HOW far should authorities go to encourage universal childhood vaccination?
The recent “Disneyland” measles outbreak in the US saw almost 200 people fall ill after an infected person visited the theme park. It prompted some tough medicine from Californian legislators.
Under new laws, children whose parents refuse to vaccinate them for non-medical reasons will from 2016‒2017 be unable to enroll in Californian schools or childcare facilities, leaving home schooling as their only option.
Opposition to the removal of vaccination exemptions on religious or philosophical grounds has been predictable, with various groups attacking the “pro-vaccine mafia”, alleging legislators were bribed by vaccine manufacturers, that truth tellers about vaccine risks have been silenced, and so on.
Unsurprisingly, public health experts have a different take.
“Other states should follow California’s common sense decision to protect the public’s health, understanding that the state’s interest in protecting children is a higher priority than the freedom of some,” argue the authors of a viewpoint article published last week by JAMA.
Although vaccination rates in the state are generally stable (around 92% for measles/mumps/rubella, for example), they are as low as 50% in some suburban areas, the authors write. More than a quarter of Californian schools have vaccination rates among school entrants below the 92%‒94% level recommended for herd immunity.
Australia faces similar challenges, with large variations in vaccination rates around the country.
Rates for full vaccination at age 5 years range from an impressive 99% in Victoria’s Goulburn Valley to just 67% in the Byron Bay area of northern NSW, according to the most recent report from the National Health Performance Authority.
Pockets of low vaccination exist in areas popular with those seeking alternative lifestyles, such as Byron Bay, but also in many wealthy suburbs, including Melbourne’s South Yarra and the eastern suburbs of Sydney.
The federal government is seeking to boost vaccination rates by restricting access to some childcare rebates and family tax benefits for families of children not vaccinated from next year.
Under the proposed changes, “conscientious objection” will no longer be a valid reason for vaccination exemption in families seeking these benefits.
Removing financial benefits is one thing, but should our legislators take the further step of restricting access to education?
It will be interesting to see whether the Californian initiative does actually bring substantial improvements to vaccination rates.
If not, the move risks being seen as simply punitive, and likely to feed the already well developed sense of martyrdom felt by many vaccine opponents.
More importantly, it could drive vulnerable children out of the education system entirely, compounding risks to their future health and wellbeing.
We’ve established that the benefits of immunisation outweigh the risks. Now we need to be sure measures designed to boost vaccination rates pass the same test.
Jane McCredie is a Sydney-based science and medicine writer.
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