Vaccinations are arguably one of the greatest medical
advancements since 1796, the invention of the smallpox vaccine by Edward Jenner
(2019). An analysis of morbidity and mortality of vaccine preventable diseases
in the United States between 2007 and 1980 showed an exceptionally high success
rate: 92% less people became ill and 99% fewer people died from diseases such
as diphtheria, mumps, pertussis, and tetanus (Roush, Murphy, & Vaccine-Preventable
Disease Table Working Group 2007). Smallpox amazingly has been eliminated worldwide,
and at the time of this study, conditions such as polio, rubella, and measles had
been eliminated in the US (Roush, Murphy, & Vaccine-Preventable Disease
Table Working Group 2007).
Lo and behold, this success did not last forever. In 2019 alone, there have already been 1,250 reported cases of measles and 2,363 cases of mumps in the US, both of which can be prevented with the MMR vaccine (CDC, 2019). How is a previously eradicated disease like measles making a comeback, you may wonder? Well, here’s the short and simple: according to the CDC (2019), measles is spreading in the US because it’s still prevalent in certain areas around the world, travelers bring it back to the US, and it spreads when it reaches a group of people where many are unvaccinated.
Lo and behold, this success did not last forever. In 2019 alone, there have already been 1,250 reported cases of measles and 2,363 cases of mumps in the US, both of which can be prevented with the MMR vaccine (CDC, 2019). How is a previously eradicated disease like measles making a comeback, you may wonder? Well, here’s the short and simple: according to the CDC (2019), measles is spreading in the US because it’s still prevalent in certain areas around the world, travelers bring it back to the US, and it spreads when it reaches a group of people where many are unvaccinated.
Why with such high success rates are there whole groups of
people who choose to avoid vaccination? The reasons are
bountiful, but some of them include: people believe vaccines are unsafe; they prefer
natural alternatives; they have great distrust in science, the government,
and/or big pharmaceuticals; they think it’s unlikely their child will even
contract the disease; or simply their child is medically unfit to receive the
vaccine(s) (Siddiqui, Salmon, & Omer, 2013).
Fun fact: vaccine hesitancy is not a new concept. Back in the 19th century, some people were hesitant because they were afraid injecting cow material would result in bestiality, they were unsure if man should intervene with a divine fate of disease contraction, or they were not yet sure how to balance autonomy and justice (individual choice vs. the greater good) (Siddiqui, Salmon, & Omer, 2013).
Fun fact: vaccine hesitancy is not a new concept. Back in the 19th century, some people were hesitant because they were afraid injecting cow material would result in bestiality, they were unsure if man should intervene with a divine fate of disease contraction, or they were not yet sure how to balance autonomy and justice (individual choice vs. the greater good) (Siddiqui, Salmon, & Omer, 2013).
As future clinicians, how do we balance the patient’s
autonomy, their right to decide their treatment plan, with beneficience, non-malfeasance,
and justice, doing no harm to the patient and society as a whole? Share your
thoughts and findings in the comments below!
References:
Measles Cases
and Outbreaks | CDC. (2019, October 7). Retrieved from https://www.cdc.gov/measles/cases-outbreaks.html.
Mumps | Cases
and Outbreaks | CDC. (2019, September 17). Retrieved from https://www.cdc.gov/mumps/outbreaks.html.
Roush, S. W., Murphy, T. V.,
& Vaccine-Preventable Disease Table Working Group. (2007). Historical
comparisons of morbidity and mortality for vaccine-preventable diseases in the
United States. Jama, 298(18), 2155-2163.
Siddiqui, M., Salmon, D. A.,
& Omer, S. B. (2013). Epidemiology of vaccine hesitancy in the United
States. Human vaccines &
immunotherapeutics, 9(12), 2643–2648. doi:10.4161/hv.27243
The History of
Vaccines. (2019). Retrieved from https://www.historyofvaccines.org/timeline/all.
Kiana,
ReplyDeleteI believe physicians should tell their patients the pros and cons of a particular treatment so that the patient can make the right choice for themselves. Just telling the patient that they should do a certain treatment option because of success rates can potentially be threatening the non-malfeasance of the patient. When physicians force a patient to do something, they are essentially doing harm in not letting the patient decide (autonomy).
