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Currently childhood vaccinations are not compulsory in the UK. Yet, compared to countries like the united states of America the UKs immunisation rates remain relatively high. However, in recent years concern over the safety of vaccinations has risen and as a result a decrease in vaccinations have been seen. Therefore, the question of making them compulsory rises, as even with the smallest dip in numbers outbreaks can be seen, such as the measles outbreak in Wales, explored later in this essay. Should vaccinations not be made compulsory in order to ensure the safety of children?
Economic value of vaccinations
Vaccinations are also one of the most cost-effective health interventions available. The effects of preventable ill-health accounts for an estimated: 50% of all GP appointments, 64% of outpatient appointments and 70% of all inpatient bed days1. Along with the growing problems within the NHS, such as a lack of funding and an aging population, the undeniably large strain of preventable illness shown by the figures would be solved with the introduction of compulsory vaccinations.
The 2012-2013 measles outbreak in Wales, due a small decrease in vaccination of measles, is another prime example to demonstrate the large consequences of a lack of vaccinations and the economic value of vaccinations. With 1,202 reported cases, 88 hospital admissions, 1 death, over 100 schools and childcare establishments affected and more than £470,000 spent for one health board2, this outbreak demonstrated the undeniable cost effectiveness of vaccinations. Even this seemingly small decrease in immunisation of the MMR vaccination resulted in an outbreak, which not only affected many even killing a sufferer, but it had very large financial effects. With the numbers of vaccinations happening decreasing we may see this event reoccurring perhaps even on a bigger scale. By making the vaccinations compulsory we may evert crisis like these and save lives and money. This example also displays the importance of very high vaccination uptakes in order to prevent infectious disease- another problem which may be solved by making vaccinations compulsory and therefore maintaining high immunisation uptake.
Importance of vaccinations to good health
Copious amounts of research have been carried out to demonstrate the widespread benefits of vaccinations throughout all stages of life. In general vaccinations save between 2 and 3 million lives a year 3. In a few examples one can show the positive protection from diseases each childhood vaccination provides : the flu vaccination which has become available in the winter of 2018 by the NHS will not only prevent bronchitis, pneumonia and a painful ear infection but families and the general population from the flu, in contrast to the only common side effect of a runny nose. The HPV vaccination ensures long term protection against HPV which is the leading cause of cervical cancer and genital warts.
The benefits of vaccinations are often talked about but with a decreasing vaccinating population, the effect of not being immunised is also extremely dangerous for the individual as well as the rest of the population as these diseases are extremely contagious even being listed as one of the top ten threats to global health in 2019 by world health organization4 .
The conflict of rights in compulsory vaccinations
When considering the compulsory vaccination of children, the legal and moral frameworks of the right of the parents autonomy and the rights of the child perhaps come into conflict. On one hand, one must consider beneficence, duty of care and the rule of rescue, which is the imperative [&] to rescue identifiable individuals facing avoidable death 5. But on the other hand, is the parents right to be involved in important decisions concerning their children (BMA Guidance 2003). Therefore, the question which comes into play is which right is of greater precedence when considering vaccinations.
Although parents have autonomy in the decisions of the childrens healthcare this becomes complicated in the realm of vaccinations, where the risk of side effects is of much less chance and fatality than the risk of the disease, not only for the child but also for the global population. Using the example of the MMR vaccination, the rate of anaphylaxis or allergic reactions has been documented to be variable with a rate of 3.5 to 10 per million doses of following a measles-containing vaccine and the risk of thrombocytopenia following MMR vaccination is 1 in 30 000 to 1 in 40 000 vaccinated children. In contrast, if a child develops measles, their risk of developing pneumonia is 1 in 20, encephalitis 1 in 2000 and death 1 in 3000 in the UK6.
Through this example and an understanding that all other vaccinations follow a similar pattern it is clearly in the interest of the child to get the vaccination as the risk of suffering from not having the vaccination is far greater than the chance of having side effects from the vaccine. In conclusion, if an individual child will benefit from a vaccine, then immunisation against parental wishes, and therefore the denial of the parents rights to make choices for their child, may still be ethically justified. Of course, the opposite is still relevant: if the child wont, statistically speaking, benefit from the vaccination than making it compulsory and in some cases against parents wishes, wont be ethically justifiable.
Conclusion
However, such a sensitive issue like the health of children requires careful action. It can of course be said that by making vaccinations compulsory the numbers of immunisations will increase but inevitably there will be a feeling of oppression of rights by the parents. Perhaps a better solution is education, as the minority of parents, which do not choose to vaccinate perhaps are not correctly targeted by making vaccinations compulsory, because often they have rather strong views. Instead by educating the population perhaps in a similar campaign to the dangers of second hand smoke which had great success- this method will give rise to a happier and more well-informed decision between parents and healthcare staff. It can be far too easy to fall into the anxiety of unapproved or researched articles which suggest bold claims of the harm of vaccinations. To take the MMR vaccination as an example, the myths that surround it are very varied but the main two could be said that having three in one vaccination is more dangerous or strains the immune system and the scares of its linkage to autism. As a result, coverage for the Measles Mumps and Rubella vaccine as measured at two years decreased in 2017-18 for the fourth year in a row. Coverage for this vaccine is now at 91.2%, the lowest it has been since 2011-127. Through education of the matter we may experience not only better results but a happier population who are not forced into a decision. A simple explanation that the common cold puts a larger strain on the immune system and antibody production than the vaccination and that a scientifically flawed article wrongly caused worries that the MMR vaccine may be directly linked to autism but also that many scientific articles have now shown this claim to be false and show that no relationship exists.
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