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April 2022 Issue 2 Empowering women leaders #IWD2022 Membership magazine of the Royal College of Physicians > Supporting the next generation of global women leaders > A new SAS doctor lead > Reframing the debate on obesityGraham Bull prize in clinical science and Goulstonian lectureship The prize is for an application and not for nomination of individuals. The work can cover a wide range of expertise, such as: > molecular and cellular biology > imaging technology > psychiatry > health sciences. The award is open to members and fellows who must apply for their own work to be considered. £1,000 is offered on a competitive basis each year. The winner will be invited to deliver the Goulstonian lecture, and offered a £100 honorarium. Email your application form, CV and a list of any academic publications (PDF format) to fundingandawards@rcp.ac.uk by 11:59pm, Sunday, 3 April 2022. Graham Bull prize in clinical science and Goulstonian lectureship – now open | RCP London Teale essay prize for trainees The winner will receive a prize of £200 and may be published by the RCP. To enter, please write an essay of 500–1,500 words in connection with the following: ‘ How do we balance the need for generalist and specialist involvement in patient care within the NHS?’ Please complete the application form and submit with a copy of your CV and a list of academic publications (PDF format) to fundingandawards@rcp.ac.uk by 11:59pm, Sunday, 10 April, 2022. Teale essay prize for trainees – now open | RCP London RCP medical student elective bursaries Up to 12 grants of £500 each are available each year to undergraduate medical students at UK universities who will be undertaking a medical elective overseas. Applicants must be medical student members of the RCP of at least 6 months’ standing. Email your application form and a copy of your latest CV to fundingandawards@rcp.ac.uk by 11:59pm, Sunday 15 May 2022. RCP medical student elective bursaries – now open | RCP London John Glyn bursaries in rheumatology These bursaries support the travel and costs associated with a visit to another centre in the UK or abroad, for the purpose of learning new clinical or research techniques relevant to rheumatology, and to bring these techniques back to the initial UK centre. Two bursaries are available, covering 1 month each, offered to one consultant and one trainee. Each bursary will be for a maximum of £2,000. Recipients are responsible for funding any additional costs. Please email your application form, CV and a list of any academic publications (PDF format) to fundingandawards@rcplondon.ac.uk by 11:59pm, Sunday 3 July 2022. John Glyn bursaries in rheumatology – now open | RCP London Samuel Leonard Simpson fellowships The fellowships enable endocrinologists to learn new techniques and acquire new experiences, ideas and stimulation through travel and the exchange of ideas. Applications will be considered from candidates in the UK wishing to make visits abroad, or from those abroad wishing to visit the UK. Up to £8,000 is available, which may be awarded to one or more candidates. Please email your completed application form, CV and publications list (PDF format) to fundingandawards@rcp.ac.uk by Sunday 31 July 2022. Samuel Leonard Simpson fellowships in endocrinology – now open | RCP London Funding, awards and lectures from the RCP Please note that any applicant for funding or awards must be a subscribing member or fellow of the RCP.April 2022 Commentary 1 ANDREW GODDARD PRESIDENT Politics and medicine are like oil and water – not naturally compatible, but forced together by circumstance and money. How should the RCP engage with politics and politicians? First up, a small declaration of interests. I often refer to myself as politically neutral and would describe my political ethos as being a conservative (with a definite small ‘c’) socialist. I have voted for all of the three main parties in England at some point over the past 20 years and try to judge a party by their policies, rather than the individuals or its history. Some may say this shows a lack of commitment, but suffice to say I have no particular political axe to grind in writing this piece. On 8 March we hosted the secretary of state for health and social care as he delivered his vision for the NHS over the next few years, or the ‘road to recovery’. It centred on four Ps – prevention, personalisation, performance and people. There wasn’t much to argue with on his themes, but there was no mention of planning and funding the workforce that would be necessary to underpin such a vision. It was clear that there will be no more money (and therefore, one presumes, no more staff). To me, this makes the vision unachievable and misses what most in the service are concerned about: there are not enough hands and feet to do the work. There was also no meaningful plan as to how we improve urgent and emergency care while simultaneously reducing the elective care backlog. What, then, should a college like the RCP do in response? Some would say we focus on what we have some control over (training, education, improvement and engagement) and leave the politics to the unions. Others would