Dr Hazir stated that more than 50% of the 550 patients with measles seen at a children’s hospital in Islamabad had previously been vaccinated (though he did not state whether they had received the recommended two doses or just one). NSNBC, quite unjustifiably, turned this into the headline “More than 50 % of those Diagnosed with Measles in Pakistan had been Vaccinated”.
One children’s hospital in one part of Pakistan is not necessarily representative of Pakistan as a whole (and, it is worth noting, one MMR or single measles vaccination is not always sufficient to protect against measles – this is why vaccine schedules tend to include two doses). I had a quick look to see what the situation was in Pakistan as a whole.
Contrary to the headline on NSNBC, it seems likely that a minority of patients with measles in Pakistan have been vaccinated – according to this report in the Tribune (the Tribune, you will note, was also the source for the NSNBC article that has been uncritically promoted by Child Health Safety). Here’s what this Tribune article (published two days before the article that NSNBC and Child Health Safety are so keen on) said:
Out of thousands of cases, 60 per cent of children — most of them below five years of age — were not administered even a single dose, though proper immunisation requires two doses of the vaccine. Approximately 20 per cent of children were vaccinated incompletely with only one dose.
60% of the children were unvaccinated, 20% were partially vaccinated and 20% were fully vaccinated according to this account.
Child Health Safety didn’t report on this piece in the Tribune. Nor did NSNBC.
It looks to me like NSNBC have cherry-picked a single quote from a Doctor at one children’s hospital in Islamabad and extrapolated from that one hospital to the entire country. I’m not sure why anyone would feel the need to make claims about the situation in Pakistan based on a Tribune report about hundreds of patients with measles attending a single hospital in one part of Pakistan when it appears that information was already available, from the same source, about the vaccine status of thousands of measles patients countrywide. The situation at that one hospital could never have told us about the situation nationwide, it could only have given us an indication (in the absence of nationwide information) as to what we might expect to find if we actually looked at that situation – which NSNBC’s source had already done. It’s almost as if information is being chosen on the basis of its usefulness in furthering an anti-vaccine agenda rather than its validity or relevance.
It may be that the figures being quoted about the situations in Islamabad’s children’s hospital and in Pakistan will be revised when further, more reliable, information is available (I’d be wary of relying on vague, provisional figures being quoted in news reports myself – we simply do not know how trustworthy those figures are at present). At the moment, we have these two Tribune reports and rather than telling us the provisional figures for Pakistan, NSNBC and Child Health Safety are telling us the provisional figures for a hospital in Islamabad and reporting on them – in headlines, as prominently as they possibly can – as if they are the figures for Pakistan as a whole.
It’s pretty clear to me that NSNBC and Child Health Safety don’t want to inform and educate their readers. Rather, they want to give the misleading impression that the measles vaccine is ineffective. In order to do this, they report on the hundreds of cases that suit them and ignore the thousands that do not.
They also neglect to tell readers what vaccine coverage is (a piece of information that is necessary for anybody wishing to make a comparison between vaccinated and unvaccinated children for rates of infection). It was 80% for one-year olds in Pakistan in 2011: WHO (one dose of measles-containing vaccine). If we lump together the partially vaccinated and the fully vaccinated, we have 40% of measles cases who have received at least one dose of measles vaccine and 60% who are completely unvaccinated against measles. With 80% vaccine coverage, this means you are six times more likely to catch measles if you are completely unvaccinated than if you have had at least one dose of measles-containing vaccine. Uptake of the second dose of MCV was 53% in 2011: WHO. Children who are unvaccinated are four times more likely to catch measles than children who are partially vaccinated. Those who are partially vaccinated are twice as likely to catch measles as those who are fully vaccinated. The unvaccinated are eight times more likely to catch measles than the fully vaccinated.
Uptake of the two doses of measles vaccine is inadequate and the unvaccinated are most at risk from measles. At present, it looks like this outbreak of measles has more to do with a failure to vaccinate than it does vaccine failure. Not that you’d know that from the reporting of NSNBC or CHS.
One more thing (though it’s not strictly relevant here, as I am focusing on vaccine uptake and incidence of measles) that is ignored by NSNBC and CHS is the consequence of the outbreak of measles in Pakistan. In the Tribune article that they have not reported on, it is stated that of 25,401 reported cases there have been 146 deaths. That is a mortality rate of 1 in 175. It is perhaps worth pointing out at this point that measles is milder in those previously vaccinated. Now, a case fatality rate that high is likely to be due to various factors – perhaps including things like crowding, vitamin A deficiency and lack of access to medical care. It strikes me, though, that now might not be a particularly good time to publish reports that misleadingly suggest that measles vaccination is ineffective – particularly when you choose to use the outbreak in Pakistan to support your argument.