By Clare Murphy

Health reporter, BBC News

Vaccines have come a long way since the eighteenth century When the Princess of Wales put forward her children for inoculation, the procedure quickly caught on. The year was 1721, and her offspring received an early and sometimes fatal prophylaxis against smallpox - in which the pus from someone with the disease was smeared into a wound of the uninfected. By the end of that century a country doctor invented a method using lymph from an infected cow instead, providing the same level of protection while using a much milder form of the disease - and the word vaccination - from vacca for cow - was born. In 1850, the English authorities made immunisation compulsory, with fines and prison for those who refused to comply, and the first mass anti-vaccination campaign began. Vaccinations have long had the power to polarise. Me and you The nineteenth century campaigners were a diverse group who rallied against state intervention in family life, but such movements have transcended time and place. In the UK, recent campaigns have focused on the safety of the MMR vaccine amid suggestions of a link with autism, in the US the mercury used, while in Germany there are a number of organised groups hostile to vaccinations. MMR fears in UK led to rise in disease A 2005 mumps epidemic affected mainly teenagers too old to have received the MMR vaccine Health experts blamed a rubella epidemic in 1996 and the more gradual rise in measles on poor uptake of the MMR vaccine

The relationship between the state and the individual has always been an element of the antipathy to some vaccine programmes. But signing up to immunisation also asks the individual - and often a parent - to consider their role in the community as they decide whether their healthy child should be treated for a condition they may never get - and which may be mild even if they do. In the case of measles, "herd immunity" - when 95% of the population are immunised - is necessary if the vulnerable are to be protected. "We are certainly much more atomised, individuated, so we don't necessarily think of ourselves in terms of our community - although we shouldn't forget that the majority do support immunisation," says Dr Mike Fitzpatrick, a London GP who has written extensively on health fears. "But it's certainly true that nowadays we have a very skewed understanding of risk and danger, to the point where it can be very hard as a doctor to provide reassurance to a patient that their risks are very low. "And while I am all for people questioning authority, it's bizarre that we often reject the voice of science in favour of the purveyors of quackery." What's the problem? It is also widely acknowledged that immunisation programmes are a victim of their own success. Smallpox was eradicated by vaccination In the West, the long absence of many childhood diseases is taken for granted as debilitating and sometimes fatal diseases - including poliomyelitis, diphtheria, whooping cough, measles and meningitis - have either been eliminated or are very rare. But it is estimated that within the 53 countries of the WHO European region, more than 500,000 do not receive full immunisation and 32,000 die each year from vaccine preventable diseases. The WHO says access and cost is often the problem, but that there is apathy on the part of health professionals as well as parents who have never seen a case of such diseases. In some areas of the former Soviet bloc there is also general mistrust of authorities and the services - including immunisation - they provide. There are also the points at which fear of the vaccine becomes greater than fear of the disease, and no vaccine is without risk. The young girl who died last week after receiving the vaccine against the virus which causes cervical cancer is now known to have been killed by a malignant tumour in her chest. But the vaccine will cause a severe, life-threatening reaction in around one in a million, so at some point a young girl may well die. This however must be juxtaposed against the risks of the disease itself. In 2007, nearly 1,000 women died of cervical cancer. No more anger And we appear to have little trouble with fearing a vaccine for one condition while worrying that not enough is being done to develop another - concerns about the speed at which a swine flu vaccine could be delivered being a case in point. A recent WHO report noted the "conflicting pressures" on health services, dealing with claims that one vaccine is unsafe or inappropriate while facing criticism for not moving quickly enough to provide another. But the future, according to Professor Ray Spier, editor in chief of the journal Vaccine, is vaccines. "There will always be anxiety about what is new, and you can argue that anti-vaccine movements have had a role in improving the quality of what is offered. Of course there should be debate, it's just a shame that it so often ends up in sensationalism. "But I do want to see a prophylactic future. We shouldn't be dealing with disease after it happens, we should be working out how to prevent it in the first place. "From coughs to cancer, with anger and addiction in the mix - these are the ideas we need to engage with."



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