On Monday Auckland-based journalist Jon Eisen issued Scoop with an article examining the safety of New Zealand's Meningococcal vaccine. Scoop approached the Ministry of Health (MoH) to comment on the findings. It has done so and refutes Eisen's claims. Scoop has published both sides of this most important issue and calls for the medical fraternity including researchers and medical students to analyse the findings and claims. See… Jon Eisen's Commentary Is Inaccurate And Dangerous (includes Eisen's claims).
Discussion of MoH and Vaccination Article
The MoH response does not actually address any of the claims in the article. Instead, two forms of expert authority are drawn on to defend the rather evasive MoH position. One is the autocratic tending, professional vs lay structure that is institutionalised as the macro side of the medical 'ethos of care'. (The micro side may be experienced as individualised doctor-patient relationships). The other form of expert authority drawn on in the Ministry response is that of hierarchy, as found in health sector bureaucracies. In a bureaucracy the expert authority is locked into structural relationships, where demands to comply flood downwards while accountability is hooked and drawn upwards, towards the State funding and legislature.
All the MoH response says is that the procedures for testing immediate outputs and evaluating longer-term outcomes are, in this case, no worse than any others in NZ. This may well be so, but evades the question in an autocratic manner. Such evasion suggests comparisons with the 'unfortunate experiment' at National Woman's Hospital, where an authoritarian bureaucratic structure allowed Dr Green and his hierarchy of support to ignore the, admittedly slow and over-polite, warnings of a few of his medical peers.
I suggest that the promise of adequate health provision in New Zealand can only come from a combination of consumer representation, medical professionalism and health bureaucracy. Yet these forms of organising are quite different in some ways, and are often found in conflict in western societies. Their range of combinations can produce harmful as well as helpful outcomes for individuals and communities. How then should the evaluation of health and harms, for instance as a consequence of vaccination programmes, be achieved?
In New Zealand this question is part of larger health sector issues where people attempt to improve and stabilise our health futures. This is tricky because these are somewhat contradictory goals. It is even trickier because if such attempts rely too much on extending the rigidity of autocratic structures, and too little on constructing dynamic stability from the flexible adjustment capabilities of public negotiation networks, then instability seems inevitable. The critical concept here, I suggest, is the capability of constructive adjustment found in trust relationships. Such constructions appear in constant entanglement with destructive seeming trials and tests. Without openess and adjustment to evidence, trust degrades into a rigid faith in autocracy. This way of looking at trust also indicates how health issues cannot be separated from issues of public expectations and consumer representation.
It seems useful to consider a professional perspective. In 2003 Dr Galler, as National President of the Association of Salaried Medical Specialists (ASMS), commented in his introduction to the report on New Zealands Professionalism Conference in April 2002 (Health Dialogue Issue 5:5-6), that:
"... Since the Cartwright inquiry of the late 1980s, the medical profession as a group, seem to have gone into a huddle and haven't come out. Well we need to come out and we need to come out now.
Medicine is about relationships and at its core is the sanctity of the doctor patient relationship. But we must not forget that medicine is also about a wider relationship, one with the public at large. Despite the many mutually satisfactory interactions between individual medical staff and individual patients, at the macro level the nature of the relationship between the medical profession and the public is better characterised as a mutual 'culture of suspicion'. What I am sure both parties want is a culture of trust."
Perhaps the 'huddle' is now breaking up, ... or perhaps reorganising along more lay-friendly lines. For instance, Associate Professor Phillip Bagshaw, one of New Zealand's most respected surgeons, was quoted in yesterday's Press as calling for greater professional effectiveness and efficiency to be achieved through greater democracy in District Health Boards. His stance aligns lay community interests with medical professional interests, which strengthens trust relationships between the public and professionals. By opposing the harm caused by 'unfortunate experiments' in managerial autocracy on District Health Boards, Phillip Bagshaw rebuilds public trust in medical professionalism.
At the same Professionalism Conference, Annette King, the Minister of Health, stated from her governance perspective:
" ... We should not feel threatened by the public's determination to talk more openly about the performance of medical professionals and safety in health."
She later emphasised, in the context of the District Health Board apparatus, the need to:
"... provide certainty to assist decision-making, a greater sense of partnership with communities, and ... re-establishing the sense of trust that many feel has been eroded in recent years."
