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Why Vaccinating the World Is the Best Thing for Australia

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With COVID vaccine boosters ready to be rolled out across Australia, a debate has arisen about the ethics of taking a third vaccine shot when nearly half of the world population has yet to receive their first. Tedros Ghebreyesus, President of the World Health Organization, has invoked the principle of health equity in suggesting that booster shots should be restricted until the world’s poorest have access to a vaccine. Daniel Burkett has argued in this very venue that the ethical choice is to boycott the booster – sending a message that we refuse to partake in ill-gotten gains – although A.G Holdier replies that any such attempt might ultimately prove futile. On the other hand, proponents of the shot highlight evidence of its efficacy in reducing infections and symptoms of COVID, and suggest that our moral obligation to get vaccinated might well extend to taking booster shots. In this case, however, we need not choose between self-interest and morality: for those of us in Australia, the two are aligned.

It might be argued that vaccines should be directed, not to the poorest countries, but to those with the highest case fatality rates (CFRs). Research has shown that COVID-19 is more deadly in countries with increased prevalence of obesity, diabetes, cardiovascular issues, and those with older populations: all apt descriptors for Australia. Such a simplistic take, however, would overlook the quality of medical care already available in Australia and our medical system’s strong (albeit still limited) capacity to deal with significant medical emergencies. Furthermore, this analysis relies on questionable data, with severe undertesting for COVID skewing statistics in poorer countries. And as noted by Burkett, any analysis based on CFR would have to consider not only the initial risk of COVID, but the diminishing returns in vaccine effectiveness. Whereas the first dose of a Pfizer vaccine can reduce the likelihood of developing symptoms by around 50%, a second dose adds around 40% more protection and a third only 10-15% when compared to baseline.

So, it is hard to make the case that we need booster shots more than those in the developing world need a first or second dose. A better argument might be that boosters would provide a net benefit to both health and the economy, and, as we can get them, we should take them. This is a kind of medical lifeboat ethics: we have the capacity to save ourselves, and we shouldn’t squander that chance on the naïve hope of saving others. After all, the responsibility of government is to look out for the interests of its citizens. Politically, vaccine boosters are local, immediate and – perhaps most importantly for the current government in the run up to an election – highly marketable to an understandably worried voter base. And whereas bioethicist Nancy Jecker points out that countries like Tanzania, Chad, and Haiti are hovering at a disastrous 1% vaccination rate, this comparison is neither apt nor helpful. The issue there is not so much with vaccine supply (although this may be a contributing factor) as the potent mix of conflict, corruption and political instability preventing acquisition and effective distribution of vaccines. In Australia, we have boosters available (and more on the way), and we have the capacity to administer them. So why shouldn’t we?

A more enlightening comparison would look not at the least vaccinated nations, but those where COVID has taken a significant toll. Countries like India, Brazil, and South Africa, with stable governments, better record-keeping and active – albeit imperfect – vaccination programs. There, the picture is grim. India’s actual COVID death toll could be well over two million (compared to the official figure of less than 500 thousand), while vaccination lags at just over 50% first dose. In South Africa, official figures suggest less than 100 thousand COVID-related deaths. However, excess mortality since the start of 2020 exceeds 250 thousand, with an estimated 95% of these deaths due to the disease. Just over a quarter of the population have received a vaccine dose, and even fewer have received two. In Brazil, somewhere around 600 thousand people have died from COVID, while less than 60% of the population are fully vaccinated (although a more impressive 75% have received at least one dose). Most disturbingly, each of these countries have seen the emergence of new, dangerous variants, with Beta coming out of South Africa, Gamma originating in Brazil, and the now-dominant Delta strain starting in India before taking over the world. This is before mentioning the fast-encroaching specter of the new, ominously named Omicron.

Here is the crucial point. On this issue, we don’t have to choose between morality and self-interest, as suggested by Nicholas Bugeja at The Interpreter. Instead, this is one of those (increasingly rare) cases where morality and self-interest align. The biggest threat to Australia is not a resurgent Delta variant attacking those whose vaccines have diminished in efficacy. The biggest threats are of new variants, incubated in highly mobile, densely packed, and largely unvaccinated populations. Every time COVID-19 is transmitted – wherever in the world that transmission occurs – there is the chance of a potentially dangerous mutation emerging. The best way to deal with this threat is mass vaccination of the unvaccinated, not marginal gains for the already protected.

