Measles Vaccination and the British State

The Spectre of Controversy: Measles Vaccination and the British State

A thesis submitted to The University of Manchester for the degree of Doctor of Philosophy in the Faculty of Biology, Medicine and Health

2017

Andrew M. Black

School of Medical Sciences, Division of Medical Education

Table of Contents

Table of Contents ...... 2 List of Figures and Tables ...... 4 Figures ...... 4 Tables ...... 4 List of Abbreviations ...... 5 Abstract ...... 6 Declaration ...... 7 Copyright Statement...... 7 Acknowledgements ...... 8 Introduction ...... 9 Primary sources ...... 21 Thesis outline ...... 22 Future Research ...... 24 Chapter 1: Making Measles Visible ...... 28 1.1 Introduction ...... 28 1.2 Globulins, antibiotics and nursing: How to manage ‘mild’ measles ...... 33 1.3 ‘A mild illness’: The limits of vital statistics ...... 44 1.4 A shot in the arm: US vaccination and British debates ...... 51 1.5 ‘1 in every 15’: Making morbidity visible ...... 65 1.6 Conclusion ...... 73 Chapter 2: Regulation by Committee: Assessing the Risks of Measles Vaccine Trials ...... 76 2.1 Introduction ...... 76 2.2 ‘A woeful product’: Assessing Britain’s first measles vaccines ...... 78 2.3 Experimenting on ‘mentally deficient children’: Britain’s first measles vaccine trial ...... 84 2.4 ‘An impracticable material’: Killed measles vaccine not on trial ...... 92 2.5 The trial that never began ...... 97 2.6 ‘An opinion of one member’: Politics and risk ...... 103 2.7 Science, politics and the public: Changing perceptions of risk ...... 105 2.8 The trial ...... 115 2.9 Conclusion ...... 117

Chapter 3: Telling a Banal Story: Representing the Medical Research Council’s Measles Vaccines Protection Trial ...... 120 3.1 Introduction ...... 120 3.2 Designing a trial ...... 123 3.3 Publicity campaign ...... 128 3.4 Withdrawn or excluded? Beckenham 20 not on trial ...... 143 3.5 Lost in translation: The forgotten story of Wellcovax ...... 148 3.6 From ‘disappointing’ to ‘satisfactory’: The results of the MVC’s protection trial ...... 151 3.7 Telling a bland story: Publicising the results of the MVC’s protection trial ...... 156 3.8 Making measles vaccination policy ...... 168 3.9 Black boxed: The MVC’s protection trial ...... 172 3.10 Conclusion ...... 177 Chapter 4: Making Wellcovax Disappear ...... 179 4.1 Introduction ...... 179 4.2 ‘Not for publication’: The private regulation of Wellcovax ...... 181 4.3 Preventing fear, panic and controversy ...... 195 4.4 From doubt to danger: Re-assessing the risks of Wellcovax ...... 205 4.5 ‘What should we do?’: The global story of Wellcovax ...... 211 4.6 Communicating closure: Making Wellcovax disappear ...... 216 4.7 A private confession ...... 222 4.8 Conclusion ...... 226 Conclusion ...... 229 Bibliography ...... 236 Archival sources ...... 236 Published Sources ...... 244

Word Count: 75,701

List of Figures and Tables

Figures

Figure 1. The front cover of the Central Council for Health 36 Education’s 1956 measles pamphlet: ‘Measles: How to Spot it and What to do About it’ Figure 2. Newspaper article reporting on British attempts to develop a 60 measles vaccine Figure 3. Draft consent form for the Measles Vaccines Committee’s 130 protection trial Figure 4. Newspaper article reporting the details of the Measles 136 Vaccines Committee’s protection trial Figure 5. Notes to aid Medical Research Council staff when answering 164 questions about the Measles Vaccines Committee’s protection trial Figure 6. The front cover of the Ministry of Health’s 1968 measles 176 vaccination leaflet: ‘Now your Child can be Vaccinated Against Measles’ Figure 7. Adverse reactions to Measles Vaccines 190 Figure 8. An advert for measles vaccination and a newspaper article 195 reporting the suspension of Wellcovax Figure 9. Department of Health and Social Security’s press release 218-219 reporting the news of Wellcovax’s withdrawal from British vaccination campaigns

Tables

Table 1. Principal causes of death in England and Wales from 1957 to 48 1962 Table 2. Number of deaths from principal infective diseases in 49 England and Wales from 1940 to 1962 Table 3. Number of cases and deaths from measles in England and 49 Wales from 1940 to 1962 Table 4. Number and rate of complications from measles 71 Table 5. Number and rate of Hospital admissions from measles 71 Table 6. Participants attending the Medical Research Council’s 79 Informal Conference on Measles Prophylaxis Table 7. Members of the Medical Research Council’s Measles Vaccine 100 Trial Committee Table 8. Members of the Joint Committee on Vaccination and 112 Immunisation’s Measles Vaccination Sub-Committee Table 9. Vaccine supply 125 Table 10. Number of adverse reactions reported to the measles vaccine 185 batch surveillance scheme

List of Abbreviations

BMA British Medical Association BMJ British Medical Journal BW Burroughs Wellcome CMO Chief Medical Officer CSD Committee on Safety of Drugs CSM Committee on Safety of Medicines DHSS Department of Health and Social Security EPHLS Emergency Public Health Laboratory Service JCVI Joint Committee on Vaccination and Immunisation MRC Medical Research Council MVC Measles Vaccines Committee NHS National Health Service NIMR National Institute for Medical Research PHLS Public Health Laboratory Service RDMSC The Roald Dahl Museum and Story Centre TCD Tissue Culture Doses TNA The National Archives WF Wellcome Foundation WHO World Health Organisation WL Wellcome Library

Abstract

Beginning in 1959, the translation of measles vaccination from the laboratory to the clinic was a difficult journey. From the very start, the decision over whether to administer experimental measles vaccines to children in Britain had been a fraught one. At various moments, experts and officials advising both the Medical Research Council (MRC) and the Ministry of Health argued over the relative risks of measles vaccines. Although the decision was finally taken in 1968 to begin Britain’s first national campaign to vaccinate against measles, it was not without its risks. In 1969, less than one year after the start of the campaign, reports reached the Ministry of Health of children suffering from serious neurological reactions following the use of Burroughs Wellcome’s Wellcovax. Following an investigation carried out by the Ministry of Health, the decision was taken to withdraw the vaccine from future campaigns. Yet despite this troubled journey, only rarely did internal tensions reveal themselves in public. Indeed, set to become another therapeutic scandal, the story of Wellcovax is remarkable for its disappearance from the public’s view.

In charting the history of measles vaccination and the British state, this thesis examines the management of medical risk. It shows how leading British scientific institutions, such as the MRC and the Ministry of Health, attempted to understand, control and communicate the risks of medical innovation. In particular, through situating the decision making process in the wider political context, this thesis examines the relationship between the state and the public sphere. I argue that central to the state’s management of experimental and medical risk was a desire to prevent public conflict. Decisions over which risks to respond to, how to respond to them, and how to communicate them to the public, were all made under the spectre of potential controversy. Through politically aware decision making and carefully constructed representations of science, the MRC and Ministry of Health attempted to control scientific, political and public perceptions and debate on the subject of measles vaccination. A story of knowledge, power and at times deception, this thesis examines the relationship between science, society and the state.

Declaration

No portion of the work referred to in the thesis has been submitted in support of an application for another degree or qualification of this or any other university or other institute of learning.

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Acknowledgements

This thesis would not have been possible without the amazing care and support I have received from many people along the way. Firstly, I want to thank my supervisor Carsten. From the very beginning you have given me both intellectual and moral support. I have not always been the easier student to supervise, but through your enthusiasm, advice and no little patience you have kept me on track. I also want to thank all the students and staff in the Centre for the History of Science, Technology and Medicine (CHSTM). It has been a really interesting and stimulating department to work in. In particular, I want to thank my fellow PhD students: Andrew, David, Erin, Hannah, Jia Ou, Kath, Rachel, Sam and Stuart. It has been a pleasure to study with you. Your research and enthusiasm for learning has inspired me and your friendship has been so important. I would also like to thank Dr Ian Burney, Dr Stephanie Snow, and Dr Elizabeth Toon. You have not only helped me make sense of my thesis, but given me opportunities to experience other academic roles.

Equally important has been the support I have received at my many visits to the archive. I would like to thank all the staff at The National Archives and the Wellcome Library. I would also like to thank the library staff at the British Medical Association, the London School of Hygiene and Tropical Medicine, and The Roald Dahl Museum and Story Centre. In particular, I want to thank Rosa Parks from the Medical Research Council for organising several archive trips for me. You not only drew my attention to so many interesting files, but helped me to understand the institution I was exploring. Thank you for your generosity.

I would also like thank my friends and family. You have been an incredible source of support and distraction, and have never made me feel bad for disappearing for long periods of time. While there are too many people to name individually, I would like to give a special mention to Paul, Ellie, Freda and Logan. Not only did you provide me with an amazing place to stay on my many archive trips down to London, but more importantly, you made me feel incredibly welcome. I am blessed to have such wonderful friends.

Finally, I must thank my partner Sarah. This experience has not always been the easiest, but you have been incredibly patient and supportive. You have allowed our home to be turned into a place of writing, pacing and historical debate. Without your care and compassion this thesis would not have been possible. Thank you.

This thesis was funded by the Economic and Social Research Council.

Introduction

In 1962, seven year old Olivia Dahl, daughter of the children’s author Roald Dahl and the American actor Patricia Neal, contracted measles.1 Olivia was one of the 184,895 recorded cases of this infectious viral disease that year.2 While little evidence exists regarding Olivia’s first few days with measles, examining case reports at the time allows us to speculate on the course of her illness. It is likely that Olivia would have experienced her first symptoms after around ten days. These symptoms would have included a high temperature, muscle aches, a runny nose, coughing, sneezing and swollen, sore and watery eyes. At this point her parents and physician may have been able to witness clusters of white lesions building up on the inside of the mouth, known as Koplik’s spots. A few days later, Olivia would have developed the classic red rash; indeed, Neal recalls trying to cheer Olivia up by calling her their ‘fantastically polka- dotted daughter’.3 If Olivia’s illness had followed a normal course she would have made a full recovery after seven to ten days. Unfortunately, this was not the case. On 17

November 1962, Olivia developed a rare and sometimes fatal complication of the disease known as measles encephalitis. Characterised by inflammation in the brain, at its most severe measles encephalitis can lead to seizures, behavioural changes, disorientation, muscle weakness and loss of consciousness. This was indeed the case for

Olivia. After several hours of emergency treatment she tragically died at Stoke

Mandeville Hospital.

1 Patricia Neal and Richard Deneut, As I Am (London: Arrow Books, 1989), 276–83; Donald Sturrock, Storyteller: The Life of Roald Dahl (London: Harper Press, 2011), 383–88. 2 Ministry of Health, ‘On the State of the Public Health: The Annual Report of the Chief Medical Officer of the Ministry of Health for the Year 1962’ (London: HMSO, 1963), 34. 3 Neal and Deneut, As I Am, 277.

The Dahl’s experience was far from unique. Although measles had become a less fatal illness since the turn of the twentieth century – a result of improved basic health, hygiene and diet – it was still a major health concern.4 An extremely virulent disease, in the first half of the twentieth century very few children in Britain escaped the biannual epidemics of measles. Concentrating on schools, the disease would cause both individual and social unrest. According to Ministry of Health records, in 1940, the first year in which measles became a notifiable disease (a law that requires all cases of a specific disease to be reported to local and central government), there were 409,521 notifications, a relatively low figure compared with some measles epidemics in the

1950s, which reached as high as 600,000 notifications.5 While these figures failed to reveal the individual experiences of children, there were occasional accounts in medical journals during the 1940s and 1950s of children suffering severe complications. Articles described children suffering from pneumonia, an inflammation of the lungs often caused by a bacterial infection; otitis media, an infection within the middle ear, leading to inflammation and potentially permanent hearing damage; and severe neurological effects, such as encephalitis.6 However, despite the clear physical and social threat measles could pose, the disease had come to be viewed as a relatively mild condition in

Britain by the middle of the twentieth century.7 In contrast to the national and international efforts to eliminate and eradicate common deadly infectious diseases such as smallpox, polio and diphtheria, measles received relatively little attention from scientific, medical and political bodies.8 Within the Ministry of Health, the disease was at

4 Thomas McKeown, The Modern Rise of Population (London: Edward Arnold, 1976). 5 Ministry of Health, ‘On the State of the Public Health’, 34. 6 J. V. Armstrong, ‘Refresher Course for General Practitioners: Measles’, British Medical Journal 1 (1950): 238–40. 7 Anon., ‘Vital Statistics’, British Medical Journal 1 (1959): 380–83. 8 Evelynn M. Hammonds, Childhood’s Deadly Scourge: The Campaign to Control Diphtheria in New York City, 1880-1930 (Baltimore and London: The Johns Hopkins University Press, 1999); J. N. Hays, The Burdens of Disease: Epidemics and Human Response in Western History (New Brunswick,

10 times discussed, but rarely examined in detail. Britain’s Medical Research Council

(MRC), the national body responsible for supporting and organising medical research in

Britain funded only a handful of studies related to the disease before 1960. Unlike other childhood diseases, such as polio, no advocacy or fundraising organisations were established to combat the disease.9 Olivia’s experience, like so many which had gone before, provoked little medical or political response in Britain.

This lack of action would soon be challenged by scientific and technological developments taking place in the United States. In 1954, after recently receiving the

Nobel Prize in Physiology or Medicine for his work on culturing the polio virus, the virologist John F Enders managed to successfully do the same with a measles virus.

Working with his colleague and friend Samuel Katz, Enders managed to attenuate the virus enough to produce one of the first live attenuated measles vaccines.10 Enders made his virus available to researchers and manufacturers both in the United States and overseas. As a result, a large number of pharmaceutical companies were working on the development of a safe and effective measles vaccine by the early 1960s. Some researchers, building on the work of Enders, focussed on the development of a live attenuated vaccine. The preferred option for British medical authorities, it involved weakening the virus enough, so that once injected into a child it could no longer cause the disease, but still elicit a strong immune response. Others worked on the development of an inactivated vaccine. The principles were the same; however, instead of weakening the virus, the process involved killing it. Crucially, news of their

New Jersey and London: Rutgers University Press, 2009); Gareth Williams, Paralysed With Fear: The Story of Polio (Basingstoke: Palgrave Macmillan, 2013). 9 Angela N. H. Creager, ‘Mobilizing Biomedicine: Virus Research Between Lay Health Organizations and the U.S. Federal Government, 1935-1955’, in Biomedicine in the Twentieth Century: Practices, Policies, and Politics, ed. Caroline Hannaway (Amsterdam: IOS Press, 2008), 171– 201. 10 Jeffrey P. Baker, ‘The First Measles Vaccine’, Pediatrics 128 (2011): 435–37.

11 development sparked a new interest in the disease. National and international conferences were organised, new research into the disease’s clinical and epidemiological nature initiated and funded. What was revealed was a more debilitating and destructive disease than had previously been recognised.

Nevertheless, while the vaccine was adopted relatively quickly in the US, the British response was somewhat more cautious.11 Still uncertain over the danger posed by measles and concerned about the risks of early experimental vaccines, between 1961 and 1963, experts advising the MRC repeatedly came to the conclusion that a measles vaccine trial in Britain was too risky. Although this decision was eventually overturned in late 1963, a number of scientific experts and medical professionals continued to voice their concerns over the risks of vaccinating against measles.

In 1964, the MRC’s Measles Vaccines Committee began their national vaccination trial.

Designed to test the safety and efficacy of various combinations of measles vaccines, the trial was heralded as a great scientific and administrative success. Based on its results, the British government’s main advisory body on measles vaccination, the Joint

Committee on Vaccination and Immunisation’s (JCVI) Measles Vaccination Sub-

Committee, recommended a national vaccination campaign against the disease.

However, despite the trial’s positive representation, it was not without its troubles. Most notably, several weeks before the trial was due to begin, one of the two live vaccines set to be tested, Burroughs Wellcome’s Beckenham 20, had to be withdrawn due to safety concerns. Its replacement, Burroughs Wellcome’s Wellcovax, was not manufactured in time to be included in the trial. Concealed from the public, secrets such as these allowed

11 Jan Hendriks and Stuart Blume, ‘Measles Vaccination Before the Measles-Mumps-Rubella Vaccine’, American Journal of Public Health 103 (2013): 1393–1401.

12 the trial to maintain its positive image and ultimately its power to persuade policy makers, medical professionals and parents to vaccinate Britain’s children.

In May 1968, the Ministry of Health began their first national vaccination campaign against measles. As the first batches of Glaxo’s Mevilin-L and Burroughs Wellcome’s

Wellcovax began to be distributed across Britain, there was a belief amongst some that the end of measles was in sight. However, this sense of optimism would soon turn to despair. Less than one year after the start of the campaign, in March 1969, the newly formed Department of Health and Social Security (DHSS) received several reports of serious neurological reactions developing after the use of Burroughs Wellcome’s

Wellcovax. One of those reports documented the case of Kay Smith.12 Kay was just seventeen months old when she was immunised at Shepperton Clinic with Wellcovax.

Several days after her visit, Kay started suffering from a collection of neurological symptoms not all together dissimilar from those experienced by Olivia Dahl seven years earlier. On 8 March 1969, after being found unconscious, she was taken to St. Peter’s

Hospital. Although her condition appeared to improve, tragically, Kay Smith died five days later, suspected of having suffered from measles encephalitis.

This thesis is a history of measles vaccination and the British state, it also a study of risk, politics and transparency. The history of vaccination has often been framed by narratives of controversy and risk. Histories of smallpox, polio, whooping cough and

MMR vaccines have all been presented as stories of protracted scientific and public conflict over the availability, safety and administration of vaccines. Some accounts examine the anatomy of a ‘vaccine disaster’, illuminating the scientific and regulatory

12 The National Archive (TNA), MH 154/64, A. J. Franklin to A. J. Rayner, ‘Report on: Kay Michele Smith’, 19 March 1969.

13 failings behind it.13 Others examine differences and conflicts over perceptions of risk, and how they are constructed in different socio-cultural, political and medical contexts.14 These accounts not only reveal tensions between the scientific community and the public in relation to risk, but also reveal tensions and disagreements from within the scientific community itself. More often, historians and social scientists have examined vaccine controversies as socially and culturally constructed events.15 They have sought to understand how and why a technology, considered by many medical authorities to be one of the most successful instruments of twentieth century medicine, could at the same time be considered one of the most controversial. These accounts illustrate how vaccine controversies are a product of social processes; highlighting the role of governments, the media, scientific and medical institutions, and the public in shaping events. They also demonstrate how concerns over vaccination reflect a set of deeper medical, political and cultural anxieties.16

13 Peter Hobbins, ‘“Immunisation Is as Popular as a Death Adder”: The Bundaberg Tragedy and the Politics of Medical Science in Interwar Australia’, Social History of Medicine 24 (2011): 426–44; Paul A. Offit, The Cutter Incident: How America’s First Polio Vaccine Led to the Growing Vaccine Crisis (New Haven: Yale University Press, 2005). 14 Christine Bonah, ‘“As Safe as Milk or Sugar Water”: Perceptions of the Risks and Benefits of the BCG Vaccine in the 1920s and 1930s in France and Germany’, in The Risks of Medical Innovation: Risk Perception and Assessment in Historical Context, ed. Thomas Schlich and Ulrich Tröhler (London and New York: Routledge, 2006), 71–92; Linda Bryder, ‘“We Shall Not Find Salvation in Inoculation”: BCG Vaccination in Scandinavia, Britain and the USA, 1921-1960’, Social Science & Medicine 49 (1999): 1157–67; Ulrike Lindner, ‘Changing Regulations and Risk Assessments: National Responses to the Introduction of Inactivated Polio Vaccine in the UK and West Germany’, in Evaluating and Standardizing Therapeutic Agents, 1890-1950, ed. Christoph Gradmann and Jonathan Simon (Basingstoke and New York: Palgrave Macmillan, 2010), 229– 51. 15 Arthur Allen, Vaccine: The Controversial Story of Medicine’s Greatest Lifesaver (New York and London: W. W. Norton & Company, 2007); Janine Arnott, ‘The Social Construction of Vaccine Controversies’ (Unpublished Thesis, The University of Manchester, 2007); Jeffrey P. Baker, ‘The Pertussis Vaccine Controversy in Great Britain, 1974-1986’, Vaccine 21 (2003): 4003–10. 16 Eula Biss, On Immunity: An Innoculation (London: Fitzcarraldo Editions, 2015); Nadja Durbach, Bodily Matters: The Anti-Vaccination Movement in England, 1853-1907 (Durham and London: Duke University Press, 2005); Matthew Smith, ‘MMR, Autism and the History of Medical Controversies’, History & Policy, 25 May 2010, http://www.historyandpolicy.org; Keith Wailoo et al., eds., Three Shots at Prevention: The HPV Vaccine and the Politics of Medicine’s Simple Solutions (Baltimore: Johns Hopkins University Press, 2010).

However, the contrasting responses to the tragic deaths of Olivia Dahl and Kay Smith point towards a different story. As I will argue in this thesis, what is interesting about the untold story of measles vaccination and the British state, is that despite sharing many of the same characteristics as these histories – a neglected disease, a risky vaccine, and the death of a young child – at no point did this story develop into a significant public event.17 According to the historian and paediatrician Jeffrey Baker, ‘In contrast to whole-cell pertussis and live polio vaccines, which were at the center of highly visible vaccine safety controversies in the 1970s and 80s, measles vaccine enjoyed wide public acceptance’.18 Although Baker’s account largely focusses on the American experience, the same could also be said for Britain.

This thesis asks why the story of measles vaccination and the British state did not become another vaccine controversy, and what happens when controversy is prevented.

In doing so, it offers new insights into the management of medical risk.19 I argue that the spectre of public controversy, whether real or imagined, served as a powerful organising agent, shaping official responses to the evaluation, regulation and communication of medical risk. Which risks became visible, how these risks were interpreted and controlled, and how they were presented to the public was as much a social and political process as it was an intellectual one. In the case of measles vaccination, expert and official decisions were informed by a reading of the public and

17 Historians writing from an American context have examined the history of measles as part of a broader narrative on the history of twentieth century vaccination. Situating responses to measles in the context of wider social and political changes in the United States, they have examined how measles was transformed from a common childhood infectious disease to become a vaccine preventable illness. For example, see James Colgrove, State of Immunity: The Politics of Vaccination in Twentieth-Century America (Berkeley and New York: The University of California Press and Milbank Memorial Fund, 2006), 149–62; Elena Conis, Vaccine Nation: America’s Changing Relationship with Immunization (Chicago and London: The University of Chicago Press, 2015), 50–61. 18 Baker, ‘The First Measles Vaccine’, 437. 19 Thomas Schlich and Ulrich Tröhler, eds., The Risks of Medical Innovation: Risk Perception and Assessment in Historical Context (London and New York: Routledge, 2006).

15 political landscape. Although not directly engaged with, the public were imagined, represented and feared by British experts and officials. The aim was not only to respond to the political context, but to manage and control it, to prevent conflict and controversy. The effects of this culture were far from predictable. Some critics argued that the MRC and Ministry of Health were too cautious in their decisions over measles vaccination; others argued that both organisations were not cautious enough. The overall effect was the successful closure of scientific debate; the prevention of a potential medical and political scandal.

In order to deal with these broader issues, this thesis will address four central questions.

Firstly, why were certain risks visible and not others, and what factors influenced the visibility of risk? Secondly, how were these risks evaluated, regulated and communicated, and by whom? Thirdly, how were these scientific practices tied to twentieth century research methods, bureaucratic cultures of decision making, and wider social and political pressures? Finally, what was the relationship between the state and the public sphere?

Through exploring the construction of closure in detail, this thesis also provides new insights into the communication of science and medicine. Driven by a desire to prevent public unrest, the MRC and Ministry of Health carefully mediated public representations of government research and regulation. However, in contrast to previous accounts of infamous experimental and therapeutic scandals, this thesis does not frame the story of measles vaccination and the British state as another example of

16 conspiracy and cover up.20 Rather, I argue that attempts to control and conceal information reflected a banality of deception. In this sense, deception within the MRC and Ministry of Health was normalised, routinized, practised with few questions.

Representations to the public did not reflect the concealment of a dark secret, but more the careful management of slightly uncomfortable tensions. Banal in tone, these representations were designed to present an uncontroversial picture of medical research and regulation. It reflected the meeting of two interconnected cultures in 1960s British society: a culture of silence that existed in the state’s scientific and public health policy making communities, and a culture of trust that existed between the public, the media and medical authorities. A window into the secretive, technocratic of worlds of the

Ministry of Health and the MRC in 1960s Britain, the story of measles vaccination and the British state is a story of everyday power, politics and control.

Although several government bodies were central the story of measles vaccination in

Britain, most important was the British Medical Research Council. A largely neglected subject in the history of medicine, the history of the MRC has largely been framed by two major works. The first, Landsborough Thomson’s Half a Century of Medical Research, is written from the perspective of a former chief administrator.21 Thomson’s work is a thorough recording of the MRC’s administrative development and subsequent programme of research up to the 1970s. He describes in detail the origins of the

Medical Research Committee under the 1911 National Insurance Act, and how its early emphasis on tuberculosis was quickly submerged into a much broader policy. In 1919,

20 Sarah Ferber, Bioethics in Historical Perspective (New York: Palgrave Macmillan, n.d.), 101–31, accessed 21 May 2017; Jonathan D. Moreno, Undue Risk: Secret State Experiments on Humans (New York and London: Routledge, 2000). 21 A. Landsborough Thomson, Half a Century of Medical Research. Volume One: Origins and Policy of the Medical Research Council (UK) (London: HMSO, 1973); A. Landsborough Thomson, Half a Century of Medical Research. Volume Two: The Programme of the Medical Research Council (UK) (London: HMSO, 1975).

17 following recommendations made by the Haldane Committee, instead of becoming a part of the Ministry of Health, it was decided that the MRC would be responsible to a

Committee of the Privy Council, thus ensuring its political ‘autonomy’.22 Thomson shows how the Council expanded in scale – through its central institutions, units and university grants – and in the variety of its research activities. He charts the rise from modest pre-war resources (in 1939 the Council had established just 3 research units) to post-war expansion; the Council by 1970 having established 77 functioning units.23

The second major work, a collection of essays edited by Linda Bryder and Joan

Austoker, analyses several important episodes in the MRC’s history leading up to 1953.24

The essays are an attempt by historians to re-examine the history of the MRC from a greater “distance” than Thomson.25 As individual case studies they illuminate several themes in the MRC’s history. Austoker shows the MRC’s early and continued emphasis, mainly under the Council’s first Secretary Walter Fletcher, on the values of ‘basic biomedical research’; something that comes across again in Austoker and Bryder’s analysis of the National Institute for Medical Research (NIMR).26 Tied to this picture,

David Cantor’s account of the MRC’s role in interwar experimental radiology examines the battle between experimental science, as espoused by the MRC, and clinical

22 John Stewart, ‘The Political Economy of the British National Health Service, 1945–1975: Opportunities and Constraints?’, Medical History 52 (2008): 455. 23 For figures regarding the number of research units see Thomson, Half a Century of Medical Research. Volume One, 133–46; and for figures showing a significant increase in the MRC’s annual budget, see ibid., 205–6. 24 Joan Austoker and Linda Bryder, eds., Historical Perspectives on the Role of the MRC: Essays in the History of the Medical Research Council of the United Kingdom and Its Predecessor, the Medical Research Committee, 1913-1953 (Oxford: Oxford University Press, 1989). 25 Ibid., v. 26 Joan Austoker, ‘Walter Morley Fletcher and the Origins of a Basic Biomedical Research Policy’, in Historical Perspectives on the Role of the MRC: Essays in the History of the Medical Research Council of the United Kingdom and Its Predecessor, the Medical Research Committee, 1913-1953, ed. Joan Austoker and Linda Bryder (Oxford: Oxford University Press, 1989), 23–33; Joan Austoker and Linda Bryder, ‘The National Institute for Medical Research and Related Activities of the MRC’, in Historical Perspectives on the Role of the MRC: Essays in the History of the Medical Research Council of the United Kingdom and Its Predecessor, the Medical Research Committee, 1913-1953, ed. Joan Austoker and Linda Bryder (Oxford: Oxford University Press, 1989), 35–57.

18 empiricism as defended by the Royal Colleges.27 The story of laboratory research is taken up again in Celia Petty’s study of Nutritional research and Jennifer Beinart’s analysis of colonial research. Both examine the effects of a move towards more reductive understandings of the body and disease by scientists.28

A number of chapters, particularly Christopher Booth’s work on clinical research, reflect a tension at the heart of the Council between pure science and applied research.29

Despite a perceived focus on the laboratory, Christopher Booth has argued that right from the outset the MRC ‘sought to encourage and foster clinical research’.30 This emphasis on the clinical work of the MRC has been taken up by historians examining the development of biomedicine after the Second World War. Opportunities presented by the newly formed NHS enabled the Council to increase its activities in this field.31

Crucially, the Council sought to mould clinical research along the lines of their experimental ethos advanced in the inter war period. In this sense its work on

27 David Cantor, ‘The MRC’s Support for Experimental Radiology During the Inter-War Years’, in Historical Perspectives on the Role of the MRC: Essays in the History of the Medical Research Council of the United Kingdom and Its Predecessor, the Medical Research Committee, 1913-1953, ed. Joan Austoker and Linda Bryder (Oxford: Oxford University Press, 1989), 181–204. 28 Celia Petty, ‘Primary Research and Public Health: The Prioritization of Nutrition Research in Inter-War Britain’, in Historical Perspectives on the Role of the MRC: Essays in the History of the Medical Research Council of the United Kingdom and Its Predecessor, the Medical Research Committee, 1913-1953, ed. Joan Austoker and Linda Bryder (Oxford: Oxford University Press, 1989), 83–108; Jennifer Beinart, ‘The Inner World of Imperial Sickness: The MRC and Research in Tropical Medicine’, in Historical Perspectives on the Role of the MRC: Essays in the History of the Medical Research Council of the United Kingdom and Its Predecessor, the Medical Research Committee, 1913-1953, ed. Joan Austoker and Linda Bryder (Oxford: Oxford University Press, 1989), 109–35. 29 Christopher C. Booth, ‘Clinical Research’, in Historical Perspectives on the Role of the MRC: Essays in the History of the Medical Research Council of the United Kingdom and Its Predecessor, the Medical Research Committee, 1913-1953, ed. Joan Austoker and Linda Bryder (Oxford: Oxford University Press, 1989), 205–41. 30 See Christopher C. Booth, ‘Clinical Research and the MRC’, Quarterly Journal of Medicine 59 (1986): 435; and Booth, ‘Clinical Research’. 31 For an overview of the development of clinical research in the post-war era, see Carsten Timmermann, ‘Clinical Research in Postwar Britain: The Role of the Medical Research Council’, in Biomedicine in the Twentieth Century: Practices, Policies, and Politics, ed. Caroline Hannaway (Amsterdam: IOS Press, 2008), 231–54; and Helen Valier and Carsten Timmermann, ‘Clinical Trials and the Reorganization of Medical Research in Post-Second World War Britain’, Medical History 52 (2008): 493–510.

Streptomycin and the development of the randomised clinical trial (RCT) was crucial, as it transferred some of the values of the laboratory into the clinic.32

However, with the exception of Thomson’s official history, very few accounts explicitly engage with the anatomy and inner workings of the MRC’s administrative system. As

Thomson shows, the Council’s structure grew significantly throughout its first fifty years. Initially led by a small Council of scientific and medical experts, in response to increased funding and a broadening of scientific interest, the Council established several permanent advisory boards and an ever evolving number of advisor committees to help inform decision making. Supporting the Council’s various boards and committees were the ever growing number of MRC medical officers. Often overlooked by historians, medical officers were central to the MRC’s day to day operation. Through helping to constitute and organise committees, shape their agenda, and communicate their outcomes, medical officers could have a significant influence over scientific proceedings, one which went largely unseen. Moreover, as administrators, they were not only responsible for managing the Council’s research operations, but also managing its public and political relations. In observing the political context, as well as attempting to shape it through its early public relations machinery, these officials attempted to maintain the MRC’s powerful and trusted position. In the case of measles vaccination, it is in following these officials through the archive trails that we witness the relationship between risk, politics and the public.

32 See Alan Yoshioka, ‘Use of Randomisation in the Medical Research Council’s Clinical Trial of Streptomycin in Pulmonary Tuberculosis in the 1940s’, British Medical Journal 317 (1998): 1220– 23.

Primary sources

As the story of measles vaccination and the British state has not been analysed in great detail before, this thesis is based on a large amount of unexplored primary material.

Central to the analysis has been a reading of government records held at The National

Archives (TNA) in Kew, London. The Ministry of Health (later the DHSS), and in particular, the MRC, were central to the development of measles vaccination in Britain.

Committees, such as the MRC’s Measles Vaccines Committee and the JCVI’s Measles

Vaccination Sub-Committee were responsible for making decisions concerning the risks of both experimental and licenced vaccines. Examining their records from the 1960s has enabled me to reveal the complex scientific, social and political interactions that informed decision making in relation to medical risk.

In order to see beyond the state’s perspective, my analysis has also been informed by several alternative sources. Examining medical journals and British newspapers from the

1960s, alongside the records of the British Medical Association (BMA) has given me some insight, although limited, into the perspective of medical practitioners and members of the public. Examining these records not only reveals the alternative ways in which the risks of measles vaccination were framed, but also the relationship between these public spaces of debate and the state. Through charting the responses of MRC and Ministry of Health officials to public accounts of measles vaccination, this thesis analyses the way the state was both influenced and sought to influence the public sphere.

Finally, although the thesis has attempted to provide an account of the manufacturer’s perspective, difficulties in accessing the relevant records have limited its scope. Many of

Burroughs Wellcome’s Research and development files are now owned by

GlaxoSmithKline, including the files related to the development of their measles vaccines in the 1960s. After speaking with their archivist on several occasions, I was eventually refused access. In order to gain some insight, I have reviewed the material related to Wellcovax still held at the Wellcome Library in London, and reviewed the correspondence between Burroughs Wellcome, the MRC and the Ministry of Health. In particular, these records have revealed the contrasting positions taken by both sides when it came to the Ministry of Health’s decision to withdrawal the use of Wellcovax.

Thesis outline

This thesis charts the translation of measles vaccination from clinical experimentation into public health policy, examining the management of risk at each stage. Chapter 1 examines the emergence of measles as a significant public health problem in Britain.

Analysing the story of Roald Dahl’s daughter, Olivia Dahl, I argue that up until the

1960s measles was perceived as a ‘mild’ childhood illness, an image informed by personal experience and limitations with current epidemiological evidence. This view began to be challenged in the early 1960s with the development of measles vaccination.

I argue that the emergence of this vaccine created a new medical and political interest in the disease. Driven by individual interest, media pressure and political anxieties, officials and experts at the MRC organised new research into the disease’s clinical effects.

Particularly important was the Public Health Laboratory Service’s study into the

‘Frequency of Complications of Measles, 1963’.33 Unlike previous research, the study not only examined mortality rates, but attempted to understand the disease’s morbidity

33 D. L. Miller, ‘Frequency of Complications of Measles, 1963: Report on a National Inquiry by the Public Health Laboratory Service in Collaboration with the Society of Medical Officers of Health’, British Medical Journal 2 (1964): 75–78.

22 at a population level. What the study revealed was a far more troubling picture of the disease than had previously been presented. According to the report, as many as one in fifteen children suffered from some form of complication. As I will argue, this study, and its statistical representation, transformed the way measles was understood by the

MRC and Ministry of Health.

In Chapter 2 I examine the MRC’s response to the testing of experimental measles vaccines. Although measles was beginning to be redefined as a significant public health problem, experts advising the MRC were reluctant to begin testing newly developed measles vaccines on children. Despite the increasing number of private trials taking place in Britain and overseas, between 1961 and 1963 the MRC refused to conduct a clinical trial. In asking why the MRC refused to organise a measles vaccine trial during this period, and how their position changed towards the end of 1963, this chapter examines the regulation of experimental risk in the MRC. It argues that decisions concerning experimental risk were not only shaped by the latest scientific evidence, but by the anatomy of the MRC’s expert committees, and the political context in which they were situated.

Chapter 3 examines the MRC’s Measles Vaccines Committee’s protection trial.

Organised at the request of the Ministry of Health, the trial was designed to test safety and efficacy of measles vaccination in Britain. Presented as a great success story of

British medical science, the trial would determine the Ministry of Health’s decision to begin a national vaccination campaign against measles in 1968. However, the trial was not without setbacks. Most notably, one of the two live measles vaccines set to be tested in the trial had to be removed due to safety concerns. As I will argue, the trial’s success was as much down to its public representation as it was its administrative and

23 scientific qualities. Through constructing a banal story of the trial, MRC medical officers attempted to avoid controversy and cultivate public support.

Finally, in Chapter four, I follow the troubling story of Burroughs Wellcome’s

Wellcovax. One of two live measles vaccines procured by the DHSS for their national vaccination campaign, in 1969 the vaccine was withdrawn after several reports of serious adverse reactions following its use. In contrasting the Department’s initial response to growing concerns over the safety Wellovax, with the events of 1969, this chapter analyses the state’s regulation of medical risk. I argue that the spectre of controversy served as a powerful organising agent. While concerns over the safety of

Wellcovax remained somewhat private, the DHSS’s response was to maintain secrecy while further investigations were made. However, following newspapers reports of more serious adverse reactions, including the death of one child, the response of the

DHSS was far more dramatic. In taking swift action to remove the vaccine, as well as controlling the story’s representation to the public, DHSS officials attempted to manage another potential medical scandal. In doing so, however, they restricted open dialogue and debate.

Future Research

Focussing on the role of the British government, and particularly the actions of the

MRC and Ministry of Health, has led to several limitations with the thesis; analytical, geographical and chronological. Firstly, the influence of the commercial sphere has received less attention. Although this was partly driven by the analytical goals of the thesis, it was also the result of restricted access to archive material. While this thesis has given a glimpse into the vaccines commercial histories through various publications,

24 marketing material and correspondence with the Ministry of Health and the MRC, it would have been interesting to have more insight into the practices and perspectives of the commercial firms involved. This would also have provided some insight into the largely unchartered global history of measles and its vaccination. Exploring the experiences of measles vaccines as they travel across different medical and socio- political contexts, would have given important insights into the different ways vaccines have been tested, regulated and administered in the second half of the twentieth century. At the same time, it would also have provided an opportunity to examine in more detail the work of international scientific networks in shaping local policy.

Although it is certainly not unique for commercial organisations to refuse access to archive material, it does further add to the mystery and suspicion, which has continued to surround Wellcovax long after its withdrawal.

Secondly, in choosing to end the story in 1969 with the fall of Wellcovax, this thesis does not examine the reforms to British vaccine regulation that soon followed. The

1970s and 1980s saw significant changes to the way vaccines were regulated. At the beginning of 1980, the Department of Health established the JCVI’s Joint Sub-

Committee on Adverse Reactions to Vaccines and Immunological Products. At the same time, these changes were situated in a wider context of regulatory reform.

Historians, particularly in the US, have begun to chart the significant changes to experimental and drug regulation that took place in the second half of the twentieth century.34 Driven by a series of interconnected social and political movements, medical regulation increasingly became external to the medical professional, carried out in an

34 Sarah Ferber, Bioethics in Historical Perspective (New York: Palgrave Macmillan, n.d.), 101–31, accessed 21 May 2017; Jean-Paul Gaudillière and Volker Hess, eds., Ways of Regulating Drugs in the 19th and 20th Centuries (London: Palgrave MacMillan, 2013).

25 ever growing number of national and local ethics and regulatory committees. How these changes have affected the evaluation of medical risk have yet to be fully explored.

Thirdly, in focussing on the evaluation and regulation of Britain’s first measles vaccines, this thesis does not examine the measles vaccination campaign which followed. Yet to be analysed by historians, examining the history of this campaign would provide important insights into the making and administration of public health policy in late twentieth century Britain. While American studies tend to represent the history of vaccination as a story of central power and public conflict, Britain’s campaign to eliminate measles offers a different perspective.35 Beginning in 1968, unlike the eventual

US policy of ‘no shots, no school’, Britain adopted a lighter policy of persuasion, education and individual choice.36 While this approach led to a significant reduction in cases of measles, it continually failed to engage with many parents and practitioners across the country. Acutely aware of the policy’s own limitations, the Chief Medical

Officer Sir George Godber wrote in his 1975 monograph Change in Medicine, ‘The great benefits of measles vaccine have not been fully exploited in this country because of that very element of personal choice for doctor and parent alike... Nevertheless, freedom of choice by parents and doctors is surely preferable to a compulsory system’.37 In looking at vaccination from a late twentieth-century British perspective, an analysis of this campaign would move the story of vaccination away from one of controversy and compulsion, to one of political caution and individual liberty. This would add an important perspective to a growing literature examining twentieth British public health campaigns.

35 James Colgrove, State of Immunity: The Politics of Vaccination in Twentieth-Century America (Berkeley and New York: The University of California Press and Milbank Memorial Fund, 2006); Elena Conis, Vaccine Nation: America’s Changing Relationship with Immunization (Chicago and London: The University of Chicago Press, 2015). 36 Colgrove, State of Immunity, 203. 37 George Godber, Change in Medicine (Nuffield Provincial Hospitals Trust, 1975), 9.

Finally, although the history of MMR has been examined from historical, sociological and anthropological perspectives, these studies tend to focus on the controversial story of Andrew Wakefield and his research that suggested a link between the MMR vaccine and autism.38 Consequently, from a British perspective, a number of interesting questions remain unanswered. Firstly, why did the British government delay introducing the MMR vaccine and what eventually led to a change in policy? Secondly, how did the government’s campaign to eliminate measles differ from previous attempts? Finally, what was the impact of this campaign on British society? Examining this history in the context of campaigns carried out in the 1970s and 1980s will help illuminate Britain’s evolving relationship with vaccination, public health and the British state.

38 Conis, Vaccine Nation, 203–26; Mark Largent, Vaccine: The Debate in Modern America (Baltimore: The Johns Hopkins University Press, 2012); Melissa Leach, Vaccine Anxieties: Global Science, Child Health and Society (London: Earthscan, 2007).

Chapter 1: Making Measles Visible

1.1 Introduction

‘I got in the car. Drove to hospital. Walked in. Two doctors advanced on me from waiting room. How is she[?] I’m afraid it’s too late. I went into her room. Sheet was over her. Doctor said to nurse go out. Leave him alone. I kissed her.’1

Etched in an old school exercise book, these were the harrowing words of the famous poet and novelist Roald Dahl describing his first daughter’s final moments in 1962.2

Olivia, just seven years old at the time, had contracted what seemed to be a typical course of measles. Tragically this was not the case. Following a period of stability,

Olivia’s condition took a drastic turn for the worse: one morning she fell unconscious, dying in hospital later that same day.

What made the events of 1962 even more poignant was that just one year later the

British Medical Research Council (MRC) began testing a series of vaccines for measles.

Based on the results of these trials, in 1968 Britain began its first national vaccination campaign against the disease. Had Britain’s measles vaccination campaign proved successful, Olivia’s story may never have become public.

However, over the course of the next two decades Britain struggled to eliminate measles. Throughout much of the 1970s and 1980s vaccination rates for two year olds

1 The Roald Dahl Museum and Story Centre (RDMSC), RD 7/2, Road Dahl, ‘Olivia’. 2 Ibid.

28 hovered around just 50%.3 Frustrated by public and government apathy towards measles, Dahl decided to tell Olivia’s story. In 1986, Dahl began working with Dr Barry

Smith, a member of the West Midlands Health Authority, together developing a novel campaign intended to improve vaccination rates in Sandwell. Dahl’s interest was sparked by an interview he heard with Smith on Radio 4’s The Today Programme discussing the low vaccination rates in his area.4 Following the interview, Dahl wrote to

Smith, and offered to help by writing a letter addressed to children. The letter, which became the centre of Smith and Dahl’s campaign, was an appeal to those parents who

‘either out of obstinacy or ignorance or fear’ failed to have their child vaccinated against measles.5 Dahl believed his voice could have a powerful effect on parents. ‘It’s tough getting through to them,’ said Dahl in an interview for the Chiltern Newspapers, ‘but they are the first to scream if something happens to their child when they get measles... I can understand their lethargy and ignorance, but by getting a child to take this tale home to their parents, the child will know who I am and hopefully ask his mum whether he has been immunised.’6 On 2 July 1986, Dahl presented his letter at a press conference held at the Midland Centre for Neurosurgery and Neurology in Smethwick. Described as a

‘unique event in the fight against infectious disease’, Dahl read out his letter to an audience of local children, parents and teachers.7 Entitled ‘Measles: A dangerous

Illness’, it began with a vivid description of the events leading to Olivia’s death:

Olivia, my eldest daughter, caught measles when she was seven years old. As the illness took its usual course I can remember reading to her often in bed and not feeling particularly alarmed about it. Then one morning, when she was

3 The National Archives (TNA), MH 154/1203, ‘Some Aspects Concerning the Epidemiology of Measles – Note by the Department’, 1982. 4 RDMSC, RD 16/1/15, ‘Chiltern Newspapers’, August 1986. 5 RDMSC, RD 6/2/1/28, Dahl, ‘Measles: A Dangerous Illness’, 1986. 6 RDMSC, RD 16/1/15, ‘News Release from Sandwell Health Authority’, 25 June 1986. 7 RDMSC, RD 16/1/15, ‘Chiltern Newspapers’, August 1986.

well on the road to recovery, I was sitting on her bed showing her how to fashion little animals out of coloured pipe-cleaners, and when it came to her turn to make one herself, I noticed that her fingers and her mind were not working together and she couldn’t do anything. “Are you feeling all right?” I asked her. “I feel all sleepy,” she said. In an hour, she was unconscious. In twelve hours she was dead. The measles had turned into a terrible thing called measles encephalitis and there was nothing the doctors could do to save her.8

Thirty years on from Dahl’s intervention, Olivia’s story has continued to be used as a

‘narrative’ instrument in the fight against vaccine refusal.9 A good example of this is given by the University of Oxford’s ‘Vaccine Knowledge Project’.10 A website designed to give the public ‘independent information about vaccines and infectious diseases’, it has used Olivia’s story to challenge certain preconceptions about measles.11 Campaign and information sites, such as the Vaccine Knowledge Project, deploy Olivia’s story to bring alive a largely forgotten history, a time before vaccination where measles roamed unchallenged, free to cause pain, suffering and sometimes death; a morbid period that could return if children remain unvaccinated. In this context, Olivia’s story has become a symbol of a forgotten deadly disease.

8 RDMSC, RD 6/2/1/28, Dahl, ‘Measles: A Dangerous Illness’, 1986. 9 Philip B. Cawkwell and David Oshinsky, ‘Storytelling in the Context of Vaccine Refusal: A Strategy to Improve Communication and Immunisation’, Medical Humanities 42 (2016): 31–35; Claire Armitstead, ‘Roald Dahl Becomes Sage of US Measles Outbreak’, The Guardian, 2 February 2015, https://www.theguardian.com/books/booksblog/2015/feb/02/roald-dahl- becomes-sage-of-us-measles-outbreak; Anna Baddeley, ‘Roald Dahl’s Measles Warning Inspires Parents’, The Telegraph, 3 February 2015, http://www.telegraph.co.uk/culture/books/booknews/11386603/roald-dahl-measles-warning- goes-viral.html; Laura Stampler, ‘Read Roald Dahl’s Tear-Jerking Letter Urging Parents to Vaccinate Their Kids’, Time, 2 February 2015, http://time.com/3692439/roald-dahl-measles- letter/. 10 Oxford Vaccine Group, ‘Vaccine Knowledge Project’, accessed 18 May 2017, http://vk.ovg.ox.ac.uk/. 11 Ibid.; Sarah Loving, ‘How Dangerous Is Measles?’, accessed 18 May 2017, http://vk.ovg.ox.ac.uk/blogs/ojohn/how-dangerous-measles.

However, a historically contextualised reading of Olivia’s story reveals an alternative picture. Despite being one of the leading causes of childhood morbidity in Britain, during the 1950s and early 1960s, measles was often described as a routine childhood illness, one that was ‘good for them’, requiring care and attention, and little treatment.12

In contrast to other infectious diseases, such as diphtheria, polio, smallpox and tuberculosis, measles provoked little social, scientific or political interest in Britain and overseas.13 Studying the American context during the 1950s and early 1960s, the

American journalist Arthur Allen has described measles as a disease ‘whose morbidity was greater than polio, if not as visible.’14 This alternative reading raises a number of interesting questions. Why in the 1950s and early 1960s was measles described by some medical authorities as a relatively ‘mild’ illness?15 And how did this view of measles come to be challenged and transformed?

