The U.S. Government on Mandatory Vaccination

What are vaccines? Vaccines contain a mixture of sugars, proteins, and certain chemicals that all serve a purpose in neutralizing the severely weakened or dead virus within. They are substances that are typically injected subcutaneously under the skin to trigger a bodily response. This response activates the creation of antibodies against the foreign compounds, which then leads to immunization from the desired disease. Although the modern story of vaccination began with Edward Jenner’s approach of introducing already infected material to a healthy subject to protect against smallpox, the idea dates as far back as 1000 B.C. in China. Before agreeing to the label of vaccination, it was generally termed inoculation. It was Jenner’s 1796 research that became the base for which smallpox ultimately became eradicated in the United States. Today we strive to advance our understanding of vaccinations to build a future free from diseases such as HIV, malaria, dengue, and RSV. Today, the government and its schools hold considerable responsibility in the control of preventable diseases. The initial mandatory vaccination laws were passed by Massachusetts in the early 1850’s. The vaccine law transpired because of the new mandatory school attendance law. It was passed in order to keep the growing number of school students safe from disease, and to halt the advancement of smallpox. Vaccines were never collectively respected though. The CDC (1) states: During the mid-1970s, there was an increased focus on personal health and more people became concerned about vaccine safety. Several lawsuits were filed against vaccine manufacturers and healthcare providers by people who believed they had been injured by the diphtheria, pertussis, and tetanus (DPT) vaccine. Damages were awarded despite the lack of scientific evidence to support vaccine injury claims. As a result of these decisions, liability and prices soared, and several vaccine manufacturers halted production.
Today the rift between vaccine promoters and vaccine dissidents seems to be larger than ever. There have been considerable strides in vaccine research to ensure its safety, but nothing is ever perfect. Although vaccines are one of the greatest breakthroughs of the 20th century, there are still risks. So the question remains – Should the government completely mandate vaccinations? The progression of vaccine development has guided not only our nation, but the world into a more disease free future. Take the disease smallpox for example. It is thought that up to 300 million people lost their lives to the disease alone between the years 1901-2000 (20th century). The death rate for those who contracted smallpox was 30%, and its vaccine was developed in 1796. “In 1965, international efforts to eradicate smallpox were revitalized with the establishment of the Smallpox Eradication Unit at the World Health Organization (WHO)…” (Cgdev). This campaign ultimately led to smallpox being completely eradicated by 1979. This is the reason why children today no longer require the smallpox vaccine to enter the public school system. Treating the common flu can be costly to those who cannot afford to lose days of work to recover, let alone diseases such as the measles or mumps. Overall, a child or family member who contracts a preventable disease is greatly at risk of missing weeks of school and work (Cdc.gov). The CDC states, “Time lost from work to care for a sick child can cause a financial burden for the family. These diseases can also cause lasting disabilities that result in expensive medical bills and long-term care.” A study done by the CDC in 2012 found that the parents of 282 children under the age of 5, who contracted the common flu, on average spent $300 to $4000 on medical expenses. They also missed anywhere from 11 to 72 hours of work (CDC.GOV/Children cost). With that in mind, the typical flu vaccine costs $20. It would be more cost effective to eliminate unneeded stress on our medical centers by mandating vaccination to all. With regard to smallpox, “The US saves the total of all its contributions every 26 days because it does not have to vaccinate or treat the disease.” (Cgdev) There are plenty of childhood ailments that are cause for concern. In the times before general vaccination, many children would contract these diseases and die due to compromised or underdeveloped immune systems. Here is where the concept of herd immunity becomes important. “This type of protection is known as “community immunity” or “herd immunity.” When enough of the community is immunized against a contagious disease, most other members are protected from infection because there’s little opportunity for the disease to spread.”(NIH). With today’s advancements in intercontinental travel, the spread of foreign disease has become more apparent. Herd immunity is the only thing standing in the way between those who were born with an immunodeficiency or pregnant mothers, and contraction of a completely preventable disease. While there are definite pros to allowing our government to completely mandate vaccination, there are some issues that cannot be neglected or overlooked. Overall, vaccines, as with anything, are imperfect. The CDC states, “Any vaccine can cause side effects. For the most part these are minor (for example, a sore arm or low-grade fever) and go away within a few days.” There are however, cases where serious allergic reactions can take place. This is called anaphylaxis, and can occur in about one per million vaccinations. Each individual vaccination carries its own risk of certain side effects. The influenza vaccine for example can possibly cause the child to develop Guillain-Barre Syndrome, which is a disorder where your immune system begins to attack the peripheral nervous system. There is no known cure for this syndrome. The issue many anti-vaccination have with a general mandate, is whether the government can assure that it is 100% safe. This is currently known not to be the case. Vaccines will always involve a very minimal risk. Secondary to safety is personal freedoms. Many anti-vaccination supporters believe that the government should not have the last say in the wellness of their children. They admit to it being a trampling of their personal right to choose, or autonomy. The Association of American Physicians and Surgeons, or AAPS, stated, “Mandatory vaccines violate the medical ethic of informed consent. A case could also be made that mandates for vaccines by school districts and legislatures is the de facto practice of medicine without a license."(AAPS). Freedom to do what you wish with your body should be the most essential freedom of all. Allowing the government to control our medical verdicts, is the same as saying that we do not own our own bodies. Our nation was created with a vision that everyone had a right to religious freedoms. With that in mind, the First Amendment states “Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof. Every religion has a different stance on vaccinations. Take the Amish for example, they vehemently defy the use of vaccines (Ciolli NCBI). Anthony Ciolli also states, “State governments have chosen to exempt certain individuals from their mandatory vaccination requirements, believing that communities can obtain herd immunity even if such individuals do not become immunized.” Only two of 50 states currently prohibit the use of religion as an exemption to the vaccination. Autonomy is at the forefront of prominent principles that are effected by a government mandate of vaccinations. Autonomy is “recognizing the right of a person to make one’s own decisions (Pozgar, 14). If the state begins to trim back individual freedoms for the overall benefit of society, it should intend to address the long-term consequences of restricting autonomy (Salmon). The transgression of autonomy is correlated to the overall strength of opposition the individual has. A patient should have the right to choose the type of treatment they wish to have. Pozgar explains, “Paternalism is a form of beneficence. People sometimes believe that they know what is best for another and make decisions that they believe are in that persons best interest.” Medical paternalism plays a significant part of the vaccination movement and the education of parents. Every physician has their own opinion on the matter of vaccination, and their ideology can very much sway a patient’s decision. In this way, medical paternalism does not allow for true autonomy. Paternalism works as a branch of beneficence, or to do what is best for the patient. The one ethical theory that comes to mind when thinking of mandatory vaccinations, is consequentialism. Pozgar states, “Consequentialism emphasizes that the morally right action is whatever action leads to the maximum balance of good over evil.” How do we apply this theory to vaccination? When debating whether to vaccinate your child or not, you must think of the consequences of your ultimate decision. Vaccinating your child is the option to take for the greater good of society. Religious or moral views must also be taken into account to ensure the minimization of possible consequences. I personally believe that vaccinations should be mandated by the government. There is a reason why diseases such as smallpox have been eradicated. Allowing for way out of vaccination impedes with the advancement of our nation’s health. The rise in the percentage of unvaccinated individuals has risen over the past few years due to the recent anti-vaccination movement, and we are ultimately allowing the invitation and reappearance of diseases that have been pushed to the brink by significant advancements in modern science. As a nation, we must have the greater good in mind. Non-immunization causes weakness in overall herd immunity, which puts at-risk individuals in more danger. It is financially more responsible to vaccinate your child, then to have to pay the exorbitant medical bills accompanying their treatment.

