chain of infection. Lobbying by the Association of Parents of Vaccine Damaged Children has prompted an acknowledgement by Virginia Bottomley, the Secretary of State for Health, that the live vaccine is responsible for 50 per cent of recent new cases of polio. Between 1978 and 1991 there were 42 cases of polio, 18 of which followed vaccination and nine of which followed infection through contact with the vaccinated child.

What can anxious parents do as their baby approaches the first vaccination? First, they can get informed. Most sources will tell parents only which jabs a child needs, but What Doctors Don't Tell You (4 Wallace Road, London N1 2PG), and The Informed Parent (29 Greyhound Road, Sutton, Surrey SM1 4BY) provide a different view.

Parents should discuss with the GP any conditions a child may have that could mean a vaccination should not be given. A report commissioned by Action Research revealed that many GPs fail to pass on information to parents about this, or give conflicting advice.

For parents who decide that they do not wish a child to have a certain vaccine which is usually given along with others, vaccines are available separately - but not on the NHS, unless there is a clinical reason. Multiple vaccines are the biggest new development, as they cut delivery costs. One, being developed by Merieux, the world's largest supplier of childhood vaccines, incorporates DTP, polio, Hib, hepatitis A and B.

Traditionalists argue that the new scepticism has arisen only because there is less evidence of disease: people don't feel under threat, so their anxieties are focused on the side-effects of immunisation. Sceptics, such as the naturopath Leon Chaitow, reply that the 'decrease in infectious diseases only causes immunologists to turn to new pastures'.

As the pounds 44m British vaccine industry grows and research into risks develops, the debate is likely to continue well into the next century.

(Photograph omitted)