ALL CHILDREN SHOULD BE VACCINATED PRIOR TO STARTING PRIMARY SCHOOL -AN ETHICAL ISSUE.

Vaccinations of infants and children are one of the major achievements of public health of the twentieth century, preventing childhood morbidity and mortality. This has been achieved by the vaccination laws and mandates. Vaccination not only provides direct immunity to the individuals but also benefits the community as a whole (herd immunity). Thus, unimmunized individuals pose a harm to the community and therefore implementation of compulsory vaccination program. However these mandates and the various ethical issues have been a topic of concern and debate amongst parents and guardians of infants and children in recent past.

Lets address some of the ethical issues pertinent to the vaccination mandate.

Regardless of the significant success achieved by various vaccination programs and reduction of incidents of life threatening diseases, there has been increase in the number of parents opting out of the procedures due to ethical and social reasons. It has been found that recently there has been increase in the number of parents hesitant and reluctant to the prescribed vaccination programs.The main reason stated by parents for objecting immunization has been fear of causing harm to their infants. Other reasons include various concerns over the safety of use of vaccines and the risks of serious side effects not being properly communicated to the public. Such behaviour pose a challenge to the primary health care centers as the vaccinations are suggested here.

The smallpox compulsory vaccination in UK

In England, compulsory laws were implemented for vaccination in 1953 and with further modification they were made stricter in 1971 that involved fines for nonconformity. The only intent behind it being universal infant immunization, control and prevent the outbreak of smallpox. However considerable number of people objected to abide by the law as they found that the law interfered with their independence and rights to freedom. Some of them considered vaccination as contamination of their infant’s body. However in case of US, stringent laws have been implemented since long time wherein all infants required to be vaccinated before their second birthday and once again before the start of their schooling. With the implementation of the laws, initially only 11 states practiced the law but by 1980 all 50 states abided by the specific immunization requirements for school entry. There has also been reported controversy against the DTP vaccine during the 1980’s, allegation had been made that the vaccine caused infants deaths. It was also asserted that there had been non-reversible injuries, “attention deficit disorders” and in some cases, “cognitive deficits” too.

Ethical issues and perception about vaccination - THE LARGER VIEW

Three major reasons for the violation of the vaccination law based on various grounds which shall be exemplified in detail in the following section.

1. The right to take decisions for their own child.

According to the UN convention of rights of the child, it has the right to achieve high health standard and therefore vaccination during any epidemic is the right of the child. This simply means that parents are obligated to take care of the child and care for its prevention from ill health by vaccinating it. However, this may vary depending on the chances of acquiring infection if not immunized and the morbidity and mortality associated to the disease.

Immunization of one’s child not only protect it from the infection but also provides the benefit to the whole population known as “herd immunity”. Similarly herd immunity also protects individuals who are vulnerable and cannot be immunized under various medical grounds, for example- too young children and immunocompromised individuals.

2. Fear of harm to infants.

Fear of causing harm to their children through vaccination was stated to be another most crucial reason by the parents for refusing immunization. Various concerns over the safety of the use of vaccines like smallpox, DPT, MMR and the risks associated with their use has created anxiety amongst the parents and guardians. However, in some cases, false stories and reports made the public believe that vaccination has more of harmful effects than beneficial. For example in 1998, Wakefield publishes an article in Lancet making false claims that the measles, mumps and rubella (MMR) vaccine was linked to autism. However, none of the scientists and researchers could reproduce the hypothesis claimed by Wakefield. In 2010, the paper was retracted since the finding were found to be fraudulent. But, this claim was considered as a major factor for increased rejection rate of the MMR vaccine which caused a sudden endemic of measles and mumps in England. Similar reaction was seen in case or pertussis vaccine which had been accepted initially but with reports and publication of serious outcomes following vaccination, the public support declined drastically which only gained significance after development and licensing of an acellular pertussis vaccine.

Another reasons for parents refusing to vaccinate their children was due to chronic medical conditions which prevented them to be vaccinated and that the children were under 12 months of age.

1. Infringement of religious beliefs.

Some of the people have particular beliefs and therefore preached to not to go against the laws of nature. These religious beliefs prevent the children from getting immunized.

School and day care vaccination

Britain and America have made it mandatory to show the immunization records while getting admitted to the school. The US schools and day care centers also had the rights to deny admission to unvaccinated children. For those unimmunized children who wish to get admitted, need to produced “personal belief exemption” (PBE) duly signed by their physician. In case of UK, the compulsory vaccination policy has not been implemented except for wales due to the outbreak of measles. Wales has implemented the options for checking and recording vaccination status an entry requirement for nurseries and schools.

The UK officials believe in maintaining the voluntary immunization system by counselling the parents about the importance of vaccinations and assist in banishing the myths associated with side effects of vaccination. In case of the management of PBE cases, it has been advised to bar them from coming to school during outbreak to protect them and prevent others from potential infection. Ethical issues sometimes overpower or come in the way of crucial practices. However, it becomes mandatory to minimize the conflicts and employ a middleway so as to be benefited from the public health services. Importance of herd immunity must be conveyed.