Measles Rubella Vaccination: Understanding the question of parental consent

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Mains Paper 2: Governance | Issues relating to development & management of Social Sector/Services relating to Health, Education, Human Resources

From the UPSC perspective, the following things are important:

Prelims level: MR and its vaccines

Mains level: Hurdles in immunization programme


News

  • Delhi High Court put on hold the govt plan for a measles rubella vaccination campaign in schools across the capital, saying the decision did not have the consent of parents.
  • The court’s order introduced a dimension to vaccination — the question of consent — that had not been adequately dealt with earlier.

The MR vaccine

  1. The latest Global Measles and Rubella Update say India had 56,399 confirmed measles cases and 1,066 confirmed rubella cases in 2018.
  2. Measles is a serious and highly contagious disease that can cause debilitating or fatal complications, including encephalitis, severe diarrhoea and dehydration, pneumonia, ear infections and permanent vision loss.
  3. The disease is preventable through two doses of vaccine.
  4. Congenital Rubella Syndrome, or CRS, is an important cause of severe birth defects.
  5. A woman infected with the rubella virus early in pregnancy has a 90% chance of passing the virus to her foetus.
  6. This can cause the death of the foetus, or CRS.

Matter of Dignity

  • The petitioners settled principle that choice of an individual, even in cases of life-saving medical treatment, is an inextricable part of dignity which is ought to be protected.

Consent not essential

  1. The consent of parents is not sought during routine immunization programmes.
  2. Consent in routine immunization is implied because it is the parents or members of the family who bring the child to the hospital or healthcare centre.
  3. For such a public good and for a vaccine that is tried and tested, there is ample evidence on safety and efficacy and something which is already a part of the universal immunization programme.

Vaccination

  1. The MR vaccine was recently introduced in the universal immunization programme. It has to be administered to all children between ages 9 months and 15 years.
  2. It is also needed to vaccinate those who did not get it earlier, and before they reach the reproductive age group.
  3. For vaccinations and such public health programmes govt. have never taken consent.

Why in schools

  • Schools, rather than health centres or hospitals, were consciously chosen because nowhere else can such large numbers of children in the relevant age group be targeted.

Global best practice

  1. Parental consent should be obtained prior to vaccination.
  2. This is the standard practice around the world.
  3. The WHO recognizes oral, written, and implied consent for vaccination.
  4. Countries are encouraged to adopt procedures that ensure that parents have been informed and agreed to the vaccination.
  5. In several US states, it is compulsory to provide vaccination records before seeking admission into school, so that the child is not a danger to others.

Way Forward

  1. MR vaccine is safe and effective, in use for over 40 years across 150 countries.
  2. The vaccine being given in the MR campaign is produced in India and is WHO prequalified.
  3. The same vaccine is being given in the routine immunization programme of India and in neighbouring countries.
  4. Vaccination is always a voluntary process, and there should not involve compulsion.
  5. Vaccines should be administered after people are sensitized about the disease and vaccine.
Health Sector – UHC, National Health Policy, Family Planning, Health Insurance, etc.
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