In most jurisdictions, the answer to your first question is "yes." There are several case law on the subject of compulsory vaccination. There are several legal doctrines or justifications that are operational to support the answer. The interplay of police power of the state, parens patriae principle and duty to protect third parties (minors) are recognized bases. A specific law on compulsory vaccination is "mala prohibitum" in nature - good faith is not a defense or intent is immaterial. Parents, as surrogate decision maker or person exercising parental authority, can sometimes invoke the "conscientious objector" right.

However, negligence is an altogether different matter. Negligence is not synonymous with violation of a "mala prohibitum" statute.

In America, the answer to both of these questions at common law is probably "no." Liability for negligence requires the existence of a duty - here, in either the teacher or the mother. I'm not aware of any legal authority imposing a duty on a parent to vaccinate their child - or on a teacher (as opposed, perhaps, to a school system) to exclude non-vaccinated children. The teacher may have a duty to exclude children who are actually ill with a disease like measles. The other problem is proving causation: that the failure to vaccinate caused other children to get sick or the non-vaccinating parent's child to suffer the sequelae - this is a tough one because the failure to vaccinate is remote in time from its consequences. There are statutes that govern vaccination, but they don't usually provide civil penalties or private rights of action.

I think it's up to the vaccine... If it is for measles for instance, they are to be compelled for obvious reason. But if it is a flu, swineflu, HPV, or the other vaccines which are scientifically contraversial, then there would be no justifiable ground to claim that parents are morally obliged to get vaccinated their children (On the contrary, one may argue that they need to be appreciated as they are conscious enough to be able to perceive the smell of corporate-science, even in all dust of media bombardment).

In accordance with article 1877 of the Portuguese Civil Code, the children are subject to parenalthtal responsibilities till their full age (18 years) or emancipation (starting from 16 years). Article 1878 determines the duties of the parents, in the interest of their children , watch over their safety and health.

So without doubt the parents can be obliged to vaccinate their children. Besides, neglicence and failure in delivering adaquate care to the children underage can lead to adequate judicial measures, which may include handing over the unprotected child to other relatives and in extreme cases to social institutions.

In Jordan, I think that there is no special law required parents to vaccinate children for the prevention of infectious diseases, but obligations parents to care for their children to force them to do vaccinate their children, but the question whether Declined parents to do vaccinate their children Is there a legal text punish them for this action?I believe that there is a lack of legislation to treatment this situation in spite of the negative health effectsThat affect society in general in the future and the spread of disease and the financial costs borne by the state to address these diseases.

In my oponion vaccination is just one aspect of an overall duty of the parents to take care of their children, who are in their direct dependance. The family obligations is a conquest of humanity, whatever be the society we live in. I've already given a bird's eye view of the Portuguese legislation on the matter. Parents have obligations towards their offsprings as long as they depend on them, and the children are obliged to respect the parents as long as they live in family community (article 1878º.2 of the Civil Code). With due respect there's no need to be a especial legal obligation for the parents to vaccinate the son/daughter in school, as there's no need for a special legal disposition for a father/mother to pay attention on the road to avoid an accident. The duty to care in the cases we're dealing, is a civilized conquest.

Hi Rodel. It is interesting in your view that non-vaccination (should mandatory vaccination be imposed by a state) be considered "mala prohibitum". I would have thought that society would regard non-vaccination as "naturally evil as adjudged by the sense of a civilized community." i.e. malum in se.

State v. Horton, 139 N.C. 588, 51 S.E. 945, 946 (1905).

I can only assume that the decimation of an infant school during a measles epidemic is a memory lost for several generations to most advanced economies but nonetheless remains a recurrent experience where vaccination is unavailable (e.g. Myanmar). The consequence of losing that collective memory is that we are apt to indulge “individual’s autonomy” over a (possibly greater) responsibility to our community as a whole, leaving it up to individuals’ consciences whether to vaccinate or not. This is the difference between saying an individual’s autonomy is the peak of our civilized western pyramid as opposed to there being no peak but rater a plateau (representing the community as a whole) that is manifest in less well developed economic communities regularly exposed to “pestilence”. Viewed in this context I believe that vaccination would not be seen as an ethically free regulation i.e. "mala prohibitum".

Hi Murat. Thanks for your reply. I am glad you mentioned corporate-science as a possible confounder for conscientious parents attempting to make a rational decision regarding vaccination. Corporate-science may have less sway in the UK than elsewhere as all vaccines are free. One company however, advocating individual vaccination rather than aggregated vaccine, has been required by the Advertising Standards Agency to remove statements regarding MMR vaccine and autism from their website. Needless to say individual vaccination is not available from our NHS but can be bought. It is clearly an advantage to plant seeds of doubt in parents’ minds in the interest of profits.

I was also interested in you grouping HPV vaccine in the “doubtful efficacy” category. It has been claimed by some experts that HPV kills 10 times more people in the UK each year than HIV (but I am no expert but will furnish references if you are interested).

Hi Mohanad. Has anyone ever been threatened with prosecution for not vaccinating his or her children in your country? Is there a difference in your view between conscientious objection and lethargy generated by Googling too much? In the UK it is sufficient for only one parent to wish for and consent to vaccination. In my experience this does not take into account the anger of the thwarted partner! A mandate to vaccinate would eliminate this potential destruction of an otherwise sound relationship.

Hi Dena. Thank you for your reply; I appreciate you taking the time to answer. I understand that there are no penalties for not vaccinating a child; it would be unconscionable to prosecute a parent of a damaged child (although it has happened with foetal alcohol syndrome and crack cocaine I believe). However what is the consequence of exclusion from “public school, primary, secondary or university”? What are the alternatives available? How do these organisations know that vaccination has not occurred? Is this an indirect financial punishment?

Hi António. I am grateful for your detailed reply to my question.

In England and Wales, as I am sure you are aware, we have similar obligations to take care of children that are our responsibility. The same applies under Scottish law, but there the age of emancipation is lower. However, as the damage that may ensue from a parent failing to adequately prepare a child for the inevitable exposure to viral infections and their possible long-term consequences occurs many years before the child’s autonomy permits them to make their own decision, are the existing protections afforded children against their parents actions adequate for these specific circumstances?

In this respect the circumstances are unlike Gillick and contraception where a child’s interest in sex and their autonomy develop along a similar timeline. (Gillick competence is a term originating in England and is used in medical law to decide whether a child (16 years or younger) is able to consent to his or her own medical treatment, without the need for parental permission or knowledge).

Hi Rodel, do you have references (if possible) for your comment: "There are several case law on the subject of compulsory vaccination". I would be most grateful as I am interested in the judicial reasoning associated with such cases.

The case of Boone v. Boozman 217 F.Supp.2d 938 (2002) is a good one. Perhaps you can retrace relevant jurisprudence about your querry. My country (Philippines) does not adopt "common law", although Supreme Court decisions "form part of the law of the land." We have statutes thru legislative enactments (Lower house and the senate). This will explain why we have special laws were the concept of "mala prohibitum" is operative. By the way, our judicial system was patterned from the American 3 tiered court levels and american jurisprudence is persuasive in our courts. This is not suprising because the Philippines was once under americal colonial rule. You can look for our Mandatory Immunization law in the Internet - R.A. 10152 and its predecesor P.D. 996. Hope that can be of help.

