Issue 3 / 1 February 2016

CAN you imagine a car today without a seatbelt? It’s so ingrained in us that it’s hard to picture. In 1970 Victoria led the world by introducing mandatory seatbelt legislation with enforceable penalties. The year following, the road toll fell by 13%. Soon after, other jurisdictions followed Victoria’s lead and made seatbelts compulsory.

Seatbelts are not perfect but overall the Victorian government made a good call. That legislation has saved thousands of lives. And, aside from some outspoken criticism citing infringement of civil liberties and government paternalism, seatbelts are largely accepted as good policy.

Vaccines are seatbelts and it’s time for us to reframe the debate.

This issue is not about choice – it’s about safety. And the longer we frame the vaccine debate as about individual choice the longer we lend legitimacy to the paranoid pseudoscience of the anti-vaccination movement.

Related: MJA InSight — Clem Boughton: Seeing is believing
Related: MJA InSight – Jane McCredie: Punitive risks

This last fortnight has seen the re-emergence – pardon the pun – of anti-vaxxers in the general media. The Age has reported results from Edith Cowan University showing that many parents who do not vaccinate their children are hiding this information out of inherent mistrust of medical science. Similarly, various outlets reported the University of Wollongong’s controversial decision to award a social sciences PhD to a candidate whose thesis attacked Australian vaccine policy despite demonstrating a glaring lack of understanding of immunology and vaccine science. It was accepted nonetheless.

Without changes in the approach to the anti-vaccination movement we are ushering in a dangerous time. If the anti-vaccination movement succeeds in propagating its fictional narrative to concerned parents who simply don’t know what to do, we risk a time where there is significantly less scope for honest dialogue between doctor and parent.

So it is time to set the record straight.

In this debate, the jury is not out. There are many things in medicine that are not clear, but the standard schedule of childhood vaccines is not one of them. We know they save lives. Like the mid-face fractures seen before seatbelts, the more debilitating consequences of diseases like polio and diphtheria have long been relegated to medical folklore because of vaccination.

Without maintaining vaccination rates above 95% these diseases will come back. Some, like measles, chickenpox and pertussis, already have. Despite what the anti-vaccination movement would have us believe, the rare side effects and potential complications of these vaccines are known and understood. The same cannot be said of the side effects and complications of the diseases themselves.

As recently as last December, over 80 children at a Brunswick primary school contracted chickenpox in an outbreak that swept through the school, reported to have an immunisation rate of only 72%. With no herd immunity, all of that population was more susceptible to a disease that is universally uncomfortable, often disfiguring and potentially fatal. The kids in that community who couldn’t be vaccinated on medical grounds needed protection by the herd, but with immunisation rates that low, no such protection existed.

How many more events like this should be accepted in the interests of tolerance?

Related: MJA — Some truths about the “low” childhood vaccination coverage in Sydney’s eastern suburbs
Related: MJA InSight – Jane McCredie: Anti-anti-vax

Now is the time for true leadership in mandating childhood vaccination together with parental penalties for non-compliance – just like if a parent failed to restrain their child in a car.

‘No Jab, No Play’ and ‘No Jab, No Pay’ go part of the way to showing the community just how important this issue is and they are a good start, but they do not go far enough.

So if there is any choice in this issue it is a choice that now, as in 1970, needs to be made by government.

We owe it to parents who want the best for their kids but don’t know who to believe. More than anyone, we owe it to the children who are not, or cannot, be vaccinated and who have no voice in this discussion. It is these children who will ultimately suffer and potentially die from preventable disease.

In 1970, the Victorian Government made a good call introducing legislation to save lives. It’s time for them to do it again.

Dr Simon Hendel is a Melbourne-based anaesthetist.

UPDATE: Editor’s note:

The poll attached to this story has been closed down as we have evidence that a Facebook group called “Vaccine Free Australia” is targeting it. Thank you for your understanding. Please also note that your comments will be published if they are civil, non-defamatory and can provide references to back up any claims you may make. Publication, as stated in the terms and conditions, is at the discretion of the editor.


