Ethical Arguments Against Mandatory Vaccination

Even prior to COVID-19, there was a push to mandate vaccines for the greater societal good. This article deals with pre-COVID vaccines and is a more general discussion about mandatory vaccines. Both sides of this issue should be considered. Nurses General Nursing Article

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Ethical Arguments Against Mandatory Vaccination

The Centers for Disease Control and Prevention (CDC, 2019) and the World Health Organization (WHO, n.d.) declare the imperative need to vaccinate all people to improve public health.  Traditional wisdom taught to healthcare professionals backs up this concept by stating that if we activate the immune system to proteins from a virus or bacteria, then the patient's immune system develops the first-line response when it sees the real antigen.  Vaccines have been in use since 1798, when Edward Jenner exposed people to material from pox blisters to see if it would give them resistance to smallpox (Plotkin, 2014).  The medical community has been thus indoctrinated that vaccines are a must to prevent disease and that they are safe and effective.  This philosophy is so prevalent that many places have, for some time, been contemplating the ethics of public policy to mandate vaccines per the CDC's ever-growing recommended vaccine schedule (Hendricks, Zimet, Meslin, 2016).  This paper discusses this prevalent philosophy, some challenges to mandated vaccination, and the lesser-known science surrounding the topic.

Ethical Debate

In chapter nine of Contemporary Issues in Bioethics, Beauchamp, Walters, Kahn, and Mastroianni (2008) discussed how ethical frameworks shape public health.  The chapter's subtopic, Ethics and Immunization Policy: Promoting Dialogue to Sustain Consensus, specifically discusses ethically creating public policy surrounding vaccinations.   The authors of this section believe that vaccines are safe and effective.  Thus, it is stated that healthcare workers are ethically obligated to educate and convince the public of the benefits of universal inoculation.  The text does admit that policy to this effect is more complicated and requires considerable thought and planning to protect the rights of liberty and justice.  Similarly, Hendrix Sturm, Zimet, & Meslin (2016) present as pro-vaccination but recognize that the ethical obligation of autonomy creates challenges to requiring them via public policy changes.

Greater Good and Public Health

The CDC purports that vaccines protect the public.  The generally accepted reason for this is herd immunity.  In other words, if most people are vaccinated, the entire population is safe from the disease.  It is argued that there is an ethical obligation for society members to participate in the establishment of this herd immunity (Giubilini, Douglas, & Savulescu, 2018).  Many papers are written with this as an assumption, often quoting CDC, WHO, and general medical acceptance of this concept as to why vaccinations should be strongly encouraged.  Few papers question this paradigm and sometimes ridicule any challengers to it.  The usual assumption is that people who refuse vaccines must be uneducated on the topic or irrational (Logan, Nederhoff, Koch, Griffith, Wolfson, Awan, & Basta 2018).  This pervasive assumption fuels the argument that public policy must be in place to protect the public against the ignorant or irrational fringe who refuse vaccines.

Autonomy and Medical Freedom

As mentioned earlier, many ethical thinkers recognize the conflict between the greater good presented above and autonomy/liberty.  Parents, many physicians, and a growing number in the scientific community are arguing for the right to medical freedom.  The "greater good" side of the argument acknowledges this as a problem as autonomy is a long-standing ethical priority, but sees it as overreaching into the harm of the public (Grzybowski, Patryn, Sak, & Zagaja 2017).  Still, the exertion that people have a right to choose what is done to them is strong and founded on significant historical lessons.  The Nuremberg Code (NIH, n.d.) is often referenced to support the importance of autonomy in light of how governments can go too far in controlling medical treatments and experiments.  As parents and some professionals advocate for autonomy, those mentioned in the "greater good" want to justify the overreach and minimize the importance of autonomy (Grzybowski, Patryn, Sak, & Zagaja, 2017; Logan, Nederhoff, Koch, Griffith, Wolfson, Awan, & Basta, 2018).  Those wishing to forego vaccination respond that their right to autonomy is grounded not on a whim, but on science that many on the other side of the debate have not considered.

Overlooked Scientific Evidence

There is a significant body of science that suggests that arguments for immunizations are often incomplete or simply wrong.  When brought up to the vaccine advocates, the response is often made that it is misinformation.  The CDC is often quoted that they claim vaccines are safe and effective.  The literature quoted to back this up tends to be written with automatic assumptions of safety and effectiveness.  This creates a somewhat circular argument of "they are safe and effective because the CDC says so, and all these authors believe it, so they must be safe and effective.”   However, if the science does effectively argue the points, then there develops an area that Pence (2007) describes as ethical relativism.  So, if both sides are making their stance because of their belief of what science supports, then this relativism does not warrant the forced impingement on autonomy.

