I occasionally have patients whose parents are strongly against vaccination, usually because they've confused correlation with causality and believe vaccines cause autism. They are often shocked to hear that I've actually given these "poisons" to my own children. I even enrolled my own daughter in a trial of a new combination vaccine as I do think if we could minimize the number of needle sticks that would be good. So I am strongly and consistently pro-vaccination. I regard anti-vaccination folks like creationsists who no amount of reason will reach; although at least I understand the source of creationsists conviction, religous belief. I've left Orac and others to refute the anti-vaccination hysteria.
What I hadn't thought much about was how compulsory vaccination should be. A recent article in the Lancet examines this issue. As a wishy-washy libertarian, I respect the argument that whatever the overall greater good, government compulsion is not to be taken lightly; as one Henning Jacobson argued in 1809, in refusing to be vaccinated against small pox:
A compulsory vaccination law is unreasonable, arbitrary and oppressive, and therefore, hostile to the inherent right of every freeman to care for his own body and health in such way as to him seems best; and that the execution of such a law against one who objects to vaccination, for whatever reason, is nothing short of an assault upon his personThe US Supreme Court rejected that argument. But I also know that there are a lot of idiots out there. In addition, since much of the benefit of vaccine is in herd immunity (no kid born in the US in 2006 is likely to ever actually get polio) there is an issue of equity in that those who forgo vaccination reap the benefits without sharing the risks (small those they are currently).
The UK does not have compulsory vaccination, but retains high vaccination rates as do several northern European countries. In the US, in contrast, school entry is contingent on vaccination, although conscientious objection is allowed in most states. As the article notes, using the school system has the advantage of entrenching the requirement in a bureaucracy that is pretty much immune to political pressure, lack of attention, etc.
I think the US approach gets it about right. Most unvaccinated kids are due to lazy parents and making school entry contingent on vaccination leads to higher vaccination rates. On the other hand, for those few who are really opposed to vaccination, I am not against exceptions. I do think getting an exception should require at least as much effort as being vaccinated, so it is not the easiest way out, as the article suggests it is in some states. I don't see requiring positive action (obtaining an exemption) as unduly burdensome on anyone's freedoms.
I do think there might be some instances (outbreak of disease) when exceptions to vaccination might not be acceptable, even with the loss of freedom that would entail.