Woman's Hour - Vaccinations - Your questions answered

Episode Date: November 7, 2019

Nine out of ten people get their children vaccinated. But even so, many people still have questions. Things like: Should I bother with the flu jab? Is it better to get single vaccines? Does immunity wear off? What about side effects? Is the aluminium in vaccines dangerous? Marnie Chesterton asks Prof Helen Bedford, Prof Adam Finn and Dr Tonia Thomas for answers.One thing we know for sure is that vaccinating or NOT vaccinating both have some element of risk. So what should people do in the face of such uncertainty? Risk expert Prof David Spiegelhalter and experimental psychologist Anne-Marie Nussberger discuss how uncertainty affects the way we behave and the decisions we make.Presenter: Marnie Chesterton Interviewed guest: Helen Bedford Interviewed guest: Adam Finn Interviewed guest: Tonia Thomas Interviewed guest: David Spiegelhalter Interviewed guest: Anne-Marie Nussberger Producer: Anna Lacey

This BBC podcast is supported by ads outside the UK. I'm Natalia Melman-Petrozzella, and from the BBC, this is Extreme Peak Danger. The most beautiful mountain in the world. If you die on the mountain, you stay on the mountain. This is the story of what happened when 11 climbers died on one of the world's deadliest mountains, K2, and of the risks we'll take to feel truly alive. If I tell all the details, you won't believe it anymore. Extreme. Peak danger. Listen wherever you get your podcasts.

BBC Sounds. Music, radio, podcasts. Hello, this is Marnie Chesterton bringing you Thursday's edition of the Woman's Hour podcast. I normally live down in nerd corner of the BBC, the radio science unit. And from there I usually present crowd science and sometimes present inside science. Both also, can I say, very good podcasts. Now, today I've climbed the stairs to the Woman's Hour studio because this edition, the entire show, is devoted to the subject of vaccinations. It's a topic that hits the headlines regularly, whether it's today's news of a shortage of flu vaccines in Scotland

or Health Secretary Mac Hancock saying that he's looking very seriously at making vaccines compulsory. And news reports tell us that vaccination uptake is on the slide. This is from September. The number of preschool children in England receiving routine vaccinations has fallen for the fifth year in a row. New figures suggest uptake for the first measles, mumps and rubella jab at 24 months was 90.3%. Northern Ireland and Scotland are hitting the 95% target. Wales was just below that. Now, as you just heard, at least nine out of 10 parents are still following the advice and vaccinating their children. But even if you've vaccinated, you may still have reservations or queries. And there's nothing

wrong with having questions. In fact, it's crucial to our programme because for the next 45 minutes, we'll be answering your concerns. Please do get in touch on Twitter, email or Instagram. I'll be monitoring them throughout the show. We put out calls earlier this week and listener Jo was one who responded, emailing womanshour at bbc.co.uk to say, I am so tired of how inflammatory and polarising this topic has become. She goes on to say the accusatory, judgmental attitudes of people on both sides make it very difficult for parents to get to the truth about risks. Well, Jo, welcome to the sneer-free, fact-laden zone of Woman's Hour. We've had a huge response from listeners and I've got a nice big pile of questions here ready to put to our panel, but first let's introduce them. Around the table with me,

we have Helen Bedford, ex-nurse and health visitor, now Professor of Child Health at UCL and Great Ormond Street. We've got Adam Finn, Professor of Paediatrics at Bristol Children's Vaccine Centre, and Dr Tonya Thomas from the Vaccine Knowledge Project at Oxford University. Welcome to you all. Thank you so much for being here. Good morning. Now, can I start with the absolute basics? Overwhelming evidence shows that vaccines work, but how do they work, Adam?

So this was a discovery made more than 200 years ago, almost by accident, by a GP who lived near Bristol, where I come from. And he worked out that if you stimulate a child's immune system and protect them against a disease, they will then not get that disease. And you can do that with a vaccine. A vaccine is anything that you can give that will stimulate that immune response and give that protection without running the gauntlet of the infection. So it could be a weakened form of the virus or the bacterium that would normally cause the disease, or it could be bits and pieces from that microbe that you just give to the child either into the mouth or the nose

or inject into a muscle. pieces from that microbe that you just give to the child either into the mouth or the nose or inject into a muscle and you're to stimulate the immune cells to remember that antigen and to fight it very vigorously when the real infection comes along. So it's a way of kind of giving your immune system a heads up but a safer way than actually exposing to the disease. Exactly and I think that that raises one of the paradoxes about vaccines, where people feel that they're in some way unnatural, whereas in fact, in many ways, they're a much more natural approach to medicine than most of the drugs that we use, which are truly artificial. We're really giving the child something that's very close to what they would encounter in real life. So you've explained how vaccines work in the individual,