By examining why measles was largely invisible to British medical authorities in the middle of the twentieth century, and how this disease emerged during the 1960s, I argue that the history of measles in mid-twentieth century Britain provides an interesting case study into ‘the making and unmaking of ignorance’.16 Although historians have largely focussed their attention on the production of knowledge, there are some fascinating

12 Patricia Neal and Richard Deneut, As I Am (London: Arrow Books, 1989), 276. 13 Helen Bynum, Spitting Blood: The History of Tuberculosis (Oxford: Oxford University Press, 2012); Nadja Durbach, Bodily Matters: The Anti-Vaccination Movement in England, 1853-1907 (Durham and London: Duke University Press, 2005); Evelynn M. Hammonds, Childhood’s Deadly Scourge: The Campaign to Control Diphtheria in New York City, 1880-1930 (Baltimore and London: The Johns Hopkins University Press, 1999); Gareth Williams, Paralysed With Fear: The Story of Polio (Basingstoke: Palgrave Macmillan, 2013). 14 Arthur Allen, Vaccine: The Controversial Story of Medicine’s Greatest Lifesaver (New York and London: W. W. Norton & Company, 2007), 217. 15 Anon., ‘Annotations’, British Medical Journal 1 (1959): 354. 16 Robert N. Proctor and Londa Schiebinger, eds., Agnotology: The Making and Unmaking of Ignorance (Stanford: Stanford University Press, 2008).

31 accounts of the way ignorance was made.17 A notable example of this perspective is

Keith Wailoo’s history of sickle cell anaemia.18 In his account of the cultural and political history of the disease in early twentieth century Memphis, Wailoo asks ‘How is it that a disease that today is widely noted for its distinctive, recurrent, and singularly painful episodes could have been so obscure in early-twentieth-century America?’19 Like

Wailoo, I examine how measles was made invisible and visible in twentieth century

Britain, and the ‘social, political, and intellectual’ processes behind these contrasting perspectives.20

Beginning with the story of Olivia Dahl, I demonstrate how measles was framed as a

‘mild’ illness in mid-twentieth century Britain. Olivia’s story, and particularly the role played by Roald Dahl’s brother-in-law, Professor Arnold Ashley Miles, is highly instructive. As the Director of the Lister Institute for Preventative Medicine, Miles’s response gives us some insight into the official perspective; a perspective, which as I will show, was informed by a combination of social theory, medical triumphalism and the limitations of vital statistics. I then examine how, during the early 1960s, measles came to be redefined as a significant medical, social and political issue in Britain. Similar to previous accounts of ‘emerging illnesses’, I argue that the emergence of measles was not only the result of scientific practices, but also social and political processes.21 Key to this transformation was the development of a measles vaccine in the United States (US).

17 Harry M. Marks, ‘Epidemiologists Explain Pellagra: Gender, Race, and Political Economy in the Work of Edgar Sydenstricker’, Journal of the History of Medicine and Allied Sciences 58 (2003): 34– 55; Philip J. Pauly, ‘How Did the Effects of Alcohol on Reproduction Become Scientifically Uninteresting?’, Journal of the History of Biology 29 (1996): 1–28. 18 Keith Wailoo, Dying in the City of the Blues: Sickle Cell Anemia and the Politics of Race and Health (Chapel Hill and London: The University of North Carolina Press, 2001). 19 Ibid., 55. 20 Ibid., 82. 21 Randall M. Packard et al., ‘Introduction/Emerging Illness as Social Process’, in Emerging Illnesses and Society: Negotiating the Public Health Agenda, ed. Randall M. Packard et al. (Baltimore and London: Johns Hopkins University Press, 2004), 2.

This development, reported across the British media, brought new public and political attention to the disease. Driven by political anxieties, as well as individual interests and scientific networks, this re-engagement with measles eventually led to new research, research which focussed on morbidity rather than mortality. What was revealed was more a significant public health issue than had previously been assumed. In demonstrating the relationship between science, politics and the public this chapter also sets the scene for the remainder of the thesis.

1.2 Globulins, antibiotics and nursing: How to manage ‘mild’ measles

In November 1962 the headmistress of Godstowe Preparatory School sent a letter home to parents informing them of an outbreak of measles. One of the children who attended Godstowe was Olivia Dahl; daughter of Roald Dahl and the American actor

Patricia Neal. ‘A strange feeling crept over me’, recalls Neal in her biography, ‘Well, I thought, we’ll just play it safe and have all the children vaccinated.’22 Dahl and Neal’s concerns were informed by their children’s particular medical histories. In 1960, just 4 months old, their son Theo was hit by a taxicab in New York City.23 This had left him with a condition known as hydrocephalus, a condition where cerebrospinal fluid builds up inside the brain, leading to increased intracranial pressure, and as a result severe neurological symptoms. Indeed it was Dahl, along with the neurosurgeon Kenneth Till and the hydraulic engineer Stanley Wade, who developed the Wade-Dahl-Till (WDT)

Valve, a cerebral shunt designed to relieve the intracranial pressure of those suffering

22 Neal and Deneut, As I Am, 276. 23 Ibid., 258–64.

33 from hydrocephalus.24 This condition left Theo immuno-compromised, and as a result extremely vulnerable to infectious disease.

As a precaution, Neal contacted Dahl’s half-sister, Ellen Marguerite. Marguerite was married to Arnold Ashley Miles, a leading British microbiologist. As the Director of the

Lister Institute for Preventative Medicine, Miles had access to the protective agent gamma globulin, the latest in a long line of blood-based prophylactic treatments, designed to prevent and control the course of measles during the first half the twentieth century. Introduced during the 1940s, gamma globulin involved administering antibodies derived from another patient’s blood to help the recipient fight off infection.

It was produced for the Ministry of Health by the Lister Institute and then distributed by the Public Health Laboratory Service (PHLS) to practitioners across England and

Wales. The difficulty was in obtaining a regular blood supply: a practical problem, because it required taking blood from patients currently suffering from measles; and an ethical one, because it often required parental consent. As a result, gamma globulin’s use was restricted to those defined by the PHLS as ‘susceptible contacts’.25 In relation to measles, the PHLS defined its use in the following terms: ‘(1) For control of hospital and institutional outbreaks. (2) For persons with intercurrent illness or living in a poor environment for whom measles would be dangerous. (3) For attenuation in children under 3 years of age.’26 In contacting Miles, Neal was hoping he could send a large enough supply of gamma globulin for her three children. ‘I pleaded Theo’s vulnerable medical history and our concern for Olivia, who always got wiped out when she was sick’, wrote Neal.27 Miles was ‘sympathetic’, but due to restrictions on the agent’s use, he

24 Kenneth Till, ‘A Valve for the Treatment of Hydrocephalus’, The Lancet 283 (1964): 202. 25 Anon., ‘Gamma-Globulin’, The Lancet 273 (1959): 250. 26 Ibid. 27 Neal and Deneut, As I Am, 276.

34 only sent enough for Theo.28 His response, a poignant one in hindsight, was ‘Let the girls get the measles. It will be good for them.’29

Almost inevitably, Olivia contracted measles. In keeping with sanitary advice at the time, Olivia was separated from her siblings to recuperate and prevent the infection from spreading. For much of the twentieth century, the medical advice to parents was that through a process of ‘careful nursing’ healthy children could avoid suffering serious complications. An example of the kind of advice parents received can be found in the

Central Council for Health Education’s (CCHE) 1956 measles pamphlet: ‘How to Spot it and What to do About it’.30 The pamphlet outlined how it was important to make a

‘special effort’ to prevent babies and toddlers from becoming infected.31 This meant at the first sign of infection the child should be separated from the rest of the family and put straight to bed. As soon as possible the local GP should be contacted, who will then visit the patient during their morning round. Parents were advised to keep their children warm, in bed, with access to fresh air, and provide them with nutrients in the form of milk and fruit drinks. According to the CCHE’s pamphlet, ‘Modern methods of treatment have greatly lessoned the danger of complications, but still your child will need careful nursing… Careful nursing is the most important thing in handling measles.’32

28 Ibid. 29 Ibid. 30 Wellcome Library (WL), SA/MWF/N.7/5, Central Council for Health Education, ‘Measles: How to Spot it and What to do About it’, 1956. 31 Ibid. 32 Ibid.

Figure 1. The front cover of the Central Council for Health Education’s 1956 measles pamphlet: ‘Measles: How to Spot it and What to do About it’. Source: WL, SA/MWF/N.7/5, Central Council for Health Education, ‘Measles: How to Spot it and What to do About it’, 1956.

This idea of ‘careful nursing’ has a far longer and more troubling history. Throughout the first half of the twentieth century the mother was clearly identified as the responsible agent in the care of a child suffering from measles. In the 1920s and 1930s, the idea that parents, particularly mothers, were responsible for their child’s outcomes, led to continued accusations of neglect by national newspapers when the latest measles mortality figures were released. Rather than blame the virus, society or the state for the thousands of deaths caused by measles during an epidemic year, some accounts placed the blame solely on mothers. Situated in the context of growing concerns over social and ‘biological decline’ in Britain, these articles framed some mothers as both ignorant and neglectful.33 One of the more striking examples of this form of reporting was published in The Observer in 1922. The article, entitled ‘A Warning against Neglect’, noted the ‘dangerous public delusion regarding a disease which costs the lives of many thousands of children annually.’34 The correspondent went on: ‘It is a great killing disease, a perpetual public injury and menace, costing our grievously undermanned

Empire a shocking annual toll of young lives... And yet the greater part of this grave mortality is easily preventable, and there is no sufficient reason why any child should die of measles.’35 This ‘grave mortality’, the article argued, was not the consequence of any deadly disease, but the result of parental neglect leading to secondary complications:

Only in the very rarest and most exceptional instances, if ever, do these complications occur at all in children who are properly looked after … The properly fed and rested and ventilated and, if possible, sunlit child will not develop broncho-pneumonia, and in that child the illness will be as trivial and free from danger as it was in nearly all of you, my readers, and in me, when we had measles as children; whereas scores of thousands of contemporaries, no

33 Dorothy Porter, ‘“Enemies of the Race”: Biologism, Environmentalism, and Public Health in Edwardian England’ 34 (1991): 159–78. 34 Anon., ‘Measles Danger: A Warning Against Neglect’, The Observer, 28 May 1922, 16. 35 Ibid.

more heavily attacked than we, were killed by neglect on the part of parents, less wise than ours.36

The article also condemned parents who ‘deliberately’ exposed their younger children to the infection. ‘Such a policy’, the correspondent stated, ‘amounts to something morally indistinguishable from manslaughter.’37

Despite the publication of several reports revealing the biological, social and economic determinants of deaths due to measles, the idea that this was a social problem of parental neglect proved pervasive.38 It framed the way some Medical Officers of Health, general practitioners and Ministry of Health officials viewed and responded to the disease. When debating the worth of making measles a notifiable disease in 1919

(something which did not occur until 1940), the Ministry of Health’s Chief Medical

Officer Sir George Newman wrote in a memo to the Ministry of Health’s Secretary Sir

Robert Morant, ‘Generally speaking measles kills nobody; it is the complications arising from bad nursing which kills the patient.’39 In this one memo Newman conceptualised the anxiety, burden and blame mothers faced in trying to protect their young children against the dangers of measles. Advice in the 1950s based around careful nursing, while less moralistic in its tone, implicitly still made parents, and particularly mothers, responsible for their children’s outcomes.

Although Olivia received great care from her family, right from the beginning Neal recalls her having ‘no energy’.40 Dahl tried to engage her. He read her stories and taught

36 Ibid. 37 Ibid. 38 James L. Halliday, ‘Medical Research Council: An Inquiry into the Relationship between Housing Conditions and the Incidence and Fatality of Measles’ (London: HMSO, 1928). 39 TNA, MH 55/553, Sir George Newman to Sir Robert Morant, ‘Measles’, 6 August 1919. 40 Neal and Deneut, As I Am, 277.

38 her how to play chess, but she struggled to respond.41 On 15 November, after Olivia had been asleep for twenty-four hours, Neal called her GP Mervyn Brigstock.

As a country practitioner, a call out for measles may not have been a common experience for Brigstock. However, for GPs working in large urban conurbations, visiting children with measles was a common part of their daily work. During an epidemic, a GP may have to visit more than 20 children in one day. Yet despite this heavy workload, the medical advice available to GPs during the period was limited. The

1962 edition of Stanley Davidson’s well-read textbook The Principles and Practice of

Medicine, advised readers that ‘Nursing on a verandah or in a well-ventilated room reduces the chances of secondary respiratory infection, and the prompt treatment of bacterial complications with penicillin is all that is required.’42

In reality, approaches varied from one practitioner to the next. Decisions over whether and when to give gamma globulin, antibiotics and analgesics, and at what dosage, were largely based on individual experience. Indeed, the use of antibiotics was the subject of intense debate in British medical journals throughout the 1950s. Some practitioners believed antibiotics could be used prophylactically, given to patients after the initial diagnosis of measles in order to prevent the onset of secondary complications. In a letter sent to the BMJ in 1955, Dr J. F. Lund described his surgery’s practice of administering either sulphonamide or penicillin prophylactically.43 According to Lund, this method had proved successful during a recent epidemic in London. Out of approximately 50 children treated prophylactically, only one child was reported as suffering from complications. Lund concluded: ‘It appears that there is a definite place

41 RDMSC, RD 7/2, Road Dahl, ‘Olivia’. 42 Stanley Davidson, The Principles and Practice of Medicine: A Textbook for Students and Doctors, Sixth Edition (Edinburgh: E. & S. Livingstone, 1962), 53. 43 J. F. Lund, ‘Measles’, British Medical Journal 1 (1955): 1279.

39 for routine prophylactic treatment in measles.’44 While some practitioners agreed with

Lund’s method, others argued that the prophylactic use of antibiotics was not only

‘unnecessary’, but, from an economic, iatrogenic and drug resistant perspective, it was also potentially dangerous.45 In 1955 the BMJ published a review on the diagnosis and treatment of measles. In describing the treatment of secondary complications, such as bronchopneumonia, otitis media, enteritis and encephalitis, the article suggested that, apart from certain institutional settings, sulphonamides and penicillin should not be administered to prevent potential illness.46 It concluded that ‘Indiscriminate dosing with antibiotics for a disease capable of causing twenty thousand cases a week has nothing to recommend it.’47 As Worboys and Macfarlane have illustrated in the case of acute bronchitis, the prophylactic use of antibiotics often took place in the absence of any clinical trials.48 In the case of measles, subsequent reports, most notably one carried out by The College of General Practitioners, confirmed the BMJs findings that the effectiveness of giving antibiotics prophylactically was limited.49 Nonetheless, whether antibiotics were effective or not, their use reinforced a growing confidence amongst

GP’s that measles was becoming a relatively benign condition, one that was increasingly under medical control.

After examining Olivia, Brigstock reassured Neal that ‘Sleeping sickness’ was a common side effect of measles.50 However, despite some signs of improvement, Olivia continued

44 Ibid., 1279. 45 J. McLuskie, ‘Measles’, British Medical Journal 1 (1955): 1475; C. Coley Grayson, ‘Measles’, British Medical Journal 2 (1955): 140–41; E. A. Knappett, ‘Measles’, British Medical Journal 2 (1955): 200–201. 46 Anon., ‘Measles’, British Medical Journal 1 (1955): 1018–19. 47 Ibid., 1019. 48 J. T. Macfarlane and M. Worboys, ‘The Changing Management of Acute Bronchitis in Britain, 1940–1970: The Impact of Antibiotics’, Medical History 52 (2001): 47–72. 49 Anon., ‘The Complications of Measles: Part II of a Report by a Study Group of The College of General Practitioners’, College of General Practitioners Research Newsletter 4 (1957): 51–68. 50 Neal and Deneut, As I Am, 277.

40 to appear uninterested and lethargic. On 17 November she woke up at around 10am.

Dahl again tried to engage her. He recalled showing her how to make animal figures out of coloured pipe cleaners: ‘I sat on the bed and showed her how to make a monkey.

“Cut it There,” I said. But she couldn’t handle The scissors properly. Usually so neat, she fumbled.’51 By this stage Neal and Dahl were becoming increasing ‘frightened’ and called for Brigstock again. After careful examination of the ears, throat and chest, he again declared Olivia ‘all right’.52 According to Brigstock, ‘she just needed a little more time than most children to recover.’53

From this moment on Olivia’s condition began to deteriorate quite rapidly. She began having convulsions, suffering from breathing problems, and subsequently became unconscious. Neal became alerted to Olivia’s dramatic change in health when she, along with Dahl’s sister Else, went to check on her in bed.54 ‘I quietly opened the door to our room and knew at once that something dreadful had happened. Olivia’s body was still, her eyes open in a fixed, walleyed stare, her mouth gaping limply, oozing spit... From some unknown place, I knew. It was not a premonition. I knew my daughter was dying.’55 An ambulance took Olivia to Stoke Mandeville Hospital where she was diagnosed with measles encephalitis, a severe condition involving inflammation of the brain, thought to affect around 1 in 1000 sufferers. Olivia would not recover; her final moments were recorded by Dahl in his journal:

Awful drive. Lorries kept holding us up on narrow roads. Got to hospital. Ambulance went to wrong entrance. Backed out. Arrived. Young doctor in charge. Mervyn and he gave her 3mg sodium amatol. I sat in hall. Smoked. Felt

51 RDMSC, RD 7/2, Road Dahl, ‘Olivia’. 52 Neal and Deneut, As I Am, 277. 53 Ibid. 54 Ibid. 55 Ibid., 277–78.

frozen. A small single bar electric fire on wall. An old man in next room. Woman doctor went to phone. She was trying urgently to locate another doctor. He arrived. I went in. Olivia lying quietly. Still unconscious. She has an even chance, doctor said. They had tapped her spine. Not meningitis. It’s encephalitis. Mervyn left in my car. I stayed. Pat arrived with Else and John. John went out to get some Whiskey. Pat went in to see Olivia. Kissed her. Spoke to her. Still unconscious. I went in. I said, “Olivia… Olivia.” She raised her head slightly off pillow. Sister said don’t. I went out. We drank whiskey. I told doctor to consult experts. Call anyone. He called a man in Oxford. I listened. Instructions were given. Not much could be done. I first said I would stay on. Then I said I’d go back with Pat and Else and John. Went. Arrived home. Called Philip [Rainsford] Evans. He called hospital. Called me back. “Shall I come?” “Yes please.” I said I’d tell hospital he was coming. I called. Doc thought I was Evans. He said I’m afraid she’s worse. I got in the car. Got to hospital. Walked in. Two doctors advanced on me from waiting room. How is she? I’m afraid it’s too late. I went into her room. Sheet was over her. Doctor said to nurse go out. Leave him alone. I kissed her. She was warm. I went out. “She is warm.” I said to doctors in hall, “why is she so warm?” “Of course,” he said. I left.56

Over the coming weeks Dahl and his family struggled to make sense of their new reality. Their struggles were compounded by a sense that more could have been done for Olivia. ‘Large doses of gamma globulin, had it been available,’ wrote Neal, ‘could well have saved her. The landslide of anger and frustration that would all but bury

Roald and me in the months to come began in those first hours.’57

Olivia’s story reveals a central paradox in the identity of measles. Throughout her illness, Olivia’s family had to manage feelings of uncertainty, anxiety, powerlessness and later anger. Their experience was one shared by tens of thousands of families across

56 Donald Sturrock, Storyteller: The Life of Roald Dahl (London: Harper Press, 2011), 386–87. 57 Neal and Deneut, As I Am, 280.

42 nineteenth and twentieth century Britain. Right throughout the first half of the twentieth century, biennial epidemics were reported in cities and schools across the country. Between 1940 – the year measles officially became a notifiable disease – and

1962 there were a total of 7318 recorded deaths due to the disease. Many more children suffered from serious respiratory, olfactory and neurological complications.58 In his

‘Refresher Course for General Practitioners’, published in the British Medical Journal

(BMJ) in 1950, the Physician Superintendent of Brook General Hospital J. V.

Armstrong argued, that while measles may no longer be as life threatening as it once was ‘it is still capable of causing extensive and permanent damage, especially to the lungs, middle ear, and eyes’.59

Yet a closer reading of Olivia’s story reveals an alternative meaning. In this alternative reading we see a set of practices and actors seemingly less concerned by the disease.

One of those actors was Roald Dahl’s brother-in-law, Professor Arnold Ashley Miles.

Miles, in keeping with standards of the time, refused to send Olivia gamma globulin as she was not defined as a ‘susceptible contact’.60 He then, according to Neal, stated the now poignant words, ‘Let the girls get the measles. It will be good for them.’61 His words may have reflected professional attempts to manage patient and parental expectations, but they also tell us something about the way measles was understood at the time. During the 1950s, practitioners reported witnessing measles as a more benign illness. In January 1959, the BMJ invited several GPs from across England and Wales to write a short account of their experience of measles in the middle of an epidemic.62 Dr

58 Ministry of Health, ‘On the State of the Public Health: The Annual Report of the Chief Medical Officer of the Ministry of Health for the Year 1962’ (London: HMSO, 1963), 34. 59 J. V. Armstrong, ‘Refresher Course for General Practitioners: Measles’, British Medical Journal 1 (1950): 238. 60 Anon., ‘Gamma-Globulin’, 250. 61 Neal and Deneut, As I Am, 276. 62 Anon., ‘Vital Statistics’, British Medical Journal 1 (1959): 380–83.

R. E. Hope Simpson of Cirencester, Gloucestershire, noted, ‘The present outbreak in this area is not distinguished by any peculiar characteristics except that it seems less severe than usual.’63 Similarly, writing under the heading a ‘Mild Ailment’, Dr John Fry of Kent described how in his practice ‘measles is considered … a relatively mild and inevitable childhood ailment’.64 And Dr R. M. McGregor of Hawick, Roxburghshire, when describing his experience of a measles epidemic back in 1955, noted that ‘many of the cases were sufficiently mild as to make diagnosis difficult.’65 While practitioners did also document the treatment of a number of complications, according to the BMJ’s editorial on the report, most agreed ‘that measles is nowadays normally a mild infection.’66 The fact that measles was viewed as a mild illness directly impacted on

Olivia’s care. How measles came to be framed as a ‘mild ailment’ in 1950s Britain is the subject to which we now turn.

1.3 ‘A mild illness’: The limits of vital statistics

While a contextualised reading of Olivia’s story does provide some insight as to why doctors had come to perceive measles as a ‘mild illness’, – in particular, their faith in healthy bodies, good nursing and antibiotics – its focus on the individual conceals the influence of two interconnected changes at the population level: the changing mortality of measles, and the increased reliance on vital statistics to interpret the disease.

For centuries measles was seen as a deadly, though not necessarily a highly prevalent disease. Disastrous epidemics were recorded in both medieval and later modern

63 Ibid., 381. 64 Ibid. 65 Ibid. 66 Anon., ‘Annotations’, 354.

Europe. In the sixteenth century it spread into the ‘virgin soils’ of the Americas through

European expeditions.67 The case of Fiji is illustrative of the devastating effects measles could have on ‘virgin soil’.68 In 1875, Fijian society experienced measles for what is believed to be the first time. Partly the result of British colonialism, the impact of its spread into a new environment proved disastrous. In just a few months measles is thought to have caused anywhere between 27,000 and 50,000 deaths, more than a quarter of the total population. As one report in Britain noted, ‘whole communities were stricken at one time, and there was no one left to gather food or carry water, to attend to the necessary wants of their fellows, or even, in many cases, to bury the dead’.69

In Britain itself, measles became a major public health problem in the nineteenth century. Industrialisation and the creation of huge, overcrowded city slums, produced favourable conditions for the spread of airborne infectious diseases such as measles.70

Studies carried out during the 1920s and 1930s revealed the influence of poor living conditions on mortality rates. The most notable investigation was James Halliday’s

‘Inquiry into the Relationship between Housing Conditions and the Incidence and

Fatality of Measles’.71 Halliday’s study, published in 1928 by the MRC, examined the course of an epidemic of measles taking place in ‘poor’ and ‘overcrowded’ tenement housing in Glasgow.72 It revealed children living in tenement houses were ‘exposed’ to measles at an earlier age, an age where the fatality rate of measles had shown to be

67 J. N. Hays, The Burdens of Disease: Epidemics and Human Response in Western History (New Brunswick, New Jersey and London: Rutgers University Press, 2009), 72–76. 68 Ibid., 189–91. 69 Ibid., 190. 70 Anne Hardy, Health and Medicine in Britain Since 1860 (Basingstoke: Palgrave, 2001), 12–46. 71 Halliday, ‘Medical Research Council: An Inquiry into the Relationship between Housing Conditions and the Incidence and Fatality of Measles’. 72 Ibid.

45 significantly higher.73 Although the impact of studies such as Halliday’s on public health policy was limited, the idea that measles was a disease of social inequality did begin to challenge individualistic and behavioural theories of parental neglect.

From the beginning of the twentieth century, evidence produced for the Ministry of

Health suggests deaths due to measles in England and Wales declined significantly.74

‘The picture is among the most remarkable for any infectious disease’, wrote the physician and historian Thomas McKeown in 1976, ‘Mortality fell rapidly and continuously from about 1915’.75 The answer to why measles became less deadly during this period has become part of a wider debate amongst historians and epidemiologists investigating modern population growth and epidemiological transition. McKeown himself argued in his provocative thesis, The Modern Rise of Population, that improvements in mortality in England and Wales resulted from a dramatic reduction in the number of deaths due to infectious disease, the consequence of improved social, economic and nutritional conditions rather than modern medicine.76 In the case of measles, analysing figures collected by the General Register Office, McKeown argued: ‘Effective specific measures have only recently become available in the form of immunization, and they can have had no significant effect on the trend of the death rate.’77 While McKeown’s overall thesis has since been challenged from a number of historical, sociological and demographic perspectives, his analysis that the mortality of measles was in decline by the early twentieth century has largely remained undisputed.78

73 Ibid. 74 TNA, MH 154/134, ‘Notification of Measles and Death Rates for England and Wales’, 5 October 1961. 75 Thomas McKeown, The Modern Rise of Population (London: Edward Arnold, 1976), 97. 76 McKeown, The Modern Rise of Population. 77 Ibid., 97. 78 Flurin Condrau and Michael Worboys, ‘Second Opinions: Epidemics and Infections in Nineteenth-Century Britain’, Social History of Medicine 20 (2007): 147–58; Flurin Condrau and Michael Worboys, ‘Epidemics and Infections in Nineteenth-Century Britain’, Social History of

Crucially, by the early 1950s, a focus on vital statistics and mortality began to frame popular, political and medical representations of measles. A series of reports published during the 1950s and early 1960s highlighted a significant reduction in deaths due to measles. This focus on mortality supported the assumption not only that the burden of measles was declining, but also that it was negligible when compared with more deadly diseases. This is particularly well illustrated by the Chief Medical Officers (CMO) annual reports to the Ministry of Health. These reports were both a review of Britain’s ‘health record’ and a commentary on novel ‘medical developments’.79 They centred on a series of vital statistics related to births, deaths and disease intended to help the Ministry make sense of changing patterns of health in British society. Following the appearance of measles through one such report illuminates how a focus on mortality figures can lead to the disappearance of a disease. For example, the Chief Medical Officer George

Godber’s 1962 annual report showed that deaths due to measles had declined from 857 in 1940 to just 39 in 1962.80 When placed in tables documenting ‘Deaths from Principal

Causes’ or ‘Mortality from Principal Infective Diseases’ the impact of measles leaves little or no trace (see Tables 1 and 2).81 A good example of this is given in Table 1 – principal causes of death in England and Wales from 1957 to 1962. What is immediately striking about the data is the number of deaths attributed to chronic disease. In 1962 there were over 180,000 deaths attributed to some form of heart disease and just over

100,000 deaths attributed to some form of malignancy. In comparison, the number of deaths recorded for whooping cough (24), diphtheria (2), acute poliomyelitis (18) and measles (39), traditional childhood ‘scourges’, is hardly noticeable. Thus, when situated

Medicine 22 (2009): 165–71; Graham Mooney, ‘Infectious Diseases and Epidemiologic Transition in Victorian Britain? Definitely’, Social History of Medicine 20 (2007): 595–606; Simon Szreter, Health and Wealth: Studies in History and Policy (Rochester: University of Rochester Press, 2005). 79 Ministry of Health, ‘On the State of the Public Health’, 1. 80 Ibid., 34. 81 Ibid., 214–15.

47 in the context of mortality, it is easy to see how measles came to be represented as a

‘mild’ infectious disease.

Table 1. Principal causes of death in England and Wales from 1957 to 1962 Cause of death 1957 1958 1959 1960 1961 1962 Tuberculosis, respiratory 4,249 3,999 3,474 3,105 3,002 2,774 Tuberculosis, other forms 535 481 380 330 332 314 Syphilis 1,072 1,041 958 944 900 822 Diphtheria 4 8 – 5 10 2 Whooping cough 87 27 25 37 27 24 Meningococcal infections 184 145 159 95 130 138 Acute poliomyelitis 226 129 66 23 59 18 Measles 94 49 98 31 152 39 Other infective diseases 1,026 981 973 1,060 1,027 1,040 Malignant neoplasm: Stomach 13,917 14,112 14,076 13,953 13,788 13,596 Lung and bronchus 19,028 19,820 21,063 22,000 22,810 23,779 Breast 8,622 9,022 8,770 9,122 9,367 9,430 Uterus 3,912 4,115 4,003 4,088 3,981 4,015 Leukaemia and aleukaemia 2,394 2,386 2,534 2,694 2,645 2,707 Other malignant neophasms 46,144 46,349 46,671 46,931 47,324 48,081 Diabetes 3,137 3,315 3,193 3,559 3,869 3,811 Vascular lesions of central 73,669 76,177 75,150 76,222 77,023 78,297 nervous system Coronary artery and 77,176 84,041 84,992 91,961 95,775 102,478 arteriosclerotic heart disease Hypertensive heart disease 12,592 12,283 11,375 11,294 11,225 10,531 Other heart disease 76,228 77,395 71,387 70,916 72,365 70,047 Other circulatory disease 22,180 23,795 23,572 24,267 25,290 25,161 Influenza 6,716 2,401 7,862 1,098 7,102 3,308 Pneumonia at all ages 23,562 24,575 27,340 25,075 29,979 31,672 Bronchitis 27,097 29,396 29,051 26,485 31,363 33,293 Other respiratory disease 5,344 5,273 5,049 5,029 5,364 5,284 Ulcer of stomach and 5,029 4,898 4,563 4,705 4,405 4,692 duodenum Gastritis, enteritis and 2,288 2,375 2,376 2,542 2,645 2,619 diarrhoea of newborn Nephritis and nephrosis 4,195 4,078 3,685 3,714 3,498 3,423 Hyperplasia of prostate 3,645 3,577 3,505 3,259 3,075 2,901 Pregnancy, abortion and 333 328 290 310 274 299 childbirth Congenital malformations 4,930 4,890 4,911 5,122 5,196 5,426 All causes 514,870 526,843 527,651 526,268 551,752 557,636 Source: Ministry of Health, ‘On the State of the Public Health: The Annual Report of the Chief Medical Officer of the Ministry of Health for the Year 1962’ (London: HMSO, 1963), 214.

Table 2. Number of deaths from principal infective diseases in England and Wales from 1940 to 1962 Disease Number of deaths 1940- 1945- 1950- 1955- 1960 1961 1962 44 49 54 59 Diphtheria 1,830 326 26 5 5 10 2 Dysentery 198 94 50 32 36 34 28 Gastro-enteritis 4,181 4,037 1,307 805 867 945 994 Influenza 7,624 3,615 5,947 4,518 1,098 7,102 3,308 Measles 693 442 193 89 31 152 39 Meningococcal 1,397 424 284 176 95 130 138 infections Acute poliomyelitis, 124 364 348 181 46 79 45 including late effects Post-abortive and 499 237 115 84 68 60 71 puerperal sepsis Scarlet fever 123 46 13 2 _ 3 2 Smallpox 1 6 4 1 _ _ 26 Tuberculosis, 21,687 18,940 10,085 4,482 3,105 3,002 2,774 respiratory Tuberculosis, other 4,365 3,142 1,346 515 330 332 314 forms Typhoid and 94 41 12 8 3 2 7 paratyphoid fever Typhus and other 1 _ _ _ 1 _ _ rickettsial diseases Whooping cough 1,206 64 37 27 24 Source: Ministry of Health, ‘On the State of the Public Health: The Annual Report of the Chief Medical Officer of the Ministry of Health for the Year 1962’ (London: HMSO, 1963), 215.

Table 3. Number of cases and deaths from measles in England and Wales from 1940 to 1962 Year Corrected Deaths Fatality Year Corrected Deaths Fatality Notifications Ratio notifications Ratio 1940 409,521 857 0.21 1952 389,502 141 0.04 1941 409,751 1,145 0.28 1953 545,050 242 0.04 1942 286,341 458 0.16 1954 146,995 45 0.03 1943 376,104 773 0.21 1955 693,803 174 0.03 1944 158,479 243 0.15 1956 160,556 28 0.02 1945 446,796 729 0.16 1957 633,678 94 0.01 1946 160,402 204 0.13 1958 259,308 49 0.02 1947 393,787 644 0.08 1959 539,524 98 0.02 1948 399,606 327 0.08 1960 159,364 31 0.02 1949 385,935 307 0.06 1961 763,465 152 0.02 1950 367,725 221 0.05 1962 184,895 39 0.02 1951 616,192 317 Source: Source: Ministry of Health, ‘On the State of the Public Health: The Annual Report of the Chief Medical Officer of the Ministry of Health for the Year 1962’ (London: HMSO, 1963), 34.

If Olivia’s death was correctly reported by her GP, then one of those 39 deaths in the

CMO’s 1962 report was Olivia Dahl’s. Her complex social, psychological and bodily experience, like those of the hundreds of thousands of children suffering from measles each year, had been reduced to a single, relatively inconspicuous figure, overwhelmed in a sea of vital statistics. In focussing on the mortality of disease, some commentators had come to the conclusion that measles was now a ‘mild illness’. As a result, measles garnered little attention from medical researchers, policy makers and commentators.

During the 1950s very few studies into the aetiology, symptomology and epidemiology of measles were supported by the British state. New serum and gamma globulin therapies, becoming increasingly popular in Europe and the United States, were applied sparingly in Britain. And the disease was rarely discussed in political and public spaces.

This representation of measles continued to inform professional and public responses to the disease as British medical authorities began to seriously consider a programme of vaccination. In 1962, just two months before Olivia’s death, the Medical Research

Council’s (MRC) newly constituted Measles Vaccine Trial Committee met for the first time to examine the possibility of undertaking human trials of measles vaccines. After some deliberation, the meeting concluded that a measles vaccine trial in Britain was

‘premature’ at this stage.82 One of the members responsible for this decision was

Professor Wilson Smith, a leading British virologist and close friend of Roald Dahl’s bother-in-law, Professor Arnold Ashley Miles. As Chairman of the MRC’s Measles

Vaccines Trials Committee, Wilson would play a significant part in what the Chief

Medical Officer George Godber later described as the MRC’s ‘failure to take part in any trial of measles vaccine’.83 Nevertheless, the emergence of a potential vaccine against

82 TNA, FD 7/507, MVC6, Measles Vaccine Trial Committee, 27 September 1962. 83 TNA, FD 23/1353, George Godber to Harold Himsworth, MRC, 21 May 1963.

50 measles brought a new engagement with the disease, and a new visibility to its unseen burdens.

1.4 A shot in the arm: US vaccination and British debates

In the late 1950s and early 1960s, British scientific and medical correspondents began reporting the work of US scientists in the development of a vaccine against measles.84 In

1954 the esteemed biomedical scientist John Enders, along with his colleague at the

Children’s Medical Centre in Boston, Thomas Peebles, successfully cultivated a measles virus in human kidney cells. Over the course of the next five years, Enders worked closely with the paediatrician and virologist Samuel Katz to produce a safe and effective live measles vaccine.85 However, unlike the optimism and enthusiasm that had framed the reporting of previous medical ‘magic bullets’, such as penicillin, reports of measles vaccination in Britain were much more restrained.86 The medical correspondent of The

Times, while acknowledging the ‘results are distinctly encouraging’, suggested ‘much further work will be required’.87

Nonetheless, in opening up the possibility to mass prophylaxis the new technology did force British medical authorities into asking new questions of measles. Responding to events in the US, MRC Medical Officers first began discussing the subject of measles

84 Anon., ‘Measles Vaccine Successes In The United States.’, The Times, 9 October 1959, 17; Anon., ‘Anti-Measles Vaccine Is Successful’, The Observer, 17 July 1960, 10. 85 Jeffrey P. Baker, ‘The First Measles Vaccine’, Pediatrics 128 (2011): 435–37; S. L. Katz, ‘John F. Enders and Measles Virus Vaccine - a Reminiscence’, in Measles: History and Basic Biology, ed. Diane E. Griffin and Michael B. A. Oldstone (Berlin, Heidelberg: Springer, 2009), 3–11. 86 Robert Bud, Penicillin: Triumph and Tragedy (Oxford and New York: Oxford University Press, 2007); B. Hansen, ‘America’s First Medical Breakthrough: How Popular Excitement about a French Rabies Cure in 1885 Raised New Expectations for Medical Progress’, American Historical Review 103 (1998): 373–418; Andrea Tone, The Age of Anxiety: A History of America’s Turbulent Affair with Tranquilizers (New York: Basic Books, 2009). 87 Anon., ‘Measles Vaccine Successes In The United States.’, 17.

51 vaccination at the beginning of 1959. Enquiries made by MRC Medical Officer Dr E.

M. B. Clements revealed a long history of scientific neglect in Britain. Only one researcher, Joyce Wright, was reported as working on the virus and according to one source ‘she was thought to be well behind the American work.’88 Reports on the development of a ‘British’ measles vaccine were similarly pessimistic. British manufacturers, Burroughs Wellcome and Glaxo, were believed to be ‘interested’ in the subject, but were noted as having made little progress.89 At a ‘Symposium on Notifiable

Infectious Diseases’, held that same year, Dr G. I. Watson, a prominent member of The

College of General Practitioners, mourned Britain’s scientific neglect of measles:

Its continuance is at once a disgrace and a challenge to public health and laboratory workers, and to family doctors, all over the world. The suggested relationship between the virus of human measles, against which we have no protection, and that of puppy distemper, for which there has long been a vaccine, makes one wonder whether the 20,000 half-crowns a week now spent on notification might not be more profitably spent on research into a measles vaccine, so that the children of this country might be given a ‘dog’s chance’ of escaping measles by vaccination.90

Despite the potentially politically ‘dangerous’ position MRC officials found themselves in – leaving themselves open to accusations of neglect from political authorities – there was little concern at this stage.91 According to Clements’ notes, researchers within the

MRC were doubtful as to whether a vaccine against measles had a future in Britain.

After speaking with interested MRC researchers, Clements recorded: ‘As the condition is a mild one in childhood, the facts of increased morbidity only being known to general

88 TNA, FD 23/1347, E. M. B. Clements, File Note, 19 February 1959. 89 TNA, FD 23/1347, David Evans to E. M. B. Clements, 28 January 1959. 90 G. I. Watson, ‘Symposium on Notifiable Infectious Diseases: A Re-Assessment, Fourth Paper’, Journal Royal Society of Health 79 (1959): 498. 91 TNA, FD 23/1347, E. M. B. Clements, File Note, 19 February 1959.

52 practitioners, Dr. Wright feels that the popular reaction to a vaccine would be a poor one.’92 Dr David Evans from the National Institute of Medical Research took a similar position. According to Clements, ‘Evans estimated that measles would never become the subject of political pressure in this country because it was not a source of major morbidity, though the situation, of course, is different in tropical countries.’93

Clements himself had doubts about this perspective, and asked Dr John Knowelden from the London School of Hygiene and Tropical Medicine for ‘some information on the mortality and morbidity figures.’94 Similar to the CMO’s reports, Knowelden’s

‘picture of measles’ relied heavily on notification and mortality data, giving the impression measles was becoming a mild illness. In his reply to Clements, Knowelden pointed out how notification rates for measles had ‘not changed radically in the last 18 years’.95 In 1940, when measles first became a notifiable disease, there were 407,468 reports made; in 1959, the last year that Knowelden had figures for, there were 539,447 reports made. More striking, however, was the shift in mortality.96 Deaths from measles had dropped from 855 in 1940 to just 98 in 1959; a shift Knowelden attributed ‘to the more effective treatment of secondary complications of measles.’97

However, Clements still remained suspicious of this perspective. While he did not question the reality of the low mortality figures, he was quick to realise these figures could be as distorting as they were revealing. In a letter sent to Dr G. I. Watson, a member of The College of General Practitioners, Clements discussed his concerns: ‘My

92 TNA, FD 23/1347, E. M. B. Clements, File Note, ‘Measles’, 3 March 1959. 93 TNA, FD 23/1347, E. M. B. Clements, File Note, 19 February 1959. 94 Ibid. 95 TNA, FD 23/1347, John Knowelden to E. M. B. Clements, 17 June 1959. 96 TNA, FD 23/1347, John Knowelden to E. M. B. Clements, ‘Table 2. Measles – Notifications and Deaths with Rates per thousand. England and Wales 1940 – 1957’, 17 June 1959. 97 TNA, FD 23/1347, John Knowelden to E. M. B. Clements, 17 June 1959.

53 impression is, that it is the secondary complications of measles which makes this still an important disease. The mortality is now so low that it is difficult to get any meaning for information beyond, perhaps, an indication that some of the more serious complications which ended in death as recently as 5 or 6 years ago, now respond to treatment.’98 Clements wanted a clearer ‘picture of measles’ in Britain, and asked for

Watson’s assistance.99 Watson, who had ‘been thinking about the problem in a general way for some time’, sent Clements a copy of a report conducted by The College of

General Practitioners, along with a copy of his own pilot study.100 In moving away from interpreting notification and mortality figures, and focussing more on the ‘medico-social effect’ of measles, Watson’s study gave a more nuanced account of the disease in

Britain.101 Firstly, Watson suggested that up to 15 – 20 percent of all witnessed cases of measles led to some form of complication, including acute otitis media and pulmonary disease. Secondly, he argued that due to the demand placed on medical services during an epidemic, the economic cost to the British tax payer was considerable. Finally,

Watson gave some insight into the level of social disruption a measles epidemic could cause: children missed school, parents had to stay at home, and medical services became overwhelmed. His summary of the ‘chaos which breaks out in a practice that is severely affected by measles’ was illuminating:

If a doctor is conscientious he likes to see every new call that is made on his services each day. At the peak of a measles epidemic, which may last for a week or two in a large practice, the rate of new calls may be as much as four times the annual average. In my own practice, I have had as many as 25 new calls for measles alone in one day… When one is working at this pressure, I am sure

98 TNA, FD 23/1347, E. M. B. Clements to G. I. Watson, 30 June 1959. 99 Ibid. 100 TNA, FD 23/1347, G. I. Watson to E. M. B. Clements, ‘College Measles Report’, 7 July 1959. 101 Ibid.

most of my colleagues would agree with me in believing that some other seriously ill patients, not suffering from measles, get less medical attention than they deserve or require.102

Watson’s perspective proved both salient and prescient. In switching perspectives from mortality to morbidity – and in particular, from prevalence to complications – Watson had revealed a more disturbing picture of measles, one that would later contribute to a reinterpretation of the disease and its medical and political importance. Yet, in the meantime, as the views of Wright and Evans illustrate, early debates around the value of measles vaccination were largely informed, not by epidemiological evidence, but by an individual’s feel or estimate of potential public or political interest in providing the resources for a research programme.103 According to some MRC researchers, unlike the morbid images of smallpox, diphtheria and polio, the image of measles was less frightening, and consequently, less socially and politically interesting. Similar to many areas of healthcare at the time, the public were discussed, represented, but not always directly engaged with.104

It would be nearly two years before the MRC started to engage again in the subject of measles vaccination. Stimulated by research coming out of the US, Professor C. H.

Stuart-Harris, a member of staff at the University Department of Medicine, The Royal

Hospital, Sheffield, told officers at the MRC that ‘he felt it was desirable that a small informal meeting be convened at Head Office to discuss possible research of measles

102 Ibid. 103 TNA, FD 23/1347, E. M. B. Clements, File Note, 19 February 1959; TNA, FD 23/1347, E. M. B. Clements, File Note, ‘Measles’, 3 March 1959. 104 David Cantor, ‘Representing “The Public”: Medicine, Charity and Emotion in Twentieth- Century Britain’, in Medicine, Health and the Public Sphere in Britain, 1600-2000, ed. Steve Sturdy (London and New York: Routledge, 2002), 145–68.

55 vaccine.’105 Invites were sent out to a variety of ‘interested parties’ both inside and outside the Council.106 Most notably, an invite was given to the vaccine’s original designer, Dr John Enders, who was soon to be visiting Britain from the US. Held on 10

May 1961, the MRC’s ‘Informal Meeting’ centred on a talk given by Enders.107 After outlining the initial technical difficulties in cultivating the measles virus, Enders described the clinical effects of current live measles vaccines. According to a note of the meeting, while the results of early human trials were generally positive, and no serious complications had been reported, ‘Experience when using the vaccine in children … indicated that some six or seven days after inoculation fever occurred in 70% - 80% of cases’.108 From both a public health and public relations point of view, MRC advisors believed this number of reactions was too many.

Although still its embryonic stage, importantly, research conducted in the US inspired wider public and political interest in the subject of measles in Britain. Just two days after the MRC’s meeting with Enders, The Times newspaper reported the latest results of a measles vaccine trial carried out by his close colleague, Dr Samuel Katz. Written under the heading ‘Measles Vaccine Tests Successful’, the account presented a triumphalist narrative of the current status of measles vaccination.109 According to the article, ‘Highly successful results from a vaccine to give lifelong protection against the common “seven- day” measles were reported today to the New York State Medical Society at Rochester by Dr. Samuel Katz, a paediatrician at Harvard Medical School.’110 Perhaps concerned this article would lead to difficult questions over Britain’s own research history in this

105 TNA, FD 23/1348, MRC, File Note, ‘Measles Vaccine’, 17 March 1961. 106 TNA, FD23/1348, ‘Extract from Prof. C. H. Stuart Harris’ Letter to Dr. Lush’, 23 March 1961. 107 TNA, FD 23/1348, ‘Note on Informal Meeting Arranged to Hear Dr. Enders’ Talk on Measles Vaccine – 10th May, 1961’, 1961 108 Ibid. 109 Anon., ‘Measles Vaccine Tests Successful’, The Times, 12 May 1961, 16. 110 Ibid.

56 area, F. T. Hallett contacted the MRC for information on what research was currently being organised in Britain on behalf of the Minister for Science, Lord Hailsham.111 The

Office of the Minister for Science had been established to tackle accusations from the opposition Labour Party that the Conservative government were squandering Britain’s scientific abilities, and Hailsham was determined to show how his party supported the development of science and technology in all fields.112 In response, and perhaps aware of the political subtext behind Hallett’s request, MRC officials attempted to construct a narrative which explained Britain’s lack of action. According to Clements,

The only potential difficulty which I see is to explain why the work of Dr. Joyce Wright was not followed up. If this were asked, the answer is, I think, that Dr. Wright was only copying Enders and when the matter was reviewed … it was realised that we were some 18 months behind America and would only be following and confirming findings stage by stage. The limited resources available in this country were put to other good uses (such as trachoma research.)113

Sent to Hallett on 12 June, Clements’s response made no mention of Britain being

‘behind’ the Americans; instead, it emphasised the limitations with US vaccines, and focussed on the work that was being carried out by the MRC and British drug firms.114

Following the meeting with Enders, the MRC’s initial plan, as outlined in a letter sent from Stuart-Harris to the MRC’s Secretary Sir Harold Himsworth, was to set up a

‘working party on measles vaccine.’115 However, possibly due to the uncertainty that surrounded the topic, it was decided that an MRC Conference should be convened

111 TNA, FD 23/1348, F. T. Hallet to V. D. Potts, 23 May 1961. 112 Norman J. Vig, Science and Technology in British Politics (Oxford: Pergamon, 1968), 79; Viscount Hailsham, Science and Politics (Faber and Faber, 1963), 19. 113 TNA, FD 23/1348, E. M. B. Clements, File Note, 5 June 1961. 114 TNA, FD 23/1348, E. M. B. Clements to F. T. Hallet, 12 June 1961; TNA, FD 23/1348, E. M. B. Clements, ‘Background Information About Measles Vaccine’, 1961. 115 TNA, FD 7/710, C. H. Stuart-Harris to Harold Himsworth, 15 May 1961.

57 instead. A standard approach taken by the MRC to tackling a new field of inquiry, the conference had two main advantages.116 Firstly, it created a space for broader and more diverse discussions; important when engaging with a new scientific and medical field.

Secondly, as outlined in a letter to the Conference’s Chairman, Professor A. A.

