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DTP or DPT vaccine safety

The Sunday Times

The vanishing victims

Can the whooping cough vaccine cause brain damage? A drug company paid out more than £2.75m, plus costs, when an Irish court declared that Kenneth Best was damaged by whooping cough vaccine. In this award-winning investigation, Brian Deer re-examined the evidence, including that of Kenneth's mother Margaret, and asks: what if the law got it wrong?

 

The Sunday Times Magazine, November 1 1998.

On Friday, October 26, 1973, Dr John Wilson, paediatric neurologist, stepped to the front of the London lecture theatre of the Royal Society of Medicine. For the past couple of hours he had been crammed among 50 professors, consultants and other specialists, listening to research and discussion papers about children's convulsive disorders. Now it was his turn to address the gathering. He slipped a typescript on the lectern and began to read.

The topic of his contribution was brain damage caused by whooping cough, or pertussis, vaccination. Wilson was a consultant at the Hospital for Sick Children in Great Ormond Street, and he planned to use the event to highlight what he believed were the dangers of the vaccine. Then, as now, it was routinely given with diphtheria and tetanus shots as the three-in-one "DTP" injection.

"Findings are presented in 36 children seen in the past 11 years who are believed to have suffered from neurological complications of pertussis inoculation," ran his paper's opening abstract. "The clustering of complications in the first 24 hours after inoculation suggests a causal rather than a coincidental relation."

Wilson, 42, was the son of teachers, and since joining Great Ormond Street in 1965 had polished a fastidious demeanour. He was a doctor of philosophy as well as of medicine and a fellow of the Royal College of Physicians. He wore a dark suit and gold cufflinks. His black hair was immaculately combed. He read his paper slowly in the voice of a bishop, with cultivated, drawn-out vowels.

"Between January 1961 and December 1972 approximately 50 children have been seen at the Hospital for Sick Children, London, because of neurological illness thought to be due to DTP inoculation," he said. "Several children with screaming and fever during the first 24 hours have been excluded from the study because of their benign outcome. The majority of the remainder, whose ages ranged from three months to seven years, were referred months or years after the acute episode."

He was by no means the first doctor, or even the most prominent, to suggest a link between the vaccine and brain damage. But few in the lecture theatre's steeply-ranked pews missed the dynamite in his presentation. Previous reports, dating as far back as 1933, had mostly been isolated anecdotes: a couple of cases here or there. They were also short on crucial facts, such as the time between the jab and the damage. Yet here was a consultant from the world's most famous paediatric centre with three dozen dramatic examples.

"One child was exceptional in that she had transient blindness after recovering from a fit; she was later discovered to be suffering from a progressive cerebral degeneration," his gruesome narrative continued. "The four children who did not convulse include the identical twin of the infant above. She vomited four days after her second DTP inoculation at 15 months, and developed severe cortical blindness and optic atrophy. She died in status epilepticus."

It was a bravura performance, based on a remarkable feat in connecting these cases together. Despite worries about the vaccine, there was no agreed description in medical literature of exactly what harm it could do. "Brain damage" is a catch-all term, and there was nothing to distinguish injuries following vaccination from many of the 2000 causes of brain damage - including genetics, infections, birth problems, and traumas - that often reveal themselves at exactly the age at which DTP is given. In Britain, about 200 babies and infants develop such disorders every week, and by chance 6% will start within seven days of a jab. And because its pertussis component can trigger a fierce immune response, this particular vaccine can cause screaming, fevers and other upsets, making parents recall it if something serious should go wrong later on.

Wilson's route through this maze produced whispers in the theatre and then murmurs throughout medicine. Three months later, his four-page paper, co-authored by two junior doctors, was published by the British Medical Association in Volume 49, issue 1 of the Archives of Disease in Childhood. With both numbers and detail, it became an instant classic, as often quoted a quarter of a century later as it was when it first appeared.

