admin
The present and severe measles outbreak that has already killed around 700 children should never have been able to get the sort of foothold it has established if all children had been taken for their free and routine checks and had received the free and routine vaccinations.
Part of the problem has arisen from decision by some parents not to have children vaccinated, and with this sort of death toll we need to ask if parents can condemn their children to death in the name of religion, and allow other children to come to harm as a result of their beliefs.
Measles is one of the most contagious of all infections. It used to kill more than 2,5 million people a year globally before the vaccines were developed and then became properly distributed in the 1980s, almost two decades after the initial development.
Besides the deaths there were the other complications, which can include blindness. So when the vaccines became available medical authorities around the world grabbed them and started jabbing.
It is sometimes difficult for younger people to imagine a world without mass vaccination. Smallpox was defeated and made extinct through vaccination. Polio was defeated and almost wiped out by vaccination, and that vaccine only became available in this part of the world around 65 years ago.
We now routinely vaccinate against polio, diphtheria, measles, mumps, rubella, scarlet fever and other illnesses that used to sweep through schools that we forget the damage, disability and death they used to cause.
In Zimbabwe as in much of the Third World this mass vaccination campaign came in the early 1980s. Unicef led the global assault to slash death rates among young children, putting together a very simple primary health programme that cost very little per child, raising support and money and helping countries establish the vaccine cold chains and other requirements.
Zimbabwe had only just achieved independence when all this came about and the new post-independence Government, with its desperate desire to improve the lives of all the people, embraced the programme to the fullest extent and made it compulsory for every child, regardless of who they were and where they lived.
So children from Borrowdale mansions and the children from the most remote rural area had identical cards recording their growth and their vaccinations, and all vaccines were free, even if the Borrowdale parent paid a small charge for a fancy private doctor to give the jabs.
Measles is easy to control through vaccination. Not every jab works perfectly, with around 5 percent of jabs not taking. Normally, under the sort of World Health Organisation recommendations that Zimbabwe faithfully follows every child is thus given two shots, which gives 97-99 percent of children immunity. So long as these failed vaccinations are randomly distributed there is then no problem.
The rest of the children in that child’s class have immunity, the rest of the children in that child’s Sunday school or church service are immune, the children the child plays with are immune, so there is no one to pass on a measles infection. This in fact is the definition of herd immunity; the immune herd protects the odd person who does not have immunity since that person is so unlikely to meet an infected person.
The problem can arise, as it has now in Zimbabwe, when an entire religious community, or a large block of it, refuses vaccination. Now we have an unvaccinated child mixing with other unvaccinated children at religious services, and since a lot of people, especially in a conservative religious organisation, tend to socialise together, that same child is likely to be playing with other unvaccinated children.
So if there is an infected child, or even adult, in that community the virus can spread easily, and this is what is driving the present spate of infection.
We also have besides the old religious centres of resistance to vaccination, new centres, driven by nut-case anti-vaxers largely on the right-wing edge of politics in America, fuelled partly by some dreadful faked research at the end of the 1990s now recognised as the most damaging medical hoax of the last century.
In the initial vaccination drive in the 1980s this was addressed. There were detailed negotiations with religious groups that resisted going to clinics and resisted vaccination. Partial solutions were worked out, at least good enough to allow the Health Ministry to limit its power to enforce childhood vaccination, and that legal power does exist.
The odd burst of measles, nothing like as severe as the present outbreak, was quickly squelched by booster shots.
When almost all your children are at school this sort of campaign is easy to organise by simply sending vaccination teams to every school, lining up the children and delivering the vaccinations. Even when parents can refuse, heads use parental apathy to advantage, by insisting parents object in writing with a tight deadline.
We are now doing the same, with the Ministry of Health and Child Care, backed by a declaration under the Civil Protection Act to add to their already considerable powers and resources when using the Public Health Act, are now vaccinating or re-vaccinating all children between 6 months and 15 years. Even if they have been jabbed before they might be in the tiny group where the vaccine did not take.
But those who withdraw children or refuse to allow their children to be vaccinated can be compelled if necessary.
This week Fr Fidelis Mukonori, a former Jesuit Superior in Zimbabwe, was coming very close to suggesting that these legal powers should be used to protect all children.
Zimbabwe is very proud of its adherence to the Constitutionally-guaranteed rights of freedom of religion, and goes out of its way to ensure that every Zimbabwean can practice their own religious beliefs and can bring up their children within that system of beliefs. And this is right.
But there have always been limits. For example, we now clamp down on those who promised young girls in marriage and we are willing to prosecute anyone who even attempts a forced marriage or a child marriage.
The Constitution gives absolute protection to beliefs, but definitely not to practices that are harmful to others and especially to children. It does allow State action on public health matters that are acceptable in a democratic society. Among the questions we need to ask are whether a person is allowed to condemn their child to death or serious illness as result of a religious belief, and whether they are allowed to condemn someone else’s child to death.
We need to remember that small percentage of vaccinated children where the measles jab does not take, and ask if that child should be at risk because of a neighbour’s beliefs.
These are important questions and we need to face them. Clearly negotiation and persuasion are better solutions. Even if we simply can persuade religious leaders not to oppose child vaccination actively, this would probably be good enough.
But if we cannot get adequate immunity levels that way, or if the children of those opposed to vaccination are dying, then perhaps we should use the legal powers in our public health legislation.
In most countries adults are allowed to refuse medical attention even if they die as a result, but most States will protect children even if that protection goes against their parents’ beliefs.
Online Reporter