Thank yo for your comments Clifford, it is kind of you to reply. The point of my question however was not to enter into a debate as to the pros and cons of vaccination but to ask if anybody could think of good (impartial) reasons in support of an argument in either direction. Your answer was engaging until the following statement: "It has also been tried before and failed - with smallpox vaccination. The vaccine killed around as many as smallpox did, so seeing children die from the vaccine parents refused and faced fines and imprisonment. The measure had to be withdrawn." I am unaware of the details of this reference and would be obliged as it may make a useful example of excessive zeal. Unfortunately I then took the opportunity to research your background. The following occurs quite high up a google search. Is this you by any chance? http://wellknowntrolls.wordpress.com/2010/06/25/clifford-g-miller/

If it is this is the sort of chaff I was hoping the forum would avoid.

Again thanks for your comments and fulsome reply Clifford. The references to the various Acts paternalistically attempting to enforce treatment are very useful. I will explore them shortly but I doubt anyone has to fear them or that they could be revitalised, especially against "common childhood illnesses" which are of course not so common now. Thanks to what, one must ask?

Another question. Do you believe that the absence of a communal memory regarding the consequences of unvaccinated exposure to, for example, measles has a powerful influence on some people's views on whether to take advantage of available vaccination programs or not? When measles, for example, was endemic in our community even I as a child remember "measles parties", sharing eating implements and beds with my spotty siblings etc. The intention I recall was to ensure infection as young as possible knowing that our relative good health and nourishment would enable us to prevail. On the other hand, like my father before me, working as a doctor in Africa and Myanmar we know that measles is not treated by parents with such disdain. Diagnosing subacute sclerosing pan encephalitis in two infants on the same day (an incredibly rare condition) does focus ones mind. Similarly the commonest cause of all admissions to paediatric intensive care units in some economically disadvantaged countries is measles pneumonia. The parents and children i encounter in Myanmar (vaccine not commonly available) do not regard measles as innocuous. Perhaps they would if they were better nourished and not burdened with so many other pathogens?

The whole topic has a surreal aspect to it. My impression is that people are either firmly entrenched in the pro camp or the no camp with very little movement between the two. Part of the reason must be because some of the more vociferous campaigners seem unable to distinguish between expert opinion emanating from professionals who ultimately risk losing their lively hood if they make misstatements, and commentators whose job it is to ask uncomfortable questions of authoritative figures but do not risk anything as a consequence nor take responsibility for those that may have been deliberately misled. Our failing as a community responsible for education is that we have not given everyone sufficient discriminatory powers to understand this difference. Some people who have been given the opportunity to acquire that necessary and contemporary skill chose to reject it. I do believe in a Darwinian selection process and would not force my views (whatever they are) on anyone. You are entirely correct "The University of Google is I suggest one you should not rely on too heavily for your citations"

Again thanks for your comments and fulsome reply Clifford. I am glad the gentleman named in that article is not you. There are some people it is just not worth having a discussion with.

The references to the various Acts paternalistically attempting to enforce treatment are very useful so thanks for those. I will explore them shortly but I doubt anyone has to fear them or that they could be revitalised, especially against "common childhood illnesses" which are of course not so common now. Thanks to what, one must ask?

Another question. Do you believe that the absence of a communal memory regarding the consequences of unvaccinated exposure to, for example, measles has a powerful influence on some people's views on whether to take advantage of available vaccination programs or not? When measles, for example, was endemic in our community even I as a child remember "measles parties", sharing eating implements and beds with my spotty siblings etc. The intention I recall was to ensure infection as young as possible knowing that our relative good health and nourishment would enable us to prevail. On the other hand, like my father before me, working as a doctor in Africa and Myanmar we know that measles is not treated by parents with such disdain. Diagnosing subacute sclerosing pan encephalitis in two infants on the same day (an incredibly rare condition) does focus ones mind. Similarly the commonest cause of all admissions to paediatric intensive care units in some economically disadvantaged countries is measles pneumonia. The parents and children i encounter in Myanmar (vaccine not commonly available) do not regard measles as innocuous. Perhaps they would if they were better nourished and not burdened with so many other pathogens?

The whole topic has a surreal aspect to it. My impression is that people are either firmly entrenched in the pro vaccine camp or the no vaccine camp with very little movement between the two. Part of the reason must be because some of the more vociferous campaigners seem unable to distinguish between expert opinion emanating from professionals who ultimately risk losing their lively hood if they make misstatements, and commentators whose job it is to ask uncomfortable questions of authoritative figures but do not risk anything as a consequence nor take responsibility for those that may have been deliberately misled. Our failing as a community responsible for education is that we have not given everyone sufficient discriminatory powers to understand this difference. Some people who have been given the opportunity to acquire that necessary and contemporary skill chose to reject it. I do believe in a Darwinian selection process and would not force my views (whatever they are) on anyone. You are entirely correct "The University of Google is I suggest one you should not rely on too heavily for your citations"

In Slovakia, we have a mandatory immunization scheme for children based on the Act No. 355/2007 Coll. on Protection, Promotion and Development of Public Health and on the amending and supplementing of certain laws. Child’s caretakers may face administrative fine for non-vaccination due other than non-health related reasons.

Depends on the individual freedom vs the public welfare. This would necessitate the discussion and visitation of the fundamental right to raise the child as we fit, and the juxtaposition and limits of government for the societal collective safety. Let's not forget nor confuse the interest of the child in the discussion based on factual circumstances of each case.

Hi Peter and Q. Thanks for your response. Q, you raise the issue of individual freedom v public welfare. This has been addressed in the UK under current legislation in relation to emergent disease. For example in the event of the emergence of a haemorrhagic fever in the UK with its associated high mortality (Marburg or Ebola for example) current legislation in the UK allows for individuals to be deprived of their freedom against their will, although not to be forcibly vaccinated (no vaccine). People can be removed from the community where they are putting others at risk. This is seen as a legitimate benefit to the community at large. It is an extreme example and I wonder if anyone would argue against it? For less extreme examples the situation is different. If the "herd immunity" within a community falls below a certain figure (80%+_) then even those who have been vaccinated become susceptible to infection. Presumably because, despite a vaccine preparing the immune systems against infective organisms, it can be still be swamped if it is presented with sufficient viral load. (Vaccination, as you may well know, is not an all or none phenomenon hence the difference between live vaccine and dead vaccine)

Now the situation arises where people who have taken precautions are put at risk by those who were disinterested, objected or were free loading by relying on the immunity of others. Should enforceable vaccination only be implemented when the known threshold for herd immunity becomes imminent? Could healthcare resources be readied in such a manner for "disaster preparedness". To go back to Clifford's point who would be vaccinated in such circumstances. I assume it would catch the merely lazy un-vaccinated (too lazy to be vaccinated, too lazy to run away :))

Peter, how is the legislation you mention seen by parents and carers in Slovakia? Is there resentment or quiet acceptance of enthusiastic endorsement? You may not have access to figures in which case what is your impression?