Not surprisingly, journalists pounced on his claims as worthy of public concern. In April 1974, ITV broadcast a half-hour, prime-time This Week documentary, focusing on one of Wilson's patients. It unequivocally blamed the vaccine, with numbing images and terrifying calculations. "Every year about 100 brain damaged," was one caption that filled the screen. Six minutes into the programme, Wilson appeared and, when asked if he thought whether the link was established, he took his crusade to millions of viewers. "I personally am," he declared, in his bishop's voice. "Because now I've seen too many children in whom there has been a very close association between a severe illness, with fits, unconsciousness, often focal neurological signs, and inoculation."

"What do you mean, you've seen a lot?" the television reporter pressed him.

"Well, in my time here, the last eight and a half years," he said of his Great Ormond Street experience, "I personally have seen somewhere in the region of 80 patients."

The national furore that followed these remarks was the prototype for modern health scares. Before the broadcast, 80% of British children were inoculated against whooping cough. By 1978, after newspaper campaigns, the number had slumped to 31%. Cases of whooping cough soared. In 1974 there were about 12,000 notifications. In 1978 there were nearly 67,000. And in an epidemic towards the end of the decade, 36 infants died and at least 17 were left brain damaged by spasms of choking and retching

While Wilson's alarming remarks had this devastating effect, he none the less believed that the dangers of whooping cough were greater than those of vaccination. He supported routine inoculation. But his crusade to warn the world about the potential dangers of vaccination gathered pace. He became adviser to the National Association of Parents of Vaccine Damaged Children, launched by Rosemary Fox, a 46-year-old social work administrator. He backed lawsuits against DTP manufacturers, and pressed for a government compensation scheme for all vaccine victims. And when a scheme was launched, in 1978, he became the chief assessor for making awards.

His message, meanwhile, spread from country to country. A global panic ensued. After a frightening television broadcast in the United States in April 1982, American vaccine makers were hit with lawsuit claims worth $10 billion. Wilson's paper was repeatedly cited. And under pressure from parents and industry alike, Congress launched a compensation scheme in 1986 like the one he helped to run in Britain.

Wilson was not alone in his campaign; other doctors became equally vociferous. But the chain of events led back, link by link, to that Royal Society of Medicine paper. From it have sprung bureaucracies that in Britain alone have paid out more than £9m and probably cost as much again to administer. Using its authority, lawsuits have been brought that have run into billions in costs worldwide. And the scare that followed it has caused parents to agonise whenever a child has a vaccination.

But at the heart of this scare lay a disturbing truth, hidden for a quarter of a century. Wilson's original three dozen vaccine victims were not as conclusive as he led people to believe. While he may have seen 80 children where he thought that there was a "very close association between a severe illness... and inoculation", as he claimed on television, by 1988 he was having to admit that in eight of his original 36 cases there was no link whatever between the vaccine and subsequent brain damage, in 15 cases there was a reasonable alternative cause, and in only 12 cases did he stand by his original report.

Of these remaining 12, only three were cases where there was no alternative explanation and on which information was reliable. Even those three could not be shown as having been injured by DTP.

Studied today, the cases reveal how wide of the mark Wilson was. One child had a bang on the head. Another recovered fully. Two had genetic conditions: tuberous sclerosis and gangliosidosis. At least three were suspected of suffering from infections, including isolated Coxsackie virus. And most of the remainder were patients who were diagnosed as epileptic - a generic term embracing a host of different symptoms, causes and possible outcomes. One child's father, sister, uncle and grandfather all had histories of fits.

Surprisingly, some of the children on whom Wilson reported suffered their first neurological symptoms before their DTP jabs. But the most striking feature of the series that he presented concerned the identical twins. Both were diagnosed with an inherited condition called Seitelberger's disease. And although their cases helped to trigger one of the century's great health panics, neither child ever had a whooping cough jab.

*****

DTP or DPT vaccine safety
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This report is copyright, Brian Deer. No portion of this article on the DTP or DPT vaccine controversy of the 1970s and 1980s may be copied, retransmitted, reposted, duplicated or otherwise used without the express permission of the author. Responses, information and other feedback are appreciated