In a study, I found it showed that some physicians when faced with parents who refuse immunization on half of their children, choose to dismiss these families from their practice (Halperin 2007). Physician dismissal of patients based on the refusal of vaccination raises ethical dilemmas to both the physician and patient. Based on autonomy, the patient does have the right to refuse any recommendation from the physician because the physician is just "recommending" options, not forcing. If the physician refuses to treat the patient because of their autonomy, then justice comes into play. While there is no perfect solution for this scenario, I believe physicians still have the duty of educating and respecting the patient's perspective about vaccinations.
Reference:
Halperin, B., Melnychuk, R., Downie, J., & Macdonald, N. (2007). When is it permissible to dismiss a family who refuses vaccines? Legal, ethical and public health perspectives. Paediatrics & child health, 12(10), 843–845. doi:10.1093/pch/12.10.843
Kiana, your post made me think about people deciding not to receive vaccinations. One additional aspect I think is important is a lack of easy access to vaccinations. I read an article that looked at immigrants in Boise, Idaho. They found that over 40% of these individuals did not have any immunity to polio (Roscoe et al, 2015). A reason could be that if individuals recently moved to the United States then they may not have health insurance yet or they have chosen not to go to the doctor for a different reason. As a result, they do not have the immunity to certain viruses. If there happens to be an outbreak where there is a vaccine available, such as measles, then these individuals would be at risk and it could be detrimental.
ReplyDeleteAdditionally, there are several major reasons for people not receiving vaccinations outside of the United States. One of the largest reasons in lack of access to vaccinations. Also, there can be stigmas behind receiving vaccines. For example, some individuals in rural areas have a fear of the poliomyelitis vaccine containing SV40 and some people think it leads to HIV, despite research proving it doesn’t and it is no longer used today. Another example is people thinking that receiving the polio vaccine would result in sterilization. This could be due to a mistrust with the government (Debunked: The Polio Vaccine and HIV Link).
In regard to balancing the patient’s autonomy, I believe it is important to stress the importance of receiving the vaccine. I would explain that by receiving the vaccine they would not only protect themselves, but they would also help protect others who are not able to receive the vaccination through herd immunity. I would fully respect their decision not to receive a vaccine if that is what they choose, but then I think there should be additional precautions for those individuals. This means that if there is an outbreak, such as the measles outbreak in 2019, all individuals who are not vaccinated should have limited contact with others who are not vaccinated. This includes preventing the children from going to school until the outbreak is complete. As an alternative, they could receive their schooling from home through a computer until the outbreak is complete. This would be using non-malfeasance by limiting the possibility of the child becoming sick.
“Debunked: The Polio Vaccine and HIV Link.” History of Vaccines, www.historyofvaccines.org/content/articles/debunked-polio-vaccine-and-hiv-link.
Roscoe, C., Gilles, R., Reed, A. J., Messerschmidt, M., Kinney, R. (2015). Poliovirus immunity in newly resettled adult refugees in Idaho, United States of America. Vaccine, 33, 2968-2970.
Kiana,
ReplyDeleteI think your post really emphasizes the point of herd immunity (similar to what Jen has already discussed). The purpose of vaccinations is to create herd immunity. It allows for a population to be protected against an infectious disease. However, the importance of herd immunity is it to remember that also protects the unvaccinated. Newborns, who cannot be vaccinated, and those who are immunodeficient are protected because the disease has a lower chance of spreading.
In that regards, I think justice comes to play when discussing bioethics. Justice argues that everyone should be able to be treated in a fair matter. If someone is unable to vaccinated (due to whatever reason) is it fair that those who are "able" to receive vaccinations to decide not to? It's a difficult to balance between non-malfeasance, justice, and autonomy.
