For people who don’t have small children and who aren’t Swiss the current brouhaha in Switzerland over measles vaccinations can be puzzling. This week’s news, that cantonal public health authorities have said mandatory vaccinations should be considered if the country continues to have outbreaks, has already sparked reporting that takes sides, but not over measles: over another agenda. It’s the ages-old French-speaking versus German-speaking tug-of-war. It will only add to the confusion for many parents and young people.

The Tribune de Geneve this morning carries a headline that the arguments in favour of mandatory vaccinations are convincing. If you read the story to the end, past the bit about how the German-speaking cantons have radically changed their opinion on vaccinations, the doctors who are quoted appear to be saying they are not in fact in favour of mandating vaccinations. I’ve interviewed Drs Masserey and Siegrist, the quoted specialists in Vaud and Geneva, including a phone conversation with Dr Siegrist Monday afternoon, part of a news story on the cantons’ decision. I interviewed her at length a year ago. I feel safe saying that while she is a strong proponent of vaccinations she was firm yesterday that she sees mandatory vaccinations as a measure of last resort and she’s proud of the fact Geneva has achieved 95% coverage without mandating vaccinations. She believes the rest of Switzerland can do the same.

The Tribune article points out that the laggards in vaccinating are some German-speaking cantons, certainly true. Basel State has had the highest number of measles cases, double the number in Vaud. The key point in the article seems to be that these cantons have now changed their minds (read that: finally changed their minds!). But the focus should now be on educating people to ensure that enough of them vaccinate, rather than on whether or not shots are made obligatory for school-age children. A few points that might help:

• Switzerland’s coverage is low, 86% instead of the 95% the World Health Organization recommends, because some cantons have only 70% coverage while others, such as Geneva, have very high, 95%
• 95% vaccination coverage should “eradicate” measles, but what does this mean? There will always be measles cases, but when the number falls to fewer than one in a million, the highly contagious disease is considered to have been eradicatd in a country. Australia was declared measles-free this month, although there are still some cases. In Switzerland, with a population of 7.4 million, this would mean under eight cases a year, countrywide.
• Some people do not vaccinate their children because of religious beliefs, others because they fear medical side-effects, of which the most commonly mentioned is autism. Feelings run high on the autism issue and while the medical world weighs in heavily on the side of no link between MMR shots and autism, doubts remain and there is enough concern, about a possible link that we don’t yet understand, for some people to remain cautious about vaccinating. As the mother of an autistic child, who was vaccinated and suffered no side effects (nor did it cause her autism, already present), I have followed these arguments and read the literature for 16 years. There are no black and white answers, and no shortage of people who insist, on either side, that there are. The US court that hears vaccination damage cases threw out three test cases linking the MMR and autism last week, but if you read closely, the legal decision was based on no link between thimersol in the vaccinations and autism. There will be more cases, based on other possible links, which for right now doesn’t mean anything except that some people believe there is a link and that they have evidence of it. Among the concerns raised: too many vaccinations at once, or at too young an age, or too close together.
• Mandatory vaccination works in the United States to the extent that measles has been eradicated there, but the programme has spawned a whole new social phenomenon of people trying to get around the rules. School systems and parents battle over it. Australia has eradicated measles without making vaccinations mandatory. A significant factor appears to be moving the second shot forward from age four to 18 months. A higher number of parents come in for the second shot at that point. The first shot is given at 12 months. The doctors who studied the impact of the change suggest that a more effective solution would nevertheless be to increase coverage for the first shot, from 93% to 96%.
• The age group most touched by the measles outbreaks in Switzerland in the past year has been adolescents, 15-18. A very high percentage, 93%, of those who fall ill, have not been vaccinated. Of the other 7% many have had only one shot.
• Measles vaccinations work quickly and anyone who has had exposure and who has not been vaccinated should see a doctor immediately. The problem, of course, is that the person who is ill may have been contagious for two weeks before showing symptoms.

For me, vaccinations are like any other part of life where there is a risk. We can’t avoid risks, so we need to approach them intelligently, and that means weighing them, trying to inform ourselves without being emotional and without listening to inflammatory rhetoric. Personally, I believe the risk of a child becoming very ill from measles, or even dying, is greater than the risk of a healthy child becoming autistic after the MMR shot, and I would vaccinate my children unless I had a specific reason not to. Hoping that everyone else will do it and you can be part of the 5% who is safe without doing it is both selfish and foolhardy, for the risk to your own child might be diminished but is still there.

For my daughter, whose health is sometimes fragile, I insist that she be given shots of any kind only if she appears to be infection-free, which I think is common sense for the rest of us, too. I would never give her several shots at once. I have an adult son whose health is fine and I just suggest caution with shots: don’t go if you have a cold.

For a small child, if and only if there are medical problems in the family, I would research these carefully, find an open-minded pediatrician who will discuss these with you, which might mean shopping around, and then ask to have shots spread out over time, if there are concerns. I would ask that the MMR (measles, mumps, rubella) be given as three separate shots. The peace of mind is probably worth it, but then be prepared for the trouble of going to the doctor more often.

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