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[OPINION] No vaccination, no education: A fair trade?

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In a statement on February 22, the Department of Education (DepEd) brought to light a Department of Health (DOH) proposal to implement a "no vaccination, no enrollment" policy in public schools. This proposal was made in response to several measles outbreaks throughout the country attributed to falling vaccination rates in the wake of the Dengvaxia scare in November 2017.

DepEd has said that in its review of the proposal, it will take into consideration whether such a policy would breach children’s right of access to education. This right, however, is not absolute. On the grounds of public safety and the protection of others’ rights, limiting unvaccinated children’s right of access to education is justified.

Such a policy, however, should be complemented with measures to improve access to vaccination services, to institute effective reminder and recall systems, and to rebuild parents’ trust and confidence in vaccination.

Herd immunity: Protecting the vulnerable

Vaccination is not simply a matter of individual health but one of public health. Simply put, the more people who are immunized against a certain disease, the less chance there will be of an outbreak of that disease. When the disease cannot infect enough hosts to be able to establish a foothold, it will eventually be eradicated. This is what is called "herd immunity."

Herd immunity is particularly important given that there is always some part of the population that cannot be vaccinated, such as people with severe allergies and compromised immune systems. These people are especially vulnerable to infection, but if the disease cannot make its way to them because of a highly vaccinated population, then these vulnerable people can be adequately protected.

Children who are unvaccinated (without valid health reasons) pose a threat to herd immunity in school communities, which compromises public safety and endangers people who are vulnerable to infection through no fault of their own. This provides sufficient grounds to refuse these unvaccinated children from entering the school community.

A "no vaccination, no enrollment" policy by itself, however, does not get to the root of the problem. In order to do so, we need to know why the vaccination rate is so low in the first place.

Why do people not vaccinate? A closer look

The DOH Monthly Surveillance Report for Vaccine Preventable Diseases includes data on reasons for non-vaccination among confirmed measles cases. This is a valuable starting point for policymakers to craft a comprehensive plan of action.

Almost 45% of non-vaccinated measles patients gave reasons involving conflict in schedule. Specifically, these reasons were “mother was busy” (20%), “child was sick” (13%) and “forgot the schedule” (about 10%). Reminder and recall systems, such as sending automated text messages to parents whose children are due or overdue for vaccinations, could be effective solutions to address these problems.

Another 15% of patients cited “fear of side effects” (10%) and “against belief” (about 5%) as their reasons for non-vaccination. These are particularly tricky issues to address, but without regaining people’s trust in vaccines, even the most effective solution would run into a wall.

The DOH is currently working on an immunization communications campaigns program with the help of the Presidential Communications Operations Office (PCOO). Enabling primary health care professionals to effectively engage with people with anti-vaccination views is also essential.

Finally, about 10% cited “difficult access to health services“ as their reason for non-vaccination. Measures are already being undertaken to address this, such as conducting a mass immunization campaign throughout the country. An interesting policy proposal for the longer term is to allow pharmacists, who are the most visited health care professionals, to administer vaccines.

What about the other 30%? They are the unvaccinated measles patients who were “not eligible for vaccination” because of certain medical conditions such as severe allergies or compromised immune systems. They are made vulnerable to diseases through no fault of their own, and badly need the protection of herd immunity.

The DOH and DepEd proposal of withholding education from unvaccinated children (without valid health reasons), while justifiable, is only a reactive response to the current crisis at hand. More long-term and systemic solutions must also be pursued to prevent future ones from happening. –

Erica Celine Yu is a Research Master student in Philosophy and Economics at Erasmus University Rotterdam, the Netherlands. Previously, she worked as a data analyst for a healthcare technology company.