Nor must we choose between vaccinating the world and protecting our most vulnerable. We can do both. Booster vaccines should be prioritized for those most at risk – the elderly and those with pre-existing conditions – while an increasing share is sent overseas to boost immunity and reduce the threat of new variants. CSL is already contracted to produce about 30 million more doses of the AstraZeneca vaccine, but the government should reconsider its decision to stop production after the current run. We might not be able to vaccinate the whole world, but we can certainly play our part.

It is important to note that this analysis takes a myopic Australian viewpoint and may not apply to much of the world. Here, despite our slow start, vaccination rates are approaching 80% of the total population (and continue to rise), while case numbers remain low. For Holdier, living in Arkansas where vaccine hesitancy (and rampant misinformation) has kept the vaccination rate below 50%, the personal likelihood of catching COVID skews the moral calculus in favor of boosters and away from admirable, but possibly futile, political posturing. There, the risk of catching a current strain may well outweigh the dangers of a new variant.

But in Australia, as borders reopen, international students are welcomed back, and international travel returns, so too does the threat of a new, more virulent, or more deadly strain hitting our shores (the much-hyped Mu variant might have been kept at bay, but Omicron is already here). Hotel quarantine wasn’t enough to keep Delta out last time, although it was a huge help. This time, we will be without our first and most effective line of defense. If we demand people get vaccinated before coming to Australia – and we should – then the onus is on us to make those vaccinations accessible. It’s in our best interest.

COVID Vaccines and Primary Care

photograph of elderly man masked in waiting room

Dr. Jason Valentine, a general practitioner in Alabama, has decided to no longer treat unvaccinated patients. Starting October 1st, that is. At the beginning of August, Valentine’s clinic made the announcement, clarifying that his personal rule applied to both current patients and new patients. So long as you are unvaccinated, Dr. Valentine will not be seeing you. When asked why he was choosing not to treat unvaccinated patients, Valentine said “COVID is a miserable way to die and I can’t watch them die like that.” In Alabama, the state with the highest number of new COVID cases per day, such a sentiment is understandable. But is it ethical?

As most people know, doctors are bound by a creed called the Hippocratic Oath. The name of this oath comes from the historical figure of Hippocrates, a fifth century Greek physician, to whom the oath is traditionally attributed (although he was likely not the original author). The Hippocratic oath is the earliest-known source of many central idea of medical ethics that we still hold to today: e.g., the patient’s right to privacy, the obligation of the physician to not discriminate between the poor and the rich, and, most famously, the pledge to do no harm.

Doctors today continue to take a version of the Hippocratic Oath, though the oath has undergone major alterations in the past 2500 years. Still, the pledge to “do no [intentional] harm” remains. Major debates have been carried out historically over what exactly falls under the pledge to “do no harm” — that is, under what conditions are doctors guilty of breaking their oaths? More specifically, is Dr. Valentine breaking the Hippocratic Oath by refusing to see unvaccinated patients?

One argument for thinking that Valentine is breaking his oath is that refusing to see unvaccinated patients constitutes an illegitimate act of medical discrimination. Medical doctors have, historically, been stoically determined to ignore unpalatable particulars about the individuals they were treating. For example, during the Civil War, doctors in both the Union and the Confederate armies treated soldiers injured on the battlefield, regardless of their allegiance (excluding, sadly, Black soldiers on either side). During the second World War, British surgeons operated on Nazi prisoners of war, in many cases saving their lives. Under the Geneva convention, doctors are bound to treat soldiers from their army and enemy soldiers impartially — enemy soldiers are not to receive worse treatment or a lower medical priority because of their military allegiance. Surely, then, if the Geneva convention would forbid a doctor to refuse to see patients who were Nazis, it would prevent doctors from refusing to treat patients who had not received a vaccination for a dangerous and highly-contagious disease?

