Should vaccination be made mandatory in Malaysia?

The number of measles cases in Malaysia has increased ten-fold, from 195 in 2013 to 1,934 in 2018 and to six deaths in 2018, which have not all been vaccinated.

At the same time, the number of cases of non-vaccination against measles has increased elevenfold, from 125 in 2013 to 1,467 in 2018.

Measles infections have also increased in many countries in recent years, for example. Singapore, Indonesia and the Philippines in Asean and many developed countries.

In addition, the number of cases of diphtheria in Malaysia increased from four in 2013 to 32 in 2017 and 18 in 2018, with five deaths in 2018, including four unvaccinated.

Pertussis cases fluctuated between 222 in 2013, 939 in 2015, 353 in 2017 and 892 in 2018, with 22 deaths in 2018, of which 19 were unvaccinated.

Vaccine refusals in Malaysia increased from 637 in 2013 to 1,603 in 2016 and 1,404 in 2017.

According to the World Health Organization (WHO), one of the ten threats to global health in 2019 is reluctance to vaccinate, that is, reluctance or refusal to vaccinate despite the availability of vaccines, which threatens to reverse progress in the fight against vaccine-preventable diseases.

One intervention proposed to address this problem is mandatory vaccination – an approach that is the subject of ongoing debate and is currently under review by our Ministry of Health.

Proponents of mandatory vaccination have often cited and extrapolated the dramatic positive impact of smoking bans and use of the seatbelt on public health and safety.

In addition, there is no evidence on the effectiveness of mandatory vaccination.

Immunization saves lives

Vaccines are one of the most effective public health interventions because they have saved lives and improved health. Only clean water performed better.

Vaccines have eradicated smallpox and almost polio. However, vaccine-preventable diseases have not all disappeared.

According to Shot @ Life, a popular awareness campaign of the United Nations Foundation, vaccines save 2.5 million children each year from preventable diseases, or about 285 children per hour.

When a critical percentage of a population is vaccinated against a contagious disease, it is unlikely that an epidemic will occur, so most members of the community will be protected – that is to say. what is called herd immunity.

Populations that can not be immunized for medical reasons rely on group immunity to prevent their infection with vaccine-preventable diseases.

Vaccines that have controlled and eradicated diseases, the devastating effects of vaccine-preventable diseases have disappeared from human understanding.

The hesitation with regard to a vaccine is partly due to concerns about vaccine safety, misplaced anxiety or concerns about vaccine safety prevailing over concerns about vaccine safety. the disease itself.

Declining vaccination rates will result in a resurgence of vaccine-preventable diseases.

Low national coverage or even small pockets of low coverage in one country have led to large outbreaks of measles and diphtheria, causing many deaths and disabilities in many countries over the past decade.

For compulsory vaccination

The 50 US states require that all children over five years old have been vaccinated prior to admission to school.

However, all states have exceptions based on medical and religious grounds, and some on philosophical objections.

Some children are immune only when they start school.

States with the most stringent laws have lower rates of pertussis and measles, suggesting that mandatory vaccination could be effective.

Compliance with child immunization schedules in Australia has been linked to preschool admission (ie, "No play, no play") and the payment of family badistance (ie d) "No blow, no salary").

Most governments and international medical organizations say vaccines are safe because their ingredients are sufficient.

Adverse reactions to vaccines are extremely rare. The most common side effect, a serious allergic reaction known medically as anaphylaxis, occurs in about one in hundreds of thousands of vaccines to one in one million vaccines.

There is a difference between badociation and causality.

Combined vaccines such as mumps, measles and rubella (MMR) have been used since the 1940s without adverse effects.

There is no evidence that the MMR vaccine causes autism, or that the vaccine against diphtheria, tetanus and acellular pertussis (DTaP) causes diabetes; or that the killed influenza vaccine causes paralysis of the seventh cranial nerve or causes asthma.

Against compulsory vaccination

Many countries have high vaccination rates, even though vaccination is voluntary, such as the United Kingdom and Finland.

The US Centers for Disease Control and Prevention (CDC) estimates that the risk of anaphylaxis is one in one million children, that is, about the same risk of being injured while flying.

According to the National Vaccine Information Center, an American organization dedicated to preventing vaccine-related injuries and deaths, vaccines could be linked to learning disabilities, asthma, autism, to diabetes, chronic inflammation and other disabilities.

The scarcity of seizures, coma and brain damage attributed to DTaP and MMR vaccines make it difficult to determine the causal link.

According to the United States CDC, there are very rare cases of serious skin rash, pneumonia, hepatitis, meningitis, seizures or severe general infection caused by the chicken pox, while reports of an badociation between influenza vaccine and Gullain-Barré syndrome – a condition of the peripheral nervous system – have changed from season to season.

Some claim that some vaccines contain harmful ingredients, for example thiomersal, aluminum and glutaraldehyde.

Other arguments include the violation of personal rights of choice and religion, the fact that vaccines are not natural, that the infection produces more effective immunity, that vaccine-preventable diseases have almost disappeared and most vaccine-preventable diseases are relatively harmless.

There are counter arguments on both sides of the debate.

For exam

The fundamental question to be addressed concerns the objectives of the vaccination policy. Is it an individual or group immunity (use of the vaccine) or is it the eradication of the disease?

Where is the balance between individual rights and society's goals?

Compulsory vaccination has legal, ethical and public health implications.

If vaccination is mandatory, which vaccine-preventable diseases would be included? How will it be applied with the growing number of children involved in home schooling?

What would be the reasons for exclusion? What are the penalties for non-compliance?

If a child had an adverse event near the date of vaccination, would the government be responsible?

There is little evidence of the benefits of mandatory vaccination, which could have unintended consequences, such as increased anti-vaccine sentiment, as was the case in Italy.

If exclusions are allowed for religious and philosophical reasons, they would be difficult to manage and, if allowed, would reduce the effectiveness of mandatory vaccination.

The EU Asset project has not demonstrated a clear link between mandatory vaccination and participation in the vaccine.

The experts' position was that mandatory vaccination could solve a short-term problem, but not a long-term solution.

Better organization of health systems and strong communication strategies can be more effective.

The research findings suggest that vaccine uptake rates among reluctant parents have increased after being interviewed with trusted health professionals.

Easy access to vaccines and health care is essential, as many unvaccinated children's parents were not hesitant to hesitate about a vaccine, but struggled to get to the hospital. their appointments or did not remember when their children needed to be vaccinated.

In summary, hesitation to vaccination must be fought through education, not by coercion, which can have unintended consequences.

In this respect, general practitioners play a vital role in their close relationships with parents in their community.

Dr. Milton Lum has been President of the Federation of Private Medical Associations and the Medical Association of Malaysia. The opinions expressed do not represent those of organizations to which the author is badociated. The information provided is for educational and communication purposes only and should not be construed as personal medical advice. The information in this article is not intended to replace, replace, or supplement a consultation with a healthcare professional regarding the medical care of the reader. The Star declines all responsibility for any loss, damage or injury sustained directly or indirectly by the use of such information.