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perience. Table n shows the Hertfordshire attack-ratesby immunisation status and year of birth.The average protection-rate for all fully immunised

children of 5 years and under was 86% compared withthe non-immunised and for children born in 1976 and1977 the rates were 94% and 93% respectively. Clearlywhooping-cough immunisation gives a high level of pro-tection. The attack-rates in the fully immunised are lowin all age-groups. In contrast, the rates in the non-immunised and partially immunised rise steadily to apeak among 4-year-olds with a dramatic drop for the5-year-olds (fig. 3) A possible explanation is thatchildren born in 1973 were exposed to the last peak of-whooping-cough, which occurred in 1974, and a propor-tion therefore had gained some natural immunity. Con-versely the cohorts of children born in 1974 or after areunlikely to have been exposed to whooping-cough. Thecomparative whooping-cough rates for children betweenages 1 and 4 years were 3-7/1000 for the immunised and43’8/1000 for the non-immunised, which gives an aver-age protection-rate of 92% for whooping-cough immuni-

sation. This is the most realistic figure for vaccine effi-cacy, since that group of non-vaccinated children were

unlikely to have acquired natural immunity to whoop-ing-cough.

CONCLUSION

The widespread abandonment of whooping-cough im.munisation during the past 4 years and the recent

whooping-cough epidemic have provided clear evidencethat whooping-cough immunisation confers more than90% protection.

I thank Mr V. A. Dickinson and Mrs T. Turton, of the Hertford-shire Area Health Authority health-information unit, for their invalu-able assistance.

Round the World

From our CorrespondentsSweden and Turkey

THE INFANT-FOOD INDUSTRY

FOLLOWING criticisms two years ago of the role of the in-fant-food industry in the poor countries1,2 mass media havedrawn attention to a joint project of the Swedish company,Semper, and the Turkish company, Mamsan, for the produc-tion of infant formulas. Swedish paediatricians found it oddthat Semper’s pædiatric consultants were not involved in theplanning of the project, and, after a lengthy internal debate,the Swedish Paediatric Association, on May 18, issued a state-ment regretting Semper’s commitment in Turkey, which wasconsidered injudicious.

The Association argues that experience proves that almostall mothers can breast-feed their babies. Only those who can-not do so (Turkish paediatricians estimate about 10%) needformula feeds. After this need has been met, any further in-crease of production is unnecessary and may indeed be harm-ful. It is therefore important to restrict the appeal of formulafeeds as much as possible. Complete breast-feeding shouldalways be the aim during the first 4-6 months; thereafter, thebreast should be gradually supplemented with solid food. Foreconomic and health reasons, this advice is especially relevantfor poor families. Every attempt, direct or indirect, to makethe mothers doubt their ability to breast-feed must be opposed.The production of infant formulas cannot be regarded as justanother industrial activity to be governed by competition, in-crease of production, and maximisation of profit. One way tolimit the appeal of formulas is to limit the profits, which couldbe done by Government restriction of the price and means ofdistribution. The Swedish Psediatric Association concludesthat Semper should reconsider its marketing plans in Turkey.The Association declares that it will watch carefully the devel-opment of Semper’s commitment in Turkey, and if the prin-ciples outlined are not followed, the Association intends topublicise the fact.

In Sweden, an association of Turkish women has also pro-tested against Semper and pointed out that in their homecountry two foreign companies, Milupa and Wyeth, are

1. Editorial: The infant-food industry. Lancet 1976; ii: 503.2. Editorial: A Swedish code of ethics for marketing of infant foods. Acta

Pædiat Scand 1977; 66: 129.

already supplying the need for infant formulas, though theirmethods of marketing are said to be unacceptable.

United States

AN EVANGELIST’S POWER

IN the U.S. many religious cults not only prosper but alsoend up as multi-million dollar industries, all deriving their sup-port from charitable donations. Oral Roberts, an Oklahomaevangelist, has long flourished not only as far as his numberof disciples is concerned but also financially. Many televisionstations regularly feature his Sunday-morning healing sessionsand his audience is numbered in millions. A compelling blendof Savanarola and Croesus, he has already built a large univer-sity in Tulsa, Oklahoma, known as the Oral Roberts Univer-sity. There was nothing paltry in its conception, and its archi-tectural design is striking. Several years ago Roberts proposedthe building of a medical school and a new 700-bed teachinghospital, but the consensus among the Oklahoma medical pro-fession and politicians was that such developments were un-necessary. As a result of recent legislation governing the build-ing of hospitals, each State in the Union has to appoint certaincommittees and groups to consider the need for additional hos-

pitals, major items of equipment, and other medical facilities.The purpose of such committees is to avoid unnecessary duph-cation and construction. The first committee to consider such

requests is known as the Health Service Administration. Whenthe Oklahoma H.S.A. came to consider the application for anew medical school and hospital in Tulsa, they decided thatthey were not necessary, and that the city already had enoughbeds. Following the H.S.A.’s rejection of the application, OralRoberts appealed to the public to apply pressure to membersof the Oklahoma State Legislature to support his request andthis they did in no equivocal fashion. An appeal against the re-fusal of the H.S.A. to grant the application was put to the Pub-lic Health Commission, the higher authority, which has fourmembers, three of whom are heads of departments of the Okla-homa State Government. Included as members of the P.H.C.are the directors of welfare and of the mental health divisionof the State of Oklahoma. Although it is said that the P.H.C.was inclined to turn down the request, all three departmentssuddenly found their appropriations had been delayed by theState Legislature while the rest of the budget was passed. It

was made clear that fiscal support would not materialise tillthe P.H.C. showed a more cooperative attitude. The OralRoberts Medical School suddenly received the blessing of theP.H.C. and the appropriations for the three departments werereleased.

REFERENCES

1. Bassili WR, Stewart GT. Epidemiological evaluation of immunisation andother factors in the control of whooping-cough. Lancet 1976; i: 471-3.

2. Stewart GT. Vaccination against whooping-cough. Lancet 1977; i: 234-7.3. Miller CL, Pollock TM, Clewer ADE. Whooping-cough vaccination. Lancet

1974; ii: 510-3.4. Church MA. Effects of the whooping-cough-vaccine scare. Hospital Doctor

1978; 10.5. Church MA. Return of whooping-cough. Br Med J 1979; i: 195.