But there is legal precedent that complicates this verdict, as well. Specifically, doctors are allowed to, and do frequently, refuse to see children who have not received their recommended childhood vaccines and do not have a medical reason barring them from receiving vaccines. Reasons for these policies often include considerations of the extreme vulnerability of other patients that the voluntarily-unvaccinated may encounter in the office, including young children who are immunocompromised and babies who have not yet received all of their vaccines. Another consideration is that many childhood vaccines prevent infection from nearly eradicated diseases like the measles. When children are not vaccinated against these illnesses, breakthrough cases stand a higher chance of spreading, thereby resurrecting an almost defeated enemy.

For these reasons, one may be inclined to praise the doctor’s choice. Surely, if people are barred from seeing their general practitioner, this might motivate the unvaccinated to receive the vaccination, and undo some of the damage done by rampant misinformation regarding vaccine safety and efficacy. However, consider a (hypothetical) doctor who refused to treat patients who drank too much alcohol, or refused to exercise. In these cases, doctors would surely be seen as refusing to do their primary job: assuring the health of their patients to the best of their (possibly limited) abilities. Some philosophers, like Cass Sunstein, refer to actions and laws like these as “paternalism”: acts of mild coercion for the sake of protecting the coerced, are sometimes seen as acceptable — seatbelt laws and cigarette taxes are commonly-accepted paternalistic laws aimed at mildly coercing safer behavior. But when the coercion becomes harmful, or potentially harmful, these measures are generally seen as morally impermissible. For example, holding someone at gunpoint until they throw away all of their cigarettes may be incredibly effective, and maybe even good for the smoker in the long-run, but is surely morally wrong if anything is. The difference between paternalistic measures and harmful coercion is usually understood as a difference in potential harm and a difference in the degree of autonomy the coerced maintains. When laws increase the tax in cigarettes, smokers may be mildly financially harmed, but this generally will not amount to anything financially destructive. Generally, they retain the choice between either taking on a small additional financial burden or giving up smoking. In the gun-to-the-head case, the smoker no longer (meaningfully) retains a free choice. She must give up smoking or face her own death. Anything less than compliance, in this case, results in the most extreme kind of harm.

Clearly there will be many instances of coercive measures that fall somewhere between these two extremes. This raises a tough question for Dr. Valentine: does refusing to treat voluntarily unvaccinated patients constitute a case of permissible paternalism, or impermissible harmful coercion? One reason for thinking that such a decision may not result in real harm is the abundance of options of doctors that most people have access to. Surely needing to switch primary care doctors is merely an inconvenience, and not a significant harm. However, there are factors complicating this. Many people have insurance plans that severely limit what doctors they can see. Additionally, if Valentine is allowed to refuse unvaccinated patients, there is nothing stopping all of the doctors in his area from taking on the same rule. Someone may be effectively denied all medical care, then, if all local doctors decide to take up a similar rule. An inability to access a primary care doctor seems like a more severe harm than the instances of mild coercion in the cases of paternalistic cigarette tax laws.

There is no easy ethical analysis to give to Dr. Valentine’s decision. While we can surely sympathize with the protocol, and hope it leads to increased vaccination rates, we do not want large swaths of the general public living without a primary care doctor. Like many other aspects of COVID-19, ethicists here have their work cut out for them mapping brand new territory.

Underrepresentation in Clinical Trials and COVID-19

photograph of vaccine waiting line

There have long been concerns about underrepresentation in the clinical trials of medical products, and there has been a large push for the testing of COVID-19 vaccines to be more inclusive due to the urgency of the problem and danger the virus poses to all of us. The current situation presents an opportunity to assess the previous model that tended to emphasize efficiency — doing the most good for the most amount of people as quickly as possible, often in the interests of speeding production — at the cost to underrepresented groups continually having to use medical products not specifically designed for them.

Historically, both medical professionals and clinical trial participants were primarily men. Making up more than half of the population, women were drastically underrepresented in medicine. This underrepresentation resulted in vast differences in healthcare for men and women. This is important because men and women present different symptoms of disease. Since men have largely been the sample for clinical trials of medical products, there is far more medical knowledge about how men present symptoms of various diseases. This makes diagnosis for women more difficult, and it makes their symptoms seem abnormal.

The underrepresentation of women in clinical trials also impacts the treatment of diseases. When male cells, male animals, and men are the basis of clinical trials, researchers are looking only at the effects on one-half of the population. Often, when women were included in these trials, their data was not analyzed separately or significantly, so differences in experiences were not addressed. After trials, women would take medicine that had not been optimized for them, which could result in negative health consequences. For example, Ambien, a sleep aid, was not tested for differences in effects on men and women. When Ambien became available for use, the slower metabolism of women meant that the drug stayed in their systems longer than men, so the dose was too high for women.

