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MumsnetGuestPosts (MNHQ) Thu 07-Nov-19 11:01:37

Guest post: “We need to look at the reasons for the decline in vaccination rates”

Professor Helen Bedford writes about mandatory vaccinations

Professor Helen Bedford

Professor of Children's Health, UCL

Posted on: Thu 07-Nov-19 11:01:35


Lead photo

“If you are going to introduce such laws you have to make it easier for families to get vaccinated”

The UK vaccination programme is very successful with high rates of vaccine uptake and as a result, low disease rates. In the UK vaccination is the norm, with the overwhelming majority of parents automatically having their children immunised. However, recently there has been a small decline in vaccine uptake of a few percentage points which has attracted a lot of attention in the media. One tabloid has even run a campaign: “Give the children their jabs”. The stories suggested this decline in uptake is due to the effects of mis-information about vaccines on social media, or parents’ ‘complacency’ about the seriousness of diseases like measles and lots of references to the rise of ‘anti-vaxxers’. One suggestion to improve rates, made by the Secretary of State for Health, is to make vaccination compulsory. At first glance, this seems sensible. Immunisation is a very safe and highly effective means of protecting our children against diseases that can be very serious, so making it compulsory seems the obvious quick fix to improve rates. But is this the best way?

First, we need to look at the reasons for the decline in rates. Contrary to some news headlines, most under-immunisation is not due to parents declining vaccines - in fact, the number of parents who do this is very small and there is no evidence to suggest there has been an increase recently. In fact, surveys, including one by Mumsnet, show that more UK parents than ever are confident in vaccination and consider it to be important for their children’s health. More practical reasons such as difficulties getting an appointment because of the conflicting pressures of busy family life and working schedules and forgetting that vaccines are due, particularly for pre-school children are more often the causes of under-immunisation. General practice, where most baby vaccines are given, has been under a lot of pressure lately with increasing workloads and fewer resources including a shortage of nurses. There has also been a decline in numbers of health visitors who provide families with advice and support in the early years including about vaccination. It is certainly true that some people may not think vaccines are so important any more as the diseases are now uncommon, but calling this ‘complacency’ is not helpful. If you have no experience of a disease, how can you be expected to know what it’s like? So wouldn’t it be better to improve all these things first and if they don’t work, then think about introducing more radical solutions?

Strengthen the things that we know work to improve uptake, rather than moving straight to legislation which could be harmful

What could mandation look like? Other countries have different ways of mandating, in some like the USA it’s a requirement for school entry, in Australia you don’t get certain benefit payments unless children are vaccinated and in some European countries, a fine is imposed. The evidence about whether this actually works to increase rates is not clear. If you are going to introduce such laws you have to make it easier for families to get vaccinated and also publicise it, otherwise it’s not fair and it might be these improvements that have the impact of increasing rates where that happens, not mandation itself.

We also have to think about the possible harms of such a measure. If we introduced a system where children had to be vaccinated before they could start school, one possible consequence would be that parents who did not want their children to be vaccinated would have to find alternative ways of educating them. This would disadvantage children in poorer families more than those of richer parents, who would have the resource to pay for quality alternative education. In some countries, legal requirements have resulted in more vaccine resistance among parents already unsure about vaccination. Health professionals are an important source of advice for parents about vaccination, with many parents saying they trust them and their advice, but what would happen to these conversations if the starting point was that the child had to be vaccinated? Would requirements mean that healthcare providers were less willing to spend time discussing vaccination with them as it was no longer a choice? Finally, while a legal requirement may be appropriate and acceptable in some countries, we know little about the views of the UK public on this issue and it would be important to establish these first. In a Mumsnet survey, 77% reported they would support such legislation, but does this actually just reflect support for vaccination?

As vaccination protects the community as well as individuals, one important benefit of high vaccine rates is that people who cannot be immunised are protected by the immunity in the rest of the community. This includes young babies, people with health conditions and pregnant women. This, it is often argued, is why we need to introduce compulsory vaccination. While community immunity is extremely important, I would argue that to introduce compulsory vaccination would require considerable extra resources. This would be better spent improving our current systems and organisation to strengthen the things that we know work to improve uptake, rather than moving straight to legislation which could be harmful.

By Professor Helen Bedford

Twitter: @HelenEBedford

Mickhasnotorso Thu 07-Nov-19 12:42:15

The reason is stupid people.