Hi Peter and Q. Thanks for your response. Q, you raise the issue of individual freedom v public welfare. This has been addressed in the UK, as I am sure you know, under current legislation in relation to emergent disease. As I understand it, for example, in the event of the emergence of a haemorrhagic fever in the UK with its associated high mortality (75-80%) (Marburg or Ebola for example) current legislation in the UK allows for individuals to be deprived of their freedom against their will, although not to be forcibly vaccinated (no vaccine). People can be removed from the community where they are putting others at risk. This is seen as a legitimate benefit to the community at large. It is an extreme example and I wonder if anyone would argue against it? For less extreme examples the situation is different. If the "herd immunity" within a community falls below a certain figure (80%+_) then even those who have been vaccinated become susceptible to infection. Presumably because, despite a vaccine preparing the immune systems against infective organisms, it can be still be swamped if it is presented with sufficient viral load. (Vaccination, as you may well know, is not an all or none phenomenon hence the difference between live vaccine and dead vaccine)

The situation now arises where people who have taken precautions (vaccinated) are put at risk by those who were disinterested, objected or were free loading by relying on the immunity of others. Should enforceable vaccination be implemented but only when the known threshold for breaching herd immunity becomes imminent? Could healthcare resources be readied in such a manner for "disaster preparedness". To go back to Clifford's point who would be vaccinated in such circumstances. I assume it would catch the merely lazy un-vaccinated (too lazy to be vaccinated, too lazy to run away :)) I believe our legislation has been left sufficiently "open" to permit such a response?

Peter, how is the legislation you mention seen by parents and carers in Slovakia? Is there resentment or quiet acceptance of enthusiastic endorsement? You may not have access to figures in which case what is your impression?

Thank you Ashwin it is always interesting to see how the Australians respond to such matters, so too the Canadians, both of which have common legal origins and accept arguments from each jurisdiction. i get the feeling that both possibly appear a little more pragmatic than the UK.

This is a recent Australian case in which a mother who wanted to use homeopathic agents on her child, was ordered by a family court to have the child vaccinated.

I do not believe that it is necessary to have 100 pc of the population vaccinated to achieve "herd immunity". It may depent on how contageous the organism is as to what proportion of the population is innoculated. It is said you only need 10 viral particles of small pox virus for contagion to occur. Similarily for HIV transmission is unlikely to occur despite a positive :-? Status provided the viral count is low. For HIV this is not achieved by vaccine but by HAART therapy. I believe that in Swiss jurisdictions this observation has allowed for HIV pos individuals to havE unprotected sex without forwarning a partneS of the potential risk and for the courts to not consider them to be reckless. So the answer would be no, 100 pc innoculation is not required. The obvious next question is who, then, do you innoculate? I suppose all those that have no religeous or medical objection. Irrational objection may not be an excuse to forcibly vaccinate patients, anymore than you can forcibly treat patients with surgery. That leaves the illinformed and the indolent I imagine.

Your list, I believe, would fit for one possible set of selection criteria, except the last one regarding rationality. It is this last element of the non-consenting adult‘s behaviour that is most difficult to define. I would not attempt to produce a definition of “rational or irrational” reasons, although it may be easier because the question deals with the circumstance of an adult making a decision on behalf of a non-competent minor. Families have had their children removed because of the bizarre behaviour of their parents. Furthermore I do not think it is possible to define “rational or irrational” by seeking advice from a committee or organisation, unless one was setting out to permanently remove all philosophers (or anyone with any point of view) from the ranks of the unemployed! ☺ Thus it would seem like an unlikely criterion.

Your point, I think, changes the focus from the behaviour of the potential vaccinee and how much that individual owes to the community as a whole, represented by their willingness, or lack of it, to be vaccinated, to the duties and responsibilities of the vaccinators. There may be parallels that already exist elsewhere which may help this discussion, which may be worth considering?

A doctor has a duty of care and confidentiality to their patients, but they also have a duty of care towards others and to the community as a whole. We have a duty, for example, to act or warn patients in our care of a potential danger posed by another patient, also in our care. This is taken to mean that if we know of a patient’s wish or intention to harm another (on account of psychiatric illness) we are obliged to warn the intended victim of this risk, even if it means breaking confidentiality. This includes harm through negligence.

A similar argument may be invoked for carriers of infectious diseases although a doctor is first obliged to encourage the infected individual to warn the uninfected of the risks of infection (HIV, Hepatitis and possibly HPV or herpes) once they know of that risk. If the infected individual does not give their partner an appropriate warning then they may open themselves to criminal liability in some Jurisdictions (and the UK possibly). HIV is not necessarily a very good example of an infectious disease as it is not controllable through herd immunity as there is no vaccine and the intimate act of infection is under the direct control of the two (or more) agents involved. For most indiscriminate airborne or waterborne infectious agents the carrier has no control over whom they infect, however there may be some parallels although arguments and court cases pertinent to HIV infection still may not give vaccinators the right to vaccinate non-consenting competent adults.

This may be a good thing. There is a potential and general danger that if vaccinations were to be imposed against individuals’ autonomy then more than just the epidemic will be terminated! Lord Reid illustrates the importance to our culture of the principle of autonomy. In 1972 he said:

“We have too often seen freedom disappear in other countries not only by coups d'état but by gradual erosion: and often it is the first step that counts. So it would be unwise to make even minor concessions.” S v McC: W v W [1972] AC 25 page 43

This statement may contain the single most important reason why doctors should not override patients’ autonomy and they should fully understand the significance, to themselves as well as patients, of doing so. There are of course times when doctors do defy the autonomous wishes of their patients – suicide requests for example.

More specifically there is no support in law for adopting a “doctor knows best” attitude, especially for individual treatments specific to that patient. For those following this discussion who may be unfamiliar with the dispassionate, patient-centric views enshrined in law they are reflected by Lords Templeman and Donaldson’s statement that:

“A mentally competent patient has an absolute right to refuse to consent to medical treatment for any reason, rational or irrational, or for no reason at all, even where that decision may lead to his or her own death”.

A doctor who breaches that refusal of consent and treats a person, even to make them less ill, would be liable to a charge of battery. Sidaway v Board of Governors of the Bethlehem Royal Hospital and the Maudsley Hospital [1985] A.C. 871, at 904–905 and Donaldson MR in re T (Adult: Refusal of Treatment) [1993] Fam. 95, p 113

However, it is some people’s opinion that autonomy is a two edged sword and respecting it above all else may be counterproductive in some circumstances as it may implicitly ignore our responsibilities to others. They have expressed their suspicion of the “religion” of selfish autonomy and argue that all of us have responsibilities beyond our selves, including to the community at large. Childless, for example, comments on the inappropriate focus on the: "oversimplified, overextended, over weighted principle of respect for autonomy." Childless JF. The place of autonomy in bioethics. (1990) Hastings Centre Report 20(1):12-7.

These theoretical arguments are not just within the preserve of academia as they have permeated the courts: In Brady, J Kay says:

“… it would seem to me a matter of deep regret if the law has developed to a point in this area where the rights of a patient count for everything and other ethical values and institutional integrity count for nothing.” R. v. Collins and Ashworth Hospital Authority ex p. Brady [2000] Lloyds Rep. Med. 355.

One may be forgiven for believing that this statement could be employed to support a doctor who wished to override a patient’s autonomy i.e. vaccinate them against their will!

Others take this argument further and argue that life-saving benevolent paternalistic behaviour is a function of a doctor’s duty of beneficence. Do doctors owe a special duty of beneficence to their patients? Gillon R. Journal of medical ethics, 1986, 12, 171-173.

At least one Californian jurisdiction has raised hackles by suggesting it is a doctor’s legal duty to preserve life above all else, including respecting patients’ autonomy. [1993] 5 Cal 4th 725.

However, in the UK, Lord Keith in Bland, reassured doctors that no such legal duty exists:

“… the principle of the sanctity of life, which it is the concern of the state, and the Judiciary as one of the arms of the state, … is not an absolute one. It does not compel a medical practitioner on pain of criminal sanctions to treat a patient, who will die if he does not, contrary to the express wishes of the patient.”

