Letters – What Kind of Obligation is Immunization?

In this past summer’s edition of Dignitas Paige Comstock Cunningham wrote a very thoughtful piece that focused upon our moral obligations to act on behalf of the common good. She is certainly on the mark when she draws upon the parable of the Good Samaritan to remind us that our neighbors include everyone and we should feel obligated, not only to help them in distress, but also to avoid harming them.

As an example of decisions that can harm others, she discusses the growing number of parents who are not giving permission to have their children vaccinated. She cites recent increases in the number contracting certain communicable diseases to illustrate how these decisions have deleterious effects for one’s neighbors. Her admonition to those who are making these decisions not to have their children vaccinated, and to all of us more generally, is that our understanding of health and human flourishing not be confined to the personal sphere to the neglect of the communal. Parents, therefore, should feel obligated to have their children vaccinated for communicable diseases in order to increase public health, the health of everyone in our communities.

Now I do not disagree with her contention that we should attend to the common good, and in matters of health, the health of others as well as of ourselves and of our own children. However, the current practices attending vaccination, and the conceptualization of what constitutes immunization against diseases, need to be critically examined.

I begin with a rather extreme example of a practice that should not only be questioned: it should not be permitted to continue. In2007, parents of 2,300 children who had not provided certificates of immunization, were issued a court order to have their children appear in court to have their children obtain state-mandated vaccinations—up to 17 doses on the spot—or face imprisonment. This occurred in Prince George’s County, Maryland at the behest of the State Attorney General and the chairman of the district’s school board. The school district stood to lose money from the state unless it complied with the state’s vaccine mandate.[i] In response, Katherine Serkes of the Association of American Physicians and Surgeons sounded the alarm:

This campaign of intimidation to brutally enforce blanket vaccine mandates by the government agencies and the school district gives no consideration for the rights of the parents or the individual medical condition of the child. . . .It’s not just local now, and parents across the county are ready to fight.[ii]

One could argue, however, that mandating certain parental behaviors on behalf of their children is something we do now for generally accepted reasons. For example, we require that children be educated in a public or private school, or in a child’s home. Educators are held to certain standards, and also held responsible for not harming those they instruct in any way, whether through what they teach, or how they discipline.This kind of enforcement of the benefits of education is regarded, not only as good for those being educated, but also for the community as a whole. Indeed, properly educated individuals can acquire the knowledge of what helps make a person healthy, a boon to them and our communities as well. However, are vaccinations an individual and communal good like education so that having one’s child vaccinated is always clearly a parental obligation? Properly carried out in accord with morally acceptable standards, education is as such beneficial.This is not true of vaccines.

The most disturbing characteristic of vaccines is that they come with risks to one’s health and life.

Even if no direct connection exists between autism and receiving multiple doses of vaccine in early life as some might propose, there are nevertheless serious risks to being vaccinated. Pharmaceutical companies knew this when they prevailed upon Congress to pass the aptly named “NationalChildhood Vaccine Injury Act” in 1986. The purpose of this law is clearly stated: “No vaccine manufacturer shall be liable from vaccine related injury or death.” (Public Law 99-660) That vaccines are risky is clearly acknowledged, and these include death. On behalf of this law, the argument that prevailed was that manufacturers of vaccines cannot profitably supply them for mass vaccinations of American children if they were to be subjected to lawsuits seeking compensation for the serious injuries and death that vaccinations can and do cause.  The law did create an“Office of Special Masters” made up of scientists and others who would determine if a vaccine had harmed someone and whether compensation was warranted. Since 1989 the National Vaccine Injury Compensation Program has handed out over 2 billion dollars to families to compensate for vaccine-related injury or death.[iii]For medical interventions generally, parental consent for their children while they are minors is required; why shouldn’t this be the case with respect to vaccinations as a general rule?

