Offit vs Salisbury: Mock Battle of the Titans

Image: What if Male Avengers Posed Like Female Avengers? by Coelasquid

The following is a critique written by John Stone, the UK Editor of Age of Autism. John has written about two very recent articles contained in a regular feature of the British Medical Journal called Head to Head. This section is supposed to provide a place where two opposing viewpoints can each have their say on a medical issue for the purpose of balance and fairness. Since there are two articles involved, we have chosen to forego the plunger / Einstein rating and just go ahead with the critique. You can read David Salisbury’s ‘against’ compulsory vaccinattion viewpoint by clicking here and Paul Offit’s ‘for’ compulsory vaccination viewpoint by clicking here. We give full attribution to the British Medical Journal for these pages and present them here for research and critiquing purposes only.

Mock battle of the Titans: Offit and Salisbury dispute over compulsory vaccination in British Medical Journal

There’s always been a small lobby for mandatory vaccination in the UK. The last time it was brought up as a high profile public issue in 2009 – driven by former British Medical Association president Sir Alexander Macara –  it came to grief as 5 panellists on BBC TV’s Question Time declared that, though MMR was quite safe (of course as politicians and journalists, they had all carefully studied the science), they did not think it should be compulsory (perhaps also secretly reflecting, as well-informed citizens, on whether they really wanted their children or grandchildren to be forced to have it after all). The following year, a motion was defeated at the BMA in debate led by the GMC panel chairman at the Wakefield hearing, Surendra Kumar, who also of course sat on two licensing authority committees but had not disclosed that fact.

The ideological differences between the UK’s ‘immunisation’ supremo, David Salisbury, and the pope of vaccination, Paul Offit, are perhaps rather slight: Salisbury bought into Offit’s 10,000 vaccine doctrine , and so their current  head to head in BMJ is, of course, completely about tactics, and ensuring compliance over however many vaccines they want your child to have. As the exchange indicates Salisbury is fairly cautious about the politics of such a departure in the UK, as he might also be about the legal ramifications.

As the recent MMR case in Italy has shown, the main defence was not that MMR did not cause the injuries (including symptoms of autism) but that the parents, not the government were responsible as the vaccine was not mandatory .  Such a move might also lead to scrutiny of the United States National Childhood Vaccine Injury Act of 1986 and its consequences where, apart from anything else, billions of dollars have quietly been paid out in compensation. In contrast, compensation in the UK is derisory and is paid out on the whim of civil servants (most years now there are no payments at all).

Moreover, Salisbury’s greatest tool of compliance is the multivac (several vaccines given in one shot). Hence perhaps the kerfuffle over Andrew Wakefield’s suggestion for single vaccines instead of MMR in 1998. At the time, this was still an option for families on the UK programme. Wakefield’s call for single vaccines was the reason for their immediate withdrawal less than 6 months later.

In both 1998 and now – the multivac was the future, with the schedule gradually being ratcheted up, most often without any public discussion. The next instalment in the UK is likely to be a 6 in 1 vaccine which for the first time will include Hepatitis B administered in conjunction with a seventh vaccine – Meningitis C. The first of these shots will be given at two months of age.

Until now, and quite remarkably, our Joint Committee on Vaccination and Immunisation have resisted the introduction of an infant Hepatitis B vaccine, presumably on the reasonable grounds that only in very distinct and identifiable cases were infants at risk from the disease. Now, it just looks as if it will be tacked on to a product that everyone is expected to have . This replicates the situation in 1988 when giving a mumps vaccine to infants was against previous medical advice. One thing is clear, it was wrong to give Hep B before, so it is not clear why this product is now being developed in partnership with the NHS.

The other factor in the UK is that the possibility of suing the manufacturers if anything goes wrong is completely theoretical. While in principle it exists, it lies in the discretion of a highly politicised body, the Legal Services Commission, which even blocked a legal suit against Merck over Vioxx despite successful litigation in the US. The protection of the civil law is really only there for the very few people who can afford it.

The moral perhaps is that while we are being leant on in the UK by the Department of Health and the National Health Service to vaccinate our children, the risk is all ours, and that’s the way the British government needs it to remain. I certainly won’t be voting for mandatory vaccination in BMJ’s present poll, but my motives will be somewhat different from those of David Salisbury.