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The Rise in Measles Outbreaks Prompts us to Take Communitarian Values Seriously

Child vaccination is not a matter of personal choice or preference; it is a parental responsibility for protecting all children in the community.

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Outbreaks of vaccine preventable diseases, like measles, are largely associated with communities in the developing world. The recent trend in measles outbreaks shows that this perception no longer holds. As the world becomes increasingly smaller due to higher international mobility, the transmission chain for infectious diseases has inversely extended. This time, measles outbreaks are not limited to developing countries, but are also surging in Europe and North America. Canada is on the list with a mini-outbreak recorded in British Columbia, and isolated cases in Ontario and Quebec.

When a vaccine preventable disease surges in developing countries, the origin or spread is often attributable to a lack of vaccines or inaccessibility to vaccines. The recent measles outbreak in Madagascar that killed over 900 children was largely blamed on the lack of vaccines, even for those who actively sought to immunize their children. The impression is that when vaccines are available and accessible in these settings, the chances of an outbreak would be at best minimal. Additionally, extensive political leadership on immunization spirals public uptake of vaccines upwards. For these developing world contexts, the key to addressing vaccine preventable diseases outbreaks is simple: make vaccines available and accessible.

The resurgence of measles in Canada, a previously eliminated disease, raises questions about how seriously Canadian parents take child vaccination. No doubt the disease was imported from abroad, but its spread was orchestrated by the presence of unvaccinated children in the affected communities. Parental distrust in immunizing their children is linked to a phenomenon referred to as vaccine hesitancy. This term describes conscious choices that parents make to not immunize their children, despite vaccines being available and accessible to them. It is an attitude reinforced by the anti-vaccine movement, which has strong roots in Canada.

Vaccine hesitancy can lead to what is referred to as “vaccine free riding” or “vaccine snacking.” Vaccine free riding describes a situation where parents choose not to immunize their children; yet, these unvaccinated children are cushioned by a ring of other vaccinated children in their communities, protecting them from possible infections. Vaccine snacking, on the other hand, involves situations where parents choose when to vaccinate and/or which vaccines to give their children. This would resonate with children receiving vaccines mostly as travel pills. It is easy to entertain ideas about potential negative side effects of vaccines and let such perceptions influence our decision to not vaccinate our children if the reality of the diseases in question is not within our neighborhood.

Vaccines work. For the doubtful minds, it may be worth taking a trip to a Sub-Saharan African country and asking parents waiting in queues to immunize their children at local health centers. Because vaccine preventable diseases are a lived reality in many African communities, child vaccination is taken seriously by parents and governments alike. A significant challenge is the limited capacity to provide these vaccines to all children. When it comes to child vaccination, it not a matter for one parent to decide; it becomes a community affair. This is because the presence of a few unvaccinated children can endanger the lives of all other children in the community; parents owe it to the community to have their children vaccinated. This moral imperative derives from an African communitarian ethic that situates the existence of persons as inherently dependent on those of others around them.

This moral imperative is relevant to Canadian society and values, especially if we take seriously the First Nations’ communitarian principle that “everything is shared.” The principle of sharing everything inherently suggests a strong community, where interdependence is valued. It mandates that in this sharing process, some bring and others receive, and those who receive would also be expected to contribute what they can, whenever they are capable. Translating this to child vaccination would imply that we all have to do whatever is within our means to protect the health not only of our children, but also that of other children in the communities where we live. If vaccinating one’s child means good health for other children in the neighborhood, then we have a responsibility to the community to do so. Going by this principle, child vaccination is not a matter of personal choice or preference; it is a public responsibility owed to all children, regardless of their parents’ views on vaccines.

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