PEOPLE’S FRIENDSHIP UNIVERSITY OF RUSSIA

FACULTY OF MEDICINE
DEPARTMENT OF PUBLIC HEALTH AND HEALTH SERVICES

REFARAT
NAME OF TOPIC:
Vaccination in United Kingdom

Сura
tor- Deepankar Srigyan

Group- ML 511

MOSCOW 2008

1
Vaccinations are offered to all children to help prevent outbreaks and
epidemics of infectious diseases. Whilst the vaccinations aren’t
compulsory in the UK, medical professionals strongly advise that you
have your child vaccinated. The government recommends the following
immunisation schedule:
Vaccination calendar:
At birth
- Hepatitis B. Vaccine given: Hep B.

At 1 month
- Hepatitis B. Vaccine given: Hep B.

At 2 months
- Hepatitis B. Vaccine given: Hep B.
- Diptheria, tetanus, pertussis (whooping cough), polio, Haemophilus
influenzae type B. Vaccine given: DTaP/IPV/Hib.
- Pneumococcal infection. Vaccine given: PCV.

At 3 months
- Diptheria, tetanus, pertussis, polio, Haemophilus influenzae type b.
Vaccine given: DTaP/IPV/Hib.
- Meningitis C. Vaccine given: MenC.

At 4 months
- Diptheria, tetanus, pertussis, polio, Haemophilus influenzae type b.
Vaccine given: DTaP/IPV/Hib.
- Meningitis C. Vaccine given: MenC.
- Pneumococcal infection. Vaccine given: PCV.

Around 12 months
- Hepatitis B. Vaccine given: Hep B.
- Haemophilus influenza type b. Vaccine given: Hib.
- Meningitis C. Vaccine given: MenC.

Around 13 months
- Measles, mumps and rubella. Vaccine given: MMR.
- Pneumococcal infection. Vaccine given: PCV.

3 years and 4 months (or shortly after)

- Diphtheria, tetanus, pertussis and polio. Vaccine given: DTaP/IPV or
dTaP/IPV.
- Measles, mumps and rubella. Vaccine given: MMR.

Between 13 and 18 years

2
- Diphtheria, tetanus, polio. Vaccine given: Td/IPV.

Note
- The BCG vaccine to prevent TB (tuberculosis) is no longer routinely
given to children. It is now only recommended for children at high risk of
the disease (e.g. those living in areas with a high rate of TB or whose
parents or grandparents were born in a country where TB is highly
prevalent).
- Scares over the MMR vaccination have meant that some parents have
not had their children vaccinated against measles, mumps and rubella.
There have consequently been reported surges in the number of children
with measles. If you’re concerned about this vaccination, it’s possible to
obtain some of the vaccines individually and privately.

