A stricter approach to vaccination

Personal belief exemptions for vaccination put at risk those who are unable to participate for medical reasons.

Despite the fact that vaccines continue to save countless lives and come with little or no health risk in themselves, parents in developed nations still choose not to give their children routine childhood vaccinations.

In the UK in late 2014, coverage of the two-dose measles/mumps/rubella (MMR) vaccine among children aged five years was 89.3%, and as low as 80.8% in London, according to Public Health England figures. This coverage falls below the 95% coverage in all areas recommended by the World Health Organization for countries aiming to eliminate measles.

December 2014 saw an outbreak of measles in Disneyland, California, in which more than 100 people have been infected to date. Overall vaccination rates can be high — median coverage of 94.7% across the United States for both MMR doses — but pockets of low vaccination allow the highly contagious measles virus to spread.

Vaccination programmes are highly effective in protecting the individual, but they also perform a wider public service. In communities with high vaccination rates, herd immunity protects the community, including those who cannot be vaccinated for medical reasons, such as those who are immunosuppressed or undergoing cancer therapy.

There are many reasons why some seek to opt out of vaccinating their children. The now-debunked links between the MMR vaccine and autism have left lingering doubts about its safety for many parents.

And there will be parents who understand the benefits of vaccination but decide they want to avoid any risk whatsoever for their own children. In California, for example, parents can sign a ‘personal belief’ waiver to exempt their children from vaccination on religious or philosophical grounds. In the school year 2014–2015, over 13,000 kindergarten-age children had their parents opt them out of vaccination. The overall personal belief exemption rate for California is 2.5%, but this figure exceeds 8% in nine separate counties, one of which has a rate of 22%, according to the California Department of Public Health. 

In Mississippi, where philosophical or religious objection is not accepted as grounds for exemption, vaccination rates are an impressive 99.7%. So governments can make it difficult for parents to opt out, although this is a tricky notion in a free society.

In the UK, parents who do not ensure their children go to school can be fined or criminally charged. Of course truancy is not akin to consent for a medical intervention. But it demonstrates that the state can intervene if it believes the interests of a child are not best served by the actions of his or her parents.

Raising awareness and providing education about vaccine safety are necessary elements, but when public health is at stake governments should consider taking a stricter approach.

Last updated
The Pharmaceutical Journal, PJ, 14 February 2015, Vol 294, No 7849;294(7849):DOI:10.1211/PJ.2015.20067849

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