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The first casualty of a medical scare

MagazineDecember 1999 (Vol. 10 Issue 9)The first casualty of a medical scare

Meningitis is a rare disease of the lining of the brain which very occasionally can be fatal

Meningitis is a rare disease of the lining of the brain which very occasionally can be fatal. Despite its rarity, late last summer the British Department of Health (DoH) started a huge campaign against it. Every first year student, said the DoH, should be vaccinated before going up to university in September.

University authorities, parents and GPs were targeted; and, although the vaccine wasn't actually compulsory, the edict like tone of the call to vaccination led some universities to refuse admission to unvaccinated students.

So successful was the campaign that GPs ran out of supplies. They appeared to be horrified. "Students lives are being put at risk," they thundered. There were red faces at the DoH, as the press rounded on them for such a scandalous cock up. But that wasn't the whole story.

What the press didn't ask was: why the sudden vaccination drive in the first place? And, even from an orthodox medical standpoint, was it really necessary?

Had they looked at the Dept of Health's own most recent publication on the subject, they would have read the following: "Routine immunisation with meningococcal (ie, meningitis) vaccine is not recommended, as the overall risk of meningococcal disease is very low" (Immunisation against Infectious Diseases, Dept of Health, 1996). In fact, the usual practice is to issue meningitis vaccine only if an outbreak occurs, and then only in the immediate local area. As a recent scientific paper on meningitis observed: "Vaccination against Neisseria meningitidis (the meningitis bacterium) is not part of routine immunisation schemes in any country; instead, targeted vaccination of groups at the highest risk is recommended during outbreaks and epidemics" (Epidemiol Infect, 1995; 115: 411-8).

But there was no epidemic in Britain this September when the mass meningitis vaccination was due to begin. So why the unprecedented urgency to routinely vaccinate students? The ostensible reason was that students are a particularly vulnerable group; and indeed, over the years, there have been occasional outbreaks in universities. But never before has routine vaccination been proposed. So, again, why the campaign and why now?

The meningitis vaccine being offered to students was first developed over 20 years ago and most experts frankly don't think much of it. First, they say, it doesn't work on the very young, who are most at risk of meningitis, and second its claimed protective effects are relatively short lived. So, over the last few years, drug companies have been racing to develop new genetically engineered vaccines that could be targeted at the very young, where a need was perceived to exist (or more crudely, where there was a hole in the market).

As it happens, clinical trials of these new vaccines were coming to an end this summer, and, although there were no published reports of the findings, the preliminary results had been shown to the Dept of Health. In fact, this time last year, David Salisbury, the DoH's principal medical officer, had been crowing to the press about how "very exciting" the results of the trials were turning out to be (The Times, 9 September, 1998). As a result, soon afterwards, the DoH announced that they intended to bring forward their planned introduction of the new vaccines by a year, starting this October. So it was clear the writing was on the wall for the old vaccine and a year earlier than forecast.

This was the real background to the first nationwide meningitis vaccination campaign ever mounted by any Western country. The vaccine being offered to students was of course, you've guessed it the old obsolescent one. The timing was perfect. The infant vaccination programme was due to happen in September, so the students would mop up the last supplies of the old vaccine. A month later, the new vaccines would be rolled out but not for any students who might have missed out on the old one. "There are limited supplies of the new vaccines," a DoH spokesman told me, "so they are not being be offered to students, but to two, three, and four month old babies who really need them." Call me stupid, but wasn't it the students who really needed them?

This appears to be a carbon copy of the other vaccination scare overseen by the DoH in 1994. Then, the DoH claimed there was about to be a measles epidemic, and wanted all schoolchildren to receive the MR vaccine in November 1994.

But Dr Richard Nicholson of the Bulletin of Medical Ethics has suggested that there was no evidence of a measles epidemic.

Certainly, it was convenient. Earlier stocks of the MMR vaccine, routinely given to 15 month old babies, were about to lose their sell by date.

Two versions of the vaccine had been taken off the market because of possible dangers of the mumps portion of the jab and, as luck would have it, the forecast of the epidemic occurred just before these vaccines were to be consigned to the rubbish heap. The manufacturers removed the controversial mumps portion, and the government had an instant supply of vaccine for a nationwide immunisation programme.

As if this weren't bad enough, the latest evidence from their own experts shows for over half the potentially fatal cases of meningitis, the old vaccine doesn't work and neither does the new one (Public Health Laboratory Service press statement, 1st October 1999).

!ATony Edwards


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