Sunday, May 11, 2008

Vaccination, Parents and Cynicism

I see that vaccination is back in the news, and for all the wrong reasons. To summarise, there was a suggestion made in the Fabian Society magazine that failure to vaccinate one's child could be punished by refusing to allow them to start school, and cutting off child benefits. Cue great outrage, mostly from parents.

(As an aside, I had to shake my head at the following comment from Sir Sandy Macara, ex-chairman of the British Medical Association: "One ought to recognise that mothers have a responsibility for ensuring their children are protected." Mothers? What world is he living in?)

As we now know, the autism scare over the MMR vaccine was completely unsupported by evidence: It is unclear how far Dr. Wakefield's controversial report was merely mistaken, and how far it was downright dishonest. In any case though, I have sympathy with any parent who chose to go for single jabs instead, given the dangerous uncertainty Wakefield caused, and I think the Government should have responded by ensuring that the single jabs were available to all parents with concerns. I also understand that as a result of the government's failures in this area, the difficulties of getting single jabs may have made it implausible for many parents, leading to them not having their children vaccinated at all.

What I do not understand is parents who still insist on refusing vaccinations for their children. The remaining hysteria surrounding the MMR, which seems to have leaked through to the very concept of vaccination itself, seems to be based on nothing more than crude anti-government cynicism: Somehow the overwhelming evidence that MMR is safe is actually some form of cover up. Why would the government perpetrate such a cover up, given that it would inevitably backfire in a major way? I don't know, but I doubt most opponents have thought about this particularly rationally.

Of course, this is not to say that a degree of scepticism is not justified. The effects of thalidomide showed that medical advances can have a dark side missed in clinical trials. For this reason, I say again that I sympathised with refusals to have MMR at the time. But the time has passed, and parents need to look past the cynicism to the best interests of their children.

But how should the government respond to this? Should the suggestion of compulsion be put into effect? To be honest, in a near-perfect world I would support sanctions for parents who refused, although I would balk at taking it out on the children (especially since logically the only ones who would be put in danger by their presence in school would be others who had not had the vaccination). Fines or worse for parents would not necessarily be inappropriate for failing to properly care for one's child.

(There is mention in the article of refusal to vaccinate for 'medical or religious reasons'. It seems wholly inappropriate to lump the two together. Medical reasons essentially mean that it would be worse for the child if they have the vaccine. Religious reasons essentially mean that the parents have values incompatible with the health and well being of their child, which should be treated exactly the same as Jehovah's Witnesses who refuse to allow their children to have blood transfusions.)

But this world is far from perfect. There is a widespread culture of giving parents near-ultimate control over their children (which I will call parential-prerogative), which can be dangerous. Certainly, it is exceptionally beneficial for each child to have one or two people looking out for their well being (as parents overwhelmingly do). But when their actions are in fact provably harmful, there is no reason for their wishes to be respected. Were it just a small minority who took such a parental-prerogative view, I would say that the problem could be solved through punitive measures. However, where there is as widespread support for the paradigm as now, such stark action would be counter-productive. I imagine that were the government to take this line, support for parental-prerogative would grow to embrace even more far-out views like the JWs on blood transfusion, cowing governments into doing less to protect children from bad parenting. On the flipside, it also may unfortunately further embolden the government to use more paternalistic mechanisms for enforcing standards on people against *their own* preferences (which is a very different issue that parents speaking for their children).

As a result, my feeling is that as a pragmatic matter, the government would be wrong to go down this line. It is too much of a leap from its current programme for protecting children, which mostly respects the wishes of parents. Maybe one day such measures would be seen as simple common sense, and that day is to be welcomed, but it is some way off. For now, the government needs to continue to send out the message that MMR is safe and that the medical profession is near-unanimous on this, along with the evidence. If necessary, it should ensure that single jabs are available as an alternative. But it cannot go much further without being counter-productive.

Maybe I am taking the whole thing too seriously. Many commentators on BBC Have Your Say are convinced that it's better to just let children have the diseases (recalling measles parties in past decades), claiming that they are not actually that serious. I am extremely sceptical of this claim, but I will leave it to my more knowledgable readers to respond more adequately.