Raina MacIntyre March 12th 2017
I am a strong advocate for immunization and have worked in this field doing research to improve protection of populations by vaccination, for over a quarter of a century. I have previously written about coercive measures to increase vaccination rates and outlined my arguments against this approach. For my sins I was shouted down by public commentators in an increasingly hostile environment for anyone who dares to question coercive public health measures. In summary my arguments against using coercion to force parents to vaccinate their children are:
Coercion may breach an accepted principle of informed consent for medical procedures, of which vaccination is one. The 10th Edition of the Australian Immunisation Handbook states that for it to be legally valid, consent to vaccination “must be given voluntarily in the absence of undue pressure, coercion or manipulation.” For parents who depend on childcare payments or childcare places, this may introduce undue coercion.
No vaccine is 100% safe or 100% effective – sometimes we get it wrong, as in the case of Rotashield, and if that happens, coercion can totally undermine a public vaccination program. Especially in a country like Australia wich does not have no-fault vaccine compensation as exists in the United States. An example of this in public health is a UK minister making his child eat a hamburger on national TV to convince the public that British beef was safe, when in fact there was a major problem with Mad Cow disease. This dogmatic approach further eroded public trust in government when the Mad Cow epidemic became clear.
Other countries such as Canada achieve high rates of vaccination without legislated coercion.
Australia is the only country in the word which imposes financial penalties to tax paying parents for refusing vaccination. There is an equity issue about this for parents as taxpayers.
There is a risk of driving vaccine-hesitant parents to become objectors, and giving fuel to the anti-vaccination lobby.
Now “No Jab, No Play” is on the agenda - to ban children from childcare centres if they are unvaccinated. Until now, such children would need to be excluded from childcare in the event of an outbreak of a disease for which they are unvaccinated, which is a reasonable public health policy. Forcing children out of childcare altogether if they are unvaccinated further increases the coercive element, with virtually no objection from any of the expert groups, and enthusiastic support from others. It has been shown in many other countries that high vaccination rates can be achieved without such a risky coercive approach. Increasing the hurdles for parents to make a choice to refuse vaccination is a better approach than coercion. There are a range of other strategies which are known to work, and which raise vaccination rates.
Meanwhile in the United States, Congress is pushing legislation to force genetic testing of employees as a condition of subsidized health insurance. In this case, there is a financial benefit to employers, who can save money by charging people with genetically identifiable health problems more for their health insurance. While these two examples are different, they both utilise elements of financial control over human health and wellbeing in a way that makes me wonder where it could lead.
These are my personal views.
Raina MacIntyre won the Public Health Association of Australia National Immunisation Achievement Award in 2014, and has worked for >25 years in vaccines and infectious diseases. She was also involved in evaluating the impact of parental financial incentives for vaccination when they were first introduced.
Conflicts of interest: Raina MacIntyre's salary and position are through UNSW, and are not controlled by government directly, thus she is able to comment independently. She has been on various Australian Technical Advisory Group working parties on immunisation, and on WHO SAGE VZV working group. She has received pharma industry support for investigator driven research on vaccines and has sat on vaccine advisory boards for GSK, Merck and Pfizer. She does not have shares in any drug company. However, views below would not tend to benefit the vaccine industry, as she does not agree with punitive measures that force parents to vaccinate.