Moncrieff, it also provided an opportunity for MRC officers and senior researchers to identify ‘the most appropriate members’ for future committees or working parties, something particularly important given the small amount of research which had been undertaken until that point.117 After some discussion within the MRC, around 20 experts from a variety of clinical, laboratory and public health backgrounds were identified.

Set to take place on 12 October 1961, unfortunately, there was one member who could not attend that date. Dr Frank Perkins, a member of staff at the Division of

Immunological Products Control, National Institute of Medical Research, was scheduled to attend a conference in the US at the same time. As an important figure in the testing of vaccines in Britain, it was initially suggested the Conference should be postponed until Perkins returned. However, MRC Principal Medical Officer, B. S. Lush, was very much against the idea. Illustrative of just how much the MRC’s response to measles had become a political one, Lush argued, that as ‘increasing public attention is being focussed on measles vaccine … we are bound to be asked difficult and important questions relating to it before long’.118 For Lush, it was more important that the MRC be seen to act immediately than ensure the attendance of every major expert.

116 For example, see Carsten Timmermann, A History of Lung Cancer: The Recalcitrant Disease (Houndsmills, Basingstoke, Hampshire: Palgrave Macmillan, 2014), 64–92. 117 TNA, FD 7/710, B. S. Lush to A. A. Moncrieff, 4 September 1961. 118 TNA, FD 7/710, B. S. Lush, File Note, ‘Proposed Conference on Measles Vaccine’, 29 August 1961.

Demonstrating the power of the British media to influence scientific debate, Lush’s anxieties were informed by two recently published newspaper articles on the subject of measles vaccination. On 21 and 22 August 1961, The Daily Telegraph and Daily Express both published articles highly critical of the government’s position on measles vaccination.119 The health services correspondent of The Daily Telegraph, John Prince, described 1961 as Britain’s ‘blackest year’, with some 733,963 cases of measles reported by August. According to Prince, ‘Research workers producing and testing vaccines against measles have received a sharp reminder of the urgency of the problem.’120

Chapman Pincher, the defence, science and medical editor of the Daily Express took an even more critical position. Famous for his work on uncovering spies and defence secrets at the heart of the British establishment, Pincher also took a keen interest in the latest developments in science and medicine.121 Before becoming a journalist, Pincher had studied botany and zoology at King’s College London and worked as a science teacher at the Liverpool Institute High School for Boys. During the Second World War,

Pincher worked for the Rocket Division of the Ministry of Supply, where he came into close contact with a number of Britain’s leading scientific advisors. This interest in science, alongside his determination to uncover the latest scoop, suddenly made measles a potentially interesting story for Pincher. In his article entitled ‘Measles: The

Unspectacular Illness Every Mother Fears’, Pincher condemned British ‘authorities’ for

119 John Prince, ‘Anti-Measles Vaccine Need’, The Daily Telegraph, 21 August 1961, 15; Chapman Pincher, ‘Measles: The Unspectacular Illness Every Mother Fears’, Daily Express, 22 August 1961, 6. 120 Prince, ‘Anti-Measles Vaccine Need’, 15. 121 Kelly Loughlin, ‘Networks of Mass Communication: Reporting Science, Health and Medicine in the 1950s and ’60s’, in Making Health Policy: Networks in Research and Policy After 1945, ed. Virginia Berridge (Amsterdam - New York: Rodopi, 2005), 302–3; Anon., ‘Chapman Pincher Obituary’, The Guardian, 6 August 2014, https://www.theguardian.com/books/2014/aug/06/chapman-pincher; Anon., ‘Chapman Pincher - Obituary’, The Telegraph, 6 August 2014, http://www.telegraph.co.uk/news/obituaries/11016167/Chapman-Pincher-obituary.html.

59 giving measles a ‘low priority.’122 ‘Why has science been so long in producing what to millions of parents – and children made miserable by the disease – seems such an obvious need?’ wrote Pincher, ‘The big trouble has been that measles is regarded as having lost the savage virulence it possessed in previous centuries when it killed in thousands. From the researchers view point the disease is unexciting compared with the more spectacular killers.’123 Pincher concluded with a powerful message to the British

Government: ‘this year’s epidemic … should warn both the Medical Research Council and the Health Ministry to put money and men into combating this Cinderella complaint without delay.’124 By finding their way into an ever-growing number of MRC and Ministry of Health administrative files on the subject, articles, such as Prince’s and

Pincher’s, were able to directly influence the terms of debate.

Figure 2. Newspaper article reporting on British attempts to develop a measles vaccine. Source: Chapman Pincher, ‘Measles: The Unspectacular Illness Every Mother Fears’, Daily Express, 22 August 1961, 6.

122 Pincher, ‘Measles’, 6. 123 Pincher, 6. 124 Pincher, 6.

On 12 October 1961, the MRC held their first Informal Conference on Measles

Prophylaxis. The conference, chaired by Professor A. A. Moncrieff, was convened with the intention of ‘(i) discussing the present state of knowledge concerning measles vaccines, and the need for additional information and research; and (ii) advising the

Council as to whether the disease justified an effort to offer active immunization if this proved to be a practicable procedure .’125 Concerning the first point, attendees came to the conclusion that the current inactivated and attenuated vaccines were unacceptable for large scale trials. Attendees were encouraged by developments with live attenuated vaccines, but due to the ‘considerable’ number of febrile reactions, they believed more work was necessary.126 With regard to the second point, and the ‘desirability’ of vaccination, opinion was more divided.127 ‘On the one hand it was felt that, since the mortality rate from measles was so low, the problem was not urgent… On the other hand, a body of opinion favoured pressing on actively with laboratory and field studies, and encouraging vaccination as soon as it could be safely offered, because of the present annual loss to the country through measles.’128 Those in favour of vaccination were likely swayed by the argument that ‘in terms of general practitioners’ time, cost of treatment, disorganization of schools, etc., [measles] constituted a by no means negligible problem’.129 The conference concluded ‘that further information was required before any recommendation could be made concerning the advisability of large-scale active immunization against measles.’130

In November 1961, just one month after the MRC’s own Informal Conference, the

International Conference on Measles Immunization was convened at the National

125 TNA, FD 7/710, ‘Informal Conference on Measles Prophylaxis’, 12 October 1961. 126 Ibid. 127 Ibid. 128 Ibid. 129 Ibid. 130 Ibid.

Institutes of Health (NIH), Bethesda (USA).131 The conference was an opportunity for researchers across the globe to present the latest epidemiological, clinical and scientific research on measles and its vaccination. The most notable attendee was John Enders.

Famous for his work on cultivating the polio virus in the 1950s, he was now being celebrated for his contribution to isolating, cultivating, and attenuating the measles virus. The conference was a significant event in the history of childhood disease.

President John F. Kennedy provided a powerful opening statement: ‘Your purpose is to advance the health of all people everywhere and especially to protect children against a formidable and widespread threat. Such meetings and such goals transcend national boundaries and unite mankind in our common striving toward a better life.’132 The papers presented on the first day revealed the terrifying medical and social impact of measles in certain areas of Africa, South America and Asia.133 Figures suggested that measles had now become one of the most deadly infectious diseases of childhood. For example, epidemiological research presented on Chile showed how measles had transformed from being a relatively minor public health problem in 1951, where it caused just 117 deaths, to become the ‘most severe infectious disease’ in Chile, taking

2,116 lives in 1960.134 Very similar papers presented on India, South Africa and Nigeria, left attendees in little doubt that a vaccine against measles was urgently required in these parts of the world.

However, from a British perspective the need for action was less clear. Britain’s main representative at the conference was Graham Wilson. Director of the PHLS, Wilson

131 ‘International Conference on Measles Immunization’, American Journal of Diseases of Childhood 103 (1962): 211–531. 132 Ibid., 213. 133 Ibid., 224–81. 134 Ibid., 236–41.

62 was a distinguished bacteriologist and an influential figure in British medical science.135

He studied medicine at King’s College London; and after several years lecturing at the

University of Manchester he moved to the London School of Hygiene & Tropical

Medicine, where in 1930 he became the Chair of Bacteriology Applied to Hygiene. As well as making a significant contribution to the field of bacteriology, Wilson also helped establish the Emergency Public Health Laboratory Service (EPHLS) prior to the beginning of the Second World War and played a key role in its transformation to become the PHLS in 1946. Crucially, through his work on a number of Ministry of

Health and MRC committees, Wilson was able to influence public health policy at the national level. Now given the opportunity to speak first at the International Conference on Measles Immunization, Wilson was again being given a platform to influence British policy. Wilson used his opportunity to question the value of measles vaccination to

Britain. Described by the journalist Arthur Allen as a ‘British skeptic of the measles vaccine’, Wilson was renowned for his cautious attitude towards vaccination.136 In his opening paper for the International Conference, Wilson described how measles had become a less fatal condition in Britain. Wilson’s argument was based on statistics, which suggested that the mortality rate of measles in England and Wales had fallen dramatically, from 318 per million at the start of the twentieth century to just 2 per million by 1960.137 Wilson asked, ‘under these conditions, is the disease worth preventing, or should we concentrate on shielding infants and very young children from the risk of infection and protecting them with γ-globulin when this is impossible?’138

135 E.S. Anderson and Robert Williams, ‘Graham Selby Wilson. 1895-1987’, Biographical Memoirs of Fellows of the Royal Society 34 (1988): 887–919. 136 Allen, Vaccine, 219. 137 Graham Wilson, ‘International Conference on Measles Immunization: Measles as a Universal Disease’, American Journal of Diseases of Childhood 103 (1962): 222. 138 Ibid.

By the early 1960s, Wilson’s cautious position on measles vaccination had, in many ways, become Britain’s official position. In the early 1960s, Wilson became a key figure on a number of Government advisory committees (including the MRC’s Measles

Vaccines Committee, the MRC’s Measles Vaccine Trial Committee, and the Joint

Committee on Vaccination and Immunisation’s (JCVI) Measles Vaccines Sub-

Committee) set up to examine the rationale for vaccinating against measles in Britain.

The minutes of these early committee meetings reveal a deep uncertainty. Members like

Wilson raised several concerns over the prospect of vaccination, including its necessity, safety, long term efficacy and potential popularity.

Concerns over the value of measles vaccination were also shared by several members of the medical profession. Letters published in the BMJ throughout the early 1960s suggest practitioners were divided over the necessity of a vaccine against measles. While supporters argued that measles remained a significant medical and social problem in

Britain, critics believed that improvements in environmental conditions and the increasing use of antibiotics in treating secondary infections had ensured that measles was only a mild disease. For example, E. James, a member of staff at Rush Green

Hospital, Romford, argued that ‘Mass vaccination against killing diseases such as diphtheria and poliomyelitis is imperative, but let us keep a sense of proportion.’139 J. H.

E. Baines agreed. In connecting the debate over measles vaccination with wider concerns over rampant medicalisation and the destruction of the environment, Baines argued, ‘Indiscriminate indulgence in vaccination is little more justifiable than the indiscriminate contamination of our environment by pesticides and the like. Least of all is it justifiable to advocate such procedures to avoid some inconvenience or for small

139 E. James, ‘Vaccination Against Measles’, British Medical Journal 1 (1963): 193.

(and nebulous) economic gain’.140 A 1963 BMJ editorial on the subject summed up

Britain’s dilemma: ‘There can be no doubt that an effective vaccine is needed for children who are especially liable to develop severe measles – for example, mentally defective children in institutions or children in underdeveloped countries. But the need or desire for a vaccine for the general population of Great Britain is much less certain.’141

Despite doubts over the ‘need or desire’ for a measles vaccine in Britain, the emergence of a potential vaccine had given the disease a new public and political visibility. Before

1959 the disease was rarely discussed within government bodies. A few commentators noted the disease’s neglect, but largely it remained hidden or ignored. After 1959, developments, particularly in the US, started to force a re-examination of the disease by

British medical authorities. A re-examination that was as much to do with press and political interest in the subject, as it was to do with technological change and epidemiological analysis. While crude mortality and notification data continued to inform debates, research, particularly the ‘medico-social’ work of Dr G. I. Watson, started to challenge certain preconceptions about the disease. As I will demonstrate below, research, again published in the US, would set in motion a series of events that would transform the way measles was understood in Britain.

1.5 ‘1 in every 15’: Making morbidity visible

Following the International Conference on Measles Immunization, the MRC organised a Second Informal Conference on Measles Prophylaxis. Held on 6 March 1962, the

140 J. H. E. Baines, ‘Vaccination Against Measles’, British Medical Journal 2 (1963): 1067. 141 Anon., ‘Vaccination Against Measles’, British Medical Journal 2 (1963): 760.

65 meeting examined the central question of ‘whether further work on measles prophylaxis was justified, in view of the low mortality and morbidity rate of the disease in this country’, as well as providing an opportunity for attendees to examine the latest information and research concerning measles vaccination.142

Having served as Britain’s main representative at the International Conference, the meeting’s course and outcome was strongly influenced by the position of Graham

Wilson. During the meeting, Wilson presented a powerful case for more research into the biological and clinical effects of measles. According to the minutes, Wilson ‘stated that one of the most significant findings reported at the American conference was the seriousness of the neurological effects of measles.’143 Wilson gave special mention to two papers. The first was written by Frederic A. Gibbs and Ira M. Rosenthal from the

University of Illinois.144 Their paper described a series of studies, which had measured

Electroencephalography (EEG) changes in children, either during an attack of measles or following vaccination. These studies suggested children underwent significant cerebral changes during an attack. For example, a study conducted at the Municipal

Contagious Disease Hospital of Chicago on 680 patients, found that 51 percent of cases showed ‘abnormally slow EEG’s during the acute or immediate postacute phase of the disease.’145 While most children showed no clinical symptoms, there were several reports of ‘convulsive disorder’, ‘behaviour disorders’, and ‘loss of intellectual power’, all linked to changes in a patient’s EEG recordings.146The second paper Wilson discussed was

142 TNA, FD 7/1345, ‘Second Informal Conference on Measles Prophylaxis’, 6 March 1962. 143 Ibid. 144 Frederic A. Gibbs and Ira M. Rosenthal, ‘International Conference on Measles Immunization: Electroencephalography in Natural and Attenuated Measles’, American Journal of Diseases of Childhood 103 (1962): 395–400. 145 Ibid., 395. 146 Ibid., 396.

66 written by Edward B. Shaw from the University of California’s School of Medicine.147

Shaw’s paper, a personal view on the ‘future of measles vaccination’, presented an image of measles largely unfamiliar to British audiences.148 While Shaw acknowledged that measles caused fewer complications than in previous decades, he believed encephalitis still posed a ‘great risk’.149 ‘There is no doubt’, wrote Shaw, ‘that the ultimate results of central nervous complications are decidedly worse than the over-all effects of paralytic polio and that survivors make up a much more dismal lot than those who survive poliomyelitis.’150 Based on the revelation that measles might lead to significant neurological changes in children, Wilson suggested that Britain should undertake its own investigations. The conference agreed and recommended ‘a small Working Party should be set up to investigate, by means of EEG examination and psychological tests, the neurological effects of measles.’151

Following the MRC’s Second Informal Conference, work began on establishing a

Working Party on Neurological Complications of Measles. On the advice of

Himsworth, Professor Denis Hill – a member of staff at the Department of Psychiatry,

Middlesex Hospital Medical School – was invited to chair the Working Party. A letter sent from Joan Faulkner, a Principal Medical Officer at the MRC, provided Hill with the relevant papers and explained to him the rationale for setting up the working party:

In this country I think it is true to say that, owing to the reduction in respiratory complications, measles is nowadays regarded as a mild and relatively unimportant illness. Protection against it might, therefore, not be given a high

147 Edward B. Shaw, ‘International Conference on Measles Immunization: Future of Measles Vaccine in the U.S.A.’, American Journal of Diseases of Childhood 103 (1962): 528–31. 148 Ibid., 528. 149 Ibid., 529. 150 Ibid. 151 TNA, FD 7/1345, ‘Second Informal Conference on Measles Prophylaxis’, 6 March 1962.

priority in the immunization programme here, although, of course, the situation is quite different in the tropics where the case fatality rate tends to be high. However, if the effects on the central nervous system are as substantial as the Americans suggest this would obviously affect the attitude in this country to prophylaxis. It, therefore, seems important to try to find out the facts of the situation.152

To the disappointment of the MRC, Hill declined the invitation to act as chair. After reading through the papers of Gibbs, Rosenthal and Shaw, Hill concluded ‘that the evidence for impaired mental function after measles is very slender and the incidence of encephalitis is not, I believe, high.’153 However, given the potential importance of the

American findings, Faulkner arranged a meeting between Hill, Moncrieff and Wilson to discuss Hill’s criticisms further. In responding to Faulkner’s invitation, Wilson acknowledged the crucial shift that was taking place between mortality and morbidity in the measles debate. ‘We cannot leave the American statements unchallenged’, replied

Wilson, ‘We must confirm or refute them. The whole policy of measles immunization will be determined by the answer.’154 Indeed, despite Hill’s continued doubts, at a meeting held on 25 October 1962, attendees recommended the undertaking of two investigations: the first, an epidemiological study to examine the prevalence of encephalitis following measles; the second, a study to examine the occurrence of EEG changes and changes in intelligence after an attack of measles.155

While advisors to the MRC had initially been more interested in the study of EEG changes, it was the PHLS epidemiological study that would prove most significant. An investigation into the ‘frequency of complications of measles’, the study reflected the

152 TNA, FD 23/1351, Joan Faulkner to Denis Hill, 6 July 1962. 153 TNA, FD 23/1351, Denis Hill to Joan Faulkner, 18 July 1962. 154 TNA, FD 23/1351, Graham Wilson to Joan Faulkner, File Note, 20 September 1962. 155 TNA, FD 23/1351, Margaret Gorill, File Note, ‘Notes on a Luncheon Meeting 25.10.62 to Discuss the Neurological Sequelae of Measles’, 26 October 1962.

68 growing influence of epidemiology on public health policy and analysis.’156 Organised by

D. L. Miller from the Epidemiological Research Laboratory, Central Public Health

Laboratory, it was designed to measure the clinical effects of measles across a large population of patients, in this case children. Using a very simple methodology, medical practitioners were invited to complete an inquiry card sent to them approximately one month following measles notification. Along with basic demographic information, the card included a series of questions related to the nature of the patient’s case of measles.

Firstly, it asked whether the patient had suffered from any complications; secondly, if these included, pneumonia, otitis media, deafness, encephalitis, motor disturbances, impaired consciousness and behaviour changes; and finally, whether the patient recovered or was admitted to hospital.157 Between January and April 1963, during an epidemic of measles, Medical Officers of Health from 47 ‘large county boroughs’ wrote to local medical practitioners inviting them to participate in the study.158 The response was reported as ‘excellent’.159 Out of a total of 55,589 inquiry cards sent to practitioners,

53,008 (95 percent) were returned completed.

The results of the PHLS’s study turned out to be significant, particularly in focussing the attention of medical authorities towards the disease’s morbidity (see Tables 4 and 5).

Published in the BMJ on 11 July 1964, the report showed that out of every 1000 notified cases of measles, 67 patients suffered from one or more complications. Out of these 67

156 D. L. Miller, ‘Frequency of Complications of Measles, 1963: Report on a National Inquiry by the Public Health Laboratory Service in Collaboration with the Society of Medical Officers of Health’, British Medical Journal 2 (1964): 75–78; for an analysis of the increasing influence of epidemiology on public health policy and practice, see Luc Berlivet, ‘“Association or Causation?”: The Debate on the Scientific Status of Risk Factor Epidemiology, 1947-c.1965’, in Making Health Policy: Networks in Research and Policy After 1945, ed. Virginia Berridge (Amsterdam - New York: Rodopi, 2005), 39–74; William G. Rothstein, Public Health and the Risk Factor: A History of an Uneven Medical Revolution (Rochester, New York: University of Rochester Press, 2008). 157 TNA, FD 23/1351, ‘Investigation of the Complications of Measles’, 1963. 158 Miller, ‘Frequency of Complications of Measles, 1963’, 75. 159 Ibid.

69 cases, 38 patients suffered from pneumonia, 25 otitis media and 4 neurological disturbances. This meant that in approximately ‘1 in every 15’ cases of measles, a child would develop complications.160 The report went on to paint a disturbing theoretical picture of what a national measles epidemic involving 500,000 children would look like:

‘This would mean that about 35,000 patients might be expected to have serious complications, and over 6,000 be admitted to hospital. Of the complications over 2,000 would be neurological, including some 600 cases of encephalitis; 20,000 would affect the respiratory tract and 13,000 the middle ear.’161 In conclusion, the report stated that

‘serious complications of measles are commoner than is generally supposed and cannot be ignored in any assessment of the need for universal measles vaccination.’162

Moreover, in providing policy makers with tangible evidence of the burden of measles to the individual child, the report also illuminated the significant social and economic cost to British society caused by the disease. As the report noted, measles is ‘a burden not only on the young patients, parents, and doctors but also on the nation's economy.’163

160 Ibid., 76. 161 Ibid., 77–78. 162 Ibid., 77. 163 Ibid., 78.

Table 4. Number and rate of complications from measles Age and Sex Total No. of Cases No. with Rate per 1,000 Complications Cases 0-5 months 232 20 86.2 6-11 1,804 151 83.7 1 year- 6,052 435 71.9 2 years- 7,559 509 67.3 3-4 years 14,915 895 60.0 5-9 years 20,911 1,436 68.7 10-14 years 795 34 42.8 15-19 years 189 13 68.8 20 years or over 210 17 81.0 Not stated 325 22 67.7 Males 27,138 1,812 66.8 Females 25,854 1,720 66.5 All cases 52,992 3,532 66.7 Source: D. L. Miller, ‘Frequency of Complications of Measles, 1963: Report on a National Inquiry by the Public Health Laboratory Service in Collaboration with the Society of Medical Officers of Health’, British Medical Journal 2 (1964): 76.

Table 5. Number and rate of Hospital admissions from measles

Complication No. Affected No. Admitted to Rate per 100 Hospital Complications Encephalitis or impaired 61 24 39 consciousness Behaviour changes 62 2 3 Motor disturbances: Fits 80 33 41 Other 13 0 0 All neurological 203 55 27 Respiratory 2,022 355 18 Otitis media 1,338 37 3 Others 117 87 74 All complications 3,532 496 14 Source: D. L. Miller, ‘Frequency of Complications of Measles, 1963: Report on a National Inquiry by the Public Health Laboratory Service in Collaboration with the Society of Medical Officers of Health’, British Medical Journal 2 (1964): 77.

While the results of Miller’s study would later become accepted as truth, at the time of the report’s publication there were some dissenting voices. Most notably, on the same day Miller’s report was published, the BMJ ran their own editorial on the subject. ‘Does this present survey of measles in England and Wales add up to a strong argument for

71 mass vaccination’, asked the unnamed writer, ‘Into the balance must go a number of other factors.’164 These ‘factors’ included: concerns over the safety of measles vaccination; the potential ‘tragic’ consequences of failing to induce long term immunity; and the likelihood that ‘vaccination would be actively sought by those of higher social status … and be overlooked by those in less favourable circumstances’.165 Moreover, in offering a reinterpretation of what Miller’s ‘67 per thousand’ cases actually meant, the article painted a very different picture of the social and economic burden of measles.

According to the article, ‘an incidence of complications of 67 cases out of 1,000 patients means that no fewer than 933 progressed to a straightforward recovery, and it might be suggested that the vaccination (with its attendant side-effects) of 10,000 persons in the hope of avoiding some 700 complications – nearly all susceptible to effective treatment

– is a rather costly undertaking.’166 The article challenged the reader to think about the limits of modern medicine: ‘We have done well to rid ourselves of the captains of the men of death – some by vaccination, some by simpler measures of environmental hygiene. In Great Britain at the moment it is not necessarily logical to say, “We can produce a vaccine; let us therefore use it.”’167

Nevertheless, as the results of Miller’s study became appropriated by policy makers and commentators, criticisms largely disappeared. At an Informal Meeting on Neurological

Complications of Measles, held on 24 June 1963, attendees agreed that the PHLS study

‘provided a most interesting and solid basis of fact, for the first time, in the investigation of the after-effects of measles’.168 Significantly, this ‘basis of fact’ would become central to the medical and political transformation of measles in Britain. As I will show in

164 Anon., ‘Measles and Measles Vaccination’, British Medical Journal 2 (1964): 72. 165 Ibid., 72–73. 166 Ibid., 73. 167 Ibid. 168 TNA, FD 23/1351, ‘Informal Meeting on Neurological Complications of Measles’, 24 June 1963.

72 chapters 2 and 3, in redefining the way measles was understood through the use of statistics, the PHLS’s study gave policy makers a new-found confidence to support vaccination. As Elizabeth Fee has argued in her work on lead poisoning, ‘Statistics are the language of public health; problems can only be perceived when they can be counted, and problems cannot be dealt with until they are perceived to exist.’169 From the Ministry of Health’s perspective, measles was now perceived as a significant public health issue. The emergence of a vaccine for measles had sparked a re-examination of a disease largely forgotten in Britain. This had brought alive an unseen world of child morbidity, family anxiety, and medical and economic strain. What had been revealed was a complex social and medical problem; an understanding more sympathetic to the experience of Dahl, Neal and Olivia.

1.6 Conclusion

Beginning with the tragic story of Olivia Dahl, this chapter has shown how measles was transformed from a private illness to a major public health issue in early 1960s Britain.

A historically contextualised reading of Olivia’s story takes us back to a time in the

1950s and early 1960s, where the identity of measles was far less certain. It provides an interesting example of ‘the making and unmaking of ignorance’. When the burden of measles was measured at the bedside, or through the lens of vital statistics, the disease came to be viewed by some British medical authorities as a mild illness. The emergence of a vaccine against measles in the United States eventually created a new political context, and with it, a re-examination of the seriousness of the disease in Britain.

Important in this transformation was the role of individuals and their scientific

169 Elizabeth Fee, ‘Public Health in Practice: An Early Confrontation with the “Silent Epidemic” of Childhood Lead Paint Poisoning’, Journal of the History of Medicine and Allied Sciences 45 (1990): 584.

73 networks. For example, Graham Wilson, initially informed by his experience in the US, was then able to influence the debate in Britain through his work on various conferences and committees organised by the MRC. The pressure he exerted within the

MRC eventually lead to new research, which in casting its gaze on morbidity rather than mortality revealed a more serious ‘medico-social’ condition in Britain.

At the same time, in examining how measles was made visible in early 1960s Britain, this chapter has begun to chart a central theme of this thesis: the relationship between science, politics and the public. As this chapter has demonstrated, while decisions concerning measles were made by a small network of officials and scientific experts working inside the MRC, ‘the public’ did have an influence. Although not directly engaged with, public attitudes towards measles vaccination were at times imagined through the prism of personal experience or media representations. This imagined public shaped the course of events. While defined as uninterested in the subject of measles vaccination, there was little pressure on the MRC to sponsor research.

However, anxious to avoid controversy, once this image began to change, and the public became perceived as interested, the MRC responded by reengaging with the subject. Similar to previous accounts of emerging diseases, institutional responses were shaped as much by the political and social context, as they were by the epidemiological one.170

Nevertheless, despite this reframing of measles as a significant public health issue in

Britain, the MRC’s decision to begin its first measles vaccine trial was not inevitable. As

I will examine chapter 2, experts advising the MRC’s various measles vaccines

170 Randall M. Packard et al., eds., Emerging Illnesses and Society: Negotiating the Public Health Agenda (Baltimore and London: Johns Hopkins University Press, 2004).

74 committees were concerned about the safety and efficacy of current vaccines. As a result, members repeatedly demonstrated an unwillingness to begin clinical trials using measles vaccines. At a number of informal conferences, committees and meetings, held between 1961 and 1963, MRC experts repeatedly came to the conclusion that a measles vaccine trial in Britain was premature. How this decision was made, and how it was eventually overturned, is the story to which we now turn.

Chapter 2: Regulation by Committee: Assessing the Risks of Measles Vaccine Trials

2.1 Introduction

‘FROM today every boy and girl in America can be given Immunity to one of the scourges of childhood – measles. The United States becomes the first country to introduce a vaccine. When will Britain do likewise?’1

In Chapter 1, I described how measles was transformed from a disease largely overlooked by medical and political authorities to be considered a significant public health and social concern. However, unlike scientific and medical authorities across the globe, in the case of Britain, increased scientific and political interest in the disease did not immediately translate into scientific and medical outcomes.2 Between 1961 and 1963 the British Medical Research Council refused to conduct any clinical trials using both killed measles vaccines and live attenuated vaccines. A decision, which as the article in the Daily Express suggested, was becoming less publically acceptable. In concluding, the article declared: ‘Britain's brilliant scientists discovered penicillin; they have virtually obliterated diphtheria. But they have so far been denied official encouragement and adequate resources to fight measles.3

This chapter examines the management of experimental risk by the MRC. In the first part of this chapter I examine why between 1961 and 1963 the MRC continually refused

1 Anon., ‘Conquer It’, Daily Express, 23 March 1963, 6. 2 Arthur Allen, Vaccine: The Controversial Story of Medicine’s Greatest Lifesaver (New York and London: W. W. Norton & Company, 2007), 215–32; Jeffrey P. Baker, ‘The First Measles Vaccine’, Pediatrics 128 (2011): 435–37; Jan Hendriks and Stuart Blume, ‘Measles Vaccination Before the Measles-Mumps-Rubella Vaccine’, American Journal of Public Health 103 (2013): 1393– 1401. 3 Anon., ‘Conquer It’, 6.

76 to sponsor any measles vaccines trials. Rightly, historians working on notorious human trials from the middle of twentieth century have emphasised a lack of care, oversight and consent in their organisation.4 My own research is not a challenge to this analysis, but in examining the MRC’s cautious approach to the evaluation of measles vaccine trials does offer an alternative perspective. By analysing the contrast between the regulation of measles vaccine trials within private institutions and the MRC’s own process of experimental regulation, this chapter illustrates the importance of the MRC’s expert committees to controlling experimental risk. Throughout the MRC’s history, expert committees have been central to their process of decision making.5 In the case of measles vaccination, several informal and formal committees were given the responsibility for determining clinical trial policy. Exploring the internal anatomy of these committees reveals how evaluations of experimental risk were shaped by the dynamics of the committee room – its relationships, networks, knowledges and politics.

In demonstrating the MRC’s more cautious approach to medical innovation, this chapter provides an alternative picture to the image of medical immorality that was emerging at the time.

The second part of this chapter examines the MRC’s change of position towards the end of 1963. In doing, so it continues to chart a central theme of this thesis: the relationship between risk, politics and the public. It argues that decisions concerning the risks and ethics of clinical testing were informed by a reading of the public and political

4 Sarah Ferber, Bioethics in Historical Perspective (New York: Palgrave Macmillan, n.d.), 101–32, accessed 21 May 2017; Susan E. Lederer, Subjected to Science: Human Experimentation in America Before the Second World War (Baltimore and London: Johns Hopkins University Press, 1995); Jonathan D. Moreno, Undue Risk: Secret State Experiments on Humans (New York and London: Routledge, 2000). 5 Joan Austoker and Linda Bryder, eds., Historical Perspectives on the Role of the MRC: Essays in the History of the Medical Research Council of the United Kingdom and Its Predecessor, the Medical Research Committee, 1913-1953 (Oxford: Oxford University Press, 1989); A. Landsborough Thomson, Half a Century of Medical Research. Volume One: Origins and Policy of the Medical Research Council (UK) (London: HMSO, 1973).

77 context. Although the public were not directly engaged with, they were discussed and represented by scientific experts and officials. Their representation had multiple effects.

Initially, concerned with how measles vaccine trials would be viewed by a public seemingly unworried by measles, MRC experts were reluctant to take the same risks as their scientific peers in the US. However, as the public mood began to be reimagined by the middle of 1963, experts and officials working for both the MRC and Ministry of

Health started to take a different view. Confident that the public were now supportive of a clinical trial, both organisations took steps to transform the British government’s policy.

2.2 ‘A woeful product’: Assessing Britain’s first measles vaccines

As I described in Chapter 1, informed by growing medical, political and media interest in the subject of measles vaccination, in 1961 and 1962 the MRC held two Informal

Conferences on Measles Prophylaxis. These conferences provided an opportunity for prominent medical researchers from a variety of clinical, scientific and public health backgrounds to examine and debate the nature of current measles vaccines (See Table

6). On both occasions attendees came to the conclusion that a measles vaccine trial in

Britain was premature. While this decision largely reflected unanswered questions over the seriousness of measles, it also reflected concerns over the nature of early vaccines.

In particular, it reflected concerns over the safety of British vaccines. According to the

American writer Arthur Allen, ‘The vaccine being tested in Britain at the time seemed to be a woeful product.’6 How the MRC came to this conclusion is where we begin.

6 Allen, Vaccine, 219.

Table 6. Participants attending the Medical Research Council’s Informal Conference on Measles Prophylaxis Conference Participant Professor A. A. Moncrieff (Chairman) The Hospital for Sick Children, Great Ormond Street, London Dr M. Clarke Division of Immunological Products Control, Medical Research Council Laboratory, London Professor G.W.A. Dick Department of Microbiology, Institute of Pathology, Queen’s University, Belfast Dr J. A. Dudgeon The Hospital for Sick Children, Great Ormond Street, London Professor D. G. Evans London School of Hygiene and Tropical Medicine Professor W. F. Gaisford Paediatrician, Cheshire Dr W. H. Galloway ‘A “fevers” Consultant’, Aberdeen Professor J. K. Knowelden Department of Preventative Medicine and Public Health, University of Sheffield Dr J. Stevensen Logan Municipal Health Centre, Essex Dr K. McCarthy Department of Bacteriology, The University of Liverpool Dr A. D. Macrae Virus Reference Laboratory, Central Public Health Laboratory, London Dr J. C. McDonald Central Public Health Laboratory, London Dr F.T. Perkins Division of Immunological Products Control, Medical Research Council Laboratory, London Sir Wilfred Sheldon Physician and paediatrician to Queen Elizabeth; advisor to the Ministry of Health Professor C.H. Stuart-Harris University Department of Medicine, The Royal Hospital, Sheffield Dr D. Thomson Ministry of Health, London Dr D. A. J. Tyrrell Common Cold Research Unit, National Institute for Medical Research, London Dr G. I. Watson The College of General Practitioners Dr E. M. B. Clements Medical Research Council, London Dr. B. S. Lush Medical Research Council, London Miss N. S. Jones Medical Research Council, London

Source: TNA, FD 7/710, Informal Conference on Measles Prophylaxis: Conference Participants, 1961.

In the early 1960s, medical officers at the MRC began to investigate work being carried out in Britain and overseas on developing a safe and effective measles vaccine. Crucially, medical officers not only examined the published material, but sought the advice of experts familiar with the latest developments. Conversations with medical researchers working for the MRC revealed a more problematic picture than had so far been presented through published reports. Although experimental vaccines manufactured in the US were known to produce adverse reactions, advisors to the MRC suggested

British strains had proved particularly hazardous. In recording the outcome of his own informal investigation into the subject, MRC Principal Medical Officer, B. S. Lush, noted, ‘Burroughs Wellcome have produced and tried their own measles vaccine in

Nigeria, in a group General Practice in Kent and at the Fountain Hospital for Mental

Defectives. Reactions with the B.W. vaccine have been both more common and more severe than with the U.S. vaccine but the trials do not appear to have been very well conducted.’7

The British vaccine was produced by Dr Alan Goffe, a virologist who worked at the

Wellcome Research Laboratories in Beckenham, Kent. Goffe had previously worked at the British government’s Central Public Health Laboratory; however, according to one source, Goffe ‘left his government job for one with a private company because he was disappointed by the lack of support he felt he and other scientists had been given by the

British government in their effort to develop a polio vaccine.’8 Once at the Wellcome

Research Laboratories, Goffe worked on developing an improved version of Salk’s killed polio vaccine, before later manufacturing Sabin’s live attenuated polio vaccine.

This experience, along with the contacts he made, helped inform the development of

7 TNA, FD 7/710, B. S. Lush, File Note, ‘Possible New Committee on Prophylactic Trials of Measles Vaccine’, 30 May 1961. 8 Gaia Goffe and Judith Goffe, Between Two Worlds: The Story of Black British Scientist Alan Goffe (London Hertfordshire: Hansib, 2008), 63.

80 his live attenuated measles vaccine. Working with his colleagues at the Wellcome

Research Laboratories, Goffe attempted to produce a live attenuated measles vaccine using material provided by John Enders.9 However, as was now being discovered by medical officers at the MRC, Goffe’s initial attempts were not without their problems.10

Concerns over the safety of current experimental measles vaccines were shared by medical researchers and practitioners who attended the MRC’s first Informal

Conference on Measles Prophylaxis.11 Held on 12 October 1961, attendees were given several papers to read prior to the meeting. As well as receiving the latest research concerning the epidemiology of measles in Britain, attendees were also provided with a summary of the current status of measles vaccines produced by Dr Frank Perkins, a member of staff at the MRC Laboratory’s Division of Immunological Products

Control.12 Like Lush’s initial investigation, what Perkins presented reviewers with was a more candid portrayal of measles vaccination than had so far been published in the media. According to Perkins,

Each manufacturer claims that his particular product gives good protection against measles, but it is difficult to assess from the small investigations made so far whether any one vaccine is markedly better than the others. However, some findings are common to all studies – the attenuated strain produces a febrile reaction and in some cases a rash and Koplik’s spots; in fact, in many instances what would seem to be a classical case of measles has resulted from injection of the vaccine. The clinicians point out that the children affected are not confined

9 Don Everitt, ‘Good-Bye Measles!’, The Readers Digets: Nigerian Edition 7 (1966): 5–8. 10 Goffe and Goffe, Between Two Worlds, 75–79. 11 TNA, FD 7/710, ‘Informal Conference on Measles Prophylaxis’, 12 October 1961. 12 TNA, FD 7/710, Frank Perkins, ‘Division of Immunological Products Control, Hampstead: Note on Measles Vaccines’, 30 September 1961.

to bed and that their appetites are normal, but nevertheless current opinion seems to be that this strain has not been sufficiently attenuated.13

Attendees at the Conference agreed with Perkins’ assessment of measles vaccination. In discussing the nature of current live attenuated vaccines, attendees noted that although initial results had proven ‘encouraging’, ‘All the products so far available had the common disadvantage of producing a considerable febrile reaction.’14 Results indicated

‘that approximately 70% of children vaccinated against measles had some form of reaction, ranging from the relatively severe to the very mild.’15 Indeed, given the nature of these reactions, some questioned whether current trials taking place in Britain were medically and ethically acceptable. According to the minutes, members noted ‘the unsatisfactory nature of the present situation in which a number of commercial firms were working independently and arranging separate trials, the results of some of which gave cause for concern.’16 Aware that some of these trials may prove controversial amongst the public, attendees were advised to distance themselves from such research.

According to the Ministry of Health’s representative at the Conference, Dr D.

Thomson, attendees were advised ‘that trials under more or less private enterprise, when children may be used to ascertain the efficacy of a vaccine which gives rise to sharp reaction, were fraught with the possibility of public criticisms and so should not be encouraged.’17 Given the uncertainty that still surrounded the severity of measles (see

Chapter 1), and the concerns over the safety of current vaccines, attendees ‘agreed’ that more research was necessary before they could recommend vaccination against measles.18

13 Ibid. 14 TNA, FD 7/710, ‘Informal Conference on Measles Prophylaxis’, 12 October 1961. 15 Ibid. 16 Ibid. 17 TNA, MH 154/134, D. Thomson, File Note, ‘Measles Vaccine’, 12 October 1961. 18 TNA, FD 7/710, ‘Informal Conference on Measles Prophylaxis’, 12 October 1961.

Following the MRC’s Informal Conference, several of the attendees travelled to

Bethesda in the United States for the first International Conference on Measles

Immunization. These conferences were central to the MRC’s evaluation of experimental risk. As well as inviting some of the world’s leading scientific researchers, they provided a private space for researches to debate and evaluate the latest results of vaccine trials.

One the papers presented at the conference was by Alan Goffe.19 Yet to be published,

Goffe’s paper documented the preliminary results of a trial that was organised to test

Wellcome Research Laboratories’ 3C strain. Tested on 152 children in Southeast

England, the results were troubling. According to Goffe the majority of children suffered from some form of adverse reaction. 74 percent of children suffered from a febrile reaction and 61 percent developed a rash. Even more worrying was the number of children who suffered from more serious complications. During the trial there were reports of earache, sticky eyes, respiratory symptoms, vomiting, tonsillitis, otitis media, delirium and febrile convulsions. A number of these children were treated with

‘chemotherapy or sedation’.20 Goffe put forward a number of medical and sociological reasons for why such a significant number of reactions were reported. For example, in response to reports of febrile convulsions, Goffe suggested ‘that the area of Britain that had been chosen for this particular study is one which, on a survey of the incidence of epilepsy in Britain, turned out to have the highest incidence of epilepsy. So it may have been possible that the febrile reaction activated latent petit mal, which had a particularly high incidence in this part of the country’.21 Evidence suggests at least some medical researchers attending his paper were less than impressed. In reviewing Goffe’s paper,

Dr Saul Krugman, from New York University School of Medicine, was critical of both

19 Floyd Markham et al., ‘International Conference on Measles Immunization: Discussion on Immunization of Man Against Measles’, American Journal of Diseases of Childhood 103 (1962): 390– 93. 20 Ibid., 392. 21 Ibid., 391.

Goffe’s vaccine and his study. Addressing the conference, Krugman stated: ‘It is most important to reemphasise that his live measles-virus vaccine was prepared at low temperatures; it is not the same attenuated virus vaccine discussed by us and others this morning.’22

By the time of the MRC’s Second Informal Conference on Measles Prophylaxis, held on 6 March 1962, the outlook concerning the safety of Burroughs Wellcome’s measles vaccines was little brighter.23 On reviewing the International Conference on Measles

Immunization for the MRC, Frank Perkins highlighted the reports of ‘severe and untoward reactions’ after using Wellcome Research Laboratories 3C strain.24 Although it was reported the firm ‘were working on the development of a further attenuated strain’, this would not be ready for testing in the immediate future.25 Given that members were also concerned by the significant number of reactions still caused by US strains, ‘It was agreed that the first essential was to develop a further attenuated vaccine’.26 As a result, attendees ‘agreed that, for the time being, no purpose would be served by holding a further meeting’.27

2.3 Experimenting on ‘mentally deficient children’: Britain’s first measles vaccine trial

Although the MRC was not prepared to organise its own measles vaccine trials on safety grounds, there was little attempt to stop commercial trials from taking place in

22 Ibid., 392. 23 TNA, FD 7/1345, ‘Second Informal Conference on Measles Prophylaxis’, 6 March 1961. 24 TNA, FD 7/1345, Frank Perkins, ‘Note on Measles Conference held at the National Institute of Health, Washington, November 7th-9th, 1961’, 1962. 25 TNA, FD 7/1345, ‘Second Informal Conference on Measles Prophylaxis’, 6 March 1961. 26 Ibid. 27 Ibid.

Britain. In the early 1960s measles vaccines trials were carried out in a variety of spaces both in Britain and overseas. It is difficult to examine what regulatory principles and procedures these trials had to go through. Archives either no longer exist or are not accessible to the general public. Published reports tend not to discuss the approval process, or methods of informed consent. However, one trial in Britain can be explored in detail. Conducted on 76 ‘mentally deficient children’ in 1961, Britain’s ‘first’ measles vaccine trial would become the subject of several government inquires.28 As a result, it not only provides some insight into the practice and culture of evaluating experimental risk, but also continues to chart the British state’s attempts to manage medical controversy.

The decision to approve the organisation of Britain’s first measles vaccine trial was taken at a meeting of the Fountain and Carshalton Group Hospital Management

Committee’s Research Sub-Committee on 19 January 1961. The Sub-Committee was responsible for overseeing research conducted at several institutions run by the Hospital

Management Committee, including two institutions that housed children defined as

‘mentally deficient’, Fountain Hospital, Tooting, London, and Queen Mary’s Hospital,

Carshalton, Surrey.29 Members of the Committee included the Chair, Frank Goldby, a professor of anatomy at St Mary’s Hospital, London; three members of the Hospital

Management Committee, J. H. Deely, M. E. H. Laurie and Dr Neil O’Connor; four members of the consultant medical staff, Dr Brian Kirman, Dr Leslie Hilliard, Dr

Stewart and Dr Foley; and the eminent mathematician and geneticist Professor Lionel

Penrose.30

28 Anon., ‘Vaccination Against Measles’, British Medical Journal 2 (1961): 1274. 29 I. R. Aldous et al., ‘Vaccination Against Measles: Part III. Clinical Trial in British Children’, British Medical Journal 2 (1961): 1250–53. 30 TNA, MH 160/908, K. G. Perona-Wright, ‘Report on Publicity Arising from the Trial on Measles Vaccine’, 14 August 1967.

Although we have very little evidence concerning the detailed discussions that took place during the Sub-Committee’s meeting, evidence suggests the decision to approve

Britain’s first measles vaccine trial was strongly influenced by the particular experience and expertise of members. In an account of the trial, which followed nearly a year later, one member of the Research Sub-Committee, Dr Brian Kirman, emphasised the importance of two factors.31 Firstly, according to Kirman, members were persuaded by their experience of the ‘considerable mortality’ caused by measles during previous epidemics.32 ‘In one outbreak a few years ago,’ wrote Kirman, ‘it was necessary to resort to tracheotomy in several cases due to oedema of the larynx.’33 Given their experience of the devastating effects measles could have on children in their hospitals, members believed ‘that the trial would have the double advantage of providing further information about the immunising value of this vaccine, and at the same time, would serve to protect some of the population against measles.’34

However, although members of the Research Sub-Committee had experience in the treatment of measles, they were considerably less familiar with the science of infectious disease and vaccination. Given their inexperience, how did members come to conclusion that experimental measles vaccines were safe? According to Kirman’s report, members were largely influenced by an account written by one of vaccine’s manufactures, Dr T. M. Pollock.35 A research scientist at The Wellcome Foundation,

Pollock had worked with his colleague, Alan Goffe, on producing a British vaccine derived from Ender’s Edmonston strain. While the Wellcome Foundation had begun trials in Nigeria, they had yet to organise a trial in Britain. In order persuade members of

31 TNA, MH 154/134, Brian H. Kirman to Barrett, ‘Trial of Measles Vaccine’, 22 November 1961. 32 Ibid. 33 Ibid. 34 Ibid. 35 Ibid.

86 the Research Sub-Committee that they should organise Britain’s first clinical trial,

Pollock prepared a one page ‘Memorandum’ on the trial for the meeting.36 The account was a largely positive and benign representation of the current status of experimental vaccines. According to Pollock, ‘The results of … American investigations indicate measles vaccination is safe and produces a considerable degree of protection against measles.’37 While Pollock’s account did briefly touch on the subject of vaccine reactions, it provided readers with little information concerning the vaccine’s development, its laboratory safety tests, and the latest experience from trials conducted in Nigeria. In particular, it failed to mention that the experimental vaccines 3C and 4A had only been tested on ‘three adult volunteers’ prior to being tested on children.38 In conclusion,

Pollock suggested a controlled trial should be undertaken to test ‘(1) the antigenic potency of measles vaccine … and (2) the type and extent of the reaction encountered after vaccination.’39 Decided behind closed doors, the decision of the Fountain and

Carshalton Group Hospital Management Committee’s Research Sub-Committee to approve Britain’s first measles vaccine trial would soon be subjected to wider public and political scrutiny.

On 10 November 1961, the Daily Herald, along with several leading national newspapers reported that the ‘Abolition of measles is “within sight”’.40 The articles were referring to a new study published in the British Medical Journal (BMJ) described as the ‘first British trials of a measles vaccine’.41 Beginning in December 1960, the trials were conducted at

36 TNA, MH 154/134, T. M. Pollock, ‘Memorandum on Proposed Clinical Trial of Measles Vaccine’, 16 November 1960. 37 Ibid. 38 A. P. Goffe and G. D. Laurence, ‘Vaccination Against Measles: Part I. Preparation and Testing of Vaccines Consisting of Living Attenuated Virus’, British Medical Journal 2 (1961): 1246. 39 TNA, MH 154/134, T. M. Pollock, ‘Memorandum on Proposed Clinical Trial of Measles Vaccine’, 16 November 1960. 40 Nicholas Lloyd, ‘Victory over Measles “in Sight”’, Daily Herald, 10 November 1961. 41 Anon., ‘Vaccination Against Measles’, 1274.

