Heroes Not Zombies

Was HPV vaccination responsible for the death of that little girl in England last week? We live in a society where simplistic and judgmental conclusions seem to be both valued and common. In response to that news story you’ll have read some people argue that the vaccine isn’t safe, and others argue that it had absolutely nothing to do with the girl’s death.
Is life so simple? Can we really be so certain in relation to cause and effect? I don’t think so.
I often say to patients that when you think about chronic illness, it’s rare to be able to ascertain a single cause. In the vast majority of cases it’s far better to think about the multiplicity of factors and influences which have challenged the person, and to think about the dynamic, continually changing ways a person responds to and copes with those challenges.
For example, it appears this girl had a tumour “heavily infiltrating” her heart and one lung. It’s highly likely that such a serious pathology would be life threatening. The presence of that disease meant she was considerably more vulnerable and more fragile than other girls in her class. So did the vaccination provoke her final, fatal incident? Sadly, the truth is, we’re not clever enough to be able to know. In fact, until we stop thinking of human beings as simple machines where this leads directly to that, we’ll never be clever enough to know. We don’t have the equipment to show the complex behaviour of the whole organism. So to say that the advocates of the vaccination could “breathe a sigh of relief” was not just insensitive, it was wrong.
The fact that 1.4 million doses of this vaccine have been administered without any deaths is reassuring to everyone except Natalie Morton’s parents.
Human beings are not reducible to numbers. In yesterday’s Guardian there was a sensitive exploration of the difference between making a Public Health announcement and making a decision about a member of your own family.
Is vaccination a biological challenge? Yes, it is. If it were no challenge there would be no provocation of the immune response. Can a biological challenge be fatal? Absolutely. An anaphylactic reaction to a bee sting in a previously fit and healthy person can be fatal. Much lesser challenges can be fatal in an already vulnerable, compromised individual. Rather than dismiss the role of HPV vaccination in this tragic case, wouldn’t we be better served by improving the screening procedures before mass vaccination? Shouldn’t we make a better attempt to assess the fitness of the individual to receive this challenge?
Maybe it’s not easy to find such answers, or to live with uncertainty, but outright dismissal of risk by simplistic explanations and population-based statistics, really don’t inspire confidence.