Chicken pox. One of those “mild” childhood illnesses that most of us assume just has to be endured at some point. Sure, it itches like crazy, but what’s the big deal?
That’s how I saw it until two friends of my four-year-old son went down with it in the same month. They described the misery their children went through, the sleepless nights for all the family, the seemingly endless quarantine. And worse: it can put children in hospital, and occasionally even kill them.
As the dreaded varicella zoster virus seemed to creep ever closer to my son’s unprepared immune system, I wondered if there wasn’t a way to protect him. Presumably not, otherwise he would have already been immunized against it as he has been against measles, mumps and all the rest. But it turns out it’s not that simple. There is a vaccine; it’s safe, 90% effective, and standard practice in a whole host of other countries. In the US, its introduction reduced infections by 80 to 90 percent. But other than in exceptional cases, the NHS won’t allow its GPs to give it, even when patients offer to hand over good money for the privilege (I know, because I tried).
With my own GP’s full approval, I took my son along to the local travel clinic and had him immunized. He’s due another dose in a few weeks and then I will relax. The total cost will be £112; not a problem for me, but a lot of parents would find it hard to stump up that kind of money, even if they knew it was an option, which most of them don’t.
So why does the NHS have this seemingly perverse policy? A recent BBC article suggests it’s partly a matter of cost, which seems more than a little myopic, given the time many parents have to take off work when their children succumb. The NHS themselves say it’s because “experts think that introducing a chickenpox vaccination for children could increase the risk of shingles in older people.” In other words, your child is expected to undergo the misery of chicken pox in order to have the privilege of challenging the immune systems of the adults he or she comes in contact with because experts “think” this “could” stop some of them catching shingles. Sounds pretty dubious to me, not to say immoral. Our children are not consenting to be used in this way, and anyway, the same vaccine my son had can also be given to older people to protect them properly against shingles.
A clue to what may be the real reason comes from the fact that in the US, children are given an MMRV shot. That’s right: our familiar and newsworthy MMR vaccine, with added varicella (chicken pox) protection. That’s the way it would make sense to do it here, but do ministers have the courage to risk igniting another round of the MMR-autism controversy that caused such political embarrassment a few years ago? So far, it would seem not. Maybe it’s now time to make it more embarrassing for them to delay any further than to bite the bullet and do the right thing.
Follow the campaign on Twitter at @chickenpoxuk.
David Carter is a computer science researcher living in Cambridge. His son Thomas is four, and will tell anyone interested that his vaccination really didn’t hurt much.
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11 Comments
Do you happen to know the cost difference between a MMR jab and a MMRV jab?
Good question. I have been trying to find that out but no success yet. Presumably it would be a lot less for the NHS buying in bulk than for an individual though, and also much less than I paid for the varicella jab on its own!
Would any health professionals reading this like to give an estimate?
Do you think that NHS spending should be determined by rational cost/benefit analysis through NICE, or through the anecdotes of potential users?
In fact the NHS very clearly explain why they don’t offer the vaccine to everyone
http://www.nhs.uk/Conditions/varicella-vaccine/Pages/FAQs.aspx#routine
Why isn’t the chickenpox vaccination part of the routine childhood immunisation schedule?
Experts have been concerned that introducing chickenpox vaccination for children could increase the risks of shingles in older people. The advice has been to start with vaccination against shingles and then to think about chickenpox vaccination.
Shingles can be very damaging to the health of older people, as complications include:
chronic nerve pain
vision loss
infection of the brain (encephalitis)
Hello g,
I am a fan of cost/benefit analysis and in fact experience from countries where vaccination has been introduced is that it tends to be a net cost saving: the cost of vaccination is less than the money saved in medical consultations and hospitalizations, even ignoring the cost to the wider economy of parents taking time off work to look after children.
The problems with the NHS statement you quote (which I also referenced and quoted in my article) are different. First, using children to boost the immunity of adults is not only immoral, it is also relatively ineffective. It reduces their chance getting shingles by 25%, whereas a shingles vaccination (which I also support) reduces it by 50%, and eating a proper diet reduces it by two thirds. It’s not even clear that chicken pox vaccination would increase adult shingles; two of the three studies in the US since CP vaccination was introduced have shown no such effect, while shingles seems to be increasing some countries where CP vaccination isn’t used.
The shingles angle is explored in more detail at http://tinyurl.com/3omew8z — please do check it out.
David
It’s an interesting view point but I think some of the thinking is a bit wrong, I don’t think you can make this a morality issue and you really have to start at the other end of the spectrum.
You say that it is immoral for children to be used to boost the immune system of adults, (as a parent of young children I have lots of sympathy for that view point). Surely though, introducing a vaccine that will artificially boost the immune system of the young at the expense of the old is also immoral?
As shingles causes more medical problems than chickenpox, surely the “moral” thing to do would be to sort out funding for that first and then find the funding for a chicken pox vaccine?
Also, from what I’ve read, the MMR issue isn’t (or wasn’t) about political embarrasment. I believe the medical world was worried that MMR vaccinations were not back up to where they should be yet and they didn’t want to risk more controversy until that rate had recovered. Also they wanted to use what money they had for a new meningitis vaccine, I would guess (as I’m not medically trained) that would be more beneficial to most children. I have a feeling that ministers (from any party) will only ever do what the doctors say on these matters, so it’s a bit unfair to say that it is their cowardice preventing it from going ahead.
