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June 2019

Should measles vaccination be compulsory?

Measles cases in Europe are at the highest level in a decade, prompting experts to debate whether the UK should adopt compulsory vaccination.

Uptake of the measles, mumps, and rubella (MMR) vaccine in the UK is 94.9% for the first dose, but this drops to 87.4% for the second dose, which falls short of the 95% needed to produce herd immunity.

Writing in The BMJ Dr Eleanor Draeger, sexual health doctor and medical writer says that mandatory vaccination has increased uptake in other countries. ‘We would argue that the UK now needs to legislate to increase vaccination rates, as current measures aren’t keeping rates high enough to ensure herd immunity.’

Many parents wrongly believe the rhetoric that vaccines are harmful, unnatural, and an infringement of civil liberties, she says.

Ethicists have argued that compulsory vaccination is acceptable because people who don’t vaccinate their children are potentially putting other people’s health at risk, particularly those who can’t be vaccinated and are therefore more vulnerable.

‘Passing a law that stops children attending nursery or school unless their vaccinations are up to date or they are medically exempt would allow free choice while protecting vulnerable children,’ she concludes.

But Helen Bedford and David Elliman at UCL Great Ormond Street Institute of Child Health and Great Ormond Street Hospital argue that rather than mandatory vaccination, the UK should concentrate on other methods to increase vaccine uptake, such as improving access to services.

They suggest ensuring that general practices have an immunisation lead and adequate appointment reminders in place, and ensuring staff have adequate time to talk to parents, and have been trained to tackle any issues that arise.

‘Only when these components are in place should we consider mandatory vaccination,’ they say.

Even then, they warn of potential unintended consequences, including loss of trust in healthcare professionals. If school entry were denied, some parents may resort to home-schooling, and if vaccination were attached to welfare benefits it would be the less well off, but determined, parents who would suffer disproportionately, they add.

Draeger E, Bedford HE. BMJ 2019;365:l2359