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 2 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 3 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 4 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