I welcome this debate in Government time on such an important topic as World Immunisation Week. It is just a wee bit tragic that it has been scheduled today, clashing with local government elections, and that therefore the Chamber is so empty when I am sure that many Members would have liked to have taken part.
This topic is of particular interest to me, and I am glad to see in the Chamber other members of the all-party group on vaccinations for all, which I chair. As the Secretary of State mentioned, the history of vaccines goes back long before Jenner to the Chinese empire. Indeed, it was common practice to carry out variolation in the Ottoman empire, too. There is documentation from travellers and the East India Company going back 100 years before Jenner.
At that time, smallpox epidemics were common and a third of people who caught it died. It is hard to get our heads around those numbers. Smallpox left survivors very scarred and damaged, and Jenner followed up the observation that milkmaids were noted for having beautiful skin. Of course there was the fallacy that milkmaids bathed in milk, and there is all the imagery of Cleopatra having bathed in milk, but it is simply that milkmaids tended to catch cowpox, which protected them from smallpox. The word “vaccine” comes from the Latin for “cow.”
Smallpox was declared eradicated across the world in 1980, and we are within touching distance of eradicating polio. Eradicating a disease from the world is an incredible achievement and could not be done using any tool other than vaccination.
The vaccinations for polio came in after five huge epidemics, which were visible here in the UK, between 1945 and 1960. Instead of about 500 or 600 young children a year being affected by polio, the figure went up to 5,000 or 6,000, with about 750 deaths. We got the Salk vaccine, the injectable vaccine described by the right hon. Member for North East Bedfordshire (Alistair Burt). I was not quite born when that vaccine came in, and I was lucky enough to get the Sabin oral sugar cube version. The oral vaccine had the huge advantage of being able to vaccinate large numbers of children very quickly and, because it was excreted in faeces, it spread protection within communities—it was an accelerated way of carrying out vaccination.
The Global Polio Eradication Initiative was established in 1988 and, as has been mentioned, the Rotary Club played a huge part in the UK. At that time, there were still 35,000 cases worldwide every year. Some 2.5 billion children were vaccinated under the programme, and at least 10 million cases of paralysis have been prevented.
Last year there were 35 cases and, as we have heard, they were predominantly in difficult areas on the border between Afghanistan and Pakistan, where a friend of mine worked for UNICEF for several years—the area is very challenging. The other area where we are not sure what is happening is northern Nigeria, because it is difficult to get data. There has always been this problem of warzones, of extreme poverty and even of communities that we hardly know exist.
The last case of wild polio in the UK was in 1984, and at that time we changed back from the oral vaccine to the injectable vaccine because it uses a dead strain that is not attenuated or weakened and cannot induce polio. As has been said, the UK can be proud of being the lead contributor to Gavi, the Vaccine Alliance, and to the global health fund—the UK is a big supporter of many of these programmes.
The last 10 years, which are being called the decade of vaccines, have seen at least 20 million lives saved, and vaccination is the single most successful health intervention ever. People will say that that is clean water, a civil engineering intervention that does bring health, but if we look at the returns and the lives saved, vaccination is even more successful.
The problem is that uptake is falling. We are lucky in Scotland to have managed to keep the uptake of childhood vaccinations above the World Health Organisation’s recommended level of 95%, which is critical to creating community protection for children who are very young, for babies who are only a few months old and are not yet vaccinated, and for those who are vulnerable for various reasons and cannot be vaccinated.
Unfortunately, the uptake of many childhood vaccines has dropped below 95% in England because of what is described as “vaccine hesitancy”. As has been mentioned, the UNICEF report refers to about half a million children in the UK being unvaccinated. That is a dangerously large pool of children and, now, of young people and perhaps even middle-aged adults who are exposed to catching these diseases.
People often put that down to the anti-vax campaign but, actually, Public Health England’s research suggests that the situation is much more complicated. When it surveyed parents, it found that only quite a small percentage had a strong anti-vaccination feeling. There are also issues of complacency and of access, which we need to tackle so that we shrink it down, as well as the need to tackle head on the fake news we see on social media.
