Originally published in March 2011 Parents PACK newsletter
A recent caller to a radio show suggested that when she looked into vaccines for her child, her moment of hesitation came when she thought about the chickenpox vaccine. She felt the disease wasn't that severe; therefore, the vaccine wasn't necessary. Her opinion led to her belief that convenience and profit were motivating the vaccine schedule. Did this caller think we should stop our fight against infectious diseases? Is there some level of severity above which we should do everything we can, but below which we should just let what happens happen?
Chickenpox is caused by the varicella virus and is highly contagious. It spreads by respiratory secretions, such as through coughs and sneezes. Infected people typically have a fever and about 300 to 500 itchy blisters covering their entire body. While most people recover after several days, some experience complications such as pneumonia, encephalitis (swelling of the brain), or severe skin infections, such as those caused by “flesh-eating” bacteria. When a pregnant woman is infected with chickenpox, her baby can be born with birth defects or die.
Before the chickenpox vaccine, about 10,000 people were hospitalized with complications each year and about 100 died. Most of these were previously healthy children.
Our society is one filled with items to make taking care of a baby easier, yet every year, we hear about infant deaths involving some of these products and often, associated recalls. In fact, in 2010:
As a society, we rightly demand that the products we use are safe and that the companies making them act responsibly. In fact, the Consumer Product Safety Commission has the sole responsibility to protect society from “unreasonable risks of injury or death.”
In the above-cited examples, the number of deaths was lower than those caused by chickenpox before a vaccine was available, yet the mom on the radio show seemed to suggest that the chickenpox vaccine was unnecessary. Would this same mom feel it was okay to keep the recalled products on the market? What if it was her child who died as a result of the product?
The heart of the issue is the cause of death. In the case of product recalls, babies died as a result of products introduced by parents and produced by companies. In the case of chickenpox, babies died as a result of something that could not be controlled—however, that was before a vaccine to prevent the disease was available. So, after a vaccine is available, if it is not used and the child suffers the disease should someone be held responsible?
Perspective is something we all bring to every situation. It varies by individual and may change through time. In the case of vaccines, we can discuss societal perspectives as they relate to individual actions.
In the 1950s and 1960s parents would have given anything to protect their children from polio. Parents were scared because they did not know what caused polio, so they did not allow their children to go swimming and they often sent them away from the city during the summer. Fortunately, a virus was determined to be the cause of polio, a vaccine was made, and children were again allowed to swim. Parents could not wait to get the vaccine; from a societal perspective the vaccine was a miracle. Today, parents are not afraid of polio.
A few years ago, the first cases of yellow fever in Paraguay in 34 years were reported. Yellow fever kills about 30,000 people throughout the world every year. People with yellow fever can suffer from fever, jaundice, and vomiting, which may appear black due to the presence of blood. People formed long lines at hospitals demanding to receive a yellow fever vaccine; however, the country did not have enough vaccine to meet demand. As a result, several thousand people blockaded a major highway near the city of Asuncion, the country's capital. The reappearance of this disease after 34 years changed the societal perspective about receiving the yellow fever vaccine.
A recent study in the United Kingdom showed a 17-fold increase in cases of measles between 1998 and 2007. Before a 1998 report suggesting that the measles, mumps, and rubella (MMR) vaccine caused autism, only about 50 cases of measles occurred per year in the U.K.; however, after the report, which was subsequently shown to be inaccurate, immunization rates dropped and cases of measles began to rise. In 2007 there were about 970 cases of measles throughout the U.K. and at least one boy died. The citizens of England had a change in perspective. Before 1998, parents felt they were protecting their children from three harmful diseases. After the report, many parents wondered if they were actually harming their children by giving them vaccines. Subsequent studies of the MMR vaccine and autism as well as the increase in cases of measles, suggest that societal perspective may not always be accurate.
In each case, societal perspective changed through time. In the case of polio, there was disease without technology or understanding. For yellow fever, there was a re-emergence of disease and a lack of vaccine. For measles, bad science scared people away from a safe vaccine and a disease that was once almost gone began to re-emerge.
These examples suggest that individual actions are based on societal perception, which may or may not be accurate. When there is disease or a lack of vaccine, such as in the example of polio and yellow fever, there is a demand for vaccine. However, in the absence of disease (e.g., measles), there may be a perception that the vaccine is not necessary. Since societal perspective is often based on individual experiences, stories of these experiences, and media reports, it is important to determine why a particular perception is held by society, what it is based upon, and whether there is information available to support it. Unfortunately, some societal perceptions (e.g., measles) lead to unnecessary harm.
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.
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:
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.
Updated: January 2013
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