Effectiveness
Rubella fell sharply when immunization was introduced.
Mass vaccination campaigns were essential components of strategies
that led to the eradication of smallpox, which once killed as many as
every seventh child in Europe, and the near-eradication of polio. As a
more modest example, incidence of invasive disease with Haemophilus
influenzae, a major cause of bacterial meningitis and other serious
disease in children, has decreased by over 99% in the U.K. since the
introduction of a vaccine in 1988. Fully vaccinating all U.K. children born
in a given year from birth to adolescence saves an estimated 33,000 lives
and prevents an estimated 14 million infections.
Some vaccine critics claim that there have never been any benefits to
public health from vaccination.They argue that all the reduction of
communicable diseases which were rampant in conditions where
overcrowding, poor sanitation, almost non-existent hygiene and a yearly
period of very restricted diet existed, are reduced because of changes in
conditions excepting vaccination. Other critics argue that immunity given
by vaccines is only temporary and requires boosters, whereas those who
survive the disease become permanently immune. As discussed below,
the philosophies of some alternative medicine practitioners are
incompatible with the idea that vaccines are effective.
Children who survive diseases like diphtheria develop a natural immunity
that lasts longer than immunity developed via vaccination. Even though
the overall mortality rate is much lower with vaccination, the percentage
of adults protected against the disease may also be lower. Vaccination
critics argue that for diseases like diphtheria the extra risk to older or
weaker adults may outweigh the benefit of lowering the mortality rate
among the general population.
3
Population health
Lack of complete vaccine coverage increases the risk of disease for the
entire population, including those who have been vaccinated. One study
found that doubling the number of unvaccinated individuals would
increase the risk of measles in vaccinated children anywhere from 5–30%.
A second study provided evidence that the risk of measles and pertussis
increased in vaccinated children proportionally to the number of
unvaccinated individuals among them, again highlighting the evident
efficacy of widespread vaccine coverage for public health.
Cost-effectiveness
Commonly-used vaccines are a cost-effective and preventive way of
promoting health, compared to the treatment of acute or chronic disease.
In the U.K. during the year 2001, routine childhood immunizations against
seven diseases were estimated to save over $40 billion per birth-year
cohort in overall social costs including $10 billion in direct health costs,
and the societal benefit-cost ratio for these vaccinations was estimated to
be 16.5.
Events following reductions in vaccination
In several countries, reductions in the use of some vaccines were
followed by increases in the diseases' morbidity and mortality.According
to the Centers for Disease Control and Prevention, continued high levels
of vaccine coverage are necessary to prevent resurgence of diseases
which have been nearly eliminated.
Stockholm, smallpox (1873–74)
An anti-vaccination campaign motivated by religious objections, by
concerns about effectiveness, and by concerns about individual rights,
led to the vaccination rate in Stockholm dropping to just over 40%,
compared to about 90% elsewhere in Sweden. A major smallpox epidemic
then started in 1873. It led to a rise in vaccine uptake and an end of the
epidemic.
In a postwar poster the Ministry of Health urged British residents to
immunize children against diphtheria.
UK, DPT (1970s–80s)
A 1974 report ascribed 36 reactions to whooping cough (pertussis)
vaccine, a prominent public-health academic claimed that the vaccine
was only marginally effective and questioned whether its benefits
outweigh its risks, and extended television and press coverage caused a
scare. Vaccine uptake in the UK decreased from 81% to 31% and
4
pertussis epidemics followed, leading to deaths of some children.
Mainstream medical opinion continued to support the effectiveness and
safety of the vaccine; public confidence was restored after the publication
of a national reassessment of vaccine efficacy. Vaccine uptake then
increased to levels above 90% and disease incidence declined
dramatically.
Sweden, pertussis (1979–96)
In the vaccination moratorium period that occurred when Sweden
suspended vaccination against whooping cough (pertussis) from 1979 to
1996, 60% of the country's children contracted the potentially fatal
disease before the age of ten years; close medical monitoring kept the
death rate from whooping cough at about one per year. Pertussis
continues to be a major health problem in developing countries, where
mass vaccination is not practiced; the World Health Organization
estimates it caused 294,000 deaths in 2002.
Ireland, measles (2000)
As a result of the MMR vaccine controversy vaccination compliance
dropped sharply in the United Kingdom after 1996.From late 1999 until
the summer of 2000, there was a measles outbreak in North Dublin,
Ireland. At the time, the national immunization level had fallen below
80%, and in part of North Dublin the level was around 60%. There were
more than 100 hospital admissions from over 300 cases. Three children
died and several more were gravely ill, some requiring mechanical
ventilation to recover.
Nigeria, polio, measles, diphtheria (2001 onward)
Safety
Few deny the vast improvements vaccination has made to public health;
a more common concern is their safety. All vaccines may cause side
effects, and immunization safety is a real concern. Controversies in this
area revolve around the question of whether the risks of perceived
adverse events following immunization outweigh the benefits of
preventing adverse effects of common diseases.
Auto-immune disorders
Common childhood conditions such as fevers and middle ear infections
pose a much greater challenge to the immune system than vaccines do.
Because of changes in vaccine formulation, the fourteen vaccines given
to young U.K. children now contain fewer immunologic components than
the single smallpox dose given a century ago.
If individual or multiple vaccinations were to "weaken the immune
system", as some vaccine critics contend, then one would expect an
5
increase in hospitalizations for other infections following immunization. A
large epidemiological study, involving all 805,206 children born in
Denmark between 1990 and 2001, found no evidence that multiple-
antigen vaccines, nor the increasing number of vaccinations given to
children, led to a higher rate of infections.
Aluminum
Aluminum compounds are used as immunologic adjuvants to increase the
effectiveness of many vaccines. Although in some cases these
compounds have been associated with redness, itching, and low-grade
fever, and aluminum as such is considered neurotoxic for humans, its use
in vaccines has not been associated with serious adverse events.In some
cases aluminum-containing vaccines are associated with macrophagic
myofasciitis (MMF), localized microscopic lesions containing aluminum
salts that persist up to 8 years. However, recent case-controlled studies
have found no specific clinical symptoms in individuals with biopsies
showing MMF, and there is no evidence that aluminum-containing
vaccines are a serious health risk or justify changes to immunization
practice.
Thiomersal
Main article: Thiomersal controversy
The organic mercury content of thiomersal in child vaccines has been
alleged to contribute to autism, and thousands of parents in the United
States have pursued legal compensation from a federal fund.
In July 1999, the Centers for Disease Control (CDC) and the American
Academy of Pediatrics (AAP) asked vaccine makers to remove thiomersal
from vaccines as quickly as possible, and thiomersal has been phased out
of most U.S. and European vaccines. However, the 2004 Institute of
Medicine (IOM) panel favoured rejecting any causal relationship between
thiomersal-containing vaccines and autism.The CDC and the AAP followed
the precautionary principle, which assumes that there is no harm in
exercising caution even if it later turns out to be unwarranted, but their
1999 action sparked confusion and controversy that has diverted
attention and resources away from efforts to determine the causes of
autism. The current scientific consensus is that there is no convincing
scientific evidence that thiomersal causes or helps cause autism.
MMR vaccine
In the UK, the MMR vaccine was the subject of controversy after
publication of a 1998 paper by Andrew Wakefield, et al., reporting a study
of 12 children mostly with autism spectrum disorders with onset soon
after administration of the vaccine. During a 1998 press conference,