say we should strongly criticise the government for not demonstrating an understanding of the situation on the ground; and if it means we are shut out from further conversations, this is a price worth paying. Making successful inroads into influencing government policy is hard and frustrating work, but neither of the two approaches above ever works. In my 19 (hard to believe) years working for the RCP I’ve watched many healthcare organisations try these approaches, and then find themselves marginalised and ignored. As my predecessor, Dame Jane Dacre, often said, it is better to be (doing a certain activity) from inside the tent than outside it. This doesn’t mean we compromise on our principles, but ensuring lines of communication stay open and that our messages are consistent, evidence based and come with pragmatic solutions will achieve results in the end. One example of this is in amendments to the Health and Care Bill currently going through parliament. After much behind the scenes work with parliamentarians and other organisations, we have successfully achieved amendments in all three areas we have been pushing on: workforce, health inequalities and research. The latter two have been accepted by government so are a done deal, but workforce is much less certain. Despite the significant majority in the House of Lords that voted it into the bill, the government is almost certain to try and remove it, with many stakeholders including MPs and peers citing the Treasury as a block. That’s why as many of us as possible need to write to our MPs to make it clear that what we’re asking for is eminently reasonable. One of my frustrations when dealing with ministers is that they change roles with a monotonous regularity and that the relationships need to be rebuilt with a new individual and their team seemingly every year. However, that is the nature of politics, and it does mean you get to meet an amazing array of people. I think of all the parliamentarians I have met over the years – some have been very impressive, and others equally disappointing (and this column is too short to say who was which). Whoever follows me when the result of the current election is known (and as an aside that seems apt for a column on politics, please vote) will need to have strong relationship management skills to be successful. Finally, a key reason why we should engage with our politicians is because we can. I look at images of Putin at the end of a long table and see his definition of engagement as one of dictatorship through military force. We should not take our democracy lightly, and we must make the most of the opportunities we are given. President’s perceptions: how should the RCP engage with politics?Contributors Featuring some of our expert contributors this issue, who have written articles or helped create the content for this issue. They share their experiences, knowledge and stories with you. Simon Burt Simon is a photographer based in Cornwall. In his 35 years behind the camera, Simon has covered a variety of genres. Starting in news in 1987, working for the Plymouth Evening Herald and Western Morning News, local newspaper photography was an ideal training ground. Between 1997 and 2004 he worked for a national news agency and had work published in all the UK dailies and Sunday papers as well as magazines across the world including Time and Observer Food Monthly. Professor Rachel Batterham Rachel is professor of obesity, diabetes and endocrinology at University College London Hospital. Rachel established and leads the Bariatric Centre for Weight Management and Metabolic Surgery. She is also the obesity theme lead for the National Institute of Health Research Biomedical Research Centre. In 1995, Rachel qualified in medicine at St Mary’s Hospital Medical School Imperial College. She then specialised in diabetes and endocrinology and developed a specialist interest in obesity. 2 Commentary April 2022 CONTENTS APRIL 2022 April 2022 Issue 2 Empowering women leaders #IWD2022 Membership magazine of the Royal College of Physicians > Supporting the next generation of global women leaders >A new SAS doctor lead >Reframing the debate on obesity Commentary Membership magazine of the Royal College of Physicians (RCP) Editor Maxwell Baker Editor-in-chief Professor Anton Emmanuel Head of Corporate Communications and Publishing Natalie Wilder Production Adam Pierce Articles published in Commentary reflect the opinions of the authors and do not necessarily represent the view of the RCP. Images copyright of RCP unless otherwise stated. Contact us Please email: commentary@rcp.ac.uk Registered charity no 210508 © Royal College of Physicians Printed: Warners (Midlands) Plc 10 1 President’s message Andrew Goddard examines the RCP’s role in influencing politicians and the best way for the college to achieve its goals. 4 News and comment News about upcoming RCP elections; governance matters; recently deceased fellows; our recent research summit; Ramadan fasting and health, and more. 10 Global Women Leaders programme The under-representation of women leaders in healthcare is an issue around the world, and the RCP is launching a new scheme to help tackle this issue. 