1. Stories from the past How the MMR and pertussis crises were used by British Public health
Gareth Millward – – Centre for History in Public Health
Go through:
-- “Learning lessons from history” – can we? Is it possible? History and policy, etc. (1)
-- What were the two crises? Very broad outline. Show notifications chart. (
-- Lessons of pertussis in MMR – the rhetoric being used
-- MMR crisis – show decline in vaccination chart.
-- Post-MMR lessons – the rhetoric being used.
-- Conclusions
Improving health worldwide

3. Pertussis as ‘déjà vu’
We should learn from the experience of pertussis, where a sustained, misinformed media campaign against the vaccine throughout the 1970s saw vaccine coverage drop from 81% to 31% … Now that the issue of MMR safety has been resolved in the scientific press, it is important to restore public confidence in the vaccine
Norman Begg et al, ‘Media dents confidence in MMR vaccine’, BMJ 316(7130) (14 February 1998): 561.
Nicoll, March 1998 – MMR is “déjà vu” -- three major pertussis epidemics in UK after 1976, 300,000 total cases, 70 deaths.
Payne, July 2000 – interesting that the “Kenneth Best case” (Irish kid died of brain damage) did not really make it over to this side of the Irish sea…
Chen et al – we need a better monitoring system – Pertussis showed that governments need very quick statistical responses to potential scares to nip them in the bud.

4. Ownership of the narrative
In citing pertussis as an example of how scare stories can damage health strategies, it is important to bear in mind that pertussis can be associated with neurological sequelae, albeit that the risks of the disease far outweigh those of vaccine. … Had clinicians … not raised the issue … children would have been put to one side, and there would have been no imperative for the production of safer, acellular vaccine. Assumption of vaccine safety, based upon inadequate safety trials and dogma contribute largely to confusion and public loss of confidence in vaccination. Public-health officials would do well to get their own house in order before attacking the position of … clinical researchers.
Andrew Wakefield, ‘Autism, inflammatory bowel disease and MMR vaccine’, Lancet 351(9106) (21 March 1998): 908.
Wakefield’s counter point – history can be manipulated. I would agree with BOTH of these historical interpretations (if not Wakefield’s conclusion!).

5. Percentage of Children Receiving First Dose of MMR before Second Birthday by Country

6. We told you so?
Public faith in MMR vaccine has been eroded, leading to falls in its uptake and now outbreaks of measles in the UK. Unless public opinion swiftly changes … cases will become commonplace, with their resultant deaths and sometimes serious morbidity, mirroring the pertussis vaccine scare in the 1970s. Doctors need to present all of the evidence to parents to allow them to make informed decisions, and that evidence comes down in favour of MMR.
‘Time to look beyond MMR in autism research’, Lancet 359(9307) (23 February 2002):637.

7. MMR lessons… “Active” monitoring systems
Continual surveillance of ‘mothers’’ attitudes towards vaccination
Engagement on Web and social media
“Vaccine hesitancy”

8. Hesitancy
Complaceny
Confidence
Convenience

10. Conclusions
There are multiple narratives from vaccine crises, and therefore multiple lessons
These cannot be separated from the politics of public health
Public health appears to have learnt explicitly that public understanding of science is complicated and multifaceted
History and other cultural studies can provide additional, information to aid discussion and decision making.