Vaccine Safety

Concerns exist surrounding the use of aluminum as an adjuvant.  An adjuvant is used to hyper-excite the immune system to trigger the development of antibodies to the target antigen.  Research such as Mitkus, King, Hess, Forshee, & Walderhaug, (2011) suggests that vaccine aluminum is safe because the body-retained levels of aluminum were below the established safe levels after occasional episodic vaccinations.  This was based on comparing estimated levels retained in the body versus established "safe" levels, but not correlated to patient outcomes.  This is flawed reasoning.  Lyons-Weiler & Ricketson (2018) clearly explain that the established values for safe levels of aluminum are based on a small adult who has a full-functioning detoxification ability. To be safe for children and infants, the values would have to be modified for size/weight and take into account the immature detoxification systems in early childhood. Current immunization schedules, which have added vaccines since the Mitkus et al. 2011 study, may be dangerous due to inaccurate "safe" levels.  Dietary aluminum is common, but much of it is bound and passes through the bowels.  Injected aluminum is not.  Aluminum is a known neurotoxin that is not only correlated with Parkinson's and Alzheimer's, but now in autism (Mold, Umar, King, & Exley, 2018).  Further, Tomljenovic & Shaw (2012) report a strong correlation between aluminum and autoimmune diseases, which have been steadily rising as the number of suggested vaccines has increased.  Many reported vaccine injuries are related to neurological damage/symptoms (AHRQ, n.d.; CDC, 2019).

Other ingredients in some vaccines also have raised alarm.  The CDC (2019) lists certain contents of vaccines, which include some that are dangerous, such as aluminum, formaldehyde, polysorbate, human DNA, and thimerosal (mercury). Review of the Formaldehyde Assessment in the National Toxicology Program 12th Report on Carcinogens (2014) warns against the dangers of formaldehyde.  Coors, Seybold, Merk, & Mahler (2005) give strong reasons to avoid polysorbate.  McGovern (2017) reports that additional concerns are that there is a substantial existence of unintended contaminants in many vaccines that contribute to safety concerns.  The under-reporting of adverse reactions is readily admitted by the CDC.  They also confess that there are inadequacies of the current Vaccine Adverse Event Reporting System (VAERS).  Despite inefficiency and underreporting, VAERS lists innumerable possible adverse reactions to vaccines that do not seem to elicit any true investigation or consideration from officials (AHRQ, n.d.).

Vaccine Effectiveness

The effectiveness of immunizations is also in question.  Influenza vaccinations consistently have low coverage rates (Demicheli, Jefferson, Ferroni, Rivetti, & Di Pietrantonj, 2018), so the theory behind their use is fallible.  Fail rates for other vaccines have also been noted to be relatively high (Modrof, Tille, Farcet, McVey, Schreiner, Borders, Gudino, Fitzgerald, Simon, & Kreil, 2017;  Klein, Bartlett, Fireman, & Baxter, 2016).  Questions of vaccine effectiveness apply to measles outbreaks in which the unvaccinated are blamed for the spread of the disease in a group that should theoretically have herd immunity. This could be explained not because the unvaccinated are a threat to others, but because vaccinations have been shown to lose effectiveness dramatically over time (Seagle, Bednarczyk, Hill, Fiebelkorn, Hickman, Icenogle, ... McLean, 2018).  Practically, this presents as a need for boosters and a significant percentage of fully vaccinated acquiring diseases anyway.

Conclusions

Both sides of the vaccine argument claim that science backs their view, even among educated experts in the field.  This statement means the science is not settled concerning vaccine effectiveness and safety.  Few topics of inquiry truly get entirely settled, but rather lead to further inquiry.  It is not a sound ethical statement to say that immunizations should be mandated for the greater good if the science is so dubious.  The fact that one perspective on vaccines is more popular does not make it more scientifically sound.  Thus, the ethical argument of a greater good does not have ground enough to justify overreaching the value of autonomy.  There are very important reasons that the bioethical concept of autonomy exists, which is to protect the individual from abuse of medical paternalism.

The fact that sound science questioning the pro-vaccine arguments is consistently suppressed suggests that nefarious interests may be at play to maintain the popular belief that vaccines are safe and effective.  Research that supports vaccines tends to get more funding and have an easier time getting published in more popular journals.  The existing prejudice and claims of misinformation are making an honest evaluation of the subject obfuscated and they foster emotional responses rather than scientific inquiry.

