Olivia Twenty Dahl was one of the children of author Roald Dahl and actress Patricia Neal. She was born on April 20, 1955 and died on November 17, 1962 of encephalitis caused by the rubella virus. The tragedy of her death is currently being used by supporters of the MMR vaccine. Some people mistakenly believe that Olivia died of the measles. In fact, it was not what we in the United States call the measles, but a completely different disease, rubella, which was then commonly known as the German Measles. The rubella vaccine was not yet available to the public in Britain where Olivia Dahl died, and her parents asked that she be given gamma globulin, but the remedy was denied to them by reason of public health rationing.
This article is not meant to give any medical advice. It is instead intended to explore ethical issues involving the conflicts of interest between “the public good” and the good of any particular individual. Olivia Twenty Dahl might have survived if her parents had been able to override decisions made in the name of the public policy in order to save their own child.
The rubella virus, also known as the German Measles, is a disease that for most people takes a fairly mild course, although it can have disastrous effects on fetal development if women contract it during the first twenty weeks of pregnancy. In order to avoid birth defects, it is usually advised today that any woman who has not already had rubella be vaccinated for it prior to attempting a pregnancy. The normal course of the disease for healthy individuals is sore throat and fever, after which there are swollen glands and a rash. About thirty percent of those infected actually do not have any symptoms at all. Lifelong immunity follows infection. In very rare cases, rubella develops into encephalitis, and then the prognosis is not good. Olivia Twenty Dahl was one of those very rare cases.
The disease of rubella has been around since before the Middle Ages, but it was not until 1941 that the medical profession began to consider it dangerous. The virus was isolated in 1962. By 1969 vaccination became routinely available worldwide.
The rubella virus is not to be confused with the measles, a completely different disease caused by the rubeola virus. But it is understandable that from a historic viewpoint people do confuse the two, because they were not distinguished until the 19th century. Today, infants are routinely vaccinated for both measles and rubella and also the mumps in the MMR vaccine. The MMR vaccine is considered safe, but it, too, carries some rare health risks and in some cases the complications become life threatening. Nothing in life is risk free.
I know about what happened to Olivia Dahl from reading her mother’s autobiography: AS I AM by Patricia Neal. I highly recommend this book for anyone interested in Patricia Neal, Gary Cooper or Roald Dahl. It is a very candid biography that in its telling of Miss Neal’s life story touches upon a lot of issues that I am interested in. I understand that there was also another, later biography, but I recommend this one, which came out in 1988.
The back story of Olivia’s death is that her family had been living in New York when her brother Theo was hit by a taxicab while crossing the street in a pram and suffered brain damage. Roald Dahl moved the family to England, where he believed his children would be safe. He was wrong.
When there was an outbreak of rubella at Olivia’s school in November of 1962, a note was sent home to alert the parents. Patricia Neal had two children she felt were particularly vulnerable, Olivia, who was always wiped out after every childhood disease, and Theo, who was injured and highly vulnerable. She was less concerned about her other daughter, Tessa, who had a strong constitution. At the time, even though the rubella virus was already isolated, the vaccine was still in the experimental stages, and gamma globulin was rare in England, and was rationed out only to pregnant women during an outbreak of rubella to help them fight the disease, rather than being used as a preventative for school children.
Ordinary people simply accepted the situation. But Patricia Neal and Roald Dahl were not just ordinary people. They were famous and well respected, and they had connections. They tried to pull strings on behalf of their children.
Roald Dahl’s half-sister Ellen was married to Sir Ashley Miles, head of the Lister Institute. Roald Dahl asked Sir Ashley to get enough of the gamma globulin for his children: Theo, Olivia and Tessa. Sir Ashley was sympathetic, but he was an upstanding British subject, and he did not want to break the rules just to accommodate family. The policy of the government was clear: only pregnant women were to be spared. Children had to risk getting the disease, as they were less vulnerable to its effects.
According to Patricia Neal, Sir Ashley laughed and said that they should let the girls come down with disease as it would be good for them. However, he did get the gamma globulin for Theo, because of Theo’s medical status as an invalid.
Olivia came down with the disease within three days. After she recovered from the usual symptoms, she was listless and lacking in energy. By the fifteenth of November, she slept for over twenty-four hours. The next day she had what appeared to be a stroke. She was taken to the hospital and died on the 17th of November.
What would you have done if this were your child, you knew that gamma globulin could save her, but the doctors and the medical establishment had decided not to give it to you by reason of public policy?
In my opinion – – and this is not a medical opinion, but an ethical one – – Roald Dahl and Patricia Neal would have been justified to buy gamma globulin on the black market or to create a rubella vaccine in their own private lab and to administer it to their daughter when they thought she needed it, and public policy be damned!
But that is not what people are now using this story to say. Instead, they are saying that every child, even the ones who would survive the disease just fine and might be allergic to the vaccine, should be vaccinated by the MMR vaccine, for the sake of children like Olivia.
Not every child faces the same risk. Even in the same family, a parent might be concerned for one child and not another. The disease killed Olivia. Tessa came out just fine. Her parents were never worried about her.
People say we should listen to our doctors. I agree. We should listen, but we should also use our independent judgment on behalf of our children. Public policy is crafted to maximize the chances of most people – – at the expense of some people. But when you have a specific child to look out for, as a parent you must do what is best for that child.
Most children would survive the usual childhood diseases. Most children also survive the MMR. It is the rare child who is the most vulnerable. Some would not survive the disease. Others would not survive the vaccine. It is your job as a parent to try to figure out what the odds are for your own child.
Vaccination for rubella used to be given separately, and children were then left to suffer through the measles and the mumps on their own. Was Sir Ashley right when he said the disease might be good for the girls? Is it ever better to suffer though a disease rather than to be vaccinated for it? I am not sure. Ask your doctor about these things and educate yourself concerning your own child’s health. What is a life saving practice for one child can be a death sentence for another. It is also possible to get one of the vaccines without the others.
Parents have a duty to their own children to see that they get the best possible care. If your doctor tells you that you should get a vaccine because your own child is seriously vulnerable to a disease, then by all means do what you can for your child. Or ask for gamma globulin, instead, during an outbreak. But if your doctor tells you your child is not vulnerable to the disease, but he should get the vaccine for the sake of other children who are less robust, then you might think again.
Ethically it is never right to sacrifice one child for the sake of another.