Vaccination - Safety, Science and The Social Contract.

Today I read an article in the BMJ (British Medical Journal) about whether childhood vaccines should be made mandatory. It's such a fascinating and important issue that I'd really love to do it justice with a full-blown article. However, a few thoughts will have to do for now.

The article was a for and against piece. Both mentioned standard examples - the notable decrease in coverage for the MMR jab after the reported (and quickly publicly, medically and completely rejected) link to childhood autism, and the subsequent rise in the spread of measles; the use of mandatory vaccination in America and the reasons that wide-spread vaccination is important. Neither side denied that - when you vaccinate your child, you're not just protecting your child, you are improving the nationwide coverage and helping development of herd immunity - the level of coverage of developed immunity at which those without protection are still at only negligible risk. This is what makes is a sociological issue and not just a medical one. It's not just a decision about health, and it's certainly not a private or personal decision - it's a decision for society as a whole.
Some other interesting points were raised. As an example of an alternative to making vaccination mandatory Australia was depicted. Financial incentives are used there for people who choose to vaccinate their children. However, those people declared as conscientious objectors are also given the incentives. I understand the arguments for preventing coercion, and that with regards to vaccination it's not those who understand and have publicly declared their objection that are the largest concern - it's those who don't know, don't care and so put their own children and those they come into contact with at significant risk. However, if incentives are given to those who haven't vaccinated their child, surely it is no longer a true incentive.
Points debated were whether making vaccination mandatory was necessary and whether it is a choice or public responsibility to vaccinate children.  The significance of 'school entry' being the target age for compulsory jabs was also contested. One side argues that this is older than the age at which many diseases pose the greatest threat, and therefore defeats the point of having a vaccine. The other side argues that this is the age at which an un-vaccinated child becomes a risk to those around them.
It's a complex and moral issue, as well as a scientific one. I personally cannot help but think that herd immunity is such an important benefit to society that we should give up a little freedom of choice in order to achieve it. It's rather like Rousseau's Social Contract (1762) - we give up some of our personal freedom in order to fall into the protective clutches of an organised society. And as long as that society protects us and we can trust it, it's a sacrifice very much worth making.

Postscript: I know I go on and on about it, but it's got to be said; this is an issue from a medical journal - it is at the very core of medicine and science and always will be. Yet it's also intensely social, moral, philosophical and psychological by nature - because it strays into areas of free will, free choice, freedom and liberty, protection of the young generation and where the government's role is in raising our own children. If psychology or sociology is denied the right to be a science, we are denying the relevance of real life in issues such as these. The effect of the MMR-autism issue reveals so clearly how science, belief and opinion can be so easily confused, to the detriment not only of science but of the people it affects. A vaccination is a chemical, but if only one person takes it - the effect is minimal. 
I know not everyone will agree on the issues I've raised here, leave a comment - I'll be happy to reply.