The number of measles cases in Malaysia increased about 10 times, from 195 cases in 2013 to 1,934 cases in 2018, with six deaths in 2018, all of which were not immunized.
Meanwhile, the number of cases that did not receive measles vaccination increased about 11.7 times, from 125 in 2013 to 1467 in 2018.
Measles infections have also increased in many countries in recent years, p. Singapore, Indonesia and the Philippines in Asean, and many developed countries.
In addition, diphtheria cases in Malaysia increased from four cases in 2013 to 32 cases in 2017 and 18 cases in 2018, with five deaths in 2018, four of which were not immunized.
Cases of pertussis have fluctuated between 222 in 2013, 939 in 2015, 353 in 2017 and 892 in 2018, with 22 deaths in 2018, of which 19 were not immunized.
Vaccine refusals in Malaysia increased from 637 in 2013 to 1,603 in 2016 and 1,404 in 2017.
According to the World Health Organization (WHO), one of the ten threats to global health in 2019 is vaccine hesitancy, that is, reluctance or refusal to vaccinate despite the availability of vaccines, which threaten to reverse progress in the treatment of preventable diseases By vaccination.
One proposed intervention for this problem is mandatory vaccination – an approach that has been debated on a perennial basis and is currently being studied by our Ministry of Health.
Proponents of mandatory vaccination often cite and extrapolate the dramatic positive impact of the smoking ban and the use of car safety belts on public health and safety.
On the other hand, there is a lack of evidence on the efficacy of mandatory vaccination.
Vaccination saves lives
Vaccines are one of the most effective public health interventions, saving lives and improving health. Only clean water worked better.
Vaccines eradicated smallpox and nearly eradicated poliomyelitis. However, vaccine-preventable diseases have not disappeared.
According to Shot @ Life, a grassroots advocacy campaign of the United Nations Foundation, vaccines save 2.5 million children annually from preventable diseases, or about 285 children every hour.
When a critical percentage of a population is vaccinated against a contagious disease, an outbreak is unlikely to occur, so most members of the community will be protected – this is known as herd immunity.
A population that can not be immunized for medical reasons relies on collective immunity to prevent its infection by diseases preventable by vaccination.
As vaccines controlled and eradicated the disease, the devastating effects of vaccine-preventable diseases disappeared from human understanding.
Vaccine hesitancy is due in part to concerns about vaccine safety, displaced anxiety, or safety concerns about vaccines over and above concerns about the disease itself.
Declines in vaccination rates will lead to a resurgence of vaccine-preventable diseases.
Low national coverage, or even small pockets of low coverage within a country, has led to large outbreaks of measles and diphtheria, causing many deaths and disabilities in many countries in the last decade.
For compulsory vaccination
All 50 states in the United States require that all children over five years of age have been immunized prior to admission to school.
However, all states have exceptions based on medical and religious motives, and some based on philosophical objections.
Some children are immunized only when they start school.
States with stricter laws have lower rates of pertussis (also known as whooping cough) and measles, suggesting that mandatory vaccination can be effective.
Compliance with Australian child vaccination programs has been associated with pre-school admission (ie "no kidding, no play") and family assistance payments (eg "do not practice, do not pay").
Most governments and international medical organizations say vaccines are safe because the ingredients in them are safe in the amount used.
Adverse reactions to vaccines are extremely rare. The most common adverse reaction, i.e. a serious allergic reaction known clinically as anaphylaxis, occurs in about one by several hundreds of thousands to one per one million vaccinations.
There is a difference between association and causation.
Combined vaccines such as mumps, measles and rubella (MMR) have been used since the 1940s, with no adverse effects.
There is no evidence that the MMR vaccine causes autism, or that diphtheria, tetanus, and acellular pertussis (DTaP) vaccine causes diabetes; or that the dead influenza vaccine causes paralysis of the seventh cranial nerve (Bell) or precipitates asthma.
Against compulsory vaccination
There are many countries that have high vaccination rates, although vaccination is voluntary, and. United Kingdom and Finland.
The US Centers for Disease Control and Prevention (CDC) estimates that the risk of anaphylaxis is one to one million children, or about the same risk of being harmed by flying in an airplane.
According to the National Vaccine Information Center, a US organization dedicated to preventing vaccine injuries and deaths, vaccines may be linked to learning disabilities, asthma, autism, diabetes, chronic inflammation and other disabilities.
The rarity of seizures, coma and brain damage attributed to DTaP and MMR vaccines make it difficult to determine the cause.
According to the US CDC, there are extremely rare reports of severe rash, pneumonia, hepatitis, meningitis, seizures, or general severe infection with the chickenpox virus strain, while reports of the association between influenza vaccine and Gullain's syndrome -Barre – an affliction of the peripheral nervous system – have changed from season to season.
There are claims that some of the vaccines contain harmful ingredients, thimerosal, aluminum and glutaraldehyde.
Other arguments include the violation of personal rights of choice and religion, that vaccines are not natural, that the infection produces more effective immunity, that vaccine-preventable diseases have almost disappeared, and that most vaccine-preventable diseases are relatively harmless.
There are counterarguments on both sides of the debate.
The basic issue to be addressed is the objectives of the vaccination policy. Is it individual or collective immunity (vaccine uptake), or is it the eradication of the disease?
Where is the balance between individual rights and social goals?
There are legal, ethical and public health implications for mandatory vaccination.
If there is mandatory vaccination, which vaccine-preventable diseases would be included? How will this be applied with the growing number of children involved in domestic education?
What are the reasons for the exclusion? What are the penalties for non-compliance?
If a child experiences an adverse event near the date of vaccination, would the government be responsible?
There is scant evidence of the benefits of mandatory vaccination, which may have unintended consequences, such as strengthening anti-vaccine sentiment, as in Italy.
If exclusions are allowed for religious and philosophical reasons, they would be difficult to administer and, if allowed, would reduce the effectiveness of mandatory vaccination.
The European Union Assets Project has not found a clear link between compulsory vaccination and the adoption of vaccines.
The experts' position was that mandatory vaccination could solve a short-term problem, but it is not a long-term solution.
Better organization of health systems and strong communication strategies can be more effective.
The research findings suggest that vaccination rates among hesitant parents in vaccines have improved when they have had discussions with trusted health professionals.
Easy access to vaccines and health care is vital, as the parents of many children who were not vaccinated were not vaccinating, but had difficulty in obtaining convenient consultations or were not reminded when their children were to be vaccinated.
In short, vaccine hesitancy must be addressed by education, not coercion, which can have unintended consequences.
In this regard, general practitioners (GPs) play a critical role in their close relationships with parents in their community.
Dr. Milton Lum is a past president of the Federation of Private Medical Associations and the Malaysian Medical Association. The opinions expressed do not represent the organizations with which the writer is associated. The information provided is for educational and communication purposes only and should not be construed as personal medical advice. The information published in this article is not intended to replace, supersede or increase a consultation with a healthcare professional regarding the reader's medical care. Star disclaims any liability for any loss, damage to property or personal injury suffered directly or indirectly by reliance on such information.