Vaccinations have been revolutionary to human
health but, recently there has been a major decrease in the amount of children
being vaccinated (Olive et
al., 2018). One justification for parents
refusing vaccines is due to a false study correlating autism to vaccines.
There have been a vast amount of studies that show there is no evidence of
vaccines causing any chronic illness or autism (Publichealth.org, 2019).
Every state in the U.S. requires children to be
vaccinated before attending public school. However, all states accept medical
waivers for those who medically are unable to vaccinate, eg. life-threatening
allergies, so they may still enter into the public school system. Along with
medical exemptions, 44 states allow religious exemptions, 16 states offer
personal exemptions, and 5 states offer non-medical exemptions (NME)
(Sandstorm, 2019).
What's the big deal with having a vaccine exemption? The higher
number of NMEs lowers the effectiveness of herd immunity. The herd immunity is
the percent of individuals that need to be vaccinated in order to protect the
rest of the population. The herd immunity is around 90-95% vaccination coverage
(Olive et al., 2018).
Despite the fact that Measles was initially thought
to have been eradicated from the U.S. in 2000, 2019 had the highest cases of
Measles outbreaks since 1992 (CDC, 2019 ; Olive et al., 2018). Most of the
people who were affected with Measles in the 2019 outbreak were
unvaccinated.
In 2016 there were some states that had more than
400 kindergartners entering school with NMEs (Olive et al., 2018). Having
a large number of unvaccinated children in a small area increases the
likelihood and spread of preventable diseases in these areas (Olive et al.,
2018).
Many states have started removing NMEs and
requiring stricter guidelines for religious waivers (Sandstorm, 2019). There
have been controversial debates about making vaccines required to attend
school, some argue that based on nonmaleficence and justice vaccines should be
required while others claim that it infringes on parents autonomy.
The choice to not vaccinate could detrimentally
affect those who are unable to vaccinate such as those with weakened immune
systems, babies, and many others. Reintroductions of these diseases to the
populations could be disastrous not only in global health but also to economic
sustainability (Hotez, 2019).
Should states remove all exemptions besides
medical? Should vaccines be required not just nationally but globally? Here two
ethical principles are clashing with one another (nonmaleficence and autonomy)
but at what point does one out-way the other? Does the right to make autonomous
decisions about immunizations outweigh the potential risks to others or that
child? What do we choose? As the old saying goes, “you are free to choose but
you are not free from the consequence of your choice.”
References:
Centers for Disease Control and Prevention. (2019, October 11).
Measles Cases and Outbreaks. Retrieved from https://www.cdc.gov/measles/cases-outbreaks.html.
Hotez, P. America and Europe’s new normal: the return of
vaccine-preventable diseases. Pediatr Res 85, 912–914 (2019) doi:10.1038/s41390-019-0354-3.
Publichealth.org. (2019, November 6). Vaccine Myths Debunked.
Retrieved from
https://www.publichealth.org/public-awareness/understanding-vaccines/vaccine-myths-debunked/.
Sandstrom, Aleksandra. “Amid Measles Outbreak, New York Closes
Religious Exemption for Vaccinations – but Most States Retain It.” Pew Research
Center, Pew Research Center, 28 June 2019, https://www.pewresearch.org/fact
tank/2019/06/28/nearly-all-states-allow-religious-exemptions-for-vaccinations/.
Olive JK,
Hotez PJ, Damania A, Nolan MS (2018) Correction: The state of the antivaccine
movement in the United States: A focused examination of nonmedical exemptions
in states and counties. PLoS Med 15(7): e1002616. https://doi.org/10.1371/journal.pmed.1002616
Personally, I do not think parents should have a choice to not vaccinated children, at least against life threatening illness. If there was actual evidence of vaccines being dangerous it would make sense, but most parents' concerns are based on misinformation. Ultimately the risk not only to the unvaccinated person, but to those who are medically unable to be vaccinated and may be exposed if herd immunity is lost, is much greater than the very rare risk of a reaction to the vaccine.
