THE VACCINATION CHALLENGE
There is little evidence that mandatory laws improve vaccination coverage; there are other ways to encourage parents to vaccinate their children
FOLLOWING a recent measles outbreak in New York state, authorities declared a state of emergency, with unvaccinated children barred from public spaces. This highlighted the global nature of important questions about the responsibilities of the state and of individuals when it comes to public health.
The measles virus is spread largely by coughing. The highly effective vaccine against measles has been administered since the 1970s as part of the measles, mumps and rubella (MMR) injection. The global incidence of measles fell markedly once the vaccine became widely available. But measles control was set back considerably by the work of one Andrew Wakefield, a discredited former British doctor who became an anti-vaccine activist and attempted to link the MMR vaccine to autism.
There is no such link, and Wakefield was later struck off by the British General Medical Council for his fraudulent work. But the damage done has proved hard to reverse. In 2017, the global number of measles cases spiked alarmingly because of gaps in vaccination coverage in some areas. Europe saw more than 80,000 cases in 2018.
The World Health Organisation has declared the anti-vaccine movement a top 10 global health threat for 2019, and the United Kingdom is considering a move to force social media companies to remove false vaccine information. The move by US authorities to bar unvaccinated children from public spaces is a different legal approach. They admit it will be hard to police but say the new law is an important sign that they are taking the outbreak seriously.
With measles rising around the world, should governments go
further and make vaccination compulsory? Most would argue that this is a terrible infringement of human rights, but there are precedents. For example, proof of yellow fever vaccination is required for many travellers arriving from countries in Africa and Latin America because of fears of the spread of this terrifying disease.
No one seems to object to that. Also, on the rare occasions parents refuse life-saving medicine for a sick child, perhaps for religious reasons, the courts routinely overrule these objections through child protection laws. But what about a law mandating that vaccines should be given to protect a child? Vaccines are seen differently because the child is not actually ill and there are occasional serious side effects.
There are curious parallels with the introduction of compulsory seat belts in cars in much of the world. In rare circumstances, a seat belt might actually cause harm by rupturing the spleen or damaging the spine. But the benefits massively outweigh the risks, and there are not many campaigners who refuse to buckle up.
Malaysia is no stranger to the vaccination imbroglio. Early this year the Health Ministry appealed to parents to follow the National Immunisation Schedule for their children, and not to believe the news and propaganda spread about vaccination on social media.
Health Director-General Datuk Dr Noor Hisham Abdullah said the ministry has monitored the streams of untrue information, with certain groups openly promoting to reject vaccination.
The spread of negative information had adversely affected ministry efforts to fight preventable and treatable communicable diseases, resulting in an increase in cases.
The number of those who rejected vaccination at government clinics increased from 637 cases in 2013 to 1,603 in 2016.
There was, however, a slight decrease to 1,404 cases in 2017, thanks to the ministry’s programmes on raising awareness of the benefits of vaccination.
Measles cases, meanwhile, rose almost 10-fold — from 195 in 2013 to 1,934 last year.
Reportedly, the ministry has mobilised a task force to study proposals and calls to make vaccination compulsory in Malaysia.
Although the ministry is inclined to make vaccination compulsory for everyone’s good, various legal and other issues must be taken into account.
Mandatory laws are not always the best way to get parents to vaccinate their children.
UN Children’s Fund (Unicef) Malaysia representative Marianne Clark-Hattingh said Unicef’s experience showed that there was little evidence mandatory laws improved vaccination coverage, and there were other more effective approaches to foster and sustain demands for immunisation.
It’s obvious that the benefits of vaccination far outweigh the risks.
Immunisation is considered one of the greatest public health achievements of the 20th century, and experts agree that immunisation is the key to staying healthy.
Vaccination saves lives — the primary benefit is that it prevents diseases from harming your children.
No doubt medicine can cause reactions, but serious vaccine side effects are rare.
Parents should realise that not vaccinating their children puts others at risk. So parents, be sensible, get your children immunised.
Although the ministry is inclined to make vaccination compulsory for everyone’s good, various legal and other issues must be taken into account. Mandatory laws are not always the best way to get parents to vaccinate their children.
The writer is vice-chair of the Governing Council of the United Nations Technology Bank for the Least Developed Countries, based in Gebze, Turkey