Mandatory vaccinations have become an increasingly hot topic in the realm of health. Some patients and families argue that insurance companies and health care providers are becoming too paternalistic, and insist on a voluntary vaccination model, whereas the opposing argument is that mandatory vaccinations are leading to decreased prevalence of diseases in the population. Proponents of voluntary vaccinations cite evidence of other countries vaccination rates as proof of the success of a voluntary-based model. In this post, I will be advocating for the support of mandatory vaccinations and their effectiveness, as well as addressing the vaccination rates of other countries.
One of the reasons for the support of mandatory vaccinations is that they prevent the risk of greater harms. For instance, many low-income families may not have access to quality medical care. They may have access to the basic standards of care, such as vaccinations and general prescriptions, but they are not in a position to afford things such as expensive medications for chronic diseases. By making vaccinations mandatory, the risk is decreased for at-risk populations contracting a disease such as the measles, and therefore, lowers their overall cost of care. Although it should be mentioned that certain risks are associated with the use of vaccines, the rate of injury is small and is outweighed by the possible benefits.
Secondly, mandatory vaccinations are seen as cost-effective. Health organizations, such as the World Health Organization and Center for Disease Control, generally have to make executive decisions on whether to promote the use of a certain vaccine or not. One of the variables they use to assess the strength of a decision is the cost, which is used in calculating the cost-benefit analysis (CBA). As Beauchamp and Childress discuss, the CBA “measures both the benefits and the costs in monetary terms” (231). The CBA can be used to factor out variables such as the ethical or moral values associated in making one decision over another. This way of reasoning could be used in demonstrating to patients that the costs to themselves are greatly reduced when they receive vaccinations compared to when they do not.
Thirdly, mandatory vaccinations are seen as the best option in the United States in terms of results. Several proponents of alternative forms of compulsory immunization make the claim that other countries who engage in alternative immunizations, such as through education, have similar rates of immunization compared to countries who engage in mandatory immunization. The country they use in the vaccination reading is Australia, whose rates of immunization are around 90%. One of the issues I have with this way of thinking is the inherent assumption it makes that Australia and the United States are equal countries apart from their differences in vaccinations. This is a false assumption, as Australia and the United States differ in several ways, one major way being how Australia has universal health coverage, something the United States does not have. This could greatly impact the rates of immunizations in itself, regardless of whether Australia participates in alternative or mandatory vaccinations. Secondly, the claim could be drawn that a 90% vaccination rate is equal in terms of results in comparison to the United States vaccination rates. This is also false, since having a 90% vaccination rate would expose the United States population to a host of diseases that are currently kept under control, such as the measles.
In conclusion, vaccinations are not risk-free. Most decisions come with their own risk of complications, and as such, should always be taken to account. Vaccination may be seen as one of the greatest public health interventions, whereas some say their infringement upon patient autonomy must be considered. I believe that mandatory vaccinations are mandatory, however, I am not opposed to change. In the future, I would like to see a vaccination model that incorporates results with the ability of patient choice.
Citation:
Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. New York: Oxford UP, 2001. Print.
Isaacs, D., Ha Kilham, and H. Marshall. “Should Routine Childhood Immunizations Be Compulsory?” Journal of Paediatrics and Child Health 40.7 (2004): 392-96. Web. 24 Mar. 2017.
Hey Kevin,
I really enjoyed the read. I agree that vaccines should be mandatory. I believe another large reason that vaccines should be mandatory is something calls “herd immunity”. Herd immunity creates an environment where the majority of the population within a community is vaccinated, creating a buffer against those that are not vaccinated. The buffer gives very little opportunity for an outbreak to occur-due to the large percentage of the community being vaccinated. (https://www.vaccines.gov/basics/protection/)
I appreciated the first two points you made, CBA and the idea that low income families may not be able to afford a vaccine; it gave me a new perspective on why some people do not vaccinate. For some reason it never occurred to me that people do not vaccinate because they are unable to.