There is complacency simply because vaccines are a victim of their own success. People do not see the awful impact of these conditions. As the right hon. Member for North East Bedfordshire mentioned, people think of measles as trivial, like a 24-hour flu—they have forgotten what it means. People do not see many cases of polio, but I remember it from my childhood. I was lucky enough to visit vaccination projects in Ethiopia with Results UK. When we pulled in to get petrol, we saw a young man, aged about 30, with obvious flaccid paralysis from polio, and it hit me between the eyes that
that is something that we do not see. If people saw the results of polio, they would never think of withholding the vaccine from their children.
We think that there are not great risks from infectious diseases and that antibiotics will treat them, but air travel brings the risk of pandemics. The Secretary of State mentioned Ebola, and when we had a huge Ebola outbreak a few years ago, work was started on a vaccine that has been used to prevent recent outbreaks from reaching the levels we saw in Sierra Leone five or six years ago.
It is important that we realise that antibiotics are not a solution. They do not work on viruses. The only option to prevent dangerous viruses is to use vaccines, and there is also increasing antibiotic resistance.
On access, as the shadow Secretary of State mentioned, across the world we are patting ourselves on the back for the fact that in poorer countries 85% of children are getting the basic vaccines. However, we have stalled—the figure is not climbing and has been at that level for a long time. When the all-party group produced its report on vaccination for all in the developing world, I was shocked to find that only 7% of children in such countries are given the full World Health Organisation 11 vaccines.
As global players prepare their next strategies and funding plans, and with the eradication of polio on the horizon, this is a time to step back and think about how we are going to help, across the world, to eliminate more of these diseases. We need to aim for the fully immunised child. We need to come up with strategies to deal with remote areas and warzones, and research is a crucial part of that. It is brilliant to read that the trial of a new malaria vaccine is beginning in Malawi. It is expected to be only 40% successful, which is quite weak for a vaccine. However, malaria is so widespread that it causes more than 400,000 deaths a year, so making 40% of children immune to it will, along with the other manoeuvres and actions being undertaken, such as the use of nets and anti-mosquito treatments, help to bring that number of deaths down.
We face access issues here in the UK. A busy parent may have several children and although the first baby may get all its immunisations, the second and third might not. That can be an issue in some of the religious communities which tend to have large families. Someone who is having their seventh, eighth or ninth baby may struggle to look after the others and get the new baby to its vaccinations. These people need easy access to their GP, nurse or health visitor, and those people need to have time to answer parents’ concerns. We are talking about one of the first big decisions a parent will make about their child and they are seeing all this swilling anti-vaccine rhetoric on social media. They need to be able to ask questions, and then not to be patronised or dismissed, but to have their questions answered.
Although uptake in Scotland is high, at above 95%, when we drill down into the situation, we also see variations in areas of deprivation, and in religious and cultural communities. We are therefore not complacent, and Scotland is embarking on a vaccination transformation programme, because keeping the rate high, and indeed improving it, will require concerted action. Sometimes this is about policy decisions. When the meningitis ACWY vaccine was introduced for 14-year-olds at school,
Scotland carried out a four-year catch-up, immunising 14 to 18-year-olds, whereas Wales did a two-year catch-up. Sadly, the advice in England was that teenagers, young adults and university students could go to see their GP. At a recent event, it was reported to me that uptake was only 40%—after all, how often are teenagers at their GP? This is not a concerted way to proceed. I do not know whether the decision was based on cost, but analysis of the cost-effectiveness of vaccines shows that they are so cost-effective as to justify any process that will actually raise uptake, even home visits to try to help a busy mother to get her babies vaccinated.
The third thing to mention is the anti-vax campaigns. As I say, Public Health England surveys suggest that we are talking about a relatively small proportion of people, and the situation does seem largely to stem from the MMR—measles, mumps and rubella—vaccine. The vaccine is 97% effective, but uptake fell dramatically after Andrew Wakefield’s paper in 1998. He has since been struck off the medical register and his research was completely discredited, yet he is being given a platform in the US again as President Trump is promoting this in America. While uptake has improved, a cohort of teenagers were not given the MMR vaccine when they were babies and they are particularly vulnerable.
