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Measles outbreak: Should we pay doctors to track down unvaccinated children?

Australian doctors receive payments to track down and vaccinate children who are more than two months overdue for their vaccines, writes Jennifer Whitmore.

Jennifer Whitmore Social Democrat Councillor and Cathaoirleach of Greystones Municipal District

ANY PARENT WHO has ever fretted over a hot and bothered child with a skin rash must shudder to hear about the latest measles outbreak in Dublin and Meath.

There’s nothing like reports of a highly contagious virus on the loose to set media and social media channels abuzz, with both experts and angry parents telling us Get Your Children Immunised.

Good reason for panic

There’s good reason for the sense of panic – at least 95% of people in our population must be vaccinated to stop the spread of measles, a threshold known as “herd immunity”.

But beyond finger-wagging, what are we to do about those people who, for whatever reasons, are just negligent or deaf to medical science, or are part of the global family of anti-vaxxers?

When my youngest children were born, I lived in Australia where parents received a modest payment if they get their children vaccinated on time, and keep up with vaccines.

Not only that, but Australia has a rule that children cannot enrol in pre-school and primary school without evidence that they have received the required vaccines. The “no jab, no play” rule is strictly enforced and only immunisation history statements from the Australian Immunisation Register are accepted as evidence of a medical reason for a child not to be immunised.

No jabs, no pay

Last year, Australia introduced another incentive, this time for health professionals. Nurses and doctors who provide immunisations receive payments to track down and vaccinate children who are more than two months overdue for their vaccines.

It also has a “no jabs, no pay” law, withdrawing child benefits from parents who do not vaccinate, unless they have sound medical reasons.

For even the most diligent of parents, it can be hard to keep track of your children’s vaccines, especially if, like me, you repeatedly misplace the vaccination booklet and have to rely on calls to your GP or health centre to fill in the blanks.

Surprisingly, there is no national database for immunisation records in Ireland. According to the HSE website, vaccines given by GPs and HSE doctors and nurses are held in local health offices, which you have to contact to request a copy of your records.

Surely it would make sense to set up a National Vaccination Register, similar to that in Australia, to collect vaccine information on each person from birth onwards, including flu jabs and other vaccines adults may require, particularly as we get older.

Allowing professionals to monitor uptake rates

A national register would also be a valuable resource for our health authorities, allowing them to monitor vaccine uptakes rates on a geographic and demographic basis. This would enable an early detection system to operate – if a pattern emerged that vaccine uptakes in Meath were low, then parents of children there could be quickly targeted with public health messages.

It would mean parents and patients, as well as health professionals, could log on to check vaccination records, much in the same way as the Revenue’s online database works for self-employed people.

While many of us might instinctively favour the use of the stick rather than the carrot to ensure the vital “herd immunity” against diseases like measles, there is worrying evidence internationally that strict rules may harden anti-vaccine attitudes.

Parents may bristle at what can be viewed as a dismissive response from authorities, especially if their concerns and prejudices are amplified through social media. Public confidence can also be badly shaken public-health mis-steps – we had a flavour of this in 2009 with the outbreak of the H1N1 swine flu pandemic.

Scare stories will always be with us

Of course, vaccine scare stories and anti-vaxxers will always be with us, as we see with the well organised opposition here to MMR (in the mistaken belief that it has links to autism) and the cervical cancer jabs for girls. What else can account for the fact that some western countries have lower vaccination rates than poor parts of Africa?

Figures from The Economist show that Eritrea, Rwanda and Sri Lanka manage to vaccinate nearly everyone. By contrast several rich countries, including America, Britain, France and Italy, are below herd immunity. This low vaccination trend worldwide is most evident for measles, which makes the recent outbreak in Dublin and Meath all the more worrying.

Vaccination statistics for Ireland show that the national MMR vaccine update rate in 2016 was 92%, according to HPSC figures, but this does vary considerably across regions.

We can learn from other countries

In the past few days, Ann Hogan, a leading Irish doctor and President of the Irish Medical Organisation, called for a campaign to promote the measles vaccine after it was revealed the Dublin North area, which is currently experiencing an outbreak, has a low uptake rate of only 82%, well below the 95% required for herd immunity.

It would be awful to think that we might be facing the return of easily preventable disease that had all but disappeared.

What’s clear is that there are many different approaches available and we can learn from the experiences of other countries. And it is vital that any government information campaign is aimed at boosting confidence in the safety of vaccines and trust in the authorities that recommend them.

Jennifer Whitmore is the Social Democrats Spokesperson for Children and Wicklow County Councillor.

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http://www.thejournal.ie/readme/column-how-has-a-major-medieval-abbey-in-the-centre-of-dublin-been-virtually-forgotten-3702243-Nov2017/

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About the author:

Jennifer Whitmore  / Social Democrat Councillor and Cathaoirleach of Greystones Municipal District

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