36April 2022 Commentary 3 Editor’s letter Following International Women’s Day on 8 March, we wanted to update members on the RCP’s Emerging Women Leaders (EWL) programme, which the college has run since 2018. Women represent approximately 56% of those entering medical school, but the under-representation of women in senior leadership roles is striking. The programme aims to inspire and develop women to consider medical leadership roles, and the RCP strongly encourages applicants for the 2022 cohort. Complementing this established programme, the RCP is launching a pilot Global Women Leaders programme. The disproportionality for senior female representation is even greater at global scale, and the potential for such a programme – developed between RCP’s Global and Education teams – is clear. If you are interested in contributing to this project, please contact global@rcp.ac.uk. The National Lung Cancer Audit (NLCA) has been part of the fabric of the RCP for the past 25 years, and has developed into an exemplar of cancer audit. There is wide clinical engagement with the NLCA, which has been hugely influential in changing the approach to lung cancer care. As the NLCA moves to be housed in the Royal College of Surgeons (London), there is a timely review of the development, evolution and successes of the programme under the stewardship of the RCP. Our first interviewee is Dr Jamie Read, the new RCP lead for SAS doctors. The long-term workforce strategy that is being developed will undoubtedly recognise the importance for career flexibility, and the interview highlights Jamie’s view of the potential for the SAS path to allow such flexibility while developing sub- specialty interests. The second interview in this edition is with Professor Rachel Batterham, coinciding with the release of her documentary on the public health challenges posed by obesity. The interview is as crisp and compelling as the documentary – and both are commended. Anton Emmanuel Editor-in-chief 12 Emerging Women Leaders Find out more about the RCP’s programme to support women leaders in healthcare. 14 National Lung Cancer Audit Celebrating the impact of the NLCA, which has been improving patient outcomes for more than 20 years. 20 A new fellowship process Information about the new proposal and self-proposal process for becoming a fellow of the RCP. 23 The RCP’s new SAS lead An interview with Jamie Read, who has been appointed as the RCP’s lead for SAS physicians. 26 Talking about obesity Professor Rachel Batterham introduces a new documentary film about the subject of obesity. 30 Medicine 2022 A preview of our annual conference, taking place in London, Liverpool and online. 35 Thank you Henry Oakeley A tribute to our RCP garden fellow, who is stepping down after 18 years in post. 36 Our new Museum exhibition A sneak preview of our upcoming exhibition, opening in May, ‘A taste of one’s own medicine’. 20 Dr Jamie Read Jamie is the RCP lead for staff, associate specialist and specialty (SAS) doctors. He is an associate specialist in geriatric medicine, with a particular interest in falls and frailty, at University Hospitals Plymouth NHS Trust. He is also the physician associate director for the trust. In addition to his clinical role, Jamie has a strong interest in medical education and is an honorary clinical associate professor in medical education at the University of Plymouth, where he is also associate head of the Peninsula Medical School. Jamie took up an associate specialist role following his PhD in medical education and he is passionate about advocating for colleagues who have chosen the SAS route in their career. Jamie’s research interests focus on developing professional identity, and this is something that he is very keen to bring to his appointment as the RCP SAS lead. 23 264 Commentary April 2022 NEWS DECEASED FELLOWS; HONOURS; NEWS IN BRIEF Munk’s Roll is the RCP’s collection of biographies of deceased fellows, published online as Inspiring Physicians: https://history. rcplondon.ac.uk/inspiring- physicians If you would like to write an obituary or notify the RCP of the death of a fellow, please: Email: munksroll@rcp.ac.uk Phone: +44 (0) 20 3075 1312 Here are the deaths reported since the previous Commentary, covering the period 15 January – 14 March. Richard Kavanagh Rondel Murtaza Husain Husaini Derek Doyle Wah Kit Lam Edward Gerald Anderson Cynthia Joan McAlpine Rasheed Ahmad John Alibe Francis Beirne Neil Cardoe Anthony Arnold James Milledge Frederick Frances Fenech Julian Candy Maurice Jack Orpin Rajeswary Rajakariar Owen Conor Ward Fanny Wai-Tsing Shek James Gerard Malone-Lee Abu Sayed Serajul Islam Khan Terry Domcen Bolin Ross Osborne Moore Ivor Vivian Wilson Richard Hugh Burnell Richard Martin Oliver Shah Tauzeeh Deceased fellows The proportion of doctors who choose not to enter the next stage of postgraduate training straight after successfully completing the Foundation Programme has been rising substantially. In 2010, 17% chose to undertake a year of gaining additional experience in roles termed Foundation Year 3, or F3. By 2019 the proportion had reached 65% – a new norm. This has implications for workforce planning. While it is relatively straightforward to track the