but there's also something called herd immunity, and that's the effect a vaccine has across a population. How's that work? Well, when you immunise a child and that child doesn't get that infection, it means that that child can't then pass the infection on to other children and other people in the family. And so there's a sort of knock-on effect. And in fact, some of the vaccines that we give are protecting children against infections,

but also protecting them against just carrying the organism in an asymptomatic way without being sick. So a lot of the vaccines against meningitis, for example, are bacteria that children quite commonly carry in their nose and throats without getting sick. And the vaccine has the effect of preventing that from happening too. So there can be very powerful effects across the population. If you give enough children a vaccine, everybody ends up being protected. Other children who've not been vaccinated, children who've been vaccinated but their protection has worn off. All those people will no longer get sick. Now, Helen, we've been talking about herd immunity and there's a big, is that what's going on with the big flu campaign at the moment?

Yeah, part of the reason for giving flu vaccine to young children is to protect them because flu can be very nasty. It puts a lot of young children into hospital. But they are what is known in the trade as super spreaders. So they're very generous with their germs and they spread it round to other people in the community who may, you know, be seriously ill, sort of older people and people with health conditions. So that's an important benefit of giving flu vaccine. Now, look, that's enough of my questions this is about the listeners as I said we've had a great response and I think it's fair to say that a huge proportion of them fall broadly under safety related issues so we're going to start with that. There was a common thread which was whether to use single vaccines instead of combined ones I think they're talking about MMR here and whether to just spread them out.

So Tamsin says, I paid for two of my children to have the first round of MMR as separate vaccines. The reason was that my eldest had her first combined MMR and she had a temperature of 40 degrees for over a week and I felt it compromised her immune system. I feel that the option should be given to have vaccines separately. And that's something that's echoed by Suzanne, who says,

it's important to remove these diseases from our country, yes, but is it actually necessary to administer vaccines more than one at a time? Surely such an onslaught of several diseases on the underdeveloped system of a small child is more likely to cause problems than giving them one at a time. I assume it's a matter of cost. So who wants to take that? Well, I can kick off. I'm sure the others can add to it. But the truth is that with the vaccines that we have and give combined, we've far more experience of using them that way than anyone has of giving them singly.

And the more you use a vaccine, the more you can be confident about its safety. Once we've got to the point that countless millions of children have received a vaccine, it's almost impossible for there to be a side effect that we don't know about. And the threshold for safety in vaccines is very, very low. We're giving these drugs to healthy people. We can't afford for them to be making them sick. So if I, my children are all grown up now, but if I was in the position now of having my children around the age of one year,

on safety grounds alone, setting aside any issues of practicality, I would definitely be giving them combined because I would know and I'd be very confident that that was a safe thing to do just because it's been done so much before. So why was a lot of the research done into combined vaccines? Why not give them separately? Well, it's a much more efficient way of protecting children as young as possible. If you separate all these vaccines out, children will be very much older by the time they're protected. And one of the things you want to do with vaccination is not only have high uptake,

but make sure children are protected as young as possible before they reach the age when they're at risk of severe disease. Donya, do you know if there's any research into whether single or combined makes a difference? So there is. In terms of the combined vaccines that we use more commonly, there's much more research to assess whether there are any side effects more likely by providing them in a combined form. One thing that I was going to mention is this is a common question that we get through our inquiry service

at the Vaccine Knowledge Project. And I think it's important to understand why people are asking this question. You know, why do people think that it is safer to have single vaccines compared with the combined ones? And I think you touched on it a little bit with the second person's question about, you know, overloading the immune system with too many viruses at once. And so I just wanted to mention that babies and children are exposed to many, many different germs every day, you know, often millions. And actually, giving them all of these vaccines, it's only a fraction of, you know, the viruses that they would be exposed to. So around a thousandth of the germs they'd be, you know, experiencing every day. So we're not

actually overloading the immune system at all. And there is lots of scientific evidence to show that. And I think it's important that we find out the reasons that the people are asking these questions and address these concerns with them. And can I move on to the contents of these vaccines? So it's not just an attenuated form of the disease. There's a number of our listeners were quite concerned about additives.

