Old World News: U.K. Moves toward Compulsory Vaccination

Abstract

How far should a democratic society go in forcing its members to be protected against disease?, In recent years in Europe that question has usually been considered in relation to fluoridation of water supplies to prevent dental caries. In the U.K., however, the issue is being raised anew in relation to immunization against infectious diseases. Across Europe the trend has been toward greater voluntariness. Countries such as Germany, where compulsion was the rule a couple of decades ago, now rely on voluntary acceptance. In Norway, it is still compulsory for children to have bacille Calmette-Gubin (BCG) immunization against tuberculosis, but a new law mill make it voluntary. Elsewhere in Scandinavia immunization is voluntary, although considerable efforts may be made to encourage parents to have their children immunized. After the introduction in 1982 of measles, mumps, and rubella (MMR) vaccination in Finland, 86 percent of children were vaccinated. Public health efforts increased coverage to 97 percent, so that by 1991 indigenous infections had been eliminated. Voluntariness indeed seems to have advantages; several European countries with voluntary systems report greater than 90 percent coverage for both MMR and diphtheria, pertussis, and tetanus (DPT) vaccines. In the U.S., on the other hand, mandatory vaccination led to coverage in 1992 for each combination of just 83 percent. Public health authorities in the U.K, however, seem determined to move toward compulsion. The first step was to offer family practitioners (GPs) financial incentives to achieve high coverage for childhood immunizations. If they immunize more than 90 percent of the children on their list who become eligible each year, they receive a bonus of over $4,000 as well as a fee for each immunization. On average each GP has only thirty children become eligible each year. So refusal of vaccination by just three or four families carries considerable financial implications, resulting not only in coercion at the local level, but also in families being told to find a different GP. The second coercive step caused great alarm outside the surprisingly closed world of public health. In November 1994 a mass vaccination campaign was held to immunize all children between the ages of five and sixteen against measles and rubella. Senior government doctors had wanted for several years to run a measles vaccination campaign. In july 1994 they suddenly announced that a large measles epidemic would occur in 1995, killing up to fifty children, unless they had a campaign. The prediction was based on a mathematical model, some details of which did not appear until December 1995, and which turns out not to have been validated using statistically reliable data. …