WelshMammaofaSlovak Thu 07-Nov-19 15:40:11

If there were greater consequences for not vaccinating your kids I think we'd find a lot of these reasons suddenly becoming less of a problem.

Freewanderer Thu 07-Nov-19 15:57:21

I had to actively chase an appointment for the vaccinations at 2 months and at 12. The excuse I was given at 2 months was that the information had been inputted into the computer incorrectly, (at the central vaccination service), and that she could be booked in at a later date. We never received a letter.
We also didn’t receive a letter at 12 months.
If I hadn’t actively sought a separate appointment with the surgery nurse, my daughter would now be unvaccinated.
Also, my surgery offers them on Tuesday afternoons only unless you book separately. No wonder working mothers like me struggle to get to these appointments. Sending a letter 2 weeks or so before with a date is ridiculous. Most people need several weeks notice to request leave from work. No wonder some parents then forget/don’t rearrange.
As usual, the system is broken and we need innovative thinking to change it!

Danascully2 Thu 07-Nov-19 17:29:57

Mine nearly didn't get his 8 week jabs on time because since his records went from the hospital to the midwife (who I saw at the GPs) I didn't realise I had to separately register him as a new patient at the GP surgery. The health visitors had asked if I'd registered him but I thought they meant the legal registering the birth rather than the GPs. When it got nearer 8 weeks I phoned the GP to find out why I hadn't heard anything about his vaccinations and they told me off severely for not registering him and said they didn't have any appointments until he was 12 weeks. I ended up phoning the health visitors practically in tears because I had no idea what to do and they were really helpful and organized an appointment for me. The stress was really not what I needed while recovering from an emergency section, sleep deprived and dealing with various hospital outpatient appointments. So I agree logistics could be better. Another issue in our area is that the surgery only has one weekly slot for vaccination which is over school pick up time, so trying to get a younger sibling an appointment is hard if you don't have local family or friends to help. I am grateful that we have access to good healthcare in this country but there is definitely room for improvement.

Justathinslice Thu 07-Nov-19 18:22:00

The thing is... some children DO react negatively to vaccines. It would be nice if there was more information around this.
People get demonized for raising this concern, they get told they're stupid.
More balanced discourse is needed.

FlowerAndBloom Thu 07-Nov-19 18:39:34

Agree....there are plenty of people whose babies are damaged or who died and they will come on this page and tell you so. This is minimised or ignored and so breeds mistrust. It doesn't matter if the chance of it happening is 1 in 500 000 if that's your baby....that is your whole world gone.

For people who says there need to be harsher consequences.....think about if you had two children and one reacted badly and you don't even know why and you are now being told to get your second child vaccinated or they can't go to school, or you will be fined and you are petrified....what do you do?

Please can everyone remember this. Vaccine damaged children do exist and I think it's morally and legally reprehensible to force any medication on anyone without their consent.

MulticolourMophead Thu 07-Nov-19 19:45:49

I arranged for my DC to have single dose vaccines years ago.

It wasnt because of autism worries. I'm highly likely to be autistic, and I have several family members with autism.

Alongside all the autism scare stuff was stuff about a new bowel issue. Now, both my mum and dad come from families with a variety of bowel disorders and I wanted to avoid the possibility of triggering a bowel disorder in my DC, while at the same time I wanted them to be vaccinated. I suspect my family has a predisposition to bowel issues.

One DC did end up having a bowel issue that they grew out of. Once all DC were much older, I played safe and they've had the MMR, as have I.

There areconcerns about vaccination, we can't just ignore that for some children , vaccination isn't the best thing to do. In fact, as I type this, I recall my late mum telling me I did have reactions to some of the vaccines.

whyonearthnot Thu 07-Nov-19 19:59:52

I vaccinated my children, I had zero hesitation but I was surprised how proactive you have to be to organise them.

In my area (which has one of the lowest vaccination rates in the country) there are no reminders, no prompting, no booking your next appointment at your current one, just a single booklet given to you post birth by the Health Visitor and that's it.

Seems like the NHS might want to address how they promote and schedule the actual delivery of immunisations before looking to make them 'compulsory' whatever that means.

Dancingbea Thu 07-Nov-19 22:12:04

Great piece

Preggosaurus9 Fri 08-Nov-19 11:26:45

It's a very slippery slope. I don't think it's sensible to mandate any health care choices. Choice and autonomy should be respected in any civilised society.

If I were in charge I'd need to see strong evidence of additional costs and additional harm caused by the reported change in rates before I would support mandating anything.

