1997_02_february_leader27feb immunisation

Australia has one of the lowest immunisation rates for the major childhood diseases in the developed world. Indeed, it is much lower than many Third World countries. As a result Australian children are needlessly suffering and dying.

They are suffering and dying though bigotry, hysteria, ignorance and apathy. There is not a great deal that can be done about bigotry. And provided that it is restricted to only 2 or 3 per cent of parents it will not matter much in overall community protection against disease. But when combined with hysteria, ignorance and apathy resulting in immunisation levels at only 52 per cent, the risk of outbreak of disease, and even epidemic, is unacceptably high.

Something has to be done. So it is welcome that Federal Health Minister Michael Wooldridge has done something. He is to withhold $200 of the maternity allowance, child-care assistance and the child-care cash rebate until immunisation certificates are produced.

The program is more creditable for the government in that it has put three major Coalition shibboleths aside in the interests of children’s health. It has seen that handing administration back to the states, as was done with immunisation, results in slackness and incompetence. It has acknowledged that giving parents the rights to do what they like with their children is not in the best interests of children. And it has acknowledged that freedom of choice is not the best policy when dealing with public health. Those methods have failed and it is time for a hefty dose of federal intervention, subjugation of parental rights to the duty of government to look after children and a bit of quasi-compulsion.

The monetary incentive is an excellent way to overcome the problem of apathy.

It is hard to say what percentage of the 48 per cent of children not fully vaccinated will be picked up by that action alone, but it should be substantial.

Ignorance and hysteria are harder to deal with. The fears that a few parents have about immunisation are misguided but understandable. The trouble is that television, the medium of emotion, plays on the fears. It means that anecdote triumphs over science. Further, a lot of parents do not understand the nature of risk and in any event are much more prepared to accept the risks generated by nature than risks generated by human intervention.

We have to be plain; there is a risk in immunisation, as with virtually every voluntary action. It is in the nature of the procedure. But risks have to be balanced. The Sabin polio vaccine causes about one case of paralysis every 3 million vaccinations. There has been only one such case in Australia. The reason is that the Sabin vaccine is a live one, containing a variant of the real polio virus, which can mutate in very rare cases back to the virulent form. The advantage, though, is that it is oral, cheap and more effective than the other form of vaccine, the killed version.

There is also a slight risk of encephalitis and brain damage from the whooping cough vaccine, but it is far outweighed by the advantages. The British experience is instructive. In the 1960s immunisation rate was a 80 per cent and cases of the disease were rare and there were no fatalities. In the early 1970s a television program on the rare brain damage cases saw immunisation rates fall to 30 per cent and in the next decade the disease itself was caught by 50,000 children causing 29 deaths and hundreds of cases of brain damage.

There are also some minor side effects, like soreness or dizziness. But the benefits of immunisation overwhelmingly outweigh the disadvantages.

It may well be that if every child in Australia except one is vaccinated, that one unvaccinated children (relying on the protection given by others against the diseases themselves) is better off not being vaccinated. But that is not the situation in Australia. As soon as more than a few per cent are unvaccinated the risks of a not being vaccinated and succumbing to disease far outweigh the risk of vaccination. The risk of vaccination is so minuscule it can be out aside. That being the case, Dr Wooldridge is quite right to start waving the financial stick.

But an education scheme is needed, too. This will help overcome the hysteria generated by media beat-ups and foolish letter writers. These cannot be ignored; that is shown by the fact of Australia’s low immunisation rate.

Education will put the isolated case of adverse reaction into perspective. It will also quell the “”after this therefore because of this” fallacy. Virtually any illness suffered by a child after immunisation will be blamed by parents on the immunisation. And as parents are being especially watchful at this time of a child’s life, a lot of things will be wrongly ascribed to the effects of immunisation. In any given two days, about one child in 5000 has a fit of some sort. If that happens after immunisation, parents immediately blame the immunisation and usually are very noisy about it.

Experience shows education can be helpful, but will not entirely overcome ignorance and will certainly not overcome bigotry. Indeed, bigotry will not be overcome, but it must be isolated. To that end Dr Wooldridge’s idea of permitting parents with conscientious objection to retain their government allowances is sensible, provided they certify a doctor has explained the risks to them. That way they do not become publicity seeking martyrs.

If non-immunisation could be contracted to only the bigots, Australian children will be almost completely protected. At present they are very vulnerable, to the shame of both parents and health authorities alike.

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