incidence of this phenomenon in routinely collected data, little was known about the perspectives of the increasing number of doctors considering and taking an F3 year. For this reason, the Health Education England Medical Education Reform Programme commissioned the RCP to gather qualitative data from doctors approaching, taking, or having completed an F3 year. Despite clinical demands from COVID-19, 163 doctors contributed rich descriptions of their motivations for taking an F3 year, and whether it provided what they had hoped. Many motivations identified in this study had been captured in other studies, but our data highlighted the strong interconnectedness of motivations and the diversity of individuals’ motivation constellations. For example, a doctor may have simultaneously sought a break from the clinical rota demands of a training programme to address or avert symptoms of burnout, and to earn more to save for a deposit on a home, and to gain additional clinical experience to strengthen an application for specialty training. Another doctor may have simultaneously sought a year of clinical practice outside a training programme, without the demands of training programme assessments and other requirements, to have more time to focus on an important family matter or a personal ambition. The interconnectedness and diversity of motivations suggest that, while there are recurrent themes in the motivations, there isn’t a discreet series of ‘problems’ to be ‘solved’ one by one. Large numbers of the study participants saw the end of the Foundation Programme as a ‘natural point’ to take a break in the long undergraduate and postgraduate training programme series. They felt that the duration of GMC recognition of their Foundation Programme completion, the number of F3 roles and fellowships advertised, and the support of senior colleagues and peers all reinforced the idea of taking an F3 year. This culture of reinforcement has grown in recent years, fuelling the new norm. This changes the workforce planning context somewhat. It also creates a new minority, those who do not take an F3 year. It will be important to track the characteristics of people in this category and whether it contributes an adverse impact to their career development. To read the report, please visit www.hee.nhs.uk/our-work/doctors- training/enhancing-working-lives The F3 phenomenon: exploring a new norm and its implications The F3 phenomenon: Exploring a new norm and its implications February 2022 Health Education England We work with partners to plan, recruit, educate and train the health workforce. www.hee.nhs.uk Dr Ruth Silverton Professor Della FreethApril 2022 Commentary 5 Making research everybody’s business RCP summit explores how to build on the successes of clinical research during the pandemic As part of its work to promote research and innovation in the NHS, the RCP convened its second research summit in February. This was the second in a series of events about the challenges facing clinical research and how we can address them. We are working with the National Institute for Health Research (NIHR) to bring together senior representatives from government, regulators and funding bodies, clinicians and patient representatives. Over the past 2 years, the rapid development of vaccines and treatments for COVID-19 has vividly demonstrated the importance of clinical research and its capacity to save lives. The pandemic has also caused significant disruption for many non-COVID-19 studies and led to the redeployment of research staff as the NHS experienced unprecedented levels of pressure. While it is vital that we focus on dealing with the largest backlog of care in the NHS’s history, we must also capitalise on the UK’s success in delivering world-leading COVID-19 research. Normalising research One of the central messages from the summit was the need to normalise research. We need to embed it in training and make it part of everyday practice for all clinicians. People who conduct research should be appropriately recognised and there should be more incentives to get involved in research at both individual and trust level. Initiatives such as the NIHR’s Associate Principal Investigator scheme provide opportunities for clinicians with a limited background in research to develop their experience and skills. The work NIHR has done with the Royal College of Surgeons to establish a network of ‘surgical heralds’ is helping to champion research in local hospitals. Accessibility The RCP knows that the majority of our members want to get more involved in research. They feel it would make their job more enjoyable, so there could be real benefits in terms of workforce retention. We also know that access to research opportunities is not equal between demographic groups and across the country, which has implications for both patients and clinicians. This was clearly recognised at the summit, which considered the crucial role that clinical research can play in addressing health inequalities. Expanding the amount of research that takes place outside the ‘golden triangle’ of London, Oxford and Cambridge should be a priority. We were pleased to note that the government’s recent white paper, Levelling