The UK is no longer classed as measles-free : The last few years have seen a decline in children having the MMR vaccination.
https://www.bmj.com/content/362/bmj.k3967
In 2018 there were 991 confirmed cases of measles in England and Wales, compared with 284 cases in 2017. This means that the UK has lost it’s measles free status, which had been previously granted by the world health organisation, based on data from 2014- 2016
(https://publichealthmatters.blog.gov.uk/2019/08/19/measles-in-england/)
and 4 influential GPs have had enough: and written to the government suggesting that un vaccinated children should not be allowed to go to school.
https://www.theguardian.com/society/2019/sep/08/stop-measles-mmr-jab-compulsory-gps
The doctors – including the chair of the all London Clinical Commissioning Group, Sir Sam Everington -say children should have the usual NHS two MMR doses before being allowed to attend school.
They argue that the only exceptions should be for children whose parents register a concencious objection, or children who can’t have it – children being treated for certain types of cancer, for example. The doctors justify this by saying measles is an increasing danger – true – that mandating vaccination has been done before – also true, in 1853, for smallpox vaccination – and that similar happens in other countries – yes, indeed.
But the question is – does compulsory vaccination work? And what about the harms?
In some ways MMR is a victim of it’s own success. We are not routinely reminded of how many deaths and blindness measles causes in the UK. But what about compulsory vaccination? Does that work?
The short answer is no. A review in the journal Vaccine examined different practice worldwide from hard to soft laws. California has financial penalties or social restrictions if a child doesn’t get vaccinated. This was initially associated with an increase in vaccination rates – but this is now falling as the number of exemptions rise –
https://www.wired.com/story/californias-vaccination-rate-slips-as-medical-exemptions-rise/
http://eziz.org/assets/docs/shotsforschool/2018-19CAKindergartenSummaryReport.pdf
leading to a further bill earlier this month to minimise exemptions.
Meantime, in Ontario, Canada, there are now softer laws – enforcing parental education but allowing opt outs. But it is very rare for the education sessions to change minds.
The authors from the Vaccine review conclude ‘mandatory vaccination does not guarantee improved vaccination rates”. Studies from the US where parents were either told or not told that their financial benefits would be penalised depending on vaccination had mixed results, and no clear advantage. Meantime, countries like Sweden have achieved excellent vaccination rates with no compulsion.
http://www.asset-scienceinsociety.eu/reports/page1.html
So what about the potential for harm?
Certainly, there are some families who, for whatever reason – transport, language, work – haven’t managed to get their child vaccinated. So: bring the vaccine to the child – there is research from Australia finding that a home vaccination service allows children to catch up on immunisations they have missed.
https://www.nice.org.uk/guidance/ph21/evidence/revised-analysis-of-the-evidence-pdf-67239037
https://www.sciencedirect.com/science/article/pii/S0264410X15005046
But other families who don’t trust MMR. No matter how good the science is, fear can often win over facts. And those fears, I think, do not respond well to threats from the medical or political establishment. Rather there is the potential to drive that family further away from evidence based healthcare, to the detriment of the child. Though there is a place for sanctions – the pedlars of fake news and bad science online: closed forums included. We have to make it possible for parents to get facts they can trust and kindness to allow a changing of minds – so much easier when you know and have faith in healthcare staff.
There is unfortunately nothing new about anti vaccination movements – when the UK Vaccine Act was passed in 1853, making smallpox vaccination compulsory, it was accompanied by an enormous opposition. It’s notable that historical reviews note that the strongest anti-vaccination movements seemed to appear in countries with compulsory laws. A commission set up to address public disquiet a few years after the Act recommended opt outs for concientious objection, and although many did opt out, the overall effect on the total population was an increase in smallpox vaccination rates. If we want to get vaccination rates up: I’d work on understanding that.
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(06)68144-0/fulltext#
https://www.nice.org.uk/guidance/ph21/evidence/revised-analysis-of-the-evidence-pdf-67239037
ulde
https://www.bbc.co.uk/news/health-49394170
https://www.bmj.com/content/362/bmj.k3967
http://www.asset-scienceinsociety.eu/reports/page1.html
https://www.sciencedirect.com/science/article/pii/S0264410X15005046
https://ec.europa.eu/health/sites/health/files/vaccination/docs/2018_vaccine_confidence_en.pdf
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(13)60907-1/fulltext
https://www.wired.com/story/californias-vaccination-rate-slips-as-medical-exemptions-rise/
http://eziz.org/assets/docs/shotsforschool/2018-19CAKindergartenSummaryReport.pdf
https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(06)68144-0/fulltext#
…https://publichealthmatters.blog.gov.uk/2019/08/19/measles-in-england/
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