Flu vaccine being drawn into syringe

Public health needs to outweigh autonomy when it comes to vaccination

In the decade before 1963 when a vaccine became available, nearly all children got measles by the time they were 15 years of age. It is estimated 3 to 4 million people in the United States were infected each year. Also each year an estimated 400 to 500 people died, 48,000 were hospitalized, and 4,000 suffered encephalitis (swelling of the brain) from measles. (CDC)

Imagine if the vaccine hadn’t been implemented in 1963. Given that the population of the United States has more than doubled since then we might have been experiencing 8 million contracting measles and 100,000 hospitalized annually. Maybe disability and mortality would not have expanded at the same rate because our supportive care has improved, but that would still be a lot of people with serious illness and a large burden on the health care system.

According to the CDC:

Among the 49 states and DC that reported 2013–14 school vaccination coverage, median 2-dose MMR vaccination coverage was 94.7% (range = 81.7% in Colorado to ≥99.7% in Mississippi); 23 reported coverage ≥95%, and eight reported coverage <90%…Among the 46 states plus DC reporting 2013–14 school vaccination exemption data, the percentage of kindergartners with an exemption was <1% for eight states and ≥4% for 11 states (range = <0.1% in Mississippi to 7.1% in Oregon), with a median of 1.8% (MMWR)

While this would suggest that nationally maybe only about 5% of school age children aren’t adequately vaccinated, low vaccination rates/high exemption rates often appear in clusters, leaving groups of unvaccinated children at risk, contributing to the outbreaks of measles we have seen in the past few weeks.

Vaccination protects not only those who receive the vaccination, but it also helps protect those in a community who cannot receive such vaccinations or for whom vaccination did not provide adequate immunity. This gives us the concept of “herd” or community immunity: when more people who are vaccinated against a disease, there are less people to potentially become infected and outbreaks of infections diseases like measles, which spread from person to person, will be less likely to occur. When there are clusters of people in a community who aren’t immune through vaccination or previous infection, it is more likely that outbreaks of infections will occur, decreasing the effectiveness of community immunity.

Currently, all states have some requirements that children receive certain vaccinations before entering school. However, some people feel that governments should not be able to mandate vaccinations. They feel it is a violation of their personal right to make their own decisions about vaccinations, a violation of their autonomy. People should, by and large, make medical decisions based on what is best for them formed from an understanding of the risks and benefits. In most areas of health care, patient’s autonomy, their ability to make their own choices, is and should be the guiding principle.

However, in areas that affect public health, the physical health of the community as a whole must be the deciding factor. Public health laws, such as mandatory vaccination, were not made to dictate medical care. They were established to protect the overall health of all of a community’s citizens, helping to ensure their happiness and well-being and, indirectly, their productivity and the community’s prosperity. Vaccinated or unvaccinated, everybody in a community where people do receive vaccination receives the benefit of their actions. People who are able to receive vaccination should do so; this act of beneficence protects those who cannot. Community immunity is a public good from which all benefit. People who are not immunized not only run the risk of becoming infected themselves, but of passing that infection on and causing illness in others in the community.

Vaccinating our children is the right thing to do. It protects our own children and families from the effects of devastating illnesses and by doing so, protects our larger community as well. Vaccinations have been proven to have very low risks of serious potential side effects and the benefits to both the individual and the community outweigh those rare risks.

References:

Measles History. CDC: Measles. Retrieved from http://www.cdc.gov/measles/about/history.html (02/05/2014)

Seither, R. Masalovich, S. Knighton, C. Mellerson, J. Singleton, J. Greby, SM. (2014) Vaccination Coverage Among Children in Kindergarten – United States 2013-14 School Year. MMWR. 63(41); 913-920. Retrieved from http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6341a1.htm

Related reading:

Dawson, A. (2011) The Moral Case For The Routine Vaccination of Children in Developed and Developing Countries. Health Affairs. 30(6). 2011. doi 10.1377/hlthaff.2011.0301 Retrieved from: http://content.healthaffairs.org/content/30/6/1029.full.html

Wilson, J. (2014) The ethics of disease eradication. Vaccine 32(2014) 7179-7183.

3 thoughts on “Public health needs to outweigh autonomy when it comes to vaccination

  1. Thank you for talking about vaccines without claiming they’re a government plot to infect us with alien DNA.

    Sometimes, people have to be protected from themselves. And from their parents.

    Ian

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    1. Thanks for taking the time to leave a comment. I appreciate the feedback.
      It really is heartbreaking to hear educated people speaking in support of anti-vaccine efforts. A former coworker of mine recently posted something on facebook along those lines and I’m trying to decide how to respond. A recent article on Vox discusses a study that found that trying to argue the sound science vaccines can actually backfire, which is really discouraging. The recommendation by the study author was that physicians and primary care providers need to be firm in their advice to parents about following the established vaccination schedule and not equivocate.
      “Studies have found that providers who use presumptive language, saying, ‘It’s time for some shots,’ are much more likely to have successful vaccine compliance than providers who use participatory language like, ‘What do you think about shots?’ It’s of course important to respect patient autonomy but I think, at the same time, the language providers use gives patients a cue about the strength of the medical evidence. If you roll into the emergency room on a stretcher with a gun shot wound, no one says, ‘How do you feel about getting bullets out of you?’ They say, ‘We need to get this out of you now.’ There is a move in medicine toward participatory approaches in contexts in which the benefits are less clear. But this is an area where the science is very clear and the language we use should reflect that.”
      Based on my personal experience, at least in adult medicine I can see how this tactic is likely to be more effective in getting patients to accept vaccination and I plan to apply that advice. As far as confronting my friend, I think I’m going to ask her why she feels the way she does and see what common ground we have to start the conversation from.

      Belluz, J. (2015) Debunking vaccine junk science won’t change people’s minds. Here’s what will. Retrieved from http://www.vox.com/2015/2/7/7993289/vaccine-beliefs

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  2. You’re quite welcome.

    Partly people don’t recognize media sensationalism or junk science, or they believe Oprah. Partly, it’s the human tendency to mistrust authority. Once it’s made a “debate” by the media, people feel justified in taking either side, as though they have equal merit.

    There’s a psychological principle that people, having taken a position, will defend it. They become committed to it. If they cannot properly evaluate evidence to the contrary, it’s rejected as an underhanded attempt to deceive them. Kind of like cult members resisting deprogramming.

    I think your approach to your coworker is reasonable.

    My attitudes toward vaccination were formed in biology class in Grade 11, before it was an “issue”. Understanding matters. In this and other areas (climate change, pipelines, fracking, alternative energy, the economy, and anything to do with health and medicine) a universal scientific education would really help.

    Ian

    Like

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