Up the United Kingdom, said the Department of Health and Social Care would do just that. We also agreed that making research patient-centred is a fundamental part of improving accessibility. We must learn from the success of COVID-19 trials and the vaccination rollout in this respect. The coming months provide some significant opportunities to embed research more deeply in the NHS. The government’s flagship health and care bill is currently passing through parliament, and a coalition of organisations, including the RCP, has successfully lobbied for this to be amended to strengthen the provisions around clinical research. As a result, NHS England will be required to ‘facilitate’ research and explain what they are doing to achieve this in their annual reports and business plans. This is likely to be one of the responsibilities delegated to integrated care systems once they become operational in July. Ahead of this, the RCP will continue to work – with those who attended the summit and other key players – to promote the importance of clinical research and how everyone in the health service can support it. RESEARCH NEWS6 Commentary April 2022 NEWS VACANCIES Awards Committee for the Royal Photographic Society’s Annual Combined Royal Colleges Medal The Combined Royal Colleges Award is awarded annually for an outstanding contribution to the advancement and/ or application of medical photography or the wider field of medical imaging. We are seeking an RCP fellow who has an interest in the field of photography and/or the use of imaging in the practice of medicine to join the Awards Committee for an initial 3-year term. For more information about the award and its past recipients, visit: https://rps.org/about/awards/history-and-recipients/ combined-royal-colleges-medal-history-and-nominations To apply, send a short (one side of A4) statement of your interest, highlighting how you would be able to contribute, to Professor Cathryn Edwards, RCP registrar, c/o howard.ellison@rcp.ac.uk by Wednesday 27 April. Archive, Heritage Library and Museum Services (AMS) Advisory Committee We are seeking a fellow with an active interest and, preferably, expertise in the history of the RCP, its preservation and presentation, and/or the collecting of books, manuscripts and artefacts. The committee provides advice to the RCP on matters relating to: > the historical and special collections of the RCP Archive, Heritage Library and Museum > the delivery of services by AMS to members of the RCP, staff and external users > the acquisition, preservation, documentation, conservation, display and security of the RCP collections cared for by AMS > the exhibition of items, including materials on loan from and to external sources > the further development of the AMS > the RCP Medicinal Garden and the garden fellows. The committee usually meets 2–3 times per year. Attendance can be in person or via telephone or video conference call, and the post is for a 3-year term. To apply, contact the registrar, Dr Cathryn Edwards, using the AMS email address (history@rcp.ac.uk) with a short CV and a one-page cover letter outlining your suitability for the role by midnight 31 March. For further information about either of these roles, please contact the Harveian librarian, Dr Louella Vaughan (Louella.vaughan@rcp.ac.uk) The RCP is all about our people – our members, our staff, our volunteers and leaders. We educate, influence and collaborate to improve health and healthcare for everyone and know we can only do this by being inclusive, encouraging and celebrating diverse perspectives. That’s why welcoming and having people who represent the 21st- century medical workforce and the diverse population of patients we serve is so important to us. Vacancies available for RCP fellows Elections 2022 Voting opened on 9 March 2022 for fellows, in good standing, to make their choices from the candidates standing for election as president, clinical vice president and Council. Online voting will remain open until midday on Monday 11 April 2022 and all fellows are encouraged to vote. Fellows, in good standing, will have received an email from Civica Election Services (CES), sent from takepart@cesvotes.com, with details on how to vote. Please check your junk folder and get in contact if not received. Fellows and members can access the hustings for president and the presidential candidates’ written answers to questions posed by the membership at: www.rcp.ac.uk/ news/meet-candidates-standing-president (behind the login on the RCP website). This page includes a confidential link so that members can also review the candidates’ election material across all elections, for wider awareness. College Day including special general meeting of fellows for the election of the president – Monday 11 April 2022 College Day agenda will be sent electronically to all fellows at least 2 weeks before the meeting. The event will be hybrid with all fellows automatically registered for virtual attendance. Fellows will have options to physically attend at RCP London, to vote in person in the election of the president, to attend lectures and book for dinner. The Samuel Gee and Fitzpatrick lectures will be accessible virtually by all