Should childhood vaccination be mandatory?
In the British Medical Journal today, two experts debate whether childhood vaccination should be mandatory in the UK.
Paul Offit, Chief of Infectious diseases at the Children's Hospital of Philadelphia believes that mandatory vaccination is needed to protect vulnerable people from infection.
He argues that, when parents choose not to vaccinate, not only are they making a choice for their own children, they are also making a choice for those with whom their children come into contact. This includes children who are too young to receive vaccines and those who can't be vaccinated and depend on those around them to be protected.
Which is paramount: the freedom to make bad health decisions or the right of the community to protect itself from those decisions, he asks?
In the United States, mandatory vaccination clearly increases uptake, he says. For example, unlike the UK and Europe, the US didn't suffer a measles epidemic after claims of a link between the MMR vaccine and autism. And in 2011, most of the 200 measles cases in the US were linked to European travel.
"Someday we may live in a world that doesn't scare patients into making bad health decisions," he concludes. "Until then, vaccine mandates are the best way to ensure protection from illnesses that have caused so much needless suffering and death."
But David Salisbury, Director of Immunisation at the UK Department of Health, argues that there are more workable ways to ensure high uptake.
He points out that between 1998 and 2010, the peak age for measles cases in England and Wales was less than five years, so if vaccination were made compulsory for school entry, the law would be coming into effect after many infections had occurred.
He believes that vaccination coverage can be raised by improving immunisation services and argues that, even after the MMR scare, compulsory vaccination "was never considered" and "would probably have made matters much worse."
He also highlights that in the US, exemptions to mandatory vaccination for school entry can be as high as 20% and the rate is increasing.
"When coverage is already high and rising, target diseases are under excellent control (although measles could be better), and parental acceptance for immunisation is high, compulsion seems a heavy hammer," he writes. "Compulsion would be unenforceable, unnecessary, and its use would probably do more harm than good."