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Measles-Rubella Vaccine
The mandatory measles–rubella (MR) vaccination drive initiated in schools by the Indian government in October 2019 has raised questions regarding whether informed consent was sought from parents prior to vaccination and its legal implications. This article presents a comprehensive picture of informed consent processes, ethics, and the law, and the need for evidence prior to implementing national vaccination policies. In the case of a combination vaccine such as the MR vaccine, we see that the rubella vaccine gained entry to India’s universal immunisation programme (UIP) without clear scientific evidence on its disease burden and in the absence of public demand for such a vaccine by piggybacking on another universal vaccine (measles).
The author is grateful to the reviewer for pointing out important omissions and commissions to make this article more authentic. The views expressed in this article are those of the author.
The mandatory measles–rubella (MR) vaccination drive in private schools in various parts of India raised many concerns following its launch in 2017. Parents asked several questions: Why are schools enforcing mandatory vaccination irrespective of prior vaccination? Why should consent be given without knowing the merits/demerits of MR vaccination? Does this extra dose provide any additional benefit to my child? What is congenital rubella syndrome (CRS)?
Conversely, a section of academia and civil society questioned the scientific grounds for this vaccination drive: Does rubella causes high mortality and morbidity in India and is there a routine survey of data on the same? What is the prevalence of rubella in India? Is the fear of CRS in India scientifically grounded? Why was this sudden attention being given to rubella vaccination, that too in combination with the measles vaccine? Is a second dose of the measles vaccine beneficial? What went on behind closed doors in the meetings held by the National Technical Advisory Group on Immunisation (NTAGI)? Who manufactures and supplies MR vaccines to the Universal Immunisation Programme (UIP)? Was this decision based on sound scientific evidence and a cost-effectiveness analysis? What are the ethical concerns and legal implications of this mandatory vaccination?
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