Measles vaccine: Mumbai, unlike NY, takes softer approach against refusers
Vaccination is not mandatory in India and, unlike New York, Mumbai’s public health department has not imposed punitive actions against refusers, but it has been forced to crack the whip occasionallyUpdated: Apr 21, 2019, 23:55 IST
On Thursday, a judge in Brooklyn, New York, ruled against a group of parents who had challenged the city’s recently imposed mandatory measles vaccination order. The parents are contesting the order.
New York is experiencing its worst measles outbreak since the nineties, with more than 300 cases since October. The US Centers for Disease Control and Prevention (CDC) has reported more than 500 cases across 20 American states.
Measles is a highly infectious viral disease that can be fatal, with complications like pneumonia and meningitis - infection in the brain. Rubella can infect pregnant women, and children with congenitally acquired rubella can suffer cardiac problems and brain complications. The diseases are a major international concern, with outbreaks in Ukraine, the Philippines and Australia, among other places. Close to 100 people have died in the Philippines. The World Health Organization has said that the number of measles cases worldwide nearly quadrupled in the first quarter of 2019 to 1,12,163 compared with the same period last year.
CDC says that the measles, mumps, rubella (MMR) vaccine is safe and effective at preventing measles, mumps, and rubella. While the vaccine has side effects, like fever, rash and joint pain, most people who take the vaccine do not have any serious problems with it. Taking an MMR shot is much safer than contracting measles, mumps or rubella.
Last week, as a public health emergency measure, New York’s mayor announced that residents of localities affected by the measles outbreak will face fines if they refuse MMR vaccines, unless they have a medical reason for the denial. The order was challenged by a group of mothers.
Mumbai, where one phase of the MMR vaccination programme ended on March 21, has also been facing vaccine refusals. Vaccination is not mandatory in India and, unlike New York, Mumbai’s public health department has not imposed punitive actions against refusers, but it has been forced to crack the whip occasionally. In February, the Brihanmumbai Municipal Corporation (BMC), which is implementing the vaccination programme in the city, threatened to cancel the licences of 16 schools, both municipal and private, for refusing to participate in the vaccination drive.
Municipal health officials said that the WHO recommends a 95% immunisation rate for a community to develop herd immunity. The estimate for Mumbai currently is 90-91%. An estimated 150,000 out of 2.4 million children in Mumbai are still to get the MMR vaccine.
“Ideally we should do 95% (immunisation). Maharashtra, on the whole, has been able to reach a rate of 96%. Mumbai is way off (the target),” said Dr Avinash Ankush from the BMC’s public health department.
There are parallels between the MMR vaccination programmes in Mumbai and New York. In New York, the resistance to the vaccinations has been in areas where Orthodox Jewish communities live.
Many of the schools that refused to participate in the programme were Urdu-medium institutions. BMC’s education officer, Mahesh Palkar, said nearly 90% of the students in municipal schools have been vaccinated. “We did not have to take any punitive measures. We had to scold parents and teachers; that worked,” said Palkar.
In Mumbai, many of the schools that refused the vaccines are in Muslim localities. One private school with over 5,000 students, run by a Muslim trust, in the B municipal ward, is still holding out. “There are also some elite schools that have refused, though they have come on board,” said Dr Ankush.
Most arguments against the vaccination, in India and in the United States, are either religious or medical: in the West, the vaccine was rumoured to cause autism; in India, the worry is that it may cause sterility. All these concerns have been proved to be far-fetched.
“Social media has been making our work difficult. Whenever there is a mass immunisation programme the anti-vaccine lobby is at work,” said Dr Ankush.
Despite the unmet target, health officials said there will be no coercion on parents in Mumbai.