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US expert calls for mandatory vaccines

DoH imms director disagrees that UK childhood jabs should be compulsory

Louise Prime

Wednesday, 16 May 2012

A US expert on childhood infectious diseases has proposed that childhood immunisation should be mandatory, because vaccination rates affect public health as well as that of the individual. But the DoH’s director of immunisation has countered on bmj.com today that this could actually have worsened matters during the MMR-autism scare, and that there are better ways of increasing uptake.

The chief of infectious diseases at the Children’s Hospital of Philadelphia and University of Pennsylvania School of Medicine in Philadelphia – Paul Offit – points out the importance of herd immunity, especially to vulnerable people who cannot be immunised. He states that because of this, as well as the benefits of immunisation for the children themselves, parents should not be allowed to decide against having their own children immunised because they have heard misleading information about the dangers of vaccines.

Offit writes that “mandatory vaccination clearly increases uptake” in the US, where there was no measles epidemic after the MMR vaccine was falsely linked to autism. And he says rates of vaccine-preventable diseases are higher in those states or districts that allow ‘philosophical exemption’ from mandated vaccines than in those that don’t.

He asserts: “Someday we may live in a world that doesn’t scare parents into making bad health decisions. 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 DoH, argues that the evidence is unconvincing on the effectiveness of making vaccination compulsory for school entry – not least because this would come too late for diseases that tend to strike early, such as measles – and contends that “other interventions are more likely to be successful than compulsion”. He also disputes the success of mandating vaccination in the US, because of the high and increasing level of exemptions granted, already up to 15-20% in some communities.

He concludes: “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. Compulsion would be unenforceable, unnecessary, and its use would probably do more harm than good.”

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