§ The Secretary of State for Social Services (Mr. David Ennals)
With permission, Mr. Speaker, I will now answer Question No. 9.
1228 There has been much public concern expressed, in the House and in the media, about the risk of brain damage caused by whooping cough vaccination. In making this statement on behalf of all the Health Ministers, I want to express our sincere sympathy to the families of the small number of children who may over the years have been damaged by vaccination. No amount of money can put right this damage.
What we can do is to ensure that the best medical help is given to the children, and that their parents are helped to bear the additional burdens. We are doing all we can under the present law to make things easier for them financially. A wide range of services and benefits is available under the National Health Service, personal social services, the social security system and the Family Fund which was extended in 1974 to help families in which there is a severely handicapped child.
I recognise the pressure on me to provide compensation for vaccine-damaged children over and above the help that we provide at present, and I understand the strong feelings that have been aroused on this issue. In fact, the Standing Medical Advisory Committee in its evidence to the Royal Commission on Civil Liability and Compensation for Personal Injury recognised that there was a reasonable case for paying compensation where vaccination was proved as the cause of damage. But this is by no means the only case where medical action can cause unforeseen damage or where Governments have urged people to use some particular part of the Health Service. That is why I cannot consider the claims for vaccine-damaged children in isolation. The Royal Commission is considering this whole field, and it would be wrong for me to pre-empt its report, which I understand is expected later this year.
I share the widespread concern for the children who may have been damaged. I hope the House will also share my concern at the alarming drop of 25 to 30 per cent. in the number of vaccinations for diphtheria, tetanus and poliomyelitis over the last three years, and the even steeper fall of nearly 60 per cent. in whooping cough vaccinations. The figures I am circulating in the Official Report will show that immunisation and vaccination have dramatically 1229 improved child health in the past 40 years, but much of the gain could be lost if parents stop worrying about the dangers of diseases which have almost been wiped out by the very success of the vaccination programme, or if they fail to give protection to their children because of fears about serious side-effects.
Although there is a small risk of brain damage from whooping cough vaccination, I am advised by the Joint Committee on Vaccination and Immunisation, chaired by Professor Sir Charles Stuart-Harris, in whom I have complete confidence, that the policy of offering whooping cough vaccine for babies should not be changed because the gains greatly outweigh the risks. Whooping cough itself is a dangerous disease. It can lead not only to brain damage but to permanent lung damage and even death. There were, in fact, 4,000 cases and four deaths last year. The Joint Committee also advises doctors that where, in individual cases, there are indications against whooping cough vaccine it should not be administered. In these cases, I urge parents not to turn their backs on vaccination against other diseases without first seeking the advice of their family doctors. Older parents will remember the days when polio and diphtheria swept across Britain. Those days must never return.
The vaccination programme will continue. But I am determined to ensure that the risks of damage are reduced to the absolute minimum. The Joint Committee has clearly stated the circumstances in which whooping cough vaccination is inadvisable, and information has been given to doctors on a number of occasions, as detailed in material I am circulating in the Official Report. But, so that there can be no doubt in anyone's mind on this, I am arranging for the most up-to-date information on contra-indications to be sent again to all doctors and the nurses who work with them. I am also considering what more can be done to improve liaison between family doctors and clinics so that all those administering vaccine are fully aware of contra-indications in individual cases.
I firmly believe that the public should be aware both of the general benefits and the hazards of vaccination, 1230 and I wish to help doctors and nurses in their task of providing information and discussing the issues with parents. To assist them the Health Education Council has been providing a leaflet. This was revised in 1975, but together with the Joint Committee I am arranging for the urgent preparation of a new and more detailed version.
The Joint Committe has access to all the available medical and scientific knowledge, including information from the Adverse Reactions Sub-Committee of the Committee on Safety of Medicines. I am reminding doctors to pay particular attention to the need to report to the Sub-Committee any damage attributed to vaccine. To ensure that nothing is overlooked I am asking the Committee on Safety of Medicines to arrange for the examination of any information assembled by the Association of Parents of Vaccine-Damaged Children which the Association considers has not already been assessed.
I realise that this has been an anxious time for parents of young children who now have to make a decision about whether to have their child vaccinated. I hope that my statement this afternoon will help them to reach a decision on this difficult matter. I hope that such parents will be better able to understand the circumstances in which vaccination against whooping cough is inadvisable. But I hope, too, that they will appreciate that in the vast majority of cases the benefits of vaccination far outweigh the risks. I am sure that the House will agree that vaccination programmes play a vital part in protecting our children's health.