Poll

Should vaccinations be compulsory, via legislation?
  • No, it's about choice (70%, 313 Votes)
  • Yes, it's about safety (30%, 133 Votes)

Total Voters: 446

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25 thoughts on “Time for government to tackle anti-vaxxers

  1. John Cunningham says:

    Hear Hear!

    I see it as every medical practitioner’s duty to uphold public health, and vacciantion is clearly the cornerstone of that. We should all write to the University of Wollongong, after reading the thesis in question, and rightly complain about the lack of rigour they have applied to this PhD. It’s Australia’s own Wakefield.

    John

  2. Robert Hall says:

    Australia runs one of the most successful immunization programmes in the world.  Our overall immunization coverage at ages 1, 2 and 5 years are the envy of most other countries.  We have very few pockets of the population where immunization levels are below those required to control or eliminate vaccine-preventable diseases.  We have been able to eliminate measles originating in Australa and the only measles cases we see now are the result of importation from overseas and subsequent transmission among mostly adults, who were not immunized as children 30 or so years ago. Measles elimination is a very good index of the success or otherwise of an immunization programme because the infectivity of the virus is so high.  For measles elimination 95% of the population must be immune, and this requires almost the entire population to actively participate and receive 2 doses of measles-containing vaccine.  In Australia we have achieved this by mobilizing both parents and immunization providers, not by compulsion. My view is that we need to continually refresh the information we provide to both parents and providers, and continue to expand support through activities like academic detailing for GPs and other immunization providers, an expanded Childhood Immunization Register and a national compensation scheme for the very few children with scientifically proven damage due to vaccine misadventure.  I think the Australian experience has shown that carrots are much more effective than sticks. I believe our goal should be active participation by families rather than passive compulsion.

  3. Simon Turner says:

    The time of dangling carrots is over.  High time that appropriate punishments are put in place for those who knowingly place the rest of society at risk. 

     

  4. Thomas Forbes says:

    I agree with the sentiment Simon and I am amazed (as well as outraged) that the University of Woolongong would be prepared to destroy their academic reputation by endorsing ‘that thesis’.

    However, generating new laws won’t translate to mass compliance and your road rule analogy is evidence for that. Whilst all good drivers wear their seat belt and don’t use their phone whilst driving, a few less good drivers break the rules (and get caught and penalised)  In some cases a one driver using their phone on the road will lead to the unfortunate death of a law abiding road user, even though they were wearing their seatbelt.

    I feel that information is the way forward. This country is known all over the world for it’s road safety campaigns aimed at informing the Australian community about the right way to behave on the roads. The reason anti-vaccination groups get any grip on our society is that they are very good at saturating our lives with their misinformation, and for some reason our government doesn’t seem to provide a counter offense.  No-jab-no-play is viewed as a stick and not a carrot. As discussed in The Age last weekend by Margie Danchin and Jim Buttery, many families being penalised by this law are not vaccine refusers, but instead have health access problems.  No-jab-no-play should include a policy for assisting these families complete vaccine schedules if it is truly going to live up to its purpose.

    So I agree that an aggressive government response is required but not penalising vulnerable children, rather aggressively righting misinformation, blocking misinformation and helping the significant proportion of accidentally unvaccinated children get picked up an immunised.

  5. Helen Solomon says:

    I voted ‘no’, but my concerns are safety as well as choice. Multiple vaccines in quick succession are not safe for many children, with genetic mutations, gut issues, allergies and autoimmune diseases (despite the fact that these no longer qualify for medical exemption in this country). 

  6. Danny Jovica says:

    So where does our Immigration policy fit into all of this?

    We have 7.7 Million visitors to Australia each year,  many from thrid world countries.  It is not compulsory for them to be fully vaccinated prior to entry.

    Source : http://www.tourism.australia.com/statistics/arrivals.aspx 

    This does not include the Millions of Australians who depart for overseas destinations where many of the diseases we are allegedly trying to eradicate run rampant.   There is no requirment to be fully vaccinated to go overseas.

    Yet you want to justify a targeted program by the Government to go after “conscientious objectors” who make up just 1.8% of the population and who in numbers amount to some 10,000 families.

