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The diphtheria death rates in England and Wales over the relevant period are shown
graphically (Fig. 1—the figures for England and Wales are used to avoid the effect of
evacuation and re-evacuation in London during the war years) and it may be mentioned
that the first full year of the diphtheria immunisation campaign was 1941. Logarithmic
scale is used in the diagram to demonstrate the relative rate of change; if the rate of
change was constant throughout the period this would be represented by a straight line.
In fact, as is demonstrated with the 0-4 years age group, there was only a very slight
downward trend before 1941 and if this trend line is continued to 1948 (dotted line)
the abrupt change in the direction of the line after the immunisation campaign began
is at once apparent. Had the previous trend continued the level of deaths in 1948 would
have been about 20 times the level actually occurring in that year. There was a similar
change in the 5-14 years group. No such abrupt change in trend occurred in the figures
of mortality of measles or whooping cough. A further very significant fact is demonstrated
by Fig. 1, namely, that the marked change in trend in 1941 occurred only in those
age groups among which immunisation was occurring, the 0-4 years and 5-14 year groups.
In the over 15 age group where immunisation was not carried out generally the change
was delayed for five years, by which time a number of immunised children had left
school.
It is probably too much to hope that opponents of immunisation will cease to spread
the erroneous suggestion that immunisation is given credit for secular changes in
diphtheria. It is important that the real facts should be widely known so that the suggestion
can be countered.
The coming of the National Health Service
National
Health
Service Act,
1946
The present arrangements for vaccination and immunisation are made under Section 26
of the National Health Service Act, 1946, which laid down five broad principles.
1. Every local health authority will make arrangements for vaccination
against smallpox and immunisation against diphtheria.
2. With the approval of the Minister of Health arrangements may be
made for immunisation against other diseases. In London arrangements of this
kind have been made in respect of vaccination against whooping cough and
poliomyelitis and, to a limited degree, immunisation against tetanus.
3. All medical practitioners providing general medical services under
Part IV of the Act to have the opportunity to provide vaccination and immunisation
under Section 26. General practitioners carrying out vaccination or
immunisation on their patients are paid a fee by the Council on providing a
record of the completed vaccination or course of immunisation.
4. The Minister may supply free prophylactics to local health authorities
and medical practitioners. The list of free prophylactics has always been limited
and selective, but smallpox vaccine has always been freely available. For a long
time the only diphtheria prophylactics available were alum precipitated toxoid
(APT) and diphtheria toxoid antitoxin floccules (TAF). At a later stage purified
diphtheria toxoid aluminium phosphate precipitated (PTAP) and fluid formol
diphtheria toxoid (FT) were added. Pertussis vaccine and combined diphtheria
—whooping cough prophylactics with or without tetanus have never been
on the Minister's free list. Since the issue of Ministry of Health Circular 8/57,
all alum-containing prophylactics have been withdrawn and the only prophylactics
supplied free have been FT and TAF (see later—page 71). All the poliomyelitis
vaccine used so far has been supplied free by the Minister.
5. The Vaccination Acts, 1867-1907 were repealed. This removed the
factor of compulsion from the sphere of smallpox vaccination and allowed the
approach to parents on this subject to be made in the same manner as that on
immunisation to other diseases.
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