So listener Dorcas mentions mercury, aluminium, formaldehyde and the substances that vaccines are cultured on. That doesn't sound good. What's going on there? Yeah. Can I just come in and say that additives may be slightly the wrong word. It sort of suggests they've been added in for no good reason. The vaccines do contain, for example, aluminium salts, but they contain them for a very good reason. And that is that the aluminium salts greatly enhance the immune response that the vaccine provides. So it makes the vaccine much more effective. It's a very deliberate additive, if you want to call it that, because it's an adjuvant, which is a compound

that makes the vaccine more effective. And just about all of the non-live vaccines that have been given around the world for decades now to countless, countless millions of children contain aluminium salts. They're extremely safe. By giving something a chemical name, you can make it sound spooky and make it sound dangerous. But actually, the truth is that these are deliberate ingredients, which I think is the right word, that either make the vaccine more effective or make it more safe by making certain that it's not contaminated

with other infections that could make the child sick. Or they're part of the production process that enables the vaccine to be consistent and effective. So these are not sort of accidental things that are in there that are contaminating the vaccine. They're ingredients, just as you have the ingredients when you make an apple pie. They're all there for a reason. Can I focus in on the aluminium just for a bit? Because, I mean, I have friends who've taken, who've changed their deodorant because they didn't want aluminium in their

deodorant. And yet when I was reading up, I was surprised to find how much aluminium is actually in everything and out in nature. Tanya? Yeah, absolutely. So there is aluminium in everything, in the food we take in, the drinks, around in the environment. And I think one thing that we need to remember with the ingredients that are contained in vaccines is the amount and the context. So, you know, there are lots of things that we encounter in our day to day lives that could be a risk to us if we were to have too much of it. Water is a good example of that. But we need to remember that the amounts contained in these vaccines are very, very small. So, for example, one of the ingredients you mentioned was formaldehyde,

and that's used in the process of actually making the vaccine itself, and sometimes there will be remnants left in the vaccine. But formaldehyde actually occurs naturally in the body and also in other things that we eat. So, for example, a pear contains about 50 times the amount of formaldehyde than is contained in any single vaccine. So it's about, you know, the context and making sure that, you know, we're talking about the amounts rather than just the ingredients themselves. That is my new pub quiz fact. Thank you very much. Can we talk about vaccines as an adult?

So Melissa says, my son is 25. He had the MMR at 18 months and had a very severe reaction and the GP agreed not to give him the booster three years later. He now works with children and there's been an outbreak of mumps locally. If he were to have the booster now, would he be likely to have a similar reaction again? And would a single month's vaccine be better? Helen? It's very difficult to give advice for a particular situation, but generally with live vaccines that

you don't get such a pronounced reaction the second time. But in that instance, I think it would be important to seek specialist advice about this. You can't get single mumps vaccine on its own. So it would have to be MMR to protect this boy, this young man. Yeah, I mean, I think if this child was referred to our clinic, we would see him and his mother, we would get a careful history of exactly what had happened to make an assessment of what kind of reaction it had been. But most likely we'd end up giving him the MMR under supervision there and then in the clinic, because the risk benefit balance, given the circumstances, sounds like it's going to be in favour of giving the vaccine.

But as Helen correctly said, you've got to take this case by case, you can't generalise. 25 year old child, so I reckon he can take it. His mum was around for the reaction though so I'd like to hear what she had to say. We've obviously had a whole range of different emails and questions but what keeps coming up again and again is this sense that people either weren't told about the side effects or they weren't given a full picture of the negative consequences or if they felt their child had had a reaction, they just weren't taken seriously. You can kind of understand why people

feel there might be a conspiracy going on. It's in the pay of Big Pharma or whatever. It's very dismissive of their concerns. Adam? Well, there isn't a single answer to that question because it's a complicated set of situations. I mean, the first thing to say is that everything bad that happens after a vaccine is not necessarily the cause of the vaccine. Sometimes there'll be a causal link and sometimes it's something that is unexplained.

