Allison M. Whelan, J.D.
Senior Fellow, Center for Biotechnology & Global Health Policy, University of California, Irvine School of Law
In a previous post, I discussed three possible methods of increasing vaccination and decreasing vaccine refusals in the United States. One of these options was using tort law and allowing lawsuits against parents for refusing/failing to vaccinate their children. The Pakistani government has recently taken it one step further, arresting and issuing arrest warrants for parents refusing to vaccinate their children against polio. Last week, approximately 512 people, 471 in Peshawar and 41 in Nowshera, were arrested and jailed and arrest warrants were issued for 1,200 more parents for refusing to vaccinate their children.
Currently, the government allows parents to be released from jail and return home if they sign an affidavit promising to vaccinate their children. Despite the fact there is no law requiring polio vaccination, some view the recent crackdown as “a blessing in disguise” for unvaccinated children. This drastic approach responds to high rates of refusal, a contributing factor to Pakistan’s significant number of polio cases. According to the World Health Organization, in the period since March 2014 Pakistan registered 296 polio cases, the most in the world and drastically higher than even the second-highest rate of 26 cases registered by Afghanistan. Why is Pakistan’s vaccination rate so low? For many reasons, including religious beliefs, attacks on medical workers, displacement of individuals due to ongoing military operations, and a lack of trust in health care workers and the vaccine.
Nevertheless, this drastic criminal law approach has successfully reduced the number of refusal cases from 47,000 in January to 23,000 in February and appears to have the support (or at least not the opposition) of various levels of government and public health officials. According to Dr. Bilal Ahmad, a UNICEF team leader based in Pakistan, this tactic is an unprecedented “last-ditch effort” to eliminate polio from “cluster zones” where large numbers of families refuse to vaccinate. It is the final step to eradicating the disease and arrests generally come after health care workers and other community members try to convince the families to vaccinate. The highly infectious nature of polio and its devastating incurable consequences are a major reason for the government’s approach.
Pakistan’s turn to criminal law may seem excessively retributive. Such an approach in the United States would raise red flags. Nonetheless, in the wake of measles and pertussis outbreaks in the U.S., some pundits have called for extreme measures, with some arguing that doctors who oppose vaccinations should lose their licenses. How do we balance civil rights, civil liberties, and parental autonomy against compelling evidence that vaccinating children is the best way to ensure broader public health and safety? Early, less extreme methods to decrease refusals, particularly for vaccines against the most infectious and devastating diseases, must be adopted and enforced to avoid the resort to criminal law. Let us hope that vaccine refusals are mediated by information, education, and access to health care in other countries and the United States to avoid seriously debating incarcerating parents who refuse to vaccinate their children.