One reason for the low representation of women in clinical trials is that researchers worried that women’s reproductive cycles and hormones would overcomplicate the study and provide confounding variables. However, these variables are part of the reason why men and women both need to be included in clinical trials. When hormonal fluctuations and reproductive cycles are not taken into account, it is uncertain exactly how a medical product will work.

Another reason women were often excluded from clinical trials was fear of harming fertility. In 1977, the FDA recommended  women of childbearing age do not participate in clinical trials for fear that medical products may harm a fetus in the event that the woman became pregnant. This recommendation was put into place after exposure to some drugs caused birth defects. In the past, little research was done about women’s health that did not relate to reproductive health. Fertility seemed to be the primary concern about women’s health, so it was treated as more important than the potential benefits of including women in clinical trials.

The FDA reversed this recommendation in 1993 over ethical concerns about prioritizing the fetus over the potential benefits of including women in clinical trials. The recommendation’s reversal was also related to concerns about autonomy. When the FDA put forth the recommendation, they made it significantly more difficult for women who wanted to participate in clinical trials to do so. Despite some women not wanting children or simply valuing the advancement of women’s health more than any potential negative health effects they may face, women were excluded from trials. The FDA attempted to address safety concerns, but ultimately changed their recommendation because of the constraints on personal choice. While there remain safety concerns, women can now choose to participate in clinical trials.

Due to the urgent nature of the pandemic, ensuring that the vaccine is viable for as many people as possible is a priority. To achieve this, clinical trials have been more inclusive of many medically underrepresented groups, such as pregnant women, minorities, and people with certain medical conditions. Pregnant women can choose to participate in the clinical trials for the vaccine far earlier than they are able to for most medical products. This is partly due to the funding for vaccine development and the higher risk that pregnant women face with COVID-19.

In the future, it is uncertain whether medically underrepresented groups will continue to have the same participation they currently enjoy. While it is clear that these groups ought to have more representation in clinical trials, some medical professionals have concerns about funding and time. Most medical products do not have the funding that the COVID-19 vaccine has. Lower funding limits the number of people who can participate in a clinical trial. Additionally, there are time constraints. When a medical product is necessary, it is important that it is released as soon as possible. Knowledge of the potential health risks for different groups must be weighed with the benefits of releasing the medical product as soon as possible. Often, this means that the human trials consist of healthy men and women with no other conditions being the primary subjects. Later, the effects for individuals with various health conditions may be tested as well, but this is rarely made a priority.

The history of discrimination in clinical trials forces us to consider whether efficiency in the production of a medical product designed for the greatest number of people is truly fair when it means that persistently underrepresented groups continue to suffer from a lack of viable medical products tailored to their particular needs.

For-Profit Coronavirus Vaccines

photograph of ampoules in automatic inspection machine conveyor

Drug giants Pfizer and Moderna announced that they have developed COVID-19 vaccines which have effectiveness rates over 90%. But these are just two of the many drug companies contracted by the U.S. government to develop and distribute a vaccine to combat the pandemic through Operation Warp Speed. Unlike the other companies, however, Pfizer and Modern plan to profit off of their vaccine. Pfizer CEO Albert Bourla justified this move by explaining that he wanted to “liberate [Pfizer] scientists from bureaucracy…When you get money from someone that always comes with strings…they want reports.” Moderna meanwhile has yet to offer a justification for its decision to set vaccine sales at a profit price.

Should drug companies making COVID-19 vaccines sell these vaccines at cost? Is profiting off of a public health crisis wrong? And who bears the burden of ensuring public health crises are addressed effectively: government or private industry?

Major U.S. drug companies have taken a range of financial positions when it comes to coronavirus vaccines. Companies such as Johnson & Johnson and AstraZeneca have pledged that they will be producing and distributing vaccines at cost. In other words, they will be charging enough to cover the costs of material and labor, rather than charging more in order to increase their corporation’s net wealth. Pfizer is in a unique position, because while they have decided to their vaccine for profit, they have also refused government money for research and development. Perhaps the most extreme stance has been taken by Moderna, who received government funding for research and development and have announced they will not sell the vaccine at cost.

