Health vs choice? The vaccination debate
In April this year, the US health authorities reported a ‘completely avoidable’ outbreak of measles. By early May, there had been 764 cases reported across 23 states, the highest number of cases since 1994, a particularly depressing statistic given that measles was declared ‘eliminated’ in the USA in 2000. The problem is that vaccination rates are low in some specific communities – like orthodox Jewish groups in New York – while they have fallen below ‘herd immunity’ rates (95 per cent) more generally in many countries. In the UK, for example, there were over 1,000 confirmed cases of measles in 2012 alone, while vaccination rates for measles, mumps and rubella (MMR) are barely above 90 per cent.
What is to be done? Scientists insist that vaccines have been thoroughly studied and are safe. Claims of a link between MMR vaccine and autism, made in a paper for the Lancet in 1998, have been debunked and the paper discredited. Yet ‘anti-vaxx’ messages continue to circulate, leaving health authorities struggling to contradict ‘fake news’ messages about health risks. As a result, there has been discussion of censoring anti-vaxx messages.
Governments in some countries, like Italy and France, have introduced new measures to compel vaccination against specified diseases, linking proof of vaccination to children’s access to state-provided schooling. In April, the city authorities in New York went further, introducing mandatory vaccination for adults and children in parts of Brooklyn unless individuals had proof of previous vaccination or a medical exemption. Failure to comply could lead to a stiff fine or even imprisonment.
These measures are presented as a necessary expression of the public good, of the right of children to be protected from serious and sometimes life-threatening diseases, and of the need to uphold truth against lies. However, the turn to compulsion has led some commentators, even some who support vaccination, to raise questions about these measures. Some say compulsion, in any form, is inferior to efforts to educate and persuade. Others point out that pinning the blame on anti-vaxxers and parents committed to ‘alternative health’ explains little about vaccine rates in many countries or about what influences the decisions of parents whose children go unvaccinated.
Over 200 years since Edward Jenner’s use of cowpox to provide immunity from smallpox, what should we make of the situation now? Is it best understood as one of fake news and false claims, which should be addressed through censorship if necessary? How much do we understand about parental attitudes across cultures and nations? Is there a legitimate right for individuals or parents to refuse vaccination? Or are claims for the public good and for the right of children to good health, expressed if necessary through compulsion, more ethically persuasive?