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Voluntary vaccination: the pandemic effect*

Published online by Cambridge University Press:  02 January 2018

Emma Cave
Emma Cave*
Affiliation:
Durham University
*
Emma Cave, Professor, Durham Law School, Durham University, The Palatine Centre, Stockton Road, Durham DH1 3LE, UK. Email: emma.cave@durham.ac.uk
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Abstract

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Justification of a voluntary vaccination policy in England and Wales rests on tenuous foundations. Two arguments against voluntary vaccination are gaining ground. The first is that globalisation necessitates preparedness strategies for pandemics. Assuming sufficient supply, compulsory vaccination of adults and children constitutes a potential policy option in the context of a severe, vaccine-preventable pandemic outbreak. The second argument is that children have a right to preventive medicine and thus to vaccination. The influence of the UN Convention on the Rights of the Child and its emphasis on parents as the trustees of their children's best interests, and the increasingly global nature of our collective and individual responsibilities with respect to the transmission of vaccine-preventable disease present challenges to the right to refuse vaccination on our own behalf and on behalf of our children. Exploring methods of compulsion and persuasion utilised across Europe, the USA and Australia, this paper argues that necessity and proportionality must be reassessed, and national public health law and policy setting out a graduated and proportionate approach to compulsory vaccination developed as a matter of priority.

Information

Type
Research Article
Information
Legal Studies , Volume 37 , Issue 2 , June 2017, pp. 279 - 304
Copyright
Copyright © Society of Legal Scholars 2017

Footnotes

*

I am most grateful to the reviewers for their helpful comments.

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13. Or injured by vaccination in pregnancy: Vaccine Damage Payments Act 1979, s 1(3) and the Vaccine Damage Payments Regulations SI 1979/432, reg 5A. Serious disablement is defined as ‘disablement to the extent of 60% or more, assessed as for the purposes of s 103 of the Social Security Contributions and Benefits Act 1922 or s 103 of the Social Security Contributions and Benefits (Northern Ireland) Act 1992 (disablement gratuity and pension)’. The list of relevant vaccines is regularly updated. Most recently, rotavirus and influenza (other than influenza caused by a pandemic influenza virus) were added by the Vaccine Damage Payments (Specified Disease) Order 2015, SI 2015/47.

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31. Ibid.

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34. Such policies are fiercely opposed. See eg the Canadian case of Clowes v Edmonton School District No. 7, 1915 CarswellAlta 56 Alberta Supreme Court, where it was held that regulations issued under the Public Health Act, s 68 requiring that no pupil could be admitted to school without proof of vaccination, were ultra vires due to conflict with the Truancy Act requirement that all children attend school.

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56. Ibid, at 49.

57. Coggon, above n 47, p 133.

58. Ibid.

59. Cooney, above n 41.

60. The new law would not compel ‘those who are honestly opposed to the practice to submit their children to vaccination, and, at the same time, leave the law to operate, as at present, to prevent children remaining unvaccinated owing to the neglect or indifference of the parent’. Ibid, at 524.

61. Herschell, above n 43, para 510.

62. Dissent of Collins and Picton, Alanson Report of the Royal Commission Appointed to Inquire into the Subject of Vaccination (London: HMSO, 1889–1897) para 296. And see para 300: ‘We believe the methods of isolation of the infected, disinfection, and the observance of strict cleanliness are both more successful and more legitimate methods for the State to encourage. They have the advantage of applying the preventive only where it is required: and they do not necessitate an operation upon the person of every health individual.’

63. Ibid, para 301.

64. Ibid, para 302.

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73. WHO Statement ‘Statement on the 1st meeting of the IHR 2005 Emergency Committee on Zika virus and observed increase in neurological disorders and neonatal malformations’ (8 April 2016), available at http://www.who.int/mediacentre/news/statements/2016/1st-emergency-committee-zika/en/ (accessed 12 June 2016).

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76. See Gostin et al, above n 37.

77. See The Centre for Law and the Public's Health ‘The Model State Emergency Health Powers Act’ (15 July 2006), available at http://www.publichealthlaw.net/ModelLaws/MSEHPA.php (accessed 12 June 2016), which reported that the Act was introduced in whole or part in 44 states.

