In 2019, in response to waning numbers of young Italians being vaccinated, the Italian government introduced legislation to make vaccinations for school children compulsory. As a result, last year saw the highest number of child vaccinations in Italy since 1990.
Vaccinations have long been controversial. Indeed, in parallel with the growth in the number of vaccinations, the presence of ‘vaccine hesitant’ groups has recently also increased noticeably. This term refers to a broad spectrum, from those who refuse to be vaccinated, to those who are merely apprehensive about the practice.
Over a number of years, vaccine refusal rates had rocketed in response to stories about various scientific experiments aimed at exposing potential negative side effects. Nevertheless, many commentators consider this trend alarming: this reluctant behaviour was identified as one of the World Health Organisation’s top ten global health threats of 2019.
Vaccinations operate by introducing a dead or altered form of an infectious pathogen into the body, with the intent of having its specific antigen coating recognised. White blood cells start producing complementary antibodies as an immune response is triggered. They target - and attach to - that specific antigen, slowing it down for another white blood cell to digest it through phagocytosis. The information needed to replicate the antibodies is stored in the patient’s body and becomes useful upon a subsequent, real exposure to the same pathogen. In this way, the response is more immediate, preventing the infection.
In the last few years, concerns about vaccinations were triggered by media stories such as that about the British physician Andrew Wakefield’s investigations into a possible relationship between vaccines and autism. His hypothesis was based on the chemical composition of measles vaccines: that the altered form of the virus caused inflammatory lesions to the colon. He tested a sample of only 12 children, with the stated intention of recording any presence of a measles virus in their intestinal biopsies, blood and cerebral spinal fluid. The results from this small sample appeared to be startling: 100% exhibited signs of lesions.
However, the scientific validity of this study was soon called into question and a 2004 Sunday Times article exposed discovered conflicts of interest. In response, a General Medical Council examination found that Wakefield had acted dishonestly and struck him off: he is no longer allowed to practise medicine in the UK and his research has been discredited.
The only form of consistent quantitative data, therefore, are public statistics that have established "at least 10 million deaths were prevented between 2010 and 2015". Dr Margaret Chan, then World Health Organisation Director-General, made this claim in a 2017 speech about the power of vaccines still not being fully utilised. At that point the global child immunisation rate stood at 86%. However, in some of the most developed countries this figure has reached 95%: the WHO’s target.
Recent outbreaks of previously eradicated diseases, in areas where vaccine rates were low, appear to back up the evidence that immunisation saves lives and is vital to preventing mass epidemics in the future.
But many people are still hesitant when it comes to vaccinations. Why? Perhaps because human decisions are often driven by fear which persists even in the absence of concrete evidence of harm. In addition, some religions and cultures prohibit the practice.
Herd immunity is a form of indirect protection achieved only when a large portion of a population is vaccinated and have become immune to infection. This also provides protection to those who are not vaccinated as the disease is eradicated in that population. So, even if a small minority of people refuse to be vaccinated, they will still be protected. This raises an interesting question about the extent to which those who are vaccinated are responsible for protecting those who aren’t.
In economic terms, achieving the positive externality of vaccinations would secure a potential welfare gain - lower healthcare costs as there would be fewer infected patients, and longer life expectancy. The economic benefits should outweigh the cost of the vaccines.
Parents previously had a choice; in Italy, the government has stepped in and made that choice for them. It’s an interesting debate and one which has, at its centre, questions about the public perception of, and communication about, scientific research and the autonomy of individual decision-making.