Wednesday, March 02, 2011

The grave risk of being successful...

A few years ago I heard an excellent presentation from a professor of infectious diseases in children on the 'life-cycle' of vaccine scares. I won't rehash the whole presentation now but one point that struck me at the time was that vaccines are very much a victim of their own success. I am increasing convinced that the NHS has a similar problem.

In the UK, as in all developed countries, we have a well established mass-vaccination program. diseases which once were common-place are now rare. Necessarily, vaccine up-take is always optional. And always should be optional.Whenever a vaccine is first introduced (the most recent being the Meningitis C vaccine) uptake is very good. This is because public awareness of the disease is very high and hence the appreciation for the value of the vaccine - the fear of the disease drives the public mood and the vast majority come forward for the jab. Now, vaccines work, really well and thus over time the disease numbers fall and then they become very rare in the community and public awareness of the disease and it's effects becomes negligable. As public awareness of the disease falls away, it takes significant Public Health / Health Education effort to keep vaccine uptake high.

The current proposed reforms to the NHS are, in my view, extremely damaging. The wholesale marketisation and fragmentation risks undermining the whole system. Because the NHS has been such a solid fixture of UK culture for so long, I think public awareness of what life would be like if it is seriously undermined in this way is very limited. There are relatively few alive today who can remember the pre-1948 days, and similarly most Britons do not have experience of other healthcare systems in the world. As a consequence, I do not think that people realise what is being done to the NHS or how dangerous it is and, I fear, will not realise until it is too late. I have South African friends who cannot understand how anyone would complain about the NHS, because they know how bad things can be.

When MMR uptake fell because of the autism scare we had a rise in measles numbers and two children in the UK died. I don't think this had a big effect nationally because it wasn't well publicised but I would suspect that those close to the tragedies saw the value of vaccination. With the NHS, will its true value only be seen once it has gone? And by then is it too late to fix it?

Ultimately a broken healthcare system leads to broken people. If we do end up with a fully Americanised system then the rich will be fine, the middle classes will struggle but get good healthcare at a much higher price and the poor and sick will be left to suffer or die quietly.