But the vaccine really wasn't responsible. But I think we're all very narrative. That's that's how the human species works. And until the 18th century, that's how we understood the world. And so when your child gets sick after a vaccine, it's logical to assume that that was the cause. communication, I think some people really want a lot more information around the potential side effects before they make a decision. And many people don't. They really just want a trusted person to advise them what they should be doing. They say, well, this is not something I'm an expert on. I trust you. You're my doctor. You're my nurse. Tell me what you think I should do, and I'll follow that advice. And they don't want a whole lot of additional information that might, I don't know, just make it

more difficult for them to decide what to do. Tonya, is this just a problem with the setup of how we give vaccines in this country? I think in an ideal world we'd have a longer appointment for giving vaccines so that, you know, healthcare professionals have the opportunity to be able to have these conversations with patients. But unfortunately, that's, you know, it's not possible with the current system that we have. So we have to provide the information in other methods so that people can, you know, find out this for themselves. And that's one of the reasons we have websites like the Vaccine Knowledge Project, which, you know, tries to explain all of this scientific evidence in a way that people can understand. And I think we need to try and

encourage people to access this information before they make the decisions. And we have to respect that people do want to, you know, see both sides before coming to the decision themselves. So a plug again, your website? Yeah, I mean, it's called the Vaccine Knowledge Project. So the address is vk.ovg.ox.ac.uk. So I mean, we'll stick that up on the website. That's fine. Google Vaccine Knowledge Project. That'll do the job.

But also, it's important to encourage people to ask questions of their health professionals. You know, if you were prescribed any medication, you went under any medical intervention, you would ask questions about possible side effects. So, you know, ask your health professional. And Public Health England produces information. I've got the information in front of me, which lists the adverse consequences of the vaccine. So just ask for the information well i should say we've also had listeners getting in touch with us to tell us the consequences of diseases that they've had um as a result of not having the vaccination and i

think that's possibly something we don't hear about so much uh 76 year old paula says she's still living with the consequences of lung damage she got thanks to whooping cough. And Bella told us how her unvaccinated husband got mumps as an adult and became infertile as a result. So, yes. Yeah, and Adam and I have just been at a meningitis septicemia conference for the last two days, hearing about real accounts of how appalling these diseases are and the impact they have on people's lives. OK, thank you, Helen Bedford, Adam Finn and Tonya Thomas for those answers. You can take a breather for now because we'll come back to you later.

If you're just tuning in, listeners, today is Women's Hour's vaccination special and we've been getting lots of comments on Twitter. There's one email I particularly like from Dorothy who says, I qualified as a midwife in the 1970s, worked as a lecturer, have taught doctors and nurses, used to run antenatal groups and I don't understand how experts can be so sure. I'm sometimes labelled as an anti-vaxxer simply because I have questions. Now, we're going to be talking about trust later on in the programme,

but I want listeners to get in touch with us. How much do you trust the medical profession when it comes to vaccines? 90% of people go ahead with vaccinations, so maybe you're feeling good about this? Contact womanshour at bbc.co.uk or send us a tweet. And if you want to hear all of this all over again, then head over to BBC Sounds and subscribe. Now, one of the big problems with vaccination is that nothing is 100% certain.

You may get vaccinated and have a terrible side effect. You might not get vaccinated and get terrible lung damage or go blind. And you might be absolutely fine either way. It's hard to know for sure. What we do know for sure is in the vast majority of cases, and you have to remember that there are millions and millions of doses of vaccine given out every year globally, most people have no ill effects and are protected from diseases as a result.

And yet, what plagues many parents is the thought that it might be their child for whom it all goes wrong. So what are people supposed to do in the face of this uncertainty? To help us with that is Professor David Spiegelhalter, Professor Sir David Spiegelhalter, Chair of the Winton Centre for Risk and Evidence at the University of Cambridge, and General All-Round Risk Guru. And on the University of Cambridge and general all-round risk guru. And on the line from Munich, we've got Anne-Marie Nussberger, an experimental psychologist from the University of Oxford.

Hello to you both. Are you there? Yep, I'm here. Great. Anne-Marie, are you there? Yes, I am. Hello. Hello. Anne-Marie, can I start with you? How does uncertainty affect our decisions? Well, there seem to be two ways, generally speaking, in which people deal with you. How does uncertainty affect our decisions? Well, there seem to be two ways, generally speaking, in which people deal with uncertainty. And one is not very helpful when it comes to vaccination, while the other one is. Let's maybe start with the not so helpful one.

So this has been studied quite a lot in research across psychology and behavioral economics. And what this research has shown is that when we make decisions that could have outcomes for others, like this is the case with vaccination, uncertainty can be a very powerful alley of selfishness. And essentially what happens is that when it's uncertain whether or not our decisions could harm others, then uncertainty provides us with an extra reason to do what is best for ourselves. And at the same time, it allows us to be overly optimistic that the others will just be fine as we will be. Can you give me an example of how that works in real life? Yeah sure so say that

I'm contemplating whether or not I should get vaccinated against the flu so I might think that personally for me it's very annoying to get the shot. I have to go in CTP or pharmacy, pay some money, maybe deal with a sore arm and so on. Now put uncertainty on top of that. What are the odds that I'd actually come down with the flu? Well, pretty low. I haven't had it in the past few years. And then even if I would catch the flu, what would be the chances of doing any serious harm to me or lasting harm? Well, lo, I'm a young, healthy person. And now what would be the odds that I would be the person to infect someone else if I had the flu?

