The great vaccination debate

Some parents are deciding not to have their children immunised, but the World Bank believes that after clean water, immunisation is the most cost-effective public health measure available.

EVERY few years vaccinations get a bad press. This time, the deaths of a number of babies within a week of receiving the DPT (diphtheria, pertussis, tetanus) immunisations recently caused alarm and much press coverage. Yet, many of the articles emphasised that vaccination prevents more than three million deaths a year worldwide (according to World Health Organisation estimates).

”Only a small part of a virus is used to make a vaccine,” explains Neil Cameron, director of the Communicable Disease Control Centre of the national Department of Health. ”This is either killed or weakened — so as not to [cause] disease — and turned into an antigen. Antigens stimulate the immune system to produce antibodies.”

Cameron does not believe that the recent deaths were linked to vaccines. The company which supplies the DPT vaccine, which now includes the Haemophilus influenza (Hib) vaccine, claims it has had no adverse reactions from the 23-million doses administered. However, many medical researchers have found links between vaccines and convulsions, brain damage, neurological problems, auto-immune diseases and deaths.

This has led some parents to question the wisdom of routine immunisations and even refuse them. But what happens when a child gets to school age? Many people believe that vaccinations are compulsory by law and that vaccination certificates are a condition of school admission. ”This is not true,” says naturopath Mary-Ann Shearer.

In South Africa, vaccination is voluntary, although strongly recommended.

The national schools’ admissions policy lists the immunisation card as one of the documents learners must submit at registration, but it does not say that acceptance to school is dependent on immunisation.

Instead, it states that if any of the required documents are missing, the child must still be registered and the principal must help the family obtain the missing paperwork. The rights of a learner to register are strong — for example, even if a learner cannot pay school fees he or she must still be accepted to school. A child cannot be refused admission if he or she rejects the school’s ”code of conduct”. Being immunised could be part of such a code of conduct.

According to the legal department at the national Department of Education, an unimmunised child’s right to attend a school has never been formally tested. However, the right to practise one’s belief or religion — even if it contradicts the school’s code of conduct — has been legally tested in terms of the South African Schools Act of 1996. These cases have shown that the Constitution is considered binding and the fundamental rights of children as enshrined in the Bill of Rights, come first. School codes of conduct are secondary to the Constitution and must be based upon it: they cannot contain provisions that contradict the Constitution.

The relevant section in the case of immunisation is the Equality subsection (3) under the Bill of Rights: neither ”the State” nor ”any person” may ”unfairly discriminate, directly or indirectly, against anyone on one or more grounds” including ”religion”, ”conscience” and ”belief”. The latter are grounds on which people may refuse vaccination.

Urging principals to ask for vaccination certificates provides a safety net: to find unvaccinated children and have the principal exert influence on parents, explains Cameron. The success of any vaccination programme depends on the coverage. The more people who are vaccinated, the more people are protected, even unvaccinated adults. Cameron estimates about an 80% vaccination coverage in South Africa.

”These days, we don’t see diphtheria, polio and measles in hospitals anymore,” Cameron says. ”The World Bank has said that after clean water, immunisation is the most cost-effective public health measure available.”

Is there a risk to school when unimmunised children are admitted? Those who are pro- vaccination are fond of quoting examples of church groups which refuse vaccinations and then suffer polio epidemics. They also point to schools in the United States that insist on vaccination as a condition of acceptance because measles epidemics have disrupted classes. At the same time, those against vaccination contend that vaccinations have actually caused polio, measles and diphtheria epidemics — numerous cases are cited by American author Neil Miller in Vaccines: Are They Really Safe and Effective? (New Atlantean Press, revised 1999).

Pharmacist Chamilla Sanua (owner of two Weleda pharmacies specialising in homeopathy) points out that if one believes in the efficacy of immunisation, immunised children should be in no danger of catching anything they have been immunised against. Homeopaths generally contend that immunisations suppress the immune system and that unimmunised children are likely to be healthier than immunised children.

German doctors Michaela Glockler and Wolfgang Goebel, the authors of A Guide to Child Health (Floris 1990), say the oral polio vaccine helps prevent epidemics but measles vaccinations may be ”antisocial”. In the US there are still epidemics in children who have been immunised. In addition, a second strain of measles was discovered which has called the entire immunisation programme into question. Also, epidemics of the severity of those recently experienced in the US were not known before the implementation of general immunisation.

In the US, vaccinations are compulsory. Why not in South Africa? Cameron believes that greatest coverage will be obtained from parents who value immunisation. He also says that compulsory vaccinations would make the state liable for damages. In the US, the National Childhood Vaccine Injury Act of 1986 officially recognises the reality of vaccine-caused injuries and death. It requires doctors to inform parents of risks and benefits beforehand and it awards up to $250 000 for death or brain damage caused by immunisation.

”In South Africa, the tuberculosis vaccine (BCG) and polio vaccine used to be compulsory (although one could get exemption on religious or health grounds),” says Cameron. In 1987, a new version of the communicable diseases regulations dropped the two compulsory requirements.

According to Miller the general public is unaware of the number of people killed or injured by the vaccines. The executive vice-president of the National Vaccine Information Centre in the US reports that every year about 12 000 children have adverse reactions to immunisation.

The South African government spends R60-million annually on Hib and DTP and R30-million on Hepatitis B, measles, polio and BCG.

— The Teacher/Mail & Guardian, April 5, 2000.

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