The Centers for Disease Control and Prevention (CDC, 2019) and the World Health Organization (WHO, n.d.) declare the imperative need to vaccinate all people to improve public health. Traditional wisdom taught to healthcare professionals backs up this concept by stating that if we activate the immune system to proteins from a virus or bacteria, then the patient's immune system develops the first-line response when it sees the real antigen. Vaccines have been in use since 1798, when Edward Jenner exposed people to material from pox blisters to see if it would give them resistance to smallpox (Plotkin, 2014). The medical community has been thus indoctrinated that vaccines are a must to prevent disease and that they are safe and effective. This philosophy is so prevalent that many places have, for some time, been contemplating the ethics of public policy to mandate vaccines per the CDC's ever-growing recommended vaccine schedule (Hendricks, Zimet, Meslin, 2016). This paper discusses this prevalent philosophy, some challenges to mandated vaccination, and the lesser-known science surrounding the topic.
Ethical Debate
In chapter nine of Contemporary Issues in Bioethics, Beauchamp, Walters, Kahn, and Mastroianni (2008) discussed how ethical frameworks shape public health. The chapter's subtopic, Ethics and Immunization Policy: Promoting Dialogue to Sustain Consensus, specifically discusses ethically creating public policy surrounding vaccinations. The authors of this section believe that vaccines are safe and effective. Thus, it is stated that healthcare workers are ethically obligated to educate and convince the public of the benefits of universal inoculation. The text does admit that policy to this effect is more complicated and requires considerable thought and planning to protect the rights of liberty and justice. Similarly, Hendrix Sturm, Zimet, & Meslin (2016) present as pro-vaccination but recognize that the ethical obligation of autonomy creates challenges to requiring them via public policy changes.
Greater Good and Public Health
The CDC purports that vaccines protect the public. The generally accepted reason for this is herd immunity. In other words, if most people are vaccinated, the entire population is safe from the disease. It is argued that there is an ethical obligation for society members to participate in the establishment of this herd immunity (Giubilini, Douglas, & Savulescu, 2018). Many papers are written with this as an assumption, often quoting CDC, WHO, and general medical acceptance of this concept as to why vaccinations should be strongly encouraged. Few papers question this paradigm and sometimes ridicule any challengers to it. The usual assumption is that people who refuse vaccines must be uneducated on the topic or irrational (Logan, Nederhoff, Koch, Griffith, Wolfson, Awan, & Basta 2018). This pervasive assumption fuels the argument that public policy must be in place to protect the public against the ignorant or irrational fringe who refuse vaccines.
Autonomy and Medical Freedom
As mentioned earlier, many ethical thinkers recognize the conflict between the greater good presented above and autonomy/liberty. Parents, many physicians, and a growing number in the scientific community are arguing for the right to medical freedom. The "greater good" side of the argument acknowledges this as a problem as autonomy is a long-standing ethical priority, but sees it as overreaching into the harm of the public (Grzybowski, Patryn, Sak, & Zagaja 2017). Still, the exertion that people have a right to choose what is done to them is strong and founded on significant historical lessons. The Nuremberg Code (NIH, n.d.) is often referenced to support the importance of autonomy in light of how governments can go too far in controlling medical treatments and experiments. As parents and some professionals advocate for autonomy, those mentioned in the "greater good" want to justify the overreach and minimize the importance of autonomy (Grzybowski, Patryn, Sak, & Zagaja, 2017; Logan, Nederhoff, Koch, Griffith, Wolfson, Awan, & Basta, 2018). Those wishing to forego vaccination respond that their right to autonomy is grounded not on a whim, but on science that many on the other side of the debate have not considered.
Overlooked Scientific Evidence
There is a significant body of science that suggests that arguments for immunizations are often incomplete or simply wrong. When brought up to the vaccine advocates, the response is often made that it is misinformation. The CDC is often quoted that they claim vaccines are safe and effective. The literature quoted to back this up tends to be written with automatic assumptions of safety and effectiveness. This creates a somewhat circular argument of "they are safe and effective because the CDC says so, and all these authors believe it, so they must be safe and effective.” However, if the science does effectively argue the points, then there develops an area that Pence (2007) describes as ethical relativism. So, if both sides are making their stance because of their belief of what science supports, then this relativism does not warrant the forced impingement on autonomy.