members, as will a lecture by the garden fellows. To access the latest information please visit www.rcp.ac.uk/news/special-general-meeting-fellows- election-president-college-day-2022 (behind the login on the website). For more information, contact Simon Land, head of professional governance: simon.land@rcp.ac.uk Governance mattersApril 2022 Commentary 7 RAMADAN NEWS Ramadan, fasting and health Dr Syed Haris Ahmed, consultant endocrinologist at Countess of Chester Hospital NHS Foundation Trust, and Dr Mohammed Yunus Khanji, consultant cardiologist at Barts Heart Centre and Newham University Hospital, explain guidance available for clinicians supporting patients fasting during Ramadan. Ramadan 2022 is expected to begin on 2 April, on the sighting of the new moon. During the month, fasting between dawn and dusk is a specific obligatory act of worship for adult Muslims. 1 It is an act that over 90% of Muslims engage in globally. 2 In the UK, the fast can be as long as 19 hours during summer, and this year will range from 15 to 17 hours. Muslims will abstain from food and drink and increase in activities that enhance their spirituality. 3 Ramadan clinical guidance Although some individuals who are ill, or who would find it difficult due to health conditions, are exempt from fasting, there remains a significant number who may fast despite potential health risks. The arrival of the COVID-19 pandemic added another dimension of complexity to understanding the implications of fasting in patients with long-term health conditions. 4 The British Islamic Medical Association (BIMA) sought to address these issues with a rapid review and clinical recommendations. The following year in 2021, a more comprehensive Ramadan Compendium was produced, building on the initial work, encapsulating emerging evidence, clinician experience and expert consensus. This is available at: https://britishima.org/ramadan-rapid-review The compendium highlights general principles and systems-based chapters for common chronic conditions such as diabetes, cardiovascular disease, respiratory disease, renal disease, cancer and epilepsy. User-friendly infographics, as well as detailed text, have been created to guide healthcare professionals in the risk assessment of their patients and allowed for shared decision-making on the suitability and duration of fasting. The credibility and robustness of the compendium is reflected by a number of positive reviews and peer-reviewed publications that followed, including commissioned work relating to Ramadan, which have directly come out of BIMA’s endeavours and form the basis of several sections within the guidance. 5–8 The compendium was internationally disseminated, including through social media, and was freely available to access online. General information around it was also presented at local mosques and through Muslim chaplains. COVID-19 and Ramadan A population-based observational study has suggested that practices associated with Ramadan did not have a detrimental effect on COVID-19 deaths in 2020. 5 This is likely to increase the confidence in both patients who intend to fast and among healthcare professionals in supporting their patients to fast safely. There was a concern that vaccine hesitancy may have been further compounded by a largely inaccurate belief that being vaccinated while fasting would invalidate the fast. This was allayed by religious guidance from Muslim scholars and through infographics disseminated by organisations such as BIMA. 9 Taraweeh, the special night prayers during Ramadan, and the regular five daily obligatory prayers, are usually performed in congregation at mosques, which may put individuals at increased risk of transmission of COVID-19. We continue to advise all Muslims to observe public health advice and limit the spread of any transmissible disease, in order to attain the spiritual satisfaction of Ramadan and be able to enjoy the communal Eid celebration that marks the end of Ramadan. Acknowledgements: Nazim Ghouri, Ammad Mahmood, Salman Waqar References and further reading 1 Most accurate prayer times, Quran, Athan and Qibla direction. www.islamicfinder.org 2 Most Muslims say they fast during Ramadan. Pew Research Center. www.pewresearch.org/fact-tank/2013/07/09/global- median-of-93-of-muslims-say-they-fast-during-ramadan 3 Surah Al-Baqarah – 1-286 – Quran.com. https://quran. com/2?startingVerse=183 4 Waqar S, Ghouri N. Managing Ramadan queries in COVID-19. BJGP Open 2020;4. 5 Waqar S, Asaria M, Ghouri N et al. Assessing the impact of Ramadan fasting on COVID-19 mortality in the UK. J Glob Health 2021;11:03060. 6 Mahmood A, Dar S, Dabhad A et al. Advising patients with existing conditions about fasting during Ramadan. BMJ 2022;376. 7 Hussain S, Hussain S, Mohammed R et al. Fasting with adrenal insufficiency: Practical guidance for healthcare professionals managing patients on steroids during Ramadan. Clin Endocrinol (Oxf) 2020;93:87–96. 8 Akhtar AM, Ghouri N, Chahal CAA et al. Ramadan fasting: recommendations for patients with cardiovascular disease. Heart 2022;108:258–65. 9 COVID-19 Vaccine Hub – Statements. British Islamic Medical Association. www,britishima.org/operation-vaccination/hub/ statementsNext >