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

[2BS Nurse, BSN]

"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 am reading the words "personal belief" and "might". A belief is not science. As nurses, we are trained to follow the evidence. Many people had "personal beliefs" that ivermectin and hydroxychloroquine would prevent them from getting (and curing) Covid too.

[2BS Nurse, BSN]

Thank you NRSKarenRN, BSN, RN for your post. I am currently reading Pox: An American History, by Michael Willrich. We humans are a vain race. If Covid-19 had scarred our faces horribly (like smallpox did), we'd be hearing a whole different point-of-view from the anti-vaccine side.

[NRSKarenRN, BSN, RN]

The scientific basis of public health efforts described in this excellent article from

Morbidity and Mortality Weekly Report (MMR) December 24, 1999 / 48(50);1141-7

Achievements in Public Health, 1900-1999: Changes in the Public Health System
 

Quote

In the early 1900s in the United States, many major health threats were infectious diseases associated with poor hygiene and poor sanitation (e.g., typhoid), diseases associated with poor nutrition (e.g., pellagra and goiter), poor maternal and infant health, and diseases or injuries associated with unsafe workplaces or hazardous occupations (4,5,7,8). The success of the early public health system to incorporate biomedical advances (e.g., vaccinations and antibiotics) and to develop interventions such as health education programs resulted in decreases in the impact in these diseases. However, as the incidence of these diseases decreased, chronic diseases (e.g., cardiovascular disease and cancer) increased (6,10). In the last half of the century, public health identified the risk factors for many chronic diseases and intervened to reduce mortality. Public efforts also led to reduced deaths attributed to a new technology, the motor vehicle (3). These successes demonstrated the value of community action to address public health issues and have fostered public support for the growth of institutions that are components of the public health infrastructure*. The focus of public health research and programs shifted to respond to the effects of chronic diseases on the public's health (12-17). While continuing to develop and refine interventions, enhanced morbidity and mortality surveillance helped to maintain these earlier successes. The shift in focus led to improved capacity of epidemiology and to changes in public health training and programs.

Key points re science methods and Public Health:

• Quantitative Analytic Techniques

• Quote

  • Methods of data collection evolved from simple measures of disease prevalence (e.g., field surveys) to complex studies of precise analyses (e.g., cohort studies, case-control studies, and randomized clinical trials)

• Periodic Standardized Health Surveys
• Morbidity and Mortality Surveillance ocurring
• Nongovernment and Government Organizations: state, County and local health departments developed

[vintagegal, BSN, DNP, RN, NP]

Ahhh... and here it is. Funny how societal viewpoints change over time. Intriguing...

[Hannahbanana, BSN, MSN]

Nice overview of the historical data, NRSKaren, and thanks to wtbcrna and Max Attack for their rational contributions. 
A modest suggestion:  AN should pin this thread's factual information and auto-post it the next (inevitable) time the vaccine conspiracists drop by, with their "beliefs" and "mights.” You could save us all a lot of time and trouble...and go a ways to restoring/improving AN's reputation as a source of factual support to the nursing profession. 

[subee, MSN, CRNA]

Wuzzie said:

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. 

I concur.  I noticed that the OP's orignal post concluded that the science of the vaccines are unknown.  UHHHH.  OP, have you any inkling of how vaccines have made the world a safer place in which to live?  I also challenge the OP to produce a single late term consequence of any vaccine.  There are NO ethical arguments against mandatory vaccines.  If one doesn't want to take a vaccine and is working in a sensitive healthcare situation, just leave your job.  There is something lacking in your medical ethics if you think that is OK and your employer is better off without you.  We don't have enough Covid positive patients in any hospital to provide enough patients for unvaccinated staff to keep their jobs. Keep you unscientific "beliefs" and go work in an unscientific field.  I think you might be a shill for American Frontline Nurses.

[Hannahbanana, BSN, MSN]

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?

So, a little more research was in order here. First, the Pfizer slur.  Credit to: https://leadstories.com/hoax-alert/2023/03/fact-check-pfizer-documents-do-not-prove-covid-vaccines-contain-graphene-oxide.html

Do Pfizer documents show that the company's COVID-19 vaccines contain graphene oxide? No, that's not true: The section of the document in question describes a procedure for analyzing a protein sample from the virus under a sophisticated microscope that includes the use of graphene oxide to help with imaging. Graphene oxide is not among the ingredients for the COVID shots.

