I was 72 last week, which means I can only remember my parents’ anxiety every summer about regular outbreaks of polio in the UK. Several hundred children died each year. Many survivors needed long-term treatment in “iron lungs,” the first types of respirators, because their muscles were too weak to breathe on their own. Some permanent degree of paralysis was common. Later, a post-polio syndrome emerged as the aging process compromised the body’s adaptations to the damage caused by the infection. My generation includes victims of this virus. We take it very seriously.
Everything changed after 1956, when mass vaccination came to the UK. Although there were early safety concerns, improvements in design and manufacturing eliminated these risks. Polio vaccines have been used worldwide for 70 years to the point where the virus is nearly eradicated. The last UK case was in 1984 and Europe has been officially polio-free since 2002. The only outbreaks since then have been associated with migration from places where the virus continues to circulate, although some parts of Europe have undesirably low vaccination rates.
That is why there is so much concern about the situation in North London, where the polio virus, which lives in the intestine, has been detected in sewage at a community level. One type of vaccine uses a weakened virus that is shed for some time after vaccination. This can mutate back into a more dangerous form, which seems to have happened in London. The UK does not use this vaccine, which has advantages in other contexts that outweigh this risk.
London has long had much lower vaccination rates than the rest of the UK. Their ethnic mix means that many groups are not easily accessible by community health services because of their distinctive languages or cultures. Housing pressures mean that people move frequently and it is difficult to keep track of children to remind parents or carers about vaccination schedules. There are also challenges in recruiting and retaining staff in community health and primary care, because they experience the same difficulties in finding stable housing and maintaining an acceptable quality of life on the wages offered.
I saw the problems 50 years ago when I was researching with health visitors in what is now Docklands. But they have been exacerbated by pressure on local government and NHS funding over the past ten years, poor workforce planning and a failure to consider the collateral impacts of Covid.
Parents’ confidence in all vaccines appears to have been shaken by the controversy surrounding Covid-19 vaccines for children. The Joint Committee on Vaccination and Immunization was created in 1963 from an earlier group that advised on polio vaccines. Their work has kept British children safe for 60 years. But when it has been challenged with individual recommendations, as with whooping cough in the 1970s, MMR in the 1990s or Independent Sage on Covid-19, the effects appear to spread.
The system is not broken, but it needs serious fixing, if it is to protect the children of North London. Part of this relates to absolute levels of resources to support engagement with parents from diverse backgrounds in a way that matches their language and culture. More immediately, the NHS could stop diverting energies towards promoting Covid vaccines for children. JCVI has clearly stated that there is little to be gained from this except where there are strong clinical indications.
Why promote a vaccine for an infection that is generally mild in children over a vaccine for an infection that has devastating consequences for a significant proportion of its victims, including children? It is time to subject Covid interventions to the same cost, risk and benefit assessments that would be applied to any other health services activity.
Robert Dingwall is Professor of Sociology at Nottingham Trent University
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