Ethical Arguments Against Mandatory Vaccination

[ldhrn73]

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. 

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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

[Alice Blackmore, MSN, RN]

I think people have lost their faith in the medical system from lack of transparency. Why did Pfizer have sealed documents on clinical trial data which they have been forced by courts to open? Who stands to benefit financially from vaccines? Why don't we hear much about vaccine injury from vaccines such as Dengvaxia given in the Philippines? Why is it "wrong" to discuss both sides? Most would agree that vaccines have saved us from the horrors of Polio and Smallpox. So what has changed?

[Hannahbanana, BSN, MSN]

I read with interest the article entitled "Ethical Arguments Against Mandatory Vaccination.” I note that it was "reviewed and fact-checked" by the AN editorial team. I'm afraid you may have missed a few important points. As an editor myself, I would point out that words such as "indoctrinated" do not lead the reader to expect a dispassionate discussion of an ethical topic. However, this critique is based more on the misrepresentations and other disinformation in the science literature here. A responsible fact checker and editor would have gone to the original source material cited to see if it really says what the author presents. TD;Dr: It doesn't.

This article highlights some very questionable sources as if they were promulgating genuine research. The "Centre for Research on Globalization" is one such. "Globalization" has a legitimate definition and is a field of study on many reputable areas in sociology, economics, climate, and health, to name a few, at universities as diverse as Yale, Groningen, and Oslo.
However, it is also broadly used as a code word in association with George Soros's name, for a "global conspiracy" in right-wing circles and publications, which antisemitic origins are as scurrilous as time.  A sample from a fact-finding article on them:
"Martin Luther King Jr. was murdered in his hospital room by J. Edgar Hoover and the FBI and not, as is commonly accepted, by a gunman dead set against the civil-rights leader's crusade. Israel has plans to annex large swaths of Jordan, Egypt, Saudi Arabia, and Iraq. The American military is dispersing heavy metals in the skies, giving the public cancer and asthma. And of course, the World Trade Center buildings were not brought down by commercial airliners but by controlled demolition."
"Those are all uncontroversial realities for the Centre for Research on Globalization, a Canadian-based conspiracy website run, since 2001, by Michel Chossudovsky, professor emeritus of economics from the University of Ottawa, who is also one of the site's most prolific writers. (Ling, 2021, https://thewalrus.ca/why-Google-has-a-responsibility-to-fight-fake-news/)"

The AHRQ references to VAERS links to a 14-year old preliminary description of a proposed sysytem of data collection, not to any reporting of adverse reports and certainly not to any research linking any methods of adverse reactions to vaccines. Note that "related to" is not equivalent to "caused by" here, as no such investigations were undertaken or reported in this report. While it was retrieved in 2020 by this author, the data are from 2006-2009.  The main objectives of this project were to:
Identify required data elements and develop systems to monitor ambulatory care EMRs for adverse events following vaccine administration.
Prepare and securely submit clinician approved, electronic reports to the national Vaccine Adverse Event Reporting System (VAERS).
Comprehensively evaluate ESP: VAERS performance in a randomized trial and compare it with existing VAERS and Vaccine Safety Datalink data.
Distribute documentation and application software developed and refined in 1 and 2 that are portable to other ambulatory care settings and to other EMR systems.
Preliminary data were collected from June 2006 through October 2009 on 715,000 patients. A total of 1.4 million vaccine doses (of 45 different vaccines) were given to 376,452 individuals. Of these doses, 35,570 possible reactions (2.6 percent of vaccinations) were identified. This is an average of 1.3 events per clinician per month. The team concluded that it is possible to automatically detect adverse events in defined ways, and to electronically report them to VAERS. Decision support functions can be repurposed, so that in addition to detecting reportable diseases, they can detect events that are related to vaccination, as potential vaccine adverse events.