The claim appeared in an article (archived at the link above) published in the Exposing the Darkness blog on Substack on March 20, 2023, titled "Conspiracy No More: Pfizer Documents Reveal That Pfizer 'Vaccines' Contain GRAPHENE OXIDE." The blog's subheading reads:

One of the reasons why Pfizer wanted to HIDE their documents for 75 Years

Please feel free to follow the link to the full article-- it's not long, and it's not scary technical. 

Next up, the Dengvaxia vaccine in the Philippines: You don't hear much about vaccine "injury" because... well, there isn't much to report. TL;Dr: There are four different serotypes of dengue, and being enfected with one gives you antibodies that (paradoxically) make your second infection (with a different serotype) more serious than the first. This is a well-known phenomenon in immunology. The vaccines were designed to protect from all four serotypes, and seemed to weakly mimic this phenomenon. But there's a catch when comparing vaccines to wild-type infections (this is where you can skip ahead to the bolded section below iin the paragraph beginning "Experiments led by Sandra Henein, ..." in case the bolding doesn't come through).

https://news.unchealthcare.org/2021/06/scientists-discover-how-dengue-vaccine-fails-to-protect-against-disease/

CHAPEL HILL, NC – Developing a viable vaccine against dengue virus has proved difficult because the pathogen is actually four different virus types, or serotypes. Unless a vaccine protects against all four, a vaccine can wind up doing more harm than good.

To help vaccine developers overcome this hurdle, the UNC School of Medicine lab of Aravinda de Silva, PhD, professor in the UNC Department of Microbiology and Immunology, investigated samples from children enrolled in a dengue vaccine trial to identify the specific kinds of antibody responses that correlate with protection against dengue virus disease. In doing so, the researchers discovered that a small subpopulation of antibodies binding to unique sites on each serotype are linked to protection. The research, published in the Journal of Clinical Investigation, provides important information for vaccine developers to consider when creating a dengue vaccine, which has long eluded scientists.

The four dengue virus serotypes are mosquito-borne flaviviruses that infect hundreds of millions of individuals each year in Southeast Asia, western Pacific Islands, Africa, and Latin America. Nearly 100 million individuals report flu-like symptoms. Though rarely deadly, the virus can cause severe illness, especially when a person who was previously infected with one serotype (and recovers) is then infected by a second serotype. This happens because antibodies from the first infection help the virus replicate during the second infection through a process called antibody dependent enhancement. A dengue vaccine induced antibody response weighted towards a single dengue virus serotype can mimic this phenomenon.

Several vaccines have been in clinical development for years, and most show that they induce neutralizing antibodies against all four serotypes. Yet, research has also shown that the creation of neutralizing antibodies alone does not correlate to protection against clinical disease. The de Silva lab conducted experiments to compare the properties of antibodies against wild-type Dengue viruses and the properties of antibodies produced by a leading vaccine candidate – Dengvaxia – which the pharmaceutical company Sanofi Pasteur created using all four dengue virus serotypes in one formulation.

Experiments led by Sandra Henein, research associate in the UNC Department of Microbiology and Immunology, and Cameron Adams, a medical and graduate student in the UNC Medical Scientist Training Program (MD/PhD), showed that wild type infections induced neutralizing and protective antibodies that recognized a part of the virus – an epitope – unique to each serotype. The vaccine, though, mainly stimulated neutralizing antibodies that recognized epitopes common among all serotypes. In vaccine trials, these antibodies did not protect children from dengue.   In the past, researchers have considered all dengue neutralizing antibodies to be protective in people. This appears to not be the case, according to this UNC-led research.

"Our results suggest that a safe and effective dengue virus vaccine needs to stimulate neutralizing antibodies targeting unique sites on each of the four dengue serotypes ,” Adams said. "Not merely the neutralizing antibodies against cross-reactive epitopes common to all four dengue types.”

Once again, it took me just moments to locate this and other fact-based articles on Dengvaxia, with links to the actual research methods and findings. I realize that certain factions in the cable news media (who are not subject to FTC fairness doctrine constraints, so they can say any damfool thing they want) go for the sound bites, realizing that most of their audience wouldn't recognize a controlled study or valid statistical measures if one bit 'em on their behinds. But nurses should know better and use the old "do your own research" (also an erstwhile perfectly good phrase forced into prostitution by gullibles) to actually look for and read, well, real research.

[Tweety, BSN, RN]

When I think about "vaccine injury" I think of a couple of things.  One is that literally billions of vaccines around the world have been given and sadly vaccine injury is a thing but I wonder what is the percentage out of those billions?  

