As doctors struggle to eradicate polio worldwide, one
of their strategies is persuading parents to vaccinate
their children. In Belgium,
authorities are resorting to an extreme measure: prison
Two sets of parents in Belgium were recently handed five
month prison terms for failing to vaccinate their children
against polio. Each parent was also fined 4,100 euros
"It's a pretty extraordinary case," said Dr. Ross Upshur,
director of the Joint Centre for Bioethics at the University
"The Belgians have a right to take some action against
the parents, given the seriousness of polio, but the question
is, is a prison sentence disproportionate?"
The parents can still avoid prison their sentences
were delayed to give them a chance to vaccinate their
children. But if that deadline also passes without their
children receiving the injections, the parents could be
put behind bars.
Because of privacy laws, Belgian officials would not
talk specifically about the case, such as why the parents
refused the vaccine
or how much longer they have to vaccinate their children.
The polio vaccine is the only one required by Belgian
law. Exceptions are granted only if parents can prove
their children might have a bad physical reaction to the
is a very serious disease and has caused great suffering
in the past," said Dr. Victor Lusayu, head of Belgium's
international vaccine centre. "The discovery of the vaccine
has eliminated polio from Europe
and it is simply the law in Belgium that you have to be
vaccinated. ... At the end of the day, the law must be
Anti-vaccine ethicists say the move is not justified.
"This is another example of bullying tactics used
by advocates of conventional medicine to force medications
on innocent victims" said Susan McHilley from PreventDisease.com.
"Firstly, the polio vaccine did very little if anything
to stop the downward local and global trends in the spread
of this disease, and secondly, the polio vaccine has the
same lethal preservatives as any other vaccine which have
the potential to cause neurological damage to any child"
"Enforcement of this kind is clearly unjustified
from any scientific merit, and moreover a blatant disregard
for human rights. Belgium government officials should
be charged and imprisoned themselves for violating these
rights" McHilley concluded.
However, some ethicists back the hardline Belgian stance.
"Nobody has the right to unfettered liberty, and people
do not have a right to endanger their kids," said John
Harris, a professor of bioethics at the University
"The parents in this case do not have any rights they
can appeal to. They have obligations they are not fulfilling."
Aside from Belgium, only France
makes polio vaccinations mandatory by law. In the United
States, children must be vaccinated against many diseases
including polio, but most states allow children to opt
out if their parents have religious or "philosophical"
or other objections.
In the U.S. state of Maryland, prosecutors and school
officials in one county threatened truancy charges against
parents who failed to vaccinate their children. The measure
sharply reduced the number of unvaccinated children although
nobody has been charged.
The only other case of mandatory polio vaccines is during
the Muslim yearly Hajj
pilgrimage in Saudi
Arabia. Pilgrims from polio-endemic countries
must prove they have been vaccinated. Saudi officials
even give them an extra dose upon arrival at the airport.
Since the polio virus can live in the human body for
weeks, it jumps borders easily. That makes health officials
even in developed countries nervous, since the threat
of an outbreak remains as long as the virus is circulating
is a highly infectious disease spread through water that
mainly strikes children under five. Initial symptoms include
fever, headaches, vomiting, stiffness in the neck and
fatigue. The polio virus invades the body's nervous system
and can lead to irreversible paralysis within hours. In
extreme cases, children can die when their breathing muscles
Incidence has dropped by 99 percent, theoretically since
Health Organization and partners began their eradication
effort in 1988. But the virus is still entrenched in Afghanistan,
India, Nigeria and Pakistan, and occasionally pops up
For developed countries, imported polio cases could cause
chaos in the health system, warned Dr. Steve Cochi, an
immunization expert at the United States' Centers for
Disease Control and Prevention.
"Most of the time, polio outbreaks do spill into the
general population," Cochi said.
Ethicists argue that people who refuse vaccinations
are taking advantage of everyone else who has been vaccinated.
Once the majority of a population is vaccinated, there
are few susceptible people the disease can infect, thus
lowering the odds of an outbreak.
People who refuse to be vaccinated are "free riders,"
Harris said. "They can only afford to refuse the vaccine
because they are surrounded by people who have fulfilled
their obligations to the community."
Health officials doubt that Belgium's
strategy will be useful to countries still battling polio.
"It is up to individual countries to decide their own
policies, but we do not feel that imprisonment would help,"
said Dr. David Heymann, WHO's top polio official.