Children in the US, Japan, Australia and Germany are routinely offered the chickenpox vaccine – but here in the UK they are not. Alex Manson-Smith asks, why not?
At best, chickenpox is an irritation – a week off school or childcare, ugly scabs that itch like crazy, and a fever. At worst, it can be a killer. Though complications are rare, they do happen and they can be serious.
But there’s a safe and effective chickenpox vaccine available, so why aren’t UK children given it routinely? After all, children have been given it for decades in many other developed countries. There’s been a vaccine available since 1988. The US introduced it in around 1995. Since 2005 Australia has offered it to all 18 month olds.
Certainly, routinely vaccinating children in the UK is something the Government has considered. In 2010, the Joint Committee on Vaccination and Immunisation, which advises UK health departments on these matters, looked at whether all UK children should be offered the chickenpox vaccine as standard. They decided against it.
One reason given was the expense. ‘The JCVI considered the impact of chickenpox vaccination on both chickenpox and shingles and concluded overall that a childhood programme was not cost effective,’ said Dr Mary Ramsay, head of immunisations at Public Health England.
But there’s an argument that vaccinating children would actually save money. ‘You have to balance the price of vaccinating people against the time parents have to take in sick leave,’ says Dr Tim Ubhi, consultant paediatrician and clinical director of the Children’s e-Hospital, an online service that teaches parents about common childhood illnesses.
Indeed, cost was the reason that Germany did introduce it in 2004, after studies found that vaccinating children would work out cheaper than parental absenteeism. ‘There is very little argument, from an economic point of view, not to have the vaccine,’ says Dr Ubhi.
But of course, cost isn’t the only factor at play. ‘Chickenpox is usually a mild illness in children with most recovering quickly from the infection and suffering few symptoms and no complications,’ says Dr Ramsay. But there is a wider public health context that goes beyond the individual child – the perceived benefit to the population at large of recurring chicken pox infection.
As the NHS website puts it: ‘There’s a worry that introducing chickenpox vaccination for all children could increase the risk of chickenpox and shingles in older people.’ This is because being exposed to children with chickenpox offers adults protection, providing them with a kind of booster. Given that it is widely acknowledged that the older you are when you first contract it, the greater the risk of complications, the ‘herd immunity’ point is routinely cited as an argument against mass vaccination.
And it isn’t just older people who would be affected. ‘There is also the risk that the number of pregnant women becoming infected with chickenpox may increase, where there is a risk that the infection could harm the baby,’ says Dr Ramsay.
This is a controversial point among some parents though who do not see why their kids should be denied the vaccine and become sick in order to provide (a not yet proven) protection to another section of the population.
Another concern is the risk of some children slipping through the vaccination net and contracting chicken pox at a later stage, when it is more dangerous. In Dr Ramsay’s view “a further concern for the UK in introducing a universal childhood chickenpox vaccine programme is the likely risk of pushing up the age at which people might contract chickenpox, particularly if uptake of the vaccination is low.’
And in the UK there’s a real risk that the uptake would be low, exposing those children whose parents elect against it to this risk. ‘There’s a huge fallout from the Wakefield saga,’ says Dr Ubhi. Andrew Wakefield is the former surgeon and medical researcher, whose 1998 paper linking the MMR vaccine to autism caused parents to stop vaccinating children and a spike in deaths from measles and mumps. Wakefield has since been struck off and his paper widely acknowledged to have been fraudulent. ‘It’s very difficult to address that. Wakefield caused so much damage and we’re still fighting that now.’
In the US and Australia the chicken pox vaccine is administered as an addition to the routine MMR. It’s unfortunately easy to see why those parents who, swayed by Wakefield’s claims, elected against the MMR (and risked exposure to measles, a far more deadly virus than chickenpox) would be unprepared to take up this vaccine.
Which is a shame, since the chickenpox vaccine has proved to be not only effective, but safe. ‘It seems to be very well tolerated,’ says Dr Ubhi. ‘Looking at the US data, there’s been nothing significant in terms of adverse effects.’
But there’s another argument, of course: one that says children should be allowed to catch chickenpox, as – for the most part – it’s a harmless illness that will boost their immune systems. It’s this thinking that led to the 70s trend for ‘chickenpox parties’, when parents would deliberately encourage their kids to hang out with an infected child.
Not everyone thinks this is the answer, though. ‘In terms of ‘educating’ the immune system, I would say that catching native chickenpox would be similar to being vaccinated,’ says Dr Ubhi. ‘But we have to remember that the child having native chickenpox will go through an illness process, and even though this is usually fairly mild, in some cases it can be quite uncomfortable for the child.’
There is always the worry that the vaccine may wear off, exposing children to the virus in later life, when it can be far more serious. ‘There are some, particularly in the UK, who believe that the vaccination process may reduce the exposure to the chickenpox virus and so adults may end up having a more severe disease,’ says Dr Ubhi. ‘This is because regular exposure may top-up the immune system, protecting against fulminant disease. However there is no data to support this that I know of, and the data from the US doesn’t support this idea.’
Even so, if you want the vaccine over here, you’ll have to go private.
On the NHS, it’s only given to what are considered vulnerable groups – namely those with compromised immune systems. ‘So that would be people undergoing chemotherapy, people on high-dose steroids, and those infected with HIV,’ says Dr Ubhi.
But if you have an otherwise healthy child and are simply hoping to skip the whole week-off-school/social-pariah thing, forget about it.
‘If parents want to get their child vaccinated, they can do so through a private clinic that can obtain the vaccine from the manufacturer. However, they will have to bear the full cost,’ says Dr Ramsay. CityDoc, which has more than 80 clinics around the UK, charges £70 per dose. Two are needed, which can be given 4-6 weeks apart to any child over 12 months.
Which leaves us with the all important question: should we have it done privately? Many friends have been told categorically to vaccinate their children, both by private paediatricians and some NHS GPs (who freely admit to having paid for the vaccine for their own kids) and the take up among those parents who can afford it is definitely on the rise as it becomes more widely known that this is an option.
‘It’s difficult to justify recommending it, because there will be people who can afford it and people who can’t,’ says Dr Ubhi. ‘We make our recommendations according to the NHS’s founding principles, which is that everyone should have the same level of care, regardless of income or background, and that it should be free at the point of contact.’
That said, he admits that he would vaccinate his own child and is optimistic that it’s only a matter of time before it’s available for everybody. ‘I would hope that one day we will vaccinate our children as I do think it’s a good thing,’ he says. ‘If other countries are doing it and there are demonstrably no ill effects, it probably will happen.’Alex Manson-Smith