On 2nd March 2016 I, along with 70 other academics, doctors, and public health professionals, wrote an open letter to ministers of health, education, and sport, and the chief medical officers and children's commissioners in the four nations of the UK, as well as the Republic of Ireland, to ask them to consider the evidence and remove the collision elements of rugby in school systems, so that children play touch and non-contact rugby.
The UK government has selected rugby union and rugby league as two of five sports it will focus on to increase the prominence of competitive sport in schools in England, and hopes to put 1,300 links in place between schools and rugby union organisations, and 1,000 links with rugby league. It wants to recruit one million school children to the game.
While it is not disputed that there are many positive things that come from this team sport, no studies have shown that benefits from this sport are greater than other sports and activities that do not involve collision. No study has weighed the harms against the benefits.
Our concern is that rugby is a high-impact collision sport with a high rate and risk of injury. Although there is no comprehensive injury surveillance in the UK, studies show that the risk of injury for a child rugby player varies from 12% to 90% over a season of 15 games, depending on the definition. A systematic review puts the average risk of injury at around 28%. These injuries include fractures, ligamentous tears, dislocated shoulders, spinal injuries and head injuries, which can have short-term, life-long, and life-ending consequences for children.
The risk of concussion for a child or adolescent rugby union player over a season is 11% - that is the equivalent of one or two players sustaining a concussion every season in every school or club rugby team of 15 players.
Research also points to the tackle being a particular cause for concern. In studies of youth rugby, tackles were found to be responsible for up to two thirds (64 per cent) of all injuries and 87 per cent of concussions. Given that children are more susceptible to injuries such as concussion, the absence of injury surveillance systems and primary prevention strategies is worrying. Children are being left exposed to serious and catastrophic risk of injury. If the game is rolled out to one million school children the potential number of avoidable injuries could rapidly approach 100,000-300,000 a year unless steps are taken to prevent them.
Parents expect the state to look after their children when they are at school. There is a special duty of care, and they do not expect their children to be injured. However neither parents nor children are given information on injury risks and causes in this sport. In many secondary schools in the UK, especially independent schools, contact rugby is delivered as a compulsory part of the physical education curriculum from age eleven. Children and their parents do not have the option to opt out of a situation that risks bringing them serious harm.
Children who want to play the tackle version can always join a club, but they shouldn't be forced to play contact rugby as part of the national curriculum when there is such a significant risk. The four rugby unions of England, Scotland, Wales, and Ireland have responded to concerns and criticisms with many initiatives, including concussion management protocols, but none have been evaluated and furthermore these initiatives are concerned with management of injury and not with prevention or avoidable injuries. Most of the serious injuries in rugby are avoidable and preventable. But prevention requires radical changes to the laws of the game. It means removing the collision element, namely the tackle. Martin Raftery, the medical director of World Rugby has now stated that the laws of rugby may have to change to reduce concussion risk, but World Rugby is dragging its feet in dealing with the dangerous tackle.
The key problem is that it is the sport's own governing bodies that determine the laws of the game for children. World Rugby determines the laws of the game even at school level, but its interests are in the professional game and business, not children. This year's Rugby World Cup is expected to bring nearly £1 billion to the UK economy. The link between the professional game and the children's game should be severed. Governance of the children's game should not be determined by World Rugby and the rugby unions.
As a signatory to the UN Convention on the Rights of the Child, the UK and Irish governments should inform and take all necessary steps to protect children from mental and physical injury and abuse and ensure the safety of rugby by removing the contact from the children's game in schools.
Writing in the British Medical Journal in January 2015, the editor-in-chief, Fiona Godlee, wrote: "Let's call the current state of monitoring and prevention of rugby injury in schools what it is: a scandal. It needs urgent remedy before more children and their families suffer the consequences of collective neglect." The BMJ poll of doctors later confirmed that 72% felt the game should be made safer.