Edibrial
The devil and the deep blue sea
There is more than the gull of the
Athi,ntic between the £20 (100 which
the British G o v e r n m e n t begrudgingly provides for the families of
vaccine damaged children and lhc
£21 700 0()() which was recently
awarded in a vaccine damage suit in
the USA, (Sunday Times 11.8.~,5).
What lurks between these pohi,rized
excesses is the demonstrated inability of either of these two st)citrics
to el)me to terms in a rational way
with a technt)logy which, when properly applied, leads to a noticeable
increase in social well-being. Not
of(Iv arc such bericlhs to be perceived in the decreased costs to the
health services but there arc also
major unaccountcd gains. Such
gains are lk)uilct in the decreased
disruption of the work effort, in the
improvcmcnls in ihc hcalth of colleagues and in the progressive mortile which people who arc mainly
well adopt to their familial and
societal activities.
"fhe consequences of societies"
responses to tile individual tragedy
of a child damaged by a vaccinc has
implications both within and bevend the individual family. Within
ihe family a too niggardl,v compcn-
sation st'home leads to alienation
from the svstenl which incurrcd the
risk: tin attitude oil "why should I,
having done my st)cial dutx, have
been penalized so extensixclv and
unrelentingly.', p" People outside the
family take the view that the risks of
vaccination tire unacceptable, and
decline the offer or spurn the opportunity to protect their chih.lren
against disease. [:cwer children are
vaccinated: the disease returns: the
t)tltConle is much worse than thnl
which would have rcsullcd from ll'ic
application of the vaccinc. "l'herc
arc implications for thc vaccine
manufacturer in that not only tire
there lost stiles of vaccine but there
is the promulgation of a tacit attitude that the society is not re(lily
behind, and fully supportive of. \accination campaigns, and therefore
is it really worthwhile risking the
obligatory £10--50 million in bringing out a ncw vaccine.
The other extreme also has its
pilfalls. A legal system which has
2
Vaccine, Vol. 4, March 1986
within its purlieu the mechanism for
an individual in the society to punish another m e m b e r of that society
is clearly in danger of unleashing
forces wilich, in another age, would
lead to civil strife, while today the
consequences are that individuals
who have suffered damagc are provided with a tinancial windfall that
is out t)f till proportion to themselves as people or, more importuullly, to the damage they have suffered. Given such opportunities for
linancial advancement the ruthless
could be mduccd deliberately to
seek damage in order to assign the
hhimc in a way which enables them
to follow stilt and claim millions.
l'hc corollary for the vaccine manufacturer is even rnorc disastcrous.
Somcthhlg is clcarlv, adrift, when as
a consequence of havin~ practised
their arts in the most perfect ~vav
known to nl:-i,n, they (.'till hc held
Ihihlc for damages wt]ich :.ire till
inevitable facet of that activity and
to a level which can reduce a }inallciallv healthy and prolilablc concern to il pauper overnight.
The iSstles behind these events
arc nol so simple. What body is
"rcsponsiblc" for the damagc c;.luscd
by the vaccine? Is it the society as
either in;.lde m;.tnifest by the collccti',¢ \~ill of the people desiring to
protect themselves fronl dam;(go
and ihcrcfl)rc incu,rring a recognized risk on their fellow members,
or the society, as represented by its
lmvernmcnt? (.)r does the responsibility devolve to the manufactu, rcr
wishine, to derive conunercial ,is
\vcll :is "image" henclits'. > flow arc
such responsibilities shared when it
is the direct policy of the govcrnI l l c n l If') n l ( ) u n t ~.i campaign Io vaccimite till the citizens'? ls the recipient
of the vaccine unique in some
immunolt)gical sense that makes it
inevitable that damage ',,,"ill bc
caused by cxposurc to a particular
immunoh)gical stimulus? What is
thc role of the legal system and the
individuals who use it, cxploil it and
pervert its basic aim of perpetrating
juslicc'? What is thc rchitionship
hetwccn "product liability" for a car
t)r I ' V and product liat;dlitv for a
vaccine? lh)w do the communica-
tion meditt discharge their function?
It is facile to exacerbate the tragic
circumstances of thc individual case
to the point where public sympathy
generates unbalanced and unjust
consequences. There is also the difficult issue as to thc establishment
of the causal rehitionship bctwecn
the act of vaccination and the onset
of the damage: tire there not circumstances in which such a person
would have been so damagcd cvcn
if he/she had not bccn vaccinated?
While the problems raised by. the
phcnonlenon of vaccine-associated
damage arc lllti,nv tile options from
which solutions and proper social
practices can be found arc rclativcl\
fe~,,. It is not unrealistic to requirc
the social purse administcred hv thc
government of the d a \ to f)rovidc
for the victims of xacchle-induccd
danltlgc the incuns ~ h c r c h \ their
willingness to participate in the
social goal of increasing the health
of all in lhc society is recognized h\
aclccltlale conlpcnsalJt)ll, ,uch emoluments to be pro~ided al ii le\cl
which cntibles thesc people to Iixc
decently and free from hardship
derived from monclar\ consitlcraliens. ,~uch policies cto pcrlain in
(}ermailv where a schelnc is ill opcratiOll ~(hich providcs cl "~lale pension" to the family supporting a v;iccine-damagcd child of some {<R.(itl(I
per ye{il.
()n ihe other side of ihc coin the
application of product liability hl\w
to the vaccine situation can <rod
must be changed. The nature of Cl
vaccine and the ~ariabililv and individual propensities of \;iCCillCCS
must be recognized in law. l h e
inevitahlc consettucncc of the COlllinuathm of the present situation is
that vaccine production in the el)minertial domain will cease. There
nl;.iv well he a case for lhc development of a partnership between the
sit(tO and the nlanufaclurer such
that responsibility for lhc producl
will properly rcst \~ith the st;.itc,
while the responsibility for cflicicncv alld cost effectiveness in lhc
manufacturinn process will rest with
the c(>mnlercial producer. For somc
societies change in these areas is
imperative.