Is it reasonable to expect drug companies not to make a profit off of a potentially life-saving treatment? Those who see no problem with the profiteering of vaccines might argue that these companies deserve to profit from the hard work and innovation they have put into developing these vaccines at a record speed. Pharmaceutical companies’ right to private patents of the coronavirus vaccine argue that “IP (intellectual property) is a fundamental part of our industry and if you don’t protect IP, then essentially there is no incentive for anybody to innovate.” While this logic is often deployed in the interest of free market economies, the difference in the current situation is that companies withholding patents have been heavily funded by governments across the world, and are not necessarily selling a competitive product to consumers. However, Pfizer and Moderna are both drug companies, and some might point out that their entire business model is reliant on profiting off of death and disease.

Other defenders of Pfizer and Moderna might argue that it is the government, not private industry, which is tasked with addressing public health. Perhaps the larger problem is that we do not have a public healthcare system which can adequately develop medical technology to combat the COVID-19 pandemic. In fact, when the outbreak first started in the U.S., it was very apparent that the Center for Disease Control was far less equipped to handle a public health crisis than private industry. It is also important to remember, however, that the necessity for private intervention came after the U.S.’s decision not to use the World Health Organization’s distributed tests.

Those who are against the profiteering of COVID-19 vaccines by drug companies might point to the fact that these vaccines are not simply a novel innovation but are a necessity to ensure the public good and its health. Charging more than necessary for the vaccines could limit access and prolong the pandemic, leading to more lives lost. Oxfam has taken a strong stance on the necessity of affordable vaccines, recently stating that a life-saving vaccine would be “zero per cent effective to the people who can’t access or afford it.” Critics of vaccine profiteering might also argue that it is especially wrong for companies like Moderna to sell vaccines at a profit since they received government funding for research and development.

Another criticism of vaccine profiteering might be based on the morality of profiting off of crisis in general. In a previous article, I examined the moral distinctions between other kinds of crisis capitalizers. Drug companies such as Pfizer and Moderna hold the power to develop and distribute potentially life-saving vaccines. Perhaps this situation makes the desire for profit even more insidious. While nobody has necessarily called for these companies to operate below cost, it does not seem outlandish to expect a lack of self-interest given the scope of such a serious and pressing disaster. Some might also believe that some degree of altruism should be expected in this situation as these companies have the capacity to ensure these vaccines are as accessible as possible to every member of society. The billionaires running  vaccine research made billions of dollars in the days following their announcement of a potential coronavirus vaccine. Though some have claimed that COVID-19 is a “great equalizer” it is clear this is not the case. Income inequality has gradually become one of the major political issues in America and suggesting that the wealthiest members of society donate to help the rest of us is not as radical of a moral suggestion as it has sometimes been regarded.

Even scientists who develop vaccines find what these drug companies are doing unethical. In an interview, Margaret Liu, the chairperson of the International Society for Vaccines, called Moderna “greedy” and suggested that “the taxpayers who have funded all of this should have expected better negotiation from the US government.” Others have expressed opposition to private licenses and disdain for public institutions which allowed private drug companies to sign contracts without this guarantee. Philanthropic organizations, such as the Bill and Melinda Gates Foundation, have also been criticized for their support of pharmaceutical patents on a life-saving COVID-19 vaccine.

While it’s clear that certain pharmaceutical companies see the pandemic as an opportunity, economists have predicted that their profit will likely be short-lived. At this point, Operation Warp Speed has already contracted out funds with no strings attached. In the future, it is up to us to decide whether or not we are comfortable with public funds funneling directly into corporate profits.

Who Should Get the Vaccine First?

photograph of doctor holding syringe and medicine for vaccination

As at least one COVID-19 vaccine is scheduled to enter clinical trials in the United States in September, and Russia announced that it will be putting its own vaccine into production immediately, it seems like an auspicious moment to reflect on some ethical issues surrounding the new vaccines. Now, if we could produce and administer hundreds of millions of doses of vaccine instantaneously, there would presumably be no ethical question about how it ought to be distributed. The problem arises because it will take a while to ramp up production and to set up the capacity to administer it, so the vaccine will remain a relatively scarce resource for some time. Thus, I believe that there is a genuine ethical question here: namely, which moral principles ought to govern who gets the vaccine when there is not enough to go around and the capacity to administer it remains inchoate? In this column, I will weigh the pros and cons of a few principles that might be used.

