I was 72 last week, which means that I am just able to remember my parents’ anxiety every summer about the regular outbreaks of polio in the UK. Several hundred children died each year. Many survivors needed long-term treatment in “iron lungs”, early types of respirator, because their muscles were too weakened to breathe on their own. Some permanent degree of paralysis was common. In later life, a post-polio syndrome emerged as the ageing process compromised the body’s adaptations to the damage caused by the infection. My generation includes victims of this virus. We take it very seriously. 

Everything changed after 1956, when mass vaccination arrived in the UK. While there were early safety issues, improvements in design and manufacturing eliminated these risks. Polio vaccines have been used worldwide for 70 years to the point where the virus is on the brink of eradication. The last UK case was in 1984 and Europe has been officially polio-free since 2002. The only outbreaks since have been associated with migration from places where the virus continues to circulate, although some parts of Europe have undesirably low vaccination rates. 

This is why there is such concern about the situation in north London, where polio virus, which lives in the gut, has been detected in sewage at a community level. One type of vaccine uses a weakened virus which is excreted for a while after the vaccination. This can mutate back to a more dangerous form, which seems to have happened in London. The UK does not use this vaccine, which has advantages in other contexts that outweigh that risk. 

London has long had much lower vaccination rates than the rest of the UK. Its ethnic mix means that many groups are not easily reached by community health services because of their distinctive languages or cultures. Housing pressures mean that people are frequently moving around and it is hard to keep track of children to remind parents or carers about vaccination schedules. There are also challenges in recruiting and retaining staff in community health and primary care, because they experience the same difficulties in finding stable housing and maintaining an acceptable quality of life on the salaries offered. 

I saw the problems 50 years ago when I was doing research with health visitors in what is now Docklands. But they have been aggravated by the squeeze on local government and NHS funding over the last ten years, by poor workforce planning, and by a lack of consideration for the collateral impacts of Covid. 

Parental confidence in all vaccines seems to have been shaken by the controversy around Covid-19 vaccines for children. The Joint Committee on Vaccination and Immunisation was created in 1963 from a previous group advising on polio vaccines. Its work has kept Britain’s children safe for 60 years. But when it has been challenged on individual recommendations, as with whooping cough in the 1970s, MMR in the 1990s or Independent Sage on Covid-19, the effects seem to spill over.

The system is not broken but it needs serious fixing, if it is to protect North London children. Some of this is about absolute levels of resource to support engagement with parents from diverse backgrounds in ways that match their language and culture. More immediately, the NHS could stop diverting energies into the promotion of Covid vaccinations for children. JCVI have clearly stated that there is little to be gained from this, except where there are strong clinical indications.

Why promote a vaccine for an infection that is generally mild in children ahead of a vaccine for an infection that has devastating consequences for a significant proportion of its victims, including children? It is time to subject Covid interventions to the same assessments of cost, risk and benefit that would be applied to any other activity by the health services. 


Robert Dingwall is Professor of Sociology at Nottingham Trent University

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