By Ashley Scott
The objections to giving mandatory H1N1 vaccinations to U.S. military personnel and New York health care workers are nothing new — there have been disputes regarding mandatory immunizations in the U.S. since the 1809 Supreme Court case affirming Massachusetts’s right to require immunization against smallpox. Since then, mandatory vaccinations for children enrolled in public schools have been determined by each state, which tend to follow the Center for Disease Control’s recommendations. Most states grant exceptions for physician-approved medical and religious reasons. Private schools, colleges, and universities use their discretion; the Claremont Colleges, for example, require the Hepatitis B and MMR immunizations. Nonetheless, while vaccination is one of the main reasons that residents of developed countries live healthier and longer than in the past, ethical concerns merit consideration. “Public health measures like vaccination raise ethical quandaries,” explains Alex Rajczi, Ph.D., a Claremont McKenna professor of philosophy and bioethics. “Mandatory vaccination presents a case where the need to protect individual autonomy is in tension with the government’s duty to protect the public.” To strike the correct balance between societal well-being and personal freedom, mandatory vaccinations should be limited to only a few, all of which should be carefully and comprehensively considered.
The federal government does not currently require any immunizations for U.S. civilians, but non-U.S. citizens must meet federal vaccination standards. For all vaccinations, the federal government requires the person receiving the vaccination to be given written information about its risks and benefits before administration, as some vaccines have proven harmful and counter-productive. (Cases are documented by the HHS’s Vaccine Adverse Event Reporting System at http://vaers.hhs.gov/). Although the risks are usually minimal, vaccinations sometimes cause accidental infections and trigger adverse immune responses. After all, they contain a dead or impaired form of the disease so that the immune system, which “remembers” pathogens, can quickly and effectively protect against the disease upon subsequent exposures. Additionally, several vaccine components are toxic and have caused adverse reactions in test animals. The H1N1 vaccine component MF-59, for instance, causes a disease similar to multiple sclerosis in rats.
Though most Americans have received several vaccinations without suffering any apparent consequences, many continue to distrust vaccines because of pharmaceutical companies’ successful lobbying efforts. This has resulted in laws such as the 2006 Public Readiness and Emergency Preparedness Act, which provides immunization manufacturers immunity from tort liability for adverse effects when the Secretary of Health and Human Services declares an epidemic or national emergency, and the 2004 Bioshield Act that “expedite(s) and simplif(ies) the solicitation, review, and award of grants and contracts for the development of critical medical countermeasures.”
The Texas-mandated Gardasil vaccine, which has proven only 70 percent effective against HPV and cervical cancer for five years, has been the object of much criticism. Although many infected people do not even realize they have HPV, as most never have symptoms, the sexually transmitted disease is widespread. The CDC estimates that at least 50 percent of sexually active men and women have had an HPV infection at some point in their lives. Although the two major categories of HPV, “low-risk” (causing warts) and “high risk” (causing cancer) are very different, 90 percent of the time the immune system naturally clears out both types of infections. Despite this natural recovery, the vaccination is common and has some serious side effects, including chronic fatigue syndrome, blackouts, muscle weakness, numbness, joint pains, Guillain-Barré syndrome, paralysis, and even death. If used only for protection against cervical cancer, Gardasil is not worth the risk. Per one million women in the age bracket targeted by Gardasil, 30 to 40 cervical cancer cases are reported annually, and about 37 percent of women who develop cervical cancer die from the disease.
UNICEF and the World Bank estimate that childhood immunizations save 3 million lives annually. Joint Science Department immunology professor Dr. Amy Chow argues, “Parents who refuse to vaccinate their children are putting their communities at risk to a far greater degree than the risk taken on for the child.” She praises vaccination for “allowing life spans to be lengthened and overall quality of life to be enhanced immeasurably.” Immunizations have eradicated smallpox and keep polio, measles, pertussis, diphtheria, and Hib infections minimal. In addition, a 64 percent decrease in outbreaks of meningitis, which is notorious for suddenly killing college students, was observed following the 2000 introduction of the vaccine. “Almost all of our increased health is due to public health,” Rajczi adds. “Clean water and sanitation are enormously important, but once measures like those are in place, other important steps are public health measures like vaccination. These are the primary reasons we don’t have mass death from communicable diseases.”
The SIR epidemiological model — a set of differential equations breaking the population into susceptible, infected, and recovered groups — shows the role that vaccinations can play in suppressing a disease. According to the model, the rate of infection and the proportions of the population that are infected, immune (either due to past exposure or vaccination), and susceptible determine if the disease will spread. R0, the number of people who catch the disease from a single infected person before his or her recovery or death, depends on the infection rate and the proportion of the population that is susceptible, divided by the removal rate (by death or recovery) from the infectious group.
When R0 is less than one, the number of people infected by the infected person is less than one, so the disease will die out. When R0 is greater than one, the disease will spread. Removing people from the susceptible part of the population by immunization can decrease R0. In addition to protecting those who have been immunized, vaccinations also slow the spread of infection in the entire population so that those who have not been immunized also benefit. This is known as herd immunity.
The effectiveness of a vaccine depends on the type of disease. Although immunizations usually provide sufficient protection against diseases such as smallpox, polio, MMR, diphtheria, and Hib, flu vaccines tend to be ineffective due to the disease’s rapid mutation; the new strains are not recognized by the body’s immune system and subsequently are not effectively eliminated. Flu vaccines are ineffective for babies and the elderly, and are only 33 percent effective in children and 6 percent effective in non-elderly adults. Effectiveness of voluntary vaccination also depends on the disease: illnesses that spread only through close contact, such as smallpox and SARS, are effectively contained through voluntary vaccination.
As Rajczi notes, “The right public policy is the one that strikes the right balance between protecting individual autonomy and protecting third-parties.” Although vaccines may pose a risk to one’s health, a susceptible person can endanger society. Hence, the choice to be vaccinated should be carefully considered, and as a matter of public policy, vaccines should be mandated only when their risks are low and the costs of a susceptible population are high. “To make a comparative assessment of risks and benefits,” Rajczi adds, “one must get the hard data about the risks of the vaccine, its costs, the current infection predictions, etc.” The impulsive poor decisions that accompany fear must always be avoided, and the implementation of vaccinations is no exception to this rule. Policies must be deliberative, not reactionary.