Mandatory vaccination – No, thank you!

My guest commentary (“Prize of hysteria”) in the Süddeutsche Zeitung on 3.13.2015.

It is as if we were in a madhouse: Politicians, Representatives of Medical Doctors, and the Media are outbidding each other with demands for a mandatory measles vaccination; Parents in Berlin are to stay at home with their infants; travel plans to Berlin are being cancelled. Some private nursery schools do not understand that measles is the only pertinent disease and have imposed mandatory vaccinations for everything, as a precautionary measure even for the sexually transmitted Hepatitis B.

Why this panic? Measles has existed as long as anyone can remember, and we had become relatively familiar with this disease. At the begging of the seventies most people had overcome measles by the age of ten. Therefore adult cases were extremely rare and infant illness had also become an exception due to the protection provided by the high antibody levels of mother’s. Complications were thus also very uncommon. Yet infections of the brain and fatalities with a frequency of 1:10,000 became increasingly unacceptable. After 1972 the rates of infection sustainably declined through the measles vaccination. Since 2004 there have been between 500 and 2,000 cases per year. Fatalities have only occurred in isolated cases and usually in the rare cases of an infant or adult infection.

Presently 97 percent of elementary school children have a single vaccination and 92 percent have a double vaccination. There is no sign that vaccination is being ignored. With the power of persuasion and clarification we could soon complete the goal of having widely curtailed measles without mandatory vaccination or monetary fines. I am working to be a part of achieving this goal in my Practice.

It is, however, clear that no vaccination strategy can accomplish the goal of a complete eradication of measles. There are not only those who are against vaccinations but also persons who do not respond to the vaccine. Both groups are probably equal in size, and together make up about ten percent of the population.

Even if you were to vaccinate 95 percent of the public about ten percent of every age group would be unprotected at an adult age and become sick upon contact with measles. Additionally, it is delusional to propose that we can perform double vaccinations on 95 percent of the world’s inhabitants: poverty, civil war, and failed states will always exist. Travelers, refugees, and migrants (as is the case in Berlin) carry the disease around the world. It can even return in communities that were thought to be immune for long periods of time.

At the very most we can curtail measles. The disease is part of the human destiny just like earthquakes and rainstorms. The question becomes: how far do we go with our human desire to feel safe about the general public’s health, and how much of our freedom are we willing to gamble with to attain it? Let us imagine a mandatory vaccination: What happens when parents refuse to vaccinate their children despite monetary fines? Will the police show up and tear crying children from their parent’s arms. What would this mean for our democratic values? What would be the long-term side effects?

In Western Germany it took us two decades to free ourselves from the muff of the authoritarian state. The legacy of the Kaiser Reich with it’s rigorous vaccination laws had long lasting influences, as did the mass vaccinations during the Third Reich as an orchestration of a common national health. Up until the sixties politicians spoke of the primacy of the “nation’s body” over the individuum.

A democratic civil society is based upon the values of freedom and self-determination. Freedom of choice also applies to the free, informed and individual choice on vaccination that is granted to each member of such a society. This is a right that we, as individuals, should not allow to be taken away from us.

Yet we do not even need to look to the constitution – human dignity, bodily integrity, right of self-determination – when considering whether we should accept those opposed to vaccination. We need these people, we need discussion, and we need non-conformists. Thanks to one of the opponents of vaccinations, the STIKO (Vaccine Commission) which until then operated in the pre-democratic shadows is now required to make public its protocols. Critical voices have ensured that the STIKO cannot wave through much longer vaccines without properly evaluating them.

Vaccine skepticism is not of ill will. In no other European country are vaccines recommended as numerous and early as they are in Germany. A proper medical consultation is no longer possible under these conditions. Vaccines are admitted on the fast track, risks are not investigated or not communicated. The constitutional lawyer Rüdiger Zuck finds the STIKO recommendations to be unconstitutional: The consideration between risks and benefits is not possible for the doctor or the patient, the government, therefore, does not meet the duty to protect the basic rights and safety of its citizens. Basically the STIKO seems to be overstrained and compromised by its ties to the pharmaceutical industry and should thus be disbanded and replaced by an “Agency for Prevention”. Its duties would be to professionally and independently examine vaccines and compare them against other preventative measures.

Those who demand vaccination should rather demand other compulsory measures: Reducing car travel, prohibition of tobacco and alcohol, and mandatory breast-feeding as this raises the life expectancy of a child. Do we want a Health dictatorship?

The same politicians that are for mandatory vaccinations are supporting the neoliberal restructuring of the healthcare system that is making hospitals ripe for attack. They want to impose free trade agreements and trade in services agreements that will permit the sale of hospitals to financial sharks and investors. The devastating influence this will have on working conditions and patient care are foreseeable. Nobody knows how many victims this will claim.

Doctors should also be careful with a call for a mandatory vaccination. First of all this is an admittance that we as doctors cannot build up a relationship of trust with our patients. Secondly our profession causes, through its eagerness to prescribe, properly taken (!) medications to become the third leading cause of death, as the Danish health expert Peter C. Gøtzsche calculates.

Back to vaccination: The will of the German government is that parents will have to console a doctor before their child is admitted in a day nursery. Why should they first do this then? According to the STIKO vaccinations should begin during the ninth week of life! And why are parents comitted, and not doctors? A detailed consultation about vaccinations with parents should be obligatory for doctors, but also be properly compensated. Currently doctors are only compensated if they vaccinate.

A lot could be done better, but not with a mandatory vaccination.

Martin Hirte

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