Hello everyone and welcome to this week's blog post. In this article, I will be discussing vaccination and whether it should be made compulsory. I will first explain why this issue is important, before discussing the pros and cons to such a scheme. Finally, I will discuss other options for increasing vaccination coverage.
Introduction
It is vital that this issue is discussed in the present climate. Following a paper published by Andrew Wakefield in 1998, which falsely asserted that the MMR vaccine was linked to autism, vaccination rates in the UK plummeted. Consequently, while vaccination rates have risen in recent years, only 94.9% of the UK population receive the first dose of the MMR vaccine. This drops to 87.4% for the second dose, which is less than the 95% required for 'herd immunity'. Herd immunity is where enough of a population is vaccinated so that transmission of the virus is vastly restricted, thus protecting those who have not been vaccinated from the disease.
As a result, along with many other European countries, the UK lost its measles-free status in 2019. Indeed, in just the first 3 months of 2019, the UK saw 231 confirmed cases of measles, providing proof that the prevalence of measles in the UK is rising. Unless some kind of action is taken, it is likely that diseases such as measles will become much more common and become a great public health risk.
Many countries already have some kind of mandatory vaccination schemes in place. For example, all states in the United States require vaccinations for children before they are allowed to enrol in public school (although some states do have exemptions for religious or personal objections). Meanwhile, Australia withholds certain welfare payments to families who do not vaccinate their children. On the other hand, while the UK did have compulsory smallpox vaccination until 1948, this is no longer the case and now vaccines are heavily encouraged but not compulsory.
The COVID-19 pandemic also adds increased urgency to this topic. At the time of writing this article, there is no vaccine for the disease. However, there are several vaccines in the third stages of clinical trials, thus making it likely that a vaccine will soon be made available.
Once a vaccine has been approved, the government would then have to decide whether to make vaccination compulsory.
If enough people don't voluntarily choose to vaccinate against the disease, then the number of people vaccinated may be less then required to confer herd immunity and protect those who can't vaccinate from the disease. This could force these people to self-isolate to protect themselves from the virus.
As such, the government will have to consider all sides of the appropriate argument and make a decision, taking into account the potential harm that compulsory vaccination could do to the people and the damage this scheme could have on trust between doctors and patients. On the other hand, the government will also have to consider the potential benefits that such a scheme would have, including helping protect those who can't be vaccinated and the impact that eradicating COVID-19 would have on the ability of the NHS to treat other diseases.
In the next part of this article, I will be summarising the main arguments for and against mandatory vaccination. Before I do so, it is worth pointing out that no one is advocating compulsory vaccinations for those who have medical reasons for not vaccinating. For example, those who have had allergic reactions to vaccines in the past would be exempt from these schemes.
Arguments in favour of mandatory vaccinations
One of the main reasons for making vaccines mandatory is that it ensures that a very large proportion of the population is vaccinated. This allows for the transmission of diseases to be halted and, in most cases, the eradication of the disease itself. For example, smallpox (a deadly disease which killed around 30% of the people it infected) was declared eradicated by the World Health Organisation in 1980. This was only possible because of a global campaign with surveillance and vaccination.
Due to vaccines, many diseases have either been fully eradicated or been significantly reduced in their prevalence. Consequently, many people forget what it was like living in a time when these types of diseases were common. To maintain a world which is largely free from deadly transmissible disease, it is imperative that vaccination rates remain high.
Protecting a population from contracting infectious diseases has many benefits. Firstly, it makes it highly unlikely that a patient will contract one of these diseases, thus reducing their chance of death and increasing average life expectancy. In addition, this also means that healthcare services don't have to treat these diseases, thus saving them time and money and allowing them to use these resources to treat other diseases.
In addition, there is also a moral consideration. Due to certain health conditions, a proportion of the population isn't able to be vaccinated. As such, if a disease outbreak were to occur, then they would be susceptible to the disease and be at high risk of death. However, if vaccination coverage is sufficiently high (e.g. 95% of the population for measles), then transmission of the disease is severely limited, as there are very few hosts for the pathogen to infect. This is called herd immunity and it protects people who can't be vaccinated from these diseases.