One fairly straightforward principle is that everyone is equally deserving of treatment: everyone’s life matters equally, regardless of their race, gender, or socioeconomic status. The most straightforward way of fulfilling the principle is to choose vaccine recipients at random, or by lot. The trouble with this method is that, although it arguably best adheres to the principle of equality, it also fails to maximize the good. We know that not everyone is equally vulnerable to the virus; choosing vaccine recipients by lot would mean that many vulnerable people would die needlessly at the back of the line.

One way of defining “the good” in medical contexts is in terms of quality-adjusted life years, or “QALYs.” One QALY equates to one year of perfect health; QALY scores range from 1 to 0. If our aim in distributing the vaccine is to maximize QALYs, then we would prioritize recipients for whom a vaccine would make the greatest difference in terms of QALYs. Since the vaccine would make the greatest difference to members of vulnerable groups, we would tend to put these groups at the front of the line. We could also combine the principle of maximizing QALYs with the equality principle by selecting individual members of each group by lot while shifting all members of vulnerable groups to the front of the line.

While the principle of maximizing QALYs would in this way help the most vulnerable, it might be open to the objection that it neglects those who perform particularly important social functions. These perhaps include government officials and workers in essential industries who cannot shelter in place. One justification for prioritizing these individuals would be that since they contribute more to the functioning of society, they are entitled to a greater level of protection from threats to their productivity, even if giving them the vaccine first would fail to maximize QALYs. Another idea is that prioritizing such individuals maximizes overall well-being, rather than QALYs: more people benefit if society functions well than if members of vulnerable groups live longer. In a sense, then, we can view the dispute between the principle of maximizing QALYs and the principle of rewarding social productivity as a dispute between two ways of defining “the good.”

Finally, we might consider using the vaccine to reward those who have made significant contributions to social welfare in their lives, both on the grounds of intrinsic desert and to provide incentives for individuals to make similar contributions in the future. For example, we might decide that, between two individuals A and B for whom the vaccine would make an equal difference in terms of QALYs, if A is a war veteran, retired firefighter, teacher, and so on, then A ought to receive the vaccine first. One troubling feature of using this criterion is that owing to past discriminatory policies, this principle might heavily favor men over women. On the other hand, men may already be favored over women by the principle of maximizing QALYs, since they appear to be more vulnerable to COVID-19.

A final suggestion is just to let the market decide who will get the vaccine. But it’s hard to see how that idea is compatible with any of the normative principles discussed in this column. This method of distribution will not maximize QALYs or reward those who make or have made significant contributions to social welfare, and it seems at odds with the notion that all lives matter equally — in effect, it expresses the idea that the lives of the wealthy matter more.

Here is my proposal, for what it’s worth. If the disease were deadlier and there was not effective basic protection against transmission, then we would have to worry much more about the ability of government and essential industries to function without the vaccine. Luckily, COVID-19 does not pose such a threat. This means that operationalizing the principle of maximizing QALYs probably also would maximize overall social well-being, despite prioritizing vulnerable groups over essential workers and non-vulnerable groups. As I suggested above, we ought to select individual members of groups by lot, so as to affirm their basic equality. And in cases where we would make a roughly equal difference in terms of QALYs, we ought to favor the would-be recipient who has made a significant contribution to social welfare in their lives.

The Ethics of Vaccination Exemptions

photograph of H1N1 vaccine bottles

On January 28, 2019, Washington Governor Jay Inslee declared a state of emergency in response to a spreading outbreak of measles in Clark County, WA. Measles is a highly contagious airborne infection caused by a virus in the paramyxovirus family. Before a vaccine was developed in 1963, the disease infected over 3 million people a year in the United States and resulted in 400 to 500 deaths annually. In 2000, thanks to a highly effective vaccination system in the U.S., the measles disease was declared eliminated by the Center for Disease Control. However, measle outbreaks have begun to emerge again in recent years due to a growing number of parents who refuse to vaccinate their children—often falsely claiming that vaccinations are either unsafe of unnecessary. Do parents against vaccinations, also called “anti-vaxxers,” have a legal right to refuse vaccinations for their children even if it means jeopardizing public health?