87 two sites housing ‘mentally deficient children’, Fountain Hospital, Tooting, London, and Queen Mary’s Hospital, Carshalton, Surrey.42 Across the two sites a total of 76 children were randomly assigned to one of four different treatment groups: 56 to three vaccination groups and 20 to an untreated control group. The three vaccines tested, 3C,

4A and 8, were all adapted (largely through a process of ‘chick-tissue-culture passages’) from the Enders Edmonston strain in the laboratories of Burroughs Wellcome, and

Parke and Davis.43 While all three vaccines ‘produced an adequate antibody response and protective effect’, most children experienced some form of reaction.44 Thirty-seven out of the 56 children vaccinated suffered with high pyrexia, and 48 suffered from morbilliform rash. Cases of tonsillitis, vomiting, bronchitis, and bronchopneumonia were also recorded. One child died in the course of the study, 8 days after he had been vaccinated. His death, due to contracting pneumonia, was reported as ‘coincidental’.45

In concluding, the authors pointed towards some positive results, but suggested ‘that further attenuation of the measles virus is desirable’.46

Initial newspaper reports of the study framed the trial as a scientific and medical success. The Daily Telegraph headline read: ‘British Measles Vaccine has “Encouraging”

Trial’.47 The Daily Mail went with: Measles Vaccine “Success” in Trials’.48 Although most articles acknowledged the adverse reactions associated with these early vaccines, they were generally celebratory in tone. Downplaying the severity of reactions experienced by the children, the Daily Express stated: ‘A British anti-measles vaccine has passed its first trials on children with flying colours… Results indicate that the vaccine

42 Aldous et al., ‘Vaccination against Measles’, 1250. 43 Goffe and Laurence, ‘Vaccination against Measles’, 1244. 44 Aldous et al., ‘Vaccination against Measles’, 1252. 45 Ibid., 1251. 46 Ibid., 1252. 47 John Prince, ‘British Measles Vaccine Has “Encouraging” Trial’, The Telegraph, 24 August 1961, 13. 48 Anon., ‘Measles Vaccine “Success” in Trials’, Daily Mail, 10 November 1961, 9.

88 can provide life-long protection against the complaint for the first time.’49 Equally enthusiastic was an opinion piece written in the same newspaper. ‘Having struck a magnificent defensive blow at polio,’ wrote the commentator, ‘science attacks measles, one of the serious ailments of child-hood, still responsible for many deaths… What a wonderful thing it is that, in its war on disease, medicine has not neglected one of the troublesome afflictions of young Children.’50 Articles such as these framed the trial as a scientific, medical and human success. Most reports paid little attention to where the trial took place, who the ‘subjects’ were, and how much risk children were exposed to.

However, not everybody saw these trials as a great success. On 19 November 1961, The

People published an article under the heading ‘Measles Test on Children “Unfair”’.51 The article reported that the Tory MP Robert Mathew was ‘demanding an inquiry into a

SUCCESSFUL test of an anti-measles vaccine – because it was carried out on mentally defective children in Hospital.’52 ‘“It seems wrong,’” Mathew was quoted as stating,

‘“Normal people can say “No.” These unfortunates are not even capable of volunteering.”’53 The next day Mathew raised the issue in a parliamentary question to the then Minister of Health, Enoch Powell. Concerned that this trial may have reflected a wider culture of uncontrolled child experimentation in Britain, Mathew asked two questions:

(1) how many controlled clinical experiments in the interests of medical research have been carried out on mentally subnormal children in the last 12 months; and (2) what experiments with the new measles vaccine, tested in this country on severely mentally subnormal children, have been carried out; and if any of

49 Anon., ‘Measles Vaccine Passes Children Test’, Daily Express, 21 October 1961, 9. 50 Anon., ‘Measles Attacked’, Daily Express, 21 October 1961, 8. 51 Anon., ‘Measles Test on Children “Unfair”’, The People, 19 November 1961. 52 Ibid. 53 Ibid.

the vaccinated subjects suffered ill effects, other than the contraction of measles.54

Despite the scope and significance of Mathew’s questions, the Ministry of Health’s first inquiry proved to be a short and partial one. Based almost solely on a letter sent from

Dr Brian Kirman, a psychiatrist who had worked on the study at Fountain Hospital, the investigation was driven by the researcher’s perspective.55 Over the course of the letter

Kirman made a series of arguments for why the trial was justified. Crucially, in response to Mathew’s question concerning the use of ‘mentally subnormal children’, Kirman argued that it was ‘particularly desirable’ to carry out a clinical trial in a long stay institution, not only because this would give practitioners the time, access and resources to observe and care for the children under study, but also because previous experience with measles in the hospital had shown that ‘retarded children are particularly likely to suffer severe effects’.56 In contrast to Mathew’s representation of the trial as ‘unfair’,

Kirman represented the trial as a moral act, designed to test a potentially lifesaving technology on a vulnerable population.57

On 4 December 1961, a House of Commons sitting was held to debate the subject of medical research on children. In responding to Mathew’s questions in Parliament,

Powell’s answers, carefully crafted by his civil servants over the previous two weeks, drew almost entirely on Kirman’s representation of the trial. Deferring to medical authority, Powell’s statement presented a benign story of the trial:

54 House of Commons Debates, ‘Medical Research (Children)’, 4 December 1961, Volume 650, Columns 925-926. 55 TNA, MH 154/134, Brian H. Kirman to Barrett, ‘Trial of Measles Vaccine’, 22 November 1961. 56 Ibid. 57 Anon., ‘Measles Test on Children “Unfair”’.

Mr. Powell: A measles vaccine was given to a group of patients at the Fountain Hospital and Queen Mary's Hospital, Carshalton, before an anticipated outbreak of measles. There were no ill effects apart from the reactions of modified measles. Otherwise, I am not aware of any controlled clinical experiments apart from those connected with research into subnormality.

Mr. Mathew: Will my right hon. Friend not agree that if these experiments are to be carried out at all, and in a number of cases there have been very undesirable side effects such as high fever, preferably they should be carried out on volunteers rather than on mentally defective children?

Mr. Powell: The parents had been asked and gave consent in writing. Subnormal children are particularly liable to measles and, therefore, this test was particularly relevant to subnormal children.

Captain Elliot: Is my right hon. Friend aware that I have discussed this matter with the senior medical officer of this hospital and he has assured me that there were no bad side effects and the only thing suffered was a slight rise in temperature and a very slight measles rash?

Mr. Powell: That coincides with my information.58

Largely evading the underlying scientific and moral questions which had inspired

Mathew’s interest, Powell did not engage with issues around informed consent, the risks of conducting clinical research on institutionalised children, or the safety of the vaccines being tested. Instead, like Kirman, he presented interested Members of Parliament with a largely positive depiction of the trial. There is no evidence that Ministry of Health officials spoke to the MRC during their investigation. Had they done so, they may have come to a different conclusion concerning the morality of the trial. As I described in section 2.2, as Britain’s leading medical research organisation, the approach of the MRC

58 House of Commons Debates, ‘Medical Research (Children)’, 4 December 1961, Volume 650, Column 926.

91 to regulating measles vaccine trials was quite different to the approach taken by the

Fountain and Carshalton Group Hospital Management Committee’s Research Sub-

Committee. With access to vast and diverse networks of scientific expertise, the MRC gathered intelligence from a variety of scientific spaces, places and experiences. The result was a very different interpretation concerning the safety of early live measles vaccines and the morality of early vaccine trials.

2.4 ‘An impracticable material’: Killed measles vaccine not on trial

While the MRC was not prepared to organise a clinical trial using live measles vaccines, there was an alternative option. Increasingly frustrated by the MRC’s reluctance to begin clinical trials, on 17 April 1962, the Ministry of Health’s Chief Medical Officer (CMO),

George Godber, wrote to the MRC’s Secretary, Sir Harold Himsworth.59 Encouraged by several reports recently published in the American Journal of Diseases of Childhood, which documented the positive effects of immunising children with killed measles vaccines,

Godber suggested the time was right for the MRC to begin their own clinical trial.60

While medical officers at the MRC suspected the ‘origins’ of Godber’s request may have been ‘political’, they were not against the idea of organising a clinical trial.61 In contrast to medical researchers who had attended the MRC’s first and second Informal

Conference on Measles Prophylaxis, medical officers at the MRC were in little doubt that some form of measles vaccine trial was desirable sooner rather than later. In responding to Godber’s request, MRC Medical Officer E. M. B. Clements noted: ‘The

59 TNA, FD 23/1349, George Godber to Harold Himsworth, 17 April 1962. 60 ‘International Conference on Measles Immunization’, American Journal of Diseases of Childhood 103 (1962): 211–531. 61 TNA, FD 23/1349, E. M. B. Clements, File Note, 7 May 1962.

92 laying on of a formal trial pre-judges the issue as to whether vaccine is worthwhile and about which the Conference felt there was insufficient evidence to judge… My own assessment would be to think that work on [a] vaccine should certainly not be held up pending an answer to the clinical investigations which are likely to take a considerable time.’62 Similarly hopeful was the MRC’s Principal Medical Officer, B. S. Lush. In a note written for Himsworth, Lush argued that although ‘Our Measles Vaccine Conferences agreed that there did not yet seem to be any vaccine worthy of trial…, we must recognise that delay means missing an epidemic year and the case for a measles vaccine is perhaps as strong in this country as in the Tropics, but for different reasons.’63

According to Lush, while ‘In the Tropics one wants to prevent a killing disease. In this country one wants to prevent a major dislocation of schooling, etc. every two years, with an associated heavy burden on the health services. Thus I have little doubt but that we should initiate a trial as soon as a safe, and potentially effective, vaccine becomes available.’64

However, whether the MRC should test a killed measles vaccine was more debatable. At the MRC’s Second Informal Conference, attendees argued that a killed vaccine ‘was unlikely to confer permanent immunity’.65 Research conducted in the US had shown that a variety of killed vaccines provoked a significant antibody response in children.

However, there were doubts over how long this immunity would last and its potential loss was of major concern to medical researchers. As measles was considered a more serious illness in adults, any vaccine that risked changing the demographics of the disease away from a disease of childhood towards a disease of adulthood was seen as almost too great a risk. According to Clements, ‘Even assuming that the antigenicity of

62 Ibid. 63 TNA, FD 23/1349, B. S. Lush, File Note, ‘Measles Vaccine’, 9 May 1962. 64 Ibid. 65 TNA, FD 7/1345, ‘Second Informal Conference on Measles Prophylaxis’, 6 March 1961.

93 a killed vaccine has been improved, the main objections would still seem to stand namely that immunity is unlikely to be permanent and this may have the effect of making measles into a disease of adulthood which generally tends to take a more serious form.’66 As a result, medical researchers attending the MRC’s Second Informal

Conference concluded that ‘for this reason an effective attenuated live vaccine would seem to have an advantage.’67

Important as immunological factors were, administrative and pragmatic concerns also informed the MRC’s reluctance to test killed vaccines. According to research undertaken in the US, three doses of killed vaccine were required in order to produce a significant immune response in a child. An administrative issue, because it required

Medical Officers of Health, medical practitioners and parents to organise three separate visits to a clinic or surgery, and a public relations issue, because it required persuading parents to allow their children to undergo three potentially painful injections. Indeed, even the preferred option, of administering a dose of killed vaccine prior to a dose of attenuated vaccine in order to reduce the frequency and severity of reactions caused by the latter, was deemed by Clements ‘to be so complicated that … Medical Officers of

Health are unlikely to regard such a scheme favourably.’68

Nevertheless, pressure from the Ministry of Health to begin a clinical trial continued.

On 11 May 1962, Clements and Lush met with Himsworth to discuss a conversation he had recently had with George Godber. According to a note of the conversation,

‘Godber anticipated that pressure for approval by the Ministry of the use of killed measles vaccine might be almost impossible to resist, and he … accordingly hoped that

66 TNA, FD 23/1349, E. M. B. Clements, File Note, 7 May 1962. 67 TNA, FD 7/1345, ‘Second Informal Conference on Measles Prophylaxis’, 6 March 1961. 68 TNA, FD 23/1349, E. M. B. Clements, File Note, 7 May 1962.

94 the Council would be prepared to ensure that the maximum information was obtained therefrom.’69 In response, Himsworth proposed a number of actions. First, Clements was asked to investigate the supply situation. If this proved favourable, he and Lush were then to explain to the Chairman of the MRC’s first and second Informal

Conference on Measles Prophylaxis why ‘an M.R.C. investigation of killed measles vaccine was inevitable despite the recommendations of the conferences he had chaired.’70 Finally, they were to establish a new ‘Working Party on measles vaccine trials’, and invite Professor David Evans to serve as its Chairman.71

On speaking with Dr. Conybeare from the Ministry of Health, it materialised that the supply situation was not as dramatic as Godber had inferred. According to an MRC file note of the meeting, Conybeare believed ‘there was no British material available or likely to be so in the foreseeable future.’72 Furthermore, although Pfizer were currently undertaking clinical trials of a killed vaccine in the United States, there were considerable doubts as to whether this vaccine would receive National Institute of

Health (NIH) approval in the near future, and thus any material made available to

Britain was likely to be of an experimental nature. According to the file note, ‘This suggests that the grounds for anticipating a surfeit of measles vaccine in the coming winter and pressure to use it is based on tenuous grounds, indeed any work such as is proposed would be of direct assistance to American manufacturers … Subject to advice by Professor Evans it would seem that a formal trial is premature.’73

69 TNA, FD 23/1349, File Note, ‘Measles Vaccine and Related Matters’, 14 May 1962. 70 Ibid. 71 Ibid. 72 TNA, FD 23/1349, File Note, 21 May 1962. 73 Ibid.

A few days later, the subject of a killed measles vaccine trial was again discussed in the

MRC, this time at an informal meeting held between David Evans, Frank Perkins and

Wilson Smith. During the meeting, arguments were made for and against a clinical trial.

On one side, members argued that ‘it would be useful to have information about the behaviour of this vaccine in this country.’74 On the other side, there were not only doubts over the quality of the vaccine, but perhaps more importantly, the message that a killed measles vaccine trial might send to the British public. According to a note of the meeting,

The use of a killed vaccine might be interpreted as being the recommended procedure and to indicate definite policy, bearing in mind the difficulty there had been to switch to the oral vaccine with poliomyelitis. If the attenuated vaccine was the prophylactic of choice, which indeed seemed to be the case, it would be unfortunate to complicate the situation by introducing temporarily, and on a limited scale, a different vaccine.75

Given ‘that the arguments were so evenly matched’, members decided it was ‘desirable to put the question to a slightly larger and more representative group.’76

On the 27 June 1962, a ‘Meeting to Consider a Possible Trial of Measles Vaccine’ was held at the MRC.77 Present at the Meeting were Dr Richard Doll, Dr Frank Perkins,

Professor David Evans, Professor A. A. Moncrieff, Dr J. Stevenson Logan, Dr N. R.

Grist, Dr D. Thomson, Sir Graham Wilson and the Secretary Professor Wilson Smith.

Also in attendance from the MRC’s head office, were Joan Faulkner, E. M. B. Clements and N. S. Jones. Similar to previous discussions, for both scientific and administrative

74 TNA, FD 23/1349, File Note, May 1962. 75 Ibid. 76 Ibid. 77 TNA, FD 23/1349, ‘Meeting to Consider a Possible Trial of Measles Vaccine’, 27 June 1962.

96 reasons, attendees were against the testing of a killed measles vaccine. Attendees felt that the addition of three injections to an ‘already long schedule’ would be ‘undesirable’ for parents and children, and were concerned that the short ‘duration of immunity’ associated with the inactivated vaccines ‘might actually be disadvantageous by postponing an attack of measles until an age when its consequences might be much more serious.’78 As the general consensus was that a live attenuated strain would eventually be the ‘prophylactic of choice’, attendees argued that a short term policy of using an inactivated strain ‘might cause confusion in the public mind’.79 As a result, members concluded that ‘a trial of inactivated vaccine was not recommended.’80 A decision, which as Clements made clear in his summary of the meeting, was not solely down to immunological considerations, ‘but mainly because it was likely to be an impracticable material and unacceptable to Public Health practice.’81 Although Godber remained frustrated by the MRC’s position, he had little choice but to accept the meeting’s decision. As a killed measles vaccine had now been defined as an unacceptable option, attention once again turned towards the testing of a live vaccine.

2.5 The trial that never began

Although the MRC’s ‘Meeting to Consider a Possible Trial of Measles Vaccine’ had been set up to examine the possibility of testing a killed measles vaccine, during the meeting members also discussed the latest research concerning the ‘further attenuated’ live measles vaccines.82 In particular, they discussed the latest clinical research concerning a live measles vaccine produced by the pharmaceutical company Pitman-

78 Ibid. 79 Ibid. 80 Ibid. 81 TNA, FD 23/1349, E. M. B. Clements, File Note, 29 June 1962. 82 TNA, FD 23/1349, ‘Meeting to Consider a Possible Trial of Measles Vaccine’, 27 June 1962.

Moore. Known as the Schwarz strain, the architect of the vaccine was Anton Schwarz, a

German scientist who had previously worked with the prominent medical researcher

Albert Sabin. Beginning with Enders Edmonston B strain, Schwarz had passaged the virus at a lower temperature than had previously been done. Although the results of a clinical trial involving 1,400 children had yet to be published, members were assured by

Perkins that the reports were ‘favourable’.83 As it was believed there may be some supplies of this material available for a trial, members concluded that ‘if it proved practicable, a trial of live attenuated vaccine … should be organised immediately’.84

Although, the MRC’s Secretary Sir Harold Himsworth was ‘a little bothered about undertaking a trial with an American-produced vaccine … when Wellcome are trying to produce a similar vaccine in this country’, he was happy to support the study.85 After informing the Ministry of Health of the MRC’s decision, the Ministry’s representative at the meeting, Dr D. Thomson, confirmed the Ministry’s approval.

However, on reviewing the current status of Pittman-Moore’s Schwarz strain, Clements discovered that the supply situation was not as positive as had originally been understood. According to Perkins and Evans, a ‘production batch’ of the vaccine had recently been produced, but the results of its laboratory safety testing were ‘not expected to be available until early September’.86 While there was the possibility of using the company’s initial research batch, this was seen as both morally and politically problematic. ‘Evans’ personal assessment’, wrote Clements, ‘is that it would be unwise to use the early research batch since if anything went wrong it would be impossible to escape from the criticism that it was not up to the specification of the N.I.H.’87 Medical

83 Ibid. 84 Ibid. 85 TNA, FD 23/1349, Harold Himsworth to Wilson Smith, 3 July 1962. 86 TNA, FD 23/1349, E. M. B. Clements, File Note, 16 July 1962. 87 Ibid.

98 officers and scientists at the MRC did explore the possibility of using Burroughs

Wellcome’s modified strains, however, the general view was that these vaccines were still at an ‘early stage’ of development.88 As it was believed ‘the urgency’ to organise a clinical trial had dissipated, the study was put on hold.89

Although a clinical trial was now in doubt, Clements still recommended the establishment of a measles vaccine trial committee. Clements believed this was important for political reasons. He argued:

‘(a) all members who attended the recent ad hoc meeting will wonder what is happening and why their recommendation has not been acted upon… (b) tactically it would be useful to have a committee all ready to conduct a trial as soon as satisfactory material was available since if we wait until material has passed the Safety Tests Committee it could then appear that its setting up followed public pressure (if it materialises).’90

Clements’s reflections reveal how the public and political context informed the thinking of MRC administrators. While public pressure would not determine MRC policy, it would influence their response. The mere possibility that public pressure may materialise was enough to keep MRC administrators and policy makers interested in the subject. Had it not been a concern, the subject of measles vaccination may have become institutionally less visible.

On 27 September 1962, the first meeting of the MRC’s newly formed Measles Vaccine

Trial Committee took place.91 Wilson Smith, the Professor of Bacteriology at University

88 Ibid. 89 Ibid. 90 Ibid. 91 TNA, FD 7/507, Measles Vaccine Trial Committee, 27 September 1962.

College Hospital Medical School was appointed as Chairman, and Frank Perkins was appointed as Secretary. The majority of members had been involved in previous discussions within the MRC and were taken from a variety of disciplinary backgrounds.

The Committee included experts in bacteriology, immunology, biological standards, child health, public health and clinical trials (see Table 7).

Table 7. Members of the Medical Research Council’s Measles Vaccine Trial Committee Committee Members Occupation Professor Wilson Smith (Chairman) Professor of Bacteriology, University College Hospital Medical School Professor D. G. Evans Professor of Bacteriology and Immunology, London School of Hygiene and Tropical Medicine Professor Wilfrid Gaisford Professor of Child Health and Paediatrics, and Director of the Department of Child Health, University of Manchester Dr J. Stevenson Logan Medical Officer of Health and Principal School Medical Officer, Southend-on-Sea Dr Christine Miller Tuberculosis Research Unit, Medical Research Council Laboratories Professor A. A. Moncrieff Nuffield Professor of Child Health, University of London Dr F. T. Perkins (Secretary) Biological Standards Control Laboratory, National Institute for Medical Research Dr I. Sutherland Statistical Research Unit, London School of Hygiene and Tropical Medicine Dr D. Thomson Deputy Chief Medical Officer, Ministry of Health Dr G. I. Watson Assistant Medical Officer for the South West Division of Surrey County Council Sir Graham Wilson Director of the Public Health Laboratories, Medical Research Council

Source: TNA, FD 7/506, ‘Committee on Measles Vaccine’, 1962.

During the meeting, members were asked to review a series of reports, which documented the results of clinical trials conducted in the US. The reports, a mixture of

100 published and unpublished research, along with personal accounts sent to the

Committee’s Secretary, Frank Perkins, gave a largely positive perspective on the development of measles vaccination.92 In particular, reports of studies using Anton

Schwarz’s further attenuated vaccine appeared to confirm previous perceptions that the vaccine was less reactive than previous strains. In a letter to Perkins, Saul Krugman, a leading American researcher based at New York University’s School of Medicine, stated that from his experience there is ‘no doubt that the Edmonston “B” strain of measles virus has been further attenuated by Dr. Schwarz.’93 Data sent by Krugman, along with

Schwarz himself, confirmed this perspective.

Despite these positive accounts, once again advisors to the MRC concluded that a clinical trial in Britain was ‘premature’.94 A decision which would establish MRC policy on the subject for the next year, it was based on several factors. After studying the reports of clinical trials carried out in the US, members remained concerned over the frequency and nature of clinical reactions still being reported. Members were particularly persuaded by a letter sent from Dr D. A. Henderson, a member of staff at the Communicable Disease Centre, Atlanta. In offering a uniquely candid portrayal of the safety of current live measles vaccines, Henderson directly challenged their positive representation in the published material. ‘From our evaluations and discussions of the measles vaccines’, wrote Henderson, ‘it has become all too apparent that there are several combinations of immunizing agents, none of which has proved wholly satisfactory. The live vaccine, used alone, induces fever and systematic symptoms of a far more alarming character than is discussed in the literature.’95 Members of the

Measles Vaccines Trial Committee agreed, and recommended that ‘further attenuation

92 Ibid. 93 TNA, FD 7/507, Saul Krugman to Frank Perkins, 6 August 1962. 94 TNA, FD 7/507, Measles Vaccine Trial Committee, 27 September 1962. 95 TNA, FD 7/507, D. A. Henderson to Frank Perkins, 8 August 1962.

101 of the virus was necessary before a vaccine would be available which could be accepted as completely safe.’96

While concerns over the safety and efficacy of current measles vaccines were influential, the uncertainty that surrounded the severity of the disease continued to figure strongly.

In contrast to the CMO George Godber’s view that measles was a serious illness in need of medical prevention, advisers to the MRC remained somewhat uncertain.

According to the minutes of the Committee’s meeting, members believed ‘Too little is known in this country about the reactions, especially brain involvement, after natural measles. If damage occurs only in a very small proportion of cases then the risk of febrile reaction following vaccination may outweigh the possibility of damage after the natural disease.’97 As I described in chapter 1, apart from the Royal College of General

Practitioner’s reports, information was based on either notification and mortality data, or personal experience. Until the Committee had a greater understanding of the burden of measles they were not prepared to endorse vaccination.

Following the meeting of the MRC’s Measles Vaccine Trial Committee the subject of measles vaccination disappeared for a time. Between September 1962 and April 1963, there was very little recorded discussion on the subject in the MRC or Ministry of

Health. Despite initial pressure from the Ministry of Health to organise a clinical trial, for now, the MRC’s Measles Vaccine Trial Committee’s position that no suitable vaccine existed, had become official policy. At a meeting of the Ministry of Health’s

Joint Committee on Vaccination and Immunisation, held on 8 March 1963, members agreed that a measles vaccine trial was premature. Yet, as I will examine below, behind

96 TNA, FD 7/507, Measles Vaccine Trial Committee, 27 September 1962. 97 Ibid.

102 the image of consensus created by official statements and sanitised minutes, there were rumblings of discontent from within the MRC. Increasingly concerned by the potential for public criticism some members decided to speak out. The emergence of these tensions reveals the extent to which the politics of the committee room was shaping judgements on experimental risk.

2.6 ‘An opinion of one member’: Politics and risk

On 18 April 1963, the Secretary of the MRC’s Measles Vaccine Trials Committee, Frank

Perkins, sent a letter to E. M. B. Clements.98 Based on his understanding of international developments, Perkins strongly believed in the value of measles vaccination and was unhappy with the Committee’s decision not to organise a measles vaccine trial. After receiving reports from the WHO and CDC of clinical trials carried out in ‘West Africa’, which demonstrated the ‘relative benign nature of the Schwarz strain’, Perkins felt the time was right to reveal his discontent.99 Reflecting a growing sense of frustration, Perkins wrote:

You may know how strongly I feel that there should be some measles trial going on in this country and at our last meeting of the MRC measles vaccine committee I expressed this opinion most forcibly… Two weeks ago the NIH licensed both an inactivated and live attenuated measles vaccine which requires a simultaneous inoculation of gamma globulin for use in America. Now that these prophylactics are on the market over there I feel that we will be under severe criticism because of our lack of activity in this country.100

98 TNA, FD 23/1353, Frank Perkins to E. M. B. Clements, 18 April 1963. 99 Ibid 100 Ibid.

103

Clements agreed and believed the decision of the MRC’s Measles Vaccine Trials

Committee not to organise a clinical trial reflected institutional politics rather than scientific reason. As Clements noted: ‘The Measles Committee has only met once and, as the minutes show, decided to do nothing and this decision was reached on perhaps emotional and non-scientific grounds so that I am wondering whether there is not a case for disbanding it and reconstituting it with a fresh membership.’101 Clements believed the Committee’s decision not to organise a measles vaccine trial resulted from the powerful position of its Chairman, Professor Wilson Smith. For some time Smith had been concerned about the potential hazards of measles vaccination. While not everybody in the Committee agreed with Smith’s view, his position as one of the country’s leading scientific figures made his perspective hard to challenge. Throughout his career, Smith had worked for some of Britain’s most prestigious scientific and medical institutions.102 Between 1919 and 1923, Smith studied medicine at the

University of Manchester. In 1927, after obtaining a Diploma in Bacteriology from the

University of Manchester, Smith began working at the National Institute for Medical

Research (NIMR) as a research assistant. In 1939, after 12 years of working at the

NIMR, Smith was appointed Professor of Bacteriology at the University of Sheffield and in 1946 he became the Chair of Bacteriology at University College Hospital Medical

School. Moreover, by 1960 he had become a Fellow of both the Royal Society and

Royal College of Physicians of London. According to his friend and fellow member of the MRC’s Measles Vaccine Trials Committee, David Evans, Smith ‘attracted the affection and admiration of many people, especially those young scientists who came under his direction, for he had great charm and was completely unselfish and

101 TNA, FD 23/1353, E. M. B. Clements, File Note, 22 April 1963. 102 David G. Evans, ‘Wilson Smith. 1897-1965’, Biographical Memoirs of Fellows of the Royal Society 12 (1966): 479–87.

104 generous.’103 This respect, along with an ‘intense conscientious outlook and fervent devotion to his work’, made Wilson a difficult figure to challenge.104 In an MRC file note looking back at the Committee’s original decision, Clements wrote, ‘I feel that events are rapidly catching up on its decision to hold its hand on the grounds that measles was not a pressing problem; a decision largely reflecting an opinion of one member and events may prove the virologists were unwise to acquiesce in this view’.105

According to Clements, Smith had been the architect behind the Committee’s decision not to begin a clinical trial. Given his hold over proceedings, what happened next becomes all the more remarkable.

2.7 Science, politics and the public: Changing perceptions of risk

In March and April 1963, several British newspapers reported the news that two US manufacturers had received a licence to market their measles vaccines. The pharmaceutical company Merck had been given a license to market their live attenuated vaccine, and Pfizer had been given a license to market their killed vaccine. Crucially, these developments in the US not only sparked a new debate on the subject of measles vaccination in Britain, but initiated a reimagining of the public amongst policy makers.

This reimagining was not inevitable, but followed a sequence of events which changed the way the public were perceived and represented by policy makers. Now imagined as an interested body, this perception of the public would prove a key factor in driving forward scientific change.

103 Ibid. 104 Ibid. 105 TNA, FD 23/1353(b), E. M. B. Clements, File Note, 22 April 1963.

105

Several weeks after newspapers first reported on developments in the US, British newspapers began to report the news that Britain was also close to licensing a measles vaccine. A number of newspapers reported that Pfizer, an American manufacturer with a British subsidiary, were applying for a license from the Medical Research Council to market their killed measles vaccine in Britain. Shaped by the manufacturer’s perspective, articles presented Pfizer’s new killed vaccine as a scientific and industrial success. In contrast to the MRC’s view that killed measles vaccines were unacceptable, reports, such as that published in the Guardian, presented readers with a positive narrative of scientific progress. Reviewed by Ministry of Health officials, the article described how

‘Britain’s first anti-measles vaccine should be available next winter – if it passes the

Medical Research Council’s safety tests. This was announced yesterday by the makers, the Pfizer Drug Company, which claims that the new “killed” type vaccine will give up to 90 per cent immunity.’106 These articles presented the introduction of Pfizer’s killed measles vaccine as almost inevitable.

Although this was not front page news, the story did spark the interest of one local MP, the Labour MP for Leicester North West, Sir Barnett Janner. Concerned that a potentially lifesaving medical intervention was not being made available to his constituents, Janner asked the Minister of Health, Conservative MP Enoch Powell, to

‘make a statement on the large-scale production, which has started in Great Britain, of a measles vaccine.’107 On 27 May 1963, at House of Commons debate on the subject of measles vaccination, Powell responded to Janner’s concerns:

Mr. Powell: I have just received an application for a licence to manufacture such a vaccine.

106 Anon., ‘New Vaccine to Fight Measles’, The Guardian, 11 April 1963. 107 House of Commons Debates, ‘Measles (Vaccine)’, 27 May 1963, Volume 678, Column 907.

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Sir B. Janner: As the Minister knows, there is an epidemic of measles, with over 200,000 cases this year. In the week ending 4th May, Leicester had 86 new cases, and there were 78 in the week ending 11th May. If this is an effective drug, will the right hon. Gentleman ensure that it is made readily usable and available to people?

Mr. Powell: This is a matter on which I am guided by the Joint Committee on Vaccination and Immunisation. The latest advice from that Committee is that it is not satisfied that measles vaccine should be recommended for general use at present.

Sir B. Janner: Is the Minister sufficiently interested to investigate the results of the use of this vaccine in the United States; and will he see from that that it is important we should use it here, if at all possible?

Mr. Powell: The latest information on these vaccines is taken into account by the expert committee which advises me.108

Prior to Janner’s intervention, the assumption amongst a number of officials and advisers at the MRC was that measles ‘would never become the subject of political pressure’.109 Accounts written by researchers and practitioners in Britain and the US repeatedly represented the public as ignorant of the dangers of measles, and apathetic towards the potential benefits of vaccination. For example, at the International

Conference on Measles Immunization, a conference attended by several members of the MRC’s Measles Vaccine Trial Committee, an American physician, Dr Edward Shaw, presented a paper on the ‘Future of Measles Vaccine in the U.S.A.’.110 During his paper,

Shaw represented parents as ignorant and criticised them for viewing measles as a trivial

108 House of Commons Debates, ‘Measles (Vaccine)’, 27 May 1963, Volume 678, Column 907. 109 TNA, FD 23/1347, E. M. B. Clements, File Note, 19 February 1959. 110 Edward B. Shaw, ‘International Conference on Measles Immunization: Future of Measles Vaccine in the U.S.A.’, American Journal of Diseases of Childhood 103 (1962): 528–31.

107 disease. ‘Unfortunately, parents seem to regard measles with indifference and almost amusement’, described Shaw.111 ‘Occasionally a mother will call me and say, “I think

Johnny has the measles,” and she laughs, as though it were funny. This exasperates me a little bit. I want to say, “How stupid can you be? Do you have any idea how serious the disease is that you are talking about?”’112 Crucially, this image of the public not only helped foster a culture of scientific and political apathy around the disease, but led some advisers to speculate whether a clinical trial would even be possible in Britain.

With news of positive results from British and American trials gradually making their way into national newspapers, and rumours circulating that Pfizer were close to obtaining a license to market their killed vaccine in Britain, officials at the Ministry of

Health began to reimagine the political context. In response to questions over the

Ministry of Health’s conduct, on 21 May 1963, George Godber sent another letter to the Secretary of the MRC, Sir Harold Himsworth. While Godber’s position was largely informed by his view that measles was a serious disease, as his letter to Himsworth suggests, the political context was becoming increasingly important. Growing increasingly frustrated by the MRC’s ‘failure’ to begin clinical trials, Godber wrote:

We have run into a certain amount of comment here on our failure to take part in any trial of measles vaccine during our current epidemic. This, I think, we both expected, but it was inevitable after the Committee had advised that there was no vaccine suitable for trial… I know that the Committee was influenced to a considerable extent by the low death rate from measles, but this is a matter which I think would have to be considered by one of the Sub-Committees of our own Committee on Immunisation, and in view of the very large amount of

111 Ibid., 528. 112 Ibid.

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morbidity from measles I think they would certainly recommend that a vaccine should be used if a safe one can be found.113

Sentiments such as these were also shared by officials at the MRC. In an attempt to reopen the debate internally, Clements wrote to the Chairman of the MRC’s Measles

Vaccines Trials Committee, Wilson Smith.114 In his attempt to persuade Smith of the necessity of organising a clinical trial, Clements highlighted the changing scientific and political picture. In particular, he emphasised the imminent licensing of measles vaccines in the United States, the latest information concerning Glaxo’s newly manufactured Schwarz strain, and most importantly, the shifting public and political context. ‘As I expect you will know,’ wrote Clements, ‘the inquiries about the Pfizer killed measles vaccine have recently been putting the office through its paces. The inquiries have left no doubt about the public interest in measles prophylaxis.’115 Given these developments, Clements believed the MRC’s position was becoming increasingly untenable:

I have an uneasy feeling that the pace of these developments may be placing the Council in an exposed position if we are unable to express an opinion on the technical characters and biological behaviour of this vaccine in this country. Whether the vaccine is used is the responsibility of the Ministry and depending on the balance of arguments of which you are very well aware. At the meeting of the Measles Vaccine Committee I feel that perhaps undue weight was placed on the argument that measles was not a pressing problem and the doubts which were expressed about the usefulness of a vaccine in practice. I have re-read the minutes and referred to my private notes of the meeting and wonder whether the situation has not changed sufficiently to justify a review.116

113 TNA, FD 23/1353, George Godber to Harold Himsworth, 21 May 1963. 114 TNA, FD 23/1353, E. M. B. Clements to Wilson Smith, 15 May 1963. 115 Ibid. 116 Ibid.

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Smith, however, remained unconvinced. According to Clements, he still believed that reactions associated with the new Schwarz vaccine would be unacceptable to the British public, and ‘was not prepared to accept that undue weight had been placed on the clinical consideration that measles was a trivial disease in this country’.117 According to

Clements, Smith believed that a trial should be organised when an ‘English vaccine’ was ready and the MRC ‘should resist all pressures to proceed.’118

Although Smith remained concerned over the safety of current live attenuated measles vaccines, his hold over proceedings was weakening. A combination of technological progress, new evidence soon to be released by the PHLS concerning the morbidity of measles and a reimagining of public interest in the subject were all shifting the scientific and political landscape. To add to these, there was now structural change taking place within the Ministry of Health and the MRC. On 27 June 1963, George Godber again wrote to the MRC’s Secretary Sir Harold Himsworth. This time the letter was to inform

Himsworth of the Joint Committee on Vaccination and Immunisation’s (JCVI) decision to establish a Measles Vaccination Sub-Committee. ‘The purpose of all this’, wrote

Godber, ‘is to reach a conclusion if we can, on the desirability of some trial within the next fifteen months provided that your people are satisfied about vaccines that will be available in that time… I am particularly concerned that we should not be caught out because we are not ready, and that does mean action by both of us before the end of this year.’119

Whether intentional or not, the Ministry of Health’s administrative change would ultimately lead to a significant redistribution of power. On 1 August 1963, the first

117 TNA, FD 23/1353, E. M. B. Clements, File Note, 28 May 1963. 118 Ibid. 119 TNA, FD 7/1270, George Godber to Harold Himsworth, 27 June 1963.

110 meeting of the JCVI’s newly constituted Measles Vaccination Sub-Committee took place.120 While members were appointed from a variety of scientific, clinical and public health backgrounds, in contrast to the MRC’s Measles Vaccine Trials Committee’s emphasis on basic scientific knowledge, there was a greater emphasis placed on public health and paediatric experience (see Table 8). Crucially, members included three of the leading advocates of vaccination, Dr Frank Perkins, Dr G. I. Watson and Sir Graham

Wilson. Importantly, the Chairman of the MRC’s Measles Vaccine Trials Committee,

Professor Wilson Smith, was not appointed. The new Chairman, Sir Wilfrid Sheldon, was not a renowned laboratory scientist from the MRC, but an experienced

Paediatrician from London; a practitioner who will have undoubtedly experienced the medical and social unrest caused by an epidemic of measles.

The meeting began with the Sub-Committee’s new Chairman, Sir Wilfrid Sheldon, reading out the Sub-Committee’s terms of reference. Although established to ‘consider the medical aspects of measles vaccination and to report to the Joint Committee on

Vaccination and Immunisation’, the first meeting of the JCVI’s Measles Vaccination

Sub-Committee focussed on one question: should the MRC be asked to organise a clinical trial?121 Perhaps given the Sub-Committee’s greater emphasis on public health and clinical experience, rather than focus on clinical trial reports, members focussed their attention on the report produced by the PHLS into ‘The frequency of complications of measles’ (see Chapter 1).122After reading the report, members were struck by the number of complications arising from a measles epidemic, particularly the incidence of otitis media, pneumonia and severe bronchitis. Figures presented from the

120 TNA, FD 7/1270, Joint Committee on Vaccination and Immunisation Measles Vaccination Sub-Committee, ‘Minutes of Meeting held on Thursday, 1st August, 1963’, 1 August 1963. 121 Ibid. 122 D. L. Miller, ‘Frequency of Complications of Measles, 1963: Report on a National Inquiry by the Public Health Laboratory Service in Collaboration with the Society of Medical Officers of Health’, British Medical Journal 2 (1964): 75–78.

111 study left members in little doubt that a safe and effective vaccine against measles would be of significant benefit to British society. After discussing the latest research concerning live and killed measles vaccines, the Sub-Committee ‘agreed that in light of recent knowledge the Joint Committee on Vaccination and Immunisation should be asked to organise trials of measles vaccine as soon as possible’; a decision, which was endorsed by the JCVI at a Committee meeting held on 11 October 1963.123

Table 8. Members of the Joint Committee on Vaccination and Immunisation’s Measles Vaccination Sub-Committee Sub-Committee Member Occupation Sir Wilfrid Sheldon (Chairman) Paediatrician, London Professor T. Anderson Professor of Infectious Diseases, University of Glasgow Dr G. O. Barber General Medical Practitioner, Essex Professor D.G. Evans Professor of Bacteriology and Immunology, London School of Hygiene and Tropical Medicine Professor Wilfrid Gaisford Director, Department of Child Health, University of Manchester Professor C. H. Stuart-Harris Professor of Medicine, University of Sheffield Professor J. Knowelden Professor of Preventative Medicine and Public Health, University of Sheffield Dr K. McCarthy Department of Bacteriology, The University of Liverpool Dr F. T. Perkins Director, Division of Immunological Products Control, Medical Research Council Laboratory Dr E. Neil Reid County Medical Officer of Health, Stirling Dr G. I. Watson General Medical Practitioner, Surrey Sir Graham Wilson Director, Public Health Laboratory Service Professor R. C. Wofinden Medical Officer of Health, City of Bristol

Source: TNA, MH 154/63, Joint Committee on Vaccination and Immunisation Measles Vaccination Sub-Committee, 16 July 1963.

123 TNA, FD 7/1270, Joint Committee on Vaccination and Immunisation Measles Vaccination Sub-Committee, ‘Minutes of Meeting held on Thursday, 1st August, 1963’, 1 August 1963.

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In reporting the outcomes of the Sub-Committee’s meeting to MRC officials, the

Council’s representative at the meeting, Clements, revealed just how crucial the PHLS study had been in transforming official attitudes towards measles vaccination. Indeed, according to Clements, the Sub-Committee’s decision had been taken in spite of the belief amongst some members ‘that the reactions to Schwarz strain are no less now than they were last year when the conclusion was that it was “too hot” for this country’. 124

On 15 October 1963, the JCVI’s Measles Vaccination Sub-Committee’s recommendations were discussed at the first meeting of the MRC’s newly reconstituted

Measles Vaccines Committee.125 The meeting began by outlining the reasons behind the

Committee’s original decision not to organise a clinical trial in Britain, before turning to an examination of the new information. Importantly, it was Graham Wilson who presented the results of the PHLS study to members. Wilson, one of several individuals who had initially raised doubts about the value of measles vaccination had seemingly completed his conversion. The minutes recorded how ‘Sir Graham felt that the sequelae were more frequent and more serious than expected and a trial was amply justified.’126

Members agreed, and after a ‘lengthy discussion … came to a unanimous decision that, in light of the fuller information obtained since its last meeting, an early trial of measles vaccines in this country had become desirable’.127

Although the MRC’s change of position was justified on scientific and public health grounds, also influential in the decision-making process was a reimagining of the political context. Prior to the licensing of measles vaccines in the US, the subject of measles vaccination had almost disappeared from Ministry of Health and MRC

124 TNA, FD 23/1354, E. M. B. Clements, File Note, 7 August 1963. 125 TNA, FD 7/1208, MVC/16, Measles Vaccines Committee, 15 October 1963. 126 Ibid. 127 Ibid.

113 discussions. While not entirely forgotten, it was only after newspaper reports of progress in the US that the subject once again gained the attention of policy makers in

Britain. Inquiries made by several interested parties provoked anxiety amongst Ministry of Health and MRC officials, ultimately leading to a reimagining of the public mood.

The public were now represented as interested in the subject of measles vaccination, creating a new political context in the minds of policy makers, and altering their priorities. It was the fear of public criticism, as much as new scientific information, which ultimately led to the MRC’s change in policy.

At the same time, discussions held during the first meeting of the MRC’s Measles

Vaccination Sub-Committee, revealed just how subjective this understanding of the public’s mood was. According to the minutes, G. I. Watson ‘believed there would be a public welcome for measles vaccination and he advocated immunising all children who had not had the disease, to attempt to eradicate it.’128 Other members, however, disagreed with Watson’s representation of the public. In contrast to his positive portrayal, it was recorded that some members ‘felt that a vaccine that produced reactions would not be accepted’ by the public.129 Although discussed, represented and appropriated, the public were never listened to. This lack of knowledge or understanding of the public mood would become all the more apparent as the MRC organised their first measles vaccine trial.

128 Ibid. 129 Ibid.

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2.8 The trial

Beginning in January 1964, the MRC’s Measles Vaccines Committee’s trial was designed to test the safety and short term efficacy of a variety of vaccine schedules in children largely between the ages of ten months and eighteen months. During the trial, each child was assigned to one of four different treatment groups or an unvaccinated control group. Children assigned to a treatment group were administered with one of the following vaccine schedules: (A) a single dose of Burroughs Wellcome’s Goffe MV 20 live vaccine; (B) a single dose of Glaxo Laboratories’ Schwarz live vaccine; (KA) a single dose of Pfizer’s killed vaccine, followed four to six weeks later by a single dose of

Burroughs Wellcome’s Goffe MV 20 live vaccine; (KB) a single dose of Pfizer’s killed vaccine, followed four to six weeks later by a single dose of Glaxo Laboratories’

Schwarz Live vaccine. In order to determine the serological effects of each vaccine schedule, a blood sample was taken from each child before vaccination, and then four to six weeks after vaccination. Using a prepared card, parents were instructed to record their child’s temperature each evening for a period of fourteen days after their final dose, and note any clinical symptoms their child experienced.130

Ending in March 1964, the MRC’s Measles Vaccines Committee’s trial turned out to be only a partial success. Initially designed to recruit approximately 1000 children, for several reasons organisers only managed to recruit 350.131 The central issue was the support of GPs. According to Clements, after reading ‘the details’ of the trial,

130 Medical Research Council Measles Vaccines Committee, ‘Vaccination Against Measles: A Study of Clinical Reactions and Serological Responses of Young Children’, British Medical Journal 1 (1965): 817–23. 131 Ibid.

115 approximately two thirds of the original 197 interested practitioners dropped out.132 As the trial began, more general practitioners followed. Work pressures, recruitment concerns, and local outbreaks of measles were all cited as reasons.133 By the end of the trial, a total of 38 practitioners had recruited just 242 children. To compensate for this small population size organisers decided to recruit children from day nurseries.134 With the co-operation of London County Council’s Chief Medical Officer, a total of 20 nurseries took part, recruiting 108 additional children. However, due to a number of exclusions during the trial, in the end the MRC only had valid data on 300 children.

On 23 June 1964, the MRC’s report into the ‘Serological responses and clinical reactions of young children to measles virus vaccines’ was presented to members at a meeting of the MRC’s Measles Vaccines Committee.135 Although the report concluded that the four schedules tested ‘were acceptable’, there remained a number of concerns and unanswered questions.136 While each vaccine schedule had provoked a ‘satisfactory’ antibody response, they had also produced a number of clinical reactions.137 Out of a total of approximately 300 children randomised, a large number of children suffered from febrile reactions, malaise, rashes and upper respiratory complications. Reactions were particularly prevalent in the two groups given live measles vaccine alone. Given that the trial only examined a small population of children between the ages of ten and eighteen months and only examined these children for a short period of time, the

132 TNA, FD 23/1354, E. M. B. Clements, 16 March 1964. 133 TNA, FD 23/1354, Christine Miller, ‘Measles Vaccines Study 1963-64: Progress Report’, 1964. 134 Ibid. 135 TNA, FD 7/1209, Measles Vaccines Committee, ‘Serological Responses and Clinical Reactions of Young Children to Measles Virus Vaccines’, 1964. 136 Medical Research Council Measles Vaccines Committee, ‘Vaccination Against Measles’, 822. 137 Ibid.

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Committee recommended that further trials should take place before a national campaign was endorsed.138

The Ministry of Health shared the MRC’s position. On 13 July 1964, the JCVI’s Measles

Vaccination Sub-Committee met to discuss the future of Britain’s measles vaccination policy.139 After reviewing the report of the MRC’s trial, members found that all four schedules were clinically ‘acceptable’, however, they agreed with members of the MRC’s

Measles Vaccines Committee that the trial itself suffered from several limitations.140

Members pointed out that only children between the ages of ten and eighteen months were included in the trial, and that it did not measure the protective qualities of each vaccine schedule over a sustained period of time. Given these limitations, members recommended: firstly, that a national vaccination campaign against measles was not possible, and secondly, that the MRC ‘should be asked to conduct further and more extensive trials of measles vaccines this autumn, in various combinations, to investigate individual immunity, the protection afforded and reactions to the vaccines in various age groups.141 Despite concerns held by some members of the JCVI, they chose to endorse the decision of Measles Vaccination Sub-Committee and the MRC were asked to undertake the first national trial of a measles vaccine in British history.

2.9 Conclusion

This chapter has examined the MRC’s evaluation and regulation of measles vaccine trials. To begin with, I examined the evaluation of Britain’s first measles vaccines. The

138 TNA, FD 7/1209, MVC/23, ‘Measles Vaccines Committee’, 23 June 1964. 139 TNA, MH 154/63, Joint Committee on Vaccination and Immunisation Measles Vaccination Sub-Committee, ‘Minutes of Meeting held on Monday, 13th July, 1964’, 13 July 1964. 140 Ibid. 141 Ibid.

117 evaluation of these vaccines demonstrates the contrasting approaches taken by different institutions towards decisions concerning clinical testing. Whereas the Research Sub-

Committee of the Fountain and Carshalton Group Hospital Management Committee was mainly made up of local practitioners, who largely relied on literature provided by the vaccines manufacturers, the MRC’s own expert committees contained many of the country’s leading scientific researchers. With access to a greater network of knowledge and information, as well as an awareness of the political costs of dangerous experimentation, the MRC’s expert committees came to a very different conclusion concerning the safety of Britain’s first experimental vaccines.