I also think about things like "Vancomycin injury" and have seen a case of renal injury, but have given literally thousands of doses to many patients over 30 years.  Would we not give someone with MRSA osteomyelitis Vancomycin at risk of losing a limb treatment because of "vancomycin injury"?  Also "chemotherapy injury" in cancer patients. On and on there is injury with just about every medicine or food someone puts into their body, somewhere around the world.  In some cases risks outweigh benefits and sometimes there is no way to predict who will be injured.

On the other hand after getting the flu this year (a mild case I might add) I've almost decided that vaccine isn't worth it to me, although I've safely taken it for about a decade now.  

But I guess the question is of mandatory vaccination and does that somehow violate our freedom of self-determination even if it's detrimental to ourselves, our children and society in general.  There doesn't seem to be an easy answer to that one.

[wtbcrna, MSN, DNP, CRNA]

Tweety said:

When I think about "vaccine injury" I think of a couple of things.  One is that literally billions of vaccines around the world have been given and sadly vaccine injury is a thing but I wonder what is the percentage out of those billions?  

I also think about things like "Vancomycin injury" and have seen a case of renal injury, but have given literally thousands of doses to many patients over 30 years.  Would we not give someone with MRSA osteomyelitis Vancomycin at risk of losing a limb treatment because of "vancomycin injury"?  Also "chemotherapy injury" in cancer patients. On and on there is injury with just about every medicine or food someone puts into their body, somewhere around the world.  In some cases risks outweigh benefits and sometimes there is no way to predict who will be injured.

On the other hand after getting the flu this year (a mild case I might add) I've almost decided that vaccine isn't worth it to me, although I've safely taken it for about a decade now.  

But I guess the question is of mandatory vaccination and does that somehow violate our freedom of self-determination even if it's detrimental to ourselves, our children and society in general.  There doesn't seem to be an easy answer to that one.

When people knowingly take on a career to take care of others and then they willingly endanger those same people in their care  "self-determination" of not being vaccinated for non-medical reasons is a non-sequitur.

Choosing not to get the flu vaccines, because you get the flu is the equivalent of choosing to not to wear a seatbelt because you got bruised from a seatbelt during a crash. 

[Tweety, BSN, RN]

wtbcrna said:

Choosing not to get the flu vaccines, because you get the flu is the equivalent of choosing to not to wear a seatbelt because you got bruised from a seatbelt during a crash. 

Fair enough.  

I understand that you can get a serious injury in a car crash while wearing a seat belt.  I've worked trauma.  That's no reason not to wear a seatbelt.  That falls into my example of "vancomycin injury" risk vs. benefit.

But it's not really a good analogy when this year's flu vaccine according to the CDC was only 54% effective in my age bracket.  Some years it's been lower than that as low as 10% in one article I've read.  But the article stated 10 to 60% is better than zero.   Since I don't get that horribly sick it would something to consider.   Of course I'd rather not get sick at all so 54% odds I suppose are good for the 54% that didn't get the flu.  Were I a sickly person with comorbidities then I would think differently.    Compare that to 92% effectiveness of the Covid vaccine.  

[wtbcrna, MSN, DNP, CRNA]

Tweety said:

Fair enough.  

I understand that you can get a serious injury in a car crash while wearing a seat belt.  I've worked trauma.  That's no reason not to wear a seatbelt.  That falls into my example of "vancomycin injury" risk vs. benefit.

But it's not really a good analogy when this year's flu vaccine according to the CDC was only 54% effective in my age bracket.  Some years it's been lower than that.   Since I don't get that horribly sick it would something to consider.   Of course I'd rather not get sick at all so 54% odds I suppose are good for the 54% that didn't get the flu.  Were I a sickly person with comorbidities then I would think differently.    Compare that to 92% effectiveness of the Covid vaccine.  

You are comparing effectiveness of not getting the flu and  ignoring the lower  morbidity and mortality rates even if you do get the flu after being vaccinated compared to non-vaccinated. The majority of deaths from flu occur in unvaccinated irregardless of comorbidities. That doesn't even get into the argument of endangering patients by not being vaccinated.

"What are the benefits of flu vaccination?

Below is a summary of the benefits of flu vaccination and selected scientific studies that support these benefits.

Flu vaccination can keep you from getting sick with flu.

