Some doctors are now recommending routine vaccination against chicken pox (varicella) - there is a suggestion that it might be combined with the (already controversial) MMR vaccine to produce MMRV [BBC News November 8th 2007].
Chicken pox killed six children in the UK and Irish Republic last year, and there were 112 cases involving severe complications. So there is certainly a risk. But is this risk high enough to warrant action? Each mass vaccination campaign has
- financial costs - could the same resources deployed elsewhere have delivered greater medical benefits to a greater number of people?
- medical side-effects - possible negative reactions to the vaccination itself in some children, reduced protection against related diseases such as shingles
- social costs - fear of side-effects (whether founded or unfounded) reducing the take-up of all vaccines, not just this one
But I have a more general concern. If this proposal makes sense, then it would make sense for every other infectious disease that kills a small number of people every year. Medical researchers think they understand the effect of a single vaccine on the human immune system, or even a compound vaccine such as MMR. But how would it be if a child never got ill, because every possible disease was preempted by vaccination? Would the immune system develop normally, or would it be weak from lack of exercise? Would new diseases emerge to fill the gap? Will medical research tell us the answers to these questions before it is too late?
Childhood disease involves some suffering, and a tiny risk of complications and even death, and most parents accept that. If I wanted to protect my children totally from any suffering or risk, then they wouldn't learn to cross the road or ride a bicycle or climb trees; they wouldn't be allowed to use the kettle or the toaster, or bathe in more than 3cm of water; and they certainly wouldn't have any contact with the opposite sex until they were at least 25 years old. This is of course ridiculous - I would be condemning them to a life-without-life.
While my heart goes out to those parents who have lost their children to childhood disease, I don't think the answer is to eliminate childhood disease altogether. It is a normal part of growing up: it develops the immune system, and equally importantly it develops confidence in the immune system. A child can feel poorly one week, with spots all over her face, and then be back at school the following week: this experience engenders a deep belief in your ability to recover, a belief that however bad you feel right now, you should feel better tomorrow.
What doesn't kill you makes you stronger.
UpdateThe Chief Executive of RoSPA (Royal Society for the Prevention of Accidents) made a similar point in his Annual Report recently.
"Rather than adopt the extremist protectionism of ‘cotton wool kids’ our argument is that a skinned knee or a twisted ankle in a challenging and exciting play environment is not just acceptable, it is a positive necessity in order to educate our children and to prepare them for a complex, dangerous world, in which healthy, robust activity is more a national need than ever before."