In 2011, Quebec experienced the worst measles outbreak that North America had seen in 20 years. Measles, which has been rare in North America since the introduction of the measles vaccine in the 1970s, and North America was declared measles-free in 2002. But with immunization rates falling, communities with low immunization coverage are left vulnerable to the re-emergence of preventable diseases including measles, mumps, whooping cough, and others.
Across Canada, the Public Health Agency of Canada estimates that 62% of 2-year-olds are up to date on their recommended immunizations- far below the 95% coverage that public health specialists estimate is required to maintain herd immunity. As we've discussed on this blog, the low rates are due to several factors. One is that young parents aren't as worried about preventable diseases as previous generations of parents, who grew up with frightening outbreaks of disease. Another is that rumours and speculation about the risks of immunization have led people to skip or avoid immunizations; prior to the now-discredited Wakefield study alleging a link between MMR immunizations and autism, the rates of immunization fell drastically. Today, fear of autism caused by vaccines is one of the top reasons parents delay or refuse immunzations, even though no casual relationship has ever been established.
Unvaccinated individuals put others at risk; the LA Times compares refusing immunizations to drunk driving or smoking in restaurants. If education fails, is the next step enforcement? Should parents who refuse to immunize their children be fined (or, as Australia is doing, refused tax benefits?) Should parents who don't immunize their children be allowed to send those children to public schools? For that matter, should unvaccinated adults be allowed to work in schools, hospitals, or anywhere they put others at risk? The LA Times reminds us that "risk perception is ultimately subjective, a combination of the facts and how those facts feel, and sometimes our fears don't match the evidence. The dangers that sometimes arise because of the way we perceive risk must be managed too. But we must act in the face of this threat to public health."
Currently, the individual's right to refuse immunizations out of fear and speculation is overruling the public's need for safety and security, especially for the most vulnerable: the sick, elderly and very young. Is there a better way to reconcile these differences than strict regulation? Can education make a difference?