Sunday, 10 June 2012

Thin end?

One recent story that doesn’t seem to have generated much interest is the recent recommendation by the Joint Committee on Vaccination & Immunisation that all children should be regularly vaccinated against flu. The rationale is that this would help prevent flu moving through the population as a whole.

Unsurprisingly this has caused a lot of the anti vaccine campaigners a fit of apoplexy. If you look up their various blogs & websites, which I’m not going to link to, you can find a level of rabid irrationality which is quite entertaining. I’m not going to spend time here dissembling their incoherent and ill informed rantings. Other bloggers out there do this far better than I could.

What is worrying is that, if you read the comments to the article, it is apparent that there are more than just a few people out there who have very odd and ignorant ideas about vaccination. As just one example one commenter seems to believe that tuberculosis is a disease of the past. If you want to spend a little time having your faith in human intelligence steadily eroded just have a good read of the comments.

But I do have one tiny reservation about these recommendations. Vaccinations against diseases other than flu are primarily promoted as being beneficial to the individual patient vaccinated. There is obviously a public health benefit too, but this is secondary. This is the very first time that I have heard of, of a vaccination programme being recommended primarily as a public health measure. Which means that the benefit to the individual patient has been placed as a secondary consideration. And that’s what bothers me just a little bit. 


  1. Dr Z - Dr No agrees that we are right to be 'bothered just a little bit' about making individual benefit secondary to public health benefit, but it is not a first. The same thin ended wedge is common feature of the arguments advanced by public health goons and those who uncritically accept their crackpot notions. The most recent example is of course alcohol, in which minimum pricing is said to be reduce average consumption (in those whose consumption is not a problem) in the ludicrous expectation, based on Rose's deviant population/deviant individual fancy, that those whose consumption is a problem will reduce their consumption.

    The principle of the primacy of public (as opposed to individual) benefit is also evident in mass prescribing for primary prevention, for example statins.

    Nor, of course, should we forget that eugenics and policies like the German T4 programme were at heart based on the same principle - it is not individuals that matter, but populations.

    So the idea of coercing individuals to accept something so that others may (allegedly) benefit is nothing new. There are of course times when it does make some sort of sense (usually when the individual may also derive some potential benefit - most vaccination programmes fit this pattern) but more generally the road to forcing individuals to accept X so Y can benefit is a bendy road of reverse cambers and oil slicks.

  2. I live in an area where many people are from overseas families and many go to visit relatives whenever they can afford it. They bring back drug-resistant TB and other nasties and pass them on.

    When people won't get TB jabs, I think of the people with compromised immune systems who can't get the jabs but are less and less protected by herd immunity.

    Jabs don't kill, TB does.

    Ah, but flu, that's just a bit unpleasant, isn't it? Not for the 4000 people who died of it in the UK last year. But 4000 people don't matter, do they?

    So I'm with you on this one, doctor.

  3. Call me cynical, but there's a whiff of a money generating exercise about this one. More people being required to get flu jabs = more stores of flu vaccine being required = more profit for someone. Swine flu anyone?

    Dr No, I disagree with you about minimum pricing, but I will write a more detailed argument about why that is on my blog.

  4. Jukie - The only time DN was wrong was when he said he wasn't always right(!). Minimum unit pricing will cause blowback on a monumental scale and here DN is talking of more than gastroenteric effects. He has posted on the matter more than once, the most recent post being Gluganomics.

    Of course, anyone who has been wrong once can be wrong again(!), so DN looks forward to your post which, coming as it does from someone placed in a country said to have a serious alcohol problem and indeed most likely to introduce MUP first, will be pertinent, and knowing you, considered and well-reasoned. We need to have this debate, lest well-meaning but misguided enthusiasts propel a bad policy into practice.