Those in favour of mandatory vaccinations argue that this moral consideration is something that should be addressed by the government and thus, the government should take action to ensure that vaccination rates don't drop and that herd immunity for these deadly diseases is maintained.
Arguments against mandatory vaccinations
The main reason against making vaccinations mandatory is that doing so would violate the principles of patient autonomy. This principle is one of the most important principles of medical ethics. It states that patients must be able to make their own decisions regarding medical treatment and that these decisions should be completely free of any form of coercion. As such, making vaccinations mandatory (e.g. by imposing fines on people who don't vaccinate) would violate this principle, as it would put pressure on people to consent to a medical procedure.
Just like many other medical procedures, being injected with a vaccine does have potential risks. For example, a small minority of patients do experience allergic reactions to vaccines. The negative impacts of vaccines are often easily treatable by doctors. In addition, the chance of these adverse reactions occurring is low. Especially when compared to potential effects of contracting diseases such as measles, rubella and diphtheria, vaccines are the best way to ensure that patients aren't harmed in the long term. Nonetheless, as with all medical procedures, many believe that this is a choice that the patient must make for themselves.
A further reason against mandatory vaccinations is the negative impact that enforcing these schemes could have. For example, some countries (e.g. Italy) have a 'no jab, no school' policy, in which parents can be fined if they send their unvaccinated children to school. Meanwhile, Australia has a similar 'no jab, no pay' policy, in which social security payments can be withheld from parents who refuse to vaccinate their children.
However, these policies could have negative effects on the children as, if they are prevented from going to school, then their education would suffer. Particularly considering that it is the parents and not the children who decide whether childhood vaccinations should be administered, it seems that this form of punishment is actually impacting the wrong people.
In addition, critics say that any system which imposes fines or withholds benefits payments is discriminatory against poorer people. As such, any enforcement system which includes fines or restricts children's access to education could have many negative consequences.
Furthermore, a system of mandatory vaccinations could also undermine the relationship between medical professionals and their patients, as patients may feel annoyed that they have to receive a vaccination and thus transfer some of that annoyance towards the medical professional. This would have severely detrimental effects on the treatment of patients.
Building a professional relationship between healthcare providers and patients is key to provide holistic care.
If this relationship is undermined then patients may be less likely to seek medical care. In addition, they may also not feel comfortable sharing enough to allow a doctor to make an accurate diagnosis. Moreover, this could also make people less trusting of public health measures and thus less likely to respond to them in the future. As such, the quality of medical treatment would decrease.
A better option?
In my opinion, vaccines are an incredibly useful tool in medical treatment. When scientifically comparing the potential negatives of vaccines to the benefits that they have, there is no doubt that everyone should be strongly encouraged to receive vaccinations. However, I do not think that vaccination should become compulsory. Not only does this go against the principle of autonomy, but it could also harm children and people from poorer backgrounds. In addition, a system of compulsory vaccination would also negatively impact the doctor-patient relationship.
This isn't to say, however, that vaccination is not important. It is crucial that vaccination rates increase. If this is not achieved, then not only will the prevalence of diseases such as measles and diphtheria increase, but herd immunity will also not be achieved, so those who can't be vaccinated will be at risk.
As such, I think there is a better option. Firstly, one reason why some people chose not to vaccinate is simply that vaccines are unavailable. Consequently, governments should make vaccinations free and widely available, as this would increase vaccination rates and make it more likely that diseases can be eradicated.
In addition, instead of forcing the people to vaccinate, the government should increase public knowledge about vaccinations and strongly encourage to vaccinate. The main reason that people choose not to vaccinate their children is that there are many myths about vaccines about their safety. For example, some people believe that vaccines have toxic metals, while others believe that vaccines can cause autism. The first step of any government response to falling vaccination numbers should be to address these concerns, as this would allow people to make informed decisions receiving vaccinations.
Yet, this has already been done by the UK government. As such, I would contend that public education efforts need to go beyond the statistics. It is very hard to truly understand statistics as a layperson. so, while statistics need to be published by the government to provide evidence for their assertions, this should be coupled with personal stories about the risks of not vaccinated. I think that this would be much easier to understand and may improve results.
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