Again here, uncertainty helps telling myself a story whereby everything will be fine for me and importantly also for others, even if I don't get my flu shot. So we can say here that uncertainty that is really inherent to the vaccination context creates an ideal condition for people to make decisions that are in a way in their own interest or might appear so, but that can really be harmful to others and which will undermine herd immunity about which we've heard earlier. So there's uncertainty attached to vaccines and it's fairly normal for people in conditions of uncertainty to basically be selfish, prioritise themselves. Exactly. That seems to be happening in quite a lot of circumstances.

Okay, David, can I bring you in here? We've heard some of the psychology there, but what are the other factors that come into play when people are weighing up the risks and benefits? Yeah, I mean, everything we do has got potential benefits and harms, and every bit of our life we're doing this informally, casually. But in vaccinations, it's particularly difficult because the potential benefits of being vaccinated are sort of downstream.

They're rather intangible. We'll never know, really know whether they've helped us or not. But the potential harms seem to be right up front and, you know, very accessible to us. And I think one of the problems with this is that now there is so little measles, mumps and etc. around us. We're not aware of the harm that could could happen if if we don't get vaccinated i mean i'm sorry i'm sounding like a real old man now but you know we're in the late 1950s i i there were no vaccines i got marched around to get measles mumps chicken pox etc from anybody who had it um you know what i didn't realize of course is that you know where there was half a million kids getting measles every year, and 100 of them were dying. So getting measles then was the equivalent risk of having,

say, 20 parachute jumps or something like that. You know, this is high risk stuff. And of course, we don't see it anymore. And so, you know, those potential benefits are much difficult to visualize and get a vivid picture of. And I think this is the crucial issue that in any communication, you know know your listeners have said they they feel they're getting very unbalanced and a biased view i think it's important that people do receive information on potential if they want to hear it on potential benefits and harms with equal sort of emotional impact but that means that each have to be fairly vivid as well but it also feels a bit fuzzy it feels like parents can't get straight answers.

Why can't a doctor just say the risk of getting a side effect is X and the risk of getting measles and flu or whatever is Y? I completely agree. I wish they could. And in other areas, there's much more effort now going into, you know, we work on advising people about cancer treatments and things where you can actually put some sort of rough number on the benefits and what the potential harms are. So people can trade those off, not in a formula, using their emotional impact, their emotions in it. But one of the big issues, of course, about vaccinations, we've heard again and again, is it's not just yourself that you're influencing.

If you don't get vaccinated, you know, and you go around, you know, you could be causing harm to kids in the community who can't get vaccinated because they're on chemotherapy or they've got a particular disease that means they can't get vaccinated. And why should those kids have to stay away from school if there is an outbreak? The other thing I'd like to point out is that there is this rather paradoxical effect that, you know, if you're in a community that where people are muttering and saying, oh, I don't want to get my kids vaccinated. I don't believe in that. The very fact of that community is not actually getting a very high vaccination rate is a reason to be get your kids vaccinated because they're at higher risk in that community then. So and but of course, as we've heard if everyone else was being vaccinated you could not bother and go along as a free rider and just take advantage of the herd

community the herd immunity so you've got this paradoxical situation that you have to really do the opposite of what you know everyone else is doing so if you're in a community where people are muttering and saying they don't want to get their kids vaccinated that is a really strong reason to get your kids vaccinated we're talking uh facts here on women's out but i'm just wondering do people actually want more evidence is that really going to change their mind well as we've heard before many people and i think i'm one of them you know i i you know i want to i want to go to some really trusted person who's considered this and i feel that they're going to give me um the advice that's best for me and say well what do you think i should do and that's and that's fair enough and I feel that they're going to give me the advice that's best for me and say, well, what do you think I should do?

