September 10, 2019 Not a time for sticks

The worm seems to have turned for Dr Lance O’Sullivan. The New Zealander of the Year in 2014 first rose to national prominence when he and his wife Tracy set up a general practice in Kaitaia, focused on providing care for those who weren’t getting it elsewhere, the poor and the apparently disadvantaged, followed by what might generally be described as the development of telemedicine.

Now the one time champion of the poor is copping it from all directions for his suggestion that parents who do not vaccinate their children should lose their welfare benefits or pay a higher rate of tax than those who do.

Not surprisingly, that suggestion hasn’t gone down especially well. More than 75 per cent of 2500 respondents to a Northland Age poll disagreed with him, and revealed the chasm that has developed between those who believe vaccination is a prime parental responsibility and those who believe it does more harm than good, that it is a parent’s choice, and even a conspiracy on the part of ‘Big Pharma’ and the medical profession.

There is even a theory that the measles ‘crisis’ is linked with naturopaths and “alternative medicine types.” At least our national paranoia seems to be in good shape.

Some see the concept of herd immunity, which, we are told, will be achieved when the vaccination rate reaches 95 per cent, as a myth, or a hoax. In any event we are still a long way short of that, despite a rush to vaccinate around the country over recent weeks, and given the strength of the anti-vaccination sentiment we may not reach that target any time soon.

There would be major problems with whacking parents who don’t vaccinate their children by depriving them of income, however. One poll respondent suggested that increasing poverty would no doubt lift the vaccination rate, but would be “rather like cutting a hole in a sinking boat to let the water out.” The suggestion also begs the question as to

where benefit-stripping and higher taxes would end. Should those who smoke tobacco, drink alcohol or succumb to obesity be punished in the same way?

That might well reduce the welfare bill, but what a complicated tax system we would have. And in any event, smokers and drinkers could quite rightly point out that they are already paying huge sums in tax for the privilege of indulging their addictions.

Last week Prime Minister Jacinda Ardern was sticking to her theory that talking nicely to people was the way to lift vaccination rates, which might be a little optimistic given the various reasons for eschewing vaccination that now abound, but really, is this a time for sticks rather than carrots? And do sticks ever work when it comes to public health issues? Unlikely.

Meanwhile it might be of some consolation that measles is not only on the comeback trail here in New Zealand. This ‘crisis’ seems to be a global phenomenon, to the point where the UK, and no doubt other countries, are, like New Zealand, reportedly at risk of losing their measles-free status.

Last week the NZ Herald quoted a vaccinologist who claimed that the outbreak in New Zealand was “predictable, entirely preventable, and the government were warned.” Responding to whatever warning was supposedly ignored would have relied upon us accepting the need to vaccinate en masse, however, and given the strength of feeling in some quarters against vaccination, that was probably not going to happen.

The Herald also told us that three strains of measles are edging this country towards what some are already describing as an epidemic. They came from Malaysia, Japan and the Philippines (where Northland’s cases originated) but the illness was becoming well-established in Thailand, Australia, Singapore, Afghanistan, the UK, China and Vietnam.

Given that is it very easily spread, and the degree to which air travel colludes with infectious diseases, this will undoubtedly become a truly global crisis, or epidemic.

Some of those who catch measles, particularly children and those whose health is already compromised in some way, will fall desperately ill. Some will die.

Nor are we alone in hosting a significant element of anti-vaccination sentiment, or what has been described in the UK as vaccination hesitancy. Whatever the rationale behind the fact that some people would rather allow their children to take their chances with the disease than trust the vaccination that will almost certainly spare them, there seems to be a significant level of belief that vaccinating is akin to Russian roulette, although this time around the theory that the measles vaccination can cause autism has yet to make an appearance.

The theory that there is a link between the MMR vaccination and autism has been thoroughly debunked, and was probably a very minor player in any anti-vaccination sentiment, however. More significant could be the belief that, prior to 1969, getting the measles was part of a child’s rite of passage. Kids got measles, mumps, chickenpox and whatever else, and in almost all cases survived unscathed. We used to hear stories of parents taking their children to ‘chickenpox parties,’ so their offspring would catch the disease from a youngster who already had it, and so get it over and done with.

Mind you, New Zealand children also used to get polio. The vaccination against that scourge was welcomed, not feared or derided.

Once upon a time parents might have had a more phlegmatic attitude towards life’s ills, and certainly an outbreak of measles would not have given rise to the near-panic we are seeing now. It is true though that measles can be nasty, and potentially fatal, and the writer doesn’t know whether the virus that is here now bears any resemblance to that which was common 50 years ago. There are now 21 recognised strains worldwide, the bad news being that there is still no specific treatment. The good news is that we can be effectively immunised.

For most who catch it the worst is over in about a week, but there can be complications, ranging from deafness, blindness and inflammation of the brain to bacterial pneumonia, hepatitis and heart problems.

And while some clearly don’t trust the vaccine, or the motives of the people who make, promote or administer it, the World Health Organisation estimates that it kills 2.6 million people every year.

What we don’t know is the degree to which declining vaccination rates in this country can be attributed to antivaccination sentiment or vaccination hesitancy, and how much is down to complacency. What it is not is a symptom of poverty, at least in this country. The vaccination, and its administration, are free for children. Money doesn’t come into it. And if those who are fundamentally opposed to vaccination are less than five per cent of the population, which hopefully they are, we can still achieve herd immunity, even if some believe that concept is a myth, or a conspiracy. Without resorting to sticks.