L.O Gostin is justified in saying that the current public health laws have two very important issues that need to be changed. I believe that these changes need to be made in order to offer all patients and even health care providers with their autonomy and a fair and just healthcare experience. The two changes Gostin suggested include adjusting the low amount of power that is not able to deal with the many health threats and risks. Also, Gostin suggests having clear rules and fair procedures to make decisions.
It is difficult to implement changes in the realm of health if the amount of power given is not adequate. Another question to consider is who should be given the power? Gostin discusses the division between state and law. The state holds more power in the realm of public health because public health issues can vary between states. The state tends to hold more power also because many of the powers that are required for public health legislation, such as police, inspection, quarantine etc. are already held by state officials and can differ drastically between states. Regardless of this, however, the federal government also has power in public health; for example the response to health risks that can affect many states at a time. This discussion in amount of power required for public health decisions can also be compared to public health issues in hospitals. The powerful debate lies between the importance of personal libertarianism versus the health of the public and the community.
Recently at Princeton University, there was an outbreak of meningitis B which has caused the death of some students. In fact, a student from Drexel who was in close contact with Princeton students died after being ill for approximately one week. To prevent the spread of this deadly meningitis disease, a high percentage of Princeton students were given a meningitis vaccine. This vaccine, however is not approved for use in the United States. The CDC and the FDA did allow the drug to be used. Through two doses of the vaccine will most likely protect the patient, the patient may still be able to spread the disease through close contact with others.
Considering the two issues that Gostin points out in his discussion of public health, one can question the morality in the decision of the CDC and FDA to make some students take the unlicensed vaccine. Was it the right decision? Was their level of power used in this situation used correctly? Did the students have a right to choose to take the vaccine or not? Such questions demonstrate that the amount of power given by some institutions is extremely confusing with regards to public health. There is ambiguity in the amount of power the FDA and CDC have, and the amount of autonomy the students SHOULD have. Did the students know this vaccine was not a drug that was approved for use in the US? The fact that this drug was only approved in 3 countries—Canada, Australia, and Europe, show that there are some risks of this drug that US health administrations were still discussing.
As Gostin pointed out, another issue is that public health statues do not give clear standards or indicate how decisions should be approached to ensure they are fair. Was it fair to give a vaccine that was not approved for US use, in the hopes of preventing other deaths, but simultaneously risking the infection of other students and also risking the life of the person receiving the vaccine? Has this happened before, and were the same decisions made? Will it happen again, and the same decision will be made? Probably not, because each situation varies so that different questions need to be asked and different ideas and issues need to be discussed. As Gostin indicates, these issues cause public health laws to be difficult to understand and difficult to implement.
Gostin, L.O. “Public Health Law in an age of terrorism: rethinking individual rights and common goods.” Arguing About Bioethics. By Stephen Holland. London: Routledge, 2012. 374-385.
Hayes, Ashley. “Philadelphia meningitis death tied to Princeton outbreak.” CNN 18 Mar. 2014 [Philadelphia] . Web. 22 Mar. 2014.
I had no idea about the incident at Princeton University and I am from that area. I think that this was a very interesting case of how the federal government power overruled the state’s power and personal autonomy. I do not think that the federal government should have gone to measures of enforcing the vaccine on the Princeton population but should have informed the Princeton community about the public health issue at hand and let them choose if they wanted to recieve the vaccine.
In terms of the legality of the vaccine, I think that it is probably perfectly safe. Many other powerful and established national have given the vaccine approval. I believe the reason that the US takes longer to give approval to so many drugs and vaccines is because of a .0001 percent (1 in a million) chance of a side effect that would go unnoticed my most. We fear not knowing this potential side effect because we fear that we may be sued. I think this speak more to the mindset of our society than to our medical capabilities.
You bring up some very thought provoking questions especially relating to the Princeton meningitis outbreak. Based on the information you presented when speaking about the efficacy of the vaccine, I do not feel the federal government was in the wrong when it allowed the use of the vaccine. Currently the FDA has an extremely long and inefficient process for putting drugs on to the market. If the vaccine had already been approved by Europe, Canada, and Australia there is a good chance it will eventually be approved by the United States. When it comes to outbreaks, personal liberties must take a backseat to protecting the population. The concept of martial law is an extreme example when the government must do what is best for the sake of the population. Outbreaks are a special circumstance where things like time can be a factor for who gets infected and who doesn’t. It’s up to government to protect its people in these cases, sometimes at the expense of individual’s personal liberty.
I think it is important to point out that no students were forced to receive. They were given the information about the lack of vaccine approval in the US, then given a recommendation by the professionals, which many students followed.
The US FDA has not approved many different drugs or vaccines that are approved in numerous other countries, just like it has approved drugs that are not approved in other countries. There are always risks in any treatment, but individuals should not be so naive as to think that because something is FDA approved it must be completely safe, or because it has not been approved that it is necessarily dangerous.
The students did have a choice in whether they received the vaccine or not, and upwards of 95% chose to do so based on the recommendations of professionals.
Were the Princeton students forced to get the vaccine or was it offered to them as a way to prevent their infection? It seems crazy that an institution such as Princeton could force students to be given a vaccine that had not passed tests or been approved in the US. However, I do think the school has the responsibility of doing everything in their power to protect their students. It seems that if the CDC approved treatment, the vaccine was likely safe and in the students’ best interests. The government has such a lengthy process in approving drugs and this drug likely was safe but just hadn’t made it through the entirety of that process yet. I think that in this case, assuming the vaccine was safe, the university has an obligation to protect their students and it is perfectly ethical to encourage or even force students to obtain the vaccine in order to protect the greater population from the outbreak.
You make a very valid argument in saying that these two changes need to take place. Sometimes the easiest solutions are the most obvious ones and I feel as though these rules are very obvious, but they have simply not been implemented. When discussing power and who has the right to have power, the decision gets sticky. In the particular case discussed with the unlicensed drug being given to students, quite naturally I believe that the students should have a right to not take the vaccine because it was unlicensed. However, because of this certain instance where there was an outbreak of the disease, the people in power had to take action somehow. In the school’s situation, they have a bigger grasp of the situation and would be held responsible if more people were to come down with the disease. I feel as though since there was a possibility of risking the lives of more people then they should not have made it a requirement for students to take the vaccine. They are not certain that this will help the predicament, but on the other hand it is their effort to help eradicate the disease. It will be difficult to make overarching rules in the health field because of varying situations like this. It becomes harder and harder to make rules clear when then situations themselves aren’t clear.
I agree that it can be hard for public health officials to enact measures that affect public health if they have limited power; however, in extreme cases there usually isn’t a huge resistance from the public concerning public health. Let’s say that this meningitis B case was extremely communicable and carried a high risk of death. People are desperate to find a way to halt the death toll because they want to avoid being part of it. They are more receptive to public health officials taking full control of the situation. As a result, they’re usually not arguing that receiving a vaccine impinges on their autonomy; rather, they are arguing over whom should receive the vaccine first. People who refuse to take the vaccine are not only seen as irrational, but also as an opportunity to ensure their survival because there is now an extra vaccine for them to take before which they didn’t have access to take. Interestingly, we see this struggle of autonomy versus utilitarianism in mild cases. These are the cases where it can be hard to enact public health precautions.
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