Should measles vaccination be compulsory?

As measles cases in Europe hit their highest levels this decade, should the UK adopt compulsory vaccination? Experts debate the issue in The BMJ today.

"We need to increase uptake of this vaccine, as we run the risk of measles becoming endemic," argues Eleanor Draeger, sexual health doctor and medical writer.

Uptake of the measles, mumps, and rubella (MMR) vaccine in the UK is 94.9% for the first dose, but this drops to 87.4% for the second dose, which falls short of the 95% needed to produce herd immunity, she explains.

She points out that mandatory vaccination has increased uptake in other countries, and that in UK society, many things are already legislated to improve individual or public health. "We would argue that the UK now needs to legislate to increase vaccination rates, as current measures aren't keeping rates high enough to ensure herd immunity."

Many parents wrongly believe the rhetoric that vaccines are harmful, unnatural, and an infringement of civil liberties, she says.

Ethicists have argued that compulsory vaccination is acceptable because people who don't vaccinate their children are potentially putting other people's health at risk, particularly those who can't be vaccinated and are therefore more vulnerable.

"Passing a law that stops children attending nursery or school unless their vaccinations are up to date or they are medically exempt would allow free choice while protecting vulnerable children," she concludes.

But Helen Bedford and David Elliman at UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital argue that rather than mandatory vaccination, the UK should concentrate on other methods to increase vaccine uptake, such as improving access to services.

For example, ensuring that general practices have an immunisation lead and adequate appointment reminders in place, making immunisation settings child and family friendly, and ensuring staff have adequate time to talk to parents, and have been trained to tackle any issues that arise.

"Only when these components are in place should we consider mandatory vaccination," they say.

Even then, they warn of potential unintended consequences. For instance, would parents still trust the NHS and healthcare professionals if GP data were used to decide whether a child was admitted to school or whether a family were allowed certain welfare benefits?

If school entry were denied, some parents may resort to home-schooling, and if vaccination were attached to welfare benefits it would be the less well off, but determined, parents who would suffer disproportionately, they add.

They welcome a recent House of Lords debate that favoured improving services rather than compulsion, and say "we believe that the UK should concentrate on improving its infrastructure and not risk alienating parents unnecessarily."