That being said, It only furthers my advocation for mandatory vaccination for those who can afford it (whether state provided or not). By not doing so it increased the chance of harming a subsection of the population that physically cannot afford it. This action would be similar to paying taxes for education/defense/public services -it helps the community which helps, overall, the state of our nation. Using a cost benefit analysis, getting vaccinated far outweighs the alternative.
Thanks,
Alex
Hi Kenquavius!
I agree that vaccines should be mandatory because of the arguments you proposed. I also agree with Alex that we should make vaccines mandatory to increase herd immunity. Many people think that refusing vaccines is a personal choice which only impacts themselves; however, it can harm others as well.
Take this story by Stephanie Tatel. Her son has cancer and due to his chemotherapy treatment, he is immunosuppressed. When her and her husband were searching for a daycare, they learned that some children in the daycare were not vaccinated, so he was unable to attend. As Tatel explains, “A single unimmunized child in an ordinary child care setting is the equivalent of a toddler time bomb to him.” Parents should consider this effect before refusing to vaccinate.
In my Introduction to Global Health course last semester, we had a guest speaker from Rollins School of Public Health, Dr. Robert Bednarczyk, speak to us about vaccines and measles. When discussing herd immunity, he explained that we need 92-94% of vaccine uptake in the population to prevent the spread of measles. If we do not, we will continue to have outbreaks such as the 145 measles cases contracted from a single case at Disneyland in 2015.
So, how to we convince parents to vaccinate their children? One of my classmates asked this question to Dr. Bednarczyk. His answer surprised me. Instead of explaining the facts and the science behind vaccines, tell them stories, he said. When talking to parents who are hesitant about vaccinating their children, give them a specific example of a child who contracted measles and died from it, for example. Perhaps making it more personal makes it more convincing.
The vaccine debate is frankly not a debate to me. I think that, as long as you are not immunosuppressed or exempted for serious reasons, everyone should be vaccinated. However, from a bioethical standpoint, there is definitely some balancing necessary between beneficence and autonomy. However, in this case, I say beneficence wins – both for the patient themselves and everyone around them.
Tatel, Stephanie. (2009). A Pox on You. Slate. http://www.slate.com/articles/health_and_science/medical_examiner/2009/10/a_pox_on_you.html
Bednarczyk, Robert. (2016). Case study in vaccines: the global (and domestic) impact of measles. Introduction to Global Health, Fall 2016.
Wow I am so sorry. I meant Kenquavius…. no idea why my brain read that incorrectly the first time
Hi Everyone,
I agree with all of your points regarding mandatory vaccinations in society with limited exceptions. In Julia’s comment, she mentions how a Dr. Bednarczyk mentioned the best way to convince parents to vaccinate children is to play with stories and, somewhat, parental emotions. Although vaccination would be in the best interest of the child in question given no unusual health circumstances, I couldn’t help but think of the ethics of this tactic in convincing conversation in relation to a parent making an autonomous choice or developing an opinion. It seems as if the parents’ opinion of vaccines would somewhat coerced by an emotional story of children dying without it, regardless of how true it might be. Not that it would be bad for parents to vaccinate their children obviously, but do you think that using this method of convincing infringes upon the parents’ ability to develop an autonomous choice or opinion? I believe that such a method other than stating the facts would, regardless of the benefit to the community or child. Let me know what you think!
Thanks,
Elisabeth Crusey
Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. New York: Oxford UP, 2009, 2013. Print.
Hi Everyone,
I agree with all of your points regarding mandatory vaccinations in society with limited exceptions. In Julia’s comment, she mentions how Dr. Bednarczyk believes the best way to convince parents to vaccinate children is to tell stories of outcomes and, almost, bring parental emotions into the picture. Although vaccination would be in the best interest of the child in question given no unusual health circumstances, I couldn’t help but think of the ethics of this tactic in convincing conversation in relation to a parent making an autonomous choice or developing an opinion. It seems as if the parents’ opinion of vaccines would somewhat coerced by an emotional story of children dying without it, regardless of how true it might be. Not that it would be bad for parents to vaccinate their children obviously, but do you think that using this method of convincing infringes upon the parents’ ability to develop an autonomous choice or opinion? I believe that such a method other than stating the facts would, regardless of the benefit to the community or child. Let me know what you think!