And that's fair enough. A lot of people want to do that. But some, and a sizable proportion, actually would like to feel that a trusted authority is telling it to them straight. And that means talking about the benefits and talking about the harms, if possible in terms of magnitudes, at least get it giving a feeling about them but of course just because there's benefits and harms does not mean it's 50 50 you know the benefits can easily very much outweigh the harms and particularly when we in this area when we take into account the benefits to the whole of society that we are members of and

Anne-Marie and apologies to listener about the quality of the line Anne-Marie, and apologies to listeners about the quality of the line. Anne-Marie, if we're talking about society and your vaccination or your kids' vaccination having an impact on other members, what's your research shown is the best bet for helping people to care about someone that's not their own kid? Yes, so our research is actually quite encouraging in that regard, in the sense that we have shown that if we direct people's attention to how their decision to vaccinate or not could impact the well-being of others,

and this doesn't have to be their own children, it can just be vulnerable members of the community, such as pregnant people or old persons who cannot get vaccinated, people with autoimmune disease, just raising that there might be people around for whom this applies and for whom it's really important that everyone healthy is vaccinated, makes people very cautious and actually makes people more likely to get vaccinated because this is what they can do to prevent this possible harm to vulnerable others. And here it's really striking that people in principle could

again exploit this uncertainty about whether or not their decision to not vaccinate would harm someone. But our research really shows that if we direct people's attention to the possibility that they could harm a vulnerable person, this makes them err on the side of caution and overweight this worst possible case in their decision making and do what they can do in order to prevent the harm, which is in many cases getting vaccinated if you're a healthy person. So you need to introduce them to someone in their immediate circle who would be at risk if they were given, say, flu. And that will have an impact. So actually, it's not necessary to introduce them to a specific person. It's really just sufficient to mention that they could encounter a healthy person for whom, for instance, say the flu, again, to come back to that example, is not a problem at all.

But there's also a chance that they could encounter an old person for whom the flu could have very severe consequences. And we don't need to, like, make this vulnerable person specific. They don't need to know that. It's sufficient to just drop this possibility and say they can't know whether they will encounter the healthy or the old person. And the behaviour essentially switches, so people really become more likely to get vaccinated or, for instance, to wash their hands and do other things that prevent the spread of infectious disease.

OK. Anne-Marie Nussberger and David Spiegelhalter, thank you very much. Now, back to the studio and back to your questions and back to Helen, Adam and Tonya. We've had quite a few questions that sum up as does immunity wear off? So let's have a look at that. We've got Linda who said my son had all the vaccinations and boosters during his childhood, but was found to have no immunity to measles, mumps or rubella when he was tested before starting a new job um so sebastian says a similar thing and says this has always puzzled me i'd love to know how it works so are a whole bunch of us vaccinated adults now blithely unprotected absolutely we are and what's more the infections themselves don't by any means always give you lifelong protection. Possibly the only infection, in fact, that does give you that kind of reliable protection is measles. So I had measles as a child. It was too old to have had the vaccine. And I'm very,

very unlikely to get measles now, even if because there is measles around and there's a risk of that. But vaccines immunity depends very much on the vaccine. Some of the vaccines make stronger immunity than the infections themselves, some of them less strong and many vaccines the immunity you get does wear off over time. It's why we give several doses and of course once again it brings us back to herd immunity. As long as enough people have their children immunised, this doesn't matter. You may get older, you may lose your immunity, but the infection isn't there and you won't get sick. If that system fails, then, of course, it all unravels.

And on Instagram, Irene says, all of my children and their friends had full MMR. There's now a round of mumps on campus and I'm struggling to give them a good explanation as to why. I'm surprised that it wears off, Helen. Well, it's well known that mumps vaccine is the least effective part bit of the three vaccines in MMR and it does wear off over time. So we are seeing outbreaks of mumps amongst notably university students because that's the way they mix and this is happening around the world. It's not just in the UK.

But of course, the answer to that is, as Adam has said before, it's about herd immunity. I prefer the term community immunity because we're not little cows. But also, if you do get an attack of mumps after you've been vaccinated, it's generally much less severe. OK, next listeners, Caroline and Chloe mentioned the importance of getting actual diseases in order to properly activate the immune system. Chloe has immunised most of her children, but says we know it's extremely important for children to be ill as it creates a strong immune system. So where do we draw the line at stopping illness? Well, children are exposed to lots of things all the time, lots of germs. You take any

young child and their nose is constantly running, they're putting things in their mouths, their immune system is being exercised with those things. So what we're doing with vaccines is giving them protection up against those infections which can be particularly serious. And it's actually a tiny fraction of the number of things that children are exposed to. One important thing is to think of the consequences of these diseases because if you have a disease, you can be very badly affected by it. You can have complications, you can die.

