Remarkable changes have occurred in Irish society over the past two decades, with the demise of religion and the extended family, and an explosion in drug use with its attendant baggage of social chaos, crime, HIV and hepatitis. Very severe levels of social deprivation continue, however, and co-exist uneasily with our much vaunted economy and its obvious material manifestations. In some parts of Dublin, singleparent families have become the norm, with the family unit consisting of a mother, her daughter and the new baby. It is remarkable to me, as a paediatrician, that against this background there has never been a safer time to be born in Ireland; the number of babies born who die by one year of age is lower than ever and among the lowest in the world.
Infant mortality rates are widely used internationally to compare how effectively different countries deploy available resources for the common good, precisely because they reflect the combined effects of education, housing, nutrition and the disease prevention/ healthcare services.
The current Irish vaccination programme is a fundamental part of our infant care services. Vaccination has resulted in the disappearance of diphtheria, polio and measles, and caused a massive reduction in the number of children infected with whooping cough, Haemophilus Influenza (meningitis, epiglottitis) German Measles and mumps.
These diseases have inflicted a huge toll over recorded history and can rapidly re-establish themselves. In countries with poorly organised vaccination programmes, infectious diseases are common.
This background is necessary to properly inform the ongoing debate on the proposed relationship between vaccinations and Sudden Infant Death syndrome - cot deaths - still the most important cause of death in Irish infants up to one year of age.
Philip Boxberger's article on this subject last week maintained that most studies of cot deaths do not include information on vaccinations, a statement which demonstrates a comprehensive ignorance of the published literature on the topic.
If vaccination increases the risk of cot death then there will be more cot deaths in a vaccinated population compared with an unvaccinated one. In this type of study it is crucial that the two populations being compared are as similar as possible, so that any differences found reflect vaccination or its absence.
Many published studies over the past 15 years on cot death have included information on vaccination status and a review of the available literature in 1992 concluded that most studies showed less cot death among vaccinated infants than in unvaccinated ones.
Since then, large cot death studies in Australia, New Zealand, England, Norway, Sweden, Scotland and North America have all shown no association between vaccination and cot death.
As a typical example of the findings from these studies in Ireland for the years 1994/95, 44 per cent of infants dying from cot death had received no vaccinations compared with 10 per cent of the control population. So rather than saying that vaccinations cause cot deaths, the reality is that infants receiving vaccinations are four times less likely to die from cot death in contemporary Ireland.
So why aren't we saying that vaccination prevents cot death? Simply because since the "Reduce the risks of cot death" campaign (aimed at placing babies on their backs to sleep, and at avoiding overheating and smoking), the cot death rate has fallen and cot deaths are now heavily associated with socio-economic deprivation (and smoking) which is also associated with low vaccination uptake rates.
Over the past 2O years there has been a genuine, and increasingly successful, effort to base medical decisions and advice on reliable data - or evidence based medicine. Hopefully in the future any "expert ", from a consultant paediatrician to a canine psychologist, will be asked to detail precisely the data underpinning any pronouncement of public health interest.
The published data in this instance unequivocally states that there is no association between vaccinations and cot death.
Professor Tom Matthews is a paediatrician attached to the Department of Paediatrics at University College Dublin, Temple Street Children's Hospital and the Rotunda Hospital in Dublin.