Trust, then, is agreed by all parties in the health arena to be at risk, yet there is no single source of trust. Although the Minister did not invite the public to talk more openly about the performance and safety issues associated with the Ministry, one might assume that in the interests of establishing trust she would have, had Ministerial protocols and interests left her free to do so. All parties in health arrangements are seen, or may be assumed, to be motivated by interests that at times conflict with the interests of others. This is why the Ministry of Health response to the media article on vaccination is so disturbing in relation to New Zealand's continuing history of health sector conflict.
The Ministry claim to being a single authority is based on its singular ‘standard operating procedures’, neatly combined with the presentation of professional medical expertise as a single supportive background voice. Yet health provision is generally not about single tidy solutions. Bodily ecologies are complex, as unpredictable at times as the consequences of social programmes. Health is about adaptability to changing circumstances, while treatment and harm prevention are about discretionary differences, a degree of chance, and evaluation of outcomes. Differences, mistakes and adjusting manoevers would be expected at any location in health provision and policy. In any health research, their absence would be grounds for distrust. That is why testing and trust provide the best basis for approaching health needs.
It would seem that the success of vaccination outcomes, (assuming the proposed methods actually work), depends on adequate public participation, which is dependent on trust. That trust seems in short supply and cannot be forced. The Ministry seems unwise in reducing it even further by tactics of evasion and 'shooting the messenger'. Nor are tactics that increase a 'culture of suspicion' helpful in attempts to improve wider public health outcomes.
Stephen Macdonald Luke - Christchurch, New Zealand.
Meningococcal Vaccine Is A Mass Experiment
In case anyone is unsure of the experimental nature of the Meningitis vaccine, what follows are verbatim quotes from the Counties Manukau/Eastern Corridor MeNZB™ Newsletter published on 10 March 2004.
“The trials, conducted by the University of Auckland in partnership with the Ministry of Health and Chiron Corporation of California are progressing well... The results of the MeNZB™ vaccine were presented today at the WHO/UNICEF Workshop on the expanded programme on Immunisation in the Pacific in Auckland. This arm of the continuing clinical trials involved 300 toddlers from all over Auckland who were aged between 16 to24 months... Trials involving toddlers are just one part of a long and rigorous evaluation looking at differing sectors of the New Zealand population. Trials involving adults, children aged 8 to12 years of age, toddlers aged 16 to 24months of age and babies aged 6 to 8months of age have been completed while trials involving babies at 6 to 10 weeks of age began in January... Pending regulatory approval, the national immunisation programme which will aim to vaccinate all New Zealanders aged 19 years and under is expected to begin in South Auckland in the middle of the year... Special efforts are being undertaken to engage the Maori and Pacific communities due to the high incidence of meningococcal disease in these communities... Members also represent District Health Boards and bring experience from primary health and public health areas. Their advice will assist the Meningococcal Vaccine Strategy project team to reach the highest possible vaccination coverage among groups who are most at risk of meningococcal disease – Mäori, Pacific and children from low socio-economic communities.”
It is crystal clear from the above statements that new Zealand children are being used to “trial” (read ‘experiment’) the meningococcal vaccine. The experimenting started with toddlers and the ultimate goal is to vaccinate as much of the New Zealand under-20 year-old population as possible.
Obvious questions are; were the parents fully informed that their children were/are guinea pigs? Who will be liable if any child is harmed or dies from this experiment? Does the Ministry of Health have the right to experiment on such a large proportion of New Zealand citizens, who MoH ‘spin doctor’ Jane O'Hallahan called “the most vunerable [sic] in our country”? When did the Ministry of Health, World Health Organisation and UNICEF usurp the right of New Zealand citizens to be consulted as to whether they want their children to become lab rats? I am sure there are many more questions that need concise answers from Minister of Health Annette King; let’s start asking them and demand that they all be answered.
To view the entire newsletter, go to: http://www.cmdhb.org.nz/Counties/News_Publications/Newsletters/MeNZB/MeNZ-10Mar04-Med-Issue1.pdf.
Dave Taggart - Napier, New Zealand.
Meningococcal" is an ADJECTIVE
"Meningococcal" is an ADJECTIVE. It MUST have a NOUN after it. I shudder everytime I hear it used that way. Whatever your position in the debate, please don't demonstrate ignorance of basic English. It is like saying "She wore a very colourful".
Rick Thomson location unknown.