Nor do I think that a doctor who does not wish to inoculate a child against the wishes of a reluctant parent be coerced into doing so on the basis that withholding treatment (vaccination) would amount to the potential criminal offence of “assisting suicide”. The child may not ever catch the contagion; they may not die even if infected; they may catch the infection despite vaccination; the active virus may no longer be the same organism the virus was prepared against, etc.

Also in Bland, Lord Goff said:

“I wish to add that, in cases of this kind, there is no question of the patient having committed suicide, nor therefore of the doctor having aided or abetted him in doing so. It is simply that the patient has, as he is entitled to do, declined to consent to treatment which might or would have the effect of prolonging his life, and the doctor has, in accordance with his duty, complied with his patient's wishes.”

It seems unlikely that medics would be compelled to inoculate patients against their wishes. It is too tenuous to contemplate.

However, none of these points deal with the essential difference between a patient who may consent or refuse treatment for a condition that will only affect them self (amputation a leg for gangrene vs. SARS for example). In this question the person defying vaccination is not even the person for whom the vaccine is intended and that person (child) will not even be ill! Indeed the vaccination, which is being imposed on them to protect others, may make them ill of itself.

I do wonder if the fact that it would be a parent refusing a vaccine on behalf of a child and against all received wisdom would make it easier for enforcers than objectors. I would be most grateful if anyone else could add more grist to this mill! ☺

I think Ngairs Case history, which presumably is the object of Ashwin's news article (thanks for both) serves as a reasonable example of why the wishes of a competent adult may be overruled if those decisions affect a minor. From the information provided it seems no one said that the mothers belief in homeopathy was irrational, only that evidence of the efficacy of her choice was lacking when compared to conventional immunisation schedules.

Hi Clifford, you, like many others are quite right to question the efficacy of vaccination programs, not just as a whole but also vaccine by vaccine. Specifically “One might ask, should 'flu vaccination be compulsory?” I believe in some hospitals in the USA staff vaccination is mandatory and a condition of continuing employment. We in the UK are “encouraged” by reminders of our duty of care to patients but it is unlikely that management could prove causation should a patient become ill with flu (and possibly die). As you may know the ability to track infective organisms between patients is notoriously difficult and becomes more difficult the more primitive/ancient the viral particle is.

“2/3rds of medical professionals do not take the vaccine” is unfortunately an overestimate of takers and the figures are probably 80% not being vaccinated. There are difficulties with collection of data of course. A doctor often works in 3-4 different hospitals and may have been vaccinated elsewhere but I agree the figures are low. Part of the problem is the oft repeated story of “I’ve never been vaccinated and when I did I became ill” This may be because they have never been systemically exposed to the virus and their response is a manifestation of what could have occurred if they had been exposed to a live virus load and it had breached their surface defenses. Doctors are not good examples of people taking their own medicine. In a recent survey of doctors’ willingness to accept treatment for a range of 10 pernicious cancers (oesophagus, stomach, pancreas etc) something of the order of 80-90% said they would not undergo treatment.

and [as has been reported many times in the past - especially by the Cochrane Collaboration] the vaccine is not effective. I think “less” effective than anticipated may be fairer!

“So it is a vaccine promoted by government over many years for reasons which appear to defy logic - so if there is one such vaccine, might there be others?” As I said, vaccine specific questions are needed as not all organisms are as infective as each other, vaccines are live or dead, concurrent medication and immune activity all vary. Some vaccines aim for herd immunity (flu, measles etc) some are individual specific (rabies) thus the logic that is applied to one vaccine cannot be applied to all.

“Are the medical professionals irrational and are they acting against "all received wisdom"? Or is the Department of Health?” I do not know, but the difference between taking advice from professionals as opposed to commentators is, as I have mentioned previously, based on the consequences to those individuals should the advice be bases on inadequate diligence. i.e. when giving advice that others will come to rely on it has to be considered, measured, balanced and honest, which means you have to include the bad news with the good. I grant you that “Bad pharma” is out there and is likely responsible for a great deal of unprofessional misinformation. (Bad Pharma: How drug companies mislead doctors and harm patients [Paperback]

Ben Goldacre. (Author). Well worth a read. They however are no better or worse in my opinion that vociferous pressure groups with political lobbyists who press in the opposite direction with equally attenuated or redacted information.

“And is the following rational or not? A medical layperson says "I don't believe the Government; I don't trust drug company drug trials; I cannot know whether any vaccine is safe for my child because they are not tested properly; the level and types of adverse reactions are unknown and heavily under-reported so I cannot know if it is safe; I know of other parents where their child suffered a serious reaction to a vaccine but the doctors deny there is any connection but have no other explanation."” So far as I am aware no one has ever claimed that vaccines, any more than any other complex organic molecule you may permit entry into your body, are free of toxic side effects. When adverse reactions occur it may be a catastrophe for those involved. My belief is that we cannot expect anything not to harm someone (peanuts, kiwi fruit, strawberries, aspirin, cat spit!) What we can do is look at the balance of probabilities. It is an unbiased presentation of this balance that would seem essential to me. Independent interpretation of manufacturers data (all of it, which may not be happening yet) as well as data from pressure groups is essential. If the latter groups presenting some data that does not substantiate their claims would make them a little more plausible!

One may argue that deep resentment may ensue from a parent who has reluctantly agreed to have their child vaccinated and who subsequently becomes ill. They may resent conscientious objectors whose children did not undergo vaccination and therefore did not get a vaccine related abreaction. However this hypothetical group is still more likely (on balance of probability) to have become ill during an epidemic should they not have been vaccinated.

Do you compel them to have the vaccine? Do you compel them to have their child vaccinated? Who is acting in the child's best interests? Who is more likely to be expected to so act?

I think these questions bring me back to a point I made earlier - 100% vaccination for “common childhood illness” is not necessary to prevent epidemics. No government would expect no dissent and the other accepted reasons for conscientious objection have all been mentioned.

Well as any other legislation, there are propoments, oponents and peole who just follow the law. In the recent years, there is lot of ado from anti-vaccination groups.

From my point of view, vaccination is also cost effective treatment of preventable diseases. Carabin reported in 2003 that cost of measles treatment was

€209-480 per case, while the cost of measles vaccination and control was €0.17-0.97 per person (http://www.ncbi.nlm.nih.gov/pubmed/12241559).

If necessary, I can obtain the numbers under freedom of information act.

Thank you Peter. Very useful reference. What do you think is the main cause for objecting to vaccination? Do you think people should be mandated to be vaccinated? Or penalised for not beinG vaccinated? (Possible a little "Stalinistic"? Thanks for your contributions

I thought I would include this from the New England J Med. To emphasize that vaccination is not an all or none phenomenon and the conscientious as well as the unvaccinated section of the population become affected if they are exposed to sufficient viral loads. Usually a highly reputable journal, but like other premier publications it has, in the past, be deliberately led astray.

Mumps Outbreak in Orthodox Jewish Communities in the United States

N Engl J Med 2012; 367:1704-1713 November 1, 2012 DOI: 10.1056/NEJMoa1202865

BACKGROUND

By 2005, vaccination had reduced the annual incidence of mumps in the United States by more than 99%, with few outbreaks reported. However, in 2006, a large outbreak occurred among highly vaccinated populations in the United States, and similar outbreaks have been reported worldwide. The outbreak described in this report occurred among U.S. Orthodox Jewish communities during 2009 and 2010.

