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Yes, Eleanor Draeger
Unicef released a sobering report on vaccination in 2018,1 that indicated that in April 2019, 169 million children had lost a first dose of measles vaccine from 2010 to 2017 – an average of 21.1 million children per year, which includes more than 500,000 children in the United Kingdom alone12.
The latest report on the use of the measles, mumps and rubella (MMR) vaccine in the UK is 94.9% for the first dose, but 87.2% for the second dose 3, which is less than the 95% needed for production. herd immunity. If vaccination rates continue to fall, we run the risk of measles becoming endemic again.
In addition to free access to government-recommended vaccines we already have in the UK, there are many ways to increase vaccination rates. These fall broadly into three categories: education (including communication and public engagement), incentives and legislation.4 Education is the most widespread practice, but legitimate online sources on vaccines must compete with false news and "anti-virus" rhetoric. An online study conducted in 2010 found that visiting a website criticizing vaccines for five to ten minutes increased the perception of the risk of vaccination and decreased the intention to vaccinate.5
Punitive policies
In Europe, vaccination is mandatory for at least one childhood disease in 11 countries, nine of which include measles. Italy has increased the number of its mandatory vaccinations from four to ten in July 2017, with measles being part of the extra vaccines.6 If children are not vaccinated when they go to primary school , their parents are fined. In January 2018, the Italian Ministry of Health reported that 29.8% of unvaccinated children born between 2011 and 2015 had been vaccinated since the entry into force of the new law7.
Australia does not have mandatory vaccination as such, but instead uses financial incentives and almost mandatory vaccination. Its national "no jab, no salary" policy prevents parents from receiving financial benefits unless their children are up to date with their immunizations or have a valid medical certificate of exemption. Four states have an additional "no jab, no play" policy, whereby children can not be enrolled in school or nursery without evidence that they are up-to-date or dispensed for medical reasons. The adoption of these policies has increased: more than 5,000 children who have never been vaccinated have been vaccinated within six months of the adoption of the new law in 2015.4
In British society, many things are legislated to improve individual or public health. The Children and Young Persons (Tobacco Protection) Act, 1991, which prohibits the sale of tobacco to anyone under the age of 18, and the 2006 smoke-free (local and law enforcement) regulations, which prohibits Smoking in enclosed public places, prevent smokers from being affected by pbadive smoking in these areas.
I would say that the UK now needs to legislate to increase vaccination rates, because the current measures do not keep rates high enough to ensure herd immunity. A recent article by Trentini and colleagues simulated the effect of current vaccine strategies on future susceptibility to measles, concluding that the United Kingdom may need to introduce mandatory vaccination to reduce sensitivity low enough to eliminate measles.8
Vaccination was previously compulsory in the United Kingdom: the 1853 Vaccination Act was adopted to strengthen smallpox vaccination. This directly led to the formation of the Anti-Vaccination League, which organized demonstrations around the UK and finally had the law amended to allow conscientious objection. The arguments of skeptics about vaccines today are very similar to those used in the 1800s, and many parents mistakenly believe that vaccines are harmful, unnatural and a violation of civil liberties.
Protecting the most vulnerable
Ethicists have argued, however, that mandatory vaccination is acceptable because people who do not vaccinate their children potentially put the health of others at risk – especially those who can not be immunized for reasons of age or immunosuppression and are therefore more vulnerable. Brennan argues that "compulsory and coercively imposed vaccinations can be justified, not for paternalistic reasons, but on the grounds that individuals may be prevented from participating in the collective taxation of a person." unfair risk of harm "9.
Adopting a law prohibiting children from going to nursery or school unless vaccinations are up to date or free from medical care would allow a philosophical objection, in that parents who do not agree with the vaccination could refuse vaccines to their children without posing a risk to schoolchildren who can & # 39; t be vaccinated for medical reasons. This would allow free choice while protecting vulnerable children.
No – Helen Bedford, David Elliman
Despite the highest rates of measles immunization ever recorded in Europe, 2018 recorded the highest number of cases in this decade (82,596), with 72 deaths10. This included 966 cases in England, 11 highest in five years.12
An inexpensive and highly effective vaccine with an excellent safety record is available 13, but measles has become a global problem again. Since non-immunized children pose a risk not only to themselves, but also to those who can not be immunized, it is not surprising that mandatory vaccination has re-emerged on the agenda. health services planning to introduce it. Before embarking on this path, however, we need to examine the reasons for this resurgence of measles and examine the evidence for possible interventions.
In the UK, the use of a single dose of MMR vaccine at the age of 2 years has gradually decreased from a high of 92.7% in 2013-2014 to 91.2% in 2017-18.3. At the age of 5, the absorption of a dose approximates 95%. 87.2% for two doses. But these global figures hide a wide variation across the country that explains why outbreaks are localized.
Challenges of infrastructure
The reasons for non-vaccination vary by country and within countries. Resistance to vaccination has been suggested as a major factor in this respect and is important in some countries, but how important is it in the UK? In high-income countries, the proportion of parents who refuse all vaccines is around 1% to 2%. 14 A large minority of parents may have concerns, but these can usually be addressed effectively by talking to professionals. of informed health, in which the vast majority of children are vaccinated. the public always has considerable confidence. Difficulties of access to services are more important.
So, before considering mandatory vaccination, we should address some of the infrastructure issues. Does every general practice have a responsibility for immunization? Do we have adequate callback systems in place? Are immunization environments suitable for children and the family? Are session times appropriate for young families, or do they coincide with sibling collection at school or nursery? Is opportunistic immunization available in other contexts frequented by children, such as outpatient clinics and nurseries (especially important for children whose immunizations are late)? Do staff have enough time to talk to parents and have they been trained to solve the small number of issues?
Uncertain consequences
We should only consider mandatory vaccination when these components are in place. Even in this case, would it be appropriate for the United Kingdom or would it have unintended consequences? 15 Evidence that compulsory vaccination has been effective in other countries is not conclusive and there is no evidence regarding the United Kingdom. Would parents still trust the NHS and health professionals if the family doctor 's data were used to decide whether a child was admitted to school or if a family was entitled to certain benefits? welfare? We believe that mandatory vaccination could be detrimental to this.
Equally important, would it work? If school entry is refused, some parents opposed to vaccination may use home schooling, or groups of like-minded parents may form informal informal child care groups. regulated. Is it fair to jeopardize the chances of children – who are so dependent on education – because of their parents' beliefs? If the vaccination was badociated with social badistance benefits, it would be the less well-off but determined parents who would suffer disproportionately. Some undecided parents may become more resistant and not wish the state tells them how to raise their children.
We were pleased to note that a recent debate in the House of Lords has promoted improved services rather than coercion16; and, unlike Trentini and colleagues 9, we believe that the UK should focus on improving its infrastructure and not risk unnecessarily alienating its parents.
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