Making vaccination compulsory?

New Zealand health workers and policy makers can be proud of the vaccination rates for children. With persuasion and guidance and good systems levels are about 94% at age 1, enough in most cases to provide what is known as ''community'' or ''herd'' immunity.

In other words, enough children are fully immunised that the pernicious diseases seldom take hold. It is the very success of immunisation, however, that works against it. Parents rarely see the results of the likes of whooping cough or measles or worse. Their biggest vaccination incentive - fear for their children's life and health - is weakened.

It is hard as well for today's parents to imagine the crippling effect of post-World War 2 polio, as the generation of children handicapped by that affliction dies off. Without doubt, immunisation has been a miracle of modern medicine and it saves millions of lives and much suffering.

Only a tiny minority oppose it on extremist religious grounds or because of the likes of ''anti-chemical'' beliefs. Unfortunately, parts of this minority can be noisy and spread misinformation.

Other parents, understandably, are cautious. They want the best for their babies and are wary of the jabs. They might be sceptical of the claims of standard medicine and are vulnerable to false ''facts''.

Another group, often poor and on the margins of society, might miss out through uninterested parenting, constant shifting and dislocation from health services. New Zealand has done well spreading vaccination into the most deprived groups, although this remains a challenge. It can, in fact, be in wealthy communities with independent-minded parents that rates slip.

Vaccination is extremely safe and vital and all babies and small children should be immunised, not just the 94% fully immunised at 2 years. But it should be acknowledged it cannot be totally risk-free nor 100% effective.

Australia, with rates a little lower than New Zealand - although even a few percentage points can make a significant difference - has been moving to a ''tough love'' policy. Unvaccinated children would be banned from childcare centres and preschools. This appears to have the support of Australian doctors and Australians generally.

Our Government has rejected a similar approach, while the Labour Party has said a ban would be ''well worth looking at''. Why should Government subsidise pre-school for parents who will not do their part to safeguard their children? Why should the community allow parents to put their children at risk of serious disease, or at least let them ''free-load'' on the vaccinations of others?

After all, even with high vaccination rates, pupils were kept home from a Christchurch school last year when an unimmunised child sparked a whooping cough outbreak.

Although Labour's proposal smacks of a bob each way, it makes sense not to rush to near compulsion but to consider the consequences while recognising the imperative to protect children's health. It could well be that strict measures just harden opposition to immunisation. While a hard core will never be persuaded, there are others who might react against what they see as being bullied by big-sister Government. A growing distrust in the West about government and even doctors could well be exacerbated.

Perhaps, there are other actions that could be taken. Parents, for example, might - without identifying particular children - be able to seek out the immunisation rates at their child's preschool. Many responsible parents might shy away from centres where rates were not high enough.

In the meantime, those in the frontline and those devising policy can continue to focus on bumping up vaccination rates. New Zealand might not have yet reached the near-compulsion stage but should do everything to be as close as possible.