Conclusion

The epidemiologic features of this outbreak suggest that intense exposures, particularly among boys in schools, facilitated transmission and overcame vaccine-induced protection in these patients. High rates of two-dose coverage reduced the severity of the disease and the transmission to persons in settings of less intense exposure.

http://www.nejm.org/doi/full/10.1056/NEJMoa1202865?query=infectious-disease

Hi Peter, I have been thinking some more about your post after listening to the BBC radio regarding the presidential elections in the USA. I was surprised to learn that there has been open debate in the States regarding the effect of either the Democrat's or the Republican's successful election on the distribution and availability of healthcare resources. Apparently the debate revolved around whether or not the economics of treating terminally ill patients, with rare conditions that require expensive medications and longterm care, would result in implementation of some form of euthanasia! Such discussions to my mind represent the triumph of the right to free speech over common sense! It may however be pertinent to this discussion on two levels.

First it emphasises the inability for quite serious people to distinguish between hypothetical questions posed by commentators and advice from people within a given field, who know their words will be relied upon by others. Similar, to my mind, as the situation that surounds the arguments relating to vaccination. Secondly it raises the issue you alluded to regarding the cost of treatment of unvaccinated patients - who despite the availability of inexpensive vaccines, decided against immunisation and acquired an avoidable condition. Furthermore the consequence of their choice is that vaccinated patients may acquire a condition despite their most conscientious efforts to avoid it. Can we afford to accommodate such autonomous behaviour? We are all charged with thinking of ways of reducing healthcare budgets. I think this differs from similar arguments that surround the treatment of those who have succumbed to ischaemic heart disease or peripheral vascular disease through a lifetimes overeating and smoking (for example). The counter argument to the threat of reduced access to healthcare in these groups is that they have, through their bad habits and associated taxes, contributed to the funds that will now pay for their proposed treatments. Can a similar argument be applied following the rejection of a free vaccine?

Hello Clifford, I have been pondering some of the information you provided at the beginning of this discussion. Specifically, the changes in the relative incidence of morbidity and mortality, where the number of people being vaccinated against smallpox and coming to grief began to exceed the number of people who came to grief as a consequence of acquiring small pox itself. Bearing in mind that we do not vaccinate against smallpox now for that exact reason. This interesting paper may cast a different light on those observations made in Parliament that you alluded to as it is based on contemporary understanding of virology and microbiology, information that was not available at that time. Of course I am not saying that we now have all the answers, only that some of the arguments that were used to counter widespread immunization in the late 1800’s can more easily be refuted now.

http://www.ncbi.nlm.nih.gov/pubmed/9027132

Verh K Acad Geneeskd Belg. 1996;58(5):479-536; discussion 537-8.

[Jenner's cowpox vaccine in light of current vaccinology]. [Article in Dutch] Huygelen C.

http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0023086

Hello Sandra, thank you for participating. May I ask you to expand on your question? I am unclear what is is that you are asking. Thanks in anticipation.

Sandra, than you for your contribution. It is important to hear from, literally, the front line. It is a shame that you should have been on the receiving end of anti vaccine parents's vitriol, especially as there is an association in some people's minds between the administration of vaccine and the onset of autism. I believe that this association is now firmly laid to rest aside from a recent court case in Italy where the spectra was raised again. It has to be said that on medical law and ethics the Italian courts do have a unique view on many matters! This, I agree does not mean that we should forget the question was ever raised, albeit that it was raised by a doctor allegedly in the pay of an organisation that would benefit allegedly from widespread acceptance of the idea. Nor does it mean that we should not remain vigilant to the adverse effects of other vaccines. However, it is a very different set of circumstances when others attack you on a personal level compared to others disagreeing with your theory or idea or argument. In essence the "official" position would be no one need hold themselves responsible for the effect that a vaccination had on their child if it was administered in good faith. It continues in saying there is no proof of association and that the risks of ill effects from the vaccine are, on balance, considerably less than no vaccine. This, of course is of little comfort to those who are living through a worst case experience.

I confess to knowing absolutely nothing about fostering or the legal status of the foster parents in relation to consenting to treatment on behalf of a child below the age of any competence. I suspect it will vary from case to case. An expert in family law may be able to enlighten us. The legality of having a child inoculated against the parents wishes will, as has been mentioned previously depend on who has responsibility for the child at that time and the child's best interests. In a nuclear family (mother, child, father) it is sufficient for one parent to wish for and consent to vaccination for vaccination to be lawfully performed, even if the other parent vehemently disagrees with the process. I believe however, that again, because of the scarcity of case histories that no generalisation can be made and each case is considered as a separate entity.

Hello Clifford, thanks for your input. I believe you may have misunderstood me to a degree. My intention in asking this question and in answering others comments are to deliberately avoid the black and white scenario you allude to. I am aware that we are all biological entities and thus differ widely in our physiological and pathological responses to same or similar stimuli, noxious or otherwise. I am aware that both pharmacological and immunological products are brought to the market for disparate reasons, some of which have nothing to do with an actual need. I am also aware that “evidence based medicine” is a misnomer and will remain so until all drug trial information is accessible, not just the information that a manufacturer makes available that supports the introduction of a new (possibly profitable) drug. I have no intention to proselytize on behalf of vaccine manufacturers and have tried to ameliorate any comments that I have made, be it a response to someone else’s comment or as a sub-question. I have included, wherever possible, caveats and counter arguments or views or included parentheses around words such as “official”, for example, precisely because I did not want to enter into a “black or white” argument. We can learn from such arguments but only in as much that they are best avoided as unrepresentative of majority views and generally reflect entrenched positions unnameable to dispassionate discussion. If I have failed to convey any attempt to remain impartial then I apologise although I confess that in essence I believe that given the opportunity, we should avoid preventable disease where possible, in the same manner as not smoking, drinking to excess of engaging in extreme sports – especially at my age!

Regulations are different from one country to the other. some countries make a list of vaccines as an obligation and some leave it for parents to decide. I think we should support the scientific facts through evidence based medicine and coming to the people with clear facts and education, then let them decide. Vaccine is a medicine where every body should be free to decide to take it or to leave it. In the same time we should recognized that vaccination for preventable diseases is a public interest where every body should do his parts.

It is my belief that too many immunizations can produce super bugs (ie. flu shot) which would normally be fought off by individuals with healthy immune systems. As a parent, I exercise my right to say no to immunizations, like chickenpox because I know my children are healthy enough to fight the virus much like their mother did when she was young. However, if the child has a weak immune system (ie. they have cancer) then the parent should be forced to immunize provided there is a guarantee that there will be no negative side effects to getting the vaccine for that child. A child with no immune system issues should not be forced to take it. If that child wants to take it and it goes against the parents belief system and they end up later on developing something which is a result of the parents forcing their beliefs upon them as a child.....well maybe but what child would sue their own parents. At some point, parents can be held accountable but the reverse is also true.....What if a child develops something negative from a vaccine that is given to them that does have negative side effects? We do sue the government for these kind of things. Either way, a child who is not immunized is of no threat to those who are immunized. These children who are not immunized are only a concern to each other. It is the responsibility of the teachers to inform all parents of any possible diseases whether immunized or not as we all know that there is not a 100% guarantee with immunization.

My easy answer is no. You cannot compel a parent to vaccinate their child.