§ Mr. Ashley
Is the Minister aware that I welcome the improved procedures but believe that in view of the clear conflict of medical opinion over whooping cough vaccine, public anxiety will not be allayed by ministerial statements? Should not an independent inquiry be held into the efficacy and safety of whooping cough vaccine, as distinct from the inquiry that is being conducted by the Ombudsman into the matter of maladministration? Is he aware that his statement does nothing for the children who are already blinded, deafened or paralysed by these vaccines? Is it not absolutely intolerable that the Minister should wait for the 1231 Royal Commission? Should he not decide now to give compensation to children so gravely damaged by his immunisation scheme?
§ Mr. Ennals
My hon. Friend has made two important points. The Joint Committee on Vaccination and Immunisation is an independent body that includes specialists in virology, immunisation, epiemdiology, infectious diseases, neurology, paediatrics, and general practice. The Committee includes 22 recognised experts, and they are unanimous in the conclusion that they have reached on the basis of all the information at their disposal.
It is a continuing inquiry and I do not think that any separate independent inquiry would establish any evidence that is not already available to the Joint Committee.
On compensation, I have great sympathy with the case which my hon. Friend has made and for which he is campaigning, but I fear that I cannot enter into a firm commitment before we have received the report of the Royal Commission, which is dealing with this and a wide range of other issues. The Government will consider the question of retrospection when the Commission makes its recommendations.
§ Dr. Vaughan
Is the right hon. Gentleman aware that we wish to join him in expressing great sympathy for those involved in these tragic cases? Would he assure us that his statement will not be the last word on the possibility of compensation? Does he accept that this is a special group of children? They are special because they were normal and healthy before the injections were given. They are also special—and it is this which really differentiates them from other disabled children—because the State recommends the injections partly in order to protect society? Surely the State should then share the responsibility when things go wrong. Does the right hon. Gentleman know that there are already six other European countries which have recognised this responsibility and which give compensation? Can he at least undertake that if the Pearson Commission recommends that compensation should be paid, he will make it retrospective?
§ Mr. Ennals
I have already dealt with the hon. Gentleman's last question. Of course this is not my last word on compensation; I have said that I have a great deal of sympathy for the case put forward on behalf of these children and have also said that the fact that the Commission is not authorised to make proposals which have a retrospective effect does not mean that the Government are not free to do that in respect of any recommendation about children who have been affected by subsequent events.
Vaccination is not compulsory in this country. In the European countries to which the hon. Gentleman referred in which compensation is paid, vaccination is compulsory. Immunisation and vaccination programmes are promoted and encouraged in this country, but it is left to the judgment of the doctors and parents whether vaccination should be carried out. All the disadvantages and dangers are brought to the attention of doctors.
§ Mr. Pavitt
Is my right hon. Friend aware that I fully support what my hon. Friend the Member for Stoke-on-Trent, South (Mr. Ashley) has said about compensation? Can he assure me that, in future, adequate notice will be given to parents on the lines which he has laid down and that this will be easily understandable and not complex? Is my right hon. Friend also aware that I support him in saying that immunisation and vaccination have done more for the health of this country in the last half century than any other aspect of the health services? Will he ensure that the vaccination programme against rubella continues? It has been established only in the last three years, but if it is fully used by parents it will save tens of thousands of children from deafness.
§ Mr. Ennals
I am grateful to my hon. Friend and I can give him the assurance which he sought in the last part of his question. Deaths from whooping cough are a fraction of what they were before mass vaccination was advised. The incidence is down from 90,000 cases and 85 deaths in 1956 to four deaths and fewer than 4,000 cases in 1976. We should also consider the incidence of brain damage, because some figures have been published which must be very 1233 alarming to parents. The Joint Committee believes that the incidence of brain damage following whooping cough vaccination is about one in 300,000 children, which corresponds to about two cases of brain damage caused by vaccination each year and compares with the Committee's estimate of an average of four such cases each year from whooping cough itself, which can also lead to permanent lung damage and other serious complications.
§ Mr. Stephen Ross
Can the right hon. Gentleman confirm that compensation is also paid in some countries where vaccination is not compulsory? Does his statement not ring rather of the thalidomide case in which compensation was ultimately paid, largely because of the activities of the hon. Member for Stoke-on-Trent, South (Mr. Ashley), whose current campaign I heartily support? Is the right hon. Gentleman aware of the heartbreak which these vaccination tragedies have caused? I am thinking particularly of a constituent of mine, the details of whose case have been given to the Secretary of State. Does he realise that it is time that he gave a definite commitment on compensation and that if it cannot be paid in full now, there should at least be an initial payment made immediately?
§ Mr. Ennals
I can go no further on the question of compensation. As I have said, the Family Fund was extended in 1974 in order to provide financial assistance, particularly for handicapped children. This has been available and a number of the cases about which we are talking have received assistance. That fund is not in place of compensation, but that will have to await the report of the Commission. One of the difficulties in making comparisons with other countries is that the patterns vary enormously. As far as I know, compensation is paid in those few countries where vaccination is compulsory—which it is not here.