Legitimate parental concerns over children's safety should not be dismissed or ridiculed. The science is not settled on vaccines.  The safety and efficacy of vaccines are justifiably challenged. Autonomy is a well-established concept in bioethics.  These points should sway medical professionals and policymakers away from mandating injections and toward sound research to prove or disprove the safety and efficacy of what is being injected into the masses. 

References/Resources

AHRQ Digital Healthcare Research: Informing Improvement in Care Quality, Safety, and Efficiency. (n.d.). Electronic Support for Public Health—Vaccine Adverse Event Reporting System (ESP: VAERS) (Massachusetts). Retrieved February 5, 2020.

Beauchamp, T. L., Walters, L., Kahn, P.P., Mastroianni, A.C. (ED.). (2008). Contemporary issues in bioethics (7th ED). Canada: Thomson/Wadsworth.

Centers for Disease Control and Prevention – CDC (n.d.). Understanding Vaccines and Vaccine Safety. Conversations. Retrieved February 5, 2020.

Centers for Disease Control and Prevention – CDC. (2019). Epidemiology of Vaccine Preventable Diseases. Pinkbook (2019, December 5).

Coors, E. A., Seybold, H., Merk, H. F., & Mahler, V. (2005). Polysorbate 80 in medical products and nonimmunologic anaphylactoid reactions. Annals of Allergy, Asthma & Immunology, 95(6), 593–599.

Demicheli, V., Jefferson, T., Ferroni, E., Rivetti, A., & Di Pietrantonj, C. (2018). Vaccines for preventing influenza in healthy adults. Cochrane Database of Systematic Reviews.

Giubilini, A., Douglas, T., & Savulescu, J. (2018). The moral obligation to be vaccinated: utilitarianism, contractualism, and collective easy rescue. Medicine, health care, and philosophy, 21(4), 547–560.

Grzybowski, A., Patryn, R. K., Sak, J., & Zagaja, A. (2017). Vaccination refusal. Autonomy and permitted coercion. Pathogens and global health, 111(4), 200–205.

Hendrix, K. S., Sturm, L. A., Zimet, G. D., & Meslin, E. M. (2016). Ethics and Childhood Vaccination Policy in the United States. American journal of public health, 106(2), 273–278.

Klein, N. P., Bartlett, J., Fireman, B., & Baxter, R. (2016). Waning Tdap Effectiveness in Adolescents. Pediatrics, 137(3), e20153326.

Logan, J., Nederhoff, D., Koch, B., Griffith, B., Wolfson, J., Awan, F. A., & Basta, N. E. (2018). 'What have you HEARD about the HERD?' Does education about local influenza vaccination coverage and herd immunity affect willingness to vaccinate?. Vaccine, 36(28), 4118–4125.

Lyons-Weiler, J., & Ricketson, R. (2018). Reconsideration of the immunotherapeutic pediatric safe dose levels of aluminum. Journal of Trace Elements in Medicine and Biology, 48, 67–73.

McGovern, C. (2017, February 4). Dirty Vaccines: New Study Reveals Prevalence of Contaminants. Global Research.

Mitkus, R. J., King, D. B., Hess, M. A., Forshee, R. A., & Walderhaug, M. O. (2011). Updated aluminum pharmacokinetics following infant exposures through diet and vaccination. Vaccine, 29(51), 9538–9543.

Modrof, J., Tille, B., Farcet, M. R., McVey, J., Schreiner, J. A., Borders, C. M., Gudino, M., Fitzgerald, P., Simon, T. L., & Kreil, T. R. (2017). Measles Virus Neutralizing Antibodies in Intravenous Immunoglobulins: Is an Increase by Revaccination of Plasma Donors Possible? The Journal of Infectious Diseases, 216(8), 977–980.

Mold, M., Umar, D., King, A., & Exley, C. (2018). Aluminium in brain tissue in autism. Journal of Trace Elements in Medicine and Biology, 46, 76–82.

National Institutes of Health – NIH (n.d.). The Nuremberg Code.

Pence, G. E. (2007). The elements of bioethics. Boston: McGraw-Hill.
Plotkin S. (2014). History of vaccination. Proceedings of the National Academy of Sciences of the United States of America, 111(34), 12283–12287.

Review of the Formaldehyde Assessment in the National Toxicology Program 12th Report on Carcinogens. (2014). National Academies Press.