    Source :  ‘No Jab No Pay’ and other immunisation measures http://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Library/pubs/rp/BudgetReview201516/Vaccination

    How do we justify this again? This whole herd immunity? Pfft with 7.7 Million visitors a year? laughable.

  7. Lissa Dale says:

    I am expected to offer up our children to medical experimentation even though this is understood world wide to be immoral, and let me clarify, the current vaccine schedule has never been tested or studied for safety and adverse reactions. While each vaccine is individually tested, they have never been tested as a complete schedule, let alone the fact that giving 8-9 vaccines in one visit to a baby or child has never been tested for safety either. This is medical experimentation. Without these trials and safety studies, who exactly is saying the schedule is safe and harmless? Who is going to guarantee our childrens future health on an untested and unproven schedule? Herd immunity theory originated in 1933 by a researcher called Hedrich. He had been studying measles patterns in the US between 1900-1931 and he observed that epidemics of the illness only occurred when less than 68% of children had developed a natural immunity to it. This was based upon the principle that children build their own immunity after being exposed to the disease. So the herd immunity theory was, in fact, about natural disease processes and nothing to do with vaccination. If 68% of the population were allowed to build their own natural defences, there would be no raging epidemic. 

  8. M. Sweeney says:

    I keep hearing the vaccine debate, but there is no debate. Why isn’t there. Let’s have the debate, get this issue out in the open. Let’s hear both sides of the story and not just force people to vaccinate. 

  9. Dr Leo Hartley says:

    I’m all for vaccination. However, using the approach advocated, maybe the Government focus on other very important health issues. They could outlaw obesity and unhealthy living, making it mandatory to eat a healthy diet and exercise regularly. That way people who exceed their BMI by staged amounts could be fined each year for their obesity. Likewise, the government could outlaw tobacco and alcohol with harsh fines being put in place. The fines could be based on BAC. Motorcyclists who don’t wear protective clothing could also be fined. Actually, just outlaw motorcycles-they’re so dangerous. Oh and push bikes – so dangerous. What else. Maybe swimming in pools could be outlawed – too many deaths from that. No babies taking baths any more. Too many deaths from that. How about putting GPS’s in all cars and automatic fines being handed out for speeding. These suggestions, along with the intense scrutiny we face from the government on our internet usage and through constant surveillance everywhere we go, should ensure our Big Brother society is free from unnessary risk, driving down the cost of health care. The savings could be put into enforcing these “protective laws”. Yes, it’s all tongue in cheek. But just asking…is it a slippery slope from enforcing vaccination, to better control of our citizens health, for their own good and of society as a whole, of course…. 

  10. Araleena is says:

    If you want to understand why people choose not to vaccinate read the 18 page insert – not the one they hand out to parents – the one written by the manufacturer. Any thinking person will have many questions that arise from this reading – investigate these questions… There are now many medical personnel who after reading these inserts are asking uncomfortable questions. The truth will prevail and hopefully we will one day have healthcare that is unaffected by the wims of bad pharma.

  11. Jack says:

    Even if vaccines were 100% safe (which nobody can argue with that they’re not) I would still make my own choice. My body is mine, not the State’s.
    My children’s bodies are my responsibility, not the State’s.

    End of story.

     

  12. Gus says:

    I’m pro-vaccine and I detest pseudoscience.

    But some of the “anti-anti-vaccination” messages sound more like hysteria than reasoned argument.  They will only serve to entrench opposition from vaccine sceptics who already don’t trust us.

    Chickenpox is probably one of the worst examples of the dangers of non-vaccination!  The rate of serious complications from chickenpox among young children is extremely small (e.g., encephalitis about 1/1000).  Most parents who refuse to vaccinate their children would have caught chickenpox as kids themselves, and all their friends would have caught it too, and likely all of them survived with zero complications.  Pick a better example!

    It is disingenuous to claim that an unvaccinated kid is a “danger to society”.

