Delhi High Court put on hold Tuesday the Delhi government’s 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 question in court
Students of private schools in the city had approached the court through their parents saying “it is settled principle that choice of an individual, even in cases of life-saving medical treatment, is an inextricable part of dignity which ought to be protected…”.
Not a routine step
The consent of parents is not sought during routine immunisation programmes. Dr V K Paul, Member (Health) at NITI Aayog, and former professor of paediatrics at AIIMS said consent in routine immunisation is implied because it is the parents or members of the family who bring the child to the hospital or healthcare centre. “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 immunisation programme, written consent should not be essential,” Dr Paul said.
Dr N K Arora, also a former professor of paediatrics in AIIMS, said: “The MR vaccine was recently introduced in the universal immunisation programme. It has to be administered to all children between ages 9 months and 15 years. But we also need to vaccinate those who did not get it earlier, and before they reach the reproductive age group. For vaccinations and such public health programmes we have never taken consent.”
Why in schools
Dr Paul said 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. “It is only practical,” he said.
Global best practice
“Parental consent should be obtained prior to vaccination. This is the standard practice around the world,” said Dr Mathuram Santosham, professor at the Department of International Health and Paediatrics, Johns Hopkins University.
The World Health Organization recognises oral, written, and implied consent for vaccination. A WHO survey in 2012 in 34 countries on consent procedures for vaccination in 6-17-year-olds found approximately half the countries used written consent. In a 2013 document dealing with the question, the WHO said: “…When children are present for vaccination unaccompanied by their parents, it is challenging to determine whether parents indeed provided consent… Countries are encouraged to adopt procedures that ensure that parents have been informed and agreed to the vaccination.”
Dr N K Ganguly, former director general of the Indian Council of Medical Research, said: “Vaccination is always a voluntary process, and there is never compulsion involved. Vaccines should be administered after people are sensitised about the disease and vaccine. 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.”
The MR vaccine
The latest Global Measles and Rubella Update says India had 56,399 confirmed measles cases and 1,066 confirmed rubella cases in 2018.
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. The disease is preventable through two doses of vaccine.
Congenital Rubella Syndrome, or CRS, is an important cause of severe birth defects. A woman infected with the rubella virus early in pregnancy has a 90% chance of passing the virus to her foetus. This can cause the death of the foetus, or CRS.
“MR vaccine is safe and effective, in use for over 40 years across 150 countries. The vaccine being given in the MR campaign is produced in India and is WHO prequalified. The same vaccine is being given in the routine immunisation programme of India and in neighbouring countries like Bangladesh, Sri Lanka, Nepal and Myanmar. Private practitioners in India have been giving measles-rubella (MR) or measles-mumps-rubella (MMR) vaccine to children for many years,” Dr Ganguly said.