The Vaccine Information Network, an online community of like-minded parents who believe children are being “poisoned” by vaccines, recently posted a message describing measles as a mild and harmless disease that leaves a “stronger, healthier child in its wake.”
In fact, measles is a highly contagious virus that can attack the fatty protective sheath that wraps around nerves in the brain and spinal cord, and children die a horrible death, said Ontario paediatrician Rick MacDonald. “The people who post these things don’t understand the complications of these diseases,” said MacDonald, who worries anti-vaxxers are becoming more rebellious, “more vicious” as measles outbreaks spread.
Globally, reported cases of measles have spiked 30 per cent worldwide since 2016, a resurgence spurred in part by misinformation about vaccine safety and Twitter bots and Russian trolls spreading anti-vaccine messages. The World Health Organization has warned countries risk losing decades of progress against measles and other entirely preventable childhood diseases, while experts here have warned Canada’s immunization rates make the country “a sitting duck” for outbreaks.
Now, with vaccine hesitancy a growing concern worldwide, a leading ethicist is asking a provocative question: If parents won’t vaccinate their children, should the state do it for them?
“I want to point out a moral stance that I don’t think has gotten enough attention and that is that every child has the right to be vaccinated,” Arthur Caplan, founding director of the division of medical ethics at NYU Langone Medical Center said in a recent video commentary posted on Medscape.
“We keep talking about parents’ rights to say ‘yes’ or ‘no,’ to avoid mandates or requirements, or do what they choose to do. But a child can’t protect himself or herself against measles, or the flu,” he said.
I want to point out a moral stance that I don’t think has gotten enough attention and that is that every child has the right to be vaccinated
“Someone has to speak up and say, ‘Well, what about the kids? Don’t they have any rights?’”
Tens of thousands of children in the U.S. and Europe are being denied vaccinations because of misinformation about their safety and parents who still cling to the “canard” vaccines cause autism, Caplan said.
“If someone comes in and says they don’t want their child taken care of by western medicine when they have diabetes or meningitis, we go to court and overrule their refusal, because we know (children) have a right to live,” he said. “They have a chance at life like anybody else. Why not take the same attitude toward vaccination?”
In Canada, one tenth of children are now going unvaccinated, meaning about 750,000 young Canadians have no immunity whatsoever against diphtheria, whooping cough, tetanus and measles.
Caplan argues that under the rhetoric of “freedom of choice,” parents are trumping the rights of children to be protected against deadly infections. “I’m not saying vaccines are 100 per cent risk free, but the case for using them to keep infants and children healthy is overwhelming,” he said.
Globally, countries are pushing back. In January, France made eight more vaccines mandatory for school attendance, bringing the total to 11. In Australia, parents who object to vaccinating their children risk losing childcare benefits and rebates. And, in California, lawmakers three years ago repealed vaccine exemptions for philosophical or religious reasons. All children attending California daycares and schools must be immunized against ten diseases, unless they have a medical exemption certified by a licensed doctor.
In an interview, Caplan said philosophical or religious exemptions should be abolished. Most religions would argue it’s important to protect the interests of children, he said.
“No religion, except maybe Christian Science, actually opposes vaccination. There is no mention of (vaccines) in the Bible or the Hindu text or Buddhism.”
There is a basic human right to health care. Children have to have it honoured for them — they can’t do it themselves
Unvaccinated children should be kept out of daycares and schools during outbreaks, parents should lose benefits like those under Australia’s “no jab, no pay” law and any parent whose unvaccinated child harms another child should be held civilly liable, he added.
“There is a basic human right to health care. Children have to have it honoured for them — they can’t do it themselves. So, when parents won’t do it, the state has a role to step in and help vulnerable children.”
No parent in Canada can be forced to have his or her child vaccinated. Manitoba, Ontario and New Brunswick have mandatory school entry laws, but all three allow non-medical exemptions on religious or conscience grounds, and, in Ontario, non-medical exemptions are rising.
Caplan isn’t alone in calling for compulsory vaccinations.
“We should not tolerate religious cop-outs anymore than we tolerate parental convictions based on nonsensical conspiracy theories,” Queen’s University bioethicist Udo Schuklenk has blogged. “Irresponsible parental conduct that is putting their children’s well-being at risk does not deserve societal accommodation.”
Others say it is not a simple argument.
“We have parents who decide not to give blood to their kids for surgeries. Or who deny a child’s right to chemotherapy for a cancer,” said Dr. Noni MacDonald, a professor of pediatrics at Dalhousie University in Halifax. “In some instances, the courts have agreed that this is such a grievous condition that the parental decision-making should be overturned.”
“But the problem we have here is that you’re looking at a whole population of children’s best interests.”
Compulsory vaccines could risk further alienating parents, she said.
“Is the penalty going to be, ‘I’m going to put you in jail?’ Or, ‘I’m going to take (the child) into care’? And how are you to police that penalty? You can make a philosophical statement that I think all kids should be immunized and we should override conscientious objection, but what’s the ‘how?’”
Mandatory vaccines for school entry turns the problem into a conflict of competing values — “the value of immunization against the value of school” — when both are important to the child, MacDonald said.
“It’s more complex than just yes or no.”