    For all intents and purposes, unvaccinated kids are a danger to themselves only.  They are not a danger to vaccinated kids.  Yes, they are a potential danger to kids who for complex medical reasons cannot be vaccinated, but that population is minuscule.  And for that to occur, all of the following would have to happen: (a) the first unvaccinated kid would have to catch the disease, (b) happen to be exposed to one of those tiny number of kids just at the time the disease is contagious, (c) the kid who can’t be vaccinated would have to catch the disease in that brief window of opportunity, and (d) would have to be one of the unlucky ones who ends up with a severe or life-threatening case of that disease, despite modern medical management.

    Is that risk high enough to justify draconian government action?

     

  13. Dr. Balaji Bikshandi says:

    Vaccines are not seatbelts! Seatbelts don’t go inside of you and have a lasting effect!! I support vaccination but even more so, I support free choice. A forced jab is no less cruel than the forced ‘family planning’ operations some countries conducted, in my opinion. We are in Australia and the people who chose to migrate here do so because it is a free country. If there is one vaccine I would support as mandatory, it is the vaccine that provides immunity against beaurocrats, politicians and media (we can call it bpm with 3 booster doses). I wonder why don’t people screaming regulation emigrate to the ever increasing dictatorian regimes and enjoy them to their heartfelt contention! You could jab anyone there you like. If you don’t like it, just leave it!

  14. Debbie Quirke says:

    Pro choice. There are risks to having vaccinations and the government are not prepared to have a compensation program in place! 

  15. Matt Richardson says:

    I agree with Simon. No analogy will align perfectly but I believe seat belts are relevant because they were unpopular by many at the time but ultimately proved incredibly effective in saving lives. Yes, seatbelts “don’t go in your body” like vaccines do, but this distinction is an arbitrary distraction from the fact that they are incredibly safe, cause harm in a minority of cases, and most importantly, work. 

    This desire for autonomy is understandable regarding your own body and in particular that of your children. However, this “choice” so fiercely demanded by anti-vaxers I believe, is purely a product of living in first world country where so few of us have seen the devastation caused by these diseases. Having worked or visited overseas third world medical services, I can assure you that you will be hard pressed to find a mum or dad debating the finer points of what anti-vaxers claim are legitimate concerns about vaccines. No, instead you will see them give literally anything to protect their child from the diseases they have seen ravage or kill their nieces, nephews, neighbors kids and even their own kids. 

    Our wealth and privilege in Australia has spawned this divide between common sense and the few that “don’t know what they don’t know”. It’s more than a shame, it’s embarrassing. And it’s time to act. Well said Simon.

     

  16. Blake Cross says:

    Now imagine that car. The car company have provided a seatbelt giving you a complete sense of security. Now imagine you are driving your car, wearing your seatbelt and you have a crash. The seatbelt was defective and you suffer an injury. And the car company have no liabilty whatsoever because the government have provided them complete immunity from any prosecution if their product is defective. What incentive is there for the car company to provide a safe product? The car company realises their product is defective so put new, sample seatbelts in their new cars but no one knows the changes that have been made or how they will be affected. More crashes and more defective seatbelts and more injuries as the test dummies (aka consumers) unwittingly trial their seatbelts in the real world. 

    There is plenty of credible, unbiased information about vaccines and the injuries they cause not only on the product insert, but in many medical and peer-reviewed documents available online. Find them. Read them. Love your babies enough to do this for them xx

  17. Pamela Forward says:

    I vote no. Free choice is everything here. No-one should be made to do something to their bodies or childrens bodies if they dont want it to happen. To be forced against peoples will is much the same as being forced to have sex with someone you dont want to. If I was made to have any compulsory vaccine against my will I would feel violated.

     

  18. Glenn Rosendahl says:

    There is a new twist to this debate.  If medical science develops a vaccine to the Ebola virus, who of the ‘anti-vax’ correspondents would choose not to be vaccinated?  A 20% – 50% death rate from infection, higher among health workers. We still do not have effective treatments, and if infection was introduced in any Western society, draconian isolation and quarantine measures must be introduced.  Effectively – martial law.  

