Should the UK make childhood vaccinations mandatory? - New Scientist

By Adam Vaughan

The measles virus produces an unplesant rash

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The UK is “very seriously” looking at making vaccinations compulsory for schoolchildren in response to falling vaccination rates — that’s what health secretary Matt Hancock told the Conservative party conference yesterday. “When the state provides a service to people then it’s a two-way street. You have to take your responsibilities too,” he said.

His comments follow figures that emerged last week showing all routine vaccinations for under-fives fell last year, a decline which UK chief medical officer Sally Davies said was troubling. Embarrassingly, this year the UK lost its official “measles-free” status, after 231 cases were confirmed between January to March 2019.

Hancock’s office did not respond to questions about what the means would be used to compel people to vaccinate their children. But there are several possible options. Some countries make vaccination a condition for children going to school. Australia uses the “no jab no pay” threat of withholding benefits.

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But is mandating vaccinations the answer? If the UK did pursue this strategy, it would be a return to the past. In the 19th century, the government did make vaccination compulsory, only later switching to a voluntary approach when the smallpox epidemic subsided and immunisation levels went up.

For a long time, the UK’s approach of recommendation worked, with overall routine vaccination rates holding steady at around 98 per cent. But in the case of the Measles, Mumps and Rubella (MMR) vaccine, coverage for the first dose in two year-old children has fallen for five years in a row and now stands at 90.3 per cent. The World Health Organization (WHO) has a target of 95 per cent coverage.

However, the WHO makes no recommendation either for or against mandating vaccinations — it is up to countries to decide the best way of ensuring high vaccination rates, it says.

Looking to other countries does not give an obvious answer to whether mandating vaccination works. Belgium, France and Italy are among the countries that do. But a 2018 review by the Sabin Vaccine Institute, a non-profit based in Washington, DC, found that examining Europe’s different legislative approaches did not point to any one best approach.

Some researchers say the UK has reached the point where mandating is necessary because measles protection has got so poor. Stefano Merler at the Bruno Kessler Foundation in Trento, Italy, says the step is needed — otherwise the overall proportion of the UK population at risk of measles infection will rise from 3.7 per cent in 2018 to 5.5 per cent by 2050. His paper found “positive effects” where countries had introduced compulsory vaccination policies.

Others think it’s not such a good idea, regardless of the stick used to compel people to vaccinate. “I do think it is premature and wrong,” says David Elliman at Great Ormond Street Hospital in London. He would like to see more work put into other efforts first, noting it is only a “very small minority” of parents who object to vaccination. Those efforts include offering appointments at convenient times for families, and ensuring practice nurses have enough time to answer parents’ questions.

Unwelcome consequences

Sonia Saxena at Imperial College London says there is “not really great evidence” for mandating vaccinations. And Helen Bedford at University College London says compulsion can have unwelcome consequences, such as excluding children from school. “Children whose parents refuse vaccination could be deprived of a proper education as such parents are unlikely to change their minds because vaccination is required.” Mandating would also have a cost to implement and enforce.

In short, it’s not clear cut that compulsion is the right way to remedy falling vaccination rates. Moreover, existing efforts may yet bear fruit and render the idea unnecesary. It was the 2018-19 figures on falling vaccination that made waves, but subsequent, more recent statistics for April to June this year show vaccine coverage for under-fives either stable or increasing slightly.

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