Vaccination is too vital to be a matter of choice


SECOND OPINION:Why do dogs have to be immunised, but children don’t?

YOU HAVE TO prove that your dog has been fully immunised against diseases before they can be accommodated in boarding kennels in Ireland, but no rules apply to places children attend such as crèches, playgroups and schools. Isn’t this amazing?

European immunisation week has just finished and the Health Service Executive (HSE) is running a campaign to improve childhood immunisation rates in Ireland. While rates are good for some diseases they are not good enough for others, including measles. In addition, some parents do not ensure that their children get all the doses required. The latest information from the World Health Organisation shows that Ireland has one of the worst rates of measles in Europe and one of the lowest immunisation rates.

According to an excellent new booklet produced by the HSE on the childhood immunisation schedule, the practice has saved more lives than any population health intervention other than clean water. Immunisation is a child’s basic human right, yet many Irish parents opt not to avail of this free service for often dubious reasons. Many myths exist about immunisation.

Myth 1: Vaccines have damaging and long term side effects. Fact: Vaccines have side effects but none is as severe as the disease itself. The polio vaccine has been in use for 40 years with no serious side effects, whereas for those who contract the disease 1 in 100 will be paralysed, 50 per cent permanently. Myth 2:Giving a child more than one vaccine at a time increases the risk of side effects which can overload the child’s immune system. Fact: A child’s immune system handles several hundred foreign bodies every day and can easily handle multiple vaccines at the same time. Myth 3Most of the children who contract vaccine- preventable diseases had been vaccinated. Fact: Almost all children who contract preventable diseases had not received the necessary doses.

These myths persist and, while some parents in Ireland have medical or strong philosophical reasons not to get their children immunised, many do not. They either can’t be bothered or think making the five visits to the GP when their child is between one and 13 months old is too much trouble.

Most of the unimmunised children are from the poorer sectors of society so these children are doubly disadvantaged: they are poor so they will have poorer health than their better-off peers and will also be more exposed to preventable diseases. Parents who don’t bother to immunise their child are relying on other parents being responsible, which is part and parcel of the general lack of civic spirit in Irish society.

I was in Germany recently and dogs are allowed on all public transport because the owners ensure the dogs are not a nuisance to anyone. Blankets were available for customers sitting at outdoor tables on chilly nights and were as clean and fresh the next day as they were the previous day. Denmark has un-vandalised chess sets in the centres of cities for everyone’s enjoyment, no problem.

Irish people have little civic spirit where people act for the good of the whole society and not just for themselves. The problem with the Irish immunisation programme is that the HSE relies on exhortation and persuasion of parents with little or no civic spirit to solve a population health problem. This won’t work.

Population health problems require population health solutions and, like that which applies to dogs, no child should be admitted to nurseries, playgroups or schools without the parents producing an immunisation “passport”. In other words, compulsory immunisation is required. This applies in the US and Australia, although not in most of Europe. However, other European countries do not seem to have the same problem getting parents to comply with immunisation schedules. Sweden, Norway and Denmark have managed to get parents to fully co-operate without compulsion.

Another approach being considered by some countries is to link social welfare payments to evidence of children’s completed immunisation schedules. This is not a good idea as it adds further indignities to people who have no jobs and a compulsory system for everyone would be fairer and more effective. This is what happened in Ireland with the smoking ban. The same should apply to childhood immunisation. If you’re not immunised you’re not getting in.

Dr Jacky Jones is a former regional manager of health promotion at the HSE