BMJ Press Release Monday, May 14, 2012 – 14:32
Should childhood vaccination be mandatory?
Is it needed to protect vulnerable people or are there more effective ways to ensure uptake?
On bmj.com today, two experts debate whether childhood vaccination should be mandatory in the UK.

Paul Offit, Chief of Infectious diseases at the Children’s Hospital of Philadelphia believes that mandatory vaccination is needed to protect vulnerable people from infection.

He argues that, when parents choose not to vaccinate, not only are they making a choice for their own children, they are also making a choice for those with whom their children come into contact. This includes children who are too young to receive vaccines and those who can’t be vaccinated and depend on those around them to be protected.

Which is paramount: the freedom to make bad health decisions or the right of the community to protect itself from those decisions, he asks?

In the United States, mandatory vaccination clearly increases uptake, he says. For example, unlike the UK and Europe, the US didn’t suffer a measles epidemic after claims of a link between the MMR vaccine and autism. And in 2011, most of the 200 measles cases in the US were linked to European travel.

“Someday we may live in a world that doesn’t scare patients into making bad health decisions,” he concludes. “Until then, vaccine mandates are the best way to ensure protection from illnesses that have caused so much needless suffering and death.”

But David Salisbury, Director of Immunisation at the UK Department of Health, argues that there are more workable ways to ensure high uptake.

He points out that between 1998 and 2010, the peak age for measles cases in England and Wales was less than five years, so if vaccination were made compulsory for school entry, the law would be coming into effect after many infections had occurred.

He believes that vaccination coverage can be raised by improving immunisation services and argues that, even after the MMR scare, compulsory vaccination “was never considered” and “would probably have made matters much worse.”

He also highlights that in the US, exemptions to mandatory vaccination for school entry can be as high as 20% and the rate is increasing.

“When coverage is already high and rising, target diseases are under excellent control (although measles could be better), and parental acceptance for immunisation is high, compulsion seems a heavy hammer,” he writes. “Compulsion would be unenforceable, unnecessary, and its use would probably do more harm than good.”

Head to Head
Should childhood vaccination be mandatory? Yes
BMJ 2012; 344 doi: 10.1136/bmj.e2434 (Published 15 May 2012)
Paul A Offit, chief of infectious diseases

Paul Offit believes that mandatory vaccination is needed to protect vulnerable people from infection, but David Salisbury (doi:10.1136/bmj.e2435) argues that there are more workable ways to ensure high uptake

Excerpt
In a better world, vaccine mandates wouldn’t be necessary. Parents would educate themselves about the diseases that vaccines prevent and learn that measles causes pneumonia and brain damage, mumps causes deafness and sterility, rubella causes severe birth defects, pertussis causes suffocation, and human papillomavirus (HPV) causes cervical, oropharyngeal, and anal cancers. They would learn about the remarkable safety and effectiveness of vaccines. And they would learn that although vaccines are not free of risk, their benefits clearly outweigh their risks. Mostly, they would learn that vaccines stand on a mountain of scientific evidence. Well informed: the choice to vaccinate their children would be an easy one.

Unfortunately, we don’t live in that world. In our world, science based information is often obscured by false and misleading claims readily available in newspaper and magazine articles, on radio and television …
http://www.bmj.com/content/344/bmj.e2434

Head to Head
Should childhood vaccination be mandatory? No
BMJ 2012; 344 doi: 10.1136/bmj.e2435 (Published 15 May 2012)
David M Salisbury, director of immunisation

Paul Offit (doi:10.1136/bmj.e2434) believes that mandatory vaccination is needed to protect vulnerable people from infection, but David Salisbury argues that there are more workable ways to ensure high uptake
Excerpt
Mandatory vaccination in the UK was attempted first in the 19th century.1 The legislation was ineffective, discriminated in favour of those able to use the exemptions, and was divisive; it fostered substantial anti-vaccine sentiment and was counterproductive. Attempts to impose compulsion today would undoubtedly be challenged in terms of autonomy, inappropriate intrusion of the state, availability of choice, and parental rights and responsibilities. Bolstered by access to information, its unacceptability to the public would be likely to have the same consequences.

Two questions need to be answered: do we need mandatory vaccination and are there examples of it being beneficial?

Compulsion is unnecessary
I presume that the purpose of mandatory vaccination is to raise coverage. If coverage is sufficiently high, compulsion is not needed. If coverage were not adequately high, other interventions are more likely to be successful than compulsion. We have reasonable ideas of what “sufficiently high” means: polio outbreaks do not occur when coverage is consistently above 80% in …
http://www.bmj.com/content/344/bmj.e2435