As British health experts become increasingly anxious about declining rates of immunisation and the risk of a serious measles epidemic in the UK, the American authorities are convinced that their tougher rules are the answer.
Parents in the US are not simply advised by the health authorities to get their children vaccinated against measles – they are obliged to do it by law. Children who have not been immunised face a “no jab, no school” exclusion from daycare, nursery and school. In extreme cases, their parents have been threatened with fines and jail.
In other cases, parents have been paid $50 (£35) a time to explain to researchers why they are in the tiny minority that is so reluctant to vaccinate their children, in studies probing parents’ lingering fears of links between the measles, mumps and rubella (MMR) jab and autism, asthma and attention deficit hyperactivity disorder.
Over the next few months, parents of toddlers across the US will begin registering their children for kindergarten and infant-school intake this September.
School districts post their registration rules online and in local newspapers, and, among the requirements for parents to bring proof of identification when registering, they are, without fail, also asked to bring their child’s immunisation record showing they have been vaccinated with MMR. No proof, no place at school.
The laws differ slightly from state to state but, overall, obligatory vaccination is so routine most parents and schools automatically accept it.
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“It’s the law. They have to have had two measles vaccinations to enter school, or even kindergarten,” says Marjorie Lapp, a school nurse at Kendall elementary school, near Rochester in upstate New York. “It’s a good thing. We don’t have many problems with kids getting the jabs. We had a problem with one parent last year where the child’s brother was autistic, but nothing has been proven on that point.”
The school has not had a case of measles in the 10 years she has been there. “The benefits of the vaccine outweigh the risks,” Lapp says.
Every state requires proof of immunisation before children can enter the state school system, or be eligible for federally funded daycare. As a result, vaccination rates among pupils starting school in the US are typically between 92% and 98%, compared with 78% in England and Wales.
Measles was declared last year to be once again endemic in the UK. Figures published last week confirmed there were 1,348 cases in England and Wales in 2008, a record high, up from 990 in 2007 and just 70 in 2001.
In contrast, in the first six months of 2008 there were just 135 confirmed cases of measles across the US, according to the Centres for Disease Control and Prevention (CDC), the government health data agency.
Even that low figure raised concern in the US, where the population of 300 million is five times bigger than the UK’s. American health experts called it the largest outbreak in a decade.
Measles was declared no longer endemic to the US in 2001. “Our vaccination rate is very high and the requirement for immunisation before attending school has been going on for decades. The CDC decided that was the best way to get the vaccine to the public,” says Dr Anne Gershon, professor of paediatrics at Columbia University Medical Centre and president of the Infectious Diseases Society of America.
She says parents who refuse to vaccinate their children have been “led up the garden path” by now-discredited links made between MMR and autism, and by a handful of celebrities “fanning the flames” by speaking out about their fears.
“We have got to regain the public’s trust in vaccinations – they do a lot more good than harm. It’s no good parents just getting their information from television, and there is so much on the internet that’s just wrong,” says Gershon.