In india we see it as a right of the child to get vaccination, thus a corresponding obligation on the parent and the state. Now this obligation is of differential value, while the parent may not be subjected to legal sanction, the state under an obligation to guarantee the right to health is seen as falling short of the obligation to take care. Vaccination is an essential part of the right to health and right to life. Here the state has taken it as a right and not subjected it to individual preferences.

Polio mellitus virus knows no religion, so why should vaccination against this virus be put in the religious mould. As a country which has had a long and successful battle through vaccination and immunisation programme, I actually wonder how we can have a religious view to negate a health issue.

Barbara, its not e issue of one child not immunised as a threat to another, but it is from the view that every child is entitled to a safe and healthy life.

http://www.alrc.net/doc/mainfile.php/alrc_st2009/557/

Thanks Clifford for drawing attention to these important issues. My readings in the last few hours is the mainstay of what I post here now. The oral polio vaccine that was administered in the country through massive campaigns every year has effectively put an end to the wild polio virus. But unfortunately the vaccine dose when administered orally contains live but heavily weakened strains of the virus. Now I am quoting here a certain expert opinion that again could not be understood beyond these few lines as it is outside my domain area of work,.

"Apart from blocking the polio virus from invading nerve cells and causing paralysis, the oral vaccine, by duplicating a natural infection, is said to raise immunity in the mucosal lining of the gut. That makes it more difficult for the virus to replicate there and spread through faeces to others."

Now scientists are suggesting a dual policy of injectable vaccine during the transition phase.

“The challenge will be to synchronise global cessation of OPV immunisation and then manage the transition, potentially lasting several years, to the point where residual VDPVs have been eliminated,” observed Bruce Aylward, the World Health Organisation's Assistant Director-General for Polio, Emergencies and Country Collaboration, and Tadataka Yamada of the Gates Foundation in a paper published last year in The New England Journal of Medicine.

Again I thank you for igniting my curiosity. We should take this further once I have done substantial readings.

Best

My take is that one must always have informed consent whenever doing something invasive to a person's body. Therefore legislating vaccination is intrinsically wrong. We cannot let governments tell us what to do with our bodies. Next they will legislate to implant microchips in us for various "good" reasons that may turn nefarious later. Where will it all end?

There is no doubt that vaccinations have a great track record in increasing overall survival and controlling massive epidemics. But this should be propagated by educational programs, and not by force of law. Otherwise, it becomes a violation of the body.

As for those who opt out of vaccinations, should they be ostracized and excluded from various groups? I don't think that is right either. No education program is going to 100% effective. But surely if a majority of a population has been vaccinated by informed consent, does it really matter if a few mavericks want to do their own thing? Can they not co-exist? So long as they are in the minority an epidemic can still be stabilized.

@Dereck Abbott: I think that „informed consent” is an overloaded operational term. How could we fill with content the „informed” part of it when there is no objective conclusion on the outcome of the procedure or, indeed, on the distribution of probabilities for various outcomes. Any parent wants most benefits and no risk for their offsprings. I presume good faith for the regulators as well, and if they lack the heuristic ability to indicate the conduct which maximizes the benefits to risks ratio for the individual and the community, how would be any parent in the position to make an „informed choice”?

@Liviu I do agree with your concern about the regulators, but is that not the same for all medicines and pharmaceutical drugs?

Your point is actually supporting my argument that we should not let the government force us to vaccinate by legislation. Given that regulators are imperfect, we cannot let government force us to do anything invasive with our bodies. That is the point.

"Informed consent" maybe an overloaded term. But the "consent" part is what is critical, as opposed to the government forcing us to have any medicine or vaccination. I agree the "informed" part is a somewhat rubbery notion, but so long as the statistics of side-effects for every medicine are out there then there are always qualified people who can interpret those and explain them to those that ask. Yes, it may be seen as imperfect, but it is better than government totalitarianism.

Agreed, although those statistics are hardly available in a form that can substantiate the choice. If that was the case, there would simply be a confrontation between rational people and bigots. How about vaccination as a conditionality set by the health insurance company (private or public)? The consequence for choosing not to vaccinate would be not a legal penalty but a higher monthly contribution to the system, as risks (for the individual and for the community) derived from the option should be supported by the one making the option. If I insist on not installing a fire alarm system, the insurance company would set me a higher contribution to issue me an insurance for my house.

That's an interesting point about insurance companies. Are there any companies our there that are increasing premiums for not being vaccinated?

Is there a reason why insurance companies haven't exploited this idea for decades?

One possible answer is that they are allowed to discriminate only on objective basis, be it statical data if not more compelling. And the statistical data on benefits of vaccination might be still challengeable. But I am only speculating.

Yeasterday a dictrict court in Nitra in a case where parent are figting fine imposed for non-compliaince with mandatory vaccination scheme for children submitted a petition to constitutional court to declare part of the vaccination legislation uncostitutional and stayed the case until constitutional court ruling. The case will be very interesting one and could have grave impact on public health legislation.

Children have the wright to be vaccinated, parents are responsible for giving this vaccines as approved by the local authority.

If parents are not complying with this regulation, should be accused

Thanks for your contributions. The plot thickens as I now see that some hospitals, especially in the USA are insisting that healthcare workers will be required to submit themselves for mandatory vaccination agains a number of contagious diseases, specifically influenza. Those who do not agree are fired. Whilst the number of staff who have been fired is small the impact on the individual is of course massive. Is this a form of hard or super paternalism or a logical progression of a need for healthcare workers not to put patients at risk? If we are compelled to be vaccinated can we reasonable extend this argument to parents? Hi Liviu, I believe that the effectiveness of anti flu vaccine is only 50 to 60 %. Would that fall within your statistical criteria?

If am an individual for whom flue could be a minor, temporary non-lethal condition, 50-60% reduced chances of not getting it is of reduced personal interest (by the way, I get regularly the shot). But my employer might prefer me to get vaccinated in order to avoid the regular waves of sick-leaves among the employees (or, in a hospital, the bump in number of nosocomial infections). I could be offered the alternative to vaccinate or to get a not-paid sick leave if I get the flu and pay compensation to the employer for the harm done by my absence. To my knowledge, the anti-flu vaccine is one of the best documented in terms of effectiveness and adverse reactions, due to its regular and large scale use. The situation (i. e. reliable statistics) is getting blurred lately due to a wave of newcomers among the producers, with announced improvements in the production/conditioning technology. As long as there is documented significant benefit with acceptable risk for society, combined with acceptable risk level for the individual - then vaccination should be actively promoted, not only offered. Active promotion includes incentives and penalties. Total privacy of decisions is limited to areas that are totally private, with no impact on tertia. The benefits and risks for society are critically defined by the cost analysis. If that is made by people with a bias towards providers of prophylactic means, it will „show” that it is better to vaccinate. If medical treatment and containment means providers are to be favored, individual choice is to be announced as optimum public policy. What we are heading to is having the same providers of medical means on both sides and also them controlling the public decision making process; as on each and every other market. The public/academic debate is useful to be monitored by them, to gauge their PR effort and for its social psychotherapeutic effect.

I believe that incentives would be an advantage but we also know that penalties have been imposed. It is the imposition of penalties that seems instinctively ethically uncomfortable. Perhaps it would help individuals to decide if it was possible to clearly demonstrate to a responsible / reasonable proportion of a community's population that information really has been suppressed or falsified or is being systematically under-reported rather than simply having a suspicion that these techniques are being utilised for commercial gains or other advantages? Should penalties be imposed on those who 'cry wolf' if there clearly is no wolf for having placed people at risk?