Seagle, E. E., Bednarczyk, R. A., Hill, T., Fiebelkorn, A. P., Hickman, C. J., Icenogle, J. P., ... McLean, H. Q. (2018, February 1). Measles, mumps, and rubella antibody patterns of persistence and rate of decline following the second dose of the MMR vaccine.

Tomljenovic, L., & Shaw, C. (2012). Mechanisms of aluminum adjuvant toxicity and autoimmunity in pediatric populations. Lupus, 21(2), 223–230.

World Health Organization-WHO (n.d.). Global Vaccine Safety. Retrieved February 5, 2020

6 Votes
ldhrn73

About ldhrn73

Landon is a RN of 25 years. He has been staff, management, and admin in various settings including ICU, cardiac and pulmonary med/surg, stepdown/progressive, inpatient rehab, LTAC, wound care, and nursing faculty. He has a MSN from Univ. of South Alabama and is a PhD candidate at Oklahoma City Univ.

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ldhrn73 said:

Questions of vaccine effectiveness apply to measles outbreaks in which the unvaccinated are blamed for the spread of the disease in a group that should theoretically have herd immunity.

In Ohio 85 cases of measles were recorded starting in October of 2022 resulting in 26 hospitalizations. All cases were in unvaccinated (by choice or by being too young to receive their first vaccination) or under-vaccinated children (those who had not completed the series) and the source was 4 unvaccinated individuals who had traveled abroad to an area where measles was prevalent. Due to the contagious nature of measles, immunity  by vaccination would require 95% of the population to be vaccinated which is a level we have never achieved and likely never will. You appear to be conflating herd immunity achieved by vaccination with herd immunity by infection. I don't recall any reports blaming unvaccinated individuals for rampantly giving measles to vaccinated individuals although I am aware of a few cases and there is some discussion about waning protection vs vaccine failure.  I don't know about you but I'd rather not support the idea of herd immunity by measles infection given the huge number of unecessary hospitalizations and even deaths that would result in our pediatric population.  

To be clear I am speaking only of measles because that is the disease you chose to highlight and because of its virulence. There are other vaccinations for which I am less supportive of mandatory compliance. People are free to choose risky behaviors or ignore safeguards all they want until their decisions impact others. 

8 Votes
Specializes in ER.

I believe vaccines are overused. I think they should only be used to prevent the most serious of diseases.

There is epidemiological trend in a dramatic rise of autoimmune disorders. My personal belief is that the overuse of antibiotics and too many vaccines might be behind this.

6 Votes
Emergent said:

There is epidemiological trend in a dramatic rise of autoimmune disorders. My personal belief is that the overuse of antibiotics and too many vaccines might be behind this.

I personally think our exposure to chemicals in our environment and the food we eat is the reason behind this moreso than vacccines. We live in a toxic cloud. It's no wonder we are having issues. 

10 Votes
Specializes in ER.
Wuzzie said:

I personally think our exposure to chemicals in our environment and the food we eat is the reason behind this moreso than vacccines. We live in a toxic cloud. It's no wonder we are having issues. 

I agree those things contribute to modern diseases. I'm tend to think they are more inclined to contribute to cancers. My intuition believes that manipulations of the immune system are more inclined to cause autoimmune diseases, since those are malfunctions of the immune response.

5 Votes
Specializes in Public Health, TB.

In lieu of mandatory vaccines, all parents and employees should be instructed on the consequences of the potential illnesses that can be contracted. People should be compelled to watch infants with whooping cough struggle to breathe, children with profound retardation after maternal rubella, children with hearing loss, teenagers with diptheria (it used to be the leading cause of death), withered limbs from polio, liver cancer from Hepatitis B, and amputated limbs from meningitis. 

https://reliefweb.int/disaster/ep-2019-000112-phl

From the Philippines:

Quote

Based on the DOH's Measles and Rubella Surveillance report and WHO Epidemiological Overview 2020, between 1 January and 31 December 2019, a total of 47,871 cases of measles, including 632 deaths, were recorded, with a case fatality rate (CFR) of 2.6 per cent. (IFRC, 12 Mar 2020).

 

11 Votes
Specializes in Critical care, rehab, administration, academics.

Most universities require vaccines, so they DO claim close to 95% vaccinations. Yet several measles outbreaks have been recorded on university campuses and were seen almost exclusively in fully vaccinated students. I researched 2 such cases, one in upstate New York and one on the University of Arkansas campus. Once the statistics were completed, the sources for both of these cases were deleted from the sites. And I then heard on mainstream news stations that they were the fault of unvaccinated. This kind of sparked my digging into questions.