§ Mr. Loyden
My right hon. Friend said that his statement was intended to convince parents that they should continue to have confidence in vaccination, but is he aware that the delay and procrastination over compensation will result in a loss of confidence in vaccination? 1234 Is he aware that there are special circumstances in these cases which go far beyond the question of compensation? Is he aware, for instance, that these children are not being educated and that a 14-year-old child in my constituency has received only three years' education? Does this not show the need for urgent measures to be taken to see that these difficulties are overcome and is not the payment of compensation the only way in which they can be overcome?
§ Mr. Ennals
As I said in my statement, I recognise the depth of feeling which exists about the case for compensation, particularly among people, such as myself, who know of children who have been affected. However, the Royal Commission will be reporting soon, and we must not get this matter out of proportion. We are not dealing just with the sad problem of these children, some of whose brain damage or other conditions may have been caused by the vaccinations and some whose conditions may not have been so caused—and that is a matter for medical judgment. We also face the problem whether the public will continue with vaccination, which I am certain it is in their interests to do. My statement does not show that there are no risks, but I hope that it will enable parents and doctors to understand better the risks that do exist and that they will not have children vaccinated if those risks are apparent. Otherwise, I hope that they will see that it is enormously to the advantage of the children and the community that the vaccination programme should continue.
§ Sir J. Langford-Holt
Is the right hon. Gentleman aware that the only assurance which the parents of the one child in 300,000 who suffers brain damage will get from his statement is that they can expect little help from him? We are talking about children, and the educational years are the most important for them. The right hon. Gentleman has said that the Royal Commission will report soon. Can he tell us when that will be?
§ Mr. Ennals
The Royal Commission will report during the course of this year. The sooner it reports the better. I do not accept the strictures of hon. Members opposite. We are dealing with a situation that has existed for a generation. We have been talking about vaccination for 1235 25 years. There is no suggestion that there is a greater incidence of brain damage to children today than there was 10 or 15 years ago. There is no new body of knowledge. It is unreasonable for hon. Members opposite to suggest that somehow or other this Government should have taken action already when they did not take action.
§ Mr. Carter-Jones
Is the Secretary of State aware that I have been conducting a campaign for poliomyelitis immunisation for a long time? Is he aware that there are still serious risks of polio either being caught here or being brought in from abroad? The decline in the number of people being immunised against polio is frightening. Is he aware that I went to be immunised six weeks ago but was laughed at and told "Not at your age"? The risk is great. Every day that my right hon. Friend delays making a decision the percentage of immunisations will drop. Does he not agree that the case for compensation has been made out? I was upset when my right hon. Friend said that protection was available from the Family Fund. Is he not aware that the resources of the Family Fund are inadequate to meet the need?
§ Mr. Ennals
I have already dealt with the second part of my hon. Friend's question. All parents will look at the matter in perspective. I doubt whether the judgment of parents would have been influenced if I had said today that I would guarantee that there would be compensation. What will influence the judgment of parents is the sure knowledge that with vaccination there is a very slight risk—and hardly any risk at all if doctors and parents recognise the indications and do not proceed in cases where the risks are great—whereas, on the other hand, there is a great risk if the vaccination programme does not continue.
There have been some polio cases in this country. There is a real danger that polio, diphtheria and whooping cough will reappear if the present programme of vaccination is not continued.
§ Mr. David Price
The Secretary of State has reaffirmed the national importance of vaccination across the board. He has also given the House figures about the fall in the take-up of whooping cough vaccinations. Does he not see the connec 1236 tion between that decline and the lack of compensation? We have been pressing Ministers for 10 years on this subject. Surely he must now see the direct connection.
§ Mr. Ennals
The Royal Commission was established because of the concern about compensation and civil liability. The Commission will report shortly. It will deal with some of these cases and with other comparable and different problems. It is unreasonable to suggest that we should leap into a decision on this aspect as opposed to the many other aspects that are being dealt with by the Commission. I am sure that the Government will take the proposals of the Royal Commission seriously, particularly in view of the pressures on behalf of these children.
§ Mr. Spriggs
Is my right hon. Friend aware that many hon. Members are disappointed with his statement today? He appears to be hiding behind the Royal Commission in order to avoid agreeing to make payments of compensation to the parents of affected children. Will he examine the different medical views which divide the medical profession and ensure that he hears each medical opinion of this drug before he receives the final report of the Royal Commission.
§ Mr. Ennals
There have already been one or two statements about vaccination policy. One of them was by Professor Stewart, who has already given evidence to the Joint Committee. Honourable Members must remember that the Joint Committee has 22 members, all of whom are experts and who have reached a unanimous conclusion. They are medical experts. They examined whether we should proceed with the vaccination programme. They did not examine the question of compensation.