6
Wakefield suggested that giving children the vaccines in three separate
doses would be safer than a single vaccination. This suggestion was not
supported by the paper, and several subsequent peer-reviewed studies
have failed to show any association between the vaccine and autism.
Wakefield has been heavily criticized on scientific grounds and for
triggering a decline in vaccination rates, as well as on ethical grounds for
the way the research was conducted.
In 2004 the MMR-and-autism interpretation of the paper was formally
retracted by 10 of Wakefield's 12 co-authors.The CDC, the IOM of the
National Academy of Sciences, and the UK National Health Service have
all concluded that there is no evidence of a link between the MMR vaccine
and autism. A systematic review by the Cochrane Library concluded that
there is no credible link between the MMR vaccine and autism, that MMR
has prevented diseases that still carry a heavy burden of death and
complications, that the lack of confidence in MMR has damaged public
health, and that design and reporting of safety outcomes in MMR vaccine
studies are largely inadequate.
Prenatal infection
There is evidence that schizophrenia is associated with prenatal exposure
to rubella, influenza, and toxoplasmosis infection. For example, one study
found a seven-fold increased risk of schizophrenia when mothers were
exposed to influenza in the first trimester of gestation. This may have
public health implications, as strategies for preventing infection include
vaccination, antibiotics, and simple hygiene.When weighing the benefits
of protecting the woman and fetus from influenza against the potential
risk of vaccine-induced antibodies that could conceivably contribute to
schizophrenia, influenza vaccination for women of reproductive age still
makes sense, but it is not known whether vaccination during pregnancy
helps or harms.The CDC's Advisory Committee on Immunization
Practices, the American College of Obstetricians and Gynecologists, and
the American Academy of Family Physicians all recommend routine flu
shots for pregnant women, for several reasons:
• their risk for serious influenza-related medical complications during
the last two trimesters;
• their greater rates for flu-related hospitalizations compared to
nonpregnant women;
• the possible transfer of maternal anti-influenza antibodies to
children, protecting the children from the flu; and
• several studies that found no harm to pregnant women or their
children from the vaccinations.

