TOPIC GUIDE: DM Israel: Compulsory Vaccinations

"Childhood vaccinations should be compulsory"

PUBLISHED: 11 Mar 2016

AUTHOR: Justine Brian & Maria O'Connor

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INTRODUCTION

In May 2015, the Israeli government reinstated plans to discourage those opposed to, or opting out of, state vaccinations programmes by stopping child support welfare payments for families where vaccination had not taken place [Ref: Times of Israel]. A small but increasing number of parents in Israel are “showing a tendency to refuse to have their babies vaccinated according to the state’s vaccination program, and deciding for themselves which vaccines they want administered”, reflecting a recent broader trend across Western societies, where 1 to 20% of parents are deciding against taking up some vaccines for their children [Ref: Ha’aretz]. A study carried out by the University of Haifa sampled 14,232 babies, of varying socioeconomic background, revealed that “7.4% - 1,052 babies - had not completed the vaccinations for their age group, and were lacking at least one of the three main immunizations in the national program” and that within this group 31.7% of the parents “skipped all three” recommended sets of vaccinations [Ref: Ha’aretz]. Given 95% of Israeli children have the recommended vaccinations, amongst the highest take-up in the world, [Ref: Jerusalem Post], and the accepted benchmark for “herd immunity to protect against contagious diseases” [Ref: Metro], some commentators considered the government’s recent move to be “draconian, unprecedented and dangerous” [Ref: Times of Israel]. With critics arguing that it discriminates “against its weakest populations amid deepening poverty rates” and that such actions will do nothing to change the minds of “those staunchly against vaccinations, known as ‘anti-vaxxers.’” [Ref: Times of Israel] This debate in Israel and across the world, raises fundamental questions such as: do parents have a right to choose what happens to their child? Does the government have a responsibility to care for wider society and overrise parental wishes? What is the best way to ensure the greatest levels of immunisation amongst populations - a voluntary or compulsory system?

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DM Israel: Compulsory Vaccinations DEBATE IN CONTEXT

This section provides a summary of the key issues in the debate, set in the context of recent discussions and the competing positions that have been adopted.

Immunisation then and now
Prior to the development of vaccines in the eighteenth century, people could only become immune to diseases by contracting, and then surviving them. The process of surviving meant the body had learnt to deal with, and ultimately destroy, the microorganisms that caused the disease. The development of modern immunisation [Ref: Wikipedia] against infectious diseases can be administered in a number of ways, but most commonly through vaccination. Artificial active immunisation delivers a very small and weakened quantity of virus into the body, giving the immune system a chance to create its own antibodies and other defence mechanisms, thus preparing it for any future attacks of the disease. Many childhood diseases, which in previous eras could have been deadly, are now readily managed and controlled, especially in the West. The introduction of the Polio vaccine in 1953 [Ref: History.com] for example, has seen an almost complete eradication of the disease worldwide. In 2014 the World Health Organisation celebrated the 40th Anniversary of its World Immunization Week, and continued to encourage global vaccination because “immunization averts 2-3 million deaths each year from diseases such as diphtheria, measles, pertussis, pneumonia, polio, rotavirus diarrhoea, rubella and tetanus” [Ref: WHO]. Vaccines are considered a breakthrough in preventive medicine, stopping people from contracting severe contagious diseases. In Israel, for example, the vaccine to prevent haemophilus influenza B was included in the vaccination schedule for children in 1994, and since then meningitis and other complications in this age group have become extremely rare;  Prevnar shots [Ref: Drugs.com], introduced in 2009, mean that pneumococcal meningitis and sepsis are now almost unseen;  and the rotavirus vaccine has “significantly cut down the number of children hospitalized for serious diarrhoea” since 2010 [Ref: Jerusalem Post].

Who is refusing childhood vaccinations, and why?
Over the past two decades there have been increasingly vocal anti-vaccination movements, particularly in the UK and the USA. According to some commentators the motivation of those opposed the programmes are a deep distrust of government, alongside beliefs that “vaccination is motivated by profit and is an infringement of personal liberty and choice; vaccines violate the laws and nature and are temporary or ineffective; and good hygiene is sufficient to protect against disease” [Ref: Washington Post] In the UK the MMR vaccine [Ref: NHS] was introduced in 1988, and a decade later in 1998, a controversial and now discredited research paper by Dr Andrew Wakefield, published in medical journal The Lancet, one of the world’s oldest and best known medical journals, suggested a connection between the MMR vaccination and the development of autism in children. Although Dr Wakefield’s research has been rejected, it is widely agreed that the scare about MMR resulted in a decline in measles vaccinations in the UK - falling from a peak of 94% for two year olds in 1995, to 78% in 2003 [Ref: Independent]. But it’s not the case that those who rejected the MMR jab for their children were ideologically opposed to vaccinations as ‘anti-vaxxers’ often are. Parents often found themselves in an impossible position, as parent Kirsty Grocott explained: “We were making decisions about an illness that many of us had never seen at first hand. Measles itself was an abstract compared to the perceived threat of autism. Parents made decisions believing them to be in the best interests
of their children, people capable of rational and intelligent thought, decided to eschew the vaccination because they genuinely felt that the risk was too great.” [Ref: Telegraph] In May 2013 the findings of a study carried out by the University of Haifa and funded by the National Institute for the Health Policy Research showed that 3.4% refuse for medical reasons and 41.3% of parents refused the vaccinations on principle [Ref: Ha’aretz]. Socioeconomic elements also factor into the refusal to vaccinate. “While socioeconomically better-off mothers refused vaccinations as a matter of choice, poorer mothers miss vaccinations because of behavioural or cultural blocks, lack of knowledge or organization”. [Ref: Ha’aretz] The study also found that university-educated parents were 2.13 times more likely to refuse vaccinations compared to parents with a high school education. Jewish parents were 4.22 times more likely to refuse to have their children vaccinated compared to Muslims, and Christian parents were 3.29% more likely to refuse than Muslim parents [Ref: Ha’aretz].