Thanks,
Elisabeth Crusey
Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. New York: Oxford UP, 2009, 2013. Print.
Hey Elisabeth,
Yeah, I had the same question myself. While I am glad it worked, it definitely seemed like a sneaky way to convince them to vaccinate their child. I don’t think it goes so far as coercion, since they still have the choice. However, I do see it as strong persuasion or manipulation for sure. What parent, after having their doctor tell them that their child could die if they don’t get the vaccine, would refuse? It’s an interesting ethical dilemma and I am glad you brought it up. Appeal to emotions is a strong and effective persuasive technique, but is it the technique that doctor’s should be using? I think that in these situations of vaccine refusal parent’s often don’t want to hear the doctor’s advice because they’ve previously decided for themselves. If a doctor brings the topic up again, with that added emotional attachment, it could make the families feel like they had no choice.
I think that doctors should do their very best to leave emotions out of all medical decisions, mainly because they run the risk of infringing on autonomy and practically coercing parents and patients to make decisions that, however good or bad they are, are no their own. Hospitals are already extremely emotional and frightening environments, and there are ways for doctors to recommend treatment without tugging on heartstrings in just about every single case. Do you think in general that emotions should play a role, not at all, or in only some situations? I’m curious to see what you think!
-Elisabeth
Hey Elisabeth,
I definitely agree with your point on the parents right to autonomy possibly being infringed upon using this tactic. While I do believe that physicians may not be the best choice of personnel for discussing the risks of not vaccinating, I do believe that parents should be notified of the harms that they may place on their child as well as other children. While paternalism may come into play when discussing the health outcomes of those who have limited autonomy (such as children), we have to keep in mind that the parent may not be fully informed of the risks of non-vaccination. However, the physician/health care personnel should also respect the role of the parent, and guide them towards making an informed decision, rather than coercing them.
Sources:
Beauchamp, Tom L., and James F. Childress. Principles of Biomedical Ethics. New York: Oxford UP, 2009, 2013. Print.
Hi Kenquavius,
I enjoyed reading your post and everyone’s additional thoughts. I agree that vaccinations should be mandatory but in implementing this change we shouldn’t be forcing parents into making these decisions against their conscience. Instead, we must consider the reasons why they chose not to vaccinate their child and educate them on why their information might not be as accurate as they believe. First off, they’re not wrong in believing there are risks involved in vaccinating their child. However, like Dr. Halsey explains, we may struggle to put that risk in perspective because we don’t experience these diseases everyday and we lose sight of how dangerous they are. People tend to fear flying more than driving but that’s because driving is common and familiar even though it’s far more dangerous. Vaccinating children can cause short-term side effects such as redness and swelling but only 1 in a million experience severe allergic reactions.
Secondly, may parents will cite ineffective flu vaccines as evidence that vaccines don’t do their job. The majority of vaccines are 85-95% effective but the annual flu vaccine is difficult to predict because there are many strains that could circulate. The vaccines effectiveness depends on the strain they pick and there’s obvious error in that process yet when the strain is correct, the vaccine greatly reduces the risk of contraction.
The third argument that’s commonly used is that forcing vaccination is a violation of personal rights. If your child was only to interact with people within the family, then sure, go ahead and hold off on vaccinations but if your child is to enter a preschool or daycare where other children may have a compromised immune system or for whom are resistant to vaccinations, your right is now trumping someone else’s. If your child has a legitimate medical reason that puts them at an increased risk if vaccinated, then of course exceptions are made accordingly to ensure their safety. The true purpose of blanket vaccination is not to push parents into a corner but rather to protect the maximum number of children from proven preventable disease and illness.
Sources:
Omer, S. B., Salmon, D. A., Orenstein, W. A., Dehart, M. P., & Halsey, N. (2009). Vaccine Refusal, Mandatory Immunization, and the Risks of Vaccine-Preventable Diseases. New England Journal of Medicine, 360(19), 1981-1988. doi:10.1056/nejmsa0806477