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80. WHO International Health Regulations (Geneva: WHO, 2005, updated 2008), available at http://apps.who.int/iris/bitstream/10665/43883/1/9789241580410_eng.pdf (accessed 12 June 2016).

81. Ibid.

82. Ibid, para 9. And see Art 12 on ‘determination of a public health emergency of international concern’.

83. Ibid, and see Arts 15, 48 and 49.

84. Ibid, Art 18(1).

85. HM Government, above n 66, para 4.1.

86. Civil Contingencies Act 2004. And see England, NHS Emergency Preparedness, Resilience and Response Framework (Leeds: NHS England, 2015).

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89. SI 2009/38.

90. JCVI Code of Practice (2013), paras 61 and 66.

91. Ibid, para 5.140.

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104. Presidential Commission for the Study of Bioethical Issues Ethics and Ebola Public Health Planning and Response (Washington, DC, February 2015) p 26.

105. Ibid, pp 27–28.

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112. HM Government, above n 66, para 3.17.

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115. As amended by the Health and Social Care Act 2008.

116. Health Protection (Notification) Regulations 2010, SI 2010/659, Sch 1.

117. Health Protection (Local Authority Powers) Regulations 2010, SI 2010/657, reg 2.

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125. Law Commission, above n 122.

126. Ibid, para 6.5.

127. See Gostin, L ‘The politics of AIDS: compulsory state powers, public health and civil liberties’ (1989) 49 Ohio St L J 1017 at 1051. Note that the Crown Prosecution Service Intentional or Reckless Sexual Transmission of Infection Guidance (London: CPS, 2012) advises: ‘Those who choose not to be tested will not necessarily avoid prosecution for the reckless transmission of a sexually transmissible infection if all the circumstances point to the fact that they knew that they were infected.’

128. Brazier and Harris, above n 119, at 182.

129. Glover-Thomas, N and Holm, S ‘Compulsory vaccination: going beyond a civic duty?’ in Stanton, C et al Pioneering Healthcare Law: Essays in Honour of Margaret Brazier (London: Routledge, 2016) p 35 .

130. Department of Health The NHS Constitution (London: DH, 2015): ‘3b Patients and the Public: Your Responsibilities, ‘Please participate in important public health programmes such as vaccination.’

131. Department of Health News ‘New social contract between the public, health and care services’ (15 July 2015), available at https://www.gov.uk/government/news/new-social-contract-between-the-public-health-and-care-services (accessed 12 June 2016).

132. For a fuller account of the criminalisation of disease transmission (from multidisciplinary and international perspectives), see Stanton, C and Quirk, H (eds) Criminalising Contagion: Legal and Ethical Challenges of Disease Transmission and the Criminal Law (Cambridge, UK: Cambridge University Press, 2016).

133. Brazier and Harris, above n 119, p 183.

134. Jordan, W ‘Majority want compulsory vaccinations’ (YouGov, 2013), available at https://yougov.co.uk/news/2013/04/11/majority-support-compulsory-vaccinations/ (accessed 12 June 2016).

135. Montgomery v Lanarkshire Health Board [2015] UKSC 11, at [108] per Lady Hale; at [80] per Lord Kerr and Lord Reed.

136. Children Act 1989, s 3(1).

137. An NHS Trust v MB [2006] EWHC 507 (Fam), at [107] per Holman J: ‘[Parental] wishes, however understandable in human terms, are wholly irrelevant to consideration of the objective best interests of the child save to the extent in any given case that they may illuminate the quality and value to the child of the child/parent relationship.’

138. Children and Young Persons Act 1933, s 1(1).

139. R v Lowe [1973] QB 702.

140. Children Act 1989, s 31(2).

141. Re Ashya King (A Child) [2014] EWHC 2964 (Fam), at [31].

142. The NHS Trust v A [2007] EWHC 1744, at [16] per Holman J.

143. See Re C (Welfare of Children: Immunisation) [2003] 2 FLR 1095, at [22] per Thorpe J.

144. [2003] 2 FLR 1095, CA.

145. [2011] EWHC 4033.

146. [2013] EWHC 2683. And see London Borough of Newham v KA (Mother) & Ors [2016] EWFC B11, per Carol Atkinson J, at [117]–[118].

147. [2013] EWHC 2683, at [5].

