UK health secretary “seriously” considering mandating childhood vaccination

The UK is “looking very seriously” at making vaccinations compulsory for all children attending school in England, according to the health secretary Matt Hancock.

At the conservative party conference held in Manchester (UK) on Sunday, Hancock said: “When the state provides a service to people then it’s a two-way street. You have to take your responsibilities too.”
Some experts have warned that it may be necessary to address the falling rates of immunization and increases in the prevalence of diseases such as measles. However, others are concerned.

Speaking at the event, Hancock said he has sought legal advice this week about how it may be possible to do this: "I have received advice from inside government this week on how we would go about it and I am looking into it very seriously."

Hancock said he is very worried about falling rates of vaccinations, especially measles, and that unvaccinated children were putting other children at risk.

For measles, the falling vaccination rates are a serious problem and it is unbelievable that Britain has lost its measles-free status. The worst thing is if you don't vaccinate your child and you can, then the person you are putting at risk is not only just your own child, but it's also the child that can’t be vaccinated for medical reasons. Maybe they have cancer and their immune system is too weak.”
Matt Hancock, UK Health Secretary

Cases of measles are on the rise

Measles is a highly contagious illness that can cause serious health complications, including lung and brain damage. In 2018, more than 82,500 new cases were recorded across Europe, which is the highest number in a decade and three times higher than the number reported in 2017.

In England, the number of children receiving both doses of the MMR jab by their fifth birthday has fallen over the last four years, to 87.2 percent. This is far below the recommended 95% that the World Health Organization (WHO) says is enough to provide the “herd immunity” needed to protect populations from disease.

Hancock has said before that he would be willing to look at all potential approaches to boosting vaccination levels in England, including mandating vaccination. Although he does not want to reach the point of imposing immunization, he said, he would also not rule anything out.

Rates of all routine vaccinations have fallen

Hancock’s latest comments come after figures emerged last week showing that the rates of all routine vaccinations for under-5s have fallen in England, a finding that UK's Chief Medical Officer, Sally Davies, has called “troubling.”

Disappointingly, the UK also lost its “measles-free” status this year, after 231 new cases were diagnosed between January and March.

Hancock would not respond to questions about how he would approach making people vaccinate the children but the options used by other countries include making vaccination a condition for children going to school. Australia threatens to withhold benefits, saying “no jab, no pay.”

Only 90.3 percent of under-2s now receive MMR vaccine in England

For many years, routine vaccination rates in the UK remained steady at around 98%, but uptake of the first-dose MMR vaccine among 2-year-olds has consistently fallen for five years and the rate is now only 90.3% in England.

The rate of MMR vaccine uptake has also been declining in many other countries. The reasons for this are not entirely clear, but the rate did fall after an article reported a link with autism. However, it started to increase again once that claim was disproved and discredited.

“Vaccination deniers” are not helping

One potential reason is the increase in anti-vaccine talk on social media and, in March, NHS England warned that "vaccination deniers" were gaining traction on the internet.

However, the WHO has made no recommendations regarding whether vaccination should be made compulsory or not, saying that it is up to individual countries to decide on the best way to ensure uptake rates remain high.

Looking at other countries for the answer does not particularly help either; a 2018 review by the Sabin Vaccine Institute found that analyzing the different legislative approaches across Europe did not point to any single best approach.

Researchers are divided

Some researchers say that mandating vaccination in the UK is now necessary, given that protection against measles has become so poor. Stefano Merler at the Bruno Kessler Foundation in Trento, Italy warns that if vaccination is not mandated in the UK, the overall percentage of people in the country that will be at risk of measles infection will increase from the 3.7% it was in 2018 to 5.5 % by 2050.

Other researchers are not so keen. David Elliman at Great Ormond Street Hospital in London called the idea “premature and wrong". He wants to see more efforts in other areas such as offering more convenient appointment times and making sure healthcare professionals have enough time to answer parents’ questions.

Unwanted outcomes

Head of Child Health at Imperial College London, Sonia Saxena, says there is “not really great evidence” for mandating vaccinations. Adding to this, Helen Bedford, Professor of Children’s Health at University College London, says compulsion can result in negative outcomes such as children being excluded from school. Mandating would also be expensive to implement and enforce, she adds.

In summary, it is not clear whether mandating is the right approach to resolving declining vaccination rates. In addition, current efforts may yet work, meaning compulsion would not be necessary.

Furthermore, it was falling vaccination rates in 2018 that caused alarm, but more recent data covering April to June this year show that uptake among the under-5s is stable or slightly increasing.

Further Reading

Adam Vaughan. Should the UK make childhood vaccinations mandatory? September 30, 2019. New Scientist.