AS A card-carrying member of the middle class, I'm occasionally stung when it is used as a term of abuse. But I understand why it happens. The middle classes are good at planning, saving and making choices that protect and advance their families. If they take care of themselves while paying taxes so the Government can look after those who can't, then what's wrong with that? writes SARAH CAREY
Nothing until those people who think only of themselves, who prioritise independence over all other considerations and self-select the communities to whom they feel an obligation, succeed in damaging the greater good: the kind of people who choose not to vaccinate their children – the kind of people who give the middle classes a bad name.
Most people are responsible enough to get their children vaccinated against diseases like TB, polio and the trio of measles, mumps and rubella. About 90 per cent of people in 2008 did the right thing. In some areas like the midlands it’s 95 per cent but in others, such as the south and southeast, it’s as low as 87 per cent. We need a 95 per cent rate across the country. The result of our failure to achieve that is an outbreak of measles.
There were 165 cases last year compared to 55 for 2008. In Cork and Kerry, there were 53 cases in 2009 compared to just five in 2008. This outbreak is disproportionately affecting children in the Traveller community. In 2000, the last time there was a measles outbreak, three children died. Measles can cause permanent brain damage. It’s a deadly disease and I know what I’d do to sort it out. I’d stop relying on moral obligation as public health policy and make immunisation mandatory. I’d drag off all the kids to get their shots.
Sometimes choice has to be sacrificed on the altar of the greater good. It won’t of course, so therefore we have to rely on moral pressure. I don’t know why Travellers don’t have their children vaccinated but I’m depressingly familiar with the reasons why a small but sufficient minority of middle-class parents spare their children the jab.
It’s due to a series of fundamental misunderstandings. First, they believe that the MMR vaccine causes autism. Second, they think that measles and other such diseases aren’t all that serious. Finally, they think that vaccination is simply about protecting their child. The result is a parent who is badly informed, making a calculation they don’t understand, feeling entitled to take a risk with their personal property.
Doubts about the safety of the MMR vaccine first surfaced in 1998 when Dr Andrew Wakefield published a paper in the British medical journal, The Lancet, which was based on a study of 12 children with autism. He claimed that eight of them developed symptoms within days of receiving the vaccine and called for the immediate suspension of the “3-in-1” vaccine and its replacement by single vaccines.
His claims were immediately challenged by medical experts but the damage was done. The public health scare prompted a drop-off in vaccinations. Since 2004 the Sunday Times’s Brian Deer has exposed not just the bad science, but the poor ethics behind Wakefield’s work. Most of the children in Wakefield’s study were clients of a lawyer who was suing the manufacturers of the vaccine. Wakefield had patented a single vaccine so he had a vested interest in recommending its use. Just last Thursday, Britain’s General Medical Council found him guilty of 30 charges of unethical conduct. In April they’ll decide if the case renders him unfit to practise. The bottom line is this: no matter what rubbish you read on the internet, the MMR vaccine is safe. By coincidence, The Lancet formally withdrew the Wakefield article yesterday, saying it was retracting the paper from the published record. Some parents persist in believing that the vaccine is not safe, but measles is, so they choose measles. Dr Fiona Ryan from the HSE is reduced to pleading with parents to believe this is a serious disease. Most children will recover quite well, but some won’t. That’s why we immunise against it. It’s also why we immunise against TB, which also made a comeback recently in Cork and whooping cough. As one nurse remarked to me recently: “anyone who’s worried about an injection should go up to Crumlin and watch a three-month-old baby with whooping cough struggle to breathe”.
But still some parents insist that it’s their child and so their choice. This exposes the most fundamental error in thinking. Your child is strong, well-nourished and fit. Your child may recover well from mumps or measles. But it’s not about your child. It’s about the child with a weak heart; the baby too small to be immunised or your daughter’s baby. If she grows up, gets pregnant and contracts rubella, how will you feel when that poor baby is born with brain damage?
It’s about the Traveller’s child whose health is compromised by being born into a community with dreadful health outcomes and whose parents’ failure to engage with the public health system increases our obligation to build up herd immunity in order to protect the weak. Vaccination is not a health choice that an individual makes about themselves or their family. It is not about the individual but a responsibility to a human being you don’t even know. And just because you don’t know them, doesn’t mean they don’t matter to someone as much as your child does to you.