Flu vaccine prevents millions of illnesses and flu-related doctor's visits each year. For example, during 2019-2020, the last flu season prior to the COVID-19 pandemic, flu vaccination prevented an estimated 7.5 million influenza illnesses, 3.7 million influenza-associated medical visits, 105,000 influenza-associated hospitalizations, and 6,300 influenza-associated deaths.

During seasons when flu vaccine viruses are similar to circulating flu viruses, flu vaccine has been shown to reduce the risk of having to go to the doctor with flu by 40% to 60%.

Flu vaccination has been shown in several studies to reduce severity of illness in people who get vaccinated but still get sick.

A 2021 study showed that among adults hospitalized with flu, vaccinated patients had a 26% lower risk of intensive care unit (ICU) admission and a 31% lower risk of death from flu compared with those who were unvaccinated.

A 2018 study showed that among adults hospitalized with flu, vaccinated patients were 59% less likely to be admitted to the ICU than those who had not been vaccinated. Among adults in the ICU with flu, vaccinated patients on average spent four fewer days in the hospital than those who were not vaccinated.

Flu vaccination can reduce the risk of flu-associated hospitalization.

Flu vaccine prevents tens of thousands of hospitalizations each year. For example, during 2019-2020 flu vaccination prevented an estimated 105,000 flu-related hospitalizations.

A 2018 study showed that from 2012 to 2015, flu vaccination among adults reduced the risk of being admitted to an ICU with flu by 82%.

A 2017 study found that during 2009-2016, flu vaccines reduced the risk of flu-associated hospitalization among older adults by about 40% on average.

A 2014 study showed that flu vaccination reduced children's risk of flu-related pediatric intensive care unit (PICU) admission by 74% during flu seasons from 2010-2012.

Flu vaccination is an important preventive tool for people with certain chronic health conditions.

Flu vaccination has been associated with lower rates of some cardiac events among people with heart disease, especially among those who have had a cardiac event in the past year.

Flu vaccination can reduce the risk of a flu-related worsening of chronic lung disease (for example, chronic obstructive pulmonary disease (COPD) requiring hospitalization).

Among people with diabetes and chronic lung disease,flu vaccination has been shown in separate studies to be associated with reduced hospitalizations from a worsening of their chronic condition.

Flu vaccination during pregnancy helps protect pregnant people from flu during and after pregnancy and helps protect their infants from flu in their first few months of life.

A 2013 study showed that during the 2010–2011 and 2011–2012 flu seasons vaccination reduced the risk of flu-associated acute respiratory infection in pregnant people by about one-half.

A 2018 study showed that getting a flu shot reduced a pregnant person's risk of being hospitalized with flu by an average of 40% from 2010-2016.

A number of studies have shown that in addition to helping to protect pregnant people from flu, a flu vaccine given during pregnancy helps protect the baby from flu for several months after birth, when babies are too young to be vaccinated.

Flu vaccine can be lifesaving in children.

A 2022 study showed that flu vaccination reduced children's risk of severe life-threatening influenza by 75%.

A 2020 study found that during the 2018-2019 flu season, flu vaccination reduced flu-related hospitalization by 41% and flu-related emergency department visits by half among children (aged 6 months to 17 years old).

A 2017 study was the first of its kind to show that flu vaccination can significantly reduce children's risk of dying from flu.

Getting vaccinated yourself may also protect people around you, including those who are more vulnerable to serious flu illness, like babies and young children, older people, and people with certain chronic health conditions.”

https://www.CDC.gov/flu/vaccines-work/vaccineeffect.htm

[Tweety, BSN, RN]

wtbcrna said:

You are comparing effectiveness of not getting the flu and  ignoring the lower  morbidity and mortality rates even if you do get the flu after being vaccinated compared to non-vaccinated. The majority of deaths from flu occur in unvaccinated irregardless of comorbidities. That doesn't even get into the argument of endangering patients by not being vaccinated.

Good point and I didn't get that sick when I've had the flu over the years I've been vaccinated, and I've only had the flu a few times.   All good points in continuing with being vaccinated for the flu.  Although throughout my 30's and 40's I was unvaccinated and never got the flu.  I think I went from age 18 to 55 without it.  I caved to intense pressure from my employer to get the vaccine and have been getting it about ten years now.  Anyway, I'm sure you understand that even the vaccinated can spread the flu to vulnerable patients, hopefully in the days leading up to me being sick that wasn't me.

At the end of the day my doctor says get it, my employer says get it, I'm not getting any younger, and I've had zero issues with getting it so I'm sure I'll get it again next year.