The most obvious retort to those who refuse vaccinations is that they thereby expose themselves, their children and others to infectious diseases that can also cause serious illness and sometimes death.However, the quest for personal and communal immunity from diseases should be viewed from a much broader perspective. Some of the dramatic declines in deaths from diseases such as measles, typhoid, and Whooping cough can and should be attributed to improved standards of living, the elimination of water-borne pathogens, cleaner food, and better standards of hygiene. Unsafe water supplies and unsanitary conditions can by themselves and even now do, result in outbreaks of deadly infectious disease—in refugee camps, for example.

Immunity from infectious diseases should not be simply equated with being vaccinated. Immunity from illness is first and foremost very much dependent upon the strength and soundness of an individual’s immune system. Ironically one even needs a relatively healthy, well-developed immune system to benefit from vaccines and avoid being seriously harmed by them. A neighbor of mine conscientiously took her flu shot and suffered a near fatal bout with the flu. Knowing her age and lack of healthy habits, her immune system was weak, too weak to cope well with flu shots. It almost took her life.

Where do all of these considerations leave us with respect to how we may best carry out our obligations to prevent infectious diseases that threaten to harm not only ourselves but others as well? All of us have an obligation to obtain the information necessary to engage in suitable physical exercise, consume nutritious food, cultivate hygienic habits, provide for wholesome physical and social environments, and make use of vitamin and mineral supplements appropriate for our ages and needs. As one ages, all of this is even more important. Further supplements may be essential for preventing growing deficiencies. This knowledge and these practices parents should provide for themselves and their children: certainly my wife and I, our adult children, and adolescent grandchildren have benefited immensely from this path. Flu, and many other ailments, are thankfully alien to us. No flu shots for this family so far, and none are contemplated for the future. I would also urge that we not only love our neighbors, but that we also love God: such love is essential to our well-being and that of our neighbors.

What about vaccinations? I would not rule them out.What we should seek in the way of public policy is a very selective use of them when the need for them can be convincingly demonstrated. And, when they are used, those who receive them should be old enough and healthy enough to receive them. Physicians and nurses should be administering vaccinations.

Whether vaccines should ever be mandated depends upon whether the following conditions are met: (1) A compelling need for a particular vaccine or vaccines can be clearly documented. That means that alternatives to vaccines have not or will not work in a timely enough fashion, and the failure to use vaccines involve much greater risks than the particular vaccinations being advocated; (2) A voluntary program that has been set in motion, and extensively publicizes, is not working. There are not sufficient number of individuals being immunized to overcome a very dire, immediate threat to public health; (3) Any mandate should only apply to communicable diseases.Vaccinating people for conditions like shingles should be voluntary; (4) Any mandate for mass vaccinations should be temporary, lasting only as long as necessary. After all, it is only in emergencies that we justifiably risk lives to save lives.

In conclusion, people should be taught immunization is not simply attained by vaccinations. Immunization is best achieved by a healthy lifestyle and environment that supports it. The disciplines of studying nutrition, the environment, and infectious diseases found in Schools of Public Health, aid us in gaining the knowledge and policies that help immunize us.

Arthur J. Dyke, PhD
Research Professor of Ethics, Harvard Divinity School
Mary B. Saltonstall Professor of Population Ethics Emeritus in the School of Public Health, Harvard University
Distinguished Fellow, CBHD

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References

[i] N. Hernandes, “Get Kids Vaccinated or Else, Parents Told,” Washington Post, November 14, 2007 http://www.washingtonpost.com/wp-dyn/content/article/2007/11/13/AR2007111301408.html (accessed December 20, 2012).

[ii] Katherine Serkes, “Doctors Oppose Maryland Vaccine Roundups: ExpectDangerous Reactions When Children Are Treated Like Cattle,” Association of American Physicians andSurgeons, November 16, 2007 http://www.aapsonline.org/index.php/article/doctors_oppose_maryland_vaccine_roundup/ (accessed May 2, 2013).

[iii]“National Vaccine Injury Compensation Program” Health Resources andServices Administration http://www.hrsa.gov/vaccinecompensation/index.html (accessed December 20, 2012).