Mandatory Health or Individual Rights: Compulsory Vaccination in Society
Full vaccination should be mandatory for all children under the age of eighteen for the purpose of individual health and the safety of the community. Immunization works. Science proves regular, on schedule vaccination, helps protect both the individual and the community by reducing the incidence and spread of infectious disease. People under the age of eighteen have little to no control over medical decisions made on their behalf, and tragically parents are making the decision not to vaccinate their children based on anti-scientific rhetoric and false beliefs.
Vaccines are effective at saving lives, reducing and preventing illness, long term injury and even death. A miniscule amount of a particular virus is injected or inhaled, which prompts the body to create antibodies to the disease, in turn creating immunity against further infection. The Center for Disease Control and Prevention (CDC) estimates 21 million hospitalizations and 732,000 deaths within the last twenty years in the United States have been prevented due to consistent vaccination. (Center for Disease Control and Prevention)
Vaccines aid society in many different ways. Broad and constant vaccination in a population creates community protection, otherwise known as "herd immunity." Basically, vaccinated people protect unvaccinated people, as not everyone is able to be vaccinated. Widespread vaccination use protects vulnerable populations, such as the elderly, people too young to receive vaccinations, "non-responders," and those with compromised immune systems. The United States also benefits economically in the net amount of $69 billion dollars due to compulsory vaccination. (Orenstein) A healthy society experiences less school and work absenteeism which results in higher productivity. Another way consistent compulsory vaccination aids society is eradication of disease. Through regular and widespread vaccination through the 1970's, smallpox was eradicated. When vaccination is frequent and constant in a society, diseases have no place to go. Unvaccinated populations keep diseases alive.
Resistance to vaccines has negative implications for both individuals and society. Deadly diseases can spread quickly through communities and "cluster areas" (geographical regions) with low vaccination rates. Cluster areas tend to be most commonly located in upper income, white regions, such as Orange County or the Bay Area in CA, which leads researchers to believe opposition to vaccines is based on anti-science beliefs versus access to vaccinations. (Bonifield) Parents in these particular cluster groups tend to be more liberal and want to raise their children more naturally with holistic remedies, diets, and without chemical exposure.
Vaccination resistance causes disease resurgence. For example, measles was thought to have been eradicated in the United States as recently as 2000. (Phadke) However, in 2014 a single person with measles caused an outbreak which ended up infecting 145 people in the United States. The vast majority of those infected were individuals who were unvaccinated or too young to have been vaccinated. The rest were under-vaccinated, as they did not receive the booster shot (which increases efficacy to from 95 to 99 percent). One person was fully vaccinated but was a "non-responder," which means they did not produce the necessary antibodies to combat the disease after being vaccinated. (Palmer) Polio, which was nearly eradicated worldwide, has made a comeback in some Muslim countries, due to suspicion of Western motives regarding vaccination, wars, and religious edicts. Polio has been considered eradicated in the United States since 1979, as no cases have originated in the States.
People are vaccine resistant for many reasons. Fear of autism from vaccines appears to be the most common motivation to not vaccinate. A study by Andrew Wakefield, which was published in The Lancet in 1998, claimed to show a link between vaccinations and autism. The results of Andrew Wakefield's study linking autism to routine childhood vaccination (namely the MMR-measles, mumps, rubella) have never been successfully duplicated and his study is considered fraud in the scientific and medical research community. Unfortunately, despite the inability to reproduce Wakefield's results, The Lancet did not retract the study until 2010, an astounding 12 years since the original publication. Wakefield's medical license was ultimately revoked, and he is no longer able to practice medicine. Regrettably, in the time before the retraction, the anti-vaccination movement caught momentum. Regardless of scientific evidence disproving Wakefield's study, people remained suspicious of vaccines and celebrities such as Jenny McCarthy continued to promote the anti-vaccination movement; ignoring science and giving the movement a public voice.