However, as important as scientific evidence and expertise were to judgements concerning the safety and morality of clinical trials, as I have showed in the second part of this chapter, the political context was also crucial. While the public were believed to be uninterested in measles and its vaccination, there was little pressure on the MRC to test either British or American vaccines. However, once this political context began to change, so gradually did the MRC’s position. Perceptions of increased public interest in the subject of measles vaccination following developments in the US, created anxiety within the Ministry of Health and the MRC. This anxiety, along with structural and political changes within the Ministry of Health, led to a new engagement with the subject and a shift in the state’s perspective. Although subtle, more power was now in the hands of the vaccines’ supporters, and their position soon became official policy.

Nevertheless, although public interest was an important factor in the MRC’s decision making process, there was very little empirical evidence regarding what the public’s view actually was. Indeed, letters written to medical journals and national newspapers at the time suggests the public and medical profession were more divided over the issue of

118 measles vaccination than was now being represented by government officials. Given this ambivalence over the subject of measles vaccination, the task now facing MRC researchers and officers in persuading thousands of parents to volunteer their children for a national vaccine trial was significant. It is to the MRC’s Measles Vaccines

Committee’s protection trial and its representation that we now turn.

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Chapter 3: Telling a Banal Story: Representing the Medical Research Council’s Measles Vaccines Protection Trial

3.1 Introduction

On 6 February 1968, the Minister of Health, Labour MP Kenneth Robinson, announced the beginning of Britain’s measles vaccination campaign. At the press conference announcing the decision, Robinson emphasised the importance of the

MRC’s Measles Vaccines Committee’s (MVC) protection trial. Undertaken in 1964 at the request of the Ministry of Health, the trial had been designed to aid Ministry experts in deciding the fate of measles vaccination in Britain. Recruiting approximately 47,000 healthy children between the ages of ten months and two years, the trial examined the safety and efficacy of two vaccine schedules: live vaccine administered alone and live vaccine administered in combination with killed vaccine. However, despite being presented as a scientific and administrative success, the trial was not without its tribulations. Most notably, for reasons which I will discuss in this chapter, one of the two live measles vaccines subsequently used as part of Britain’s national campaign had not been included in the trial. Originally included, due to safety concerns, Burroughs

Wellcome’s Beckenham 20 was excluded before the trial had even begun. Following this decision, Burroughs Wellcome quickly produced a new live measles vaccine.

Commercially known as Wellcovax, its development came too late for it to be entered into the MRC’s trial, yet it was still utilised by the Ministry of Health in their national campaign. Largely concealed from the public’s view, this episode was one of several stories hidden behind a carefully mediated public narrative of the trial.

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This chapter examines the history of the MVC’s protection trial. In particular, it examines the importance of the trial’s public representation. Over the last two decades, historians have demonstrated the MRC’s growing role in clinical trials following the

Second World War. Alan Yoshioka’s account of the streptomycin trials in the 1940s shows the Council’s role in the development of the randomised clinical trial (RCT).1 A significant event, not just because RCTs became the ‘gold standard’ for clinical research, but because in keeping with the Council’s values it reflected a more experimental approach to the clinic. Carsten Timmermann’s work explores the MRC’s research into hypertension and lung cancer in the 1950s and 1960s.2 By taking a comparative approach, Timmermann illustrates some of the complexities the MRC faced in organising clinical research in areas where strong medical cultures already existed.3

Timmermann’s analysis reveals several important characteristics of the MRC’s approach to research; the application of the scientific method to the clinic; the use of formal and informal networks in the organisation of research; and the ambition to expand its territory beyond the laboratory.4

1 Alan Yoshioka, ‘Use of Randomisation in the Medical Research Council’s Clinical Trial of Streptomycin in Pulmonary Tuberculosis in the 1940s’, British Medical Journal 317 (1998): 1220– 23. 2 Christopher C. Booth, ‘Clinical Research’, in Historical Perspectives on the Role of the MRC: Essays in the History of the Medical Research Council of the United Kingdom and Its Predecessor, the Medical Research Committee, 1913-1953, ed. Joan Austoker and Linda Bryder (Oxford: Oxford University Press, 1989), 205–41; Carsten Timmermann, ‘Hexamethonium, Hypertension and Pharmaceutical Innovation: The Transformation of an Experimental Drug in Post-War Britain’, in Devices and Designs: Medical Technologies in Historical Perspective, ed. Carsten Timmermann and Julie Anderson (Basingstoke: Palgrave Macmillan, 2006), 156–74; Carsten Timmermann, ‘As Depressing As It Was Predictable? Lung Cancer, Clinical Trials, and the Medical Research Council in Postwar Britain’, Bulletin of the History of Medicine 81 (2007): 312–34; Helen Valier and Carsten Timmermann, ‘Clinical Trials and the Reorganization of Medical Research in Post- Second World War Britain’, Medical History 52 (2008): 493–510; David Healy, The Antidepressant Era (London: Harvard University Press, 1997). 3 Carsten Timmermann, ‘Clinical Research in Postwar Britain: The Role of the Medical Research Council’, in Biomedicine in the Twentieth Century: Practices, Policies, and Politics, ed. Caroline Hannaway (Amsterdam: IOS Press, 2008), 244–47. 4 Ibid., 247.

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However, while these studies provide rich insights into how clinical trials have been designed, organised and evaluated in Britain, they have had less to say about their representation. Given the significance of public relations to a trial’s success, this admission is important. As Stephen Mawdsley argues in his examination of the

American gamma globulin trials from the 1950s, ‘Since all clinical trials harbour risks and many require submitting to unpleasant procedures, human subjects and their guardians require some form of persuasion to volunteer.’5 In the case of the MVC’s protection trial, I argue that carefully mediated presentations of the trial were crucial to persuading the public and medical profession of the trial’s safety, value and success.

Designed to serve a number of social and political interests, examining the trial’s archive material illuminates how representations could conceal as much as they would reveal.

However, unlike accounts of research conducted on vulnerable or institutionalised groups in the twentieth century, I argue that the deception that took place during the

MVC’s trial was more subtle, more banal, but no less important.6 In the case of

Wellovax’s story, its concealment goes someway to explaining how a vaccine, described by Ministry of Health and MRC officials as ‘insufficiently’ tested, could be approved, bought and subsequently administered to over one million children in Britain.7 A story of knowledge, power and at times deception, the history of the MVC’s protection trial provides a fascinating and perhaps somewhat alarming case study into the communication of medical science, the management of public perceptions and the construction of scientific truth.

5 Stephen E. Mawdsley, Selling Science: Polio and the Promise of Gamma Globulin (New Brunswick, New Jersey, and London: Rutgers University Press, 2016), 12. 6 Sarah Ferber, Bioethics in Historical Perspective (New York: Palgrave Macmillan, n.d.), 101–31, accessed 21 May 2017; Susan E. Lederer, Subjected to Science: Human Experimentation in America Before the Second World War (Baltimore and London: Johns Hopkins University Press, 1995). 7 TNA, FD 23/1361, E.M.B. Clements, File Note, ‘Reactions Following Measles Vaccine’, 19 June 1969.

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3.2 Designing a trial

Planning for the MVC’s protection trial began in July 1964. After a meeting of the

MRC’s Measles Vaccines Committee, held on 29 July 1964, a select group of advisors, which included David Evans, Frank Perkins, Christine Miller and Ian Sutherland, were asked to develop the trial’s protocol. Developed in private, the protocol defined the object of the study as to ‘determine the frequency and severity of vaccination reactions and the degree and duration of protection against measles after vaccination with a dose of killed vaccine followed by a dose of live vaccine and with a dose of live vaccine given alone.’8 In order to achieve this, the plan was for children between the ages of ten months and two years, who had not already experienced measles, to be randomised to one of three different groups: (1) ‘Killed & Live vaccine’; (2) ‘Live vaccine only’; and (3)

‘Unvaccinated Control’.9 Children randomised to one of the two treatment groups would be administered with either a dose of Glaxo’s Schwarz live vaccine or Burroughs

Wellcome’s Beckenham 20 live vaccine. Initially it was intended participants would be recruited from eleven Local Authorities – Bristol, Edinburgh, Hull, London County

Council, Middlesex County Council, Oxford, Portsmouth, Southampton, Southend-on-

Sea, West Riding of Yorkshire and West Sussex; however, by the time of the trial this figure had risen to thirteen, with Cardiff and Manchester added at a later date. Local

Health Authorities, and in particular the local Medical Officer of Health, were responsible for organising the trial in each area. It was their responsibility to recruit participants, obtain parental consent, and co-ordinate vaccination at local clinics. Once vaccinated, in order to measure both the short term and long term effects of vaccination, it was decided that children would be followed-up on four separate

8 TNA, FD 7/509, ‘Investigation of Measles Vaccines by Medical Officers of Health and the Medical Research Council: Protocol’, 31 August 1964. 9 Ibid.

123 occasions over a nine-month period by a Local Health Authority nurse. After three weeks, the nurse would contact the parent to establish if their child had suffered from any clinical symptoms following vaccination. Each parent would then be contacted at three months, six months and nine months to see if their child had suffered from measles. The results of each enquiry would then be recorded on specially designed cards and returned to the MRC for processing. The trial could then be extended depending on the information required by the MRC and the Ministry of Health.

One of the few subjects open to debate was the trial’s size. Estimates of population size ranged from as little as fifty thousand subjects to as large as two million subjects.

Forecasts provided by manufacturers suggested the amount of vaccine available by the end of 1964 could be quite considerable. Pfizer estimated they could have approximately 1 million doses of killed vaccine available by August; Glaxo 120,000 doses available by October. Similarly, Glaxo expected to have 120,000 doses of live vaccine available by December; Burroughs Wellcome 500,000 doses by October (See

Table 6).10 However, in deciding on the size of the trial, Ministry officials and MRC advisors had to consider a number of economic, social and political factors. They had to consider whether a large scale trial would create a ‘demand’ for vaccination which could not easily be satisfied; whether such a trial would potentially upset those local health authorities not participating; and, as one Ministry official put it, ‘there is the general question of committing the Government to the future expenditure of large sums by the conduct of successful trials under Government aegis.’11 Based on these social and political considerations, some Ministry officials believed a smaller and more discreet trial, involving some fifty to sixty thousand children, might be more appropriate.

10 TNA, MH 154/134, Gordon Martin, File Note, ‘Measles Vaccine’, 23 April 1964. 11 TNA, MH 154/134, H. Herzmark to Littlewood, ‘Measles Campaign’, 11 May 1964.

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Although the MRC’s protocol did not state a particular figure, internal file notes suggest they too had settled on a trial population size of approximately 50,000 children.12

Table 9. Vaccine supply Date Glaxo Burroughs Pfizer Maximum Available Available Wellcome Supplies All Sources m. doses m. doses m. doses m. doses Killed Attenuated Attenuated Killed Killed Attenuated August, 1964 1.0 1.0 October 0.12 0.5 1.12 0.5 November 0.025 0.12 1.145 0.62 December 0.025 0.12 0.12 1.170 0.86 January, 1965 0.025 0.025 0.12 1.220 1.005 February 0.025 0.025 0.12 1.270 1.150 March 0.025 0.025 0.12 1.320 April 0.025 0.025 0.12

Source: TNA, MH 154/134, Gordon Martin, File Note, ‘Measles Vaccine’, 23 April 1964.

Sent to the Ministry of Health on 1 September 1964, the protocol received a mixed response. While on the whole Ministry officials were content with the plan, there was some concern over the study’s inclusion criteria. Initially, it had been decided by the

JCVI’s Measles Vaccination Sub-Committee that the trial would include children of

‘various age groups’.13 To the disappointment of some Ministry officials, the final version of the trial’s protocol stated that only children between the ages of ten months and two years would be included. The person most frustrated by this decision was the government’s Chief Medical Office (CMO), George Godber. Based on the ‘old theory’ that epidemics tend to result from ‘the accumulation of susceptibles in school’, Godber

12 TNA, MH FD 23/1354, E. M. B. Clements, File Note, 4 June 1964. 13 TNA, MH 154/134, A. T. Roden, File Note, ‘Trial of Measles Vaccines’, 3 September 1964.

125 believed that the initial measles vaccination campaign should focus on school entrants.14

This would not only protect children at the age of five and six, but prevent the disease from spreading to their younger brothers and sisters. In a letter to the MRC’s Principal

Medical Officer, B. S. Lush, Godber made his concerns about the trial very clear: ‘I hope that the plan includes immunisation of a substantial number of children over the age of 2 including school entrants who have not had measles. If it does not, we will be in the position of not knowing what we might expect by way of control of the emergence of the biennial epidemic when the next one comes round two years hence.’15

Members of the MRC’s Measles Vaccines Committee strongly disagreed. After speaking with colleagues at the MRC, Lush mounted a robust defence of the Committee’s decision:

You will note that, although the Committee were conscious of the Ministry’s interest in school entrants, they were unanimous in deciding to study primarily the effect of vaccinating children 10 months to 2 years for the following reasons:

1. This is the age group in which primary vaccination of measles is most likely to be used when generally available in a routine immunization schedule. 2. The first trial during which antibody responses to vaccination were measured showed that in the 10 to 18 months age group less than 2% of the children had antibody before immunization. Thus the need to bleed infants was eliminated. 3. A history of not having had the disease reported by the parent was not regarded as sufficiently reliable to eliminate the necessity of taking blood samples from school entrants. It was felt that the taking of blood would be a considerable obstacle to obtaining volunteers in sufficiently large numbers. 4. It was not agreed that the 10 months to 2 years age group would be protected against the disease by vaccinating school entrants unless all school entrants were

14 TNA, FD 23/1355, George Godber to B. S. Lush, 4 September 1964. 15 Ibid.

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given vaccine within a short time. Since the disease has such a high morbidity and the stocks of vaccine were limited, it was felt that any attempt to protect the pre-school child by vaccinating some of the school entrants was unrealistic.16

Lush’s defence illustrates how scientific, pragmatic and political factors informed the construction of the MRC’s trial. In choosing children between the age of ten months and two years, the Committee believed they could avoid the ‘need to bleed infants’. This would save the organisers time and money, and perhaps, more importantly, make the trial more attractive to volunteers. At the same time, in deciding to focus only on the 10 to 24 month age group, the Committee were constructing the trial through a particular policy perspective. In doing so, however, the exploratory nature of the trial had been limited; something which Godber was acutely aware of. Important questions concerning the relationship between age, vaccine schedule and clinical response would remain unanswered, and a valuable opportunity would be lost. In response to Lush’s letter,

Godber issued one final warning to the Council:

The fact remains, however, that the epidemic of 1966 will occur amongst [school] entrants unless it has been decided to attempt to prevent this by vaccinating them. We must therefore obtain sufficient information about school children before that time… I quite understand the primary concern with younger children and if the Committee is satisfied that its present study will provide sufficient information about the older age group to enable this Ministry and its Advisory Committee to reach conclusions about what should be done in 1966 we will certainly be content… I wrote to you because I was concerned lest our Advisory Committee felt that the results of the study now in hand gave insufficient information to reach firm conclusions.17

16 TNA, FD 23/1355, B. S. Lush to George Godber, 18 September 1964. 17 TNA, FD 23/1355, George Godber to B. S. Lush, 21 September 1964.

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While these questions would later come back to haunt policy makers, for now the issue was resolved quickly. Reflecting the shortage of time, as well as the authority of the

MRC, Godber agreed with Lush that it was ‘manifestly impossible’ to alter the trial at this late stage.18 Kept within the confines of the committee room, anxieties and conflicts over the trial’s necessity, safety (see Chapter 2) and design would largely remain hidden from wider professional and public scrutiny. As I will argue in the case of the trial’s publicity campaign this privacy allowed MRC officials to carefully construct a suitable public narrative for the trial; a process which would see internal tensions around the trial’s meaning carefully mediated to the public.

3.3 Publicity campaign

Organisers and officials at the MRC first started to discuss the publicity campaign in late

August 1964. As organisers were well aware, the success of the MRC’s protection trial would rest on their ability to recruit thousands of parents and children to the cause.

This was not an easy task, given that it required persuading thousands of parents to enter their young children into an experiment using a recently developed medical technology, against a disease many parents still perceived as mild. In order to recruit parents, publicity material had to convey a number of messages. Firstly, it needed to reassure parents that the vaccines were both safe and effective. Secondly, it had to explain why experimental conditions were justified, and why many children would not be vaccinated at this time. A rhetorical tightrope, it would be navigated by a process of compromise, sanitation and at times deception.

18 Ibid.

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At the heart of MRC’s recruitment campaign was the consent form for the trial.

Although children were too young to consent, the MRC’s latest advice to medical researchers, given in their recently published pamphlet, ‘Responsibility in Investigations on Human subjects’, argued ‘that it is clearly within the competence of a parent or guardian of a child to give permission for procedures intended to benefit that child when he is not old or intelligent enough to be able himself to give a valid consent.’19

Given this advice, organisers believed it was ‘essential’ to provide parents with a consent form, providing them with a summary of the trial’s aims and validity.20 Sent out by

Medical Officers of Health to the parents of eligible children throughout the winter of

1964-5, the consent form was essential to the trial’s public image (see Figure 3).

It is important to situate this consent form in a changing medico-legal context rather than a transformation in the doctor-patient relationship. In providing parents with only the most basic information, this form hints a continued paternalistic attitude amongst the medical profession and the state. For example, the form does not discuss doubts raised in chapter 2 over ‘adverse reactions’, long term ‘efficacy’, or differences between

‘killed’ and ‘live’ vaccine strains. Nor does it use the language of ‘assessment’, ‘trial’ and

‘experimentation’, which the MRC used internally. Instead, it reads as though measles vaccination has already become routine: ‘If you have a child between 10 months and 2 years who has not had measles and whom you would like protected, please register the child by signing the consent below.’21 Such limited information, gave little indication of the experimental nature of the study. Those parents with little knowledge of clinical terminology may have never guessed that they were entering their child into a major clinical trial.

19 TNA, MH 160/908, ‘Responsibility in Investigations on Human Subjects’, 1963. 20 TNA, FD 9/2488, File Note, 1 September 1964. 21 TNA, FD 23/1355, Trial Consent Form, ‘Measles Vaccination’, 1964.

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Figure 3. Draft consent form for the Measles Vaccines Committee’s protection trial. Signed: TNA, FD 9/2488, ‘Consent Form: Measles Vaccine’, 1 September 1964.

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A crucial part of the MRC’s consent form was the emphasis placed on the vaccines

‘short supply’ or ‘limited quantity’. As previous studies of the MRC have demonstrated, access to a ‘short supply’ of a particular agent, whether it be a research agent, such as radium, or a therapeutic agent, such as streptomycin, enabled the MRC to justify to the public and the medical profession the use of experimental conditions.22 In the case of the MVC’s protection trial, suggesting there was a shortage of vaccine supply

(something that according to preliminary figures collected by the Ministry of Health at the beginning of 1964 was not entirely accurate (see Table 6)) served a number of purposes. It enabled organisers to justify the use of a controlled group and the selection of children from a small number of areas. It also enabled organisers to present a benign image of the trial: a trial that was not an experiment, but a rational response to a limited supply of measles vaccine.

These ‘terms’ of communication would become the subject of private criticism from one member of the public, Margaret Godden.23 In October 1964, Godden wrote a letter to the Area Medical Officer for Ealing, Dr Payne. ‘I wish to object to the terms of the communication I recently received on the subject of Measles Vaccination’, began

Godden, ‘It is clear to the attentive reader that the vaccine offered is still the subject of experimentation.’24 Godden’s argument was based on a close reading of the consent form. According to Godden, the use of ‘two different vaccines’, a ‘control group’ and the term ‘study’ suggested parents and children were being invited to consent to an

22 David Cantor, ‘The MRC’s Support for Experimental Radiology During the Inter-War Years’, in Historical Perspectives on the Role of the MRC: Essays in the History of the Medical Research Council of the United Kingdom and Its Predecessor, the Medical Research Committee, 1913-1953, ed. Joan Austoker and Linda Bryder (Oxford: Oxford University Press, 1989), 181–204; Yoshioka, ‘Use of Randomisation in the Medical Research Council’s Clinical Trial of Streptomycin in Pulmonary Tuberculosis in the 1940s’. 23 TNA, FD 9/2448, Margaret Godden to the Area Medical Officer for Ealing, 19 October 1964. 24 Ibid.

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‘experiment’, but without true understanding they were doing so.25 To Godden, the banal language used in the consent form was obscuring reality rather than empowering the parent: ‘I am not suggesting that the vaccine is in any way unsafe’, wrote Godden,

‘but I do think that parents should be told that they are being invited to involve their children in a medical experiment and that they should be told so quite explicitly. It is not enough that the astute should be able to read between the lines.’26

Organisers of the trial took a slightly different view on what the term experimental meant. They believed that as the vaccines had previously demonstrated their safety and short term efficacy that this was not an experiment. In her first attempt at a reply to

Godden, the trial’s main organiser, Christine Miller, wrote:

It is certainly not our intention to conceal the facts of this investigation from parents. These vaccines are not experimental and their safety and efficacy for the individual have been fully investigated. This is, however, the first time that the vaccines have been made available on a comparatively large scale in this country, and we naturally wish to keep in touch with all children in the eligible age group. This study will, we hope, confirm the value of the vaccines to the community in the control of measles.27

MRC Medical Officer E. M. B. Clements believed Miller’s letter was too much of a

‘“slap down”’ and drafted an alternative account.28 Clements believed that Godden was

‘reading what is actually not between the lines’, and suggested ‘that a reply presenting the consent form at its face value might be the best defence’.29 In his draft reply,

25 Ibid. 26 Ibid. 27 TNA, FD 9/2448, Christine Miller to Margaret Godden, Draft Letter, ‘M.R.C. Investigation of Measles Vaccines’, 29 October 1964. 28 TNA, FD 9/2448, E. M. B. Clements, File Note, 4 November 1964. 29 Ibid.

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Clements emphasised that although the vaccines constituted ‘new material’, each vaccine was ‘beyond the experimental stage’.30 Drawing directly from the consent form,

Clements reiterated that the purpose of the trial was not to examine the vaccine’s safety, but to ‘study the best way of protecting children … against measles.’31

Clements’ suggestions did not entirely allay the concerns of some MRC officers, who believed that Godden’s criticism had some merit. ‘At first sight it seemed, since the letter had been forwarded to the Council for action, that it would be unwise to let the matter go by default. However, I am now not at all sure that there isn’t considerable substance in Mrs. Godden’s arguments’, wrote MRC Principal Medical Officer Dr M. P.

W. Godfrey.32 According to Godfrey, he and another MRC Principal Medical Officer,

Dr Joan Faulkner, had met trial organisers Miller and Pollock several months earlier,

‘anxious’ to make sure ‘full information about the study’ was provided to parents.33

However, as information had already been sent out to Medical Officers of Health, it was deemed too late to change the material. Given that Godfrey shared Godden’s concerns about the lack of trial information made public, he found it difficult to respond to Godden’s letter. He believed that Miller’s reply was ‘a little abrupt’, but at the same time suggested Clements’ redraft was ‘too detailed.’34 ‘To know how to answer

Mrs. Godden is a little bit of a problem’, wrote Godfrey,

I have attempted to produce … something half way between the two, but you may well feel that it might be better to let sleeping dogs lie for the moment, and wait and see whether – having made her point – Mrs. Godden demands anything further. I am myself just a little bit inclined to do this since her letter is

30 TNA, FD 9/2448, E. M. B. Clements to Margaret Godden, Draft Letter, 1964. 31 Ibid. 32 TNA, FD 9/2448, M. P. W. Godfrey, File Note, 5 November 1964. 33 Ibid. 34 Ibid.

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informed and somewhat militant, and she may well be a member, for example, of the Patients Association and unfortunately, I do not think that our ground is terribly strong.35

The reply that was eventually sent to Mrs Godden three weeks later did not convey any of these anxieties. Signed by Clements, it stated:

It is true that the vaccines being used are still the subject of study in the sense that we do not yet know how best they should be used to ensure maximum protection of children against natural infection by measles, which is the object of the study. What is not true is that the vaccines are experimental in the sense that they have not been thoroughly tested for safety and efficacy in this country’36

The letter appeared to have the desired effect. There is no evidence that Godden replied and no evidence that her concerns were ever made public. Yet, had Godden had access to the MRC or Ministry of Health administrative files the story may have been different.

In those files she would have found Godfrey’s admission of deception. She would have also been able to read the study’s protocol, which stated that the ‘object’ of the investigation was ‘to determine the frequency and severity of vaccination reactions and the degree and duration of protection against measles.’37 As Godden herself acknowledged, there was no suggestion that these vaccines were ‘unsafe’, but in carefully avoiding potentially provocative information, the consent form can be seen as an attempt to cultivate banality.38

35 Ibid. 36 TNA, FD 9/2448, E. M. B. Clements to Margaret Godden, 9 November 1964. 37 TNA, FD 7/509, ‘Investigation of Measles Vaccines by Medical Officers of Health and the Medical Research Council: Protocol’, 31 August 1964. 38 TNA, FD 9/2448, Margaret Godden to the Area Medical Officer for Ealing, 19 October 1964.

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This construction of a benign image also informed attempts to advertise the trial. As well as being responsible for sending out the consent forms, Medical Officers of Health were responsible for marketing the trial in their local area. They were asked to distribute posters, inform local newspapers and register eligible children. Importantly, they were instructed to present a very simple and benign narrative of the trial. According to the trial’s protocol,

The Medical Officer will inform the parents of eligible children in his area that measles vaccination will be available for a short period this autumn. Parents will be invited to register their children for vaccination but will be informed that the vaccine is in short supply and that not every child registered will be vaccinated this year; children not vaccinated this autumn will however be given priority for vaccination next year.39

Similar to the consent form, Medical Officers were to present the trial as a routine medical procedure, not an ‘experiment’ designed to remedy scientific uncertainty.

News of the trial first began to be reported by local newspapers in September 1964.40

Articles, informed by both MRC publicity and Medical Officers of Health looking to promote the trial in their local areas, presented the reader with a set of basic information: the structure of the trial, the nature of the vaccines, the scientific and moral case for a clinical trial, and the process of applying to participate. These were

39 TNA, FD 7/509, ‘Investigation of Measles Vaccines by Medical Officers of Health and the Medical Research Council: Protocol’, 31 August 1964. 40 Anon., ‘Plea to Parents: Anti-Measles Jabs for Children’, Bristol Evening Post, 1 September 1964; Anon., ‘The First Measles Vaccine’, Western Daily Press, 2 September 1964; Anon., ‘Southampton to Be Measles Test City’, Southern Evening Echo, 11 September 1964; Anon., ‘Measles Vaccines on Trial’, Glasgow Herald, 16 September 1964; Anon., ‘Children in Trial of Measles Vaccine’, Edinburgh Evening News, 15 September 1964; Anon., ‘Anti-Measles Vaccine Trial in 11 Areas’, Birmingham Post, 17 September 1964; Anon., ‘Anti-Measles Vaccine’, East Anglian Times, 17 September 1964; Anon., ‘Anti-Measles Vaccine Test’, Yorkshire Post, 17 September 1964.

135 largely positive pieces, designed to increase public confidence and participation. For example, an article published in Hull’s Daily Mail, quoted the views of the Medical

Officer of Health there, Dr A. Hutchinson.41 Hutchinson made sure parents knew the trial was ‘entirely voluntary’, that each vaccine was in ‘short supply’, and that it was

‘anticipated’ the vaccines would ‘give a very high degree of protection’.42 ‘“It would be a wonderful thing if we could get rid of measles,” said Dr Hutchinson. “We are extremely hopeful that the new vaccine will produce results and I hope that parents in the city will give us full co-operation in this investigation”’.43

Figure 4. Newspaper article reporting the details of the Measles Vaccines Committee’s protection trial. Source: Anon., ‘Measles May Soon be on the Way Out’, Ipswich Evening Star, 6 November 1964.

41 Anon., ‘Thousands of Hull Children in Anti-Measles Drive’, Hull Daily Mail, 4 September 1964. 42 Ibid. 43 Ibid.

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Although responsibility for marketing the trial was largely devolved to Local Health

Authorities, medical officers at the MRC still had a role in orchestrating events, particularly through the national press. As news of the trial started circulating through the media, MRC Principal Medical Officer, Joan Faulkner, suggested ‘it would be a good idea to have a responsible accurate statement in the Professional Journals’.44 On

19 September, the British Medical Journal (BMJ) published a joint statement from the

Ministry of Health and the MRC. Similar to statements made by Medical Officers of

Health, the MRC’s statement, designed to be read by general practitioners and interested members of the media, included only the most basic details. Readers were given little information concerning the nature of the individual vaccines, their risks, their uncertainties, and their unknowns. In emphasising the role of leading scientific and medical authorities in the decision-making process, the statement was designed to project an image of scientific consensus, and in doing so, increase professional trust and cooperation in the trial. The statement read:

The Joint Committee on Vaccination and Immunization of the Central Health Services Council has been reviewing the question of vaccination against measles. The Public Health Laboratory Service carried out a detailed study of the complications of measles during the last biennial epidemic, and during the past year the Medical Research Council arranged a limited investigation into antibody responses and vaccination reactions to measles vaccine produced in this country. Both reports were considered by the Joint Committee, which asked the Medical Research Council to proceed with a larger study of the protective effect of various vaccine-schedules at different ages.45

While most articles tended to follow the Ministry of Health and MRC’s official line, it was not always possible to control the media narrative. One notable defection was an

44 TNA, FD 23/1355, Joan Faulkner, File Note, 16 September 1964. 45 Anon., ‘News and Notes’, British Medical Journal 2 (1964): 767.

137 article published in the newspaper, Medical News. Just days before the MRC and the

Ministry of Health were set to release their joint statement, MRC officials were informed that Medical News was going to publish a piece on the trial on 18 September.46

Beginning with a detailed account of the purpose and schedule of the trial, the article went on to present a more critical picture of the trial and its experimental agents. As well as touching on the subject of ‘severe’ vaccine reactions, perhaps more worrying for readers was the article’s quite candid portrayal of the uncertainty that still existed over the vaccine’s long-term ability to provide immunity.47 ‘If the immunity afforded should prove to be short-lived so that in effect we merely postpone an attack unless the subject is revaccinated, it might well prove a mixed blessing’, stated the medical correspondent.48 As I described in Chapter 2, this was a view shared by several medical experts working inside the Ministry of Health and the MRC, though one that neither organisation was looking to publicise.

Questions raised by the Medical News article did not come as a surprise to trial organisers. The difficulty, however, was in knowing how to respond to them without damaging recruitment for the trial. On 23 September, following a number of press enquires, one of the trial’s organisers, Dr T. M. Pollock, telephoned Faulkner to explain how he had been responding to enquiries.49 While questions had mainly focussed on the necessity of vaccinating against measles, Pollock was also asked a series of questions concerning the safety and morality of the trial. According to Faulkner,

He had … been asked whether there were likely to be any reactions from vaccination and had been saying that a very small proportion of children might

46 TNA, FD 9/2448, File Note, 16 September 1964. 47 Anon., ‘Testing Time Soon for Measles Vaccine’, Medical News, 18 August 1964, 3. 48 Ibid. 49 TNA, FD 9/2448, Joan Faulkner, File Note, 23 September 1964.

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show some general upset and listlessness and just a few might show a rash… As regards the ethics of conducting a trial at this stage he had been pointing out that the vaccine is in short supply and not everyone can have it and therefore it is much better to give it to children in a controlled way so that the effect of giving it can be measured properly.50

From a rhetorical perspective, Pollock’s ethical argument was extremely powerful. As I described in relation to the trials consent form, justifying a controlled trial on the basis that measles vaccines were in ‘short supply’ was rhetorically very potent. Firstly, it legitimised treating only a small section of the population, defending the institution against accusations of unfairness and neglect, and secondly, it presented parents with an uncontroversial reading of the trial; i.e. this was not a clinical trial testing the safety and efficacy of experimental prophylactics, but a reasonable way of rationing a valuable, but rare therapeutic substance.

At the same time, in providing a clear narrative of why greater state intervention was not possible at this stage, Pollock’s argument also served the Ministry of Health’s political goals of defending itself against accusations of medical neglect. As I discussed in Chapter 2, Godber had been concerned that the Ministry was likely to face criticism for a perceived delay in introducing measles vaccination in Britain. As marketing for the

MRC’s protection trial was getting underway, Godber was anxious to avoid any public criticism now that action was being taken. On 1 September 1964, concerned by increasing media interest in the trial, Godber telephoned the MRC’s head office to coordinate the ‘line’.51 According to an MRC file note,

50 Ibid. 51 TNA, FD 9/2448, Joan Faulkner, File Note, 1 September 1964.

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Sir George said that it was important that the Council and the Ministry took the same line if there were press enquiries about this trial. He thought that the Ministry would be under criticism for not having introduced measles vaccination generally. The line they would adopt was that a joint committee on the subject … has been discussing the whole question over the past year and in their view the situation has not been reached when measles vaccine can be made generally available to children. Measles is a widespread and relatively mild disease and there have been considerable differences of opinion as to whether the giving of yet another injection to children, to protect against it, was justified. In any case it is only very recently that satisfactory preparations have become available and in the Ministry’s view field trials in limited areas are necessary before it can be decided that an adequate degree of protection will be conferred by these vaccines.52

Godber’s desire to manage public expectations eventually led to one notable publicity scandal. On 5 November 1964, one month into the MRC’s protection trial, the Daily

Telegraph presented readers with an update on the latest research concerning measles vaccination.53 The article, based on the Chief Medical Officer’s latest annual report, presented readers with a surprisingly uncertain picture of the current status of measles vaccination in Britain: ‘Vaccines are available. They confer protection, but cause a reaction too serious to be acceptable except perhaps in tropical countries where the disease is rife and lethal, says Sir George Godber… He looks forward to “a vaccine effective and free from complications, which may make it possible to break the biennial cycle of measles epidemics.”’54

Up until this point, the media presentation of the trial had been carefully managed by

MRC staff. Publicity material described each vaccine as safe and effective; the trial was

52 Ibid. 53 Anon., ‘Research Towards Safe Measles Vaccine’, The Daily Telegraph, 5 November 1964, 28. 54 Anon., ‘Research Towards Safe Measles Vaccine’.

140 not experimental, but was being organised to investigate the best method of protection.

In questioning the safety of the vaccines, trial organisers were deeply concerned that

Godber’s comments would create public uncertainly and have a detrimental effect on recruitment. Indeed, early evidence suggested they already had. The Medical Officer of

Health for Middlesex reported parents turning up ‘anxious’ to vaccination clinics.55

Other reports suggested parents were ‘withdrawing their children’ from the study.56 In response, MRC officials urged Godber to alter his statement and challenge any misrepresentations. However, according to one MRC file note, ‘This he declined to do on the grounds that (a) not everyone reads the “Daily Telegraph” and (b) newspaper scares quickly blow over.’57 Moreover, as it turned out Godber’s divisive comments were more than just a mere accident. As the file note went on to say, ‘In addition, he volunteered that he had said what he had said because otherwise the Ministry would have been attacked for not releasing the vaccine to all who wanted it.’58 In presenting measles vaccination as an uncertain instrument, Godber believed this would legitimate the Ministry of Health’s decision not to begin mass vaccination sooner, hopefully preventing any public criticism. The price of managing the political context, however, was the damage done to the very research designed to inform the Ministry’s policy. As the file note concluded, ‘It is indeed unfortunate that doubt should have been cast on these vaccines for it may prevent us from being able to answer the questions the

Ministry wish us to answer.’59

Curiously, while it was initially decided to leave the story alone, just four days later the

Daily Telegraph published an update and a partial retraction to their original story. The

55 TNA, FD 9/2448, E. Andrew, File Note, 9 November 1964. 56 TNA, FD 9/2448, File Note, ‘Adverse Publicity on MRC Measles Vaccine Trial’, 9 November 1964. 57 Ibid. 58 Ibid. 59 Ibid.

141 article, written by the Daily Telegraph’s health services correspondent, John Prince, addressed the reader in a very different tone:

TRIALS in which 40,000 children in 13 areas of Britain are taking part have shown that safe and effective measles vaccines will be available to combat next year’s expected epidemic. The children have received injections of both live but weakened vaccines and killed vaccines. “There has been no evidence of adverse reaction.” I was informed authoritatively last night. The vaccines are British- produced. Their efficacy, I understand, has been demonstrated both in laboratory tests and clinically by the protection they have given to children.60

How much influence MRC officers and Ministry of Health officials had on this article is unclear, but it was not uncommon during this period for medical and science correspondents to rely on insider accounts for their stories, enabling the state to mediate the public narrative.61 The difficulty here was in deciding what that narrative should be, and whose priorities should inform it. Godber’s misadventure neatly illustrates the political tensions officials faced in constructing trial publicity. If the vaccines were presented as too safe and effective, the government might face accusations of neglect for not having made the vaccines available to all children.

However, if the vaccines were presented as too risky, and the trial too experimental, this might put parents off volunteering their children’s bodies for the study. The ethical argument, that vaccine supplies were ‘limited’, played an important role in negotiating these tensions and with it managing public expectations. This power to control the public narrative was not only crucial to recruiting subjects, but would prove particularly important for managing the trial’s first potential moment of crisis.

60 John Prince, ‘Safety in Measles Vaccines’, The Daily Telegraph, 9 November 1964, 21. 61 Anne Karpf, Doctoring the Media: The Reporting of Health and Medicine (London: Routledge, 1988).

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3.4 Withdrawn or excluded? Beckenham 20 not on trial

On 14 October 1964, just as the MRC’s protection trial was getting underway, the trial’s main organiser, Dr Christine Miller, telephoned the MRC’s head office to report a disturbing telephone conversation she had just had with an inquisitive journalist.

According to Godfrey,

Dr. Miller telephoned me in a great state this morning to say that Mr. Everett of Readers Digest had been touch with her yesterday ... He seemed very well informed, and during their conversation wheedled out of her the fact that only one type of live vaccine might be used because the other was likely to be in short supply. This had, apparently, produced a sharp reaction from the manufacturers. I told her that there did not appear to be very much that we could do now, and agreed that I would deal with any further enquiries from Mr. Everett along the lines – that the final plans for the trial had not yet been completed, but that it was hoped that two types of live vaccine would be used.62

Six weeks later, on 27 November 1964, MRC member of staff, E. Andrew, received a curious telephone call from another medical correspondent, this time Dr Alfred Byrne of The Sunday Times. According to Andrew, Byrne was enquiring ‘about the withdrawal of the measles vaccine Beckenham 20’ from the MRC’s national vaccine trials ‘on account of severe side effects’.63 As news of Beckenham 20s withdrawal came as a surprise to Andrew, she asked fellow MRC officer, Clements, to investigate. After speaking with two of the organisers of the trial, Pollock and Perkins, Clements discovered that Byrne was partly right; the Beckenham 20 strain had indeed been removed from the trial protocol after failing preliminary tests.64 This meant the trial now

62 TNA, FD 9/2448, M. P. W. Godfrey, File Note, 8 October 1964 63 TNA, FD 9/2448, E. Andrew, File Note, 27 November 1964. 64 Ibid.

143 only included two schedules: Glaxo’s live vaccine given after a single dose of Pfizer’s killed vaccine and Glaxo’s live vaccine given alone. Unfortunately, organisers of the trial had ‘forgotten’ to inform Medical Officers at MRC of the changes.65

Over the next few days, further enquiries made by MRC Medical Officers would clarify the situation. It turned out the MRC’s initial plan was to include Beckenham 20 in their national trials. However, private tests carried out by Pollock one month before the trial was due to begin had revealed that Burroughs Wellcome’s new commercial batches caused a significant number of adverse reactions. To the ‘dismay’ of Pollock, out of 32 children tested in the West Riding area of Yorkshire, over fifty percent suffered from some form of reaction; two of which suffered from ‘quite severe convulsions’.66

Consequently, Pollock, along with the Chairman of the Safety Tests Committee, David

Evans, took the decision not to include Beckenham 20 in the MRC’s national trial.

Subsequent tests carried out by Burroughs Wellcome confirmed that this was the right decision.

In responding to the medical correspondent of The Sunday Times original question, MRC

Principal Medical Officer, Joan Faulkner, presented a favourable reading of events.

Carefully avoiding the potentially sensational results of Pollock’s private trials, Faulkner focussed her response on the technical inaccuracy of Byrne’s claim of ‘withdrawal’: ‘I spoke to Dr. Byrne myself and told him that on looking into the matter I found that the

Wellcome vaccine was not being used in our trial, so that there was no question of it ever having been withdrawn.’ 67 It could be argued Faulkner was technically right. The only live measles vaccine to be administered during the trial was Glaxo’s Schwarz strain.

65 Ibid. 66 TNA, FD 9/2448, Joan Faulkner, File Note, ‘Trial of Measles Vaccines’, 30 November 1964; TNA, FD 9/2448, Joan Faulkner, File Note, ‘Measles Vaccination’, 4 December 1964. 67 TNA, FD 9/2448, Joan Faulkner, File Note, ‘Trial of Measles Vaccines’, 30 November 1964

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However, in deciding not to tell Byrne that Beckenham 20 was originally included in the protocol or about Pollock’s preliminary investigations, this was a somewhat incomplete account of events. Nevertheless, from Faulkner’s perspective, her conversation with

Byrne appeared to be a success: ‘He said that he thought there was not really a story for him to use and I looked in the Sunday Times and could not see anything about measles vaccine, so that I hope this whole thing has now died down.’68

Yet, the episode was not quite dead. During his pursuit of answers, Byrne had been given several versions of the story. He was initially told by an unnamed source that

Beckenham 20 had been withdrawn from the MRC’s protection trial due to safety concerns. He was then told by Burroughs Wellcome that a quantity of Beckenham 20 had been ‘delivered’ for testing and ‘was being used by the M.R.C. as they thought fit’.69

And finally, he was now being told by the MRC’s Joan Faulkner, that rather than withdrawn from the MRC’s trials, Beckenham 20 was never included. Clearly feeling uneasy by these contrasting narratives, Byrne again contacted the MRC looking for answers. According to a file not written by the MRC Medical Officer, D. J. Cawthorn,

Byrne wanted to know whether the ‘Beckenham 20 vaccine had “not at any stage been used in the current measles vaccine trial”’.70

Following Byrne’s request, Cawthron contacted Burroughs Wellcome’s Press Officer,

Basil Sanders, to discuss the ‘whole affair’.71 A note of the conversation between the two suggests media interest in the vaccine had been triggered by a private conversation between Sanders and the medical correspondent for Reader’s Digest, Don Everitt.

According to the MRC’s file note, Sanders ‘told’ Everitt that Beckenham 20 had been

68 Ibid. 69 TNA, FD 9/2448, E. Andrew, File Note, 27 November 1964. 70 TNA, FD 9/2448, D. J. Cawthron, File Note, 3 December 1964. 71 Ibid.

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‘withdrawn’ from the MRC’s trials.72 He believed the conversation was a ‘general (and confidential) chat’, and did not expect his remarks to be passed on to other journalists.73

It appears they had been. What followed was the meeting of an inquisitive journalist,

Alfred Byrne, with two different public relation machines, the MRC’s and Burroughs

Wellcome’s, leading to conflicting stories.

Rather than clarify the mysterious circumstances surrounding Beckenham 20’s disappearance, Burroughs Wellcome chose to remain quiet. Cawthron believed this silence had led to Byrne’s critical questioning: ‘In the course of our conversation it became clear our ‘stories’ coincide on all essential points’, explained Cawthron, ‘The conflicting information which Dr. Byrne is presenting us with now arises, I believe, from B.W.’s natural reluctance to accept (publicly) that their vaccine is not being used in this trial.’74 To avoid any further publicity issues, both parties came to a mutually beneficial arrangement: ‘Mr. Sanders and I agreed that for the future they would not touch any questions arising out of any trials undertaken under the Council’s auspices … but would refer any inquiries to this office. I told Mr. Sanders that we for our part would avoid if we possibly could giving reasons why the B.W. vaccine was not being used in our current trial.’75 Within the space of a couple of hours, this policy was being put into action. Responding on behalf of Joan Faulkner to another telephone call from

Dr Byrne, Cawthron communicated the party line:

I jumped in the deep end … and confirmed that “Beckenham 20 had not been used in the current trial”. He asked if it had been used in “part of it” and I said “No”. This satisfied him and he asked no more questions. I told Dr. Bryne that

72 Ibid. 73 Ibid. 74 Ibid. 75 Ibid.

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I wd. let you know we had spoken and ... if you felt you had anything to add to what I had said you could phone him… I added, however, that since he now “seemed satisfied” you would probably not think this necessary (unless you feel I was being less than honest in my answer to his supplementary question about “part of the trial”. It is of course arguable I suppose that Dr. Pollock’s “private” trial was not unconnected with the main trial now in hand).76

Cawthron’s discomfort at possibly being ‘less than honest’ illustrates the moral tensions behind the MRC’s attempts to manage the public’s understanding of the trial.77 Officials were anxious to avoid any controversy. In doing so, they attempted to construct a banal story of Beckenham 20’s exclusion that relied heavily on providing limited responses. It appears their efforts were successful. The real story behind Beckenham 20’s disappearance was not published by Byrne or any other national newspaper at the time.

Indeed knowledge was so restricted by the MRC that some newspapers continued to report the vaccine’s involvement in the trial. In January and February 1965, several local newspapers, including the Lincoln, Rutland and Stamford Mercury, the Monmouthshire Free

Press, the Stirling Observer, the Widnes Weekly News, the Cumberland Evening Star, the

Warrington Guardian, The New Daily, and The Recorder, all published stories of Beckenham

20’s successful rise and testing.78 While the public may have had little idea of

Beckenham 20’s more problematic history, inside the MRC headquarters the story would continue to leave uncomfortable traces which would need careful management.

76 TNA, FD 9/2448, D. J. Cawthron, File Note, 3 December 1964. 77 Ibid. 78 Anon., ‘Goodbye Measles!’, Lincoln, Rutland and Stamford Mercury, 29 January 1965; Anon., ‘Current Measles Epidemic May Be Britain’s Last’, Monmouthshire Free Press, 29 January 1965; Anon., ‘The Defeat of the Measles’, Widness Weekly News, 26 February 1965; Anon., ‘Vaccines May Make Measles Thing of Past’, Cumberland Evening Star, 27 January 1965; Anon., ‘The End of Measles’, Warrington Guardian, 19 February 1965; Anon., ‘New Vaccine’, The New Daily, 30 January 1965; Anon., ‘New Vaccine’, The Recorder, 13 February 1965.

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3.5 Lost in translation: The forgotten story of Wellcovax

Following the exclusion of Beckenham 20 from the MRC’s protection trial, Wellcome laboratories went back to work on developing a vaccine that was acceptable to British authorities. Through further processes of attenuation they worked on producing a vaccine potent enough to achieve long-term immunity, without causing an unacceptable level of reaction. The end result was Beckenham 31, later marketed as Wellcovax. While it was too late for Beckenham 31 to be entered into the MVC’s protection trial, there was plenty of opportunity to test the vaccine overseas, especially in places where measles was still a major cause of mortality. A report produced for the MRC’s Measles

Vaccines Committee in 1967 showed that by the late 1960s Beckenham 31 had been used in nineteen different investigations across the world, involving a total of over ten thousand children. In the space of just a couple of years, the vaccine had travelled far and wide; tested in Beckenham, Brazil, Canada, Ceylon, Cheshire, Chile, Egypt, Hong

Kong, Iran, Lebanon, Manchester, Nigeria, Philippines, Rhodesia, Singapore, South

Korea, Turkey and Uganda.79

Although these trials often produced varying results, they broadly showed that

Beckenham 31 was a qualified success. In particular, studies repeatedly demonstrated that the vaccine produced higher levels of antibodies than its competitors, an indicator of immunogenicity. The downside, however, appeared to be that Beckenham 31 also caused a higher number of reactions than its competitors, particularly in comparison to the Schwarz strain. A study carried out in Hong Kong in 1966, organised by the local authorities’ Measles Vaccine Committee, found a ‘statistically significant difference (1 %

79 TNA, FD 7/510, Measles Vaccines Committee, ‘Report on the Use of Wellcome Measles Vaccine – MV31’, 1967.

148 level) between the total complication rates for the two vaccines given by intramuscular injection’.80 When given intramuscularly, the Beckenham 31 strain was reported as causing symptoms in 82.2 percent of children, compared with the Schwarz strain that produced symptoms in 68.8 percent.81 In conclusion, the authors suggested ‘that either vaccine may usefully be given for measles prophylaxis’, but,

The choice between Beckenham 31, with a higher complication rate and higher antibody levels, and Schwarz, with fewer complications but lower antibody levels, would depend on the type of community, the adequacy of the medical services, the severity of measles and an assessment of how either vaccine, with its known complications, might affect other immunization programmes.82

In other words, it was for each country to decide on what was the most appropriate agent for them.