    Zika virus is spread by mosquitoes and by sexual insemination.  An infected male has already passed it to a female in ejaculate.  If the risk is microcephaly – evident in a newborn, one expects it will continue, with major intellectual disfunction.  That will continue as children born with the condition grow – as we observe in children born with microcephaly from other causes, or no known cause at all. How will anti-vaxxers respond to this new exigency?  There will be no ‘medical treatment’ of a woman desirous of having a child – apart from vaccination.  There is no way any putative ‘antibiotic’ could be tested for safety.  We can develop vaccines – that use the body’s own immune system to develop effective antibodies – that will protect the mother and the child.

    Do we develop a vaccine?  Will the anti-vaxxers use it?  Will Dr Wilyman please add a postscript to her thesis and tell us what is the appropriate response?  After all, she is now a recognised, university authenticated authority!  

    Abortions will be one resolution.  If US reveals evidence of microcephaly, I expect termination will be offered.  But inevitably children with this problem will be born.

    Do we stop having babies?  Is that a solution?

  19. Mark Zammit says:

    Great article Simon. As usual, the comments section and poll have been infiltrated by the usual anti-vax suspects, regurgitating nonsense about lack of safety and efficacy and misinterpreting product inserts. No other pharmacologic agents have been as rigorously studied as vaccines. They are safe and effective and it is high time we start disregarding the anti-science anti-vax movement. As you mention, no jab no pay/play is a good start, but the stringent legislation regarding seat belts and smoking in public are good models to develop even stricter policy in regards vaccination. 

  20. (Dr) James Collins (ret) says:

    Shame on every medical expert purporting to be experts in vaccination. Take a breath dear colleagues, read your MIMS annual. Read the physician’s package inserts. Read the myriad research (that which is not funded by the manufacturing companies). Educate yourselves on the history and background of the immunisation programs around the world. This is above and beyond the scope of just about every person commenting here, or you are simply as closed minded as your honesty deficiency will allow. My heart bleeds at the direction medicine has taken. It is no longer about us being on call 7 days a week, 24 hours a day. It is no longer about truth and integrity. It is no longer about elucidation. It is now about wealth, absolute cowardice and being educated by the media and pharmaceutical reps. Since retiring and moving to Australia, I have continued my education and have been astounded at the sheer amount of knowledge that these parents have accrued. Arguably exceeding any modern ‘doctor’. The habit of attacking any expert who does not agree with your bias, without remorse, should make all of you hang your heads in shame.

  21. Mark Zammit says:

    No doctor here has claimed to be an expert on vaccination “Dr” Collins, You claim understanding this topic is beyond the scope of everyone here, yet are astounded at the knowledge of parents who get their information from ?Dr Google and Dr YouTube. You’re the only one who should be holding their head in shame. No respectable medical professional would espouse such nonsense. You’re simply repeating anti-vaccine propaganda. Were you a doctor of osteopathy, chiropractic or homeopathy by any chance?

    Real doctors appreciate they can not have broad knowledge across all specialties, and so refer to experts in the field like Dr Helen Petousis-Harris, director of research at the Immunisation Advisory Centre at The University of Auckland. She recently dissected the fraudulent PhD awarded to Judy Wilyman at UOW. Immunisation is about the health of our society and nothing else. Claims of pharmaceutical bribes and media bias simply confirm you’re part of the anti-vax movement this article is directed at. 

  22. Elizabeth Hart says:

    In your article you say: “In this debate, the jury is not out. There are many things in medicine that are not clear, but the standard schedule of childhood vaccines is not one of them.”

    According to the current National Immunisation Program Schedule, children aged from birth to teenage years will have at least 43 doses of vaccines via combined vaccines and revaccinations, (33 of these doses will be given in the first 18 months, this will rise to 36 doses when the PBAC approved 18 month diphtheria, tetanus and acellular pertussis ‘booster’ is implemented, therefore making a total of 46 vaccine doses up to teenage years).

    Dr Hendel, can you please clarify your position?

    Do you think the science is settled on childhood vaccination, i.e. that the current science supporting vaccination published in the ‘peer-reviewed literature’ is infallible?