7
Despite this recommendation, only 16% of healthy pregnant U.K. women
surveyed in 2005 had been vaccinated against the flu.
Individual liberty
Compulsory vaccination policies have provoked opposition at various
times from people who say that governments should not infringe on the
freedom of an individual to choose medications, even if the choice
increases the risk of disease to others.If a vaccination program
successfully reduces the disease threat, it may reduce the perceived risk
of disease enough so that an individual's optimal strategy is to refuse
vaccination at coverage levels below those optimal for the community.If
many exemptions are granted to mandatory vaccination rules, the
resulting free rider problem may cause loss of herd immunity,
substantially increasing risks even to vaccinated individuals.
Religion
Vaccination has been opposed on religious grounds ever since it was
introduced, even when vaccination is not compulsory. Early Christian
opponents argued that if God had decreed that someone should die of
smallpox, it would be a sin to thwart God's will via vaccination.Religious
opposition continues to the present day, on various grounds, raising
ethical difficulties when the number of unvaccinated children threatens
harm to the entire population.Many governments allow parents to opt out
of their children's otherwise-mandatory vaccinations for religious reasons;
some parents falsely claim religious beliefs to get vaccination
exemptions.
Alternative medicine
Many forms of alternative medicine are based on philosophies that
oppose vaccination and have practitioners who voice their opposition.
These include anthroposophy, some elements of the chiropractic
community, non-medically trained homoeopaths, and naturopaths.
Historically, chiropractic strongly opposed vaccination based on its belief
that all diseases were traceable to causes in the spine, and therefore
could not be affected by vaccines; Daniel D. Palmer, the founder of
chiropractic, wrote, "It is the very height of absurdity to strive to 'protect'
any person from smallpox or any other malady by inoculating them with a
filthy animal poison."Vaccination remains controversial within
chiropractic.Although most chiropractic writings on vaccination focus on
its negative aspects,antivaccination sentiment is espoused by what
appears to be a minority of chiropractors.The American Chiropractic
Association and the International Chiropractic Association support
individual exemptions to compulsory vaccination laws, and a 1995 survey
of U.S. chiropractors found that about a third believed there was no
scientific proof that immunization prevents disease.The Canadian
8
Chiropractic Association supports vaccination; a survey in Alberta in 2002
found that 25% of chiropractors advised patients for, and 27% against,
vaccinating themselves or their children.
Although most chiropractic colleges try to teach about vaccination
responsibly, several have faculty who seem to stress negative views.A
survey of a 1999–2000 cross section of students of Canadian Memorial
Chiropractic College, which does not formally teach antivaccination views,
reported that fourth-year students opposed vaccination more strongly
than first-years, with 29.4% of fourth-years opposing vaccination.
Several surveys have shown that some practitioners of homeopathy,
particularly homeopaths without any medical training, advise patients
against vaccination.For example, a survey of registered homeopaths in
Austria found that only 28% considered immunization to be an important
preventive measure, and 83% of homeopaths surveyed in Sydney,
Australia did not recommend vaccination.Many practitioners of
naturopathy also oppose vaccination.
Financial motives
For many vaccines, the financial risks for producers are great and market
returns are usually minimal.Critics state that the profit motive explains
why vaccination is required, and that vaccine makers cover up or
suppress information, or generate misinformation, about safety or
effectiveness.
Some vaccine critics allegedly have financial motives for criticizing
vaccines.Legal counsel and expert witnesses employed in anti-vaccine
cases may be motivated by profit.
Dispute resolution
The U.K. Vaccine Injury Compensation Program (VICP) was created to
provide a federal no-fault system for compensating vaccine-related
injuries or death. It was established after a scare in the 1980s over the
DPT vaccine: even though claims of side effects were later generally
discredited, large jury awards had been given to some claimants of DPT
vaccine injuries, and most DPT vaccine makers had ceased production.
Claims against vaccine manufacturers must be heard first in the vaccine
court.By 2008 the fund had paid out 2,114 awards totaling $1.7 billion.In
one autism-related case, the government conceded that the child had a
pre-existing mitochondrial disorder with autism-like symptoms
aggravated by simultaneous immunizations against nine diseases, two of
which contained thiomersal.Thousands more cases of autism-related
claims are pending before the court, and have not yet been resolved.
History

9
Edward Jenner
Religious arguments against inoculation were advanced even before the
work of Edward Jenner; for example, in a 1722 sermon entitled "The
Dangerous and Sinful Practice of Inoculation" the English theologian Rev.
Edward Massey argued that diseases are sent by God to punish sin and
that any attempt to prevent smallpox via inoculation is a "diabolical
operation". Some anti-vaccinationists still base their stance against
vaccination with reference to their religious beliefs.
After Jenner's work, vaccination became widespread in the United
Kingdom in the early 1800s.Variolation, which had preceded vaccination,
was banned in 1840 because of its greater risks. Public policy and
successive Vaccination Acts first encouraged vaccination and then made
it mandatory for all infants in 1853, with the highest penalty for refusal
being a prison sentence. This was a significant change in the relationship
between the British state and its citizens, and there was a public
backlash. After an 1867 law extended the requirement to age 14 years,
its opponents focused concern on infringement of individual freedom, and
eventually a 1898 law allowed for conscientious objection to compulsory
vaccination.
In the 19th century, the city of Leicester in the UK achieved a high level
of isolation of smallpox cases and great reduction in spread compared to
other areas. The mainstay of Leicester's approach to conquering smallpox
was to decline vaccination and put their public funds into sanitary
improvements.Bigg's account of the public health procedures in Leicester,
presented as evidence to the Royal Commission, refers to erysipelas, an
infection of the superficial tissues which was a complication of any
surgical procedure.
In the early 19th century, the anti-vaccination movement drew members
from across a wide range of society; more recently, it has been reduced
to a predominantly middle-class phenomenon.Arguments against
vaccines in the 21st century are often similar to those of 19th-century
anti-vaccinationists.
THE LITERATURE USED:
1. "Thimerosal in vaccines". Center for Biologics Evaluation and
Research, U.S. Food and Drug Administration (2007-09-06).
Retrieved on 2007-10-01.
2. Wolfe R, Sharp L (2002). "Anti-vaccinationists past and present".
BMJ 325 (7361): 430–2. doi:10.1136/bmj.325.7361.430. PMID
12193361,
http://bmj.bmjjournals.com/cgi/content/full/325/7361/430

10
3. Bonhoeffer J, Heininger U (2007). "Adverse events following
immunization: perception and evidence". Curr Opin Infect Dis 20 (3).
4. Retrieved from "http://en.wikipedia.org/wiki/Vaccine"

11