YourOpinionIsNoted Fri 08-Nov-19 15:30:54

Both mine are up to date with their vaccines and I would never dream of not vaccinating them. But I have had to chase for appointments, haven't had reminder letters (in spite of health visitors telling me I would), have had to battle with unhelpful gp receptionists who just want you off the line when trying to book my youngest's 1year jabs just last week. It would be very easy to miss a round of vaccinations where I live.

SwampOfDeath Fri 08-Nov-19 16:53:04

I know some families whose children would not be unimmunised if single vaccines were still available. The "how can we increase vaccination uptake?" question could easily be solved with the reintroduction of single vaccines, as many parents who currently do not vaccinate (but can not afford to go private) would chew your hand off for them.

JasBBGG Fri 08-Nov-19 19:04:50

Agree giving the choice of singles would improve it most definitely. I paid for singles for my eldest but it was too difficult for my youngest and I could only get MR combined so went with full MMR. I also think the known problem with certain east European immigrant countries needs to be addressed. We screened for bird flu why not screen for this if it's a problem 🤷‍♀️

slipperywhensparticus Fri 08-Nov-19 19:12:01

So to get a vaccine at the clinic we got a letter and a time but it turns out so did about forty other people plus people wanting to see the health visitor and about twenty slots the maths didnt work out so they tried special vaccines clinics same deal first come first served I had a thirty minute walk to the clinic to find out it's a waste of time the clinics ran until three pm coincidentally the time my other child finished school a forty minute walk away from the clinic my kids are fully vaccinated but it wasnt easy with a system like that

JenniR29 Fri 08-Nov-19 21:33:45

It does seem like there is a genuine access issue here, especially for working parents. Perhaps walk in clinics on weekends could help? Maybe there is a language or cultural barrier for immigrants too, perhaps run clinics with translators in certain communities?

I don’t think social media helps with the anti-vaxx message at all, they quite simply aren’t doing enough to dispel myths and bad science.

I see quite a few people here suggesting single vaccines, I think this is testament to just how much damage the media in general has done for public confidence in the MMR vaccine. It’s safer, less distressing and more effective than single jabs but not many people seem to believe this.

PickAChew Fri 08-Nov-19 23:52:56

We know what the reasons are. We need to look at why people are still believing Wakefield.

PickAChew Fri 08-Nov-19 23:54:35

Though I will add, it's less cut and dried when you have teenagers who won't consent to vaccinations. I'm sure they've been more of a constant than parents in tin foil hats, though.

JenniR29 Sat 09-Nov-19 03:53:24

We know what the reasons are. We need to look at why people are still believing Wakefield.

Because instead of being in jail where he belongs he’s still peddling his pseudoscience in the USA.

TheCanterburyWhales Sat 09-Nov-19 06:42:07

Genuine access problems for working parents?

I don't get paid if I don't work.

I think I'd prioritise obtaining a potentially life saving vaccination over my hourly rate tbh.

FlowerAndBloom Sat 09-Nov-19 06:56:54

I have an ex-colleague who now works for a major vaccine manufacturer and she, nor ANY of her colleagues vaccinate their children....that speaks volumes to me.

JenniR29 Sat 09-Nov-19 07:07:12

I have an ex-colleague who now works for a major vaccine manufacturer and she, nor ANY of her colleagues vaccinate their children....that speaks volumes to me.

Cool story bro 😒

slipperywhensparticus Sat 09-Nov-19 08:05:04

And the antivaxers are here!

I had to get my daughter vaccinated at the height of wakefield I spoke to my mom who said I had a five in one vaccine as a child and still got mumps I spoke to the nurse who said she would vaccinate her own child with it I read from more than one source ..she got her vaccine

FlowerAndBloom Sat 09-Nov-19 08:33:16

Are you suggesting I made that up?! That's nice

JenniR29 Sat 09-Nov-19 08:52:49

@FlowerAndBloom Yes, yes I am. It’s a lie and a lazy one at that. Vaccines are manufactured by existing pharmaceutical companies and they manufacture whatever they have the patent for, there is no such thing as a ‘vaccine manufacturer’. The major pharmaceutical companies also do not manufacture very much in the uk either.

Where exactly do they work? What exactly is it about the manufacture of vaccines that serves as a deterrent to vaccinating ones children? How do you know what their colleagues actually choose to do?

I know someone who works in a car seat manufacturing company and they don’t use car seats at all for their kids.....that speaks volumes to me*

*This is totally a lie but that’s how silly it sounds!

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