    Do you think discussion on vaccination policy and practice should be restricted to academics who have been published in the ‘peer reviewed literature’?

    Do you think citizens should be forbidden from asking any questions about taxpayer-funded vaccine products and vaccination policy and practice?

    Do you think committees making decisions on adding vaccine products to the taxpayer-funded National Immunisation Program Schedule should be accountable to citizens for their decisions?

  23. cswannell@mja.com.au says:

    A NOTE FROM THE EDITOR:

    I have been asked why comments are being edited to remove personal references to Dr Hendel. The answer is because this debate deserves to be of a higher standard than that. Additionally, if we exclude Dr Hendel’s opnions and arguments because he is not an immunology specialist, then presumably I should exclude all opinions expressed by non-immunologists. Which would leave this comments section quite bare.

    As to whether MJA InSight is “biased” about vaccinations … of course it is. It is a publication aimed at qualified medical practitioners, the vast majority of whom practice evidence-based medicine and are therefore thoroughly committed to the concept of vaccination and vaccination programs.

    Third, nobody is dictating anything to anyone here. This opinion piece is exactly that. An opinion. It is not legislation, nor is it official government policy, nor is it the start of the next fascist regime. It is simply an opinion piece. One of many.

    On that note, the comments section on this story will now be closed. Thank you all for your contributions, and readership. Come back next week, when, no doubt, we’ll start another conversation.

    Cate Swannell
    cswannell@mja.com.au

  24. Simon Hendel says:

    Thanks everyone for their comments. The great thing about science is that it is always testing and retesting hypotheses and bases the strength of its recommendations on the increasing strength of available evidence. No medical practitioner or scientist would ever say that any intervention or treatment is 100% safe or 100% effective. That is true for vaccines – as it is for seat belts in the analogy above – but, and this is a big but, the efficacy and safety of the standard schedule of childhood vaccines has been well established. The inefficacy of many proposed alternatives to standard vaccination has likewise been established.

    My article was never about making all vaccines compulsory – no scientist would argue for that. It is however about recognising the widely supported view that the debate is no longer about whether the standard schedule of vaccines works or not at preventing disease. That debate is over except for within a very small minority who will never be convinced by rational discussion or evidence.

    The debate is now about how to best implement effective public policy in relation to vaccines. Mandating the childhood schedule is one option that I have argued the case for in the above article. As many comments have pointed out there may be other effective policy options that achieve the same effect. These comments stimulate interesting discussion and debate about how to put good evidence into good policy and the challenges of weighing individual choice with collective safety. 

    I would say that publications such as MJA InSight and the comments above demonstrate that no one is or will be forbidden from asking questions about issues that affect them. 

    Simon

     

  25. Glenn Rosendahl says:

    Elizabeth, I have  observed – even been responsible for – vaccination of children for over 40 years.  I have seen, or been made aware of – the occasional episode of fever or irritability that can be associated with the immune system doing its job. I consider that – overwhelmingly – it has done its job well. I have actually been clinically in charge of 3 third world patients with tetanus who had not been vaccinated.  Two died.  Yet not a single allied soldier died of tetanus in the second world war.  I have not seen long term adverse effects in the cohort of children, and young adults in my care, that reasonably could be attributed to vaccination.  Certainly no succession of parents making allegations of dysfunction or disease after vaccination.  The human immune system has processed millions of antigens by adulthood.  46 is infintesimal in that scheme of things.  But not infintesimal in the advantage to the child, the adult human being.  When I was a child, I could well have suffered the life-long debility of poliomyelitis.  I had my vaccination in my early teens.

    Dr Hendel does not need to ‘clarify her position’.  Science is settled on childhood vaccination.  You are fully entitled to discuss ‘vaccination policy and practice’  But please be informed. Citizens are not forbidden from asking questions, the relevant committees are accountable to citizens, have acted, and are acting competently.

    You are entitled to believe the earth is flat, even argue the point.  We are not obliged to believe you, or spend resources reexamining the matter.  I am amused by the righteous indignation I am reading – but only to a point.  Beyond that, you are wasting my time.

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