Consequences for ‘anti-vaxxers’ in Israel
Recent figures reveal that the number of parents opting out of some or all childhoods vaccinations are “primarily from within some segments of the ultra-Orthodox community as well as Bedouin families in southern Israel with limited access to medical treatment (another group is found among upper-to-middle class Israelis, based on ideological grounds)” [Ref: Times of Israel]. “As a society, we don’t condone behaviour that puts others at risk for injury or death” argues American doctor Robert Pearl. “Refusing vaccination for reasons other than a serious medical condition is unfair and dangerous to those who can’t protect themselves.” [Ref: Forbes] The key argument about herd immunity, put forward by many calling for compulsory vaccinations, is that an individual choice, when it puts other members of society of risk, is no longer a valid one. “Risking other children’s lives, and other parents’ pain, is exactly what you’re doing when you don’t vaccinate your child: you’re not just making decisions about your children’s health, but the health and safety of the children around them.” [Ref: Guardian] Should the children be punished for the choice of their parents? Should the state be allowed to exercise such levels of control on its citizens? While the legal measure would not be unprecedented globally (Australia has conditioned benefits on vaccines beginning in 2016 [Ref: BBC News]), this debate raises difficult issues about the importance of parental autonomy to make decisions about their children, versus the needs of society as a whole: “The fact that individual rationality is sometimes at odds with the requirements of the common good is a quandary at the heart of moral and political philosophy. The function of the state, according to standard liberal theories, is to find a practical resolution to this central tension and solve collective action problems that otherwise won’t get solved in order to provide public goods—public order, military defence, public sanitation, environmental protection, etc—that otherwise won’t get provided.” [Ref: Economist] But others counter that: “In an era when people are less accepting of authority and do not expect to do something because the government says so, trying to enforce immunization may actually make matters worse.”[Ref: New York Times]

ESSENTIAL READING

It is crucial for debaters to have read the articles in this section, which provide essential information and arguments for and against the debate motion. Students will be expected to have additional evidence and examples derived from independent research, but they can expect to be criticised if they lack a basic familiarity with the issues raised in the essential reading.

AGAINST

Why I believe vaccines should not be mandatory

Deborah Jacobi Algemeiner 2 March 2015

In Britain, vaccinate with persuasion not coercion

David Elliman & Helen Bedford New York Times 23 March 2014

Parents deserve to have a choice about vaccinations

Jennifer Margulis New York Times 23 March 2014

IN DEPTH

Cultural perspectives on vaccination

The College of Physicians of Philadelphia 15 December 2014

KEY TERMS

Definitions of key concepts that are crucial for understanding the topic. Students should be familiar with these terms and the different ways in which they are used and interpreted and should be prepared to explain their significance.

BACKGROUNDERS

Useful websites and materials that provide a good starting point for research.

I was on the front line of L.A’s last measles outbreak

Ken Fujioka Time Magazine 24 August 2015

Onwards and upwards

Economist 21 February 2015

Return of the vaccine wars

David Oshinsky Wall Street Journal 20 February 2015

Shifting the old debate over vaccines

Theresa MacPhail Huffington Post 9 February 2015

How to cause a measles epidemic in 5 easy steps

Dr Paul Marantz Huffington Post 6 February 2015

Of vaccines and vacuous starlets

Economist 31 January 2015

Why some experts want mandatory flu vaccinations for school children

Justin Worland Time Magazine 7 January 2015

Why I wish my daughter had been vaccinated

Sophie Heawood Guardian 24 April 2013

ORGANISATIONS

Links to organisations, campaign groups and official bodies who are referenced within the Topic Guide or which will be of use in providing additional research information.

IN THE NEWS

Relevant recent news stories from a variety of sources, which ensure students have an up to date awareness of the state of the debate.

AUDIO/VISUAL

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