(Written 28^th May, 2018, Aral Bereux. Published 2020.)

Mandatory childhood immunisation continually sparks debate in both developing and developed nations. In Australia, the active mandatory childhood immunisation campaign relies heavily on promoting the individual’s responsibility to society by adopting phrases like ‘herd immunity,’ to push for high rates of immunisation.[1] However, often the debate is one sided, and those considered ‘anti-vax’ are portrayed as conspiracy-minded, uneducated or uninformed. As a result, the discussion often aligns one-sided in support of new health legislation to promote a utilitarian approach rather than encourage healthy debate from both sides.[2] Although the importance of herd immunity should not be detracted from, the question of whether childhood immunisation places undue risk on children with a genetic predisposition to complications because of intervention, cannot be ignored. Equally important are the ethical issues surrounding government-mandated immunisation on the citizen choosing to opt out; the philosophical debate of the needs of the one versus the needs of many; and the scientific evidence backing up both sides of the argument. As global concerns mount with the emergence of new measles cases, whooping cough and other diseases,[3] the mandatory childhood immunisation agenda debate continues to prompt a conflicted discourse that shows no signs of fading, with the role of government in the centre of the argument and the fundamental rights of the individual’s decision making in the background.

Within the mandatory childhood immunisation debate, there are two dominant streams of thought. The first considers the government’s right to intervene medically because to not vaccinate risks harm to society.[4] The other is the citizen’s right to refuse this intervention by exercising free will and maintaining autonomy. Several Western and European governments across the world have adopted mandatory childhood immunisation programs via the education system, directing parents to ensure children are fully immunised prior to attending school. In Australia, as with other nations, the goal is herd or ‘population immunity,’ where most people are vaccinated to create a safety net for unvaccinated people. Although most nations are reluctant to enforce the no jab no education policy, the Australian Federal Government has attempted to ‘compel’ parents after studies revealed in 1997 that “forty-seven percent of Australian children are not immunised” – a rate lower than some third world countries.[5] This came at a time when Australia witnessed an increase in measles and whooping cough, and 42 related deaths over 10 years.[6]  Statistics available suggest a direct correlation between childhood immunisation and disease outbreak, a situation, says libertarian science correspondent Ronald Bailey, that is akin to “child neglect.”[7] According to Bailey, a parent has a duty to fulfil childhood immunisation requirements as a moral and ethical responsibility to society, to prevent further harm to “friends, neighbours, and fellow citizens.”[8] Furthermore, Bailey adds that the state has a responsibility to compel parents into action, in turn, safe-guarding herd immunity and reducing harm and death rates.[9] For Bailey, refusing to participate in mandatory childhood immunisation equates to deliberately harming another in an act of narcissism, and states the government has an ethical obligation to enact mandatory immunisation to “prevent harm to others.”[10] 

The argument for establishing mandatory childhood immunisation programs is supported with numerous studies citing the dwindling numbers of up-to-date childhood vaccination schedules with increasing cases of preventable diseases recorded.[11] However, the Australian government, like its counterparts in Canada and the United States, are frequently accused of omitting pertinent statistics on the risks associated with childhood immunisation.[12]  Whooping cough, also known as pertussis, has long been touted by the Australian government as an immunisation success story. Widely claimed to be a preventable disease, ACNEM Journal published an article examining the historical account of pertussis and the negligible effects of mandatory childhood immunisation on similar diseases. The article discusses minimal correlation between mandatory immunisation programs and a decrease in pertussis cases after a sharp decline of pertussis was discovered to have occurred prior to immunisation programs. This suggests the real cause is largely attributable to the improvement of sanitary and nutritional conditions, and the arrival of antibiotics – not immunisation.[13] The conclusion is based in historical scientific data and current trends from the 1950s onward, where herd immunity is considered a short-term benefit of 2 to 3 years after immunisation,[14] comparable to a life time of natural immunity achieved from contracting a disease through natural infection.[15] And although the Australian government promotes the lower incidence of contracting pertussis with mandatory immunisation, data reveals cases of people immunised as still contracting the disease. This was witnessed after an outbreak in the United States. There, of a large group of people contracting pertussis, 74 percent were fully vaccinated against the disease. This event remained unexplained in the context of herd immunity.[16]  

Mandatory immunisation is considered unethical when there is little evidence suggesting an obvious benefit to the population.  According to Dr Jeffrey Singer, an advocate of immunisation, immunity is not always guaranteed when vaccinated. He concludes from this a government that coerces the population into mandatory immunisation on the assumption that everyone vaccinated falls into herd immunity, imposes on the citizen’s autonomy unnecessarily and creates needless contention with immunisation programs.[17] Singer likened the situation to a scene out of the movie Minority Report, where a certain level of precognition is required to ascertain if a person is guilty of a crime before it is committed, as he disputes Bailey’s reasoning for mandatory childhood immunisation. According to Bailey, those not vaccinated are guilty of harm – even death – against society.