Safety
The McGovern citation for "Dirty vaccines ... prevalence of contaminants" is a review article at the website from the so-called Children's Medical Safety Research Institute (CMSRI) which was a US-based anti-vaccination group that funded and then promulgated pseudoscience about vaccines purposting to link aluminum in vaccines to autism. This article touts a study published in the "International Journal of Vaccines and Vaccinations,” which is a predatory journal known to publish junk science. Predatory journals charge authors for their submissions, do not do real peer review, and choose their names to resemble real ones, in this case, the well-established Journal of Vaccines and Immunology, in order to seem more scholarly. You can search "Beall's List" for more information on this movement.

These articles and pseudoscience "studies" were withdrawn, roundly discredited, and debunked by the Lancet, the Annals of Internal Medicine, legitimate researchers in the World Health Organization, and others. I don't ordinarily give Wikipedia as a source for information, but their articles do have links to original sources, and you can find them there easily. (Garland DE, 2019)

The Coors et al. citation on polysorbate is a single case report, not a study; its references were from 1995-2002 and largely from the dermatology and lab science literature. As the citation is from 1995, I wonder why the actual article as linked includes references from 2002.

The 2014 National Academies of Sciences, Engineering, and Medicine formaldehyde report associating formaldehyde with cancer "reviewed reports published by other authoritative bodies, and it examined primary literature, reviews, and meta-analyses that were publicly available in the peer-reviewed literature." If is freely available online in PDF. I read it all so you don't have to, but if you're interested, the section on exposure assessment is illustrative, page 186 ff. TL;Dr: They looked at occupational exposure, both peak and cumulative over time. There is absolutely nothing in this report related to formaldehyde in vaccinations. (https://nap.nationalacademies.org/read/18948/chapter/9#196)

The University of Oxford in 2022 notes that the amount of formaldehyde left in vaccines during manufacture is less than the amount naturally occurring in the human body. "People may think of formaldehyde as a man-made chemical, but in small quantities it is also found naturally in the bloodstream.” (https://vk.ovg.ox.ac.uk/vaccine-ingredients) "Humans produce about 1.5 ounces of formaldehyde a day as a normal part of our metabolism. Inhaled formaldehyde is rapidly metabolized and ultimately converted to carbon dioxide and exhaled. Formaldehyde does not accumulate in the body.”(American Chemistry Council, 2022, https://www.americanchemistry.com/chemistry-in-america/chemistries/formaldehyde)

Effectiveness
The Demicheli et al. report of Cochrane Review on vaccines does not state that their results were "fallible" or that flu vaccine is not of use. The article cited, updated in 2014, also looks at data from 1969-2009, and finds, "We did not find any evidence of an association between influenza vaccination and serious adverse events in the comparative studies considered in this review. Fifteen included RCTs were industry funded (29%).” We do know now that before mRNA vaccines were made, the flu vaccine took 18 months to produce, and was therefore based on a best guess as to the prevalent strain that would be circulating more than a year later. Since the influenza virus mutates rapidly and often, some years the vaccine was effective over the prevalent strain, and sometimes it wasn't.

The Modrof et al. study cited does not say that measles vaccines "fail,” or become less effective. It described findings in healthy plasma donors whose plasma was used to harvest IVIG, intravenous immunoglobulin, a therapeutic preparation with application as antibody replacement therapy in persons with primary immunodeficiency disorders. Persons who had been vaccinated had lower titers than people with natural infection, which was a problem because they couldn't produce as much for harvesting. "This study aimed to confirm whether the introduction of measles vaccination in the early 1960s in the United Stated led to an almost complete disappearance of natural infections, that translated into lower measles virus antibody titers in source plasma donors. Subsequently, revaccination of plasma donors was investigated as a means to potentially boost measles virus antibody titers, an intervention that might allow manufacturers to meet the minimum potency requirements as defined by the FDA."