@ Clifford Miller: That is the reality we already live in, for all marketed medical procedures and products. There is nothing specific to vaccination in it, so the management of that kind of distortion is for the wider debate on regulating medical products/procedures/provision of services. The only specific thing in vaccination is that it brings direct measurable benefits not only to the patient, but to the community/society as well. The „my body - no state business” approach could be made an option, as long as (i) it is linked to a waiver for any further assistance claimed from the system in case of illness and (ii) eventual harm to other people's health, traceable to this option, can be turned into a personal liability.

@Eric Lawes: 1. I would favor keeping penalties and introducing compensations for the cases when adverse reactions occur. I see a parallel with other prophylactic measures, like sanitation. For a limited number of people, washing hands repeatedly and wearing protective gloves for long hours might induce skin conditions. We keep those procedures compulsory for the medical personnel, bearing penalties for noncompliance, but we provide compensation as for professional hazards if they generate complications for an individual. The compensation system would also limit the appetite for enhancing the set of compulsory procedures imposed on the individual, as long as compensation is paid by the producer. If both compensation and the vaccination is paid by the public system... we get down from the clouds into earthly reality, and everything spirals up. 2. No, those who 'cry wolf' by using anecdotal or speculative examples as opposed to scientific knowledge should be combated by effective and massive public information/persuasion effort, and not by penalties. The victims on the way are a smaller price than the long term damaging effect of systematic suppression of whistle-blowers; it is the public debate that should make the difference between champions of truth and impostors/fools. Of course, that does not equal to indulging bad science, lying, or cheating. It is valuing independent opinions, concerns, or information from outside the circles of regular stakeholders and decision makers, or from insiders who diverge. This kind of valuation is currently lost from practice and survives in university manuals, in independent media, and in policy statements nobody cares about. Hopefully it will be recovered. If not soon, most probably after a major global crisis.

I would also highlight (although I know you know) that in case of epidemics/pandemics, in correlation with estimated risks, actions much more intrusive than compulsory vaccination are or could be imposed on citizens, with no compensation for adverse effects, incidents or later proof of lack of necessity.

The problem of finding the right balance between the public interest and the protection of private rights is legal in nature and therefore I agree that no matter the circumstances, the decisions of the administration must be transparent and open to review. The main difficulty is that even if we talk about different branches of government in the end the problem is the same: who will control the controller?

Scientific progress is not a straight line forwards, but a tortuous path and the influences of the political sphere on the development of science are not always positive and not always (if ever) objective and fully honest. In nice words we refer to the lobbying exercised by the big business sphere on the political decisions. The pharmaceutical companies are naturally the big businesses that I am pointing out here. The only KEY the public has at hands is the right to be informed, but in general citizens are not very versatile in using it as an effective tool.

Vaccination is a brilliant invention and no one can contest this fact. However the human being has an odd ability to use positive shared goals or even humanitarian means in order to achieve personal/selfish goals. The dictatorship of the good intentions, this is the framework in which we live today. Undeniably, it is true that vaccination is a good invention and that mass surveillance can give governments a smart tool against terrorism, but the price to pay (in terms of less protection for the individual rights) should not be disregarded. For this issue, certain principles can guide towards the correct solution: proportionality, transparency and good administration. The unsolved issue remains nevertheless the same: who will control the controller?

@ Clifford Miller Whoa! I am not that far from you in my concerns. I am just diverging in what I see as realistic solutions and I don't have English as mother tongue to express my thoughts, so I face difficulties in getting them trough.

I never said I accept, and even less without protest, the current abuses and distortions of the medical system. I just stated my evaluation that a lost ground (i.e. current situation) on reliability of official information for the other kind of medication and services is a valid assessment on vaccination as well, and any attempt to correct the latter would (and should, of course) address the fundamentals of the system, and not just a particular or special branch. My position on the abuses and distortions in the system is not of compliance but of realistic engagement. Once the progress in the field was left to commercial competition, once health assistance was consecrated as a business and not as a public service, there is no win-win outcome for the stakeholders (including patients). The best hope for preserving some weight for the patient interest in the game is to face openly the present and the predictable actions/reactions of the major stakeholders.

Yes, I think vaccination can and should be mandatory if the benefits for public health are significant.

It is not clear to me what you mean by „compulsory medication of entire populations of healthy individuals the vast majority of whom are not at any particular health risk except from the pharmaceutical you propose”. I am not aware of any such proposal, and I see any such thing as madness. But there might be a misunderstanding on the meaning of health risk in a population. These are already technical terms, with rather well defined meaning in the WHO jargon. Luckily, in the last 100 years we see indeed only few members of exposed populations falling victims to diseases we actively avoid and intensively treat. I hope we do not need a comeback of mass epidemics to decide that a good thing is a good thing.

No, I did not suggest balancing the refusal of vaccination with opting out from the entire health insurance system, but with losing the right to get covered the cost of treating an eventual illness that could have been avoided by vaccination, plus liability for costs induced on others by the same possibly avoidable, but eventually occurring illness. So not paying to skip vaccination but paying for my treatment of the avoidable disease if I opted to skip vaccination and for the harm my decision did cause, although the risk had been presented to me. I am oversimplifying, as some vaccines do not prevent illness, but are effective only on symptoms. And that brings me to flu.

I am rather upset by your allegation that Cochrane review on flu vaccine „well demonstrated (...it...) to be ineffective”. My reading of English at http://summaries.cochrane.org/CD001269/vaccines-to-prevent-influenza-in-healthy-adults

(published on June 4, 2013) is „Authors' conclusions: Influenza vaccines have a modest effect in reducing influenza symptoms and working days lost. There is no evidence that they affect complications, such as pneumonia, or transmission.”, or from the Main results section: „In the relatively uncommon circumstance of vaccine matching the viral circulating strain and high circulation, 4% of unvaccinated people versus 1% of vaccinated people developed influenza symptoms (risk difference (RD) 3%, 95% confidence interval (CI) 2% to 5%). The corresponding figures for poor vaccine matching were 2% and 1% (RD 1, 95% CI 0% to 3%). These differences were not likely to be due to chance. ”. As for the Cochrane review on vaccination of children: „Influenza vaccines are efficacious in preventing cases of influenza in children older than two years of age, but little evidence is available for children younger than two years of age.” - See more at: http://summaries.cochrane.org/CD004879/vaccines-for-preventing-influenza-in-healthy-children#sthash.bfmDXpyG.dpuf

What is the point to ask for rigour and transparency from the producers and regulators if we do not start with using those criteria in our own process of integrating information?

Might be of interest to you.

http://www.abc.net.au/news/2013-08-18/labor-to-cut-tax-benefit-for-parent-who-don27t-immunise-childr/4894390

Labor to cut tax benefit for parents who don't immunise children

"Prime Minister Kevin Rudd has announced that parents who choose not to have their children vaccinated will miss out on thousands of dollars in government benefits."

The debate appears to be very interesting and thought provoking. People who advocate compulsory and forceful immunisations should disclose any conflicts of interest in the first place. They should understand that mass immunisation campaigns are important for killer diseases and not for preventing few days of sick absenteeism. With regard to flu vaccine, when we do not have efficacy data for majority of children what is the need to vaccinate them by compulsion and force?. If the national governments own pharmaceutical companies which manufacture highly efficacious vaccines on a not for profit basis and if a vast majority of scientific community believes that the vaccine is effective for preventing a major health catastrophe, only then can a vaccine be promoted for universal use that too not by force but by imparting education and empowering the beneficiaries. If such a thing cannot happen in highly advanced western countries, what can be said of the developing countries where people are used as guinea pigs for phase IV trials?