In early 1965, members of the MRC’s Measles Vaccines Committee recommended that

Beckenham 31 should be tested as part of the MRC’s protection trial.83 The plan was for

Beckenham 31, along with Glaxo’s live vaccine, to each be administered to 1000 children following an initial dose of Pfizer’s killed vaccine, allowing the two schedules to be compared. ‘The reason for doing this work’, Clements outlined, ‘was based on the assumption that the results were likely to show that the recommended procedure would be for a live vaccine to be preceded by a killed vaccine and, in these circumstances, it could be that the Wellcome vaccine might be more satisfactory than the Glaxo

80 Hong Kong Measles Vaccine Committee, ‘Comparative Trial of Live Attenuated Measles Vaccine in Hong Kong by Intramuscular and Intradermal Injection’ 36 (1967): 379. 81 Ibid. 82 Ibid., 383. 83 TNA, FD 7/509, MVC/27, Measles Vaccines Committee, 31 May 1965.

149 vaccine.’84 However, informed by his previous experience with Burroughs Wellcome’s

Beckenham 20, Clements was concerned that a change in trial design could lead to further unwanted press scrutiny. In a letter outlining the proposed change in design to the Measles Vaccines Committee Chairman, Wilson Smith, Clements warned Smith of the potential provocation it could cause: ‘This is entirely a scientific matter but as background I should explain that the Press got wind of the fact that Wellcome vaccine was not being included in the large survey and were only pacified with difficulty, so that a change in policy may have repercussions for which we should be fully prepared.’85

However, as I will examine later, any doubts about this ‘change in policy’ were banished following the disappointing interim results of the MVC’s protection trial.

Over the next three years, the MRC would organise several clinical trials to investigate the protective and clinical effects of administering the ‘less attenuated Wellcome live vaccine’ alone or in combination with a killed vaccine.86 Generally the results were considered positive. The protective effects of giving Beckenham 31 either alone or in combination with a killed vaccine compared favourably with those of Glaxo’s Schwarz strain. Although most studies did suggest that Beckenham 31 caused more side effects than its counterpart, – most notably a trial conducted in Southampton, which found that out of 361 children vaccinated with Beckenham 31, 80 suffered from ‘moderate’ side effects and 22 suffered from ‘severe’ side effects, more than double the number of

‘moderate’ (36) and ‘severe’ (7) side effects reported after using Glaxo’s strain – the

MRC’s Measles Vaccines Committee found both vaccines to be broadly ‘acceptable’.87

84 TNA, FD 23/1355, E. M. B. Clements, File Note, 5 February 1965. 85 TNA, FD 23/1355, E. M. B. Clements to Wilson Smith, 18 February 1965. 86 TNA, FD 7/509, MVC/27, Measles Vaccines Committee, 31 May 1965. 87 TNA, FD 7/510, Measles Vaccine Committee, ‘Comparison of Wellcome and Glaxo Measles Vaccines in Southampton’, 1967.

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Nevertheless, these trials had important limitations. Firstly, they were conducted on only a few thousand children, as compared with the 47,000 thousand children which took part in the MVC’s protection trial. Secondly, they rarely used a control group, meaning local variables potentially influencing the results went largely unnoticed. And finally, these trials remained unpublished. This meant that unlike the results of the

MRC’s protection trial, which would later be subjected to broad scientific and medical scrutiny, trials of Beckenham 31 were only seen and evaluated by a select group of MRC experts. Yet, despite the vaccine’s troubled experimental journey, its clinical and scientific history was rarely debated by policy makers, the medical profession or the media. This was a result, as I will argue below, of a broader washing away of the vaccine’s history from the MVC’s protection trial.

3.6 From ‘disappointing’ to ‘satisfactory’: The results of the MVC’s protection trial

Meanwhile, in January 1965, the MVC’s protection trial was drawing to its conclusion.

In anticipation of its completion, a number of newspaper correspondents started speculating on the Ministry of Health’s future policy. To the dismay of several MRC

Medical Officers, an article published in the Observer boldly stated: ‘THE measles epidemic sweeping towns and cities throughout the country is likely to be the last of its kind in Britain. The Ministry of Health is expected to give its blessing to general measles vaccinations for children before the end of the year.’88 However, despite this optimistic pronouncement, the results of the MRC’s protection trial would prove inconclusive.

Indeed, it raised as many questions as it did answers.

88 Anon., ‘Measles Jabs on the Way’, The Observer, 21 March 1965.

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On 20 April 1965, concerned about the pace at which the trial data was being processed, the CMO, George Godber, wrote to the MRC’s Secretary, Sir Harold

Himsworth. For both public health and political reasons Godber was anxious for the

Ministry’s main advisory committees to review the results as soon as possible.

According to Godber, ‘It would be disastrous to get recommendations to proceed which could not be put into effect until the early autumn by which time a schedule consisting of two injections would be too late.’89 After taking advice from the MRC’s

Principal Medical Officer, B. S. Lush, Himsworth was able to reassure Godber that the matter was in hand. In his response to Godber, Himsworth promised the CMO that information would be available in time for the Ministry’s Joint Committee on

Vaccination and Immunisation (JCVI) to make an early decision.90

Prepared in the space of just two months, the interim report of the MVC’s protection trial was presented at a meeting of the Committee, held on 31 May 1965. According to the minutes, organisers of the trial, Christine Miller and T. M. Pollock, were ‘anxious to emphasise that the data taken from the running returns and the final figures may differ appreciably from those in the report.’91 Just 8 pages long, it included a brief outline of the trial’s progress, along with a series of tables documenting participation, adverse reactions and short term protection.92 As Clements candidly commented in one MRC file note, ‘the present report was put together hurriedly and was interim and even tentative in nature, it was all that would be available for some considerable time and without a lot more work.’93 The report showed that out of approximately 47,000 participants, approximately 9,000 received a single dose of live vaccine, 11,000 received

89 TNA, FD 23/1355, George Godber to Harold Himsworth, 20 April 1965. 90 TNA, FD 23/1355, Harold Himsworth to George Godber, 20 April 1965. 91 TNA, FD 7/509, MVC/27, Measles Vaccines Committee, 31 May 1965. 92 TNA, FD 7/509, ‘M.R.C. Measles Vaccines Committee: Brief Progress Report on the Measles Vaccine Protection Trial’, 1965. 93 TNA, FD 7/509, E. M. B. Clements, File Note, 8 June 1965.

152 a combination of killed vaccine and live vaccine, and 16,000 were used as controls. A further 11,000 were recorded as defaulted. Although initial data suggested both vaccine schedules caused a significant number of ‘minor’ reactions, members appeared largely unconcerned.94 Attention focussed on the number of convulsions reported; 11 in the killed and live vaccine group, 25 in the live vaccine group and 31 in the unvaccinated group. According to the minutes, ‘It was agreed that, although a convulsion was not a serious episode in the life of a child at this age, the vaccine schedule giving the least number of convulsions was to be preferred.’95 More troubling for members, however, was the number of cases of measles reported in each vaccination group during the first three months of follow-ups. Preliminary data showed that a total of 290 cases of measles were reported in the live vaccine group and 252 cases in the killed and live vaccine group. While some of these cases may have been the result of misdiagnosis or vaccination, ‘the committee felt that the degree of protection was not as high as they expected from an affective vaccination schedule’, and suggested ‘that the Schwarz strain may be too attenuated to give solid immunity.’96 The committee agreed that further research was required. Firstly, they suggested organising a clinical trial using the ‘less attenuated Wellcome live vaccine’. Secondly, they suggested undertaking a series of clinical trials ‘with a view to eliminating measles in a few selected areas.’97

Concerns over the degree of protection produced by each vaccine were shared by members of the JCVI’s Measles Vaccination Sub-Committee. At a meeting held on 1

July 1965, members discussed the results of the MRC’s interim report.98 Members noted

94 TNA, FD 7/509, ‘M.R.C. Measles Vaccines Committee: Brief Progress Report on the Measles Vaccine Protection Trial’, 1965. 95 TNA, FD 7/509, MVC/27, Measles Vaccines Committee, 31 May 1965. 96 Ibid. 97 Ibid. 98 TNA, MH 154/63, Joint Committee on Vaccination and Immunisation Measles Vaccination Sub-Committee, ‘Minutes of Meeting held on Thursday, 1st July, 1965’, 1 July 1965.

153 that each vaccine schedule ‘conferred only about 75% protection during the first three months after vaccination’; a figure, which if accurate, could lead to tens of thousands of children each year remaining susceptible to measles.99 Immunologist George Dick, a critic of previous Ministry of Health vaccination policies, ‘said the figure was disappointing.’100 Frank Perkins, a strong supporter of measles vaccination, was equally gloomy. He shared the view of the MRC’s Measles Vaccines Committee that the

‘Schwarz live vaccine may have been too far attenuated.’101 In concluding, the Sub-

Committee ‘agreed that insufficient evidence was at present available on which to advise either a national vaccination campaign or local blanketing of large towns.’102 As well as recommending that further trials should take place using the ‘less attenuated live vaccines’, the Sub-Committee hoped more clarity would be provided by a fuller account of the MVC’s protection trial.103

Presented at a meeting of the MRC’s Measles Vaccines Committee held on 20 October

1965, the full report of the Committee’s protection trial provided readers with a far more positive outlook.104 The biggest change was the report’s depiction of the degree of protection offered by each vaccine schedule. The interim report had suggested that both vaccine schedules ‘conferred only about 75% protection’ against measles, the new report suggested this figure was actually around 85 percent. This improvement was not only due to the processing of more data, but a subtle change in the way the protection data was being analysed. Originally, all cases of measles, regardless of whether they had been diagnosed by doctors or parents, had been included in the analysis. This had led to

99 Ibid. 100 Ibid. 101 Ibid. 102 Ibid. 103 Ibid. 104 TNA, FD 7/509, ‘M.R.C. Trials of Measles Vaccines: Outline of Main Findings in the Protection Trial,’ October 1965; TNA, FD 7/509, MVC/32, Measles Vaccines Committee, 20 October 1965.

154 a relatively high number of measles cases being recorded for each vaccination group and subsequently a disappointing protection rate. In this new report, however, the definition changed to only include cases of measles seen and diagnosed by a general practitioner.

Two weeks later, on 4 November 1965, the report was discussed at a meeting of the

JCVI’s Measles Vaccination Sub-Committee. Held to examine the future of Britain’s measles vaccination policy, the report of the MVC’s protection trial took centre stage.

The meeting examined the safety and efficacy of both the combination of ‘live vaccine’ given after ‘killed vaccine’ or ‘live vaccine’ given alone.105 Members were informed by

David Evans that both vaccine schedules conferred a similar degree of protection, although the combination of killed vaccine followed by live vaccine appeared to cause fewer reactions. However, while the results of the protection trial proved ‘satisfactory’, they failed to persuade members to advocate a national vaccination campaign against measles.106 A number of important questions still remained unanswered. How long was the duration of protection conferred by each vaccine schedule? How effective were they at eliminating disease? And how popular were they amongst parents and practitioners?

In particular, Ministry advisors were concerned about the long-term impact of measles vaccination on the collective health of the nation. If unsuccessful, either due to the efficacy of the vaccine, or its unpopularity, a vaccination campaign risked leaving thousands of children susceptible to measles, and as a result transforming the disease into a condition of adult life, something believed to be far more dangerous. At this stage, the MRC’s protection trial did not provide enough reassurance to reconcile

Ministry fears of a dystopic future. Following further debate, members agreed that although ‘the M.R.C. trial had shown that the vaccine schedules used were effective and

105 TNA, MH 154/63, Joint Committee on Vaccination and Immunisation Measles Vaccination Sub-Committee, ‘Minutes of Meeting held on Thursday, 4th November, 1965’, 4 November 1965. 106 Ibid.

155 acceptable’, due to ‘insufficient information’, a national campaign was deemed premature.107 Instead, members recommended that measles vaccines should be made available to those parents and practitioners wishing to vaccinate individual children and that a series of community based programmes should be established by the MRC to examine: 1. the effect of a campaign aimed at schoolchildren; 2. the popularity of the vaccines; and 3. the use of a ‘mixed prophylactic’.108

Curiously, one subject that was not discussed at the meeting was that of Burroughs

Wellcome’s live measles vaccines. According to the minutes, there was no discussion concerning the different forms of live vaccine used in the trial. Members did not examine Beckenham 20 or Beckenham 31’s non-inclusion in the trial, or Beckenham

31’s unique clinical research history. Indeed, despite its subsequent approval, it appears the vaccine’s troubled experimental journey was not discussed at all. As MRC officials prepared to present the results of their trial to the medical profession and the public, this was one of several uncomfortable aspects of the trial, which would need careful managing.

3.7 Telling a bland story: Publicising the results of the MVC’s protection trial

As we have seen throughout the story of the MVC’s protection trial, MRC officials and organisers attempted to direct the public narrative. Administrators and practitioners were under strict instructions not to discuss the details of the study with the public or the media. Consent forms, press releases and private meetings, were all designed to

107 Ibid. 108 Ibid.

156 control how the trial was perceived. Official correspondence walked a tight line between promoting the trial and managing public expectations. Crucially, it was about managing, or indeed preventing, public controversy. This construction of a more benign story of the trial now shaped MRC efforts to publicise its results. Key to the MRC’s success were the Council’s close relationships with the medical press, national media and the pharmaceutical industry.

Following the JCVI’s recommendation to allow the use of measles vaccination on an individual basis, attention turned within the Ministry of Health towards matters of publicity. After some debate, Ministry officials decided that information should be sent in two forms. Firstly, a circular should be sent to local health authorities advising them on the nature of the Ministry’s decision and the various options available to them in their local community. Secondly, a ‘Dear Doctor’ letter should be sent to general practitioners providing them with information on the nature and use of each individual vaccine schedule. Importantly, the Ministry was anxious to avoid any perception that their position amounted to ‘official encouragement’ of measles vaccination.109

Conscious that the manufacturers would begin their own advertising campaigns as soon as they became aware of the Ministry’s decision, officials believed it was important to prepare their information ‘as soon as possible’.110 However, this was far from an insignificant undertaking. Letters had to be drafted and reviewed internally. They then had to be sent out and reviewed by a number of external medical authorities. Finally, they needed to be signed off by the Minister. Increasingly aware that this could not be achieved before manufacturers started to distribute their own advertising material,

109 TNA, MH 154/135, A. T. Roden, File Note, ‘Vaccination Against Measles’, 19 November 1965. 110 TNA, MH 154/135, H Herzmark, File Note, 11 November 1965.

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Ministry officials began to look for solutions. One idea was to seek help from the manufacturers themselves. As one official noted, ‘There is … a danger that the vaccines may come on the market before we are ready …, unless we can agree informally with the manufacturers on a date of release that will suit us both. Fortunately we understand that they would be very ready to discuss this, and the nature of advice to be put out by them.’111 At a meeting held on 31 December 1965, which included representatives from the Medical Research Council, the Government’s various health departments, and the three main manufacturers, Glaxo, Wellcome and Pfizer, industry representatives agreed not to place measles vaccines on the British market until the end of February 1966.112

Importantly, this would not only give the Ministry of Health time to prepare their own material, but also allow the MRC’s Measles Vaccines Committee time to control the release of their own report.

In January 1966, in anticipation of the Chief Medical Officer’s announcement, members of the MRC’s Measles Vaccines Committee prepared their final report for publication.

Concerned that the results were already being discussed in the national press, Frank

Perkins asked Clements to review the final draft as quickly as possible.113 As a member of staff at the MRC’s head office, Clements saw things from both a scientific and political perspective. In reading the report, he was as much interested in some of the more morally and politically provocative aspects of the study as he was with the quality of the scientific analysis. After reviewing the final report, Clements sent Perkins a list of suggested changes. Clements wanted the report to give a clearer explanation of some of the more contentious aspects of the study. These included: an explanation as to why

111 TNA, MH 154/135, File Note, ‘Measles Vaccination’, 15 December 1965. 112 TNA, MH 154/135, ‘Note of Main Points Arising out of Discussion with Representatives of the Manufacturers, the Medical Research Council and Health Departments on the Forthcoming Issue of Measles Vaccine’, 31 December 1965. 113 TNA, FD 9/2449, Frank Perkins to E. M. B. Clements, 25 January 1966.

158 only children between the ages of ten months and two years had been selected; an acknowledgement that parents were made fully aware that not all children who participated in the trial would be vaccinated; and a note on the relevance of a personal or family history of convulsions to decisions over future vaccination policies.114

Perhaps Clements’ biggest concern, though, was the potential of the report to stimulate a re-opening of Beckenham 20’s buried history. In particular, Clements was worried about the report’s opening passage, which made specific reference to the MRC’s first trial, and its use of two live measles vaccines. The draft stated: ‘During the early part of

1964 a trial of measles vaccines was made in Britain under the auspices of the Medical

Research Council's Measles Vaccines Committee. About 300 children took part and four vaccination schedules were used involving two different live attenuated vaccines and one inactivated (killed) vaccine’.115 While the opening passage made no specific reference to the different commercial strains used, Clements was concerned that making any reference to the MRC’s first trial, and the use of ‘four schedules’, would draw unwanted attention to the difference with their current trial and its non-inclusion of

Burroughs Wellcome’s live vaccine.116 His suggestion was to construct a more banal introduction. ‘At one stage this was a “hot” topic’, wrote Clements, ‘and I suggest that we pass this over, if possible, and do not specifically remind people of the difference by the detailed reference to the earlier report. I suggest that the introduction is reduced along the lines suggested in Appendix A, and that we blandly state, as you have done, that the attenuated vaccine used was Glaxo.’117 Removing any trace of Beckenham 20’s controversial past, Clements proposed changing the opening paragraph to ‘blandly’ read: ‘The report of this first investigation of measles vaccination stated that a further

114 TNA, FD 9/2449, E. M. B. Clements to Frank Perkins, 25 January 1966. 115 TNA, FD 9/2449, ‘Vaccination Against Measles’, 1966. 116 TNA, FD 9/2449, E. M. B. Clements to Frank Perkins, 25 January 1966. 117 Ibid.

159 and larger trial of the long-term protective effect of measles vaccines was being undertaken in children aged from 10 months to two years of age.’118 Perkins, however, did not agree; apart from editing the punctuation, he made no changes to the opening passage.

On 19 February 1966, the MRC’s Measles Vaccines Committee report was published in the BMJ. Wary of the public’s growing interest in the subject of measles vaccination,

MRC officials carefully managed the report’s release. In order to control the way the report was narrated by the media, MRC officials took the unusual step of issuing a press notice. According to one MRC official, ‘it would be desirable to raise a press release – with the necessary embargo – before the Measles Vaccine Trial Report appears in the

BMJ; … there have already been a number of premature and inaccurate press reports on this subject and a factual statement should be helpful in preventing further misrepresentation.’119 Importantly, this would not only inform readers, but aid MRC and

Ministry of Health staff in managing potential public enquires. As Joan Faulkner explained in a letter seeking the permission of the BMJ’s Dr Stephen Lock, ‘It would be of the greatest assistance to our staff here if such a release were to be issued, because we know from experience that there is a very great deal of public interest in the subject of measles vaccination. To be able to refer to a press release greatly lightens the load of those who have to deal with large numbers of telephone enquiries.’120

The BMJ were happy to oblige; however, in reviewing the press release its reviewers noticed ‘that the statement in the last paragraph was contradictory’ to the final

118 Ibid. 119 TNA, FD 9/2449, File Note, 8 February 1966. 120 TNA, FD 9/2449, Joan Faulkner to Stephen Lock, 16 February 1966.

160 statement made in the MRC’s report.121 This was indeed true. The final statement made in the Measles Vaccines Committee’s report presented readers with a largely optimistic view of the trial’s results. According to the report, ‘no matter which procedure is chosen it is clear from the results of this trial that vaccination, if done on a large scale, could produce a substantial reduction in the incidence of measles in this country. Such a reduction would undoubtedly lighten the burden placed on family doctors and parents’.122 However, in contrast to the report, the final statement made in the MRC’s press notice was far more restrained. Providing the reader with a more cautious tone, the press notice stated: ‘It emerges from the trial that vaccination confers a substantial degree of protection against the disease but it must be noted that there is no information yet on the duration of immunity induced by the vaccine procedures studied. Such information should become available when the children in the trial have been followed up for a further period.123’

While there is no evidence of direct intervention on the part of the Ministry of Health, the MRC’s attempt to rewrite the trial’s conclusion through its press notice undoubtedly aligned with the Ministry’s political interests. Following the JCVI’s recommendation,

Ministry officials were concerned they would be heavily criticised for not supporting an immediate national campaign. Any publicity material perceived to be too enthusiastic towards measles vaccination was deemed a threat to maintaining their position. Hence, they were particularly concerned by the positive statement made in the MRC’s report.

As Godber remarked in a Ministry note, ‘In view of the last few sentences we may well come under attack for not providing for measles vaccination of everyone we can

121 TNA, FD 9/2449, Joan Faulkner, File Note, 17 February 1966. 122 Medical Research Council Measles Vaccines Committee, ‘Vaccination Against Measles: A Clinical Trial of Live Measles Vaccine Given Alone and Live Vaccine Preceded by Killed Vaccine’, British Medical Journal 1 (1966): 446. 123 TNA, FD 9/2449, ‘Vaccination Against Measles: Medical Research Council Report’, February 1966.

161 persuade to be vaccinated before the next epidemic.’124 Seen within this frame, the

MRC’s press notice, and its attempt to lower public expectations, can be seen as another attempt to manage the Ministry’s political anxieties. As Joan Faulkner noted, while ‘it was too late’ to change the MRC’s report, ‘we must hope that journalists use the release rather than quoting from the paper itself.’125

Timed to be released the day before the MRC’s report was set to be published by the

BMJ, the press notice gave interested journalists the central narrative of the study.126 On the surface it was a balanced representation. It described the process of recruitment, the frequency of reactions, the rate of protection demonstrated by both vaccine schedules, and the need for further research. However, read from an alternative perspective, the statement can be seen as another attempt to construct banality. Firstly, in offering no detailed account of the enrolment procedure, in particular details of the morally contentious consent form, the press notice avoided drawing attention to questions of experimental ethics. Secondly, while the statement presented the frequency of reactions, it presented very little information concerning their nature. Reports of children suffering from ‘loss of appetite, vomiting, disturbed sleep, malaise, rash, fever, respiratory symptoms, and diarrhoea’ were described in the report, but not in the press release.127 Finally, in reducing the identity of the vaccines to a ‘live vaccine’ or an

‘inactivated (killed) vaccine’, readers were given no indication that Glaxo’s Schwarz strain was the only live vaccine used in the trial, and more importantly, were given no indication that Burroughs Wellcome’s Beckenham 20 had been withdrawn, or that their

124 TNA, MH 154/135, George Godber, File Note, 8 February 1966. 125 TNA, FD 9/2449, Joan Faulkner, File Note, 17 February 1966. 126 TNA, FD 9/2449, ‘Vaccination Against Measles: Medical Research Council Report’, February 1966. 127 Medical Research Council Measles Vaccines Committee, ‘Vaccination against Measles’, 443.

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Beckenham 31 vaccine had been developed too late to be included.128 Read through the representation of the MRC’s press notice, the MVC’s protection trial was an administrative, moral and scientific success.

Illustrating just how seriously MRC Medical Officers were taking the trial’s public relations, in anticipation of some potentially ‘awkward’ questions from the media following the reports publication, Clements produced a set of pre-prepared notes, which MRC administrative staff could quickly draw upon when needed.129 The notes dealt with many of the central scientific, ethical and politically provocative issues. They provided staff with guidance on how to answer questions concerning the non-inclusion of Beckenham 31, the age of participants, the ethics of a controlled trial, the nature of convulsions, the degree and duration of protection, and the number of adverse reactions reported (see Figure 5).130 The notes were bland in tone, purposefully presenting a seemingly unproblematic picture of the study.

128 Ibid. 129 TNA, FD 9/2449, E. M. B. Clements, File Note, 8 February 1966. 130 TNA, FD 9/2449, ‘Possible Questions Which May Follow on the Publication of the Measles Vaccines Committee Report on the Clinical Trial, 1964/65’, 1966.

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Figure 5. Notes to aid Medical Research Council staff when answering questions about the Measles Vaccines Committee’s protection trial. Source: TNA, FD 9/2449, ‘Possible Questions Which May Follow on the Publication of the Measles Vaccines Committee Report on the Clinical Trial, 1964/65’, 1966.

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Given their importance to the trials representation, the first three bullet points are worth examining in more detail. They demonstrate the way MRC Medical Officers attempted to construct an uncontroversial image of the trial. This was achieved not only by writing a story, but by controlling how that story was told. The first bullet point on the handout prepared staff for any questions concerning the subject of Burroughs

Wellcome’s non-inclusion in the trial. Again providing the user with a ‘blandly’ written narrative, the handout suggested stating: ‘only the Glaxo vaccine was used as Burroughs

Wellcome, who had … been invited to participate, were unable to meet the deadline.’131

The second prepared staff for any questions concerning the age of participants. In doing so, it presented the decision to use ‘Children between the ages of 10 and 24 months’, as one not influenced by pragmatic and marketing concerns over the bleeding of school children, as it had been originally portrayed by trial organisers, but as an ethical decision, based on what was most beneficial and least harmful for the individual child.132 Finally, the third bullet prepared staff for any difficult questions concerning the use of a controlled group. Similar to previous marketing material, this decision was presented not as a moral or scientific choice by trial organisers, but as an inevitable consequence of there being ‘limited’ vaccine supplies.133 Once signed off, Clements suggested that all three companies involved should be sent a copy of the handout;

Glaxo and Pfizer because their products were being tested, and Burroughs Wellcome,

‘so that they can consider how best to answer why they were not included.’134 The hope was that the MRC, the manufactures and the media would all align to tell one story.

How much the MRC’s management of the media actually influenced subsequent public representations of the trial is debatable, however, a batch of press cuttings received the

131 Ibid. 132 Ibid. 133 Ibid. 134 TNA, FD 9/2449, E. M. B. Clements, File Note, 8 February 1966.

165 day after the MRC’s report was published, showed most articles following the MRC’s press notice.135 An article published in the Daily Telegraph, under the heading ‘Measles

Vaccination Available Soon’, explained to readers, that while the trial had proven a success, ‘further inquiries’ were necessary.136 Referring directly to the MRC’s press release, the health services correspondent for the Daily Telegraph, John Prince, wrote, ‘“It emerges from the trial,” says the report, “that vaccination confers a substantial degree of protection.” But whereas an attack of measles gives life-long immunity, “there is no information yet on the duration of immunity induced by the vaccine procedures studied.”’137 Articles highlighted the ‘85 per cent’ protection rate, the frequent, but ‘mild’ nature of reactions, and the need for ‘more research’.138 Articles rarely discussed in detail the age of participants, the ethics of the trial, and the nature of convulsions. As one

MRC official noted, ‘I have had a number of enquiries on this subject from various provincial newspapers but none of these have presented any difficulty’.139

Most importantly, Clements worst fears never materialised, as the subject of Burroughs

Wellcome’s Wellcovax was not discussed. Articles did not examine the subject of

Beckenham 31 or Beckenham 20’s non-inclusion in the trial, nor their unique scientific and clinical histories. Instead, like the press notice, they referred to a ‘live’ vaccine and a

‘killed’ vaccine.140 This invisibility was reinforced by information sent to GPs following

135 James Wilkinson, ‘Measles Vaccine Works for 85 in 100’, Daily Express, 18 February 1966; Anon., ‘Go-Ahead on Measles Jab’, Daily Mirror, 18 February 1966; Anon., ‘Vaccines Beat Measles’, Sheffield Morning Telegraph, 18 February 1966; Michael Jeffries, ‘Away Those Spots! New Measles Vaccine Gives Protection’, The Evening News, 17 February 1966; Ronald Bedford, ‘Warning to Doctors on Measles Vaccine’, The Sun, 18 February 1966; Anon., ‘Vaccines Break Grip of Measles’, The Guardian, 18 February 1966; Anon., ‘Vaccines Cuts Down Measles Cases’, The Times, 18 February 1966. 136 John Prince, ‘Measles Vaccination Available Soon.’, The Daily Telegraph, 18 February 1966, 17. 137 Ibid. 138 Ibid. 139 TNA, FD 9/2449, File Note, 18 February 1966. 140 Wilkinson, ‘Measles Vaccine Works for 85 in 100’; Anon., ‘Go-Ahead on Measles Jab’; Anon., ‘Vaccines Beat Measles’; Jeffries, ‘Away Those Spots! New Measles Vaccine Gives

166 the Chief Medical Officer’s announcement. The Ministry’s ‘Dear Doctor’ letter, designed to provide general practitioners with the latest information regarding the soon to be released measles vaccines, presented a reductive narrative.141 The letter described the protective and clinical effects observed during the MRC’s ‘protection trial’ of an

‘inactivated’ vaccine – reduced to the symbol ‘K’ – and a live attenuated vaccine – reduced to the symbol ‘L’.142 The letter stated:

The Joint Committee on Vaccination and Immunisation … has considered the findings in the Medical Research Council’s protection trial … and has concluded that an injection of killed measles vaccine followed four weeks later by an injection of live measles vaccine (K + L) or one injection of live measles vaccine given alone (L) are effective and acceptable immunising procedures.143

In making no reference to what the letters L and K represented, the complex histories of each commercial strain disappeared from view.

With no open discussion of the problems which had affected the MVC’s protection trial, and the media largely following the MRC’s official line, the trial increasingly gained in authority and legitimacy. A BMJ review of the trial triumphantly stated: ‘The Measles

Vaccines Committee of the Medical Research Council is to be congratulated on the organization of the large-scale… It is an excellent example of the collaboration which can be achieved for work of this kind between the Medical Research Council, the Public

Health Laboratory Service, medical officers of health, and general practitioners.’144

Protection’; Bedford, ‘Warning to Doctors on Measles Vaccine’; Anon., ‘Vaccines Break Grip of Measles’; Anon., ‘Vaccines Cuts Down Measles Cases’. 141 TNA, MH 154/64, George Godber to Medical Practitioners, ‘Vaccination Against Measles’, 21 February 1966. 142 Ibid. 143 Ibid. 144 Anon., ‘Vaccination Against Measles’, British Medical Journal 1 (1966): 435.

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Importantly, this view of the trial, as a scientific and administrative success, would not only inform the public and medical profession’s imagination, but would also influence the minds of those charged with determining national vaccination policy. Despite its limitations, as the JCVI’s Measles Vaccination Sub-Committee prepared for their meeting to decide on the future use of measles vaccination in Britain, this trial would come to represent medical truth.

3.8 Making measles vaccination policy

The meeting to decide the ‘Future use of measles vaccines in the United Kingdom’ took place on 13 November 1967.145 According to the meeting’s agenda, members of the

JCVI’s Measles Vaccination Sub-Committee were asked to discuss three papers: a summary of the latest research regarding measles vaccination in Britain and the US; the latest report of the MVC’s protection trial; and a preliminary report of the MRC’s investigation into the effect of ‘blanketing a local area’.146 Despite repeated pronouncements that the Sub-Committee’s decision would be based on ‘further research’, particularly ‘community’ based studies, their decision largely came down to an uncritical reading of the MVC’s protection trial.147

At the meeting, members began by listening to a summary of the latest report of the

MVC’s protection trial. Presented by Dr Ian Sutherland, the report showed that both vaccine schedules – live vaccine administered alone and live vaccine administered after

145 TNA, MH 154/64, Joint Committee on Vaccination and Immunisation Measles Vaccination Sub-Committee, ‘Minutes of Meeting held on Monday, 13th November, 1967’, 13 November 1967. 146 TNA, MH 154/64, Joint Committee on Vaccination and Immunisation Measles Vaccination Sub-Committee, ‘Agenda’, November 1967. 147 TNA, MH 154/63, Joint Committee on Vaccination and Immunisation Measles Vaccination Sub-Committee, ‘Minutes of Meeting held on Thursday, 4th November, 1965’, 4 November 1965.

168 an initial dose of killed vaccine – continued to produce a high rate of protection following a second epidemic. However, unlike the Committee’s first report, which had shown that both vaccine schedules produced a similar rate of protection, the

Committee’s second report showed that the rate of protection produced in the live vaccine group was 95 percent, compared with 89 percent in the killed/live vaccine group. According to the minutes, two of the trial’s organisers, Frank Perkins and T. M.

Pollock, believed the ‘figures gave a very gratifying result.’148

Less gratifying, however, were the results of the MRC’s blanketing trials. Designed to evaluate the effectiveness of administering measles vaccines across a wide population, a

‘disappointing’ public response to the trials meant that out of a total of eight regions involved ‘the only helpful information’ available to members came from a study carried out in Oxford.149 The report, a 2 page extract of a paper published by Dr J. F. Warin in the Royal Society of Health Journal, showed how the combination of giving live vaccine, after an initial dose of killed vaccine, had significantly cut the number of measles notifications in the city during 1967.150 According to the minutes, ‘it was generally considered that, taken in conjunction with the Medical Research Council’s results and those of the U.S.A., the Oxford figures strongly suggested that the reduced incidence of measles in the City was due to vaccination.’151 Studies carried out in Bedford, Bristol,

148 TNA, MH 154/64, Joint Committee on Vaccination and Immunisation Measles Vaccination Sub-Committee, ‘Minutes of Meeting held on Monday, 13th November, 1967’, 13 November 1967. 149 TNA, FD 7/510, MVC/44, Measles Vaccines Committee, 8 May 1967; TNA, MH 154/64, Joint Committee on Vaccination and Immunisation Measles Vaccination Sub-Committee, ‘Minutes of Meeting held on Monday, 13th November, 1967’, 13 November 1967. 150 TNA, MH 154/64, ‘Extract from the Royal Society of Health Journal – September/October 1967 Article by J. F. Warin on Routine Measles Vaccination as a Community Health Measure, page 266, Addendum’, 1967. 151 TNA, MH 154/64, Joint Committee on Vaccination and Immunisation Measles Vaccination Sub-Committee, ‘Minutes of Meeting held on Monday, 13th November, 1967’, 13 November 1967.

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Cardiff, Kingston upon Hull, Leicestershire, Newcastle upon Tyne and Southampton were not reviewed at the meeting, and remained unpublished.152

Members then went on to discuss the ‘future use of measles vaccines’ in Britain.153 The

Chairman, Sir Wilfred Sheldon, began by asking ‘the Sub-Committee to consider whether a national campaign for vaccination against measles should not be launched.’154

Based on their experience of organising the MVC’s protection trial, both Miller and

Pollock had some doubts over the popularity of the vaccine. Miller noted concerns over the ‘duration of immunity being unknown.’155 Pollock agreed, and added that ‘some doctors still regarded measles as a mild disease for which protection by vaccination was not necessary.’156 Whilst George Dick was not opposed to a national campaign, he believed a ‘selective campaign’ might be more appropriate.157 In terms of the most effective schedule, most members preferred the option of administering just a single dose of live vaccine. This was not only based on the immunogenic and pragmatic advantages of the schedule, but was also based on concerns coming from the US regarding the safety of killed vaccines. In the end the decision was ‘unanimous’.158 Based on the ‘gratifying’ results of the MVC’s protection trial, the Sub-Committee

‘recommended that all children from one year of age upwards who had not had measles and had not been vaccinated against measles should be offered live attenuated measles vaccine’.159

152 TNA, FD 7/510, ‘Investigation of Intensive Measles Vaccination’, 1967. 153 TNA, MH 154/64, Joint Committee on Vaccination and Immunisation Measles Vaccination Sub-Committee, ‘Minutes of Meeting held on Monday, 13th November, 1967’, 13 November 1967. 154 Ibid. 155 Ibid. 156 Ibid. 157 Ibid. 158 Ibid. 159 Ibid.

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However, in making their decision, members did not discuss any of the limitations with the MVC’s protection trial. Important debates, which had previously framed the interpretation of the trial, such as the small age range of participants, the nature and frequency of adverse reactions, and the community effect of vaccination, largely disappeared. As important as these subject were, arguably, the most notable absence from discussions, (and one that would later cause some moral and political discomfort within the Ministry of Health), was the subject of Burroughs Wellcome’s Wellcovax.

According to the minutes, members did not discuss Wellcovax’s non-inclusion in the

MVC’s protection trial, or Wellcovax’s problematic scientific and clinical research history. The subject had been reviewed at a recent meeting of MRC’s Measles Vaccines

Committee, however, for some unexplained reason, members had ‘agreed’ not to send the report of its evaluation to the Sub-Committee meeting; a report, which again demonstrated the vaccine’s immunogenic qualities, but also its susceptibility to produce more ‘moderate’ and ‘severe’ reactions.160 Considering that the vaccine was one of only two live vaccines currently being procured by the Ministry of Health, there was remarkably little evaluation of its effects. The only report that specifically mentioned the vaccine was Dr Warin’s account of the Oxford study. However, the study did not examine the effects of giving Wellcovax alone, and did not include any information concerning the safety of the vaccine. Undoubtedly, some members will have been familiar with the research history of Burroughs Wellcome’s live measles vaccines, particularly those who also sat on the MRC’s Measles Vaccines Committee, but the subject was curiously absent from discussions. An illustration of just how much the

MRC’s protection trial had come to represent medical truth, this lack of debate concerning the trial’s limitations would have long lasting consequences. In the

160 TNA, FD 7/510, MVC/44, Measles Vaccines Committee, 30 October 1967; TNA, FD 7/510, Measles Vaccine Committee, ‘Comparison of Wellcome and Glaxo Measles Vaccines in Southampton’, 1967.

171 meantime, it was this representation of the trial as a scientific and administrative success that would take centre stage as the Ministry of Health announced the beginning of

Britain’s first measles vaccination campaign.

3.9 Black boxed: The MVC’s protection trial

On 6 February 1968, the Minister of Health, Kenneth Robinson, announced the beginning of Britain’s vaccination campaign against measles. Carefully orchestrated by

Ministry of Health officials, planning for the announcement of the Ministry’s decision began within weeks of the JCVI’s recommendation. Towards the end of November a group of Ministry officials met to discuss the ‘publicity arrangements’.161 Amongst a number of proposals put forward, officials believed a Prime Minister’s Question and an early press conference was essential to controlling the public narrative. As Philip

Muston noted in his record of the meeting, ‘This would secure national coverage for the new vaccination, both by the press and the broadcasting organisations and would forestall the “leaking” of information, possibly garbled, to a few correspondents only.’162

At the press conference itself, as well as listening to Robinson’s speech, journalists were presented with a set of prepared questions and answers, intended to guide the reader through the Ministry’s decision.163 At the same time, Robinson himself was provided with his own set of prepared notes, intended to guide him through any difficult questions posed by the media. Marked ‘Not to be distributed at press conference’, these

161 TNA, MH 154/529, Philip Muston, File Note, ‘Measles Vaccination: Publicity’, 24 November 1967. 162 Ibid. 163 TNA, MH 154/529, ‘Measles Vaccination: Some Questions and Answers’, 1968.

172 notes, like the press conference itself, were designed to achieve scientific and political closure, rather than stimulate wider debate.164

At the press conference announcing the decision, Robinson gave an account of the decision making process which had been carefully crafted by Ministry of Health officials: ‘Having received advice from the Joint Committee on Vaccination and

Immunisation to the effect that extensive trials carried out by the Medical Research

Council show that measles vaccination gives effective protection to the vast majority of the children so vaccinated’, stated Robinson, ‘it seems right to me that we should add measles vaccination to the immunisation procedures we already employ to protect our children against infectious diseases.’165 Drawing on the results of the Public Health

Laboratory Service survey, Robinson then presented the Ministry’s case for the necessity of vaccinating against measles. In particular, he noted that out of every thousand notified cases of measles, 38 patients developed pneumonia, 25 otitis media and 4 neurological disturbances. ‘All this clearly adds up to a great burden of illness and worse,’ declared Robinson, ‘causing family distress and placing a great load on the material and manpower resources of the general medical services, the general pharmaceutical services and the hospital services of the National Health Service.’166

Again, highlighting the importance of expertise in the decision making process,

Robinson concluded: ‘That is why I welcome the evolution of this effective vaccine and the authoritative recommendation for its use I have received from the Joint Committee

164 TNA, MH 154/529, ‘Additional Possible Questions and Answers: Not to be Distributed at Press Conference’, 1968. 165 TNA, MH 154/529, ‘Vaccination Against Measles: Minister’s Opening Remarks at Press Conference’, 6 February 1968. 166 Ibid.

173 on Vaccination and Immunisation, a distinguished body of doctors and scientists under the Chairmanship of Lord Cohen of Birkenhead.’167

Presented as an archetypal example of evidence-based policy making, the Ministry’s announcement on Britain’s measles vaccination policy can also be seen as the final act in the State’s decade long narration of the MVC’s protection trial. Like those previous scenes, the representation of the trial was carefully managed. Both during the Ministry’s press conference, and in a series of publications which followed it, the trial was presented as an unproblematic scientific success, an image of the trial that was used to sell measles vaccination to medical practitioners, parents and children across Britain (see

Figure 6). For example, on 8 April 1968, a letter signed by the CMO George Godber was sent out to all general practitioners informing them of the details of the Ministry’s decision. Godber’s letter made it perfectly clear why the decision had been taken: ‘The present recommendations … are based on the second report to the Medical Research

Council by the Measles Vaccines Committee, of a clinical trial of live measles vaccine given alone and live vaccine preceded by killed vaccine (shortly to be published).’168 In making no reference to the trial’s problems and limitations, Godber represented the trial as an unproblematic scientific success; an image that concealed a much more complex reality. Now summarised in a single line, or referred to in a footnote, the trial had achieved the status of an uncomplicated scientific truth; a complex social history of controversy, contingency and uncertainty had entirely disappeared.

Perhaps the most notable disappearance was the subject of Burroughs Wellcome’s

Wellcovax. Now one of only two live vaccines procured by the Ministry of Health, the

167 Ibid. 168 TNA, MH154/136, Godber to the Medical Profession, 8 April 1968.

174 story of its non-inclusion in the MVC’s protection trial was not discussed in any of the

MRC’s or Ministry of Health’s publicity material. Indeed, the subject was all together avoided in the MRC’s second report of the trial. Published in the BMJ on 25 May 1968, the second report of the MVC’s ‘Clinical Trial of Live Measles Vaccine Given Alone and Live Vaccine Preceded by Killed Vaccine’ continued to mask a well-kept secret.169

The prosaic language of the first paragraph concealed a more problematic past. In contrast to the opening statement made in the Committee’s first report, the opening statement made in their second made no mention of the MRC’s first trial, and its use of

‘two different live attenuated vaccines’.170 In erasing any link between this trial and the

MRC’s first, something E. M. B. Clements had asked for in the original report, the second report of the MRC’s Measles Vaccines Committee finally severed the trial’s ties with the uncomfortable history of Burroughs Wellcome’s live measles vaccines. Future reports would continue to obscure this past. The issue of Wellcovax’s non-inclusion in the MVC’s protection trial, like a number of other issues the trial had faced along the way, would never become the source of public debate.

169 Medical Research Council Measles Vaccines Committee, ‘Vaccination Against Measles: Clinical Trial of Live Measles Vaccine Given Alone and Live Vaccine Preceded by Killed Vaccine. Second Report to the Medical Research Council by the Measles Vaccines Committee.’, British Medical Journal 2 (1968): 449–52. 170 Medical Research Council Measles Vaccines Committee, ‘Vaccination against Measles’, 441.

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Figure 6. The front cover of the Ministry of Health’s 1968 measles vaccination leaflet: ‘Now your Child can be Vaccinated Against Measles’. Source: TNA, MH 154/529, ‘Now your Child can be Vaccinated Against Measles’, 1968.

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3.10 Conclusion

Through charting the history of the MVC’s protection trial, this chapter has examined the way MRC Medical Officers mediated public perceptions of the trial and its meaning.

MRC Medical Officers not only attempted to present the trial as a morally, politically and scientifically legitimate act, but as the interconnected stories of Beckenham 20 and

Beckenham 31 illustrate, they also wanted to represent it as an uncontroversial one.

Similar to accounts of representations of other notable trials from the period, such as

Stephen Mawdsley’s account of the polio gamma globulin trials carried out in the US during the 1950s, representations of the MRC’s trial were designed to sell the study to parents, practitioners and policymakers; an endeavour, which like Mawdsley’s own story, ultimately led to moments of deception.171 As I have argued, this was achieved through various means. By maintaining the privacy of the committee room, defusing potential controversies and presenting a banal story, MRC officials were able to control the public narrative of the trial, leaving little or no trace of internal tensions. Newspaper and medical correspondents, reliant on official statements for their stories, presented a largely uncritical picture. A condition reinforced by a feeling of trust that existed at the time for what were largely celebrated institutions.

Such power, however, had moral and epistemological costs. In particular, it limited wider scientific and political engagement. Over time, the consequences of this lack of wider public and professional scrutiny would become apparent, as previously unresolved issues would become a source of growing concern for experts advising the newly formed Department of Health and Social Security (DHSS). While the ideal age, schedule and eligibility criteria for vaccination would all become subjects of future

171 Mawdsley, Selling Science.

177 debate, it would be the issue of Burroughs Wellcome’s Wellcovax, which would cause the most immediate discomfort for government officials. As I will argue in the next chapter, as concerns around the safety of Wellcovax began to grow, this control of

‘risky’ knowledge would continue to be an important practice in both the state’s management of medical risk and the prevention of medical controversy.

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Chapter 4: Making Wellcovax Disappear

4.1 Introduction

As the Ministry of Health (soon to become the Department of Health and Social

Security) prepared to launch Britain’s first national vaccination campaign against measles, there was a belief amongst some that the end of measles was in sight. The Daily

Express drew comparisons with past medical conquests, declaring that: ‘the complaint should quickly join polio, diphtheria, and smallpox as an infection which most doctors never encounter in a lifetime of general practice.’1 This sense of optimism, however, would soon turn to despair. Less than one year after the start of the Ministry of Health’s campaign, newspapers were reporting the tragic news that three British children had suffered serious neurological reactions following the use of Burroughs Wellcome’s

Wellcovax. One of those children, Kay Smith, just 17 months old at the time, died 13 days after being vaccinated. A decision was taken by Burrough’s Wellcome, along with the Department of Health and Social Security (DHSS), to suspend the use of the vaccine pending an investigation. Although a number of medical authorities questioned whether Wellcovax was indeed the cause of these neurological complications, the investigation, carried out by the Government’s Joint Committee on Vaccination and

Immunisation (JCVI) Measles Vaccination Sub-Committee, eventually led to the permanent withdrawal of Wellcovax from British campaigns. A dramatic tale of triumph, tragedy and death, the story of Wellcovax was set to become another famous medical scandal.

1 Chapman Pincher, ‘As Measles Goes Out, Who Remembers Polio?’, Daily Express, 8 February 1968, 6.

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Yet, what is interesting about the story of Wellcovax is how much the medical and political drama played out behind closed doors, ending quickly and peacefully. This satisfactory resolution is all the more remarkable given the context in which this episode occurred. Over the past decade, the British public had been subjected to a number of therapeutic scandals. The ‘Cutter incident’ – in which 200,000 US citizens were injected with a defective polio vaccine – was widely reported across British newspapers in the mid to late 1950s, and led to the initial decision by the Ministry of Health not to import

Jonas Salk’s killed polio vaccine.2 In 1961, thalidomide – a drug primarily used for the treatment of tension, insomnia and morning sickness – was banned from Britain following reports of serious birth defects occurring in children whose mothers had used the drug during pregnancy. What became known as the ‘thalidomide scandal’, it inspired criticism, scrutiny and subsequently change in the way drugs were tested and regulated in many countries.3 More controversies surrounding the regulation of drugs and the ethics of clinical research further chipped away at the medical optimism that had epitomised the 1950s. Partly inspired by these events, the 1960s became a period of growing critical engagement with biomedicine and its institutions. Newspaper correspondents were slowly starting to challenge official statements, and in 1967, the

British medical practitioner, Maurice Pappworth, published his sharp critique of modern medical experimentation, Human Guinea Pigs.4 Given this growing age of medical anxiety, along with a deep historical ‘suspicion’ of vaccination, the silence surrounding

Wellcovax in Britain becomes all the more unusual.5

2 Paul A. Offit, The Cutter Incident: How America’s First Polio Vaccine Led to the Growing Vaccine Crisis (New Haven: Yale University Press, 2005). 3 Sarah Ferber, Bioethics in Historical Perspective (New York: Palgrave Macmillan, n.d.), 132–52, accessed 21 May 2017. 4 Maurice Pappworth, Human Guinea Pigs: Experimentation on Man (London: Routledge and Kegan Paul, 1967). 5 Jeffrey P. Baker, ‘The Pertussis Vaccine Controversy in Great Britain, 1974-1986’, Vaccine 21 (2003): 4003; Nadja Durbach, Bodily Matters: The Anti-Vaccination Movement in England, 1853-1907 (Durham and London: Duke University Press, 2005).

