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
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