914
questionable one that preceded it cost the country and the leading manufacturer about [1 million. A recent judgment on legal aid for several other historical cases may lead to even greater expenditure. Large sums in compensation have been paid under the Vaccine Damage Act 1979. The need is for medical, not legal, clarification of the issues. Much more may some day be said about why this has not been done. Meanwhile two other matters must be considered. The judge in the Loveday case1 agreed that the vaccine could cause convulsions but he was not persuaded that convulsions could, per se, cause brain damage. He did not draw any distinction between a solitary, coincidental febrile convulsion and repeated or prolonged non-febrile convulsions; nor did he consider non-neurological incidents with neurological sequelae. This legal opinion stands as a contradiction to current medical wisdom and practice. The second point is that whole-cell pertussis vaccines are not uniform products: they are mixed brews with active impurities that have never been convincingly separated from the immunising components. There is no scientific basis, before use, for assessing activity and safety? Vaccines found very effective in the multicentre trials of 1950-57 were described as, at best, not very effective by the same testing authorities in 1958-68. This was the period, long before any publicity, when very many severe reactions were reported to, but not mentioned by, the Ministry of Health. In the UK, as in Sweden, outbreaks continued from 19689 but there was no independent, prospective test of identified batches of vaccines. Meanwhile, several international vaccine producers, not under obvious legal duress, abandoned manufacture of pertussis vaccines, and others are
embarking
upon
risky development
programmes
on non-
cellular vaccines.7 Would Preston or any other adults who are sure that "Whole-cell
pertussis vaccine really is safe" care to receive three doses, adjusted for body weight from the infant schedule? I do not recommend this; nor
does the main manufacturer.lO
1.
Queens Bench Division, High Court, 29-30 March,
concentrations were measured before induction of anaesthesia and in the immediate postoperative period. In the medical abortion group the maternal serum AFP concentration did not rise in any of the twenty patients during the 48 hours between mifepristone administration and insertion of a prostaglandin pessary. AFP concentration rose to more than 25% above baseline values in three (15%) patients after uterine emptying at the end of the 4-hour clinical observation; in the control group a rise of 25% or more was seen in twelve (60%) patients (p
questionable one that preceded it cost the country and the leading manufacturer about [1 million. A recent judgment on legal aid for several other historical cases may lead to even greater expenditure. Large sums in compensation have been paid under the Vaccine Damage Act 1979. The need is for medical, not legal, clarification of the issues. Much more may some day be said about why this has not been done. Meanwhile two other matters must be considered. The judge in the Loveday case1 agreed that the vaccine could cause convulsions but he was not persuaded that convulsions could, per se, cause brain damage. He did not draw any distinction between a solitary, coincidental febrile convulsion and repeated or prolonged non-febrile convulsions; nor did he consider non-neurological incidents with neurological sequelae. This legal opinion stands as a contradiction to current medical wisdom and practice. The second point is that whole-cell pertussis vaccines are not uniform products: they are mixed brews with active impurities that have never been convincingly separated from the immunising components. There is no scientific basis, before use, for assessing activity and safety? Vaccines found very effective in the multicentre trials of 1950-57 were described as, at best, not very effective by the same testing authorities in 1958-68. This was the period, long before any publicity, when very many severe reactions were reported to, but not mentioned by, the Ministry of Health. In the UK, as in Sweden, outbreaks continued from 19689 but there was no independent, prospective test of identified batches of vaccines. Meanwhile, several international vaccine producers, not under obvious legal duress, abandoned manufacture of pertussis vaccines, and others are
embarking
upon
risky development
programmes
on non-
cellular vaccines.7 Would Preston or any other adults who are sure that "Whole-cell
pertussis vaccine really is safe" care to receive three doses, adjusted for body weight from the infant schedule? I do not recommend this; nor
does the main manufacturer.lO
1.
Queens Bench Division, High Court, 29-30 March,
concentrations were measured before induction of anaesthesia and in the immediate postoperative period. In the medical abortion group the maternal serum AFP concentration did not rise in any of the twenty patients during the 48 hours between mifepristone administration and insertion of a prostaglandin pessary. AFP concentration rose to more than 25% above baseline values in three (15%) patients after uterine emptying at the end of the 4-hour clinical observation; in the control group a rise of 25% or more was seen in twelve (60%) patients (p
