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

[Wuzzie]

MD married to RN said:

We need to at least consider that the mRNA vaccine producer have profit as a primary driver. 

Nobody is ignoring this it simply isn't the focus of the post. The discussion is about all vaccines. 

[MaxAttack, BSN, RN]

MD married to RN said:

None seemed to address the for profit nature of pharmaceutical companies.

The fact that every company in healthcare is concerned about their revenue doesn't negate the evidence to support the safety and efficacy of vaccines.

If we're actually going down the rabbit hole and saying no study can be trusted if it shows a benefit to a profitable product then what are we left with and how do we advance? Do we also equally acknowledge the profit that's made in misinformation? Most conspiracy theorists leave that second part out.

[subee, MSN, CRNA]

MD married to RN said:

I tried to read every post. None seemed to address the for profit nature of pharmaceutical companies. For a long time, consensus was that 'doctors undertreat pain,' especially in disenfranchised populations. Studies were done that proved this claim. I, like many providers, was required to complete pain management education or risk my license. I knew it was suspect but complied. Now with the benefit of the retrospect-o-scope, we all know it was a lie. Purdue pharma and others manipulated us all to treat pain better and created the opiate epidemic, all for profit. We need to at least consider that the mRNA vaccine producer have profit as a primary driver. 

What kind of moron would believe a salesman hawking oxycodone as a mon-addicting pain killer.  That's where the "manipulation" started.  The physicians could have nipped thus in the bud.  How could doctos be manipulated by puffery so easily?

[wtbcrna, MSN, DNP, CRNA]

The "profit" conspiracy falls apart when you consider for that to be a valid argument then every country's equivalent of the FDA would have to be paid off, along with thousands of researchers, and millions of healthcare workers.

Vaccines are the only pharmaceutical product that has to undergo large RCTs compared to other drugs (usually about 10x more people have to be in a vaccine study compared to other drugs), and vaccines are the only pharmaceutical product that undergoes constant phase 4 studies/post marketing studies for safety and efficacy. Those studies are not usually done or paid for by the pharmaceutical companies. That means that even if a vaccine could get through the approval stage by falsifying data that would quickly fall apart during phase 4. With the COVID19 vaccines we had data being published within weeks of release that showed the initial studies from the Pfizer and Moderna were correct in the safety and efficacy of the vaccines. It took tens of millions of doses to find out that the J&J vaccine had increased risk of blood clots and it took millions more to find out that myocarditis/pericarditis risks were slightly increased in adolescents with mRNA covid vaccines. Those types of rare side effects are not going to be found in normal clinical trials, because it is impossible to run a clinical trial that includes millions of people. 

Every company seeks to make a profit. A profit does not inherently make a product unsafe, especially vaccines which are held to the highest of standards. 

[robinasq]

There is autonomy. I.e. Parents who do not want to vaccinate can homeschool , you do not have to go to the hospital and subject yourself to science and public health measures, when you are sick, that's a choice. The autonomy to reject science and/or  public health, while living in a community, includes the responsibility to agree not to endanger others. This means not using public services that require in person contact. It is quite simple.

[subee, MSN, CRNA]

Emergent said:

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.

The rates of pediatric diabetes rose long before the RNA vaccine.  You will have to demonstrate to me that Type 1 diabetes has doubled or tripled in recent years.  Type 2 certainly has but we are getting too fat for our pancreases to keep up!

[wtbcrna, MSN, DNP, CRNA]

subee said:

The rates of pediatric diabetes rose long before the RNA vaccine.  You will have to demonstrate to me that Type 1 diabetes has doubled or tripled in recent years.  Type 2 certainly has but we are getting too fat for our pancreases to keep up!

"Conclusions

Autoimmune conditions requiring hospital care are rare following mRNA and inactivated COVID-19 vaccination with similar incidence to non-vaccinated individuals. The association between first dose BNT162b2 vaccination and immune-related sleeping disorders requires further research.”

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9008125/#:~:text=Conclusions,sleeping disorders requires further research.

