Should Vaccines Be Compulsory?

In the US children must have proof of vaccination before entering the public school system, although it is becoming easier in many states for parents to gain exemptions from this requirement. In the UK there is no such requirement. This distinction has allowed for a comparison of the impact of scaremongering about the safety of vaccines and the effectiveness of campaigns to improve vaccination rates.

In the UK the scare that the MMR vaccine may be connected to autism (it isn’t) triggered by the bogus study by Andrew Wakefield resulted in a precipitous drop in vaccination rates down to about 78% overall. This is far below what is necessary for herd immunity, when immunity is prevalent enough to prevent a disease from spreading around a population. And the 78% figure is an average – but there are pockets where the number is even lower. This resulted in a surge of measles – from a low of less than 100 cases per year to 1,348 cases in 2008. The surge contniues despite an aggressive campaign to inform the public about the safety of the MMR vaccine.

By contrast the US has seen continued high overall vaccination rates of about 90%. The MMR and other vaccine scare came to the US a bit later than the UK but it is in full swing here, without much effect on overall vaccination rates.  However, we are beginning to see the emergence of low vaccination rates in specific communities, with subsequent outbreaks of measles (131 cases in 2008), mumps, and whooping cough.

It remains to be seen if vaccination rates will suffer as much in the US as they have in the UK. So far it seems that the requirement for vaccination to attend public school has dampened the effects of unwarranted scares over vaccine safety. Further, it is in communities where those laws have been weakened, or there is an anti-vaccine culture that teaches parents how to circumvent the requirements, that we have been seeing a resurgence of vaccine-preventable diseases among the unvaccinated.

It is for this reason that theUK is now contemplating making vaccination compulsory. Sir Sandy Macara, a UK health expert, is quoted by the BBC as saying:

“Our attempts to persuade people have failed. The suggestion is that we ought to consider making a link which in effect would make it compulsory for children to be immunised if they are to receive the benefit of a free education from the state.”

The BBC also reports:

The BBC has learned, however, through a freedom of information request that the strategic health authority in London asked the government if it could introduce compulsory vaccinations.

However, officials respond:

“Our strategy is to maintain a voluntary immunisation system and invest efforts in educating parents about the benefits of vaccination and dispelling ‘myths’ about vaccine safety.”

But how effective is this strategy? It turns out, there isn’t much evidence to support the assumption that educating the public about risks and benefits will actually lead to changes in behavior. It turns out, we humans are not as rational as we like to think we are. This has to do partly with the fact that it is much easier to scare someone than it is to educate them.

Further, there is evidence that campaigns to dispel myths may actually increase belief in those myths. If you tell people that vaccines do not cause autism, many of them will remember “vaccines” and “autism” in the same sentence, and the association will stick.

Therefore, the more public health officials try to fight against the scaremongering surrounding vaccines, the more they feed the fire. This likely explains why vaccination rates are declining despite increasing efforts at educating the public about their safety.

Further, the anti-vaccine lobby has been engaging in an effective pre-emptive strike against public health officials. They are telling the public that doctors and public health officials are all part of a “Big Pharma” conspiracy to hide the awful truth about vaccines. They are sowing distrust in the very people who would correct the myths and misinformation the antivaccinationists are trying to spread.

This strategy also creates a Catch-22 for making vaccines compulsory. The BBC reports:

Professor Adam Finn, a vaccine expert in Bristol, said the media was largely to blame for scaremongering over the MMR jab.

“I think this would be handing a gift to the anti-vaccine lobby, because they would say ‘look they can’t persuade you it is right, so they are going to have to force you’.”

So what is the solution? It seems that the US and UK experiences favor making vaccines compulsory for public school attendance, even if it means taking a PR hit. The PR ramifications should be dealt with a campaign to explain why compulsory vaccinations are necessary.

Public education campaigns also need to be rethought in light of what we know about what works and does not work. For example, we should not be saying that vaccines do not cause autism (because that will likely increase belief in this myth), but rather that vaccines are safe and effective.

There also seems to be no way to avoid the conclusion that we need to fight fire with fire – fear with fear. We have to make parents more scared that their children will contract serious preventable infectious diseases than they are about the false fears surrounding vaccines. And I need to emphasize – parents should be more scared of this. Vaccines prevent many more diseases an ill effects then the rare vaccine reactions cause. That is why professional and public health organizations are pushing vaccines – they work.

Parents have largely lost their fear about these diseases, however, due to the prior success (ironically) of vaccines. Some believe it will take serious outbreaks of these diseases to strike fear back into the public and show them the value of the vaccination program. I hope it does not come to that, but it may.

It is also somewhat controversial whether or not fear campaigns themselves are effective. They don’t seem to dissuade teenagers from drinking, but it is not at all clear if that applies to parental fears over the health of their children. Another strategy is called social norming – essentially exploiting peer-pressure to affect behavior (again, maybe more effective for teens than for parents). The social norming approach would be to tell parents that most parents vaccinate their children – which is true. The implication is that you would be out of step with the normal social behavior of your peers if you do not vaccinate your children.

Therefore a combination of making vaccines compulsory with more thoughtful and effective public education campaigns about vaccines may dampen the effects of anti-vaccine fear mongering. Research and monitoring into the safety of vaccines also needs to continue, and be transparent. And, we need to remind the public often about outbreaks of vaccine-preventable diseases among the unvaccinated.

It may not be rational, but it is a fact of the human condition that talking about the death of 4 week old Dana McCaffery from whooping cough (she contracted the disease due to the loss of herd immunity in her community, which is a center of the anti-vaccine lobby in Australia) is likely to have more of an effect on public perceptions than all the science and statistics we can muster.

Posted in: Science and Medicine, Vaccines

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