The Measles Vaccine, the Right to Choose and the Anti-Vaccination Movement
In the United Kingdom, there were a total of 953 lab-confirmed cases of measles last year, compared to 280 cases in 2017. This significant rise is linked with the growing incidence of measles in mainland Europe, which saw 82,596 total cases in 2018, according to the World Health Organization (WHO). It has been found that the virus has been imported to the UK from infected travellers returning from infected European regions (there were 109 imported cases in 2018), with the disease then spreading locally. The incidence rate of measles in Europe in 2018 was nearly three-times that of 2017, which saw 25,863 cases. Recent measles outbreaks have additionally occurred in the USA, despite it having been declared ‘eliminated’ in the US in 2000.
Measles is one of the world’s most infectious diseases, producing cold-like symptoms, a high temperature and greyish-white spots on the inside of the cheeks, which is then followed by a red-brown blotchy rash. The condition is common in unvaccinated children. The likelihood of children with measles developing serious complications, such as pneumonia and encephalitis (inflammation in the brain), is about 1 in 15. Other serious complications include ear infections and diarrhoea. However, in extreme cases, measles can lead to SSPE (subacute sclerosing panencephalitis), a viral infection that leads to the eventual demise of the central nervous system, causing epilepsy, loss of motor control, dementia and eventually death. Serious side-effects are rare. No associations between vaccines and long-term health detriments have been found. The likelihood of having an allergic reaction remains low (between 3.5 - 10 in 1,000,000), and seizures occur in approximately 1 in 1,000 doses.
Given the potentially serious nature of the condition, the figures showing its rate of incidence are startling. One could argue that the figures are relatively low in comparison to the high incidence of other viruses in the UK, such as the Common Cold or Influenza. However, the figures are startling when one considers that two-doses of the MMR (Mumps, Measles and Rubella) vaccine administered in childhood confers life-long immunity to almost all recipients. The vaccinations are readily available in the UK, free of charge, and form a part of the standard inoculation schedule for children (albeit one that is voluntary). After the introduction of the MMR vaccine in the UK in 1988 and the eventual widespread coverage to approximately 90% of the UK population the incidence rate of measles dropped exponentially.
Wide-spread inoculation, recommended to be at or above a threshold of 95% of the population by the WHO, protects the entirety of the population through ‘herd immunity’. That is, if a high proportion of the population are vaccinated against the disease, the transmission rate of the virus is low, meaning fewer non-vaccinated people are likely to catch it. As such, those who are unvaccinated, including young children and those who cannot be immunised on medical grounds (including those who are severely immunosuppressed or young children), will benefit significantly from widespread vaccination, with a reduced likelihood of being exposed to the virus. However, the UK coverage for the uptake of the second MMR vaccine in 2018, which confers life-long immunity, was a worrying 87.2% (year 2017-18), significantly lower than the WHO’s recommended 95% target, necessary to sustain the elimination.
History illustrates the benefits of mass immunisation. Where vaccination levels have dropped, the number of individuals catching the virus have increased. There is no debate over the public health benefits to widespread inoculation. The minimal likelihood of serious side effects and the benefit bestowed on the recipient from the measles vaccine trumps the risks associated with not receiving it. The Jury is in, the verdict has been reached: the benefits of vaccination far out-weigh the consequences.
Attributable as one of the major obstacles to widespread vaccination coverage is the ‘anti-vaccine movement’, that likely fuels vaccine hesitancy. The movement has existed since the introduction of the smallpox vaccination in the 1800’s. Many reasons have been cited in opposition to the vaccine since its introduction, but most notably is the unfounded and baseless link between the MMR vaccine and Autism, propagated by the now-disgraced gastroenterologist, Andrew Wakefield. Wakefield authored a paper published in the British medical journal, The Lancet, which claimed that the link existed. Following its publication, vaccination rates fell significantly. The paper was later retracted by The Lancet, after Wakefield and several of his colleagues were accused of misconduct and falsifying data. The majority of co-authors have now withdrawn their support for the paper and its findings. Numerous follow-up studies have failed to corroborate Wakefields findings (a list of studies to this effect can be found here).
Other reasons for refusal to vaccinate children include safety concerns (as propagated by “anti-vaxxer” content disseminated on social media), for religious and spiritual grounds, and for philosophical reasons. A 2016 meta-study conducted in the US by Phadke and colleagues found that out of 970 cases of measles where detailed vaccination data was available, since the declared elimination of measles in the US in 2000 41.8% had non-medical exemptions (i.e. for philosophical and religious reasons).
It is here where my choice to insert the caveat of ‘somewhat’ before my identifying as libertarian becomes justified. One vehemently advocates of the protection of certain liberties, not least one’s right to speak freely and to think openly, one’s right to religious freedom, a females unrestricted right to elective abortions, and the right to acquire and utilize assistance in terminating one’s own life to relieve unmanageable chronic suffering. However, like all things, this libertarianism only goes so far. One’s libertarian outlook does not incorporate the belief that a parent has the right to raise children however he or she sees fit. The sanctimonious expression “a mother always knows what is best for her child” can be rendered fallacious when one considers that what is defined as the best life more-often-than-not incorporates a life that is healthy and long, and devoid of significant psychological and physical pain. Now, it’s here where my view that vaccinations should be compulsory for all children becomes relevant, because not all parents believe this to be true, despite the overwhelming scientific consensus providing mandate against the contrary. At the very least, not choosing to get your children vaccinated when you can do so without hinderance or cost, while having an awareness of the consequences of your lack of action, is neglect. At the most, it’s tantamount to child abuse. Many parents are knowingly putting their children at risk of contracting a serious, potentially deadly, disease. You’re playing chicken with your child’s prospects of living a healthy and long life, devoid of significant physical pain. You clearly do not know what is best for your child. Philosophical or religious reasoning fails to provide adequate justification for your inept choices. Certainly, roll the dice with your own life, but not with someone else’s.
