Viva Vitality Column: Immunization

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    by Dr. Lena Derie-Gillespie

    I spend a lot of my time talking about immunization. I talk about the benefits, I talk about the risks, I talk about the history and I talk about the evidence. I talk and talk and honestly, I am getting sick of the sound of my own voice.

    Immunization remains a hot topic and one which still seems to divide people. It can divide patients from their caregivers, friends from friends and even family members. I hear a lot of frustration voiced regarding vaccine refusal or avoidance and also a lot of mistrust on both sides.  This frustration often boils over into discussion of the merits of “mandatory vaccination,” and even I bristle at bit at that word choice.

    We live in a free and democratic society which respects autonomy and thus, I think the idea of “mandatory” is a falsehood.  We will never be tying people to beds and forcibly vaccinating them against their express refusal.  It won’t happen, so let’s stop saying “mandatory.”  I think we need to re-frame the discussion to focus on consequences.

    The idea of consequences related to vaccinations may sound obvious; if you don’t get vaccinated you increase your risk of disease. Obvious, right?  True, but getting disease is not the only consequence of importance when deciding whether or not to vaccinate. For too long I think the threat of natural disease has been the only focus of education and discussion regarding vaccination and I think we need to broaden the conversation.

    In some locations there are schools/daycares that require vaccination, thus, the consequence of not vaccinating is not attending. Such restriction does not amount to mandatory vaccination; it amounts to knowing the potential outcomes of a decision and weighing those factors when reaching a decision.

    Medical Officers of Health can exclude people from their occupations or school in certain cases if such action is required to control a disease.  Therefore, if you chose not to be vaccinated you could be legally excluded from working and that would be a consequence of your decision. I as a Medical Officer of Health am not “forcing” you to be vaccinating. You are “choosing” what is more important to you – the ability to work or your decision not to be vaccinated. If we want society to respect our autonomy to make decisions for ourselves, then we need to take responsibility for the outcomes of those decisions.

    For a consequence to affect behavior it must be known ahead of time, be related to the behavior of interest and be applied consistently.  Anyone who has trained an animal (or raised a child for that matter) understands where I am coming from. As such I think it is important we avoid blame and recrimination when we talk about the consequences of not vaccinating, and approach it as a practical matter. If you have a newborn infant at home and choose not to have un-vaccinated people visit your infant, you are setting the consequences for choosing not to vaccinate (at least in a confined population). If this stipulation is communicated clearly to your friends and family and enforced, it will then be their decision as to what their behavioral choice will be.

    So I encourage everyone to reframe the conversation away from “mandatory” vaccination and towards a conversation of appropriate consequences for vaccination decisions. When you hear me talking on and on about immunization, know my goal is to arm you with evidence-based benefit data and also legitimate consequences information so you can make an informed choice.

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