The article we suggest to read this week is "Mandatory Measles Vaccination in New York City - Reflections on a Bold Experiment", published on The New England Journal of Medicine in July 2019.

SUMMARY

Though a vaccine has been available for more than 50 years, measles has recently reemerged as a public health threat in the United States. Outbreaks have arisen where vaccination rates have waned, and local governments have responded, through encouragement to vaccination given by officials and religious leaders, quarantining people exposed to the virus, free visits, meetings with community leaders, barring unvaccinated students from all schools and from public spaces designed for more than 10 people, and fines and jail time for disobedience.

New York City and Rockland County have seen the most cases. On April 9, its health commissioner ordered that, within 48 hours, anyone more than 6 months old who lived, worked, or attended school within four Brooklyn ZIP Codes, unless immune or medically exempt, “shall be vaccinated against measles.” The city first threatened civil and criminal repercussions but eventually settled on a $1,000 fine. Reactions were mixed.

Notably, mandatory vaccination is not forcible vaccination. But the city’s “shall be vaccinated” language appears to leave the latter option open, and the health commissioner said it could be considered on a “case-by-case basis.”

For competent adults, forcible vaccination should represent an unconstitutional intrusion on liberty. Forced vaccination of children may be different: vaccination offers near-certain protection from illness, and some scholars argue that vaccination is a human right.

The author reported many open questions on this topic, concluding that unless New York City clarifies its order or the issue arrives in federal court soon, physicians may wish to consider their response to a directive to forcibly vaccinate a child.

The author presented her own opinion about the matter: vaccination should be reserved for extraordinary cases, in which the risk of death or disability is overwhelming, after less intrusive options have been exhausted.

By May 29, New York City had issued 123 civil summonses for noncompliance with

its order. Between October 2018 and March 26, 2019, when its state of emergency began, the county tallied 16,958 MMR vaccinations. Over the next 9 weeks, it added 4624. But Rockland did not order vaccination.

To reset vaccination norms, state legislatures could lower the age of consent, eliminate nonmedical exemptions to school-entry vaccination laws, and fund research on combating vaccine disinformation.

The author concluded warning that force does not educate, develop trust, or protect human dignity, and it will never be an antidote to fear.

Full artile is available here: https://www.nejm.org/doi/full/10.1056/NEJMp1905941

AUTHOR: Julie D. Cantor