          However, without the necessary statistics to support the correlation between mandatory immunisation and declining rates in disease, which ACNEM’s article claims is lacking, the justification for governments to implement mandatory childhood immunisation appears more to benefit the pharmaceutical companies than it does society. Dr Sandy Reider argues the increase in the number of vaccinations represents this possibility, citing tetanus and hepatitis B vaccines now required for school entrance as evidence. According to Reider, the “junk science” which calls into question the necessity to immunise against non-communicable diseases is a “two-way street.”[18] Relative to the debate, Reider questions how far mandatory childhood immunisation should go, when historical data suggests a decline in the mortality rates occurred with diphtheria by 60 percent, and pertussis and measles by 98 percent prior to the introduction of mandatory immunisation.[19]

The historical statistics might not adequately represent the science of the situation, however. According to Dr Ian Gemmill, outbreaks of influenza and meningococcal, over the last thirty years, were effectively combated by immunisation programs.[20] Mandatory immunisation policies are appropriate in certain environments, such as schools and hospitals, but admits that not all vaccines fall into this category. Gemmill advocates for the right to exemption from mandatory immunisation on medical grounds but holds issue with those of a philosophical nature, suggesting more needs to be done to counter the “untruths” surrounding the debate regarding adverse reactions and infant mortality.[21] However, according to Edda West of the Vaccination Risk Awareness Network, “invasive medical procedures of any kind that carry a risk of injury and death must always be left to the discretion of the patient, or the patient’s parents in terms of a minor.” [22] This is irrespective of exemptions, with West objecting that health care providers often fail to inform parents of the risks immunisation carries and the exemptions available to them.

Mandatory childhood immunisation remains a contentious issue among not only the medical community but politicians. Individuals and groups argue over the importance of mandatory childhood immunisation not only because of the high health stakes involved, but because of conflicting evidence from either side of the debate to suggest the effectiveness of mandatory vaccination policy. Ethical consequences also remain at the forefront of the discussion, struggling to strike a balance between a citizen’s right to autonomy and a  government policy to eradicate diseases through mandatory immunisation, either with or without religious or philosophical exemptions put into place. What is known for certain is the diseases vaccinated against in mandatory childhood immunisation programs still exist, and that an agreeable solution is yet to be discovered.

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Bibliography

Anonymous. “Should Vaccines Be Mandatory?” Reason 45, no. 11 (2014): 18-26. 

Brough Jodie. “Children Without Jabs May Be Refused School,” Sydney Morning Herald,

  January 30, 1997.

Chow Maria, “Parental Attitudes, Beliefs, Behaviours and Concerns Towards Childhood

Vaccinations in Australia: A National Online Survey.” Australian Family Physician

 46, no. 3 (2017): 145-151.

Walkinshaw Erin. “Mandatory Vaccinations: No Middle Ground.” Canadian Medical

 Association Journal 183, no. 16 (2011): 1830-1.

Wilyman Judy. “Coercive and Mandatory Immunisation.” ACNEM Journal 27, no. 2 (2008):

 6-9.

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[1] Anonymous, “Should Vaccines Be Mandatory?,” in Reason 45, no. 11 (April 2014): 3.

[2] Ibid, 4.

[3] Ibid, 1.

[4] Erin Walkinshaw, “Mandatory Vaccinations: No Middle Ground,” in Canadian Medical Association Journal 183, no. 16 (November 2011): 1830-1.

[5] Jodie Brough, “Children Without Jabs May Be Refused School,” Sydney Morning Herald, January 30, 1997, pg 1.

[6] Ibid.

[7] Anonymous, Should Vaccines Be Mandatory?, 2.

[8] Ibid.

[9] Ibid.

[10] Anonymous, Should Vaccines Be Mandatory?, 4.

[11] Maria Chow et. al, “Parental Attitudes, Beliefs, Behaviours and Concerns Towards Childhood Vaccinations in Australia: A National Online Survey,” in Australian Family Physician 46, no. 3 (March 2017): 1.

[12] Judy Wilyman, “Coercive and Mandatory Immunisation,” in ACNEM Journal 27, no. 2 (October 2008).

[13] Ibid, 7.

[14] Ibid, 8.

[15] Ibid, 7.

[16] Anonymous, Should Vaccines Be Mandatory?, 8.

[17] Ibid, 6.

[18] Anonymous, Should Vaccines Be Mandatory?, 8.

[19] Ibid, 7.

[20] Walkinshaw, Mandatory Vaccinations: No Middle Ground, 1.

[21] Ibid, 2.

[22] Ibid.