Immunisation takes us into even more difficult territory. Unlike confinement,immunisation depends on an ‘invasion’ of the person. It also depends on ‘herdimmunity' to be fully effective. In other words when the proportion of vaccinated people in a population exceeds a given percentage, the spread of the disease is effectively stopped - to the benefit of the unvaccinated as muchas the vaccinated. This percentage depends on the disease and the vaccine,but 90% is not uncommon. Failure to take up immunisation thus places at risknot just that individual, but also every other un-immunised person – includingpeople who may be allergic, too young or too old.The classic recent example of this was the debate over MMR, where becauseof fears about a relationship between the vaccination and autism, vaccinationlevels in some areas of the country have fallen well below the herd immunitylevel, with consequent increase in infection rates.Even with high vaccination levels those affected by measles are notevenlydistributed.
Where vaccination is widely practiced, as in the United States since1962, measles has continued to occur in poorly immunized subgroupsthat are characterized by low educational level and economic status,very young age, or religious beliefs forbidding acceptance of vaccine.Ultimate success of a systematic immunization program requiresknowledge of distribution of susceptibles by age and subgroup and maximal effort to reduce the concentration of susceptibles throughout the community rather than aiming to reach any specific proportion of the overall population.
The vulnerable sub-groups described above presumably do not choose to bevulnerable and the low take up of MMR vaccine in these groups is not ingeneral related to concerns about side effects. By contrast parents who dochoose not to immunise their children are doing so because of specific fearsabout the MMR vaccine. In doing so they are effectively deciding that the riskof adverse effects to their child from the combined injection outweighs the riskof contracting Measles, Mumps or Rubella including the
in that riskas a result of the decline in herd immunity.If these fears are unfounded, as is almost certainly the case, then thesecalculations are erroneous and are increasing the general risk of infection for all children. Setting those particular concerns aside for the moment however,it must be recognised that there will still be some cases of an adversereaction. In those circumstances would it be legitimate to make vaccinationcompulsory?It seems to me that for low levels of adverse reaction the case can be madebut it is by no means clear-cut. The number of children aged 10 and under inthe UK in 2001 was slightly over 8m. Assuming for the moment an adversereaction rate of 1 in 100,000 children, this would mean 80 children wouldsuffer across the country as a result of the MMR injection if every one of the8m were given the vaccine. An outbreak of measles triggered by thevaccination rate falling below the herd immunity level would almost certainlylead to many more than that suffering serious illness including blindness.