§ Mr. Adley
Is the Secretary of State aware that there seems to be a worldwide conspiracy in the medical profession to hush up these difficult matters? Does he not agree that his comment that brain damage may—and only may—be caused by whooping cough vaccination is inconsistent with the tragedies suffered by an increasing number of parents? Is he aware that a doctor in my constituency recently carried out an investigation into the circumstances of a 1237 child suffering from brain damage and was critical of the pre-vaccination examination procedures in this country? Will the Secretary of State pay close attention to that? Is he aware that many vaccinations are given in clinics by people who are in a hurry and who do not know the medical history of each child? Nobody is blaming the Secretary of State personally, but we cannot afford to wait and force these parents to grovel for compensation as they did over thalidomide. He must accept responsibility as the user of the powers obtained by the Department of Health and Social Security in the Health Services Act 1946 and by his Department in 1957.
§ Mr. Ennals
I used the word "may" because, tragically, many children suffer from brain damage that is not caused by vaccination. One would have to prove that brain damage was caused by vaccination. Many people who are dealing with other cases of brain damage ask why there should be special compensation for one group of brain-damaged children and not another. It is difficult to determine whether an illness occurs naturally or is the result of the administration of a vaccine. I do not believe that the medical profession is seeking to cover up anything. It is as concerned with the health and welfare of children as any hon. Member or parent.
It is important that the medical profession and parents should know enough about both the hazards and the advantages of vaccination so that together they may make a wise decision. That is the purpose of my statement and of the material that I shall make available through my Department, doctors and nurses. I recognise the problems of liaison between clinics and GPs.
§ Mr. Speaker
Order. A Question has been answered at the end of Question Time. I deliberately allowed more time for it because of the deep interest in the House and the nature of the subject. I propose to take two more questions from each side but then we must move on. Two hon. Members wish to make Standing Order No. 9 applications.
§ Mrs. Wise
Does my right hon. Friend accept that he is asking parents to undertake a procedure not simply for the health 1238 of their children but generally to safeguard the population? Does that not make the issue different from that of other cases of brain damage? The best way to demonstrate his confidence that the risk is small—if he is confident that it is small—is to say that the number involved is so small and the cost of compensation so little that he will go ahead with a satisfactory scheme.
§ Mr. Ennals
My hon. Friend will recognise my sympathy for a proposal that children who may have suffered brain damage over a period of 20 to 25 years should receive compensation. The number involved is small. But is it a different situation? It would be if vaccination were compulsory. In fact, we do not say that all children should be vaccinated. We have stated clearly that vaccination should not take place where certain illnesses have occurred and where there have been particular conditions—fits, for example. We do not say that everyone should be vaccinated. We say to parents that they should consider with their doctors the best thing to do in the light of the great advantage to be gained by vaccination, both for the individual and for the community.
§ Mr. Farr
Is the right hon. Gentleman aware that "waiting for a Royal Commission to report" is a hackneyed phrase which is of little value in these circumstances because many of the vaccine-damaged children are nearly adults now? Will he say why he has not mentioned the possibility of smallpox vaccination coming under consideration, because evidence exists that some children who have been vaccinated against smallpox have suffered from brain damage? Will the right hon. Gentleman look into that point?
§ Mr. Ennals
Certainly the World Health Organisation—and this applies to my Department—regards smallpox as having been virtually eradicated as a disease, whereas that does not apply to the other diseases about which I have been talking.
§ Mr. Corbett
Will my right hon. Friend not think me offensive if I ask him to confirm that it is he who is still running his Department and not the Royal Commission? Will he further explain why—and quite rightly—he wants the vaccination and immunisation programme to go ahead? How can it be that parents are expected to take even the slightest risk if 1239 my right hon. Friend, having encouraged them to do so in the public interest, does not acknowledge that the public then has a duty to the small number of parents whose children get damaged in this way to do what it can to help the children to live the best possible lives that they can after that damage has occurred?
§ Mr. Ennals
I believe that parents will decide to have their children vaccinated because they recognise that it is much less likely that the children will suffer in any way as a result of vaccination than it is if they fail to do so. That is the judgment that parents will make. Of course, the question of compensation is of vital importance to that number of people, the children and parents concerned, but I believe that the basic judgment will be taken on the balance of risk and advantage, and all the evidence shows the advantage of vaccination as opposed to the risks.
I recognise that everyone in the House is very impatient about the length of time that the Royal Commission is taking, but many of us are glad that the right hon. Gentleman has emphasised that there are other cases of children involved. Their claims may not be exactly the same but they have a strong case for compensation. Does not the right hon. Gentleman agree that it is right that they should be included in any examination, as well as the vaccine-damaged children?
§ Mr. Ennals
It is precisely that point which makes it difficult to pick out one group and to say now that that group must have compensation. It is precisely those points that are in the minds of the Government—and I assure my hon. Friend the Member for Hemel Hempstead (Mr. Corbett) that I do run my Department—before we take a decision.