People are fearful the ingredients in vaccinations will cause harm to their children, physically and mentally. They are worried about vaccine reactions and/or allergies. In actuality severe reactions are extremely rare. Only 1 out of 1,000,000 vaccinated individuals experiences any sort of reaction. Thimerosal, a mercury-based preservative, has been used in vaccines for decades and has never been proven to be a harmful additive. Ironically, Thimerosal has also never been used in vaccines such as the MMR, varicella, or inactivated polio. As a precautionary method, Thimerosal was removed from all childhood vaccines beginning in 2001. (Center for Disease Control and Prevention)
Vaccine resistant parents also cite religious and philosophical reasons. Some parents give no reason at all: they just do not want to vaccinate. All fifty States and the District of Columbia allow medical exemptions in the schools regarding vaccinations. Only California, Mississippi, and West Virginia have strict mandates for school attendance and reject philosophical or religious reasons for vaccine refusal. Individuals favoring vaccinations dispute the quasi-mandatory policies which allow philosophical and religious vaccine opposition based on the interest of public health.
People believe compulsory vaccination is a violation of their individual civil liberties, legal rights to choose, and bodily autonomy. Vaccines permanently alter the body. Those opposed to vaccines do not believe the State has the right to such imposition on their bodily sovereignty. People have been granted the right, which is protected by the United States Constitution, to refuse to be medicated, referred to as a "liberty interest." Traditionally liberty interest applies to those who have terminal illness, mental illness, and the like. Individuals who oppose vaccinations believe vaccination should fall under the category of bodily integrity protection and autonomy as well.
Websites foster and spread anti-vaccination sentiment and encourage "natural immunities," i.e. catching the disease and building antibodies from the actual spread of disease instead of from vaccinations. These websites overemphasize the dangers of vaccines and minimize the danger of infectious disease. Ironically, the generation of parents who were vaccinated by their parents are not willing to do the same for their children. They do not seem to validate and appreciate the serious nature of being infected and will gamble with the well-being of their and other children's health. Some people do not care if other children or members of society are infected due to their resistance. "In February, Dr. Jack Wolfson, an Arizona cardiologist, told CNN he did not vaccinate his two sons and that he could live with himself if his unvaccinated child got another child gravely ill. "It's an unfortunate thing that people die, but people die. I'm not going to put my child at risk to save another child," Wolfson said." (Bonifield)
Several methods have been used to promote vaccine compliance. In the early 1900's, Boston Massachusetts experienced an outbreak of smallpox which resulted in 1596 cases of smallpox and 270 deaths between 1901 and 1903. (Gostin) The State of Massachusetts decided to uphold and enforce compulsory vaccination in the interest of public health but was challenged by Henning Jacobson in Jacobson vs. Massachusetts (1905). The Supreme Court sided with Massachusetts and upheld the authority of the State to protect public interests over individual rights. Social distancing methods, for example, temporarily removing unvaccinated children from schools during disease outbreaks, were reinforced by the Court in Phillips v. City of New York (2014). (Yang) Two Catholic families had filed a religious exemption with the school. When a student was diagnosed with chicken pox, their children were temporarily barred from attending school, not just for their protection, but because unvaccinated people are a conduit for the spread of disease to others. Again, the Court, citing Jacobson vs. Massachusetts, sided with the precedence of public safety superseding individual rights. "The Court cited the Supreme Court's statement in Prince v. Massachusetts, 321 U.S. 158 (1944), that "[t]he right to practice religion freely does not include liberty to expose the community or the child to communicable disease or the latter to ill health or death." (Mulry) Mississippi, West Virginia, and California schools are the only states in the nation which do not allow vaccine exemptions, such as religious or philosophical persuasions. No exemptions outside of medical reasons are accepted. Unfortunately, social distancing methods may contribute and reinforce the feelings of discrimination and prejudice to those within the anti-vaccination movement. This may further validate feelings of separateness from the rest of society, victimization, and foster increased isolation and resistance.
