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US county bars unvaccinated children from public spaces amid measles emergency

BMJ 2019; 364 doi: https://doi.org/10.1136/bmj.l1481 (Published 28 March 2019) Cite this as: BMJ 2019;364:l1481

Linked opinion

Measles in America—what’s playing out in New York State is nightmarish

Response 3 to Dr Anand: Callous Disregard For The Vulnerable Innocents

Anand writes: “I am immensely grateful to Dr Harrison for continuing to demonstrate his philosophy of treating fellow human beings. He believes in compulsion, in bullying. I believe in discussing, converting. Here in the UK, we abolished compulsory vaccination against smallpox in 1948. Smallpox disappeared from the world in 1978, if my memory serves (Anand, 2019).”

As I previously wrote, which he seems to ignore, we live in communities, thus we have both rights AND responsibilities (Harrison, 2019ab). Prior to the 21st Century, vaccine rates remained quite high; but as individual and organized groups of antivaccinationists proliferated, clusters of low vaccination rates grew, resulting in outbreaks of measles, involving suffering for 7 - 10 days, hospitalizations, cases in intensive care, potential disabilities, and deaths. Numerous studies have found that, despite attempts to explain the safety profiles of vaccines, the risks from vaccine-preventable diseases, and the effectiveness of vaccines, many who have chosen not to vaccinate their children ignore this or actively believe that it is all lies, part of a vast conspiracy to further the profits of the pharmaceutical industry (e.g., Benegal, 218; DeStefano, 2019; Fisher, 2019; Hornsey, 2018; Kennedy, 2019; Linus, 2019; Motta, 2018ab; Moyer, 2018; Rodriguez, 2018) I have far more articles. In fact, as an example, despite both appeals from public health authorities and chief rabbis, some groups of Orthodox Jews remain unvaccinated (e.g., Boodman, 2019; Kadish, 2019). So, as I’ve written numerous times, how do we protect those who can’t be vaccinated or, for whatever reason, the vaccines didn’t take?

Though in the early part of the 20th Century, compulsory vaccinations for smallpox were carried out (College of Physicians, 2019), compulsory vaccination has not been implemented in the US during my life-time (CDC, 1991, 2016). And if one looks at the high infectious rate and deaths from smallpox at the beginning of the 20th Century, its highly contagious nature, together with the urban poor living conditions in dense crowded housing with little sanitation, compulsory vaccinations were a valid public health measure. Compulsory vaccinations ended in US as well as UK; but we kept stockpiles of vaccines ready if smallpox shouId arise in our respective nations. I remember traveling to Europe in 1968, smallpox vaccination was required, despite having been vaccinated as an infant; but no longer. However, given, for instance, the current outbreak of measles, unvaccinated kids have been banned from schools, playgrounds, public areas, but no compulsory vaccinations.

In both the US and UK we have laws against drinking and driving. Someone’s right to drink and drive doesn’t trump others rights to avoid accidents caused by drunk drivers. Police can pull a driver over, request he/she takes a breathalyzer test. If they refuse, they are taken to local hospital for a blood test. We have laws against loud music late at night. We have laws against owning unlicensed firearms, though the UK superior to US in this regard, with, despite a high immigrant population, a far lower homicide rate. And both nations have quarantine laws. Yet, both nations also have educational programs to discourage people from drinking and driving, from owning unlicensed firearms, etc. Perhaps, Anand believes all the above wrong, i.e., society has no right to impose any restrictions on individual behavior.

At some point when educational programs fail, how would Anand suggest we protect the vulnerable innocents? I am all for education and persuasion; but, when these fail, I apparently care much more about the vulnerable innocents than Anand. So, if he chooses, because I care about the vulnerable innocents, to accuse me of supporting compulsion and bullying, absurd, I accuse him of a callous disregard for the vulnerable innocents in our respective societies.

In the current exchanges with him, I have shown him wrong on a number of claims he made, and he has not responded (Harrison, 2019ab), nor offered a response for how to protect the vulnerable innocents among us except for “discussing, converting,” apparently unaware or ignoring just how much effort has gone into this, failed and continues! And I support continued efforts to use education and persuasion; but, even if they eventually succeed, in the meantime, the vulnerable innocents remain !

