The Scene
Measles is a highly contagious viral illness which presents with a rash, fever and cold-like symptoms; in rare cases it can lead to severe complications and even death. The fact that measles is a killer has gone largely under-publicised, even in the wake of extensive coverage following the MMR controversy, which continues to linger after 15 years. In 2011, the World Health Organisation (WHO) estimated there were 20 million cases and 158,000 deaths attributable to measles – over 95% of these coming from LEDCs. This is nearly a quarter of yearly deaths attributed to malaria for example (660,000), yet doesn’t appear to receive a proportional level of focus from charities and campaign groups. The reason for this is simple – why would we support measles vaccination projects in India, when we’re still not completely comfortable with vaccinating our own children?
Today
A couple of days ago (30/04/2013), the number of confirmed cases of measles in Wales (as of November 2012), rose above 1,000. The reason we have seen this epidemic is directly due to the decrease in MMR uptake which began in 1998 (see above graph). Public health officials have warned that those aged between 10-15 are most at risk – in other words, children born between 1998 and 2003, when immunisation rates were steadily declining to their lowest point of 80%.
This epidemic will no doubt continue to rise in Wales in the coming weeks while thousands slowly play catch-up and it would be no surprise to see a similar crisis arise in London, as several London boroughs currently have a vaccination rate of only 70%.
Targets
In the wake of a large, highly publicised, national health scare such as the MMR controversy, it would seem unrealistic to aim for 100% vaccination coverage. And as far as public health is concerned, total coverage is unnecessary, as effective ‘herd immunity‘ requires only 95% coverage. Herd immunity is a concept which means not everyone needs to be vaccinated in order to stop the progression of a disease, this is because if enough of the population are protected there is a very low probability that an infected individual will encounter somebody who is not immune. In other words, if you have a population of 20 people, of whom 19 are vaccinated, the 20th person is protected as there is no one to carry the disease to them. For many diseases the herd immunity threshold is between 80-90%, but for measles it is slightly higher.
Figures from 2012 in the UK show that MMR uptake is beginning to move in the right direction, with on average 91% of children under 2 receiving their first dose. Encouraging news, but still short of eradicating the kind of epidemics we have seen in Wales.
How do the rest compare?
When looking at worldwide statistics for MMR coverage and measles incidence, results vary, and naturally show that less-developed countries are on the whole poorly covered when compared to developed countries. There are however plenty of examples which can serve to embarrass the UK – Cuba, Honduras, Albania, Iran, Sri Lanka, Thailand, Hungary and Panama are just a few notable countries with MMR vaccination coverage between 98-100%.
In 2010, Zambia had 97% coverage, despite having on average just 1 doctor per 100,000 capita. Rwanda have managed to successfully maintain 95% coverage for the past 4 years and have eradicated measles-related mortalities completely thanks to an aggressive vaccination schedule led by their national health service, along with charitable support which the Rwandan government actively asked for.
Why not just make vaccinations compulsory?
Injecting some life into the debate over compulsory immunisations
Why not indeed! The United States, Canada, France, Italy, Slovenia, Iceland, Poland, Bulgaria, Japan, Switzerland and numerous other countries have mandatory vaccination schedules for children, surely it’s time the UK followed suit. It must be clarified that these are not totalitarian healthcare agendas, there are still provisions for exemptions based on religion and philosophy – if asked for (having to choose to opt out, rather than opt in).
The main argument against this motion revolves around parental autonomy and tends to sound something like:
“Mandatory immunisations would impede on my basic human rights.”
The simple response to this is no, no they would not. It is not a human right to be able to subject your offspring to preventable diseases. However, one of the actual basic human rights (article 3 of the Universal Declaration), states ‘everyone has the right to life, liberty and security’ – all of which would be stripped of an infant unfortunate enough to be born into a family where the stubborn autonomy of the parent overrides the life of the child.
Also, as is often repeated, as well as being highly negligent to the child in question, it is grossly inconsiderate to children who are unable to be vaccinated (possibly due to chronic disease). The afore-mentioned notion of herd immunity is there to protect these individuals who for whatever reason have been unable to get immunised and their risk of disease contraction rises with every susceptible person that surrounds them.
Other opposition focuses on the adverse effects some vaccines carry. Every health intervention has some risk and whether you are being vaccinated, medicated or operated on, the health professionals concerned have to weigh up the risk of harm from treatment, against the risk of harm from non-treatment. Parents who refute this are actively ignoring the better judgements of doctors and the hoards of researchers who preceded them. Compulsory vaccinations would hopefully quash some of the ignorant dissidents and immunise the wider public against the super-contagious virus of unfounded fear.
This isn’t to say that people in this category are poor parents, morally deficient or stupid – they are simply wrong. It is an important distinction to make, as no change of thought will occur whilst healthcare professionals continue to patronise.
There are plenty of other remarks which come from a host of conspiracy theorists and alternative medical practitioners which do not justify the time to comment on.
The future
A recent poll conducted by yougov showed that 55% would be in favour of a mandatory vaccination policy, comparable with that in the United States, as opposed to 28% who opposed (17% did not know). This was a relatively small study and in the wake of the epidemic in Wales is likely to be slightly high.
MMR coverage has recovered once again and returned to pre-controversy levels (91%), but this is nothing to be complacent about, as we are still short of the target line. The issue of mandatory vaccinations was raised last week on BBC Newsnight (24/04/2013), one of the guests was the Chair of the Royal College of General Practitioners Council, Dr. Clare Gerada. When discussing coverage rates, Dr. Gerada nonchalantly stated there will ‘always be 5% or so who don’t get vaccinated’. Is this something that we should simply tolerate? It was disappointing to hear this from one of the UK’s most senior GPs, who should be leading the charge on the issue, rather than lazily conceding that the status quo is something we must realistically accept.
The pertinent voice in favour of a legislated, compulsory vaccination program must sound loud and true if future incidents like those seen in Wales are to be avoided. It would be nice to exist in a time where the ‘debate’ over vaccinations has finally silenced once and for all and the words such as ‘measles’ remain only in the names of their respective vaccines.
A Dose of Debate 