The Klein et al. article indicates that pertussis antibodies conferred by the combined tetorifice-diphtheria-acellular pertussis (DTaP) vaccines of childhood wane after the fifth dose at age 4-6.  Adolescents who took the later doses of Tdap (a different formulation) were more likely to test positive for pertussis the longer it was from their last vaccine. That's not a failure, that's congruent with the decreased pertussis coverage after the DTaP of early childhood. This means that the Tdap should be given more often in adolescents to maintain coverage. "Routine Tdap did not prevent pertussis outbreaks. Among adolescents who have only received DTaP vaccines in childhood, Tdap provided moderate protection against pertussis during the first year and then waned rapidly so that litle protection remained 2-3 years after vaccination."

The Seagal et al. article cited does not say that vaccinations "have been shown to lose effectiveness dramatically over time,” contrary to this author's assertion. TL;Dr: Here's their methods and result.
Methods: Children vaccinated with the second dose of measles, mumps, rubella vaccine (MMR2) at 4-6 years of age were followed up to 12 years post-vaccination. The rates of antibody decline were assessed using regression models, accounting for differences between and within subjects.
Results: Most of the 302 participants were seropositive throughout follow-up (96% measles, 88% mumps, 79% rubella). The rate of antibody decline was associated with MMR2 response and baseline titer for measles and age at first dose of MMR (MMR1) for rubella.

I did not research all the citations for ethics for this critique. However, if they are as inaccurate and distored as the "unknown science" presented, I wouldn't be the least bit surprised.

[wtbcrna, MSN, DNP, CRNA]

Vaccine safety and effectiveness is always being researched. Vaccines are the only pharmaceutical product that has to undergo constant phase IV/post-marketing testing for safety and effectiveness. 
Aluminum adjuncts have been exhaustively tested. The whole argument against aluminum always skips the basic premise that aluminum is the most common metal in the Earth's crust. We eat, drink, and breathe in aluminum constantly. By the time we are adults your bones and tissues have more stored aluminum than in all vaccines combined. 
We are here to do no harm to our patients and one of those ways is by decreasing the risk of spreading infections. That can be by proper hygiene/washing hands, wearing masks/PPE, and being vaccinated. 

Herd immunity does not mean that a vaccinated person cannot get measles/influenza etc. Herd immunity decreases the overall spread of infectious illness. Measles has a 90% infection rate (the effectiveness of two doses measles vaccines is 98%) and the measles virus can stay active in the air for two hours after the infected person leaves. Assuming that herd immunity didn't work and in college campus where a 1,000 people came into contact with 1-2 being infected you would about 20 to be infected. Instead at most we rarely we see 2-3 become infected and that is mainly d/t herd immunity. 

https://pubmed.ncbi.nlm.nih.gov/26004568/

https://historyofvaccines.org

 

[wtbcrna, MSN, DNP, CRNA]

"Q. Why should my newborn receive the hepatitis B vaccine if I know that I am not infected with hepatitis B virus?

A. Before the hepatitis B vaccine became a routine recommendation in 1991, every year about 18,000 children in the United States were infected with hepatitis B before they reached 10 years of age. Half of those 18,000 early-life infections were not contracted during birth from an infected mother. Instead, they were caused by exposure to someone who, knowingly or not, was infected with hepatitis B virus. Because the hepatitis B virus is present in such large quantities in the blood of someone who is infected, it can be transmitted through quantities of blood not able to be seen with the naked eye, such as from shared toothbrushes or washcloths. Because a large number of people infected with hepatitis B are unaware they have the disease, it is extremely difficult to be confident we can avoid the infection through our own actions.”

https://www.chop.edu/news/newborns-and-hepatitis-b-vaccine

 

[wtbcrna, MSN, DNP, CRNA]

"Numerous studies have examined many different vaccines. To date, none have consistently been shown to cause autoimmune diseases. In some studies influenza vaccine was shown to cause GBS at a rate of one case per million vaccine recipients. But, this should be viewed in light of the fact that natural influenza infection causes GBS in 17 per million people infected. So, in a sense, influenza vaccine could be viewed as preventing a more common cause of GBS.”