Pediatricians and physicians struggle to find a way to communicate the importance of vaccination to resistant parents. The American Academy of Pediatrics (AAP) recommends attempting to communicate with parents and attempt to educate them regarding the safety and benefit of vaccinations, but also supports physicians who ultimately choose to bar vaccine resistant individuals from their practices. (Rucola) Medical providers have contacted Child Protective Services (CPS) citing medical neglect for refusal of vaccinations. Typically though, reporting parents to CPS for medical neglect would only be appropriate in immediate care incidences, such as during an outbreak or for an urgent need, for instance, a tetanus shot. Although a medical neglect case could be made for refusal of regular scheduled vaccinations due to the serious nature of the diseases, other realities need to be considered. An ethical question of removing children from the home and the ability to place the children in appropriate care is a concern. The system may not be able to take on a large number of children and may decrease available placement for children in crisis.
Australia has implemented a program called the Family Tax Benefit (FTB) also amusingly referred to as "No Jab, No Pay." Families with children who are vaccinated on schedule receive their full tax benefits. Australia does not allow for any type of conscientious objection to qualify for the tax benefit. Only medical exclusions are accepted. Unvaccinated children are also prevented from attending schools and daycares ("No Jab, No Play"). In addition to not qualifying for the tax break, parents were fined annually for not vaccinating. As of July 1, 2018, Australia began fining unwilling parents biweekly. The current rate for vaccination in Australia is now 92.2 percent. (Keck) Perhaps the pocketbook is the biggest motivator for parents to immunize their children.
Surprisingly political party affiliation has no significant bearing on antivaccination sentiment. Both non-vaccinating liberals and conservatives on the fringe end of the parties equally oppose vaccines based on the belief of being unsafe. However, when opposing immunization based on individual liberties, the majority are conservative leaning. Essentially though, the opposition to vaccines is not dependent on party necessarily, rather it depends on the level of political involvement and political position regarding the spectrum of either party. (McCoy)
Widespread immunization is an essential part of a strong and healthy society and should be mandatory for those under the age of eighteen. Science and medical research prove that vaccines are effective for the vast majority of the population and cause harm to an extremely small percentage of people. A solution providing for compulsory vaccination must be found to bridge the gap between science and belief. Finding productive methods of education and knowledge about immunization for vaccine resistant parents can decrease falsehoods concerning vaccines. Increased vaccination will provide a roadblock to the spread of highly contagious diseases and increase potential eradication of diseases. Hopefully, a method will be found to bridge gaps between the strong anti-science beliefs and the truth about the benefits of routine vaccination.
Works Cited
Bonifield, John. "California's rich, white unvaccinated kindergartners." CNN
"Report shows 20-year US immunization program spares millions of children from diseases." Center for Disease Control and Prevention
"Thimerosal in Vaccines." Center for Disease Control and Prevention
Gostin, Lawrence O. "Jacobson v Massachusetts at 100 Years: Police Power and Civil Liberties in Tension." National Center for Biotechnology Information
Keck, Madeleine. "Australia Will Fine Parents Every Two Weeks if They Don't Vaccinate Their Children." Global Citizen
McCoy, Charles. "Anti-vaccination beliefs don't follow the usual political polarization." The Conversation
Mulry, Kevin P. "Second Circuit Rejects Constitutional Challenge To New York School Vaccination Requirement. Farrell Fritz, P.C.
Orenstein, Walter and Ahmed, Rafi. "Simply put: Vaccinations save lives." 10 April 2017. National Center for Biotechnology Information
Palmer, Katie M. "Why did Vaccinated People get Measles at Disneyland? Blame the Unvaccinated." Wired.
Phadke, Varun K, et al. "Association Between Vaccine Refusal and Vaccine-Preventable Diseases in the United States." National Center for Biotechnology Information.
Rucola, Ruben J. "How to address vaccine hesitancy: New AAP report says dismissal a last resort." AAP News and Journals
Yang, Y. Tony and Silverman, Ross. "Social Distancing and the Unvaccinated." New England Journal of Medicine
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3. Transition between paragraphs/order.
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