Immunisation in Education

Success

What would happen to the road-toll if drink-driving became an individual choice? Vaccines are the greatest success of modern science, yet, they’re still an individual choice in New Zealand. They’re safe, effective and necessary for a healthy population. Vaccines eradicated smallpox (Koplow, 2003) and controlled polio, tetanus, measles, varicella, HPV and pertussis. Unimmunised children are a health risk to the entire community (Omer, Salmon, Orenstein, Dehart, & Halsey, 2009). Schools are environments where infectious diseases spread quickly, so a high coverage is needed to keep a population safe, known as herd immunity (Ministry of Health, 2017a; Fine, 1993). When the coverage drops, infectious diseases spread quickly and lead to outbreaks (Hayman, Marshall, French, & Carpenter, 2017). Unimmunised children should not be allowed to attend schools in New Zealand.

Freedom of Choice

The issue with mandating anything is that the government is then taking away the right to choose. Freedom of choice is important in a society. But, when that choice impacts someone else, a change is needed. Drink-driving is illegal, for good reason. Amy Tuteur (2017) accurately likens drink-driving to vaccine refusal. If an irresponsible parent refuses to vaccinate their child, they are potentially endangering everyone that child comes into contact with.

In New Zealand, the Ministry of Health proposed a policy in 2012 that would prevent families receiving welfare payments if their children were not fully immunised. This was rejected in 2015, as it was seen to impeach the Bill of Rights Act, 1990 (Ministry of Health, personal communication. 28th July 2017). Article 11 states that “Everyone has the right to refuse to undergo medical treatment” (Parliamentary Council Office, 2013). Yet, the United Nations Convention on the Rights of the Child states that a child has the right to preventive health care (United Nations, 2017). Maybe it’s time for people to stop treating their children like property and realise they have rights of their own. The choice would still lie with the parents, except the choice would then be whether the child attends school or not.

In places where vaccination is a requirement rather than a choice, the coverage increases, outbreaks are far less likely to occur, and eradication gets closer. Places such as some parts of the US (Omer et al., 2009), Australia (Australian Department of Health, 2016), and Italy (Signorelli, Guerra, Siliquini, & Ricciardi, 2017). Australia’s total coverage in 2016 was 93.55% (Australian Department of Health, 2016), while New Zealand’s is only 88% in 2017 (Ministry of Health, 2017b).

Science Blogs writer, Orac (2017), recently wrote about California, where Personal Belief Exemptions have been outlawed. A child can no longer be exempt from vaccination on personal or religious belief alone. They require real medical reasons. When this law was first passed, the coverage increased from 92.8% to 95.6%, a very safe number.

Vaccines work

But, if vaccines work, why is my unvaccinated child a danger to your vaccinated child?  This is a question asked by people who fail to understand how vaccines work.

Firstly, not everyone can be vaccinated, such as immunocompromised people, with HIV, chemotherapy patients, pregnant women (for some vaccines) or young infants (Ministry of Health, 2017a). Some people may also be allergic to certain ingredients in the vaccine itself. This presents a problem.

This is when herd-immunity (Hayman et al., 2017; Fine, 1993) comes in. If enough of the population is protected by immunisation, then the diseases are less likely to spread. In NZ, for Measles, this is said to be 90% of all children by 5 years of age. In December 2016, the rate of full immunisation of 5-year-olds was 88.9%. Close, but not enough. Lower rates in previous years have led to outbreaks and closures of schools (Ministry of Health, 2017a).

Secondly, unfortunately, nothing is perfect. If a child is immunised with the first dose of the MMR vaccine, the efficacy is 85-100%. In 5-10% of recipients, the first dose can result in a “primary vaccine failure”, due to the body’s lack of immune response. The second dose of MMR is to protect this 5-10%, and no failure has been reported with the second dose (Ministry of Health, 2017a). So, even in vaccinated individuals, the risk of infection is still real.

Conspiracy and denial

What about the side-effects? Don’t vaccines cause autism? Vaccines do not cause autism (Taylor, Swerdfeger, & Eslick, 2014). This claim was made in a retracted, fraudulent study from ex-physician Andrew J. Wakefield, in 1998. The autism link, along with conspiracy theories, (flat-earth, doctors are bad, faked moon-landing), endures through social media and the delusion of a belief system in science (Arthur, 2016; Larru, Offit, 2014).

Commercial websites flout non-scientific statements, claim conspiracy and make accusations that the pharmaceutical companies and doctors don’t care about our health, they’re just in it to make money. These sites also sell unproven, natural alternatives to vaccines, like homeopathy, which cost a lot of money and don’t work (Arthur, 2017). The homeopathic industry is “expected to be worth US$17,486.2 Million by 2024” (PR Newswire Europe, 2017).

Some think newer vaccines are not to be trusted, such as the HPV vaccine. Human Papillomavirus (HPV) has been linked to cancers of the cervix (the most preventable), penis, vulva, vagina and throat (de Martel, Plummer, Vignat, & Franceschi, 2017). HPV is sexually transmitted. It’s highly infectious. This needs to be a mandatory vaccine.

Dunning and Kruger (1999) observed in tests, that the under-skilled overestimate their ability and the skilled overestimate the ability of the under-skilled, known as the Dunning-Kruger effect. This effect explains how celebrities (ex-Playboy model Jenny McCarthy, & Jim Carrey, the comedian) and individuals with no medical training to give advice on vaccines (Arthur, 2016), and the public taking it as truth. Desperate parents, seeking answers, have taken to blaming vaccines for their child’s problems, even Shaken Baby Syndrome (Buttram, & England, 2011). The autism link lives on, despite the studies showing no link (Taylor et al., 2014).

