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Posted on July 26, 2019 at 12:31 AM

This week’s Nature has a worthwhile read, “Mandate
Vaccination with Care.”
    The recent rise in the number of cases of
measles is well-documented in the general press, and there is a strong argument
that it is a social good that sufficient numbers of children be vaccinated for
a range of infectious diseases.  Your correspondent
considers it unfortunate, to put it mildly, that there is a persistent belief
that vaccines for the standard childhood diseases are harmful.  Although some cases of vaccine harm occur,
they are rare—rarer than many in the general public believe—and the cost of
under-vaccination is great.  I, for one,
never want to see an infant with pertussis (whooping cough) again, and, although
I recall having had measles and chicken pox when I was a kid, it’s best to
prevent them.  Some can even be eradicated
(see: smallpox—which we should fervently hope is never purposely re-introduced,
now that we don’t routinely vaccinate for it). 

In brief, the authors in this case argue for promoting
vaccination in the public with such steps as ensuring supply and access, providing
information and allowing public forums, monitoring safety carefully, and
tracking vaccination rates.  They argue,
reasonably, that mandatory vaccination that carries the wrong kind of penalties—such
as, fines or even jail sentences imposed in some countries—for non-compliance
actually can harm poorer, medically underserved people, and as such be
counterproductive and, frankly, unfair. 
They comment that harsh mandates can unnecessarily prompt a backlash,
with increased resistance.

They say, further, that if mandates are deemed
“politically appropriate,” then the procedures should be just, with
constraints on choice as limited as possible; any penalties must be
proportionate; those who do suffer complications should be adequately
compensated.   They speak favorably of creating
administrative hurdles to getting exemptions from mandates.  They also argue against governments mandating
only some vaccines while excluding others. 
They claim that making some vaccines only “recommended” can
limit the uptake of all. 

This last point may be the most questionable of all in this
article.  It is easier to justify
mandating vaccination for highly contagious diseases that can have devastating
effect (e.g. measles, rubella, diptheria, and others), than, for example,
vaccination for human papilloma virus (HPV), infection with which predisposes
to certain kinds of cancer but transmission of which is through sexual
activity.  In this last case, the
argument for a mandate is substantially weaker; vaccination at a fairly young
age might be wise, but one might still reasonably accept, for oneself or one’s
child, the less certain and more remote risks of the consequences of infection,
and therefore reasonably object to mandated vaccination.

Again, a worthwhile read.


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