In this essay, I intend to discuss a host of factors associated with the theme of vaccinating one’s child, with particular emphasis on views and perspectives from a stance towards anti-vaccination. A vaccination is an injection of a weak/attenuated pathogen, with the intention of stimulating active immunity to result in immunological memory. The purpose of this essay is to advise parents Mary and Joe, as to whether they should vaccinate their children against MMR.
An individual infected with the measles virus experiences a host of symptoms, which usually occur 10 -12 days after exposure to the disease- this is the duration of the incubation period of the disease. Symptoms are most typically characterised by a fever that occurs for 2-3 days as well as malaise and anorexia. These symptoms occur during the prodromal phase of the disease and are accompanied by cough, conjunctivitis and coryza. Most of these consequences of measles are caused by the non-specific inflammatory immune response of the body to the virus. Koplik’s spots are another symptom of the disease. These are pathognomonic of measles and are bluish-white spots that occur on the buccal mucosa. Although they are not a necessary symptom of measles, a study stated that using Koplik’s spots as a means to diagnose measles improved the probability that diagnosis of measles occurred correctly. Development of an exanthema in the form of a maculopapular rash which spreads from the face to the rest of the body usually occurs 14 days after infection. More serious complications associated with Measles include ear infections, pneumonia, diarrhoea and most severely encephalitis. Encephalitis, inflammation of the brain, is the most common central nervous system complication associated with this virus. Despite this being a rare consequence due to its 0.07% incidence rate, it can be detrimental since it can potentially lead to brain damage- presented in the form of dementia, personal and behavioural changes and more severely death.
Herd immunity refers to the ability of vaccinated individuals to reduce the risk of infection to a particular disease to non-vaccinated individuals in a given population. This phenomenon can be explained by Figure 1- whereby transmission of a disease within a vaccinated population is significantly reduced since individuals who have received a vaccine are not infected. But more importantly, the likelihood of unvaccinated individuals catching the disease is reduced since its passage of transmission is interrupted.
It is important to note from both a public health perspective and from the point of view concerning one’s own health, that direct vaccination is a more effective way of maintaining protection against contagious diseases such as measles instead of relying on the uncertain reduced risk of exposure to disease offered by herd immunity. One must recognise that due to the inconsistent nature of herd immunity within a population, relying on herd immunity alone will make an individual more vulnerable to unpredictable factors within society. A study conducted in 2008 demonstrated that non-vaccinated individuals tend to be concentrated within particular geographic areas, often creating areas of susceptibility to epidemics such as measles. This, therefore, highlights the important point that unvaccinated children can remain at high risk of catching measles even in areas where vaccination rates remain particularly high. Therefore caution should be taken by parents including Mary when considering herd immunity as means to protect her child as opposed to providing vaccinations.
Also, for diseases such as measles which are highly contagious the vaccination rates within a population necessary to proffer herd immunity must be 90-95%. As a result, there is little scope for individuals within society to refuse vaccinations. The importance of maintaining high vaccination rates within a population is highlighted in the case study when Mary describes receiving leaflets urging parents to vaccinate children due to rates falling below 80%. Such is the significance of herd immunity that provision of leaflets and information regarding vaccines is necessary to maintain sufficiently high vaccination rates.
When considering the advantages/disadvantages of vaccines it is important to extend our perspective beyond an individual’s personal gain from having received a vaccine, but we must also assess the benefit to society achieved. From the perspective of public health, the advantages of vaccines in providing herd immunity to populations who are particularly susceptible to disease- individuals who cannot have vaccines due to allergies or being immunocompromised far outweigh the risks associated with not doing so. Therefore, it is important for Mary to reflect upon the advantages of vaccinating Matty since he will be able to help offer herd immunity to his sibling Jess, who is particularly vulnerable to developing Measles due to the high incidence of the disease amongst children between the ages of 1-3. But more importantly, since she has only received the first round of the MMR vaccine- which means she has not fully developed immunity against MMR.
Social media has played a significant role in the anti-vaccination movement. Evidence shows how celebrities influenced parents’ views towards the MMR vaccine by incorrectly claiming links between the vaccine and autism. The impact of such claims on parental perspectives can be shown by the tweet Mary refers to during her consultation which suggests behavioural problems associated with the MMR vaccine. Distribution of information in this way has drawbacks of which the most significant is that there is no accurate way of assessing the reliability of the information provided. The impact of the spread of misinformation can be reflected by the MMR scandal of 1998, suggesting a causal link between the MMR vaccine and autism. Andrew Wakefield a former British doctor and researcher published controversial research in 2008 claiming this. Despite his results being disproven due to unethical research methods and manipulation of data for personal gain, his research had detrimental effects on the uptake of the MMR vaccine. A study conducted showed that despite Andrew Wakefield’s paper being retracted, his incorrect findings led to an 8% drop in MMR vaccination rates. When considering the high vaccination rates required for herd immunity, such drops in vaccination uptake can significantly reduce the protection of unvaccinated individuals within a population.
Of the psychological factors associated with this topic, the impact of being ostracised within society for supporting the anti-vaccination movement and the implications of this on mental health and social interactions are important to consider. When considering how to best advise Mary in particular regarding vaccinating her children, it is important to reflect upon how she used to regularly attend baby and toddler sessions and how they offered important social interaction for her and her child. Choosing not to vaccinate Matty may lead to Mary feeling excluded from such an environment since pro-vaccination leaflets were distributed there. This could be of detriment to Mary’s mental health in that she feels she cannot otherwise participate as she does not conform to what may be considered as a social norm. The effects of Mary’s decision could perpetuate in that Matty also experiences social exclusion in the school setting due to him not being vaccinated. Issues surrounding this are detailed in the leaflet provided to Mary.
Finally, with regards to ethical reasons concerning this subject, beneficence a key pillar of medical ethics must also be considered. Should individuals choose not to get vaccinated, the secondary impacts on groups in society may be of greater significance than the individual advantages/disadvantages of not doing so. For example, when choosing not to vaccinate oneself, as an individual you are not only putting yourself at higher risk of being infected, but you are reducing the effectiveness of herd immunity by lowering vaccination rates which could lead to an increase in transmission rate within a population. This could have further negative impacts in society, since if you are not only increasing the probability of other people catching a particular disease but also should you get infected, resources will be directed to help treat your otherwise preventable illness when it, in fact, they could be allocated to individuals who need them more. The allocation of resources in a fair and equal manner (justice) is pertinent not only to NHS values but should also be considered when choosing not to be vaccinated.
Another concern regarding the adoption of an anti-vaccination stance is that should an individual who chooses not to have the Measles vaccine become infected, it is possible that 11-73% of their existing antibodies will be wiped out. Since the measles vaccine is capable of causing immune amnesia, the prospect of this could undermine developments in public health interventions to increase our protection as a society against disease. Should this occur, this will undermine resources and time spent into the provision of healthcare and could lead to a rise in endemics.
In conclusion, there is a range of factors concerning the decision of whether to vaccinate one’s child against measles or not. From the perspective of a healthcare advisor, the best steps to take would be to ensure Mary and Joe are adequately informed of the advantages and disadvantages of vaccinating their child- as well as the consequences of the decisions they make. Overall, information should be presented in a clear, balanced manner so that they feel they are in a position to make a well-informed decision for Matty.