REFERENCES

CDC Study: Treating Children’s Flu Illness Costly. (2012, May 21). Retrieved May 01, 2016, from http://www.cdc.gov/flu/spotlights/childrens-flu-costly.htm

Ciolli, A. (2008, September). Mandatory School Vaccinations: The Role of Tort Law. Retrieved May 01, 2016, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2553651/

Five Important Reasons to Vaccinate Your Child. (n.d.). Retrieved May 01, 2016, from http://www.vaccines.gov/more_info/features/five-important-reasons-to-vaccinate-your-child.html

History of Vaccine Safety. (2015, September 29). Retrieved May 01, 2016, from http://www.cdc.gov/vaccinesafety/ensuringsafety/history/index.html

Salmon, D. A., & Omer, S. B. (2006, September). Individual freedoms versus collective responsibility: Immunization decision-making in the face of occasionally competing values. Retrieved May 01, 2016, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1592474/

Smallpox Disease Overview. (2015, January 16). Retrieved May 01, 2016, from http://www.bt.cdc.gov/agent/smallpox/overview/disease-facts.asp

Wein, H. (2011, October). NIH News in Health. Retrieved May 01, 2016, from https://newsinhealth.nih.gov/issue/oct2011/feature2 What are the Reasons to Vaccinate My Baby? (2015, August 26). Retrieved May 01, 2016, from http://www.cdc.gov/features/reasonstovaccinate/