By Richard Hoey
The experts can't agree on whether under-fives should get the vaccine, so GPs should be allowed to simply provide it on request, argues Pulse editor Richard Hoey
I was having a conversation with a friend of mine at the weekend, about whether she ought to find some way of having her young child vaccinated against swine flu.
It's a question many GPs have faced from anxious parents too, and it's not an easy one to answer. In fact, it's impossible to give any sort of definitive answer, given the lack of consensus about the merits of a child vaccination campaign among the UK's finest brains in paediatric immunology.
We learned last week that the flu sub-group of the Joint Committee on Vaccination and Immunisation had recommended that GPs give all under-fives the vaccine, only to be overruled by the main committee.
Those experts apparently felt that the high rates of exposure to the H1N1 swine flu strain among children – 62% in London and 43% in other parts of England – rendered a national programme for those without risk factors unnecessary.
But their view can hardly be regarded as the final word either, given the criticism of it from some high-profile and apparently equally qualified experts, and the fact that the Government has asked the committee to think again for next year.
Then there's the clear disagreement between leaders of public health programmes in different parts of the country, with GPs in Bury for instance being told to stop their local campaign offering vaccination to all under-fives.
The truth is that number crunching and cost-effectiveness analysis can only tell us so much – and on this occasion, it has been unable to deliver a black and white answer about whether a universal campaign in young children was merited.
Some 15 children under 14 have died of flu-related illness so far, and 70 people between the ages of 15 and 64. Three quarters of them would have fallen in at-risk groups, so the number of deaths that could have been prevented by a universal child vaccine campaign is pretty small.
But that has to be set against the rarity of deaths from other causes among children, and those intangible factors that make a death of a young child such an unparalleled tragedy.
Initially of course the key question was one of priorities – with concern that every vaccine a GP provided to a healthy child under five would be one less to a patient in an at-risk group (with their 18-fold increased risk of dying from swine flu).
That's less of a worry now the Government has released millions of last year's swine flu vaccines, which ought to mean there is finally enough for everyone who wants one.
So back to my friend again – it was difficult to know how to respond to her question about whether to have her child vaccinated, but largely because Government policy has made it so difficult to give the right answer.
We are supposed to live in an era of patient choice, in which we encourage patients, and parents, to take an active role in decisions about healthcare.
Surely, given the lack of any consensus over whether to run universal campaign, it is ridiculously paternalistic of the Government to make itself the sole arbiter of whether a child should be vaccinated or not – even to the extent of closing down local vaccine programmes and placing barriers in the way of accessing the vaccine privately.
The most honest response to parents, given the uncertainty of the evidence and the availability of the old swine flu vaccine on the NHS, ought to be a simple one.
GPs should be allowed to say - it's up to you.
Richard Hoey, Pulse editor
