Meningococcal disease: Battle for lives – and minds
15 July 2004
It's a logistical nightmare organising a nationwide mass vaccination programme against meningococcal disease – and some parents will choose not to immunise their children. Sid Pickering reports.
Health officials battling a killer meningococcal disease epidemic will first have to overcome the logistical nightmare of vaccinating more than one million young people, and some parents' unwillingness to have their children immunised.
The plan is to administer almost 3½ million injections to the 1.15 million New Zealanders under the age of 20, starting in Auckland next week.
When the national meningoccocal immunisation programme moves to the Waikato early next year, it will aim to give the region's 76,000 young people 228,000 injections.
Meningococcal disease is a bacterial infection which can lead to blood poisoning, brain inflammation and death. It is fast acting and notoriously difficult to diagnose because its symptoms are identical to that of a flu.
The Health Ministry predicts that if it reaches its target of 90 per cent coverage, the campaign will prevent 70 per cent, or 241 new cases, of the epidemic strain of meningococcal disease each year.
But the very people who need the vaccine most will be the hardest to find.
Maori and Pacific Island children living in deprived areas are the groups most likely to come down with the disease, but health authorities say they are also the ones that have the least contact with the health system.
The lack of a national database to keep track of people's vaccinations means health officials do not know if there are particular areas of the Waikato that need special attention.
It is hoped a national immunisation register, due to be set up in the Waikato in October, will address that problem.
Perhaps the biggest challenge will be getting people to come back for their second and third vaccinations – for the vaccine to be effective, each person needs three injections six weeks apart.
In an effort to vaccinate as many people as possible, health authorities will be working with community groups to encourage people to get the jabs.
But there is a group of people that health authorities will find even harder to convince – parents who have decided against any vaccination.
Sasha Taylor won't be among the legions of parents signing consent forms.
The Hamilton massage therapist's two children, Dylan, 6, and Mia, 5, have never had any vaccinations.
For Mrs Taylor, the decision not to vaccinate was made when her son Dylan was approaching six weeks old, the traditional time for his first set of vaccinations – against diptheria, tetanus, whooping cough, polio and hepatitis B.
"My friend's baby had a reaction to the mumps, measles and rubella vaccine, and I started to read some information about vaccinations and found there was a lot of other ideas out there."
After reading about the risks in magazines such as Waves (Warnings About Vaccine Expectations), she decided to take her children's health into her own hands.
"I'm not saying the medical establishment is bad – if you cut your arm off, where are you going to go?: the doctor – but there are some things I want to take responsibility for," Mrs Taylor said.
She said the "medical establishment" did not provide parents with enough information about the dangers of vaccinations, and that there were more natural ways to build children's immunisation systems.
Mrs Taylor regularly visits a herbalist and homeopath to get advice on the role that nutrition and herbal remedies can play in protecting against disease.
Asked if she was concerned about her children spreading disease to others, she said if her children were to get sick they would then have immunity for life unlike some vaccinations which needed to be updated.
Anti-vaccine lobby group the Immunisation Awareness Society said this week only 0.009 per cent of New Zealanders became ill from meningococcal disease.
Spokeswoman Sue Claridge said the $200 million being spent on the national vaccination campaign would be better used addressing problems that contributed to the disease, such as overcrowding, poverty and bad nutrition.
Ms Claridge estimated about two to five per cent of parents would join her in choosing against vaccination.
A 2002 study by the doctor-run Immunisation Advisory Centre, which looked at the reasons why parents chose not to immunise their children, found one of the biggest barriers was that parents of children who had a minor illness often thought it was better to wait until they were well before taking them to be vaccinated.
Other reasons were that parents did not think the diseases protected against by vaccination were a danger to their children, and that struggling parents of large families had more immediate priorities than vaccination.
VACCINES PUT THROUGH STRINGENT TESTS
The World Health Organisation designates a disease has epidemic status when the incidence is more than three cases per 100,000 a year.
Most Western countries have fewer cases of meningococcal disease than this figure, but New Zealand last year recorded 14.4 cases per 100,000, resulting in 540 cases including 42 in the Waikato. There were 13 deaths nationwide.
Before any vaccine is approved for use it goes through a stringent set of scientific tests and trials overseen by New Zealand's medicine safety authority, Medsafe.
The Immunisation Advisory Centre said there could never be an absolute assurance that the meningococcal vaccine was completely safe, but there was enough evidence to confirm it would be safe for most children.
There might be a rare side effect for some children which had not yet been picked up by the clinical trials.
Waikato's public health unit physician Anita Bell said it was a question of which risk parents thought was more immediate.
The risk of unvaccinated people getting meningitis was far greater than for those who were vaccinated, Dr Bell said.
Vaccination was voluntary in New Zealand and it was important to work with the community to find out what were the concerns, she said.
"There have always been anti-vaccination groups and people concerned about vaccines' safety.
"We have to listen to their concerns and try and reach as many people as we can.
"There might be that one-in-a-million case where vaccines cause unexpected side effects, but the bottom line is it saves lives," Dr Bell said.
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