On the other hand, if one is confused as to whether to get one’s child vaccinated in light of “safety concerns” and holds a general ignorance concerning the consequences of not having one’s child vaccinated, in this instance I will refrain from labelling you as a ‘child-abuser’. However, if one is confused, adequate research and conversations with health professionals should prove sufficient in dispelling the confusion and eliminating the ignorance.
Where the scientific consensus is overwhelming and the consequences are clear I believe the state should be involved in this area of child-rearing. It is justified to override a parent’s choice to not vaccinate their children. The magnitude of the associated risks of non-vaccination are high enough for all parents to be mandated by law to vaccinate their children, except where medical exemptions apply, with penalty afforded to parents choosing to act to the contrary. (One’s belief that all forms of justice should be primarily restorative is not sacrificed here; the penalty should be as small as reasonably possible, but still adequate to act as a deterrent, and justice should be about rehabilitating, or educating, the parent. Improving their scientific literacy would be a start. And measures should be put in place to protect the child.) Religious and philosophical exemptions should be refused. Parents have a duty to act in the best interests of their children, and it is clear that vaccinations are in the best interests of their children. If they fail to act in their best interests, their autonomy should not be respected. Autonomy comes with responsibility. Here, civil liberties have exemptions. If a parent were physically abusing a child, they would be prosecuted, and the child would be removed from their care. Voluntary non-vaccination of your child, where medical exemptions do not apply and with awareness of the consequences of non-vaccination, is a form of physical abuse.
One could frame it as a betrayal of an individual’s right to choose how to bring up their own children, but it’s a complicated issue. It’s a unique situation. The child cannot provide informed consent at the age when the question of vaccination is most pressing. The child’s right to choose is not an option, as they are too young and uninformed. As such, the authority either sits with the parents or the state. It’s on this basis, providing the state’s position is mandated by an overwhelming scientific consensus detailing the huge risks of non-vaccination, which it is, where the parent’s right to raise children how they see fit is trumped by a need to provide legal mandate for the compulsory vaccination of children.
Of course, legislation alone will not suffice to address the cause of the issue. Penalising parent’s will not change their misbeliefs concerning the dangers of vaccines. Surely, fire should be met with fire. Those propagating falsities should be met with fact and reasoned argument. We can only counter lies and untruth with truth.
Efforts to this end are already underway. The Health and Social Care Secretary, Matt Hancock, is pushing for new legislation to force social media companies to remove content publicising false information concerning vaccines. This follows a warning earlier this month from the head of NHS England, Simon Stevens, warning of the traction “vaccine deniers” are attaining on Facebook. However, the picture is complicated. A recent study found that despite rhetoric historically focusing on misplaced ideas regarding the link between vaccinations and autism, misinformation on Facebook extends beyond this one falsity to four other central themes, including mistrust of science and government agencies, a fear of safety risks, a belief in conspiracy theories and support of alternative treatments. As such, efforts to dispel myths and educate people on the necessity of vaccinating children requires the specific addressing of numerous and distinct barriers.
Facebook has already vowed to take action against anti-vaccine content, while GoFundMe has banned anti-vaxxers from raising funds on their site and Amazon has removed anti-vaxxer documentaries from their Prime video service. Furthermore, videos containing anti-vaccination content will be demonetised on YouTube.
However, I find this knee-jerk, heavy-handed response towards censorship and internet-policing unsettling. In light of my opposition to any movement that thwarts our right to speak freely, this is likely unsurprising. However, when one positions that freedom against the freedom of the child to grow up and live a long and healthy life, a liberty threatened by a parent’s refusal to vaccinate a child, it becomes less clear. However, preventing exposure to anti-vaccine content is not the only means of reducing the influence of the anti-vaccine movement. The most effective thing we can do to counter the spread of myths and falsities is to seek to maximise media literacy and scientific literacy, through education. The benefits of doing so extend far beyond reducing vaccine-hesitancy, and are crucial in this post-truth, “alternative facts”, fake-news era. Efforts to this end have never been more warranted. Should temporary censorship of anti-vaccination material be used, perhaps, but it sets a worrying precedent. Yet, I find the recent report by The Guardian that anti-vaccination groups are able to obtain donations through AmazonSmile equally disconcerting. One is not opposed to measures being implemented preventing anti-vaccination films from being recommended to users (notably, there is a clear difference between recommendation and availability), nor the prevention of anti-vaxxers from profiting from the dissemination of their lies, but far superior in increasing vaccination uptake (certainly superior to censorship) is a mandatory vaccination programme, and efforts to improve scientific and media literacy should additionally take precedence.
Useful Websites:
A useful website detailing a list of studies looking at the relationship between vaccines (including the MMR vaccine) and the development of health issues (such as Autism Spectrum Disorder): https://www.healthychildren.org/English/safety-prevention/immunizations/Pages/Vaccine-Studies-Examine-the-Evidence.aspx
A website by NHS England providing information on Measles, including the symptoms and basic information about how it is transmitted and means of preventing transmission (i.e. vaccination): https://www.nhs.uk/conditions/measles/
A page by NHS England detailing the common and rare side effects of the MMR vaccine: https://www.nhs.uk/conditions/vaccinations/mmr-side-effects/