Parents PACK Newsletter

April 2008

Parents Pack Newsletter

Possessing, Accessing and Communicating Knowledge About Vaccines

In this issue:

• Feature Article: Mandates and Individual Liberties
• Spotlight: Measles Outbreaks in the U.S.
• Did You Know?. . .Measles around the World
• Ask the VEC - Separating or Delaying Vaccines

Feature Article: Mandates and Individual Liberties

On March 26, 2008 a panel discussion about vaccine mandates titled "Should the Government Make You Do It?" was presented at the Franklin Institute in Philadelphia, Pennsylvania. One of the panelists that evening was Dr. Arthur Caplan, Chair of the Department of Medical Ethics at the University of Pennsylvania. This article is a summary of remarks Dr. Caplan made regarding liberty. View the entire discussion»

After reviewing Dr. Caplan's remarks, we would like to hear your thoughts. Please email any comments, questions or thoughts to contactPACK@email.chop.edu.

According to Webster's unabridged dictionary, liberty is "freedom from arbitrary or despotic government or control." When it comes to vaccine mandates, some individuals feel that vaccine mandates are contrary to liberty because they are requirements imposed by the government. 

Dr. Caplan argued that in certain cases liberty can ethically be restricted. These include:

•  Cases in which individuals do not have enough information to make informed decisions - Despite popular belief that everyone can be an expert by accessing information on the Internet, there are cases in which experts must be relied upon for the best interests of society.
• Cases involving destruction of the common good - When something enjoyed by all will be destroyed by invoking individual liberties, the common good should take precedence. Preservation of public parks would be an example.
• Cases in which one person's individual liberties would inhibit another person's space - As stated by Oliver Wendell Holmes, "The right to swing my fist ends where the other man's nose begins." In other words if my personal decision will affect your person or property, I should not be allowed the liberty.
• Cases in which the decision is being made for people who do not have the liberty of deciding for themselves - Decisions being made on behalf of children or members of society who cannot otherwise represent themselves would be included in this reasoning. 

Based on these criteria for revoking individual liberties, Dr. Caplan went on to argue that vaccine mandates are justified because they fall into all of these categories.

First, despite popular belief, individuals do not have enough information about vaccines to make informed choices. We rely on experts from the Centers for Disease Control and Prevention, American Academy of Pediatrics and American Association of Family Physicians to review the data and offer recommendations regarding best health practices surrounding vaccines. 

Second, vaccines involve a common good in the name of herd immunity. Herd immunity occurs when enough people in a society are immunized that the disease will not be likely to spread throughout the community. As a result, certain members of society will be protected from the disease even if they cannot get a vaccine or if the vaccine does not work for them. When a certain number of people in a population forego immunization, herd immunity does not work thereby affecting the common good. Recent outbreaks of measles in California, Arizona, Wisconsin and New York have resulted from a sufficient decrease in herd immunity.

Third, an individual's liberty to take advantage of herd immunity is affected by another's liberty to forego immunization, or said another way, "the right to swing my fist ends at the start of your nose." 

Finally, most vaccine mandates affect children who cannot represent themselves and whose interests, therefore, must be represented in the name of liberty.

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Spotlight: Measles Outbreaks in the U.S.

Between January and the end of March 2008, 24 cases of measles have been diagnosed in the U.S. These cases have occurred in Arizona, California, Hawaii, New York, Virginia, Colorado and Michigan. All resulted from importation of the disease from other countries; however, not all of the infected people had traveled. Most were unvaccinated individuals who happened to come into contact with the travelers in their communities, in airports, or in healthcare settings. In a few cases, infants too young to have been vaccinated got measles from coming into contact with the infected individuals.

Did You Know?. . . Measles around the World

According to the World Health Organization (WHO), an estimated 242,000 people around the world died from infections with measles during 2006. Most of the deaths occurred in Southeast Asia. However, many countries still have endemic measles. The WHO along with UNICEF identified 47 countries to target for measles eradication in the Global plan for reducing measles mortality, 2006-2010. These 47 countries account for 95 percent of measles-related deaths each year. Learn more about measles and measles eradication efforts»

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Ask the VEC —  Separating or Delaying Vaccines

Q.  I have an 11-month-old daughter and would like to have her get the MMR vaccine in its three separate components or delay having her get it until she is older. Can you tell me if this is possible?

A. It is not recommended to separate or delay the MMR vaccine for your daughter.

Separating the vaccine into its three component parts is not recommended because:

•  No evidence exists that separating the vaccine into its individual components makes it safer.
• These vaccines are called "live, viral vaccines" which means that at least one month must pass before a second one of them is given to your daughter. Assuming you are able to get appointments one month apart, your daughter will still be susceptible to the other diseases for one to two months during the time you are waiting for her next appointment. Both measles and mumps outbreaks have occurred in the U.S. over the last few years.
•  In order to separate the vaccine, your daughter will have to go to three doctor's visits, receive three shots instead of one shot, and you will likely have to pay for three visits without increasing the safety of the vaccines.

Delaying the vaccine is not recommended because:

•  The MMR vaccine is recommended at one year of age because as infants get older, protection once afforded by maternal antibodies decreases.
•  During the time that you are waiting to get your child the vaccine, she is susceptible to three dangerous diseases. Measles typically causes a rash, cough, runny nose, eye infections, and fever as high as 103 - 105 degrees. In about three of every 10 cases of measles infections, there are complications that could include diarrhea, ear infection, pneumonia, seizures, swelling of the brain, or rarely, death. Mumps infections lead to headaches, low-grade fevers, inability to eat, fatigue, and swelling of the salivary glands. Although about one in five people with mumps do not know they are ill, others may experience complications including meningitis, swelling of testicles or ovaries, infection of the pancreas, deafness, and death. Rubella infections in children are relatively mild, but can be severe and may lead to congenital rubella syndrome if a pregnant woman is infected. Babies born to mothers infected with rubella during pregnancy may be deaf, mentally retarded or autistic, or have damage to their eyes, hearts, liver, bones or spleen. 

Send us your comments

If you have any comments about this newsletter or suggestions about how we can make our Web site more helpful, please send your comments to contactPACK@email.chop.edu.

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