17 January 2011

Vaccination

A friend has pointed me to media coverage of a Family Court order requiring a mother to have her five-year-old daughter immunised for whooping cough. In following up the recent post on the Wakefield article the coverage is interest for how the mass media report science and the law rather than merely for the judicial precedent and notions of possessive individualism.

The child's parents reportedly separated before her birth, with the father (who wishes access to his daughter) going on to remarry and have other children with his new partner. He sought an order regarding vaccination of the daughter against preventable diseases, both for her own wellbeing and for the health of his other children. That rationale is consistent with a recognition that diseases such as whooping cough and measles can kill or maim and that it is not feasible to protect everyone through innoculation (ie give a shot to all babies on delivery, with the consequence that some young children might be placed at serious risk through exposure to an unvaccinated person who is encountered at home, school, in a shopping mall, on a bus or other location).

The father produced medical evidence that immunisation provided no unacceptable risks for his daughter. He reportedly noted that if she remained un-vaccinated she would be forced to withdraw from school during outbreaks of some diseases and that she would also be unable to spend time with any babies in his second family, given that she was not immunised against whooping cough.

The girl's mother reportedly said that her daughter was healthy, that the risk of vaccine-preventable diseases was very small and that vaccination was dangerous. She was criticised in the magistrate's judgment (not yet available on the Family Court site or on AustLII) for submitting evidence from an "immunisation sceptic" who made what were described as "outlandish statements unsupported by any empirical evidence".

As the media circus got underway Professor Robert Booy of the National Centre for Immunisation Research & Surveillance argued that immunisation prevents serious diseases, commenting that -
The only way we can protect the vulnerable - and that may be a newborn, or someone with an immune deficiency - is to ensure other people are vaccinated.
Chiropractor Warren Sipser reportedly denounced the judgment as "dangerous", with reportage indicating that he was "shocked" (being shocked and/or saddened or outraged are presumably inevitable), commenting -
It's a sad situation ....

I think it's dangerous to impose [immunisations] on anyone when there are two opposing viewpoints and when there is credible evidence they may do more harm than good
Much law involves two or more "opposing viewpoints", with courts being asked to decide on what those tribunals hold to be credible evidence. In this instance the court - along with most of the scientific community - held that evidence about the dangers of vaccination is unpersuasive and that non-vaccination wasn't the default.

Other foes of vaccination were less restrained than Sipser. Meryl Dorsey of the Australian Vaccination Network (AVN), vehement opponents of vaccination, commented on that group's Facebook page -
Court orders rape of a child.

Think this is an exaggeration? Think again. This is assault without consent and with full penetration too. If we as a society allow this crime to take place, we are every bit as guilty as the judge who made the order and the doctor who carries it out.
Using that analysis all surgery on children would be illegal.

The NSW Health Care Complaints Commission (an independent body established under the Health Care Complaints Act 1993 (NSW) to protect public health and safety by dealing with complaints about health service providers in NSW) last year issued a public warning about the AVN, noting that the Commission's investigation established that the AVN website -
• provides information that is solely anti-vaccination

• contains information that is incorrect and misleading

• quotes selectively from research to suggest that vaccination may be dangerous
It went on to comment that
The Commission recognises that it is important for there to be debate on the issue of vaccination. However, the AVN provides information that is inaccurate and misleading.

The AVN’s failure to include a notice on its website of the nature recommended by the Commission may result in members of the public making improperly informed decisions about whether or not to vaccinate, and therefore poses a risk to public health and safety.
The Commission is reported to have noted complaints that the AVN harassed the parents of a child who died of whooping cough last year, after those people had advocated the importance of childhood vaccination.

Australian law embodies a balance between the rights of individuals and the community, with restrictions on what individuals can do. Those restrictions reflect a recognition of potential harm to the community and to the individual. We thus impose requirements regarding safety helments while riding motorcycles, wearing seatbelts while driving cars, freedom from hallucinogens or other mind-altering substances while driving forklifts or conducting surgery ... all constraints on an ideal of possessive individualism. Health law - sometimes dubbed 'typhoid mary' provisions - provides for the detention of people who wilfully expose others to highly contagious serious diseases or prevent them from being protected. Compulsory treatment orders - and statutory authorisation for blood transfusion and other action contrary to parental wishes, under for example the Transplantation & Anatomy Act 1978 (ACT) s 23 - are evident in all major Australian jurisdictions, with sanctions against evasion by parent/guardians

Some examples are Director-General, Department of Community Services; Re Jules [2008] NSWSC 1193, S v South Eastern Sydney & Illawarra Area Health Service and anor [2010] NSWSC 178, Re Bernard [2009] NSWSC 11 and Director-General of DOCS v BB [1999] NSWSC 1169.

Magical thinking about the supposed harms of vaccination and the dismissal of hard science is seductive but should be resisted and should not be enshrined in law.

It is conceivable that the decision will be appealed. Readers should note that the decision was made under the Family Law Act 2005 (Cth); it does not provide for enforced vaccination outside that statute.