Some who receive vaccinations can experience adverse reactions, such as fever, rash, or in the case of allergies, anaphylaxis. However, these are extremely rare and can easily be dealt with. Some reactions are correlated to the vaccine. These include the presentation of autism, asthma, eczema and others. Although autism symptoms can be associated with the timing of the MMR vaccine, it is unrelated (Taylor et al. 2014). While adverse reactions to vaccines are rare, adverse reactions to the diseases are far more likely and serious. Nobody wants their child to die of a preventable disease.

Closure

Vaccines eradicated smallpox and contained tetanus, polio, measles, varicella, HPV and pertussis. Unimmunised children are a risk to everyone around them, especially the immunocompromised. They have been proven safe, effective and necessary. The coverage rate needs to be kept high in order to protect our population from infectious, preventable diseases. The choice needs to be made for all of us. No more opting out on non-medical grounds. Correlation is not causation. Anecdotes on Facebook are not evidence. Making vaccines a compulsory part of education in New Zealand is the next logical step.  

References

Arthur, D. C. (2016). Negative Portrayal of Vaccines by Commercial Websites: Tortious Misrepresentation. University of Massachusetts Law Review, 11 (2), 122-192. Retrieved from http://scholarship.law.umassd.edu/cgi/viewcontent.cgi?article=1111&context=umlr

Australian Department of Health, (2016). AIR - current data. Retrieved from http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/acir-curr-data.htm

Buttram, H., & England, C. (2011). Shaken Baby Syndrome Or Vaccine Induced Encephalitis-Are Parents Being Falsely Accused?  USA: AuthorHouse.

de Martel C., Plummer M., Vignat J., & Franceschi S. (2017). Worldwide burden of cancer attributable to HPV by site, country and HPV type. International Journal of Cancer, 141(4), 664-670. https://doi.org/10.1002/ijc.30716

Fine, P. E. (1993). Herd immunity: history, theory, practice. Epidemiologic reviews, 15(2), 265-302.

Hayman, D.T.S., Marshall, J.C., French, N.P., & Carpenter, T.E. (2017). Global importation and population risk factors for measles in New Zealand: a case study for highly immunized populations. Epidemiology and Infection (145) 1875-1885. https://doi.org/10.1017/S0950268817000723.

Koplow, D. A. (2003). Smallpox: the fight to eradicate a global scourge. Univ of California Press.

Kruger, J., & Dunning, D. (1999). Unskilled and unaware of it: how difficulties in recognizing one's own incompetence lead to inflated self-assessments. Journal of personality and social psychology, 77(6), 1121-1134.

Larru, B., & Offit, P. (2014). Communicating vaccine science to the public. Journal of Infection, 69, S2-S4. https://doi.org/10.1016/j.jinf.2014.07.009

Ministry of Health. (2017a). Immunisation Handbook 2017. Wellington, New Zealand: Ministry of Health.

Ministry of Health, (2017b). National and DHB immunisation data. Retrieved from http://www.health.govt.nz/our-work/preventative-health-wellness/immunisation/immunisation-coverage/national-and-dhb-immunisation-data

Omer, S. B., Salmon, D. A., Orenstein, W. A., Dehart, M. P., & Halsey, N. (2009). Vaccine refusal, mandatory immunization, and the risks of vaccine-preventable diseases. New England Journal of Medicine, 360(19), 1981-1988. https://doi.org/10.1056/NEJMsa0806477

Orac, (2017). Medical exemptions to school vaccine mandates soar in California as SB 277 makes personal belief exemptions unavailable. Retrieved from http://scienceblogs.com/insolence/2017/08/18/medical-exemptions-soar-in-california-as-sb-277-makes-personal-belief-exemptions-unavailable/

Parliamentary Council Office, (2013). New Zealand Bill of Rights Act 1990. Retrieved from http://www.legislation.govt.nz/act/public/1990/0109/latest/DLM224792.html

PR Newswire Europe, (2017). Homeopathy Product Market is Expected to Reach US$17,486.2 Million by 2024; the Market is on a Favorable Growth Curve in Europe and North America. Retrieved from http://www.marketwatch.com/story/homeopathy-product-market-is-expected-to-reach-us174862-million-by-2024-the-market-is-on-a-favorable-growth-curve-in-europe-and-north-america-2017-01-11-62033139

Signorelli, C., Guerra, R., Siliquini, R., & Ricciardi, W. (2017). Italy's response to vaccine hesitancy: An innovative and cost effective National Immunization Plan based on scientific evidence. Vaccine, 35(33), 4057-4059. https://doi.org/10.1016/j.vaccine.2017.06.011

Taylor, L.E., Swerdfeger, A.L., & Eslick, G.D. (2014). Vaccines are not associated with autism: An evidence-based meta-analysis of case-control and cohort studies. Vaccine, 32, 3623-3629.        https://doi.org/10.1016/j.vaccine.2014.04.085

Tuteur, A., (2017) Vaccine refusal is the equivalent of drunk driving. Retrieved from http://www.skepticalob.com/2017/02/vaccine-refusal-is-the-equivalent-of-drunk-driving.html

United Nations, (2017) Conventions on the rights of the child. Retrieved from http://www.ohchr.org/EN/ProfessionalInterest/Pages/CRC.aspx