I am not saying to vaccinate or to not vaccinate. However, the science is not settled concerning safety and effectiveness of vaccines. Information we are given is not always accurate or transparent, and patients should still have some autonomy.  Information exists that warrants deeper investigations.

2 Votes
ldhrn73 said:

However, the science is not settled concerning safety and effectiveness of vaccines.

Well, since we don't have thousands of people being harmed or worse, killed, by polio, measles, smallpox or rubella I think the effectiveness and safety of these vaccines is kind of obvious to most with the exception of the Wakefield fan base. I think allowing personal autonomy to reintroduce these particular pathogens into the community would be irresponsible and tragic. I do not feel the same about some of the other vaccines that are currently available. 
Despite your protestations I feel an undercurrent of anti-vax sentiment in your article. Again, I agree that the option to get certain vaccines should remain a personal choice but the Polio and MMR should remain required to protect our vulnerable neighbors who don't have that option.  We really don't want to go back to this. 
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14 Votes
Specializes in Public Health, TB.
ldhrn73 said:

Yet several measles outbreaks have been recorded on university campuses and were seen almost exclusively in fully vaccinated students. I researched 2 such cases, one in upstate New York and one on the University of Arkansas campus. Once the statistics were completed, the sources for both of these cases were deleted from the sites. And I then heard on mainstream news stations that they were the fault of unvaccinated. This kind of sparked my digging into questions.

I am not saying to vaccinate or to not vaccinate. However, the science is not settled concerning safety and effectiveness of vaccines. Information we are given is not always accurate or transparent, and patients should still have some autonomy.  Information exists that warrants deeper investigations.

I think the science is settled on MMR vaccine. I cannot find documentation of your outbreak cases. Exactly how many cases were there? Because measles is so highly contagious, 1 case is considered an outbreak. And even though the vaccine is 95-99% effective, breakthrough cases are possible. 

It is well known that mumps vaccine tends to wain, so often boosters are offered in the cases of outbreaks. In the USA, mumps vaccine is only available in the MMR or MMRV combo. 

I am old enough to have contracted mumps and I wouldn't wish that on anybody. I can't even imagine the pain that goes with orchitis. 

6 Votes
Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.
Emergent said:

I agree those things contribute to modern diseases. I'm tend to think they are more inclined to contribute to cancers. My intuition believes that manipulations of the immune system are more inclined to cause autoimmune diseases, since those are malfunctions of the immune response.

I have long considered that. All of my children are selectively vaccinated, on a delayed schedule. In fact, I mentioned that here once (the idea that the multitude of autoimmune disorders correlated to the many vaccines we give to immature immune systems) many years ago and was excoriated.

5 Votes
Specializes in OB-Gyn/Primary Care/Ambulatory Leadership.
nursej22 said:

In lieu of mandatory vaccines, all parents and employees should be instructed on the consequences of the potential illnesses that can be contracted. People should be compelled to watch infants with whooping cough struggle to breathe, children with profound retardation after maternal rubella, children with hearing loss, teenagers with diptheria (it used to be the leading cause of death), withered limbs from polio, liver cancer from Hepatitis B, and amputated limbs from meningitis. 

Actually, Oregon does that very thing. If a parent wishes to exercise their right for philosophical exemption from routine vaccine requirements, they are required to watch a video on vaccine-preventable illnesses. At least, that was the requirement back in 2016, it may have changed.

4 Votes
Specializes in ER.
klone said:

I have long considered that. All of my children are selectively vaccinated, on a delayed schedule. In fact, I mentioned that here once (the idea that the multitude of autoimmune disorders correlated to the many vaccines we give to immature immune systems) many years ago and was excoriated.

That's exactly how I handled it with my children.

Unfortunately, the discussion about vaccines is often dominated by extremes on both sides, and lots of emotion. We saw this intensely during the covid pandemic.

It feels to me like academic researchers have been agenda driven and shortsighted regarding the cumulative effects of vaccines. I remember in nursing school during my OB rotation that we were giving Hep B vaccines to brand new babies. That was 30 years ago when the vaccine was pretty new. I went along with it because I was a nursing student, but I totally disagreed with what I was doing.

Now we have people in their thirties with much higher rates of autoimmune diseases. Type 1 diabetes rates have doubled or tripled since that time. I'd like to see some honest reevaluation of some of the policies that have been in place.

4 Votes
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