What immunization injection has as „usual reaction” „two lumps in the body”? Information on predictable adverse reactions are provided to parents prior to vaccination AS A RULE.

Parents are under a duty of care concerning their children. From such duty we could draw a clear responsibility for parents in case they do not do whatever it is possible and available to them in order to guarantee their children's wellbeing.

Mother of course not be held accountable for the problems because basically by its very nature as a compassionate human being as a mother would want the best for their children, there are a few exceptions to the above conditions, the socio-economic factors that tend to lead to the mother's ability to meet the needs of their economic and X factor that can only be described as criminal law and psychology

I think that teachers can't be held responsible of facts that don't are absolutely predictable: no predictable is, for example, the infectivity and the virulence of vaccinated children compared to unvaccinated, so as you can not know the ideal environmental conditions to the spread of specific infectious condition.

Parents that refuse vaccinations to their child can not be held liable for damages resulting from the choice of non-vaccination because they are aware of the potentially adverse reactions caused by vaccines. Between the two possibilities, parents choose the lesser evil ..

i chose to vaccinate my child against most reemerging diseases and those that i felt most compelled to protect her and society from. Polio, MMR, tetanus, to name a few. But it seems that pharmaceutical companies are developing risky vaccines for lesser diseases and that the government legislates them into necessity. There are now more damaged children and disabled children due to the prominence of these vaccines. Is Aspergers worth the risk? Or a lifetime of physical or behavioral problems worth the risk? Parents should be willing and able to weigh the risks of one disease over the possible future health problems associated with vaccinations.

i know one man age 42 who has the development of a 2 year old, thanks to a MMR vaccine, I thought long and hard before i got it for my daughter because i knew of at least that risk. Unfortunately, pharmaceutical companies will create all kinds of things to make money and then campaign to get them institutionalized before all the long term effects are known because shareholders dont want to wait for their dividend checks.

I hope parents do the research instead of entrusting the health of their child to $$$BIG PHARMA$$$ and I hope that they also weigh the social consequences of avoiding certain vaccinations like polio and TB before they forgo all vaccinations in fear of, frankly, very real consequences for their children.

Caregivers should have the ability to exclude infected, not unvaccinated children. Lack of vaccination does not guarantee infection risk.

Circumcision is quite another issue. Male circumcision lessens the risk of painful adhesions for the man and cervical cancer in women. Men can choose to be circumcised later in life, possibly with less risk to the genitals than to those of a newborn. Personally I find the uncircumcised penis unattractive and potentially unsanitary. The fact that it may also cause me cancer is another reason to steer clear of un cut men. I do consider it a personal choice, however. Either of the parents, guardians or, preferrably, the men themselves, and am only speaking of my personal preference.

Parents can be held responsible if they are intentionally not getting their children vaccinated..We can take example of some areas of Pakistan where Polio has emerged again due to the reluctance and resistance by the parents...

Needles and injections are always going to be scary for some people , but adults and children. It is very unfortunate there are been a few organization which see it at their raison d'ete to spread as much misinformation and fear as they can, They will use utterly false sources of statistics and otherwise confuse people with a argument which sounds persuasive, but is completely spurious. Ultimately the put you and your family at risk. I have attached an article which sets out the Australian vaccination program. It also identifies the risks.

We have also had case law here which shows immunizing your child, with out a doubt, is the sate, caring action of a parent.

An article on immunisation,

Without a doubt immunization is safe and effective strategy to prevent child mortality. The question is how many vaccines you need to give? Do you need to give vaccines for diseases that do not kill or disable? Now that is the big question. Proper selection of vaccines depending upon disease burden and disease specific mortality in a particular community and cost effectiveness of vaccination vis a vis treatment and the Risks vs benefits of administering a vaccine for a trivial infection as against the side effects of a vaccine all have to be considered before advocating forceful immunizations.

The Pulse Polio vaccination drive of the government of India (started in 1978) is a good example to examine. By end 2014, India plans to declare the country 100% Polio free.

The campaign involves thousands of health workers, NGOs and other charitable agencies who have gone to the households, schools, community gatherings, etc, explaining the effect of polio and the need to have vaccination. As we may appreciate there is no 'forcing' the parents. The need is to educate them.

The points mentioned above like political motives, drug company machinations and vested interests are true. But like Clifford Miller's statement above, we need to trust the State.

In my country, our National Supreme Court had stated that parents have a duty to care for their children and they have to fulfill all the medical procedures that are conceive as a way to protect individual health and social health, as vaccination. That when it comes to such a conflict between rights (parental decision, child health and social health) it's understood that the burdens it implies to leave aside parental rights are less important that the benefits for child and social health. There's a saying in Bioethics (which comes from Prince vs Massachussetts) that parents right can be overturned when their child is at risk. Parental rights are understood as a way to protect a child, not to harm him/her.

Dear Eric,

Looking into the elements of your original statement, the following questions seem to rise:

1. Can we hold teachers and play group leaders responsible for failing to segregate children based on their vaccination state? While we should be happy that we have two more categories to pin responsibility (sorry to put it this way), by doing so we would be actually compelling the teachers to expel children from class / school at the slightest doubt or even excuse over their immunisation state. Schools will start demanding that the parents produce proof from public health authorities that the child is vaccinated before giving admission into school. I am not sure whether such a step would be desirable at all.

2. Can we take the mother to court for electing not to get the child vaccinated? Well, I have a counter question. Can government spend time and effort on such court cases incurring infructuous public expenditure? Such measures will actually be counter productive not only to the child and parents but also to the entire society.

What do we want? We want that every child born on this earth must get vaccinated against possible afflictions. In no society we would come across a parent who does not want his/her child to be healthy. We do not need to force the parents about this. We need to educate them. That, I feel, is the job of all of us, particularly those of us directly connected to promoting public health.

The reason perhaps why you asked these questions is on the issue of 'compelling' a child because 'compulsion' is anathema to human rights. I have only one point to make in this regard. If parents are 'responsible' for parenthood, then we must accord them the authority also to do what they must for the child. Public health is not only for their child, it is for the entire society and this must be driven home to them more through education and awareness programs than through compulsion. It is important that such education also includes an element of their social responsibility.

I fully endorse what Maria Ciruzzi has stated above.

Kind regards.

Thank you Srinivasan! I fully agree with you. All of us working in public health know , for sure, that we must focus on education not in punishment. Parents should be our allies when taking care of a child's health, and this can only be obtained with patience, empathy and education. Cheers!

truly a difficult question. So called "herd immunity" is needed to eliminate some diseases and this requires a high percentage to be vaccinated. Here is another issue. There are many individuals who are immunocompromised or cannot be vaccinated for various reasons. One mother's choice not to be vaccinated and send her child to school can mean the death of other mothers' children who had no choice. Furthermore, widely accepted pandemic protocols will deny respirators to individuals with chronic conditions if they became scarce during a flu pandemic. This means if the child of the mother who refused immunization and the child of the immunosupressed child come to the hospital in a pandemic, they would likely allow the child who refused immunization to have a respirator and allow the immunosupressed child to die. It may be cruel to say, but I believe it would be more fair to deny respirators to those who refused immunization in a pandemic than to refuse them to the victims of their decisions.