As Members have heard, people think that measles is trivial, like a 24-hour flu, yet 2.5 million people died from it in 1980. The figure came down to 73,000, its lowest point, in 2014, but last year the number of worldwide deaths from measles had increased to 110,000. Sadly this year, by only 2 May, 112,000 young people worldwide have lost their lives to measles. It is literally the most contagious disease, and if there is a local outbreak, 90% of unvaccinated people will get infected—it is unavoidable. People are incredibly infectious before there is a rash and the disease is spread simply in the air. During a recent outbreak in America, it was found that patient zero had infected more than 40 people before he even knew he had measles. Last year, we saw 82,000 cases in Europe and 72 deaths. There will a similar number of encephalitis cases, as was mentioned by the former Minister, the right hon. Member for North East Bedfordshire. The disease leaves children with brain damage, and it can leave them blind and deaf. Those are not minor sequelae, but life-threatening things.
In England, thankfully, there have not been any recent deaths due to the disease, but whereas in 2017 there were 259 cases, that had increased nearly fourfold to almost 1,000 last year. In Scotland, we had only two cases, and they involved people who had been travelling outwith the UK. That did not start an outbreak, because we had 97% uptake of the vaccine, so community protection was in place and there was no opportunity for the disease to spread. Community protection is crucial. I know that people use the term “herd immunity”, which sounds awful, because it sounds like animals, but we are talking about community protection that allows us to protect our babies under one year old and our most vulnerable.
Even the uptake of the meningitis vaccine, something parents were campaigning for in this House just two years ago, is now only at 92.5% in England. Parents have an image of meningitis. They may know people who have had it and they will certainly have seen the appalling photographs of a child who is dying of meningitis and meningitis sepsis. In Scotland, the uptake is still at almost 96%, but we face the same issues of anti-vax
sentiment; for many vaccines, we also see a drifting down of a few points every year. We cannot allow that to become critical, so we need open dialogue with parents. We must not push their concerns under the carpet, as that simply breeds a greater sense of conspiracy and leaves them open to these terrible social media campaigns.
Just two years ago, the O’Neill report on antibiotic resistance highlighted how crucial antibiotics will be in the future in fighting antibiotic resistance. At the moment antibiotic resistance causes 700,000 a year, but it is estimated that we will have 10 million a year if we reach a truly post-antibiotic world. As a surgeon, I can tell the House that many procedures simply cannot be carried out if we do not have the ability to protect with antibiotics.
Most antibiotics have a lifespan from development to resistance of less than 10 years—the longest have a lifespan of less than 20 years before we see resistance—yet we are using vaccines that are 70 or 90 years old and do not have resistance. It is crucial that we tackle this anti-vax idea if we are ever to tackle antibiotic resistance. This is particularly the case for respiratory infections, because that is where the greatest use of antibiotics is. There are three ways in which vaccines will help us on this. The first is simply by preventing a drug-resistant infection in the first place. Secondly, they will also prevent the secondary infections from viruses and other conditions, where, again, we are using antibiotics. Thirdly, they will help in respect of viruses, where antibiotics are not going to work in the first place. It is important to realise that vaccines are absolutely central to that battle.
We now see vaccines preventing cancer. A study in Scotland looked at the effect of HPV, partly because we had such good uptake of the HPV bivalent vaccine, and also because our cervical screening started at 20. That study has shown an 85% reduction in precancerous changes on the cervix, which means we are on the road to seeing a really dramatic fall in cervical cancer. Having watched one of my friends lose her daughter to cervical cancer at 28 just a few years ago, I know that eliminating that disease is worth it in its own right.
We will be moving on to directing vaccines against cancer itself, and there is huge potential in vaccines to be realised as we tackle other diseases and scourges, such as multi-drug-resistant TB, but we will realise that potential only if we can tackle the anti-vaccination campaign and re-establish real confidence among parents, not just here but around the world.
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