Vaccine Safety
Concerns exist surrounding the use of aluminum as an adjuvant. An adjuvant is used to hyper-excite the immune system to trigger the development of antibodies to the target antigen. Research such as Mitkus, King, Hess, Forshee, & Walderhaug, (2011) suggests that vaccine aluminum is safe because the body-retained levels of aluminum were below the established safe levels after occasional episodic vaccinations. This was based on comparing estimated levels retained in the body versus established "safe" levels, but not correlated to patient outcomes. This is flawed reasoning. Lyons-Weiler & Ricketson (2018) clearly explain that the established values for safe levels of aluminum are based on a small adult who has a full-functioning detoxification ability. To be safe for children and infants, the values would have to be modified for size/weight and take into account the immature detoxification systems in early childhood. Current immunization schedules, which have added vaccines since the Mitkus et al. 2011 study, may be dangerous due to inaccurate "safe" levels. Dietary aluminum is common, but much of it is bound and passes through the bowels. Injected aluminum is not. Aluminum is a known neurotoxin that is not only correlated with Parkinson's and Alzheimer's, but now in autism (Mold, Umar, King, & Exley, 2018). Further, Tomljenovic & Shaw (2012) report a strong correlation between aluminum and autoimmune diseases, which have been steadily rising as the number of suggested vaccines has increased. Many reported vaccine injuries are related to neurological damage/symptoms (AHRQ, n.d.; CDC, 2019).
Other ingredients in some vaccines also have raised alarm. The CDC (2019) lists certain contents of vaccines, which include some that are dangerous, such as aluminum, formaldehyde, polysorbate, human DNA, and thimerosal (mercury). Review of the Formaldehyde Assessment in the National Toxicology Program 12th Report on Carcinogens (2014) warns against the dangers of formaldehyde. Coors, Seybold, Merk, & Mahler (2005) give strong reasons to avoid polysorbate. McGovern (2017) reports that additional concerns are that there is a substantial existence of unintended contaminants in many vaccines that contribute to safety concerns. The under-reporting of adverse reactions is readily admitted by the CDC. They also confess that there are inadequacies of the current Vaccine Adverse Event Reporting System (VAERS). Despite inefficiency and underreporting, VAERS lists innumerable possible adverse reactions to vaccines that do not seem to elicit any true investigation or consideration from officials (AHRQ, n.d.).
Vaccine Effectiveness
The effectiveness of immunizations is also in question. Influenza vaccinations consistently have low coverage rates (Demicheli, Jefferson, Ferroni, Rivetti, & Di Pietrantonj, 2018), so the theory behind their use is fallible. Fail rates for other vaccines have also been noted to be relatively high (Modrof, Tille, Farcet, McVey, Schreiner, Borders, Gudino, Fitzgerald, Simon, & Kreil, 2017; Klein, Bartlett, Fireman, & Baxter, 2016). Questions of vaccine effectiveness apply to measles outbreaks in which the unvaccinated are blamed for the spread of the disease in a group that should theoretically have herd immunity. This could be explained not because the unvaccinated are a threat to others, but because vaccinations have been shown to lose effectiveness dramatically over time (Seagle, Bednarczyk, Hill, Fiebelkorn, Hickman, Icenogle, ... McLean, 2018). Practically, this presents as a need for boosters and a significant percentage of fully vaccinated acquiring diseases anyway.
Conclusions
Both sides of the vaccine argument claim that science backs their view, even among educated experts in the field. This statement means the science is not settled concerning vaccine effectiveness and safety. Few topics of inquiry truly get entirely settled, but rather lead to further inquiry. It is not a sound ethical statement to say that immunizations should be mandated for the greater good if the science is so dubious. The fact that one perspective on vaccines is more popular does not make it more scientifically sound. Thus, the ethical argument of a greater good does not have ground enough to justify overreaching the value of autonomy. There are very important reasons that the bioethical concept of autonomy exists, which is to protect the individual from abuse of medical paternalism.
The fact that sound science questioning the pro-vaccine arguments is consistently suppressed suggests that nefarious interests may be at play to maintain the popular belief that vaccines are safe and effective. Research that supports vaccines tends to get more funding and have an easier time getting published in more popular journals. The existing prejudice and claims of misinformation are making an honest evaluation of the subject obfuscated and they foster emotional responses rather than scientific inquiry.
Legitimate parental concerns over children's safety should not be dismissed or ridiculed. The science is not settled on vaccines. The safety and efficacy of vaccines are justifiably challenged. Autonomy is a well-established concept in bioethics. These points should sway medical professionals and policymakers away from mandating injections and toward sound research to prove or disprove the safety and efficacy of what is being injected into the masses.
References/Resources
AHRQ Digital Healthcare Research: Informing Improvement in Care Quality, Safety, and Efficiency. (n.d.). Electronic Support for Public Health—Vaccine Adverse Event Reporting System (ESP: VAERS) (Massachusetts). Retrieved February 5, 2020.
Beauchamp, T. L., Walters, L., Kahn, P.P., Mastroianni, A.C. (ED.). (2008). Contemporary issues in bioethics (7th ED). Canada: Thomson/Wadsworth.
Centers for Disease Control and Prevention – CDC (n.d.). Understanding Vaccines and Vaccine Safety. Conversations. Retrieved February 5, 2020.