https://www.chop.edu/centers-programs/vaccine-education-center/vaccines-and-other-conditions/vaccines-and-autoimmune-diseases

[wtbcrna, MSN, DNP, CRNA]

Alice Blackmore said:

I think people have lost their faith in the medical system from lack of transparency. Why did Pfizer have sealed documents on clinical trial data which they have been forced by courts to open? Who stands to benefit financially from vaccines? Why don't we hear much about vaccine injury from vaccines such as Dengvaxia given in the Philippines? Why is it "wrong" to discuss both sides? Most would agree that vaccines have saved us from the horrors of Polio and Smallpox. So what has changed?

When people say they want to discuss both sides they often mean they want to talk about conspiracies and pseudoscience articles/websites. 

I would say people have lost faith in vaccines because of misinformation from people that do not understand the science and wish to demonize vaccines for whatever goal. We are currently seeing a global drop in vaccine rates for this very reason.
 

The smallpox vaccine has always had some of the worst side effect profiles and still does to this day. Smallpox is still a requirement for all military personnel and certain first responders. 

[wtbcrna, MSN, DNP, CRNA]

An infant is constantly exposed to antigens in quantities that far exceed what is in vaccines. Vaccines don't overwhelm the immune system.
 

https://www.sciencealert.com/study-refutes-anti-vaccination-myth-vaccines-overwhelm-immune-system

[toomuchbaloney]

Thank you to the health professionals offering a reasoned argument for use of vaccines to protect our people and economy. 

[MaxAttack, BSN, RN]

Why does AN allow this trash? And this was supposedly reviewed by the editorial team? Let's start with the beginning. OP's bias is evident right from the get-go with "The CDC purports that vaccines protect the public" and it went straight downhill from there. The entire post is a beautiful example of how someone can cite cherry-picked science and have a basic grasp on the English language to throw together a post that would be convincing if you didn't understand what was being discussed. This is pure propaganda and just contributes to confusing parents into not trusting the real science.

I looked into just the very first study that was presented under vaccine safety (Lyons-Weiler & Ricketson, 2018) and it amounts to nothing more than a flawed thought experiment. We have actual experimental data regarding aluminum in children so when you evaluate this study in a broader context is contributes absolutely nothing. This makes sense when you dig deeper and look at the authors and their motivation. James Lyons-Weiler is a known anti-vaccine activist that pushed numerous false claims during the height of COVID. He made it to PolitiFact and was roundly debunked there. That was just the first study.

I'm tired of people pretending that vaccines have this huge conspiracy behind them like there hasn't been decades of studies and actual vaccines pulled from the market when appropriate.

[FolksBtrippin, BSN, RN]

This is very poorly written. 

[MaxAttack, BSN, RN]

ldhrn73 said:

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.

This has to be trolling. You do realize colleges allow for waivers and partial vaccination, right? I can't find anything close to that number.

"Upstate New York" was too broad so I looked at University of Arkansas and I'm not entirely sure what you're referencing. I've learned you take liberties with your speech so I'm assuming you meant the 2016-2017 or 2019 mumps outbreaks? In this case you're confusing vaccination status. The majority of those students in both cases appear to have been partially vaccinated which, as a PhD candidate interested in vaccines, you know is not the same as fully vaccinated. I'm not even going to get into what your idea of "completed" statistics are or whatever new conspiracy you're trying to push there.

I'm also hoping you understand that vaccines are not a guarantee. Two doses of the MMR vaccine has an 88% effectiveness against mumps. I also hope you can appreciate I don't get excited about a small college outbreak when put into context of the hundreds of thousands of cases there were each year in the US before a vaccine was introduced.

I really get that you're hoping everyone will buy into this narrative you're throwing out but you have to do better. This isn't Twitter or Reddit. These baseless claims and empty articles aren't going to fly here.

