Great Ormond Street Hospital experts fully back the safe and effective MMR vaccine. While strongly supporting its use, they are not persuaded that compelling parents to have their children vaccinated will be either wise or effective.
"Last year in England, there were 1331 confirmed cases of measles, more than had been seen for over 13 years. Already this year, there have been 260 cases in Wales alone. Approximately one in every 1,000 children infected will die. In each year of 2006 and 2008, a teenager died. They were on drugs that suppressed their immune system. This meant they could not be given the MMR vaccine, but if they did catch measles it was more likely to be serious.
This has prompted some people to suggest that rather than relying on encouragement or persuasion of parents, to have their children vaccinated, it should be made compulsory for children to be vaccinated before they start school. Although some countries have policies along these lines, they do not necessarily have higher vaccine uptake rates than countries without any element of compulsion. Most countries with some legal requirement allow exemption on religious and/or philosophical grounds, which means that vaccination uptake will never be 100%. In fact there are often pockets of low uptake, with many susceptible children. In USA, whooping cough, measles and German measles are much commoner in these groups.
There are other limitations too in that some parents delay having their child vaccinated until they are about to start school. This means delaying for some years, leaving many children unnecessarily exposed and at risk. It is not easy to see how this might be policed without jeopardising the relationship between parents and healthcare professionals. Some parents may object on principle and be made martyrs, resulting in even lower rates.
A more attractive option might be to make it compulsory for parents to declare their child’s immunisation status on starting playgroup, nursery or school. If measles occurred in the school, the child could be excluded, both to protect them and to halt the outbreak."
Dr David Elliman (Great Ormond Street Hospital) and Dr Helen Bedford (UCL Institute of Child Health)
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