[subee, MSN, CRNA]

wtbcrna said:

"Conclusions

Autoimmune conditions requiring hospital care are rare following mRNA and inactivated COVID-19 vaccination with similar incidence to non-vaccinated individuals. The association between first dose BNT162b2 vaccination and immune-related sleeping disorders requires further research.”

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9008125/#:~:text=Conclusions,sleeping disorders requires further research.

What is your point here?  That we MAY have a problem with narcolepsy? Certainly no relationship between vaccine and diabetes was discovered in this study.  But there is certainly a relationship between having Covid and becoming diabetic.  I'm not saying that it's a causal relationship but the poster who claimed a doubling or tripling in the incidence of diabetes due to the vaccine is off-base. 

 

[Emergent, RN]

subee said:

The rates of pediatric diabetes rose long before the RNA vaccine.  You will have to demonstrate to me that Type 1 diabetes has doubled or tripled in recent years.  Type 2 certainly has but we are getting too fat for our pancreases to keep up!

Type 1 Diabetes May Be Growing at an 'Alarming' Rate

Quote

The CDC's newest 2020 National Diabetes Statistics ReportTrusted Source released in mid-February estimates an almost 30 percent increase in T1D cases within the United States in just the past 2 years. The condition is growing most sharply in youth populations and minority groups.

 

[MaxAttack, BSN, RN]

Emergent said:

Type 1 Diabetes May Be Growing at an 'Alarming' Rate

This article specifically mentions factors that may be playing into this. There's nothing scientific about finding increasing trends and automatically attributing it to a single cause that scares you (ie vaccines).

From your source:

Quote

JDRF says these main theories of what causes T1D may play into the higher incidence and prevalence rates among youth:

Environmental. Possibly a viral infection of some sort, for example if children are exposed to a virus during daycare settings. One study on this is underway in Finnish populations, which still needs to be cross-validated in other locations and expanded upon.

Hygiene. This theory posits that a decrease in the incidence of autoimmune diseases might be rising because of a decreasing frequency of childhood infections due to improved hygiene. In other words, in our modern world, we live so cleanly that the immune system has nothing to do and goes haywire.

Prenatal. This is an in-utero focus, looking at the first few months that could dictate one's autoimmune and T1D susceptibility for the rest of life.

Gut Microbiology. Research suggests that changes in gut microbiota — or the population of microorganisms that reside in the intestine — play a role in the development of T1D. Various clinical studies are underway in this area, funded by both public and private institutions.

Genetics. This one stems from the long-held scientific belief that individuals may have a genetic predisposition to T1D. Researchers are looking at this in varying ways, including how modified genetics may be changing the diabetes picture across the world.

If you want to have a real discussion I'd imagine we'd have to look at the risk of diabetes after vaccination, the risk of diabetes from the infection itself, and the total risk of morbidity and mortality from the infection we're trying to prevent with vaccination. Everything is risk vs benefit. Excess fluid administration can lead to pulmonary edema, heart failure, kidney failure, abdominal compartment syndrome, and can ultimately kill patients but I don't see many nurses arguing that we should stop administering fluids.

[wtbcrna, MSN, DNP, CRNA]

subee said:

What is your point here?  That we MAY have a problem with narcolepsy? Certainly no relationship between vaccine and diabetes was discovered in this study.  But there is certainly a relationship between having Covid and becoming diabetic.  I'm not saying that it's a causal relationship but the poster who claimed a doubling or tripling in the incidence of diabetes due to the vaccine is off-base. 

The point/results of the article is that after looking at 1.1 million people getting the COVID19 vaccines and 9 different autoimmune diseases there was no correlation. 

[subee, MSN, CRNA]

Emergent said:

Type 1 Diabetes May Be Growing at an 'Alarming' Rate

A lot of these studies were done in low income countries where people weren't tested for diabetes before.  So rates will be artificially higher.  It's always more complicated than those not.expert in research think it is.  I am not that expert but have the patience to wait for the facts.