[NRSKarenRN, BSN, RN]

ldhrn73 said:

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. ...

Agree with Hannahbanana, BSN, MSN and wtbcrna, MSN, DNP, CRNA article criticisms, stated better than I can.  Adding my own 2cents.

As a child of the 50's-60's who lost classmates from communicable diseases and witnessed the family distress from the loss of a child (almost lost my 6yo brother from whooping cough), the language used in this article distorted several medical scientific concepts.

One of greatest PUBLIC HEALTH achievements in the past 100 years is vaccination.

https://www.CDC.gov/mmwr/preview/mmwrhtml/mm4850bx.htm

National efforts to promote vaccine use among all children began with the appropriation of federal funds for polio vaccination after introduction of the Polio vaccine in 1955 --year I was born. 

In 1962, the Vaccination Assistance Act (Section 317 of the Public Health Service Act) was passed and signed by President John F. Kennedy to "achieve as quickly as possible the protection of the population, especially of all preschool children...through intensive immunization activity over a limited period of time".  Section 317 has been reauthorized repeatedly since 1962. It remains one of the most important means of supporting health department immunization activities with federal funds to date.  My  PA county of  500,000+ persons finally reestablished a Health Department in 2022 and using this act to fund programs.

Numerous scientific studies are done in the  5-10 year development of a new vaccine prior to FDA approval with monitoring occurring afterwards.  During the mid 70's-early 80's, there was increased focus on personal health and vaccine safety. Several lawsuits were filed against vaccine manufacturers and healthcare providers by people who believed they had been injured by the diphtheria, pertussis, tetorifice (DPT) vaccine.  Damages were awarded despite the lack of scientific evidence to support vaccine injury claims in many cases.  liability and prices soared, resulting in several vaccine manufacturers halting production. A vaccine shortage resulted and public health officials became concerned about the return of epidemic disease.

Manufacturers' concerns about their liability exposure to lawsuits led them to transfer responsibility to the U.S. government for informing recipients of vaccine risks, as well as benefits, for vaccines administered in the public sector.

The National Childhood Vaccine Injury Act (NCVIA) was signed by President Ronald Regan in 1986.  It requires healthcare providers who administer vaccines to provide a vaccine information statement (VIS) to the person getting the vaccine or his or her guardian. A VIS must be given with every vaccination, including each dose in a multi-dose series. Each VIS contains a brief description of the disease as well as the risks and benefits of the vaccine. CDC develops VIS's and distributes them to state and local health departments as well as individual providers. My  son received his first immunizations  that year and our Pediatrician provided us vaccine info sheet each dose. 

The NCVIA also requires healthcare providers to report certain adverse events (health effects occurring after immunization that may or may not be related to the vaccine) following vaccination to the Vaccine Adverse Event Reporting System (VAERS). Under this act, the National Vaccine Injury Compensation Program (VICP) was created to compensate those injured by vaccines on a "no fault" basis.  

Thusly, parents, guardians, and adults getting immunizations should be aware of risks, side effects to observe and report to their healthcare provider = informed consent.  Those persons with concerns are free to not have their child immunized or delay  vaccination schedule.   In talking with my children's former pediatrician on this issue, they are getting parents/guardians to sign a form documenting declining/ delaying vaccination schedule as documentation of discussion and risks. There are VALID reasons for children not to be immunized as we learned in our nursing programs due to individuals health condition/medical treatment. 

Vaccine ethical issues have been well discussed in medicine and nursing.  Life is not 100% guaranteed, but I'll take a 90+ percent reduction in  U.S. childhood morbidity as an improvement in health.

50 years of vaccine progress: vaccines timeline from the 1950s to the 2000s

Proceedings of the National Academy of Sciences  2014: History of vaccination

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One of the brightest chapters in the history of science is the impact of vaccines on human longevity and health....