Centers for Disease Control and Prevention – CDC. (2019). Epidemiology of Vaccine Preventable Diseases. Pinkbook (2019, December 5).
Coors, E. A., Seybold, H., Merk, H. F., & Mahler, V. (2005). Polysorbate 80 in medical products and nonimmunologic anaphylactoid reactions. Annals of Allergy, Asthma & Immunology, 95(6), 593–599.
Demicheli, V., Jefferson, T., Ferroni, E., Rivetti, A., & Di Pietrantonj, C. (2018). Vaccines for preventing influenza in healthy adults. Cochrane Database of Systematic Reviews.
Giubilini, A., Douglas, T., & Savulescu, J. (2018). The moral obligation to be vaccinated: utilitarianism, contractualism, and collective easy rescue. Medicine, health care, and philosophy, 21(4), 547–560.
Grzybowski, A., Patryn, R. K., Sak, J., & Zagaja, A. (2017). Vaccination refusal. Autonomy and permitted coercion. Pathogens and global health, 111(4), 200–205.
Hendrix, K. S., Sturm, L. A., Zimet, G. D., & Meslin, E. M. (2016). Ethics and Childhood Vaccination Policy in the United States. American journal of public health, 106(2), 273–278.
Klein, N. P., Bartlett, J., Fireman, B., & Baxter, R. (2016). Waning Tdap Effectiveness in Adolescents. Pediatrics, 137(3), e20153326.
Logan, J., Nederhoff, D., Koch, B., Griffith, B., Wolfson, J., Awan, F. A., & Basta, N. E. (2018). 'What have you HEARD about the HERD?' Does education about local influenza vaccination coverage and herd immunity affect willingness to vaccinate?. Vaccine, 36(28), 4118–4125.
Lyons-Weiler, J., & Ricketson, R. (2018). Reconsideration of the immunotherapeutic pediatric safe dose levels of aluminum. Journal of Trace Elements in Medicine and Biology, 48, 67–73.
McGovern, C. (2017, February 4). Dirty Vaccines: New Study Reveals Prevalence of Contaminants. Global Research.
Mitkus, R. J., King, D. B., Hess, M. A., Forshee, R. A., & Walderhaug, M. O. (2011). Updated aluminum pharmacokinetics following infant exposures through diet and vaccination. Vaccine, 29(51), 9538–9543.
Modrof, J., Tille, B., Farcet, M. R., McVey, J., Schreiner, J. A., Borders, C. M., Gudino, M., Fitzgerald, P., Simon, T. L., & Kreil, T. R. (2017). Measles Virus Neutralizing Antibodies in Intravenous Immunoglobulins: Is an Increase by Revaccination of Plasma Donors Possible? The Journal of Infectious Diseases, 216(8), 977–980.
Mold, M., Umar, D., King, A., & Exley, C. (2018). Aluminium in brain tissue in autism. Journal of Trace Elements in Medicine and Biology, 46, 76–82.
National Institutes of Health – NIH (n.d.). The Nuremberg Code.
Pence, G. E. (2007). The elements of bioethics. Boston: McGraw-Hill.
Plotkin S. (2014). History of vaccination. Proceedings of the National Academy of Sciences of the United States of America, 111(34), 12283–12287.
Review of the Formaldehyde Assessment in the National Toxicology Program 12th Report on Carcinogens. (2014). National Academies Press.
Seagle, E. E., Bednarczyk, R. A., Hill, T., Fiebelkorn, A. P., Hickman, C. J., Icenogle, J. P., ... McLean, H. Q. (2018, February 1). Measles, mumps, and rubella antibody patterns of persistence and rate of decline following the second dose of the MMR vaccine.
Tomljenovic, L., & Shaw, C. (2012). Mechanisms of aluminum adjuvant toxicity and autoimmunity in pediatric populations. Lupus, 21(2), 223–230.
World Health Organization-WHO (n.d.). Global Vaccine Safety. Retrieved February 5, 2020
wtbcrna, MSN, DNP, CRNA
5,128 Posts
Type 2 diabetes developed less in vaccinated individuals than unvaccinated individuals.
"Discussion
In this cohort study, COVID-19 infection was associated with increased risk of diabetes, consistent findings of a meta-analysis.1 Our results suggest that this risk persisted as the Omicron variant became predominant, and the association remained even after accounting for temporal confounders. Diabetes risk after COVID-19 infection was higher in unvaccinated than vaccinated patients, suggesting a benefit of vaccination. Mechanisms contributing to postinfection diabetes risk remain unclear, although persistent inflammation contributing to insulin resistance is a proposed pathway. Study limitations include reliance on diagnostic coding, unaccounted confounders (infection severity indices), and insufficient sample size and statistical power for testing multiple interactions. Additional studies are needed to understand cardiometabolic sequelae of COVID-19 and whether COVID-19 vaccination attenuates risk of cardiometabolic disease.”
https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2801415