2.20 Promoting Immunisation
Parents are relying on the media for much of their information regarding immunisation. They read scare stories about MMR or see adverts in newspapers and on TV championing the cause of vaccinations (Rogers and Pilgrim, 1995).
Should the consumer of health care decide to pass the burden of decision making to their doctor? It is therefore important that ethical codes are linked to the assurance that, given the role of the supplier, the doctor’s conduct is determined by medical rather than economic objectives (McGuire et al, 1995). There is an obvious potential for exploitation here, particularly if financial incentives are given, which bring about a level of consumption different from that which would have occurred were the consumer fully informed and able to choose freely. Fraser (2000) reported on the practice of not registering unvaccinated children with GPs to enable the practice maintaining Government vaccination targets.
Curtis (1995) reported that doctors receive a bonus of £2,300 for 90 per cent. vaccination uptake in their practice and nothing if it falls below 70 per cent. One wonders whether voluntary consent is possible when those who are recommending vaccination stand to profit from it.
Research by Schlaffly (1999) suggests that physicians do not have the time or know-how to evaluate all the evidence about vaccines. Cohen, Lauderdale, Shete, Seal and Daum (2003) noted that childhood vaccine providers in the United States have substantial knowledge deficits of immunisation schedules and contraindications. Schaffly (1999) submits that the physician has an ethical responsibility to give patients an informed choice but that government authorities monitor physician compliance and give financial reward to high vaccination rates.
Zimmerman, Schlesselman, Mieczkowski, Medsger and Raymund (1998) investigated physician concerns about litigation and beliefs regarding vaccine safety. They reported that physician perceptions about the risk of adverse effects and protection afforded by the Vaccine Injury Compensation Program influenced their concern about litigation, and, to a lesser extent, their reported likelihood to administer immunisations.
Compliance for compulsory vaccination has been gained by using the right to education as a reward in North America. According to Salmon, Haber, Gangarosa, Phillips, Smith and Chen (1999), all US states require proof of immunisation for school entry.
Respect for autonomy here seems to have been ignored. Unless individuals are aware that vaccines can cause harm and can be expected to learn medical terminology when performing their own research and when reading package inserts, they surely cannot make autonomous choices or provide truly informed consent to vaccination. The onus should be upon the expert to disclose adequate information and not the parent who cannot possibly ask all the appropriate questions if they do not even know what should be asked.