148. Cave, E ‘Adolescent refusal of MMR inoculation: F (Mother) v F (Father) [2013] EWHC 2683 (Fam)’ (2014) 77(4) Mod L Rev 630 .

149. RK and AK v the United Kingdom (no 38000/05), ECtHR, 30 September 2008.

150. Rights of Children and Young Persons (Wales) Measure 2011, s 1.

151. As opposed to human rights that apply to children: see Ferguson, L ‘Not merely rights for children but children's rights: the theory gap and the assumption of the importance of children's rights’ (2013) 21 Int'l J Children's Rts 177 .

152. UN CRC 1989, Arts 24(2)(a) and 24(2)(f).

153. See Engelhardt, JT Jr ‘Beyond the best interests of children: four views of the family and of foundational disagreements regarding pediatric decision making’ (2010) 35(5) J Med & Phil 499 .

154. Children Act 1989, s 1(1): ‘When a court determines any question with respect to – (a) the upbringing of a child; or (b) the administration of a child's property or the application of any income arising from it, the child's welfare shall be the court's paramount consideration.’

155. R (HH) v Deputy Prosecutor of the Italian Republic, Genoa; and two other cases [2012] UKSC 25, at [15] per Lady Hale; R (on the application of SG) and Others v Secretary of State for Work and Pensions [2015] UKSC 16, at [256].

156. Engelhardt, above n 153.

157. Pandemic Influenza Preparedness Team Factors Associated with Uptake of Vaccination Against Pandemic Influenza (London: Department of Health, 2011) p 25 .

158. Ibid.

159. WHO, above n 80.

160. Public Health England, above n 16.

161. CRIN ‘Compulsory vaccinations’ (CRINMail 1435, 1 July 2015).

162. CRIN ‘Mandatory vaccinations’ (CRINMail 34, 22 April 2014).

163. Editorial ‘Court: health ministry can continue with mandatory child vaccination’ Prague Daily Monitor 24 February 2015, available at http://www.praguemonitor.com/2015/02/24/court-health-ministry-free-order-child-vaccination (accessed 12 June 2016).

164. CRIN ‘Compulsory vaccinations’ (CRINMail 1435, 1 July 2015); Editorial, ‘Parental permission not needed for child vaccination, top court rules’ Hurriyet Daily News Turkey 22 June 2015, available at http://www.hurriyetdailynews.com/parental-permission-not-needed-for-child-vaccination-top-court-rules-.aspx?pageID=238&nid=84292 (accessed 12 June 2016).

165. Editorial ‘Parental consent needed for vaccination: Turkey's top court’ Hurriyet Daily News Turkey 16 November 2015, available at http://www.hurriyetdailynews.com/parental-consent-needed-for-vaccination-turkeys-top-court.aspx?pageID=238&nID=91200&NewsCatID=373 (accessed 12 June 2016).

166. Data Team ‘Ebola in graphics: the toll of a tragedy’ The Economist 30 December 2015.

167. The development process was escalated and recent Phase III trials point to a highly efficacious candidate: Henao-Restrepo, AM et al ‘Efficacy and effectiveness of an rVSV-vectored vaccine expressing Ebola surface glycoprotein: interim results from the Guinea ring vaccination cluster-randomised trial’ (2015) 386(9996) Lancet 857 ; WHO ‘News release: World on the verge of an effective Ebola vaccine’ (31 July 2015), available at http://www.who.int/mediacentre/news/releases/2015/effective-ebola-vaccine/en/ (accessed 12 June 2016).

168. Considerable debate surrounds the equitable distribution of scare resources in a pandemic. See eg McLachlan, HV ‘A proposed non-consequentialist policy for the ethical distribution of scarce vaccination in the face of an influence pandemic’ (2012) 38 J Med Ethics 317 .

169. Department of Health and The Rt Hon Jeremy Hunt MP New Social Contract Between the Public, Health and Care Services (London: DH, 2015).

170. Department of Health, above n 130.

171. See eg Booy, R et al ‘Mandating influenza vaccination in health-care workers’ (2011) 378(9803) Lancet 1626 .

172. ‘Should childhood vaccination be mandatory?’ BMJ.com (14 May 2012), available at http://www.bmj.com/press-releases/2012/05/14/should-childhood-vaccination-be-mandatory (accessed 12 June 2016).

* I am most grateful to the reviewers for their helpful comments.