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Should childhood vaccination be mandatory? No

BMJ 2012; 344 doi: (Published 15 May 2012) Cite this as: BMJ 2012;344:e2435

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Re: Should childhood vaccination be mandatory? No

David M Salisbury argues against the introduction of mandatory vaccination in the UK and he suggests that compulsion is not necessary if the immunisation coverage is above a “sufficiently high” level.1

In 2008, the first author came to Scotland from Hungary hoping to learn lessons on communicable disease control to take back home, including undertaking a formal comparison of the two countries. In 2010 we published on the two countries' communicable disease control systems, including childhood vaccination.2 We showed that in 2007, vaccination coverage rates regarding MMR and DTPa were essentially 100% in Hungary, which was primarily due to the long-standing mandatory immunisation system there. In Scotland, the coverage rates of MMR and DTPa were 88.9-93.8% and 94.1-97.8% respectively. These rates can be considered reasonably high for a country with voluntary immunisation system, and surely above the “sufficiently high” level. Despite this relatively small gap in vaccination coverage, considerable differences in disease rates were seen between the two countries.

In 2007 the number of reported pertussis cases was 48 in Hungary and 98 in Scotland (0.5 vs 1.9 per 100,000 inhabitants). There were no notifications of rubella and measles, and only 16 cases of mumps in Hungary, whereas the Scottish numbers were 146 cases of rubella (incidence rate per 100,000: 2.8), 168 cases of measles (incidence rate: 3.3) and 2741 cases of mumps (incidence rate: 53.3). As the systems of notification, the collection of data, and the structures in place were very similar, we think it unlikely that these differences were merely statistical artefacts.

On this evidence, we believe that mandatory vaccination has significant advantages over the voluntary system, however, we also agree that its introduction in the UK would present serious challenges. Our comparison surprised us. There are lessons to be learnt from other countries, including on mandatory childhood vaccination.

1. Salisbury DM. Childhood vaccination: should it be mandatory? No. BMJ 2012;344:e2435
2. Stefler D, Bhopal R. Comparison of the Hungarian and Scottish communicable disease control systems: Lessons for a convergent European Community. Public Health 2010;124:167-173

Competing interests: No competing interests

31 May 2012
Denes Stefler
PhD student in cardiovascular epidemiology
Professor Raj Bhopal
Department of Epidemiology and Public Health, University College London
1-19 Torrington Place, London, WC1E 6BT