The Spectator

Healthy debate

Healthy debate
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It is not hard to make the case that vaccination programmes have been one of the greatest contributions to mankind over the past century. It is sufficient simply to list the most common causes of death in 1915 of British children aged under five, in descending order: measles, bronchitis, whooping cough, diphtheria, tuberculosis, pneumonia, infective enteritis and scarlet fever. Few parents in Britain now have to undergo the trauma of nursing a child suffering from any of these conditions, still less of burying a child who has died from one.

That these diseases have receded into history is down entirely to advances in medicine and public health. We have a health service which methodically inoculates children against infectious diseases at clearly defined stages of their development, capturing all socioeconomic groups. Near-universal coverage is crucial, because if the overwhelming majority of a population is inoculated, it helps to promote the effect of ‘herd immunisation’ — meaning that even those few children who slip through the net and are not vaccinated will not be exposed to the disease.

All this has been known for decades. Yet for some people, the astonishing benefits of vaccination are a lesson which they seem determined not to learn. The ‘anti-vaxxer’ movement has instead managed to convince itself that vaccination is a form of oppressive government control over a country’s citizens. It is a deeply irresponsible falsehood being spread through social media and its effect can be traced in falling rates of take-up of the MMR vaccine and in rising numbers of measles cases: 259 in 2017, rising to 913 cases in the first ten months of last year. The number can be expected to rise. Just 87 per cent of British children have been vaccinated — below the level of 90 per cent that the World Health Organisation considers necessary for population-wide immunity.

But if there is a policy measure which would make this bad situation worse, it would be the one proposed by the health secretary, Matt Hancock, this week. He said that he is considering laws to make the spread of misinformation on vaccination a criminal offence, with social media firms ordered to eliminate such material from their sites or face prosecution. It is a staggering suggestion, showing a complete lack of understanding of the principles of free speech — let alone the likely effect of such censorship.

While many anti-vaxxers might be deranged conspiracy theorists, a great many are open to persuasion. Most of the information they read comes via the internet. Chatrooms show fairly simple questions. Why is it necessary to give the vaccinations after just a few months? Are single vaccinations safer than a combined jab? Given that so many of the diseases have been eradicated, why is vaccination necessary? Such questions have easy answers. But telling parents it is wrong — or even criminal — to query vaccination would be a gift to the conspiracy theorists.

It is repressive and wrong-headed to try to criminalise those who dissent from mainstream opinion, be it on science or anything else. And it is not hard to see where such laws could take us: to a situation in which genuine concerns over medical treatments could be silenced. Imagine if such laws had been in force in the 1950s and early 1960s when pregnant women with morning sickness were being given Thalidomide — a drug that was later found to stunt the growth of limbs in foetuses. Pharmaceutical companies might well be delighted if people expressing concern about their products were put under fear of prosecution, but it would hardly serve the rest of us.

As for the alleged link between MMR and autism, it did not bubble up from anti-government obsessives blogging from wooden cabins in backwoods Nebraska. The claims were first made in a respectable scientific journal, the Lancet, in 1998, by a then uncontroversial gastroenterologist, Andrew Wakefield. That it took over a decade finally to discredit his study is testament to how difficult it can often be to establish scientific proof on the safety of medical treatments. Should it really have been illegal to repeat the now debunked link between MMR and autism? For all the world knew in 1998, Wakefield could have been on to a genuine phenomenon, with implications for millions of children.

The best way to tackle misinformation is with information. Try to ban it, on the other hand, and you merely fuel the conspiracy theories, by making it appear that you have something to hide. Why not hand every new parent a leaflet explaining the history of vaccination, and how it has helped bring down the infant mortality rate from 140 per 1,000 live births in 1900 to just 3.8 today? Or answer the most common questions, and point to where people could learn more? As for autism, prevalence has indeed risen dramatically in recent decades, but there was no upwards shift coinciding with the introduction of MMR. The trend has a lot to do with better understanding of the condition, enabling far wider diagnosis.

Would anti-vaxxers still succeed in dissuading parents from inoculating their children if the health secretary and the NHS were themselves making a better defence of vaccination? It would be a lot more difficult for them to do so. Parents could see the facts for themselves, and make an informed decision. For vaccination to continue to save countless lives, there is no need for free speech to be suppressed.