Obviously, there needs to be a better conversation between providers and patients in order to discuss the benefits and negative consequences of vaccinations. In an article I found, a doctor argues that it's important to try and see what all anti-vaxxers have in common. The studies show that many people who don't want a vaccination are refusing them because of religious reasons, personal freedom, and a fear of needles. The article discusses that patients will argue the information they are given, likely due to confirmation bias. Furthermore, the studies found that it was more difficult to try and take on the mis-information itself and disproving it. Instead, another study showed that educating parents on the consequences of not vaccinating their children made a larger impact. The doctor would show a photo of someone who has mumps, measles, and rubella and that would show more success.
Reference:
Swingle C. A. (2018). How Do We Approach Anti-Vaccination Attitudes?. Missouri medicine, 115(3), 180–181.
Prevention is better than Cure,
ReplyDeleteTo address the concept of autonomy; we have to address both the pros and cons of being immunized. Educate the parent and/or patient on the history of diseases that have been eradicated or highly reduced due to the introduction of vaccinations. Show data, numbers, and diagrams if they are visual learners. Help the parent and/or the patient understand exactly what is going on based on their understanding. If they still do not want to be immunized based on the resources you're capable of giving them; they have the right to leave but also let them leave with some new resources that they can personally follow up on if they are still curious with the matter at hand.
For beneficence and non-maleficences, as stated before educating the parent and/or patient the advantage and disadvantage of not being vaccinated in the community. The harm can bring to the individual if placed in a non-immunized area or an area prone to infectious disease outbreaks. How that individual is safe due to her immunity, but once taken out of the group it becomes unsafe. Education is key when it comes to situations like these.
Orenstein, W. A., & Ahmed, R. (2017). Simply put: Vaccination saves lives. Proceedings of the National Academy of Sciences of the United States of America, 114(16), 4031–4033. doi:10.1073/pnas.1704507114
This comment has been removed by the author.
ReplyDeleteThe anti-vaxxer movement is frightening to say the least. The movement born from a British journalist stated that there was link to Autism and administering vaccines. However, this paper was retracted almost as quickly as it was published. Needless to say, this one paper paired with a slim minority population of people has grown this movement to the point where previously eradicated illness are now making a comeback. I have looked up the main reason for individuals not vaccinating their children the top four response are 1. personal and philosophical reasoning 2. Religious beliefs and 3. Safety concerns.
ReplyDeleteStudies found that the number of parents refusing to vaccinate their children was up 74.5% in 2006 to 87.0% percent in 2014 and the number is slowly on the rise. Mentioned before the main reason for this incline is parents believing that vaccines are unnecessary. To help combat this belief, I believe that doctors should continue to educate the public on the growing severity of this problem and why vaccines are so important. This gives the patient overall autonomy, by also highlighting that these diseases are preventable and will potentially save the child’s life. If financial reasons are preventing the vaccination there is the Vaccines for Children program (VFC), which offers extremely low to free vaccination for children in need. This is offered at majority of hospitals for people who qualify and ask. With that being said if a patient were to refuse the vaccination strictly because they find it unnecessary, a clinic doctors are well within their rights to deny that patient future treatment.
One physician wrote, “I have patients who are premature infants and incapable of receiving vaccines to protect their weak heart and lungs. I have kids with complex congenital heart disease. I have kids on chemotherapy for acute lymphoblastic leukemia who are unable to get all their vaccines. In short, I have patients who have true special needs and true health issues who can suffer serious injury or death from being around an unvaccinated child.”
Working in a family practice, doctors have regular patients who they treat. If they have patients who are unable to get vaccinated, they are practicing non-malfeasance for those children. Education is key, however, when an individual is placing another at harm for the choices that they made it becomes the doctors discretion on how to handle the situation. This gives the physicians the power to deny treatment if that means they are trying to protect those that can not protect themselves.
Reference:
Chiaravalloti, D. (2019, March 21). More Pediatricians Are Dismissing Patients Who Refuse to Vaccinate. Retrieved November 13, 2019, from https://www.boardvitals.com/blog/pediatricians-patients-refuse-vaccinate/.
Vaccines for Children (VFC) Program. (2019, April 17). Retrieved November 13, 2019, from https://www.cdc.gov/features/vfcprogram/index.html.