References:

Anand JK (2019). Re: US county bars unvaccinated children from public spaces amid measles emergency. Response to Dr Joel Harrison. BMJ Rapid Response. Available at: https://www.bmj.com/content/364/bmj.l1481/rr-28

Benegal S (2018). Overconfidence and the discounting of expertise: A commentary. Social Science & Medicine; 213: 95-97.

Boodman (2019 May 10). What a Grand Rabbiʼs request might teach each us about combating vaccine hesitancy. STAT. Available at: https://www.statnews.com/2019/05/10/measles-rabbi-combating-vaccine-hesi...

CDC (1991 Dec 13). Vaccinia (Smallpox) Vaccine Recommendations of the Immunization Practices Advisory Committee (ACIP). MMWR; 40(RR14): 1-10. Available at: https://www.cdc.gov/mmwr/preview/mmwrhtml/00042032.htm

CDC (2016 Aug 30). History of Smallpox. Available at: https://www.cdc.gov/smallpox/history/history.html

College of Physicians of Philadelphia (2018 Jan 17). Government Regulations. History of Vaccines. US Supreme Court Addresses Vaccination 2/20/1905. Available at: https://www.historyofvaccines.org/timeline#EVT_107

DeStefano F, Bodenstab HM, Offit PA (2019). Principal Controversies in Vaccine Safety in the United States. Clinical Infectious Diseases. Available at: https://academic.oup.com/cid/advance-article/doi/10.1093/cid/ciz135/5316263

Fisher F (2019 Jan 28). The Hidden Reason Behind Low Vaccination Rates In The U.S. Forbes. Available at: https://www.forbes.com/sites/nicolefisher/2019/01/28/the-hidden-reason-b...

Harrison JA (2019a May 8). Response to Dr Anand. BMJ Rapid Responses. Available at: https://www.bmj.com/content/364/bmj.l1481/rr-17

Harrison JA (2019b May 15). Response 2 to Dr Anand. BMJ Rapid Responses. Available at: https://www.bmj.com/content/364/bmj.l1481/rr-25

Hornsey MJ, Harris EA, Fielding KS (2018). The Psychological Roots of Anti-Vaccination Attitudes: A 24-Nation Investigation. Health Psychology; 37(4): 307-315. Available at: https://www.apa.org/pubs/journals/releases/hea-hea0000586.pdf

Kadish A (2019 Apr 22). When did measles become Jewish?: Vaccinating children is a moral, ethical and religious requirement. New York Daily News. Available at: https://www.nydailynews.com/opinion/ny-oped-when-did-measles-become-jewi...

Kennedy J (2019 Feb 25). Populist politics and vaccine hesitancy in Western Europe: an analysis of national-level data. European Journal of Public Health. Available at: https://academic.oup.com/eurpub/advance-article/doi/10.1093/eurpub/ckz00...

Linas BS (2019 Feb 23). Anti-Vaxxers Are Here to Stay. Scientific American Blog Network. Available at: https://blogs.scientificamerican.com/observations/anti-vaxxers-are-here-...

Motta M, Sylvester S, Callaghan T (2018a Jul 12). Why vaccine opponents think they know more than medical experts. The Conversation. Available at: https://theconversation.com/why-vaccine-opponents-think-they-know-more-t...

Motta M, Callaghan T, Sylvester S (2018b Aug). Knowing less but presuming more: Dunning-Kruger effects and the endorsement of anti-vaccine policy attitudes. Social Science & Medicine; 211: 274-281. Available at: https://www.sciencedirect.com/science/article/pii/S027795361830340X?via%...

Moyer MW (2018 Aug 4). Anti-Vaccine Activists Have Taken Vaccine Science Hostage. The New York Times. Available at: https://www.nytimes.com/2018/08/04/opinion/sunday/anti-vaccine-activists...

Rodriguez R (2018 May 4). The 'Attitude Roots' Underlying Antivaccination Beliefs. The Infectious Disease Advisor. Available at: https://www.infectiousdiseaseadvisor.com/home/topics/prevention/the-atti...

Smith TC (2017 Summer). Vaccine Rejection and Hesitancy: A Review and Call to Action. Open Forum Infectious Diseases; 4(3). Available at: https://academic.oup.com/ofid/article/4/3/ofx146/3978712

Competing interests: No competing interests

18 May 2019
Joel A Harrison
Long-Retired Epidemiologist
None
I have NEVER worked for the FDA, NIH, CDC, any pharmaceutical company, nor ever purchased pharmaceutical stocks