And we also know with measles that actually having an attack of measles affects your immunity to other infections. It sort of resets the immune system, if you like, and it makes people more vulnerable to other infections for up to five years after an attack. A bit of a change here, but I'm wondering, we've had several questions about this compensation scheme via a government website. It's called the Vaccine Injury Compensation Scheme, and it's paid out millions since its conception. And lots of people are going, well, if vaccines are safe, why on earth does this thing exist? So I'm no expert on the compensation scheme, but I can tell you it's a judicial rather than a scientific process. And I think it makes absolute sense that no one is in fact saying that vaccines are 100% safe.

This whole programme has been around the fact that this is a decision where you make between benefits and risks. And I think, I hope we've got across the message that if you really know about the benefits and risks, it's a no-brainer. You clearly will always go for the vaccine, at least the ones that are recommended. But nevertheless, no one is saying that vaccines are entirely safe all of the time. And given all of this discussion around herd protection, in other words, that we are exhorting people not only to protect their children, but to protect everybody, it seems completely logical that if it were to be the case that someone is judged to have been harmed, and they've done this as part of a buying into society, society should compensate them for that adverse outcome.

So I think it's wrong to see a compensation scheme as somehow a proof that vaccines are not safe. On the contrary, it's proof that society is, we're all part of something that we're doing jointly and together, and that we all opt into this because it's good for everybody. But if there were the occasional person that suffers, then we should all join in and compensate them for that. Well, talking about something that we're all doing together, it's flu jab season right now and lots of families are getting letters in school book bags although there is a shortage in Scotland

at the moment but that aside is it worth having? One listener has vaccinated her children for everything else but is going to reject the flu spray. She says the thing that helped me make my decision was the NHS website. It says flu is an unpredictable virus that can be unpleasant, but if you're otherwise healthy, it'll usually clear up on its own within a week. Now that seems reasonable to me. Flu can be very nasty in children. It puts a lot of children in hospital. There were 13 deaths in children last year.

Ten of them had underlying conditions. 13 deaths from flu? 13 deaths from flu in children last year. Ten of them had underlying conditions. Thirteen deaths from flu. Thirteen deaths from flu in children. So it's not always a benign condition by any means. And although we know the flu vaccine varies in how well it works, it's still worth having because it can, you know, it does reduce the number of flu infections. But people say it doesn't really work. Well, this is true because there is an element of prediction there that, you know, matching the flu vaccine to exactly which are going to be the predominant strains is a bit of a prediction issue. And this is a problem for flu

vaccine. But nevertheless, it does reduce the amount of flu. Even if it's only protecting 20%, it reduces the amount of flu it's worth having. Can I come back to the formaldehyde pear issue we've had a comment on Twitter that says come on BBC let's challenge the experts in inverted commas 50 times more formaldehyde in pears than jabs you eat pears you inject vaccines um so tonya what have you got to say about that um so that's true but the way that compounds are processed in the body is the same um so the way that we um excrete uh you know compounds that we don't need and and things like aluminium um is via the kidneys and so regardless of how you actually ingest it it will be processed and metabolized in the kidneys and excreted in the same way it may get there quicker depending on

you know the way it's taken into the body but essentially it will be processed the same and excreted in the same way Adam's a scientist who can probably add to this yeah I mean I think in a way I take the listener's point and you could argue the toss on that. The more important point to make is that the amounts of formaldehyde in vaccines are not dangerous. And that's definitely known

that their trace amounts, they're a byproduct of the manufacturing process. And we know very well that it's not a problem. So don't worry about it, I think is the answer. And it's in the body naturally. It's part of the metabolism process.

So we make it. We make it, yeah. Now, we're running short of time. So I want to move to the wider question of trust. We asked people earlier to send in their thoughts and you've not disappointed us. We've had a whole bunch of of confused people and annoyed people. And I just want to bring in something that Matt Hancock said as well. The issue of compulsory vaccination. Here he is speaking recently.

Well, I do think that we need to consider all options. Failure to vaccinate when there isn't a good reason is wrong. And these people who campaign against vaccinations are campaigning against science. The science is settled. Now, I don't want to have to reach the point of compulsory vaccination. But you would look at that. Well, I said that I rule nothing out. I don't want to reach that point.