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Beginning with an examination of how private concerns over the safety of Wellcovax were managed by Ministry of Health officials and advisers, this chapter then charts the events leading up to the vaccine’s suspension and subsequent withdrawal. In examining how and why the story of Wellcovax did not become another medical scandal, this chapter offers a unique perspective on the history of vaccination and the history of therapeutic regulation. I argue that the spectre of controversy served as a powerful organising agent, influencing the way political and scientific institutions responded to, investigated and communicated medical risk. Although only rarely articulated in private, the implicit aim of health officials and advisors during this period was to prevent medical and political scandal. This was achieved by the careful management of public perceptions. Through operating in secret, controlling the decision making process and mediating the distribution of information, the DHSS was able to manage Wellcovax’s public narrative. Despite questions remaining unanswered over Wellcovax’s relative safety, the DHSS was soon able to construct scientific and political closure. While from a DHSS perspective the story of Wellcovax came to represent the successful regulation of a vaccine, I argue that from a moral and medical perspective the resulting construction of scientific and public ignorance proved far more problematic.6

4.2 ‘Not for publication’: The private regulation of Wellcovax

Our story begins back in November 1965, with the recommendation of the JCVI’s

Measles Vaccination Sub-Committee that live measles vaccines, either administered alone or in combination with a killed vaccine, could be used by GPs in Britain (see

Chapter 3). It was following this decision that Ministry of Health advisors first began to

6 Robert N. Proctor and Londa Schiebinger, eds., Agnotology: The Making and Unmaking of Ignorance (Stanford: Stanford University Press, 2008).

181 discuss the potential risks of administering measles vaccination on a wide scale and how these risks could be monitored. One approach was to rely on the Committee on Safety of Drugs (CSD) yellow card scheme. Established in 1963 following recommendations made by the Joint Sub-Committee on the Safety of Drugs – an expert committee set up by Enoch Powell in response to the ‘thalidomide disaster’ – the CSD (later known as the Committee on Safety of Medicines) was given the task of assessing the safety of drugs both before and after clinical testing.7 As outlined by the CSD’s first Secretary,

Wilfred Turner, its main aims were ‘to review the safety of new drugs, to monitor adverse reactions to existing drugs and to keep medical practitioners informed.’8 Given no statutory powers, the CSD relied on a ‘voluntary system’, whereby pharmaceutical companies agreed to submit their new drugs for approval prior to marketing. Once on the market, the responsibility of monitoring adverse reactions fell on the newly appointed Sub-Committee on Adverse Reactions. At the heart of their work was the

CSD’s yellow card scheme. Another voluntary system, it relied on general practitioners reporting adverse reactions to the CSD using a specially designed card; a reliance some observers suspected led to a significant degree of underreporting. Once submitted, these reports would then be reviewed at regular meetings of the Sub-Committee on

Adverse Reactions. In the case of vaccination, this information would be reviewed, then collated and sent to the JCVI and its various Sub-Committees for review.

However, while the CSD’s yellow card scheme offered some form of surveillance and security, when it came to regulating biological agents, such as vaccines, it had a particular limitation. Vaccines were produced in batches, and although the manufacturing of vaccines followed a standard protocol, there was always the potential

7 L. A. Reynalds and E. M. Tansey, eds., The Committee on Safety of Drugs, Wellcome Witnesses to Twentieth Century Medicine, Volume 1 (London: The Wellcome Trust, 1997), 103–32. 8 Ibid., 108.

182 for subtle variations between the qualities of each batch. These subtle variations in production could occasionally lead to the making of a dangerous batch, something the

CSD’s yellow card scheme would only make visible once the damage had already been done. The problem, according to the MRC’s Frank Perkins, was that the ‘possibility of the occurrence of a batch to batch variation in the reactivity of the vaccine … may not be detected by any of the in vitro and in vivo tests in the laboratory.’9 Perkins’ concerns were voiced in a letter to the Chief Medical Officer (CMO) George Godber in January

1966, and followed a meeting of the MRC’s Advisory Committee on Immunological

Products Control. In discussing the potential dangers of ‘batch to batch variation’ the

Committee recommended the establishment of a measles vaccine batch surveillance scheme. According to the minutes of the meeting, for every new batch that was introduced, ‘a sample of the vaccinated children should be kept under surveillance during the first three weeks following vaccination.’10 The idea was that the acute surveillance of a small group of children following the introduction of a new batch of vaccine would allow the CSD to identify any potential safety hazards before its use on a large scale.

Based on his earlier experience with BCG and smallpox vaccination, Ministry of Health official A. T. Roden preferred a scheme organised by interested local health authorities.

‘It is possible that a sufficient number of general medical practitioners might be prepared to undertake this work’ wrote Roden, ‘but it would be difficult to ensure that observation of all children in the vaccinated sample would be complete and conducted on a uniform plan with comparable criteria of severity of reactions.’11 Despite these concerns, the Ministry chose to co-ordinate the scheme only using GPs. After some

9 TNA, MH 154/635, Frank Perkins to George Godber, 7 January 1966. 10 Ibid. 11 TNA, MH 154/635, A. T. Roden, File Note, ‘Surveillance of Measles Vaccines’, 27 January 1966.

183 discussion it was agreed that 100 doses of each new batch would be tested by 20 local practitioners. Each practitioner would test 5 doses on children from their own practice and report the results to the CSD using specially designed cards. Most importantly, the test was intended not to pick up on any ‘slight variations in the severity of reactions’, but to highlight an ‘obvious and marked increase in the severity of reactions to any particular batch compared with normal expectation.’12

By the middle of 1966, the CSD had analysed its first set of reports. Most significantly, the results appeared to show an ‘excess of reactions to the BW [Burroughs Wellcome] vaccine.’13 These results were reinforced by a subsequent analysis in October 1966, which again suggested ‘Wellcome batches show a very much higher proportion of reactions than the Glaxo batches’ (see Table 9).14 For example, batch AM29-B.W. was recorded as causing 60 reactions, a mixture of rash, respiratory symptoms and fever.

This was in stark contrast to the experience reported by practitioners using Glaxo’s

Schwarz strain (now marketed as Mevilin-L), where for example, batch 35A-Glaxo was recorded as causing just 10 reactions of similar severity.15 While these figures inspired little concern, the way they were interpreted illustrates just how speculative early means of measuring these risks were. As one official commented: ‘There is no space on the report cards to comment on the severity of the side effects, but it may be significant, that on none of the cards that I have seen have any of the GP’s taking part added any note to the effect that the reaction was severe’.16

12 TNA, MH 154/635, File Note, ‘Batch Surveillance of Measles Vaccines’, 1 February 1966. 13 TNA, MH 154/635, File Note, ‘Surveillance of Measles Vaccines’, 9 June 1966. 14 TNA, MH 154/635, File Note, 31 October 1966. 15 Ibid. 16 Ibid.

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Table 10. Number of adverse reactions reported to the measles vaccine batch surveillance scheme Batch Manufacturer Doses Rash Respiratory Fever Total of Given Symptoms Reactions AM29 B.W. 64 22 15 23 60 AM28 B.W. 17 6 2 7 15 35A GLAXO 63 3 2 5 10 42D GLAXO 41 3 3 7 13 42E GLAXO 6 0 1 4 5

Source: TNA, MH 154/635, File Note, 31 October 1966.

The first major scare with Wellcovax turned out to be a false alarm. On 27 March 1968, just over a month since the Ministry of Health had announced the beginning of

Britain’s national vaccination campaign against measles (see Chapter 3), the Chairman of the MRC’s Measles Vaccines Committee, Professor David Evans, reported to the

MRC’s Principal Medical Officer, B. S. Lush, that a child in Bristol had developed encephalitis following vaccination with Wellcovax. According to the file note, ‘Evidence was at present scanty but superficially the time relationships suggested a true measles encephalitis’.17 Lush advised Evans to do the following: firstly, ‘alert’ the information sections of the MRC and the Ministry of Health ‘to give non-committal replies to any queries’; secondly, obtain all the latest information on the child’s condition; and finally, convene a meeting, to be chaired by Evans himself, to discuss a possible response.18

Both decided ‘against any panic measures such as advising the withdrawal of the

(Wellcome) vaccine in question’.19 While on this occasion no further action needed to be taken, as the post-mortem tragically revealed the child was suffering from a brain tumour at the time of death, the discreet way in which this case was managed provides us with an insight into the culture of silence characterising the state’s management of

17 TNA, FD 7/511, B. S. Lush, File Note, 28 March 1968. 18 Ibid. 19 Ibid.

185 medical risk. The immediate impulse was to deflect inquiry and limit the information available, following practices established in previous years (see Chapter 3). Indeed, even within the confines of a private memo the name of the ‘vaccine in question’ remained grammatically sealed inside brackets.

Reflecting growing concerns over the safety of measles vaccines, in July 1968, the

DHSS began to set up a ‘small group of experts’ to examine reports of adverse reactions associated with measles vaccination.20 The need for such a group had been reinforced by events in Kingston-upon-Thames, where the Medical Officer of Health there had advised doctors to temporarily suspend the use of measles vaccines following reports of unusual adverse reactions.21 Four Members of the JCVI’s Measles Vaccination Sub-

Committee – Sir Wilfred Sheldon, David Evans, Frank Perkins and G. I. Watson – were invited to take part, along with Dr Christine Miller, a member of the MRC’s Measles

Vaccines Committee, and Dr Hugh Webb, a virologist recommended by Dr Dennis

Williams. The choice of personnel reflected both medical and pragmatic concerns.

According to the Secretary to the JCVI, W. F. Lake, ‘We think it best to have members who are working in or near London as this is a group which may have to be convened at short notice if undesirable reactions are brought to notice.’22

On 11 October 1968, the first meeting of the newly constituted advisory group took place. Chaired by Sir Wilfrid Sheldon, the group examined reports from both the

Committee on Safety of Drugs yellow card scheme and the measles vaccine batch surveillance scheme. Both reports ‘suggested’ that between May and October 1968

20 TNA, MH 154/530, A. T. Roden to Denis Williams, ‘Surveillance of Measles Vaccines’, 9 July 1968. 21 TNA, MH 154/530, ‘Adverse Reactions to Measles Vaccine Reported from Kingston-upon- Thames’, 1968. 22 TNA, MH 154/530, W. F. Lake to Lord Cohen, ‘Surveillance of Measles Vaccine’, 9 August 1968.

186 reaction rates associated with Wellcovax were considerably higher than those recorded for Mevilin-L.23 Of the 107 adverse reactions reported to the CSD, 83 had been caused by Wellcovax; 21 of these were recorded as convulsions.24 The latest results of the

CSD’s batch surveillance scheme proved equally striking; out of 123 reactions documented, a total of 122 were ascribed to Wellcovax.25 Given these results, along with anecdotal evidence suggesting some GPs had stopped using the vaccine, the group recommended that the dose of Wellcovax should be reduced from 1000 to 200 tissue culture doses (TCD). However, in spite of the clear acceptance that Wellcovax caused a greater number of adverse reactions than Mevilin-L, the group insisted that ‘no statement about the dilution should be made until it is possible to assess the result’.26

Anxious to keep concerns over the safety of Wellcovax contained, officials at the

Ministry of Health took a crucial decision to try and limit their spread. Towards the end of 1968, officials in charge of running Britain’s measles vaccination campaign were becoming increasingly disturbed by its relatively low acceptance rate and believed it was time to begin a new publicity drive. However, despite figures showing that less than 25 percent of children were being vaccinated against measles in some parts of the country, the Chief Medical Officer of Health, Sir George Godber, took the decision to place the publicity campaign on hold. This decision, which from an epidemiological perspective appeared problematic, was driven by a conscious desire to avoid stimulating wider public awareness of individual concerns over Wellcovax. This was made clear in a letter sent from the Ministry of Health’s Dr Rayner to G. W. H. Woodman of the Health

23 TNA, FD 7/511, ‘Note of an Informal Meeting on 11th October 1968 to Consider Reported Reactions to Measles Vaccine’, 11 October 1968. 24 TNA, FD 7/511, ‘Total Reported Reactions to Measles Vaccines’, 1968; TNA, FD 7/511, ‘Reported Reactions to Measles Vaccines – Convulsions Only’, 1968. 25 TNA, FD 7/511, ‘Batch Surveillance – Measles Vaccine: Reported Reactions to 31st October 1968’, 1968. 26 TNA, FD 7/511, ‘Note of an Informal Meeting on 11th October 1968 to Consider Reported Reactions to Measles Vaccine’, 11 October 1968.

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Education Council informing him of the Department’s decision to ‘defer further publicity until the new year’.27 According Rayner, this decision did not reflect genuine concerns over dangers associated with Wellcovax, but ‘simply that the reservations some doctors have about that vaccine would be liable to be expressed much more publicly and forcibly if a new national publicity campaign were to be mounted at this point in time.’28 A position that was made even clearer by DHSS official Philip Muston, who stated in a private note: ‘we have not so far used the two publicity films for fear of stimulating general practitioners’ suspicions of the B.W. vaccine to the extent of overt public criticism and opposition.’29

Over the course of the next three months, each one of the Government’s interested committees would meet to discuss the situation regarding Wellcovax. On 11 November

1968, the JCVI’s Measles Vaccination Sub-Committee met for the first time since the previous November. The discussion centred on the advisory group’s main proposal to reduce the strength of Wellcovax. Several members were ‘doubtful’ as to whether reducing the dose would make any significant difference.30 Professor Stuart-Harris agreed and added that the effect of reducing the concentration of a vaccine on its ability to ‘confer immunity’ was not yet known.31 Professor George Dick and Dr McCarthy were even more pessimistic, arguing ‘Burroughs Wellcome should be asked to consider using a different strain.’32 Despite this lack of enthusiasm, the Sub-Committee recommended that the MRC should be asked to carry out a clinical trial comparing

27 TNA, MH 154/136, Rayner to G. W. H. Woodman, ‘Vaccination Against Measles’, 22 October 1968. 28 Ibid. 29 TNA, MH 154/136, Philip Muston, File Note, ‘Measles Vaccination’, 11 November 1968. 30 TNA, MH 154/64, Joint Committee on Vaccination and Immunisation Measles Vaccination Sub-Committee, ‘Minutes of Meeting held on Monday, 11th November, 1968’, 11 November 1968. 31 Ibid. 32 Ibid.

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Wellcovax at a dose of 200 TCD50 to Wellcovax and Mevilin-L at their standard dose of

1,000 TCD50; a decision that was endorsed that same day at a meeting of the JCVI.

The recommendation of the JCVI’s Measles Vaccination Sub-Committee to test a reduced dose of Wellcovax reflected a growing sense in the DHSS that it was becoming increasingly undesirable to administer a vaccine that was producing more reactions than its competitors. Internal notes, memos and minutes illustrate how the DHSS, along with its main advisory bodies, was becoming increasingly unsure over the vaccine’s future. A note from Philip Muston, documenting the testing of Wellcovax in a ‘“weaker” form’, reveals how as early as November 1968 the Department were preparing themselves for the worst: ‘Maybe this will reduce reactions. But against the possibility that this hoped for result does not come about, should we consider meanwhile what is to be done in that event? If that action were to be discontinuance of the use of B.W. vaccine maybe

B.W. should be alerted now to this possibility.’33

However, in response to DHSS concerns, Burroughs Wellcome presented an alternative picture. On 20 November 1968, a meeting was held between officials from the DHSS, the Chairman of the MRC’s Measles Vaccines Committee, Professor Evans, and the

Research Director of the Wellcome Foundation, Dr David Long. According to Roden’s notes of the meeting, Long was fully aware that Wellcovax gave rise to more febrile types of reaction, but argued ‘this was the price one paid for a vaccine which … was more effective in the prevention of measles than vaccines which produced less febrile reaction.34’ This defence of the vaccine, on the grounds that its dangers were a price worth paying, was shared by the MRC’s Measles Vaccines Committee. At a meeting

33 TNA, MH 154/136, Philip Muston, File Note, ‘Measles Vaccination’, 11 November 1968. 34 TNA, MH 154/526, ‘Adverse Reactions to Measles Vaccines: Note of a Meeting held on 20 November 1968 with Research Director, Wellcome Foundation’, 20 November 1968.

189 held on 9 January 1969, the Committee reviewed the latest reaction figures from the

CSD, alongside two ‘unpublished’ reports of clinical trials that had recently been carried out in Southampton and Chester comparing Wellcovax with Mevilin-L (see Figure 7).35

Again, the Committee agreed that Wellcovax gave rise to more moderate and severe types of reaction, but concluded ‘It was possible that the protection given by the

Wellcome MV31 strain may be better than that given by the Schwarz strain and we could only find this out by continued use and surveillance of this vaccine.’36

Figure 7. Adverse reactions to Measles Vaccines Source: TNA, FD 7/511, Measles Vaccines Committee, ‘Comparison of reactions following each of two live measles vaccines (Wellcome and Glaxo) when given alone, 1969.

35 TNA, FD 7/511, Measles Vaccines Committee, 9 January 1969; TNA, FD 7/511, Measles Vaccines Committee, ‘Comparison of reactions following each of two live measles vaccines (Wellcome and Glaxo) when given alone, 1969. 36 Ibid.

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Also discussed at the meeting of the MRC’s Measles Vaccines Committee was the request by DHSS officials to organise a clinical trial to examine the effects of reducing the strength of Wellcovax. Reflecting a somewhat cumbersome and fragmented bureaucratic culture, this discussion was being held nearly three months after the recommendation was initially made. After reviewing a ‘collection of abstracts’ taken from studies published in 1962, which had examined the effects of using different strengths of Ender’s Edmonston B virus, along with data generated following the

distribution of a modified version of Wellcovax (‘about 250 TCD50’), the Committee decided against organising any trial.37 Members believed there was already sufficient evidence from the United States to suggest that reducing the strength of a measles vaccine made little difference to its overall safety profile. The Committee concluded that the ‘information likely to be obtained could not justify the expense and organisation that would be required to undertake such a trial.’38 This decision was communicated to the DHSS on 27 March; nearly three months after the meeting took place.39

It is worth noting that DHSS concerns over the safety of Wellcovax, along with much of the scientific literature that informed them, were never made public during this period. At no point was new information released to GPs or parents, either informing them of reports of more serious adverse reactions to measles vaccination, or how these reactions were often associated with one particular strain of vaccine over another. The last information sheet GPs had received from the Ministry of Health was sent on 8

April 1968. With regard to adverse reactions, the sheet highlighted the possibility of

‘Mild febrile reactions’, ‘transient rashes’ and a ‘rise in body temperature’, however, it

37 Ibid. 38 Ibid. 39 TNA, FD 7/511, E. M. B. Clements to Lake, 27 March 1969.

191 failed to mention reports of ‘moderate’ or ‘severe’ reactions, or their association with one particular vaccine strain.40

In the case of measles vaccination, practitioners became aware of complications through individual experience or the experiences of others. Several of these adverse reactions were reported in letters sent to the BMJ from 1968.41 The letters not only revealed the nature of individual concerns over measles vaccination, but also illuminated hidden problems with the state’s culture of drug regulation. One of the earliest letters was written by D. P. Choyce.42 An ophthalmic surgeon from Westcliffe-on-Sea, Choyce was also the parent of a five-year-old child who had recently suffered a severe reaction following vaccination against measles. In his letter, Choyce recalls how following the

Ministry of Health’s recommendation, he and his wife took their son to the local practitioner to be vaccinated. At the surgery, they were ‘told that in 10% of children there was slight malaise, slight fever, and a fleeting rash 7-10 days later.’43 All appeared to be going to plan, until on the seventh evening after vaccination their son suddenly became ‘very feverish and disorientated’.44 Choyce tried to treat him with soluble aspirin, but its effect was limited due to continued vomiting. His symptoms lasted for a further three days, and it took almost week before he was back to his ‘usual good health.’45 Angered by his son’s experience, Choyce stated, ‘My non-medical wife states flatly that she would never have agreed to this inoculation had she known it would have made the child so ill. My own feeling is that had some constitutional weakness of heart,

40 British Medical Association (BMA), 2(3)5(1)43 E/2/375/10, George Godber to Medical Practitioners, ‘Notes on the Use and Storage of Measles Vaccine (live attenuated) for routine vaccination,’ 8 April 1968. 41 D. P. Choyce, ‘Measles Inoculation’, British Medical Journal 3 (1968): 254; K. W. Heaton, ‘Measles Inoculation’, British Medical Journal 3 (1968): 435; Robert Linton and Elliot Shinebourne, ‘Measles Vaccination’, British Medical Journal 4 (1968): 642–43. 42 Choyce, ‘Measles Inoculation’. 43 Ibid., 254. 44 Ibid. 45 Ibid.

192 lungs, etc., been present, we could have had a very sick child on our hands.46’ Published in The Times newspaper under the heading ‘Doubts over measles vaccine’, Choyce’s account offered readers a momentary glance into a largely hidden world.47

Similar accounts of secrecy have been described by historians and social scientists examining the history of British drug regulation.48 The work of John Abraham and

Courtney Davis, and their study of the beta blocker practolol, is particularly instructive here.49 Studying the regulation of practolol in the 1960s and 1970s, Abraham and Davis have argued that ‘British regulators were willing to allow new drugs on to the market, fully aware of uncertainty about their safety, but unwilling to be pro-active in issuing warning letters about risks and requiring “certainty” before acting to withdraw a product’.50 This was certainty the case for Wellcovax. As I have shown, between March

1968 and January 1969, emerging concerns over the safety of Wellcovax generated much private debate, but little action. Officials at the DHSS were not prepared to make a decision on Wellcovax while uncertainty lingered. It was hoped that either the MRC’s proposed trials using a reduced dose of Wellcovax would provide clarity, or the decision would be devolved to local practitioners after the Department’s policy of centrally purchasing the vaccine ended on 31 March 1969. While this promise of future clarity through further scientific investigation never materialised, rhetorically it served as a powerful means to defend a lack of action.

46 Ibid. 47 Anon., ‘Doubts Over Measles Vaccine’, The Times, 26 July 1968, 3. 48 John Abraham, ‘Distributing the Benefit of the Doubt: Scientists, Regulators, and Drug Safety’, Science, Technology, & Human Values 19 (1994): 493–522; John Abraham and Courtney Davis, ‘Testing Times: The Emergence of the Practolol Disaster and Its Challenge to British Drug Regulation in the Modern Period’, Social History of Medicine 19 (2006): 127–47; Jesse Olszynko-Gryn, ‘Primodos Was a Revolutionary Oral Pregnancy Test. But Was It Safe?’, The Guardian, 13 October 2016, https://www.theguardian.com/science/the-h- word/2016/oct/13/primodos-was-a-revolutionary-oral-pregnancy-test-but-was-it-safe. 49 Abraham and Davis, ‘Testing Times’. 50 Ibid., 127.

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Despite uncertainties over the safety of Wellcovax, at the end of 1968, DHSS officials took the decision to revive Britain’s measles vaccination publicity campaign. Recent figures had shown that while the campaign had successfully reduced the number of cases of measles in 1968, tens of thousands of children were still contracting the disease.

Given that questions were beginning to be asked by MPs, the DHSS believed the time was right to organise a new publicity drive.51 In communicating the decision to the

Health Education Council’s G. W. H. Woodman, Ministry of Health official E. L.

Mayston noted: ‘Adverse reactions to measles vaccination … continue occasionally to be reported, but not, in our view, in sufficient numbers to make it any longer undesirable to issue fresh publicity for the campaign.’52 In March 1969 the Health

Education Council launched a new publicity drive. A number of local and national newspapers were included and sent a selection of publicity material by the DHSS. One particular advert, ‘Measles is misery’, was printed in the Daily Express on 19 March.53

The advert stated: ‘Vaccination is free for all children between 1 and 15, who have not had measles or been previously immunised against it. Ask your doctor or health clinic now.’54 Incredibly, printed on the front page of the same edition of the Daily Express was the dramatic headline: ‘Measles Jab Alert After Child Dies’.55 The story of

Wellcovax had now become public.

51 House of Commons Written Answers, ‘Measles Vaccination (National Campaign)’, 17 December 1968, Volume 775, Columns 353W-354W; House of Commons Written Answers, ‘Measles Vaccination (National Campaign)’, 18 December 1968, Volume 775, Columns 397W- 398W. 52 TNA, MH 154/136, E. L. Mayston to G. W. H. Woodman, ‘Vaccination Against Measles’, 15 January 1969. 53 The Health Education Council, ‘Measles Is Misery’, Daily Express, 19 March 1969, 8. 54 Ibid. 55 Anon., ‘Measles Jab Alert After Child Dies’, Daily Express, 19 March 1969, 1.

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Figure 8. An advert for measles vaccination and a newspaper article reporting the suspension of Wellcovax. Source: The Health Education Council, ‘Measles is Misery’, Daily Express, 19 March 1969, 8; Anon., ‘Measles Jab Alert After Child Dies’, Daily Express, 19 March 1969, 1.

4.3 Preventing fear, panic and controversy

The tragic news that several British children had developed encephalitis following routine vaccination with Wellcovax was reported to officials at the DHSS in the middle of March 1969. The child at the centre of the story was Kay Smith. A seventeen-month old girl from Walton-on-Thames, Kay died just thirteen days after being vaccinated. A detailed report sent to the DHSS from A. J. Rayner, a Paediatric Registrar at St. Peter’s

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Hospital, Surrey, documented the events leading up to Kay’s death.56 Several days after being vaccinated, Kay lost her appetite, became lethargic, started to vomit and developed diarrhoea. Following an episode of twitching and a rise in temperature, a GP visited Kay and prescribed her the barbiturate Phenobarbitone. Despite a brief period of relief, Kay’s health began to deteriorate. On 8 March she was found ‘to be unrousable and breathing rapidly’ and was taken straight to St. Peter’s Hospital.57 At St

Peter’s, Kay’s condition continued to deteriorate and she became ‘deeply unconscious’.58

The hospital ran a series of clinical and laboratory tests while trying to treat her symptoms. Cooling measures, such as ‘tepid sponges’ and ‘ice bags’, were employed to try and reduce her temperature, and for a brief period she ‘became more reactive’.59

Phenobarbitone was again used to reduce the number and severity of her spasms.

However, she did not improve. At approximately 12:20 am on 13 March it was decided

‘that her brain had died’ and it was time to switch off her ventilator.60

Although several newspaper articles would later link Kay Smith’s death to the use of

Wellcovax, Rayner’s report raised several doubts over this relationship. Rayner noted that at no point during Kay’s illness had a measles rash been detected, and that there was no family history of adverse reactions to vaccination. Most notably, Rayner documented how another child, just nine days earlier, had died after suffering from a very similar condition which was unrelated to measles vaccination. Rayner stated: ‘Post mortem examination on this child showed ulcers throughout the bowel and generalised

56 TNA, MH 154/64, A. J. Franklin to A. J. Rayner, ‘Report on: Kay Michele Smith’, 19 March 1969. 57 Ibid. 58 Ibid. 59 Ibid. 60 Ibid.

196 oedema of all tissues. It was thought that this condition collated with that described as an acute encephalitis or encephalophathy associated with gastroenteritis.’61

Nevertheless, Wellcovax’s association with brain damage and death, whether real or not, had the potential to create a spark, one that if we follow the standard narrative arc of vaccine and therapeutic controversies, usually ends with a dramatic public event.62 In his history of twentieth century American drug regulation, Harry Marks described the typical story as follows:

A novel drug passes intense regulatory scrutiny. The drug’s makers heavily promote it. Following widespread use, a previously unnoticed side effect is observed. Investigative journalists then trumpet the drug’s fall from grace, revealing a “back story” in which the warning signs of harm were ignored or suppressed. The drug’s makers defend their product and their integrity while medical reformers and social scientists condemn corporate cupidity. Members of a bewildered public wonder about drug safety while injured patients and politicians call for remedial action.63

Given the underlying tensions that had already framed Wellcovax’s approval and regulation, the extent to which officials at Burroughs Wellcome and the DHSS managed to control the public narrative becomes all the more remarkable.

61 Ibid. 62 Janine Arnott, ‘The Social Construction of Vaccine Controversies’ (Unpublished Thesis, The University of Manchester, 2007); Baker, ‘The Pertussis Vaccine Controversy in Great Britain, 1974-1986’; Durbach, Bodily Matters; Melissa Leach, Vaccine Anxieties: Global Science, Child Health and Society (London: Earthscan, 2007); Offit, The Cutter Incident; Jean-Paul Gaudillière, Volker Hess, and Harry M. Marks, eds., ‘Making Risks Visible: The Science, Politics, and Regulation of Adverse Reactions’, in Ways of Regulating Drugs in the 19th and 20th Centuries (London: Palgrave MacMillan, 2013), 97–120. 63 Gaudillière, Hess, and Marks, ‘Making Risks Visible’.

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After receiving news of Kay Smith’s death, along with several other reports of children having suffered serious neurological complications following the use of Wellcovax,

Burroughs Wellcome, in conjunction with the DHSS, decided to suspend the vaccine pending an investigation. The first decision officials at the DHSS had to make was how to deliver news of the vaccine’s suspension to medical practitioners. Several options were available, including the use of television, radio and the written press. Instead,

Department officials, along with advisors from Burroughs Wellcome, chose a more discreet medium. A letter dated 17 March 1969, signed by George Godber, was sent out to Medical Officers of Health. The letter informed Officers of Wellcovax’s ‘immediate suspension’ and the need to advise all medical practitioners currently using the vaccine of the Ministry’s decision.64 The letter recommended that while ‘the exact nature of the condition now reported has not yet been ascertained … it seems wrong to continue to use the Wellcome vaccine unless and until further investigation exonerates it. The Glaxo vaccine is made from a different strain of virus and there is no reason to suspend its use.’65

The Department’s decision to send out letters rather than use a more immediate form of communication proved controversial. The concern for medical practitioners was the slight chance of administering a suspended treatment while waiting for the letter to arrive. The following day Godber telephoned the British Medical Association (BMA) to give a more detailed explanation of events. A record of the telephone conservation between the BMA’s Dr Gullick and Godber reveals the anxieties of the medical profession. ‘I expressed doubt as to how long it would take for this information actually to reach family doctors if it has only gone out in a letter from the Department

64 British Medical Association (BMA), 2(3)5(1)43 E/2/375/10, George Godber to Medical Practitioners, ‘Measles Vaccines’, 17 March 1969. 65 Ibid.

198 yesterday’ wrote Gullick.66 The BMA’s concerns were taken up by the Conservative MP for Garston, Tim Fortescue. Fortescue, who would later raise the issue in parliament, was interviewed about the subject of Wellcovax by his local newspaper, the Liverpool

Daily Post. Clearly informed by party political interests, Fortescue’s telling of events painted a murky picture of the Labour Government’s incompetency and potential human tragedy. ‘The manufacturers seem to have behaved very well and alerted the

Ministry promptly’, said Fortescue, ‘But then the matter kicked around in the Ministry for too long, and getting the information to doctors involved two lots of 5d stamps with all the delays that could imply. One does not know, but a delay in a case like this could prove fatal.’67 Like officials at the BMA, Fortescue believed the DHSS should have announced the decision to suspend the use of Wellcovax using a more immediate form of communication. According to Fortescue the decision ‘should have been announced immediately in the Press and on television to alert doctors.68

On 24 March 1969, Fortescue raised his concerns in the form of a parliamentary question to the then Secretary of State for Social Services, Labour MP Richard

Crossman.69 Clearly not happy with Crossman’s slightly evasive first answer, Fortescue raised the issue again, a week later, in a second parliamentary question on the subject.

This time taking a more direct approach, Fortescue ‘asked the Secretary of State for

Social Service why the manufacturers’ advice that the use of the anti-measles vaccine

Wellcovax should be immediately suspended was conveyed by his Department to general practitioners through letters to medical officers of health and not through the

66 BMA, 2(3)5(1)43 E/2/375/10, Gullick to Lowe, ‘Measles Vaccine’, 18 March 1969. 67 Anon., ‘MP to Query Measles Moves’, Liverpool Daily Post, 21 March 1969. 68 Ibid. 69 House of Commons Written Answers, ‘Anti-measles Vaccine Wellcovax’, 24 March 1969, Volume 780, Columns 208W-209W.

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Press, radio and television.’70 Again keeping his cards close to his chest, Crossman replied, ‘The occasion was not such as to call for the methods of communication suggested by the hon. Member.’71

Why had the DHSS decided to only send out letters to general practitioners? In deciding how to communicate the suspension of Wellcovax, the manufacturer, along with DHSS officials, were having to balance a series of commercial and political tensions. In particular, officials were concerned about inciting public panic. This anxiety was informed by a particular vision of the public that persisted amongst health officials at the time. As historians working on early and mid-twentieth century public health campaigns have shown, medical and political authorities often shared a view of the public as an irrational and profoundly anxious body.72 For example, historians working on the history of cancer education in mid-twentieth century Britain have argued that

British cancer specialists objected to the promotion of such campaigns, because they viewed them as dangerous for a ‘gullible and emotional’ public.73 As Elizabeth Toon has described for 1940s Britain: ‘opponents of cancer education fretted that a discussion of symptoms would drive “neurotic” Britons to surgeries, while others who might actually have cancer, now paralyzed by fear, would stay away.’74 A similar conceptualisation of the public seemed to inform the state’s response to decisions over measles vaccination.

70 House of Commons Written Answers, ‘Anti-measles Vaccine (Withdrawal)’, 31 March 1969, Volume 781, Columns 23W-24W. 71 Ibid. 72 David Cantor, ‘Representing “The Public”: Medicine, Charity and Emotion in Twentieth- Century Britain’, in Medicine, Health and the Public Sphere in Britain, 1600-2000, ed. Steve Sturdy (London and New York: Routledge, 2002), 145–68; Elizabeth Toon, ‘“Cancer as the General Population Knows It”: Knowledge, Fear, and Lay Education in 1950s Britain’, Bulletin of the History of Medicine 81 (2007): 116–38. 73 Toon, ‘Cancer as the General Population Knows It’, 118. 74 Ibid., 124.

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These beliefs were revealed in an interview, again carried out by the Liverpool Daily Post, with a spokesman from Burroughs Wellcome:

Q. Do you think that to send warnings by letters was prompt enough action by the Ministry? A. It is a very difficult question. We don’t want to cause unnecessary alarm among the many people who use the vaccine… One million doses have been used in this country and a total of five million in the world and they have given good protection against measles.

Q. But surely if it was felt necessary to suspend the vaccine at all, it would have been best to have put out a warning as quickly as possible – possibly by a Ministry statement to Press and TV? A. In taking this decision we may be causing alarm in people needlessly… If one had had an absolutely clear-cut connection between the two (the case of death and illness and the vaccine), then one would take immediate action.

Q. But the matter was felt to be serious enough to warrant suspension of the vaccine. If there was some doubt in the case, would it not have been better to act immediately? A. Supposing you have something which is known to be dangerous then you can act with maximum speed. What you have here is a situation which needs investigating.75

The interview carried two central messages: firstly, that the real danger facing the British public was not from the vaccine itself, but the ‘unnecessary alarm’ wide public exposure could bring; and secondly, that one should only risk introducing public panic when there was a certain degree of scientific certainty about the danger. This was certainly the message that Godber looked to convey to the British Medical Association (BMA). In a memo written by Dr Gullick after another telephone conversation with ‘Sir George’, the

75 Anon., ‘MP to Query Measles Moves’.

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CMO was noted as stating he ‘was anxious not to create a scare … in the light of the as yet unproven and mathematically very low incidence of reported reactions.’76 In choosing to use a more discreet form of communication, Godber understood the power of the medium that the rhetoric was delivered in. Presenting the events on television and radio would have created a very different experience for parents, one that may have led to increased public fear and panic. In a letter to the Chairman of the BMA’s General

Medical Services Committee, Dr James Cameron, Godber wrote, ‘the action best calculated to give us speed without panic seemed the right course.’77

When the story of Wellcovax’s suspension was eventually published in the media on 19 and 20 March 1969, its representation was carefully mediated. Largely narrated by

Burroughs Wellcome’s own press statements, rather than providing a graphic account of the traumatic experience of each child and their families, articles mostly presented the public with a sober reading of events. Articles followed a similar narrative arc, moving from an undramatised account of the events leading to Wellcovax’s suspension, before providing a set of reassuring figures, quotes and official statements, which largely demonstrated how successful the vaccine had been both in Britain and overseas.78

Typical of this style of reporting was this article published in The Daily Telegraph on 19

March 1969:

Burroughs Wellcome, the pharmaceutical manufactures have suspended supplies of their Wellcovax measles vaccine following the death of a young child and reports that two others are seriously ill within eight days of being

76 BMA, 2(3)5(1)43 E/2/375/10, Gullick to Lowe, ‘Measles Vaccine’, 18 March 1969. 77 BMA, 2(3)5(1)43 E/2/375/10, George Godber to J. C. Cameron, 19 March 1969. 78 Anon., ‘Measles Jab Alert After Child Dies’, 1; Anon., ‘Withdrawal of Measles Vaccine’, Times, 19 March 1969, 3; William Breckon, ‘Vaccine Firm Halts Measles Jabs’, Daily Mail, 19 March 1969, 1; Anon., ‘Measles Vaccine Supply Halted’, The Guardian, 19 March 1969, 20; James Wilkinson, ‘Another Victim in Measles Jabs Mystery’, Daily Express, 20 March 1969, 7.

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vaccinated. A spokesman for the company said last night the cause of death had been diagnosed as encephalitis – inflammation of the brain, which affects the central nervous system. The three children were all between one and two years old, he said. Over one million doses of the vaccine have already been used in the United Kingdom and a total of more than five million in the world, the spokesman said. “We don’t want to alarm people, but while there is any question at all of the vaccine being harmful we have decided to stop all supplies.” … Commentating on the manufacturer’s announcement, Dr. Derek Stevenson, secretary of the British Medical Association, said: “we are glad that such prompt action has been taken and we shall take all steps we can to bring this to the notice of family doctors.” … A spokesman for Glaxo said last night production was proceeding normally with their vaccine. “We have had no reports of any illnesses following vaccination.” The Ministry of Health said … “The withdrawal of Wellcovax will leave us with vaccination in short supply. “We felt it unwise to continue using it until there had been further investigations into the matter. The Glaxo vaccine is made from a different strain of virus and there is no reason to suspend its use.”79

In offering a space for commercial and government organisations to collectively present their own narrative, the press aided officials in their attempts to construct an image of administrative care, control and consensus, hopefully calming any public fears. It is important to note that this did not necessarily reflect a harmonious relationship between the media and health authorities during the 1960s, but rather that science and medical correspondents at the time relied heavily on official statements and insider accounts for stories and information. As both Kelly Loughlin and Anne Karpf have illustrated through their examinations of science, health and medicine reporting in mid- twentieth century Britain, while medical journalism took a more critical stance throughout the 1960s (partly stimulated by a series of controversial medical events),

79 Anon., ‘Measles Vaccine Halted after Child Dies’, The Daily Telegraph, 19 March 1969, 17.

203 medical news still seemed to be informed by a medical culture of silence and paternalism.80

This reliance on official statements not only allowed commercial and government organisations to control what could be seen, but also what could not. Articles, such as the one published in The Daily Telegraph, illustrate just how successful the DHSS had been at preventing private concerns over the safety of Wellcovax from reaching a public space. No article exposed a back-story of Government concealment and indecision; indeed, articles were largely supportive of the vaccine and its administrators. For example, in his own analysis of the events surrounding the withdrawal of Wellcovax,

The Sun’s science editor, Ronald Bedford, noted how ‘Stringent safety precautions are taken in test and manufacture – and encephalitis is a common factor in measles itself with roughly four children in every 1000 with the disease being affected… The anti- vaccinationists, sincere people, will say: “I told you so,” but the fact remains that all medical procedures carry some risk.’81 A sympathetic account of the science of vaccination, and the institutions which underpin it, Bedford’s article made no mention of Wellocovax’s more troubled history.

Judged solely on the basis of newspaper reports, the approach taken by Burroughs

Wellcome and the DHSS to manage the public narration of this event appeared to be a success. Just two weeks after the initial reports of encephalitis were made public, the

Chairman of the BMA’s General Medical Services Committee, James Cameron,

80 Anne Karpf, Doctoring the Media: The Reporting of Health and Medicine (London: Routledge, 1988); Kelly Loughlin, ‘Publicity as Policy: The Changing Role of Press and Public Relations at the BMA, 1940s-80s’, in Making Health Policy: Networks in Research and Policy After 1945, ed. Virginia Berridge (Amsterdam - New York: Rodopi, 2005), 275–94; Kelly Loughlin, ‘Networks of Mass Communication: Reporting Science, Health and Medicine in the 1950s and ’60s’, in Making Health Policy: Networks in Research and Policy After 1945, ed. Virginia Berridge (Amsterdam - New York: Rodopi, 2005), 295–322. 81 Ronald Bedford, ‘Measles: Problem that Faces Every Parent Today’, The Sun, 20 March 1969.

204 commented in a letter to George Godber, that ‘by the time the committee met, this storm seemingly had settled reasonably satisfactorily.’82 The only criticism Burroughs

Wellcome had of some media reports was their implicit assumption that Wellcovax had been found to be the cause of illness. A letter drafted for the editor of the Daily Express argued: ‘to say that “four children developed encephalitis probably as a result of the measles vaccine produced by Burroughs Wellcome” is to draw a conclusion which is not justified by the medical evidence available.’83 As the DHSS began their own investigation into the safety of Wellcovax, it was to this medical evidence that they now turned.

4.4 From doubt to danger: Re-assessing the risks of Wellcovax

While publicly the Department’s message may have been one of innocence until proven guilty, privately, Wellcovax had almost been hung, drawn and quartered. ‘I asked

Professor Evans what he meant by the word “withdrawn”,’ wrote B. S. Lush in an MRC file note on the 18 March, ‘and he said that effectively it meant, he thought, that the ministry had advised Burroughs Wellcome that they should withdraw the vaccine, and that the Ministry would not sanction its further use in the N.H.S until some modifications had been made.’84 While the speed and certainty of this decision clearly reflected the sense of ambivalence that had grown around the vaccine over the previous year, it also reflected the impact highly emotive stories of iatrogenic illness can have on perceptions of risk. As Godber argued, ‘once suspicion of encephalitis has been raised in connection with a live virus vaccine, I do not see it being re-established.’85 By the

82 BMA, 2(3)5(1)43 E/2/375/10, J. C. Cameron to George Godber, 1 April 1969. 83 WL, WF/M/PL/407 3 of 3, Burroughs Wellcome to the Daily Express, Draft Letter, 1969. 84 TNA, FD 9/2449, B. S. Lush, File Note, ‘Withdrawal of Measles Vaccine’, 18 March 1969. 85 TNA, MH 154/526, George Godber, File Note, 21 March 1969.

205 time the JCVI’s Measles Vaccination Sub-Committee met to discuss the vaccine’s future, its recommendation that Wellcovax ‘should be discontinued’ had become almost inevitable.86

The Committee met on 31 March 1969. The meeting began with George Godber describing the circumstances that had led to the suspension of Wellcovax and the actions taken by the Department to inform medical officers of health.87 It then centred on a detailed examination of several types of clinical evidence. Members began by examining a series of individual case reports of children who had potentially suffered from encephalitis. A number of these reports had been worked through at an ‘informal meeting’ of the Sub-Committee ten days earlier.88 The third case reviewed was that of

Kay Smith:

The child, a girl aged 1 year 5 months, developed diarrhoea and vomiting 4 days after vaccination (Batch AM 75/6) followed by fever and twitching 7 days after vaccination. The following day she was unconscious with hyperpyrexia (1080F) and severe diarrhoea. In spite of energetic treatment the child’s condition deteriorated and she died five days later. Throughout her illness no skin eruption was seen. After consideration of the detailed clinical and laboratory findings the group concluded that there was evidence of encephalitis, but expressed doubt as regards a causative association with measles vaccine. The severity of the diarrhoea and vomiting and the fact that two other fatal cases of encephalopathy had recently been admitted to the same hospital, one of them associated with diarrhoea, suggested the possibility of some other causative agent.’89

86 TNA, MH 154/64, Joint Committee on Vaccination and Immunisation Measles Vaccination Sub-Committee, ‘Minutes of Meeting held on Monday, 31st March, 1969’, 31 March 1969. 87 Ibid. 88 TNA, MH 154/64, ‘Joint Committee on Vaccination and Immunisation Measles Vaccination Sub-Committee: Adverse Reactions to Measles Vaccines; Summary Report of an Informal Meeting held on 21st March 1969’, 21 March 1969. 89 Ibid.

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The notes of the meeting illustrate the complexities medical experts faced in assigning causation based on studying individual cases. This issue was raised in a report published in the BMJ two days before the Sub-Committee’s meeting. The report stated: ‘As the number of vaccinations increases so do the opportunities for encephalitis coincidental with, but not caused by, the vaccine, and thus the difficulty of distinguishing causation from association grows.’90 Department experts worked their way through the material, looking for clues, building a case based on circumstantial evidence. Every little detail mattered: the timing of events, the surrounding environment, and the changing nature of the body as it moved from life to death. Eventually these complex investigations would be translated into statistics; inscriptions hiding a more intricate story of interpretation and negotiation. After reviewing all the reported incidents, the Sub-

Committee concluded that out of five cases of encephalitis believed to be ‘consistent with a causative association with vaccination’; four of them were caused by Wellcovax.91

As the Committee moved further through the material, a familiar story began to reveal itself. A total of 178 reactions were reported to the DHSS and the CSD between May

1968 and February 1969. The nature of these reactions varied. The main symptoms reported were fever, rash, pyrexia, anorexia, diarrhoea, febrile convulsion and measles.

Crucially, out of a total of 178 reactions reported, 137 were associated with Wellcovax,

41 of which were recorded as convulsions.92 These figures were tempered slightly by the fact that during the same period a total of 1,256,531 doses of Wellcovax were issued compared to just 634,250 doses of Mevilin-L. However, as the Chairman of the Measles

Vaccination Sub-Committee, Professor C. H. Stuart-Harris ‘stressed’, ‘the available

90 Anon., ‘A Measles Vaccine Withdrawn’, British Medical Journal 1 (1969): 794. 91 TNA, MH 154/64, Joint Committee on Vaccination and Immunisation Measles Vaccination Sub-Committee, ‘Minutes of Meeting held on Monday, 31st March, 1969’, 31 March 1969. 92 TNA, MH 154/64, ‘Summary of Reported Reactions to Measles Vaccine Received from May 1968 to February 1969’, 1969; TNA, MH 154/64, ‘Summary of Reported Convulsions Following Measles Vaccination Received from May 1968 to February 1969’, 1969.

207 evidence suggested that Burroughs Wellcome vaccine had given rise to adverse reactions, proportionately to the number of doses issued, at least twice as often as

Glaxo vaccine.’93 Although members were concerned about losing their main source of vaccine supply, just two weeks after concerns over Wellcovax’s safety first became public the JCVI’s Measles Vaccination Sub-Committee recommended its discontinuation from British campaigns; a decision that was confirmed a month later at a second meeting of the Sub-Committee.94

However, while the decision to withdraw Wellcovax was reported as unanimous, not everybody was happy with the outcome or the process. One individual who could not attend the meeting of the JCVI’s Measles Vaccination Sub-Committee was Dr G. I.

Watson. A general practitioner and long-standing member of the Sub-Committee,

Watson had been involved in testing some of the early derivatives of Wellcovax, and was concerned by some of the conclusions quickly being drawn. He decided to send the

Sub-Committee a letter before the meeting recording his own interpretation of events.95

Watson began the letter by examining the ‘fatal case’ of Kay Smith and concluded that the evidence ‘was not at all convincing as regards measles vaccine being the principal cause of death’.96 He then meticulously worked his way through the Sub-Committee’s main concerns regarding encephalitis and severe convulsions, again concluding that there was insufficient evidence to suggest a strong association between the vaccine and these reactions. While Watson’s interpretations were largely based on clinical experience, his most powerful observation came from the use of statistical evidence.

93 TNA, MH 154/64, Joint Committee on Vaccination and Immunisation Measles Vaccination Sub-Committee, ‘Minutes of Meeting held on Monday, 31st March, 1969’, 31 March 1969. 94 TNA, MH 154/64, Joint Committee on Vaccination and Immunisation Measles Vaccination Sub-Committee, ‘Minutes of Meeting held on Wednesday 30th April, 1969’, 30 April 1969. 95 TNA, MH 154/64, G. I. Watson to the Joint Committee on Vaccination and Immunisation Measles Vaccination Sub-Committee, ‘Suspension of Wellcovax’, 1969. 96 Ibid.

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Using a set of unpublished results, Watson noted that the ‘majority of reported convulsions after measles vaccine have occurred in children aged between one and two years.’97 He argued that if the vaccine had been given to children at a minimum age of

30 months, around 89 per cent of the convulsions reported may have been avoided.98

According to Watson, if the age of vaccination was extended, Wellcovax could remain an important part of Britain’s fight against measles.