In current articles that describe novel technologies, it is often said that they will enable "rational" development of vaccines. The opposite of rational is irrational, but presumably the writers mean to contrast rational with "empiric.”  However, in fact, vaccine development has been based on rational choices ever since the mid-20th century, when immunology advanced to the point of distinguishing protection mediated by antibody and that mediated by lymphocytes, and when passage in cell culture permitted the selection of attenuated mutants. After that point, successful vaccines have been "rationally" developed by protection studies in animals; by inference from immune responses shown to protect against repeated natural infection (the so-called mechanistic correlates of protection) (6); and from the use of passive administration of antibodies against specific antigens to show that those antigens should be included in vaccines.

Editorial: Simply put: Vaccination saves lives

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Few measures in public health can compare with the impact of vaccines. Vaccinations have reduced disease, disability, and death from a variety of infectious diseases. For example, in the United States, children are recommended to be vaccinated against 16 diseases (1). Table 1 highlights the impact in the United States of immunization against nine vaccine-preventable diseases, including smallpox and a complication of one of those diseases, congenital rubella syndrome, showing representative annual numbers of cases in the 20th century compared with 2016 reported cases (2, 3).  All of the diseases have been reduced by more than 90% and many have either been eliminated or reductions of 99% or more have been achieved.

A recent analysis of vaccines to protect against 13 diseases estimated that for a single birth cohort nearly 20 million cases of diseases were prevented, including over 40,000 deaths (4). In addition to saving the lives of our children, vaccination has resulted in net economic benefits to society amounting to almost $69 billion in the United States alone. A recent economic analysis of 10 vaccines for 94 low- and middle-income countries estimated that an investment of $34 billion for the immunization programs resulted in savings of $586 billion in reducing costs of illness and $1.53 trillion when broader economic benefits were included (5). The only human disease ever eradicated, smallpox, was eradicated using a vaccine, and a second, polio, is near eradication, also using vaccines (6, 7).

Table 1.

WHYY 2014 60th anniversary of polio vaccine, first administered in Pa.

  I received my Sabin  sugar cube vaccine in 1962

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At first, the vaccine developed by Salk and Dr. Albert Sabin at the University of Pittsburgh was injected. Later, it was given by Sabin vaccine-that sugar cube dosed with serum and taken orally.

Healthline 2010:  Measles in America: What Life Was Like Before and After the Vaccine

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...Schaffner added that in the past, measles could commonly lead to middle ear infection, and even more seriously, pneumonia as well as encephalitis, inflammation of the brain. He said one in a 1,000 children would get encephalitis from the measles prior to the development of the vaccine.

A sneaky condition, symptoms might not appear until about 10 to 14 days after a person is exposed. This incubation period can lead the virus to spread.

UNICEF 2021:  Global Under-five mortality

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The under-five mortality rate refers to the probability a newborn would die before reaching exactly 5 years of age, expressed per 1,000 live births. In 2021, 5.0 million children under 5 years of age died.  Globally, infectious diseases, including pneumonia, diarrhoea and malaria, remain a leading cause of under-five deaths, along with preterm birth and intrapartum-related complications.

The global under-five mortality rate declined by 59 per cent, from 93 deaths per 1,000 live births in 1990 to 38 in 2021. Despite this considerable progress, improving child survival remains a matter of urgent concern. In 2021 alone, roughly 13,800 under-five deaths occurred every day, an intolerably high number of largely preventable child deaths.

CDC 2011: Vaccine-Preventable Diseases, Immunizations, and MMWR --- 1961--2011

Healthline 2010:  Measles in America: What Life Was Like Before and After the Vaccine

Reuters 2008: Research shows why 1960s RSV shot sickened children

CDC 2022: Vaccine Safety

John Hopkins 2021: The Long History of mRNA Vaccines

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Messenger RNA, or mRNA, was discovered in the early 1960s; research into how mRNA could be delivered into cells was developed in the 1970s...