‘Vaccination is not above serious debate, and it is sceptics – as distinct from anti-vaxxers – who drive medical progress’
At the time of writing, an effective vaccine against COVID-19 remains elusive. It is possible that one will be available soon, and probable that it will be the catalyst for further debate around vaccination and its related scientific and ethical issues.
The health benefits conferred by vaccination are undeniable. For example, Olshansky and Hayflick (2017) reported how the diploid cell strain WI-38 – derived from a human fetal lung taken following a surgical abortion (Hayflick, 1965) – had treated or averted 4.5 billion cases of poliomyelitis, measles, mumps, rubella, chicken pox, shingles, adenovirus, rabies and hepatitis A infections worldwide, saving 10.3 million lives.
However, Professor Leonard Hayflick's contribution to global public health was condemned as evil by the Pontifical Academy for Life (2005), as were those who prepared, marketed, and used aborted tissue-derived vaccines for health reasons. Similarly, when Ahmed et al (2018) reported a sharp increase in the number of vaccine-preventable diseases, such as polio, diphtheria, measles, tetanus and pertussis, in Muslim-majority countries, they cited ‘a celebrity singer with a huge following in Malaysia and Indonesia [who] openly declared his support for an anti-vaccination stance, posting “Allah is all powerful, vaccines have no power” on social media’.
These examples illustrate the ease with which dogma can compromise public health, and they invite reflection on Howard Jacobson's observation in The Dog's Last Walk (2017), where he ponders ‘the absurdity of giving principle precedence over the humanity which principle exists to serve’. In this context, Peters et al (2018) are correct to assert that ‘the anti-vaccine movement is characterised by irrational speculations and exaggerations related to vaccine outcome’.
However, there is another narrative, which, in my view, risks throwing out the baby of scientific enquiry with the anti-vaccination bathwater. For example, the first sentence of a report by the House of Commons Science and Technology Committee (2018) states: ‘Selective non-publication of the results of research distorts the published evidence base and is a threat to research integrity’. The report cites the warning of Dr Ben Goldacre, that the public are increasingly aware that a lack of transparency includes the withholding of trial results, and that failure to address such challenges provides ‘fertile ground for quacks, anti-vaccination conspiracy theorists, and climate change denialists’.
I accept this argument. But does it necessarily follow that I should also accept that Jørgensen et al (2018) are ‘anti-vaccination conspiracy theorists’ because their evaluation of a Cochrane human papilloma virus vaccine review by Arbyn et al (2018) considered it to be ‘incomplete and ignored important evidence of bias’? The evidence-based contribution of Jørgensen et al (2018) raises legitimate points for scrutiny. For example, whereas the Cochrane review by Arbyn et al (2018) included 26 randomised trials, Jørgensen et al (2018) identified 46 trials that met Cochrane inclusion criteria. In their 30-page rebuttal on behalf of Cochrane, Tovey and Soares-Weiser (2018) regret such debates occurring in public: ‘There is already a formidable and growing anti-vaccination lobby. If the result of this controversy is reduced uptake of the vaccine among young women, this has the potential to lead to women suffering and dying unnecessarily from cervical cancer.’
The House of Commons Science and Technology Committee (2018) are rightly concerned about ‘selective non-publication’ of research results, and Dr Ben Goldacre fears that this might allow anti-vaccination theorists to advance views that are not evidence-based. But their assertions do not appear to consider that there are some who question the findings of vaccine researchers in a spirit of genuine scientific enquiry; some who are not motivated by prejudice against vaccination but wish to apply evidence-based principles in a search for truth.
It seems to me that some health professionals consider certain concepts to be too difficult for the public to grasp. But the public is composed of individuals, many of whom have common sense and can read without moving their lips. Vaccination is not above serious debate, and it is sceptics – who are distinct from anti-vaxxers – who drive medical progress.
Science is more than a simple fact-finding operation, and it is perhaps worth noting philosopher Mary Midgley's observation: ‘Views about facts never stand alone. They are always shaped by background world-pictures which are often scarcely noticed’ (Midgley, 1992).