From Watson’s perspective there was a danger that a potentially valuable vaccine was being judged too quickly. In concluding his letter, Watson put forward five main proposals for the Sub-Committee to discuss further: first, that if the death of Kay Smith was found to be a coincidence ‘adequate steps should be taken to give equally wide publicity to the verdict as was given to the damaging news of the interim suspension of

Wellcovax’; second, a detailed investigation should be carried out with the aim of clarifying whether Wellcovax could be considered an ‘encephalitic agent’; third, a debate should be had on the value of increasing the age of vaccination to 30 months; fourth, as it was considered more dangerous to vaccinate during winter months, consideration should be given to postponing measles vaccination until the spring; and finally, the medical profession and the public should be given more information on the ‘nature and timing of the normal reactions to be expected after measles vaccine’.99 The minutes of the Sub-Committee’s meeting suggest only one of Watson’s proposals was discussed, that of increasing the age of vaccination. His unique interpretation of the evidence did little to spark a more substantial debate.

97 Ibid. 98 Ibid. 99 Ibid.

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At a meeting of the JCVI, held on 13 May 1969, members chose to endorse the decision of its Measles Vaccination Sub-Committee and recommend the discontinuation of

Wellcovax from British vaccination campaigns. The contrast between the speed and clarity of their response at this stage, as compared with the speed and clarity of their response prior to Wellcovax’s association with iatrogenic encephalitis, is striking. In this new context, meetings were organised within days; scientific uncertainty was less inhibiting; and decisions were taken quickly without the need for further deliberation, debate and investigation. Indeed, despite their long-term interest in the subject, neither the MRC, CSD nor Burroughs Wellcome were consulted regarding the decision to discontinue the use of Wellcovax. A note in one of the MRC’s administrative files, written the day after the Measles Vaccination Sub-Committee’s first meeting, states: ‘I feel that we should not formally associate ourselves with the recent Ministry of Health decision to ban the Wellcome vaccine since the decision was, in fact, taken without any prior consultation with the Council.’100 This episode illustrates the power of the dramatic and emotive in cases of iatrogenic illness. A steady accumulation of ‘moderate’ and ‘severe’ reactions, such as convulsions, inspired little action and little attention. The story of Kay Smith and encephalitis caught the attention of the media, and prompted the Government and medical authorities into action.

At the same time, this decisive action left a number of questions unasked and unanswered. Did Wellcovax cause encephalitis? Could Wellcovax have been given to children aged three years and over? What effect would suspending Wellcovax have on supply and demand? An article published in the BMJ in 1969 asked: ‘Considered solely from the point of view of the avoidance of reactions, the Schwartz strain is clearly superior, but what of the relative duration of protection conferred by the two vaccines?

100 TNA, FD 7/1270, B. S. Lush, File Note, 1 April 1969.

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Might immunization with the less attenuated Beckenham strain prove of greater benefit in the long term by producing a more durable protection?’101 As important as these questions were, from a moral and public health perspective, as I will examine in the next section, arguably the most important question that needed to be asked, was could

Wellcovax have a life outside of Britain?

4.5 ‘What should we do?’: The global story of Wellcovax

On 17 March 1969, just 48 hours before concerns over Wellcovax’s safety first emerged, the Daily Mirror reported that a British ‘life saver’ was being used to immunise children in Nossa Senhora Do O, ‘a primitive township perched on a hill outside Sao

Paulo.’102 This article was just one of a long line of heroic pieces, which had documented the journey of Wellcovax from a British laboratory in Beckenham, Kent, to its eventual use in saving the lives of thousands of children across the globe. This particular report followed the story of Dr. Jose Vieira Da Rocha and his attempts to vaccinate local children. The results according to the article were staggering. Of the 600 hundred children Dr. Da Rocha vaccinated, not one suffered an attack of measles. This was compared with the tragic events in a nearby village, where in the space of just a single week, 10 unimmunised children died after an outbreak of the disease. Like so many articles written about Wellcovax before the events of March 1969, this was a story of medical triumph against a deadly childhood disease.103

101 Anon., ‘A Measles Vaccine Withdrawn’, 794. 102 Anon., ‘Something to Shout About’, Daily Mirror, 17 March 1969, 17. 103 Anon., ‘A Beckenham Triumph: New Measles Vaccine Knocks Spots off the Others!’, Beckenham Advertiser, 7 April 1966; Don Everitt, ‘Good-Bye Measles!’, The Readers Digets: Nigerian Edition 7 (1966): 5–8; Roy Herbert, ‘New Measles Vaccine Now Available’, Guyana Star, 14 April 1966; John Prince, ‘Vaccine May Rid Britain of Measles’, The Telegraph, 1 April 1966.

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When news of Wellcovax’s suspension reached the British public, the vaccine had reportedly been used on over five million children across the globe. Given that measles was a major cause of childhood mortality in some parts of the world, its suspension provoked anxiety internationally. This anxiety was vividly brought to life by two clinicians working at Makerere University Medical School, Kampala, Uganda. J. P.

Stanfield and M. Moffat had been working on a measles vaccination campaign in

Uganda using Wellcovax, and following the news that the vaccine had been suspended by Burroughs Wellcome were concerned at the potential repercussions this decision could have on their own campaign. Given that measles was a significant cause of mortality in Uganda, they wondered whether Wellcovax could still have a significant role to play. In an effort to engage a wider debate on the subject, they wrote a letter to

The Lancet:

Measles is a major cause of death in young children in most developing countries. The prevention of measles by vaccination is regarded as a matter of first priority, and immunisation programmes are being carried out in many areas, including Uganda, where the Beckenham 31 strain is in current use. In contrast to this, in developed countries where measles is more of a nuisance than a threat to life, measles immunisation has been adopted with greater caution and debate. The recent withdrawal of Beckenham 31 measles vaccine because of a few isolated cases of complications involving the central nervous system may be justified in the latter circumstances, but is it in the former? With reports of this withdrawal reaching the local Press we are placed in a further dilemma. What should we do?104

Similar questions were raised by campaigners working on a measles vaccination programme for Oxfam. Before safety concerns over Wellcovax began to emerge, in

104 J. P. Stanfield and M. Moffat, ‘Measles Vaccine in Developing Countries’, The Lancet 293 (1969): 293.

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January 1969 Oxfam approached the British Government for help in obtaining a source of measles vaccine. The vaccine was specifically intended for a campaign being organised in Biafra where a deadly combination of civil war and epidemic disease had left parents and children in an extremely vulnerable position. Consequently, Oxfam’s

Deputy Director, Nicolas Stacey, wrote to Britain’s Secretary of State for Social

Services, Richard Crossman, on behalf of the International Red Cross, asking for help in acquiring 300,000 doses of the ‘Schwarz strain’.105 Privately, DHSS official Philip

Muston thought this might serve as an opportunity to offload some unwanted stock:

‘As you know experience has shown a slightly higher level of reaction to the Burroughs

Wellcome vaccine which some doctors here have found unacceptable and for this reason it would be preferable if the Oxfam supply came from Burroughs Wellcome. But this may be impossible to arrange without upsetting Glaxo’.106 In the end Oxfam did accept an offer from Burroughs Wellcome for 300,000 doses of Wellcovax. However, this was not the result of any Machiavellian manoeuvring on the part of the British

Government, but rather reflected the faster pace of production Burroughs Wellcome could offer.

By the time the DHSS and Burroughs Wellcome had suspended the use of Wellcovax in

Britain, Oxfam had received around half of their total order. Officials at Oxfam now found themselves in a precarious moral position. Should they use their remaining stock to vaccinate against a potentially lethal disease, or was the use of a vaccine now deemed unacceptable in one country, also unacceptable in another. According to a DHSS file note, ‘Burroughs … left it to Oxfam to decide whether to continue to use what they had, against the knowledge that an attack of measles in Biafra is deadly and should

105 TNA, MH 154/526, Nicolas Stacey to Richard Crossman, 27 January 1969. 106 TNA, MH 154/526, Philip Muston, File Note, 28 January 1969.

213 therefore be prevented.’107 Two months later, an official from Oxfam again got in contact with the DHSS. The military situation had changed in Biafra, and Oxfam were again seeking the Department’s advice about whether Wellcovax could be used in a different medical context. According to the Departmental official W. F. Lake,

Oxfam had not been able to use all the measles vaccine they had bought. They were considering using it in other African countries, but were uncertain whether they would be able to – or indeed should – in view of the withdrawal of B.W. vaccine in the U.K… I told him that the decision was in any case for themselves to make, but that it was unlikely that B.W. vaccine would have been withdrawn in the U.K. if it had been the only available vaccine.108

Despite the urgency and importance of these questions, the private discussions between

Oxfam and the DHSS were unique moments of introspection. Very few national and international institutions investigated whether Wellcovax could continue to be used overseas. Instead, countries across the globe followed Britain’s recommendation to discontinue its use. This led to mass shortages of measles vaccines in many parts of the globe and created anxiety amongst parents and medical authorities. In areas such as

Australia and New Zealand the vaccine was banned before a campaign had even begun.109 Even in areas where Wellcovax had proved successful, it was quickly discontinued. In Hong Kong, for example, Wellcovax had led to a significant reduction in the total number of cases of measles, without any recorded case of encephalitis.110 In

1967, the year prior to the introduction of Wellcovax, the number of measles cases reported was 6,702, and the number of reported deaths 995. In 1969, following the

107 TNA, MH 154/526, B. H. Betts, File Note, ‘Measles Vaccine. Oxfam’, 27 March 1969. 108 TNA, MH 154/526, W. F. Lake, File Note, 19 May 1969. 109 Anon., ‘Canberra Measles Campaign Suspended’, The Canberra Times, 20 March 1969, 1; Anon., ‘Only One Measles Vaccine in UK Held Up’, The Canberra Times, 21 March 1969, 1. 110 Anon., ‘Measles Vaccinations Declining in HK’, South China Morning Post & HongKong Telegraph, 8 May 1969, 6.

214 introduction of Wellcovax, the number of measles cases reported was just 727 and the number of deaths recorded was just 35. Yet, despite these positive results, medical authorities in Hong Kong believed they were left with little choice but to withdrawal the vaccine following the decision in Britain.

The decision of overseas medical authorities to withdraw Wellcovax based largely on

British representations of the vaccine left Burroughs Wellcome frustrated. Concerned by the ‘overseas’ repercussions of Britain’s decision to withdraw Wellcovax, the

Research Director of the Wellcome Foundation, Dr David Long, wrote to the

Committee on Safety of Drugs for help.111 ‘As long as the vaccine is not used in this country,’ wrote Long, ‘it is difficult for the W.H.O to recommend that it should be used in their programmes and, accordingly, they are continuing to refuse to endorse the use of the vaccine.’112 Long was unhappy with the DHSS’s previous investigation. He believed the DHSS had not provided Burroughs Wellcome with sufficient information to make an informed decision, and the evidence they had received suggested there was no ‘statistically significant difference’ between the rates of encephalitis following the use of Wellcovax and Mevilin-L.113 In a bid to calm British and global fears now surrounding the vaccine, Long asked the CSD to ‘review all data on “Wellcovax” and to advise … as to whether it may be marketed in this country provided proper safeguards are taken on the age of vacciantion’.114 Unfortunately for Long, the CSD could offer little support. Their role was to examine the safety and efficacy of an individual product.

Based solely on this, the CSD had already made it clear that they had ‘no objection’ to

111 TNA, MH 148/563, Committee on Safety of Drugs, Sub-Committee on Adverse Reactions, ‘Status of “Wellcovax” Measles Vaccine: Note by Medical Assessor’, 13 October 1969. 112 TNA, MH 148/563, David Long to D. A. Cahal, 29 September 1969. 113 Ibid. 114 Ibid.

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Burroughs Wellcome ‘marketing’ Wellcovax in Britain or overseas.115 However, decisions concerning national immunisation policy were the responsibility of the JCVI, and their decision was final.

4.6 Communicating closure: Making Wellcovax disappear

The communication of the JCVI’s decision to discontinue the use of Wellcovax was a highly orchestrated event. In contrast to the discreet way in which officials at the DHSS had communicated Wellcovax’s original suspension, officials now sought a more public setting to communicate the permanent withdrawal of Wellcovax. On Tuesday 10 June

1969, a letter was sent first class to medical officers of health and second class to GP’s using a medical mailing agency. On Wednesday 11 June a press notice was issued for publication in the next morning’s newspapers. Finally, a ‘more detailed exposition’ of the reasons behind Wellcovax’s withdrawal was sent to the BMJ and The Lancet for publication on 14 June.116 While the decision to inform the media first would once again place the DHSS’s approach to communicating new drug safety information under the spotlight, in presenting a powerful message of scientific closure, the Department’s approach had the desired effect.

Crucial to this communication with the public was the DHSS’s relationship with the media. As I described earlier, newspaper correspondents’ reliance on official statements for their stories enabled the DHSS to frame the terms of public debate. When it came to announcing the Department’s decision to withdraw Wellcovax, most newspapers either followed their official press statement or quoted it verbatim. The Sun and The

115 TNA, MH 148/63, D. A. Cahal to David Long, 3 October 1969. 116 TNA, MH 154/526, W. F. Lake, File Note, ‘Vaccination Against Measles’, 3 June 1969.

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Daily Telegraph both went with the headline ‘Measles Vaccine Banned’; other headlines included: ‘Ditch Vaccine Doctors Told’; ‘Measles Vaccine Withdrawn after Side

Effects’; and ‘Don’t Use this Vaccine’.117 These headlines proclaimed a sense of closure.

Rather than a space for analysis and critique, the media became an instrument of the

DHSS; part of its public relations machinery.

Like previous press statements, the information presented to the public was carefully mediated. Readers were given very little clinical and epidemiological information regarding reactions. For example, none of the individual case reports of encephalitis were made public and the only clinical symptoms that were mentioned were reports of

‘convulsions’ and ‘febrile reactions’. There was no discussion of interpretative differences between experts advising the JCVI, MRC, CSD and Burroughs Wellcome.

And there was no mention of administrative difficulties with the CSD’s drug surveillance system. In concealing the uncertainty and conflict of the committee room, the Department’s statement presented a picture of expert consensus and scientific closure designed to stifle further inquiry and controversy (see Figure 8).118

117 Anon., ‘Measles Vaccine Banned’, The Sun, 12 June 1969; Anon., ‘Measles Vaccine Banned’, The Telegraph, 12 June 1969; Anon., ‘Doctors Advised on Measles Vaccine’, Financial Times, 12 June 1969; Anon., ‘Don’t Use Measles Vaccine, Doctors Told’, Belfast Telegraph, 12 June 1969; Anon., ‘Don’t Use This Vaccine Again, Doctors Told’, Daily Express, 12 June 1969, 11; Anon., ‘Measles Vaccine Withdrawn after Side Effects’, The Guardian, 12 June 1969, 5; Anon., ‘Vaccine Not to Be Used’, The Times, 12 June 1969, 1. 118 TNA, MH 154/526, ‘Not for Publication before Morning Papers, Thursday, 12th June, 1969: Vaccination Against Measles’, 12 June 1969.

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Figure 9. Department of Health and Social Security’s press release reporting the news of Wellcovax’s withdrawal from British vaccination campaigns. Source: TNA, MH 154/526, ‘Not for Publication before Morning Papers, Thursday, 12th June, 1969: Vaccination Against Measles’, 12 June 1969.

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219

On 14 June 1969, the DHSS published its ‘more detailed exposition’ on the reasons behind Wellcovax’s withdrawal.119 Focussing on the period between 1968 and 1969, this statement would be the only official account of the history of Wellcovax released by the

DHSS. Published in the BMJ, the article described the events leading to Wellcovax’s suspension and the reasons behind its subsequent withdrawal. It began by describing how between May 1968 and April 1969 the CSD received 241 reports of adverse reactions associated with measles vaccines, 189 of which were associated with

Wellcovax. It then went on to describe in some detail the number of convulsions associated with each vaccine and their relationship to the child’s age. According to the review ‘a total of 80 convulsions after measles vaccination were reported, 15 after Glaxo vaccine, 61 after Wellcome vaccine, and 4 where the manufacturer was not recorded.’120

Finally, it described the events of March 1969 and the realisation that ‘some of the adverse reactions associated with measles vaccine were less benign in their ultimate outcome than had hitherto been recognized.’121 According to the review ‘the above information is consistent in every way with the conclusion that Wellcome vaccine gives rise to at least twice as many serious reactions as Glaxo vaccine.122

Through its careful representation of time, statistical evidence and institutional decision making, the DHSS’s report presented an image of effective drug regulation. At the same time, it continued to conceal a more problematic history. Firstly, in beginning the story in the middle of 1968, readers were kept unaware of Wellcovax’s more troubled research trajectory (see Chapters 2 and 3). Most notably, they were kept unware of

Wellcovax’s non-inclusion in the MRC’s Measles Vaccines Committee’s protection trial and of earlier evidence coming out of the Ministry of Health’s batch surveillance

119 Anon., ‘News and Notes: Measles Vaccines’, British Medical Journal 2 (1969): 701–2. 120 Ibid., 701. 121 Ibid., 702. 122 Ibid.

220 scheme, which suggested Wellcovax caused more reactions than Glaxo’s Schwarz strain.

Secondly, in examining the events leading up to Wellcovax’s initial suspension through safety data received from ‘May 1968 to April 1969’, readers were given no indication of the uncertainty and anxiety that existed in the DHSS at the time.123 They were not told about the various ad hoc committee meetings arranged to discuss growing concerns over the safety of Wellcovax, and the nature of discussion, debate and disagreement which existed within them. Finally, in explaining the JCVI’s decision to withdraw

Wellcovax from Britain’s campaign, the report made no mention of interpretative differences between the Committee, the CSD and Burroughs Wellcome. Arguments in favour of Wellcovax’s continued use, such as the vaccine’s potentially greater immunogenicity, or its potential use in children over the age of three were left out.

While the article did leave traces that there was more to this story, in leaving out the uncertainty, conflict and secrets of the committee room, the DHSS’s statement presented a position of scientific objectivity, consensus and closure. In concluding, the report stated: ‘The Measles Vaccination Subcommittee at its meeting on 30 April 1969 decided to recommend continuation of the campaign using only Schwarz vaccine or a vaccine of a similar degree of attenuation. This recommendation was endorsed by the

Joint Committee on Vaccination and Immunization on 13 May 1969.’124

After this article was published, the subject of Wellcovax largely disappeared from political and medical life. Although Burroughs Wellcome asked for ‘a clearer statement’ on the vaccine’s safety, no further account was ever published.125 Indeed, its disappearance has led to certain degree of uncertainty and mystery surrounding the vaccine. For example, the founder of the Association of Parents of Vaccine Damaged

123 Ibid., 701. 124 Ibid., 702. 125 TNA, MH 154/526, George Godber, File Note, 31 October 1969.

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Children, Rosemary Fox, stated in her biography published in 2006: ‘Presumably, there is a report somewhere of a study to decide what went wrong and why the vaccine was allowed to be issued in the first place ... If such a report exists it was never published for the information of the public.’126As I will examine below, had an alternative version of the report been published, Wellcovax’s disappearance may have been far more difficult to manage.

4.7 A private confession

On 20 March 1969, the day after reports of encephalitis were first published in the media, Dr W. N. Dunnet of the DHSS wrote a brief summary of Wellcovax’s research and clinical history for Government Ministers.127 The main purpose of Dunnet’s memo was to investigate the decision-making process behind Wellcovax’s original approval. In particular, Dunnet was interested in the relationship between the MRC’s clinical trials and the JCVI’s Measles Vaccine Sub-Committee’s decision to approve the use of

Wellcovax back in 1967 (see Chapter 3). Unsure about several aspects, Dunnet sent a copy of his notes to E. M. B. Clements at the MRC for review. ‘In assembling the material I was struck by two things’, wrote Dunnet, ‘First that the 1964/65 M.R.C. large scale trials did not include live B.W. vaccine… Second that there appears, so far as I can discover, to have been no detailed information laid before any of the various sub- committees about reactions to the B.W. live vaccine later than those from the small scale trial in 1964.’128 In response, Clements presented an unproblematic reading of events. Firstly, he argued ‘The Medical Research Council had hoped to use both Glaxo

126 Rosemary Fox, Helen’s Story (London: John Blake, 2006), 259. 127 TNA, FD 23/1361, W. N. Dunnet, ‘Measles Vaccine Trials’, 20 March 1969. 128 TNA, FD 23/1361, W. N. Dunnet to E. M. B. Clements, ‘Measles Vaccine, Burroughs Wellcome’, March 1969.

222 and Burroughs Wellcome live vaccines... However at the time of the trial it was not known whether the new batches of Wellcome vaccine had similar characteristics to the batch used in the early trial.’129 Secondly, he argued Wellcovax had been tested in several later trials, including studies in Southampton, Chester, Oxford and Bristol. However, what Clements failed to mention was that these studies were not presented to members of the Measles Vaccination Sub-Committee during their meeting in November 1967.

Whilst Clements’ response largely evaded the central moral concern at the heart of

Dunnet’s questions (i.e. was the decision to recommend the use of Wellcovax made in ignorance), evidence suggests he shared Dunnet’s unease. In an MRC administrative file note, written late in 1968 in response to growing concerns over the safety of Wellcovax,

Clements confessed:

The incidence of severe reactions encountered in the general use of measles vaccine is rather disquieting particularly as they are mainly attributable to Burroughs Wellcome material. It may be recalled that the MRC trials used Glaxo material and only at a late stage was Burroughs Wellcome included. It looks as though this material was insufficiently used on a trial basis before its general release and despite their late start it appears that most of the material used has come from Burroughs Wellcome.130

Indeed, Dunnet’s request seems to have stimulated a certain level of introspection within the MRC. On the same day that Clements responded to Dunnet’s letter, he recorded the MRC’s own version of events in a file note: ‘The Medical Research

Council has proceeded very cautiously with the work on Burroughs Wellcome vaccines.

This is evident from the records of meetings which were attended by representatives of

129 TNA, FD 23/1361, E. M. B. Clements to W. N. Dunnet, 24 March 1969. 130 TNA, FD 7/511, E.M.B. Clements, File Note, 15 November 1968.

223 the Ministry, although the Council may be under some criticism for not having been more vocal in expressing the doubts.’131 Clements would go on to write a more detailed account of Wellcovax’s trajectory, raising several concerns over the process of the vaccine’s development, testing and regulation.132 He recalled the events of 1964, and the

MRC’s decision to exclude Beckenham 20 from the MRC’s Measles Vaccines

Committee’s protection trial following reports of ‘severe reactions’ taking place during a private trial.133 He also recalled the small scale trials that were undertaken to compare the safety and efficacy of Wellcovax with Glaxo’s Schwarz strain. Most significantly, he recalled a meeting of the Immunological Products Advisory Committee held in

December 1965. At this meeting specific reference was made to the introduction of

Wellcovax. The minutes stated: ‘It was … agreed that since vaccine made from the

Wellcome strain had not been used as widely as that made from the Schwarz strain, the

Chairman would see Colonel Mulligan of Wellcome Laboratories and stress the need for slow release of the vaccine into the community.’134 Crossed out below the copy of this minute, Clements wrote, ‘retrospectively the advice to proceed circumspectly might have been better conveyed to the Dunlop Committee and the Ministry.’135 ‘In summary’, wrote Clements,

Wellcome vaccine has been known to give a higher proportion of reactions as compared with Glaxo material, but because this might have provided a better and longer lasting protection against the natural disease this might have been a good thing. The number of doses of Wellcome vaccine used in the M.R.C. trials was relatively small and experience was limited, however, the measles vaccine

131 TNA, FD 23/1361, E. M. B. Clements, File Note, ‘Withdrawal of Burroughs Wellcome Measles Vaccine, 24 March 1969. 132 TNA, FD 23/1361, E.M.B. Clements, File Note, ‘Reactions Following Measles Vaccine’, 19 June 1969. 133 Ibid. 134 Ibid. 135 TNA, FD 23/1361, E.M.B. Clements, File Note, ‘Reactions Following Measles Vaccine’, 30 April 1969.

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campaign of the Department has used twice the amount of Wellcome vaccine as Glaxo material.136

A confession of sorts, Clements’ account revealed a history of uncertainty, secrecy and misadventure.

Unlike the DHSS’s carefully constructed report, Clements’s less restrained account was never published. Had it been, the story of Wellcovax may have taken a very different journey. As historians and social scientists studying cases of scientific and medical

‘crisis’ have shown, media and public attention is often drawn towards dramatic narratives of government secrecy, inaction and uncertainty. Whether this representation is true or not, it is these images which have inspired intrigue, anxiety and at times controversy. The histories of thalidomide, BSE and MMR, all reveal how the media were partly driven by the suspicion of secrecy and immorality. For example, examining the ‘The Thalidomide Affair’ in the 1980s, June Goodfield has argued that ‘the journalists from The Sunday Times (London), and their editor refused to withdraw from the struggle until certain basic aims had been achieved: full disclosure of the truth of the matter; acknowledgement of moral and legal responsibility; redress for the families.’137 In the case of Wellcovax and the British state, without access to these dramatic narrative tropes, the media lost interest in the story very quickly. As a result the more complex story of Wellcovax remained hidden.

136 TNA, FD 23/1361, E.M.B. Clements, File Note, ‘Reactions Following Measles Vaccine’, 19 June 1969. 137 Goodfield June, Reflections on Science and the Media (Washington: American Association for the Advancement of Science, 1981), 68–86.

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4.8 Conclusion

On 18 July 1969, Wellcovax made one final public appearance. Published in several newspapers that day were the results of the coroner’s inquest into the death of Kay

Smith.138 Believed to be caused by a ‘form of gastro-enteritis’, the coroner’s report confirmed that Kay Smith had ‘died from natural causes’.139 While no detailed information regarding the inquest was presented to the public, the coroner, Lieutenant

Colonel George McEwen, made one thing clear: ‘In this case the measles vaccination did not cause death.’140 However, while Kay Smith’s death may not have been caused by

Wellcovax, as I have argued in this Chapter, her death was a defining moment in the vaccine’s trajectory. Prior to her death, and away from the public spotlight,

Departmental experts and officials struggled to make sense of a growing number of adverse reactions reported to the CSD. In making concerns over the vaccine’s safety publicly visible, Kay Smith’s death created a new political context, and with it, a reinterpretation of the vaccine’s dangers.

This Chapter has argued that decisions concerning the regulation of Wellcovax were informed by the spectre of controversy. Decisions over which risks to respond to, how to respond to them, and how to communicate them, all reflected a fear of the controversial. Echoing a number of twentieth-century British public health campaigns, the public were implicitly framed as an anxious body in need of care by a paternalistic state. This was achieved not only through the careful construction of public rhetoric, but also the form, timing and medium this information was presented in. The journey

138 Anon., ‘Measles Vaccine “Not Guilty”’, The Sun, 18 July 1969; Anon., ‘Vaccine Cleared but Its Future Is Still in Doubt’, Daily Mail, 18 July 1969, 9. 139 Anon., ‘Vaccine Cleared but Its Future Is Still in Doubt’, 9. 140 Ibid.

226 of information from the committee room to the public sphere was a highly mediated process. New knowledge concerning the vaccines safety was kept secret and conflicts over the meaning of Wellcovax’s evolving safety profile remained hidden within committee minutes. From a political perspective, the result was a carefully managed event: the prevention of a potential medical and political ‘storm’.141 However, from a moral and epistemological perspective, the result was the constructing of ignorance: the closure of a scientific debate that still had questions to answer.

Nevertheless, while the story of Wellcovax may have ended, the uncertainty and discretion which had framed its journey lived on. Adverse reactions to measles vaccination continued to be reported throughout the next two decades. At times it was difficult to make sense of them. Assigning causation was always problematic and a combination of under reporting, along with unreliable administration figures, compounded the uncertainty. In general, government advisors were reassured that the benefits of vaccination always outweighed the risks. However, the element of uncertainty continued to cast a shadow over the campaign. Surveys suggested both medical practitioners and parents remained suspicious of the safety of measles vaccines.

Many decided not to vaccinate their children during the 1970s and 1980s. Echoing moments in the story of Wellcovax, several commentators believed the spectre of adverse reactions, and the desire to avoid public controversy, was inhibiting DHSS action. This was certainly the view of the Chairman of the JCVI’s Measles Vaccination

Sub-Committee, Sir Stuart-Harris. In a review of Britain’s ‘Future Policy on Measles

Immunization’ conducted in 1981, Stuart-Harris agued the ‘principal stumbling-block concerning extension of present policy by a campaign to increase the uptake of measles

141 BMA, 2(3)5(1)43 E/2/375/10, J. C. Cameron to George Godber, 1 April 1969.

227 vaccine appears to be the fear of causing adverse reactions and possibly encephalitis.142’

Other commentators argued that a fear of the medico-legal consequences of vaccine reactions was paralysing DHSS action. Similar to the DHSS’s response to growing anxieties over the use of Wellcovax, their response to measles vaccination during the

1970s and 1980s was to follow the path of least political resistance. In contrast to previous analyses of vaccine controversies, which have emphasised the damage they do to public confidence and trust, this thesis argues that the fear of controversy, and the active attempts to supress it, may prove equally problematic.

142 TNA, MH 154/1203, C. H. Stuart-Harris, Future Policy on Measles Immunization’, 13 January 1982.

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Conclusion

Through charting the history of measles vaccination and the British state, this thesis has examined the relationship between risk, politics and transparency. In contrast to previous accounts in the history of vaccination, which emphasised ‘a long history’ of vaccine controversies, the history of measles vaccination in Britain presents an alternative picture.1 As I have shown, despite the uncertainties, tensions and setbacks, which informed its journey, the translation of measles vaccination in Britain was remarkable for its lack of public conflict. In asking why the story of measles vaccination and the British state did not become another major medical and political scandal, this thesis offers new insights into the management of medical innovation and risk. Central to this management was the relationship between state organisations and the public. I have argued that the spectre of public controversy served as a powerful organising agent, shaping the way government experts and officials made decisions concerning medical risk. Which risks became visible, how these risks were evaluated and controlled, and how they were communicated, reflected not only technical and intellectual practices, but also social and political processes. Moreover, in examining how the

Ministry of Health and the Medical Research Council were able to avert crisis, I have drawn attention to the state’s power to control the circulation of knowledge, information and debate.

1 Matthew Smith, ‘MMR, Autism and the History of Medical Controversies’, History & Policy, 25 May 2010, http://www.historyandpolicy.org; Arthur Allen, Vaccine: The Controversial Story of Medicine’s Greatest Lifesaver (New York and London: W. W. Norton & Company, 2007); Janine Arnott, ‘The Social Construction of Vaccine Controversies’ (Unpublished Thesis, The University of Manchester, 2007); Jeffrey P. Baker, ‘The Pertussis Vaccine Controversy in Great Britain, 1974-1986’, Vaccine 21 (2003): 4003–10.

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As examined in Chapter 1, measles came to be defined as a significant political and public health issue in Britain in the early 1960s. Its transformation from a ‘mild’ disease, affecting the individual and the family, to a significant social, economic and medical burden, requiring government intervention, was informed by several factors.2

Developments in vaccine research politicised what had been a largely invisible illness.

Increased scientific interest, as I have shown, led to new epidemiological research centred on morbidity rather than mortality, revealing a more dangerous childhood illness.

At the same time, this transformation also reflected the influence of public and political pressure. Throughout this thesis, I have illustrated how official responses to decisions over measles vaccination were shaped by a fear of the controversial. Decisions over which risks to respond to, and how to respond to them, were largely informed by a desire to avert public controversy. We witnessed signs of this in Chapter 2, with the way decisions concerning the risks of medical experimentation were informed by a reading of the wider political context. It was then seen again in Chapter 3, in the way MRC officers attempted to mediate, and at times conceal, more troubling aspects of their measles vaccines protection trial. And finally, as we saw in Chapter 4, it was central to the way the withdrawal of Wellcovax was managed by DHSS officials. In the minds of officials, controversy was seen as not only a threat to their position, but also a danger to the nation’s health.

Thus, while previous accounts of twentieth century British medical regulation have largely neglected the role of the public, this thesis suggests the public – albeit an imagined one – did have an influence on the decision making process. In particular,

2 Anon., ‘Vital Statistics’, British Medical Journal 1 (1959): 380–83.

230 accounts of measles vaccination published in the British press were often interpreted as an expression of public mood. Charting the MRC and Ministry of Health’s changing response to measles and measles vaccination, against the backdrop of the evolving media coverage on the subject, demonstrates this close relationship between the press, the imagined public and decision making. For example, in Chapter 1, we saw how several newspaper reports, critical of the British government’s lack of response to measles vaccination, forced the MRC to re-engage with the subject. Crucially, these newspaper reports did not determine research policy, but politicised a subject that was in danger of being marginalised within the Council. Similarly, in Chapter 2, we saw how positive newspapers reports documenting the introduction of measles vaccination in the

United States created anxiety amongst some MRC and Ministry of Health officials over their decision not to undertake a clinical trial in Britain. Again, these reports did not determine clinical trial policy, but contributed to a reimagining of the public mood, one that was appropriated by supporters of measles vaccination to persuade the MRC to rethink their position.

As I have shown, MRC and Ministry of Health officials not only sought to understand public perceptions, but also manage them. As well as averting controversy, the Ministry of Health and the MRC attempted to cultivate trust, legitimacy and support amongst the

British public. As previous accounts of medical research have shown, positive public perceptions were deemed crucial to the evaluation, management and acceptance of medical innovation and risk.3 The state’s success in achieving such perceptions, not only came from the decisions they made and the actions they took, but crucially, the images they conveyed. In the case of measles vaccination, certain structures and cultures

3 Sydney A Halpern, Lesser Harms: The Morality of Risk in Medical Research (Chicago and London: The University of Chicago Press, 2004); Stephen E. Mawdsley, Selling Science: Polio and the Promise of Gamma Globulin (New Brunswick, New Jersey, and London: Rutgers University Press, 2016).

231 embedded within government bodies were essential to the control of knowledge, information and ultimately public debate. As I will examine below, these structures enabled the state to present an image of scientific consensus, closure and truth.

Firstly, at the centre of the MRC and Ministry of Health’s decision making process was the expert committee. The Ministry of Health’s JCVI and JCVI’s Measles Vaccination

Sub-Committee were central to formulating, recommending and often determining measles vaccination policy. Similarly, the MRC’s Measles Vaccines Committee was responsible for regulation, organising and reporting on the MRC’s trials. However, as well as making crucial decisions, these committees, and the privacy in which they operated, were central to the state’s control of public representations. Throughout this thesis, we have witnessed how the committee room provided a space for conflict, debate and disagreement, but also a space to lock away these tensions, presenting an image of scientific closure and consensus. Moreover, as an instrument of social control, the committee room also appeared to discipline dissenting voices. Take for example the history of Dr G. I. Watson. A member of both the MRC’s Measles Vaccines Committee and the JCVI’s Measles Vaccination Sub-Committee, at various moments throughout this story Watson had been critical of the decisions taken by both organisations. Most notably, it was his letter, sent just before the JCVI’s Measles Vaccination Sub-

Committee was due to meet to discuss the withdrawal of Wellcovax, which raised several concerns over the vaccine’s potential exclusion. Yet despite the Sub-Committee ignoring a number of his concerns, Watson did not air his grievances in public. Indeed,

Watson, like his fellow committee members, very rarely revealed any internal tensions.

Secondly, as this thesis has shown, when information was communicated to the medical profession and the public, it was carefully mediated by MRC and Ministry of Health

232 officials. Information concerning the testing, evaluation and regulation of measles vaccines was controlled through various administrative means. MRC and Ministry of

Health experts and officials were able to control what research and data was published, how it was published, and where it was published. At the same time, close relationships with the press during this period, allowed MRC officials to carefully manage media representations.4 As we saw in Chapter 3, private conversations with medical correspondents, along with well-timed press releases, allowed officials at the MRC to present the MVC’s protection trial as a scientific, medical and ethical success, while keeping hidden matters of potential public disquiet. Similarly, as we saw in Chapter 4, the Ministry of Health’s power to firstly conceal emerging concerns overs Wellcovax’s safety, and then control the representation of its withdrawal through the media, proved crucial in the management of this potential moment of crisis.

Key to this management of public information were MRC medical officers. While accounts of medical research and public health policy making often focus on the role and influence of the expert committee, this thesis has illustrated the importance of individual administrators.5 For example, MRC medical officer, Dr E. M. B. Clements, was central to the development of measles vaccination in Britain. In Chapter 1, we saw how through organising MRC conferences – including their personnel, agenda and literature – and promoting particular avenues of further research and policy, Clements was able to challenge certain assumptions concerning the burden of measles. Clements may not have determined policy, but in framing discussions, along with mobilising interest and support, he was influential in its development.

4 Kelly Loughlin, ‘Networks of Mass Communication: Reporting Science, Health and Medicine in the 1950s and ’60s’, in Making Health Policy: Networks in Research and Policy After 1945, ed. Virginia Berridge (Amsterdam - New York: Rodopi, 2005), 295–322; Anne Karpf, Doctoring the Media: The Reporting of Health and Medicine (London: Routledge, 1988). 5 Virginia Berridge, ed., Making Health Policy: Networks in Research and Policy After 1945 (Amsterdam - New York: Rodopi, 2005).

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Clements’ influence, however, is particularly visible in the way he attempted to shape public understandings of measles vaccination. As we saw in chapter three, Clements was a key figure in controlling the representation of the MVC’s protection trial. Most notably, it was Clements, along with several other MRC medical officers, who successfully managed to censor the story of Beckenham 20’s non-inclusion in the trial.

It is through Clements’ attempts to manage the press that we see the conscious desire of

MRC officials to represent the MRC and its research as ethically, technically and politically sound, but it is also through Clements that we start to see the moral tensions at the heart of this control.

The successful closure of the story of Wellcovax was thus the consequence of a set of structures, cultures and relationships already firmly imbedded in two of Britain’s most important public health and medical bodies. Whether by accident or design, these elements enabled the state to control the distribution of information, and consequently inform the nature of public and professional debate. However, this concealment of a more complex reality raises a number of moral and epistemological concerns. It not only meant many parents and practitioners remained uninformed, raising moral questions over patient choice and informed consent, but it also meant potentially valuable debates around the nature of an effective vaccine were confined to a very narrow political and scientific space, unable to develop organically across rich cultural and scientific boundaries. As a result, many questions remained unasked and unexplored; questions that were not only relevant to British children, but children in countries across the globe.

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This inhibition was most clearly articulated by one individual who was prepared to speak more openly. In 1966, Graham Wilson, a member of both the MRC’s Measles

Vaccines Committee and the JCVI’s Measles Vaccination Sub-Committee, was offered a lectureship at the London School of Hygiene and Tropical Medicine. Based on the four lectures he gave in November of that year, he published a study under the provocative heading, ‘The Hazards of Immunization’. Although his study – an in-depth investigation into the history of vaccine ‘accidents’ and ‘complications’ – was not a direct challenge to the basic principles of vaccination, Wilson still felt uncomfortable about publishing it.

‘That the book will be criticized on the ground that the digging up of so many unsavoury facts is neither necessary nor expedient, and that it will merely strengthen the case of the anti-vaccinationists, I am well aware’, wrote Wilson, ‘but what has influenced me most in its preparation is the need to understand how mishaps have arisen, so that with the exercise of due care they may be avoided in the future.6 In this one quote,

Wilson reveals the tension at the heart of this thesis. This is not a history of scandal and conspiracy that has framed previous analysis of experimentation and regulation from this period. As Wilson’s book demonstrates, experts and officials advising the British government on vaccination cared deeply about the technologies benefits and risks. As we saw in Chapter 2, Britain was renowned for its uniquely ‘cautious’ position’.7

However, as Wilson book also demonstrates, experts and officials were afraid of speaking openly about vaccination; afraid of revealing a more uncertain picture to the public. This fear ultimately led to the construction of public ignorance and its moral and epistemological consequences. Like Wilson, this thesis does not serve as challenge to the value of vaccination, but seeks to understand a more complex world.

6 Graham Wilson, The Hazards of Immunization (London: The Athlone Press, University of London, 1967), v. 7 Jan Hendriks and Stuart Blume, ‘Measles Vaccination Before the Measles-Mumps-Rubella Vaccine’, American Journal of Public Health 103 (2013): 1393–1401.

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TNA, FD 23/1351, Denis Hill to Joan Faulkner, 18 July 1962. TNA, FD 23/1351, Graham Wilson to Joan Faulkner, File Note, 20 September 1962. TNA, FD 23/1351, Margaret Gorill, File Note, ‘Notes on a Luncheon Meeting 25.10.62 to Discuss the Neurological Sequelae of Measles’, 26 October 1962. TNA, FD 23/1351, ‘Investigation of the Complications of Measles’, 1963. TNA, FD 23/1351, ‘Informal Meeting on Neurological Complications of Measles’, 24 June 1963. TNA, FD 23/1353, Frank Perkins to E. M. B. Clements, 18 April 1963. TNA, FD 23/1353 (a), E. M. B. Clements, File Note, 22 April 1963. TNA, FD 23/1353(b), E. M. B. Clements, File Note, 22 April 1963. TNA, FD 23/1353, E. M. B. Clements to Wilson Smith, 15 May 1963. TNA, FD 23/1353, George Godber to Harold Himsworth, MRC, 21 May 1963. TNA, FD 23/1353, E. M. B. Clements, File Note, 28 May 1963. TNA, MH FD 23/1354, E. M. B. Clements, File Note, 4 June 1964. TNA, FD 23/1354, E. M. B. Clements, File Note, 7 August 1963. TNA, FD 23/1354, E. M. B. Clements, 16 March 1964. TNA, FD 23/1354, Christine Miller, ‘Measles Vaccines Study 1963-64: Progress Report’, 1964. TNA, FD 23/1355, E. M. B. Clements, File Note, 5 February 1965. TNA, FD 23/1355, E. M. B. Clements to Wilson Smith, 18 February 1965. TNA, FD 23/1355, George Godber to Harold Himsworth, 20 April 1965. TNA, FD 23/1355, Harold Himsworth to George Godber, 20 April 1965. TNA, FD 23/1355, George Godber to B. S. Lush, 4 September 1964. TNA, FD 23/1355, B. S. Lush to George Godber, 18 September 1964. TNA, FD 23/1355, Joan Faulkner, File Note, 16 September 1964. TNA, FD 9/2448, File Note, 16 September 1964. TNA, FD 23/1355, George Godber to B. S. Lush, 21 September 1964. TNA, FD 9/2448, Joan Faulkner, File Note, 23 September 1964. TNA, FD 23/1355, Trial Consent Form, ‘Measles Vaccination’, 1964. TNA, FD 23/1361, W. N. Dunnet, ‘Measles Vaccine Trials’, 20 March 1969. TNA, FD 23/1361, E. M. B. Clements to W. N. Dunnet, 24 March 1969. TNA, FD 23/1361, E. M. B. Clements, File Note, ‘Withdrawal of Burroughs Wellcome Measles Vaccine, 24 March 1969. TNA, FD 23/1361, W. N. Dunnet to E. M. B. Clements, ‘Measles Vaccine, Burroughs Wellcome’, March 1969. TNA, FD 23/1361, E.M.B. Clements, File Note, ‘Reactions Following Measles Vaccine’, 30 April 1969.

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TNA, FD 23/1361, E.M.B. Clements, File Note, ‘Reactions Following Measles Vaccine’, 19 June 1969. TNA, MH 55/553, Sir George Newman to Sir Robert Morant, ‘Measles’, 6 August 1919. TNA, MH 148/563, Committee on Safety of Drugs, Sub-Committee on Adverse Reactions, ‘Status of “Wellcovax” Measles Vaccine: Note by Medical Assessor’, 13 October 1969. TNA, MH 148/563, David Long to D. A. Cahal, 29 September 1969. TNA, MH 148/63, D. A. Cahal to David Long, 3 October 1969. TNA, MH 154/63, Joint Committee on Vaccination and Immunisation Measles Vaccination Sub-Committee, 16 July 1963. TNA, MH 154/63, Joint Committee on Vaccination and Immunisation Measles Vaccination Sub-Committee, ‘Minutes of Meeting held on Monday, 13th July, 1964’, 13 July 1964. TNA, MH 154/63, Joint Committee on Vaccination and Immunisation Measles Vaccination Sub-Committee, ‘Minutes of Meeting held on Thursday, 1st July, 1965’, 1 July 1965. TNA, MH 154/63, Joint Committee on Vaccination and Immunisation Measles Vaccination Sub-Committee, ‘Minutes of Meeting held on Thursday, 4th November, 1965’, 4 November 1965. TNA, MH 154/64, George Godber to Medical Practitioners, ‘Vaccination Against Measles’, 21 February 1966. TNA, MH 154/64, A. J. Franklin to A. J. Rayner, ‘Report on: Kay Michele Smith’, 19 March 1969. TNA, MH 154/64, Joint Committee on Vaccination and Immunisation Measles Vaccination Sub-Committee, ‘Minutes of Meeting held on Monday, 13th November, 1967’, 13 November 1967. TNA, MH 154/64, ‘Extract from the Royal Society of Health Journal – September/October 1967 Article by J. F. Warin on Routine Measles Vaccination as a Community Health Measure, page 266, Addendum’, 1967. TNA, MH 154/64, Joint Committee on Vaccination and Immunisation Measles Vaccination Sub-Committee, ‘Agenda’, November 1967. TNA, MH 154/64, Joint Committee on Vaccination and Immunisation Measles Vaccination Sub-Committee, ‘Minutes of Meeting held on Monday, 11th November, 1968’, 11 November 1968. TNA, MH 154/64, A. J. Franklin to A. J. Rayner, ‘Report on: Kay Michele Smith’, 19 March 1969. TNA, MH 154/64, ‘Joint Committee on Vaccination and Immunisation Measles Vaccination Sub-Committee: Adverse Reactions to Measles Vaccines; Summary Report of an Informal Meeting held on 21st March 1969’, 21 March 1969. TNA, MH 154/64, Joint Committee on Vaccination and Immunisation Measles Vaccination Sub-Committee, ‘Minutes of Meeting held on Monday, 31st March, 1969’, 31 March 1969.

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242

TNA, MH 154/526, B. H. Betts, File Note, ‘Measles Vaccine. Oxfam’, 27 March 1969. TNA, MH 154/526, W. F. Lake, File Note, 19 May 1969. TNA, MH 154/526, W. F. Lake, File Note, ‘Vaccination Against Measles’, 3 June 1969. TNA, MH 154/526, ‘Not for Publication before Morning Papers, Thursday, 12th June, 1969: Vaccination Against Measles’, 12 June 1969. TNA, MH 154/526, George Godber, File Note, 31 October 1969. TNA, MH 154/529, Philip Muston, File Note, ‘Measles Vaccination: Publicity’, 24 November 1967. TNA, MH 154/529, ‘Vaccination Against Measles: Minister’s Opening Remarks at Press Conference’, 6 February 1968. TNA, MH 154/529, ‘Measles Vaccination: Some Questions and Answers’, 1968. TNA, MH 154/529, ‘Additional Possible Questions and Answers: Not to be Distributed at Press Conference’, 1968. TNA, MH 154/529, ‘Now your Child can be Vaccinated Against Measles’, 1968. TNA, MH 154/530, A. T. Roden to Denis Williams, ‘Surveillance of Measles Vaccines’, 9 July 1968. TNA, MH 154/530, W. F. Lake to Lord Cohen, ‘Surveillance of Measles Vaccine’, 9 August 1968. TNA, MH 154/530, ‘Adverse Reactions to Measles Vaccine Reported from Kingston- upon-Thames’, 1968. TNA, MH 154/635, Frank Perkins to George Godber, 7 January 1966. TNA, MH 154/635, A. T. Roden, File Note, ‘Surveillance of Measles Vaccines’, 27 January 1966. TNA, MH 154/635, File Note, ‘Batch Surveillance of Measles Vaccines’, 1 February 1966. TNA, MH 154/635, File Note, ‘Surveillance of Measles Vaccines’, 9 June 1966. TNA, MH 154/635, File Note, 31 October 1966. TNA, MH 154/1203, C. H. Stuart-Harris, Future Policy on Measles Immunization’, 13 January 1982. TNA, MH 154/1203, ‘Some Aspects Concerning the Epidemiology of Measles – Note by the Department’, 1982. TNA, MH 160/908, K. G. Perona-Wright, ‘Report on Publicity Arising from the Trial on Measles Vaccine’, 14 August 1967. TNA, MH 160/908, ‘Responsibility in Investigations on Human Subjects’, 1963. WL, SA/MWF/N.7/5, Central Council for Health Education, ‘Measles: How to Spot it and What to do About it’, 1956. Wellcome Library (WL), WF/M/PL/407 3 of 3, Burroughs Wellcome to the Daily Express, Draft Letter, 1969.

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