ReplyDeleteErin,
ReplyDeleteThis is a very relevant topic in today’s day and age. I was curious what reasons lie behind parent’s choice to not vaccinate their children as it seems counter-intuitive to me. One study found that there are four categories that these parents can be grouped into: religious exemptions, personal beliefs or philosophic reasons, safety concerns, and a desire for more information from healthcare providers. In the category of religious reasons the two largest points of contention were the animal-derived gelatin used in producing some vaccines and the human fetus tissue used in the rubella vaccination. In the category of personal beliefs or philosophical reasons, there are some people that believe if their child contracts a preventable disease, it will help the child in the long-term by strengthening their immune system. Other parents believe that the disease we vaccinate for are not very prevalent so their children are at minimal risk of contracting that disease, therefore the potential negative side effects of vaccination outweigh the benefits. Many parents do not see the diseases to be vaccinated against as dangerous or life-threatening and therefore do not see a reason to put extra chemicals into their child’s body. Often these parents are under the impression that if their child contracted one of these diseases it would be easily treatable. The third, and typically the largest category of parents, express concerns about the safety of vaccines. Most of these concerns are based on information parents have received from the media and acquaintances that overwhelm the parent rendering them unable to sort through the information and make their own well-informed decision about vaccination. This is the category of parents who believe there is a link between vaccinations and autism/brain damage/behavioral changes. The component thought to be causing this link—thimerosal—has been removed from vaccinations for over a decade and does not pose a risk any longer. None the less parents can be influenced by these safety concerns. The fourth and final common reason cited is that parents want more information regarding vaccinations. They would like to have all the information necessary to weigh the risks and benefits of each vaccine. Many parents in this group reported they did not have access to the information they needed to make this decision. (McKee and Bohannon, 2016)
Over all, three out of four of these categories could be addressed by unbiased factual information relating to vaccines and the ability of a healthcare provider to build a trusting relationship with the family so they feel they are receiving the full truth. Parents need to feel free to ask questions without judgement and examine the facts on their own to determine what is best for their child’s healthcare. When parents are unable to get this information they will often opt out of vaccination. (McKee and Bohannon, 2016)
As a college educated science major it would be very easy for me to assume that parents are making bad decisions based upon faulty evidence. More often than not these parents do not have access to the information that would help them make good decisions for their child’s healthcare and are not well versed in scientific exploration and reading to find this information for themselves. To the average parent the amount of information is overwhelming and it would be easy to believe mass media that vaccinations are potentially unsafe. I am not advocating that refusing vaccines is right, but it might be the best the parents are able to do with the information they have, As science majors we have the duty to examine all sides of the story and see what factors are leading the general public to the information they receive. It would be our ethical duty to share our knowledge and skills in scientific thinking to help spread the facts and dispel the myths.
Mckee, C., & Bohannon, K. (2016). Exploring the Reasons Behind Parental Refusal of Vaccines. The Journal of Pediatric Pharmacology and Therapeutics, 21(2), 104–109. doi: 10.5863/1551-6776-21.2.104
Erin,
ReplyDeleteI believe that this topic is at the heart of a lot of the difficulties we are facing right now as a nation. Parents declare, “I have the right to refuse vaccinations for my child,” just as many people declare, “I have the right to own automatic weapons.” The problem is that these people are not thinking of the greater good. If less people owned automatic weapons, it is likely that children wouldn’t be getting killed in schools. If parents vaccinated their children, herd immunity would protect children who can’t get vaccinations due to immunodeficiencies, as well as babies who are just too young to have gotten all their shots. I can’t provide any statistical data that proves we are becoming more entitled and ignorant as a nation, but I think actions certainly speak louder than words. There are plenty of cases in which children have died due to their parents’ negligence.
An article titled “The Horrifying Consequences of the Anti-Vaccine Movement” tells the story of Mobius, a four-month-old baby who was taken to the hospital with measles (Sole-Smith, n.d.). The family had gone to Disneyland over the weekend, and because some parent(s) didn’t vaccinate their child, Mobius and his family had to be quarantined for a week. Although Mobius recovered, there is an increased chance that he will develop encephalitis, which can lead to learning disabilities, convulsions and deafness (Sole-Smith, n.d.).
Not all children survive. In another story outlined in the article, a woman didn’t get her Tdap vaccination when she was pregnant, and her two-month-old baby developed pertussis. She died shortly after (Sole-Smith, n.d.).
Another challenge exists because the medical field has largely eradicated these illnesses. Many doctors haven’t actually seen them in real life, and this makes it much harder to diagnose (Sole-Smith, n.d.). The herd immunity that had previously been established cannot exist when more people are refusing to vaccinate their children. The World Health Organization listed “Vaccine Hesitancy” as one of the top ten world health threats this year (Trimble, 2019). I would argue that this is a scenario in which non-malfeasance far outweighs parental autonomy.
Sole-Smith, V. (n.d.) The horrifying consequences of the anti-vaccine movement. Parents Magazine. Retrieved from https://www.parents.com/baby/health/vaccinations/the-horrifying-consequences-of-the-anti-vaccine-movement/
Trimble, M. (2019). WHO: anti-vaccine movement a top threat in 2019. U.S. News and World Report. Retrieved from https://www.usnews.com/news/national-news/articles/2019-01-16/who-names-vaccine-hesitancy-as-top-world-threat-in-2019