"Whenever I go into a restaurant, I order both a chicken and an egg to see which comes first"

Friday, September 21, 2012

Opting Out Of Vaccinations–Is It Ethical?

Opting out of vaccination programs has become common in many parts of the country.  Parents, concerned about the reputed side effects from immunizations, fearing government-pharmaceutical conspiracy, or simply ‘going organic’, have decided to take their chances in what the perceive to be a benign environment where cases of  measles, whooping cough, and other childhood illnesses are extremely rare.  Yet these diseases have not been completely eradicated, the world’s borders have become increasingly porous, and while the perceived threat might be low, the actual possibility of infection if not epidemic is high.

Since most childhood vaccines have been around for decades with no credible,scientific evidence of any serious side effects, why would a mother not vaccinate her child eliminating all risk for him and perhaps as importantly her community?  No childhood disease is innocuous, and while most cases are relatively mild, some are dangerous if not life-threatening.  Many of these diseases, such as mumps, can have serious consequences if they are acquired in adulthood.  One would assume that parents would want to avoid them at all costs.

As mentioned above, short-term perception seems to rule.  Fortunately one sees very few childhood diseases anymore, and it is easily to conclude that they have been eliminated when in fact they are alive and well in most populations.  Second, many parents believe that childhood diseases are a simple rite of passage as it was for their parents before them – unpleasant, unfortunate, but ultimately harmless and more of a temporary bother than a serious health issue. 

Third, many Americans persistently believe that vaccines are harmful and cause more health issues than they prevent.  No matter how many reports are issued by the American Medical Association, the Centers for Disease Control, or the Federal Drug Administration; and no matter how far back the longitudinal studies extend, the wariness continues. Fourth, the organic-locavore-natural-environmental movement where many marginally-related but philosophically resonant theories are conflated, has many adherents in ‘progressive’ communities such as Vashon Island, Washington:

A stronghold of vaccine skeptics is Vashon Island, a short ferry ride from Seattle, where the share of parents who have opted out of having their children vaccinated has been as high as one in four.

Not only that, conspiracy theories abound, not unlike the surprisingly durable one concerning fluoridation of water (Communist plot). Lastly, parents feel that they can immunize their children ‘naturally’, by deliberately exposing them to disease.  Chickenpox parties are all the rage in some communities where children have sleep-overs and use blankets and bedding used by others who have already had the disease.

Sabrina Tavernise, writing in the New York Times (9.20.12) has chronicled Washington State’s tightening of the opt-out laws regarding immunizations and referred to these ill-advised popular theories:

A distrust of the medical establishment has also fueled skepticism about vaccines. And while the Internet is a powerful source of information, it has also allowed the rapid spread of false information, such as the theory by Andrew Wakefield, a former British surgeon, that the measles-mumps-rubella vaccine was linked to the onset of autism.

“With the Internet, you can have one cranky corner of Kentucky ending up influencing Indonesia,” said Heidi Larson, a lecturer at the Project to Monitor Public Confidence in Immunization, at the London School of Hygiene and Tropical Medicine.

Other more politically-motivated parents opt out of immunization programs because they see an unholy alliance between states and pharmaceutical companies who collude greedily to push an unsafe product on unwary consumers for profit.

Jonathan Bell, a naturopathic doctor in Washington State who encourages his patients to vaccinate their children. Those who opt out, he said, tend to distrust the public health establishment because of what they see as its unsavory connections with the pharmaceutical industry. “The argument is, ‘Oh no, I’m putting off vaccines,’ ” he said. “ ‘I’m part of a group that’s smart enough to understand the government is a pawn of big pharma.’ ”

The problem of ‘holes’ in the protective coverage provided by vaccines is of growing concern, and the debate has centered around the rights of the individual and the rights of the state representing the public interest.

For despite efforts to educate the public on the risks of forgoing immunization, more parents are choosing not to have their children vaccinated, especially in states that make it easy to opt out, according to a study published on Thursday in The New England Journal of Medicine.

And while the rate of children whose parents claimed exemptions remains low — slightly over 2 percent of all kindergarten students in 2011, up from just over 1 percent in 2006 — the national increase is “concerning,” said Saad Omer, an assistant professor of global health at Emory University who led the study.

Families of unvaccinated children tend to live in close proximity, increasing the risk of a hole in the immunity for an entire area. That can speed the spread of diseases such as measles, which have come back in recent years.

Opting out of state vaccination programs is a good example of what some critics have referred to as the hyper-individualism of today.  People have come to believe that all government is corrupt, inefficient, burdensome, and antithetical to individual liberty; and that individual enterprise and expression are the only true values in American society.  Not only is a sense of shared communal values being lost, but more importantly the responsibility to behave ethically towards your neighbors.

While parents might be cavalier about the health of their own children, putting conspiracy theories, bad science, and New Age belief ahead of reality, it is ethically if not morally wrong to subject others to these convictions.

Once these holes of vaccine opt-outers get large enough, childhood diseases will be back with a vengeance.  The state has a compelling interest in public health, but obviously cannot force people to have vaccinations.  It can make it difficult for a family to opt out as Washington has done; but a more drastic and perhaps more effective solution will come from the private sector. Eventually private insurance companies will drop families whose children have not been vaccinated or refuse to pay for treatment of the disease.

It is a shame that families have taken individualism so far, and this very sentiment is producing a result opposite to the one intended – creating yet another role for government.  It is time for people to begin to think more responsibly and ethically about the communities in which they live.

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