While the history of the anti-vaccination movement can be traced all the way back to the 1800’s, a study released in 1998 that claimed a false link between the measles vaccinations and autism has fueled much of the contemporary anti-vax fire. Author of the study, British doctor Andrew Wakefield, was found to have been paid by a law board to falsify evidence in support of a litigation case that claimed vaccines had harmed children. The study was formally retracted by its publisher in 2010 and Wakefield lost his licence to practice medicine in Great Britain. Since then, numerous studies (including one released on March 5th, 2019)  have failed to find any link between vaccines and autism.

There are legitimate medical reasons to delay or avoid vaccinations, but they are rare. While some doctors have decided to profit off the anti-vax craze by selling false medical exemptions to parents, most who refuse vaccinations for their children do so through non-medical, state-issued means. Most common is an exemption based on “religious beliefs.” Overall, no major world-religion has a theological objection to vaccinations. However, certain offshoots of ‘faith-healing’ denominations, such as Christian Science, reject modern medicine altogether. Some religious fundamentalists also claim that vaccines are unnecessary. Gloria Copeland, an Evangelical Christian minister who sat on the Trump campaign’s evangelical advisory board, claimed in a 2018 video on Facebook that Jesus was the best protection against the flu and people can avoid the disease by repeating “I’ll never have the flu.”

Many states also allow for “philosophical” or “personal” vaccine exemptions that do not require religious backing. Much of the motivation to acquire such exemptions stems from the spread of misinformation on social media sites like YouTube, Facebook, and Pinterest. Ethan Lindenberger, an Ohio teen who chose to get vaccinated against his parents wishes spoke of the necessity in addressing misinformation when he testified before congress on March 4th, 2019. Lindenberger said, “For my mother, her love, affection and care as a parent was used to push an agenda to create a false distress, and these sources which spread misinformation should be the primary concern of the American people.”

Non-medical vaccine exemptions (NMEs) endanger public health by reducing “herd immunity.” No vaccine is 100% effective, but when a population is highly vaccinated it prevents the spread of germs from one person to another—effectively protecting the population. The less vaccinated a population becomes the more susceptible both vaccinated and unvaccinated individuals are to diseases. This is why public schools require vaccinations for children who attend. In 2015, the Second Circuit U.S. Court of Appeals in Manhattan upheld a ruling that students who receive religious exemptions can be kept out of the classroom during a disease outbreak. The court stated, “The right to practice religion freely does not include liberty to expose the community or the child to communicable disease or to the latter to ill health or death.”

Proponents of NMEs believe public health should not take precedence over individual liberties and that mandated vaccinations are a threat to personal autonomy. However, in the case of public spaces, such as schools, vaccines are analogous to other government mandated safety measures. Exceeding the speed limit, running a red light, or breaking other rules of the road is illegal when driving because it threatens the safety of others. The famous ‘harm principle’ of British political theorist John Stuart Mill argues that infringing on personal liberties is justifiable when it protects others from harm. Under this principle, vaccination exemptions should be highly restricted since they pose a threat to public health.

Dr. Barbara McAneny, the American Medical Association’s president, argues, “Protecting our communities’ health requires that individuals not be permitted to opt out of immunization solely as a matter of convenience or misinformation.” A 2013 measles outbreak in Brooklyn, New York that infected 58 people was caused by a single unvaccinated child. Such an incident shows that, to keep a population best protected from disease, vaccination exemptions should only be allowed for legitimate medical reasons. While preventing the spread of misinformation is paramount to combating the rising rates of NMEs that are endangering both domestic and global health, the most effective means of reducing communicable disease is to do away with NMEs all together.

The Unknown Nature of Zika

Many of us had never heard of the Zika Virus until recently, when it first took the media by storm. The Zika Virus, first discovered in Uganda Forest of Zika in 1947, is a mosquito-transmitted pathogen similar in nature to yellow fever and the West Nile Virus. This May, it made its first appearance in the Western Hemisphere, with an outbreak in Brazil. Now, the virus is running rampant, and has spread to numerous other countries, even making as far as the U.S. in Texas.

Continue reading “The Unknown Nature of Zika”