You would be much better off sticking to the cost/benefit argument when putting forward your case, but again you would also have to take into account other factors. As more people live longer it is likely that their children will end up providing care for them. In this scenario it is just as likely that the children have to take time of work to look after their parents, so in order to gain the full benefit you would still need to sort out the shingles issue first.
No vaccine is 100% safe! Long before the MMR scare there was the issue of faulty batches of Measles vaccines in the 1960s. My two sons and my niece were all vaccinated then – my sons were lucky, my niece was not – she suffered permanent brain-damage resulting from a febrile fit caused by complications after having been given the vaccine. She will never ever be able to lead an independent life and is totally dependent upon her parents for her care. She is now in her mid-40s – so to say that the Measles vaccine was 100% safe was wrong then and to say that similar vaccines are 100% safe is wrong now!
There are much more serous illnesses which need to have vaccines developed – meningitis is one of them. The ordinary childhood illnesses could and should be contracted so that a child’s natural immune system can develop. No-one would argue against vaccination against smallpox, diphtheria, TB, polio and other SERIOUS childhood ailments, but I do question the obsession with other vaccines developed in order to prevent children from contracting ordinary illnesses from which they will recover if treated in the normal way. I think probably Rubella vaccine is also a legitimate one as this disease can be very dangerous in its infective stages for women who are in the first trimester of their pregnancies – that can be justified because the infected person may not know they have it at its crucial stage.
If we continue to vaccinate against all known childhood diseases children will grow up with no natural immunities to anything and I find this very worrying.
Hello chris_sh,
All interesting points.
I see what you mean, but I stick by the morality argument. I think it’s wrong to sacrifice the interests of one group to another, especially when the first group is a vulnerable one like children, and when the benefits to the second are marginal. But actually, we don’t have to trade off childhood chicken pox against adult shingles, because as I said, there are more effective ways to combat the latter. We should certainly have a two-pronged approach, though I would rather see both prongs proceed together unless there’s clear evidence that the children should have to wait. Other countries got going with this years ago and Japan and the US now have many years of hindsight we can all benefit from.
You may be right that I am unfair to ministers over MMR(V) and if so I apologise to them, but when situations do arise where expert advice and public opinion conflict, we all know which way they tend to jump! It’s entirely possible that before too long the expert committee at the Department of Health will feel that MMRV is in principle the right thing (as some experts already do) but misplaced fears by a minority among the public will stop anything happening. Hence the need (I think) for a campaign to change perceptions.
Finally, it’s not really a matter of cost/benefit because US evidence shows the net cost is negative, over time anyway. The government should think of this as a great investment opportunity!
Thanks again for your thought-provoking comments. There is more on some of these issues in the campaign blog if you’re interested.
Living in Germany, our son has had the Varicella vaccine. It isn’t included in MMR- it’s administered separately.
David Carter,
Apologies for any brusqueness in my initial post, but I am very wary of arguments that place the layperson in control of NHS spending decisions at a treatment level. Healthcare decisions, unlike almost every other aspect of government, are strengthened when ideological and personal biases are stripped out given the underlying evidence base. There is a wealth of evidence avilable to healthcare professionals (and the wider public) on the cost effectiveness of various treatment and it is for the greatest benefit that these data are analysed as bias free as possible to ensure maximum benefit for cost.
Pensioner and g, apologies to you both for the delay in replying.
Pensioner, I’m very sorry to hear about your niece. What a tragic story. You are quite right, no vaccine is 100% safe. Mistakes can always be made. However I am not aware of any reported reactions to chicken pox vaccine that are anything like as bad as permanent brain damage. What I am aware of is serious consequences up to and including death resulting from catching the disease itself. The numbers are small, but nevertheless devastating for those they affect.
Yes, there are certainly more serious diseases than chicken pox, but it’s not a question of diverting research effort from other diseases — the vaccine already exists! And children’s immune systems will develop anyway — there are always plenty of microbes out there. Whether there are negative consequences of the kind you imply from the vaccination programmes in developed countries today is a question worth researching, but the benefits, for vaccination against many diseases including chicken pox, are well documented and quantified.
g, no offence taken! I couldn’t agree with you more that ideological and personal biases should be stripped out. Quantitative evidence is absolutely key, and I summarize some aspects of it (in amongst some personal stories, which I think are essential to get many people to take this issue seriously) as best I can in various posts here. One of the things shown fairly clearly in the evidence (from the US) is that varicella vaccination more than pays for itself — it’s a win-win, giving both a reduction in disease and a financial saving, hence there should be no need to play it off against other uses for the same money.
David
Please do remember that unless you are an immunologist, virologist or scientist in the field etc, then you may, may, just not have the right clinical judgement and expertise in making these ‘lay people’s’ comments. As far as I can see, we are awaiting further data on the developments in the countries that do vaccinate. We therefore await further clinical evidence to launch yet another vaccination programme. Strange that these countries have private based medicine and powerful pharmaceutical companies isn’t it? Wait for the joint committee on vaccinations to peer assess the evidence – that is until some lobbyist from a pharmaceutical company interfers in science perhaps!?