November 18, 2009

experts react to news of a survey in Pulse that half of GPs’ pregnant patients are declining the swine flu vaccine

The survey, published in the GP magazine Pulse, has raised awareness of the public’s concern over the safety of the vaccine, as well as the issue of what proportion of the public will take up the vaccine.

Prof Adam Finn, Professor of Paediatrics, Head of the Academic Unit of Child Health at Bristol Medical School, Director of the South West Medicines for Children Research Network and head of the Bristol Children’s Vaccine Centre, said:

“People being offered vaccines need to make individual decisions about this. Population-based statements like “the disease is mild” are of limited use to them. Generalisations like “the vaccines are untested” don’t help them either – obviously the vaccines have been tested and equally obviously there’s not been as much testing done on brand new vaccines that have been made over a few months as there has been on vaccines that have been around for years.

“Most pregnant women are not that bothered about whether or not they get a mild illness. They are concerned about whether they get a serious illness – especially one that poses a risk to their baby. Swine flu doesn’t usually do this, but it does occasionally and it is more likely to do this in pregnant women than in other healthy people – about 3 or 4 times more likely in fact. It might be easier if everyone forgot about all the mild and asymptomatic illness the swine flu virus often causes and we all agreed to call the occasional serious disease another name like “bad flu”.

At the moment there’s tons of “mild flu” and quite a lot of “bad flu” around. Every hospital, including ours, has several seriously sick people on their wards with this infection. The same thing is going on all over Europe. Overall, based on what we know about “bad flu” and the vaccines available, the risk to a woman who is pregnant – especially in late pregnancy – and her unborn child are very definitely in favour of getting the vaccine. In other words, if you wanted to make a rational decision that would minimise risk of anything “bad” right now, you would get vaccinated. This is because we know you are very unlikely to get “bad flu”, but much more unlikely to get any bad outcome from having the vaccine.

“Lots and lots of women will have to be immunised to prevent one case of “bad flu”. But if that one case is you, then it will have been the right decision for you. Whether the risks (and cost) of immunising all those women to prevent that one case add up is a problem for the public health doctors and the government. But for the individual pregnant woman it’s much easier. She doesn’t have to worry about all the small theoretical risks of giving vaccine to thousands or millions of women all added up. She only has to worry about the tiny theoretical risk of the vaccine to her and her baby balanced against the much larger (although still very small) real (not theoretical) risk of the infection.

“By the way, the same applies to “mild flu”. That is, you are fairly likely to have a mild but unpleasant flu illness due to this virus. You are less likely to get mild symptoms like fever, headache and pain from the vaccine and if you do, they won’t last as long. But you may not really care about this, it’s definitely less important to most people.

“Finally, if you have the vaccine, we know you are VERY likely to make lots of antibody to the virus which will stop you getting either “mild flu” or “bad flu” – but only if you get the vaccine at least a week or two before you get exposed to the infection. So it’s a kind of: “if you are going to do it, get on and do it now” situation.”

Prof Robert Dingwall, formerly Director, Institute for Science and Society, University of Nottingham, said:

“It is clear from various sources that quite a lot of GPs are not actually offering the encouragement and reassurance that pregnant women might reasonably expect to get when asking questions about the vaccination. This is carrying consumerist medicine and patient autonomy too far.

“Of course, no-one should be forced to be vaccinated. However, it is a failure of professional duty not to emphasise that there are no good reasons to be concerned about the safety of this vaccine, that there are small but real risks of fatal consequences for pregnant women and their unborn children from swine flu, and that it is not predictably a trivial illness among the age-group into which most pregnant women fall. Vaccination of mothers will probably also provide some protection for their babies for a period after birth, when they would otherwise be at risk of a very serious illness if they caught the flu. If women are making decisions based on poor information, GPs are not obliged to take these at face value: they shouldn’t remain neutral in the face of bad science, even if they have ultimately to accept their patients’ choices.”