PREVENTION NATION

03.27.14

Thank You, Croatia: All Hail Mandatory Vaccinations

With its recent decree that all children must be vaccinated, little ‘ole Croatia is setting the global standard for intelligent, evidence-based public health.

This week, Croatia moved far ahead of the United States and countless Western European countries in the realm of public health. They weighed the evidence for and against mandatory vaccination of children, summarizing the problem as follows: “The child's right to health is more than the rights of parents to the (wrong) choice.” 

(Attention non-Croatians: The above summary comes courtesy of Google Translation, which renders the text intelligible if a little stiff, as if an old-school 007 bad-guy were speaking).

And with this insight they decreed that childhood vaccination—for measles and hepatitis and pertussis and diphtheria and all the rest—will be mandatory throughout the country. No more guff from anti-vaccine parents allowed.  

Yes, Croatia, home region of Josip Tito and a part of Tito’s Yugoslavia till 1991, the place that also spawned actor Eric Bana and coach Nick Saban, a country ranked 84th in the world with an annual GDP of about $78 billion and a population of 4.5 million, a country that just joined the European Union last year—that Croatia—is now setting the global example for intelligent, evidence-based public health.

Of course, the same evidence is also available for other countries that might want some facts. The facts are not faintly controversial for those who believe in reality: vaccination saves lives, families, and dollars. Vaccination has saved more lives by far than penicillin. Vaccination is the best medical innovation of all time. That said, vaccination is not without small but real risk. In Western societies where measles is gone (sort of), and pertussis (whooping cough) is tamed (well, almost), and mumps too has disappeared (oops, sorry)—the diseases are still so rare that the heart-break reality of losing a child to measles or watching your kid cough till he faints from pertussis is lost—only the vaccine risk remains. So we carry on a lop-sided, non-reality-based debate comparing the risk of vaccination against the apparent absence of risk of the disease, making the vaccine look mighty awful. Effective prevention is always a victim of its own success.

It surely is ironic that so many pushing for “personhood” of the fetus in the abortion debate are willing to cede the same personhood altogether around the issue of vaccine—here, Mommy and Daddy know best. The Croatians, though, know better. Because it is the infection, not the remedy, that is awful. And the diseases—as recent experience has shown again and again—do not go away. 

Kids must go to school. People must pay taxes. Children must be vaccinated. It is called living in modern society.

For example, Afghanistan and Pakistan and Nigeria still have cases of polio because so many in these countries refuse vaccination, thinking it a U.S. plot to kill or sterilize or spread AIDS. As one lawyer in Pakistan said in 2012: "These vaccines are meant to destroy our nation…The [polio] drops make men less manly, and make women more excited and less bashful. Our enemies want to wipe us out."  But it’s even worse than that: Polio vaccinators have been murdered in Pakistan and elsewhere for trying to save lives.

Such irrational primitive fear of vaccination is surely disturbing in the U.S. (though let us keep in mind that a sham hepatitis B vaccination program was the ruse used to obtain Osama bin Laden’s family’s DNA, enabling his identification after the raid); but the U.S. and Western Europe anti-vaccine crowd, though more sophisticated, is every bit as deliberately and cruelly uninformed. And as with any irrational, faith-, not evidence-based belief, to push the countervailing point is not to move the debate forward at all, but rather to harden the resistance.

Which means that government—good old intrusive Nanny State government— must step in even more. Just like Croatia. Nothing like a former Communist country to show how to handle a problem—they have a long ignoble history of decisiveness. But public health imperatives and individual rights are often at odds: a country like the U.S. that values the rights of the individual always has trouble with laws that remind us that not everything is a choice. Kids must go to school. People must pay taxes. Children must be vaccinated. It is called living in modern society.

Both the Left and the Right find occasional moments of inspiration in the little red book mentality of the old Commie regimes. It has been interesting to watch the right wing in America fall in love with the manly manliness of Vladimir Putin who is portrayed as the Duke Wayne of the steppe, willing (eager) to make tough decisions—unlike a certain pointy-headed, overly introspective President You-Know-Who who actually wants to think things through and consider long-term consequences. 

And here am I singing the praises of the iron-fisted totalitarian approach of Croatia, which was frequently on the wrong side of business in World War II. But a good idea is a good idea—and mandatory vaccination that places “the child’s right to health over the parent’s right” to make decisions is a sound judicial, ethical, and public health approach.