I don't think we're near there. Okay, that's a tricky issue, I think. I think that's a can of worms. And how do you guys feel about compulsory vaccination? I think there's a lot we can be doing before we even need to think about compulsory vaccination. We know that a lot of under-immunisation is just because people have busy lives, forget that they need to get the immunisation. So it's about reminding people, but it's also about making services more accessible because it can be difficult. And general practice is under a lot of pressure at the moment. There are fewer nurses about. All these sorts of issues need to be addressed first before

we even start thinking about compulsion. Tonya, surely compelling people to have vaccines if people have questions is just going to put people's backs up. Is it going to help? I don't think it would help to have compulsory vaccinations. I think there are some situations where it's necessary if there's an outbreak. It may be a public health tool to overcome that particular outbreak. But in general, I think it's much better that we talk to people, that we understand their concerns, that we address the concerns and allow people to make a decision based on the information that we give them. We've had a tweet from Gareth who says, I personally don't trust vaccines due to unclear side effects. I'm not sure if they actually work. Could you raise the efficacy of vaccines and perhaps look into how effective they are? So how effective are they? Sure, sure. I think that's an important question. And in particular, the newer vaccines, the level of evidence that you have to produce that the vaccine actually works before you introduce it is really now very high. So those of us in the business of doing research on vaccines spend a lot of time doing exactly those kind of studies where children either

receive the vaccine or don't receive the vaccine in a randomised controlled trial, and then we observe and see if they get sick or not. So there's a really high level of evidence that is required before you can even get a licence to make the vaccine and make it available. The older vaccines, you know, those kind of studies were not done. We're talking about vaccines introduced 40, 50 years ago. And the evidence is predominantly that if you look where the vaccines were introduced, the disease just went away and did that almost immediately over a period of a year or two in a way that no other trends could explain. So there's very compelling evidence of that kind from around the world that

if you give the vaccine, the disease goes away. And now I'm afraid something that's not been said in this programme, if you don't give the vaccine, the disease comes back again. And the interesting discussion we were hearing earlier about the risks and benefits, unfortunately, we're now seeing more whooping cough, we're seeing more measles, we're beginning to see more rubella. because the vaccine rates are going down. That's a worry. OK, so we've clearly got a whole load more to discuss. But to end on a happy note, I wanted to make clear that we have had an awful lot of positive comments about vaccination as

well. Ingrid is a big fan. She says, I had a nightmare with a friend virtually camping on my door to stop me from going to a doctor to get my son vaccinated. I did vaccinate my son before we went to live and work in Africa. He's 11 now, and I wouldn't hesitate to vaccinate now. So thanks to all of our listeners. Thanks to all of you, Helen Bedford, Adam Finn and Tonya Thomas. And thanks to everyone who sent us questions. I think it's fair to say that vaccination is about as much about the feelings as it is about the science. But hopefully some of the answers you've heard today have been in some way useful. And we've had some decent feedback on email and Twitter. So thank you for those. Steph says, wow, great to hear a whole show dedicated to vaccines. I got all three of our

boys vaccinated for everything and get my flu jab every year. And I think the amount of misinformation on the topic is mind boggling. Zoe says, I'm so disappointed by today's programme. Are you aware that there are thousands of medical professionals who've changed their opinion, read the efficacy and safety and even need for vaccines? Evie says, interesting discussion. All pro-vaccine people on the programme, very biased discussion, should have been a fair debate. Well, it's one of those things, Evie, like climate change, where I think the science is overwhelmingly in one direction and that's pro-vaccine. However, we wanted to represent the middle ground where parents still have a load of questions that haven't been answered when they go to the doctor or whatever.

And I hope that we managed to do that. More positive notes from Minnie, who says, Talking about vaccines. I had a kidney transplant and my immune system is suppressed. So I need the herd immunity to protect me because I can't protect myself. This is so important. Thank you, Kevin, for writing. This debate has much wider implications. A society in which the uninformed are unashamed, proud even to stand up and admit they prefer to believe some random blog to a qualified expert. Should I vaccinate my

children? Let's think what to trained medical professionals do. Giving airtime to people who think differently is probably a good idea, but inevitably patronising. For how else do you deal with combined ignorance and stupidity from adults supposedly responsible for children's health? Well, Kevin, I do agree with vaccines, but I do feel we had a lot of very sensible and reasonable questions. And B says, I'm so glad this programme is happening. I'm 67. I had measles at about three to four years old when no vaccines And B says, Well, homeopathy, that's another can of worms, which I'm sure Women's Hour will deal with at another time. I'm off to go and make a pear chocolate and formaldehyde tart. Thank you so much for having me.

And it's Jane Garvey tomorrow. Warning everybody. Every doula that I know. It was fake. No pregnancy. And the deeper I dig, the more questions I unearth. How long has she been doing this? What does she have to gain from this? From CBC and the BBC World Service, The Con, Caitlin's Baby. It's a long story, settle in. Available now.