Debate over mandatory MMR vaccination
Author: Adrian O'Dowd
A doctor whose own child contracted measles is calling for the measles, mumps, and rubella (MMR) vaccine to become mandatory in the UK to avoid the possibility of the disease becoming endemic.
Other experts, however, are calling for alternative ways to ensure greater uptake of the vaccine, such as guaranteed vaccination leads in all GP practices, improved appointment systems and better clinician knowledge on the subject.
In a head to head* article published in The BMJ today, doctors debate whether or not measles vaccination should be made compulsory in the UK.
The discussion comes as measles cases in Europe have reached their highest levels this decade.
Eleanor Draeger, sexual health doctor and medical writer in Gravesend, said: “We need to increase uptake of this vaccine, as we run the risk of measles becoming endemic.”
Uptake of the MMR vaccine in the UK is 94.9% for the first dose, but this drops to 87.4% for the second dose, which falls short of the 95% needed to produce herd immunity, she explained.
Mandatory vaccination had increased uptake in other countries, she added, and in UK society, many things were already legislated to improve individual or public health.
“We would argue that the UK now needs to legislate to increase vaccination rates, as current measures aren’t keeping rates high enough to ensure herd immunity,” argued Dr Draeger, whose own son caught measles when he was too young to have had the vaccine himself. He made a full recovery.
Many parents wrongly believed the “rhetoric” that vaccines were harmful, unnatural, and an infringement of civil liberties, said Dr Draeger.
Ethicists had argued that compulsory vaccination was acceptable because people who did not vaccinate their children were potentially putting other people’s health at risk, particularly those who could not be vaccinated and were therefore more vulnerable.
“Passing a law that stops children attending nursery or school unless their vaccinations are up to date or they are medically exempt would allow free choice while protecting vulnerable children,” she concluded.
However, Helen Bedford and David Elliman at University College London, Great Ormond Street Institute of Child Health and Great Ormond Street Hospital, argued that rather than mandatory vaccination, the UK should concentrate on other methods to increase vaccine uptake, such as improving access to services.
Examples they gave included:
- ensuring that general practices had an immunisation lead
- adequate appointment reminders were in place
- immunisation settings should be made child and family friendly
- staff should have adequate time to talk to parents and have been trained to tackle any issues that arise.
“Only when these components are in place should we consider mandatory vaccination,” they said.
Even then, they warned of potential unintended consequences, such as the possibility that parents could lose trust in the NHS and healthcare professionals if GP data were used to decide whether a child was admitted to school or whether a family were allowed certain welfare benefits.
“Evidence that mandatory vaccination has been effective in other countries is not conclusive, and no evidence exists in relation to the UK,” they added. “If school entry were denied, some parents who were determinedly opposed to vaccination may resort to home schooling.”
In addition, if vaccination were attached to welfare benefits it would be the less well off, but determined, parents who would suffer disproportionately.
“We believe that the UK should concentrate on improving its infrastructure and not risk alienating parents unnecessarily,” they said.
*Draeger E, Bedford H E, and Elliman D A C. Head to Head: Should measles vaccination be compulsory? BMJ 2019;365:l2359. DOI: 10.1136/bmj.l2359