Introduction
The use of vaccines is generally seen as one of the biggest breakthroughs in medical science and public health, providing an effective, non-invasive, and relatively cheap method of protecting the public from deadly viral diseases. Since the first vaccinations by Edward Jenner in 1796, the method and technology of vaccines have developed into a complex science, leading to virtual eradication of diseases such as smallpox and polio that once ravaged through the population through a simple principle of herd immunity (Lemons 177). Vaccines are universally recognized by all international, national, and local health organizations and experts as the most effective and safest means of building the herd immunity and highly reducing the risk of infection in individuals.
To increase vaccine uptake, governments around the world have created regulations at various levels to mandate immunizations. However, throughout history, the issue of mandatory vaccinations has been controversial with various arguments ranging from religious beliefs to severe side effects to conspiracies surrounding pharmaceutical companies – all part of the group known as ‘anti-vaxxers’ or, in official terms, vaccine hesitancy. This paper argues in support of government-mandated vaccinations as the benefit to society far outweighs the risk of individual complications (for which there are safeguards) and any personal beliefs that one may hold in order to reduce the risk of infection spread and increase public health protections.
Vaccination Policy
Currently, the United States does not have federal mandates for vaccinations, but there are laws at the state level which establish vaccination requirements. The vaccination requirements typically apply to children as well as certain professions such as healthcare and frontline workers or other specialized circumstances. Furthermore, organizations and employers, both public and private, may require immunizations. Essentially, although no one is physically forcing individuals to receive a vaccine, the laws and regulations make it so as to function normally in society (education, work), one most often needs to be vaccinated. These restrictions are in place to achieve vaccination uptake and maintain the most optimal levels of herd immunity.
Despite the U.S. vaccination policy reflecting that of other developed nations to a large extent, based on scientific knowledge and recommendations for best practices, it remains a controversial issue. While vaccinations have been in use for close to two centuries and their effectiveness, safety, and cost-benefit have been proven for the large majority of the population, whenever a policy of mandatory vaccines arises – it becomes controversial, largely due to a vocal opposition that are vaccine hesitant.
Evidence Supporting Mandatory Vaccination
In general, medical research supports the vitality and efficacy of compulsory vaccinations. Vaccines are developed, tested, and implemented for the specific purpose of protecting individuals from transmissible diseases, and by doing so achieving the herd immunity necessary to protect communities (Newman 2). Herd immunity is a concept which suggests that society is protected against a disease when the majority of individuals (95% is the optimal number) are immune to it, either from getting sick and recovering or through vaccinations. Theoretically, even if a disease does enter a community through a host, if herd immunity is present, it will not be able to afflict new hosts since immunized individuals cannot contract the disease, nor usually carry it as the immune system kills the virus upon entering the system. Therefore, it limits the potential of transmission, particularly to susceptible individuals such as children or immunocompromised. The transmission chain can be broken with a high herd immunity rate, even slightly below 100% (“Vaccines”).
The efficacy of immunization has historically led to the significant decline or eradication of highly viral diseases in the United States such as smallpox, diphtheria, and polio (Newman 2). Other diseases associated with high morbidity and mortality rates such as measles, mumps, and pertussis also strongly declined with the use of mandatory vaccinations in children (Yoo 2). Herd immunity is built in a community based on the vaccine coverage rate. However, due to vaccine hesitancy, herd immunity is declining stably. The Centers for Disease Control reported recently 1,282 cases of measles which is a record high for almost three decades. Meanwhile, 2015 and 2019 outbreaks at California Disneyland theme parks which then spread throughout the California region had been linked to non-vaccinated children of vaccine hesitant families and tourists that came to the state (“Vaccines”). As a result, California implemented stricter mandatory vaccination policies and sought to restrict religious exemptions that had been fraudulently manipulated by anti-vaxxers to legally avoid immunization. Nevertheless, these incidents and statistics demonstrate the working efficacy of vaccines and what can occur to communities and population disease spread when herd immunity declines due to vaccine hesitancy.
Common Counterarguments
One of the most prevalent concerns cited by opponents of mandatory vaccination is safety and effectiveness. These safety concerns range from acute complications such as anaphylactic shock and clotting to long-term effects. There are a number of vaccine safety concerns such as risk of autism in children, negative impact on the immune system from increased number of immunizations, and life-long neurological development impairment. Newman suggests that the U.S. Supreme Court states that no government should administer treatment or medication that is “arbitrary or unreasonable” or “cruel or inhuman” or “one that can seriously impair health or possibly cause death” (Newman 3). It is the legal defense that has been used by those that are vaccine-hesitant, indicating that there is a risk of complications, even acknowledged by the CDC.
These safety concerns have been supported by studies conducted over the years. The connection to autism was established by a 1998 study on MMR vaccines, which at the time and currently is compulsory for all children. The study suggested that the preservative containing ethyl mercury in the vaccine produce was responsible for causing autism. Another case, the Health Protection Agency in the UK identified that the swine flu vaccine could cause a life-threatening neurological disease Guillain-Barre. A vaccine expert, Dr. Sherri argues, “vaccines’ efficacy leaves much to be desired, yet they expose recipients to a wide array of risks” (Newman 3). Indeed, evidence has shown that some vaccines are at high-risk for complications while providing limited protection (either in time or in actual defense against the illness). As stated, “the presence of antibodies does not guarantee that you will not get sick” (Newman 3). These factors of proven vaccine ineffectiveness and risks are driving forces behind concerns of safety for those opposing mandatory vaccinations, indicating that it should be a matter of personal or family choice on whether to take on these risks.
Another aspect proposed to counter mandatory vaccinations is to present it as a violation of ethical and human individual rights. Legal and social scholars have challenged any such mandates in regarding to health as the infringement of individual liberties. The argument suggests since adults have the right to reject health treatment, including immunization, there should be no mandate forcing either adults or children to participate in immunization if they are able to make an autonomous decision. Patient autonomy is a key medical ethic, so even if there is a government mandate, medically, there should be an option to decline vaccine. Most states have policies which require immunization for entry to schools, but such mandates may cause ethical dilemmas such as the HPV vaccine which many rejected on religious grounds as they believed it promoted a sense of false safety in sexual relations among adolescents.
Nevertheless, the ethics debate goes beyond assumed personal interests and values. Mandatory vaccinations in itself are coercive rather than persuasive, and from an ethical perspective there is no good reason to use any form of coercion for risks they are not willing to take. Furthermore, bringing in the concept of distributive justice, it can be argued that it is unfair to force individuals to assume certain risks so that others benefit. Regardless of the situation at hand, the person getting immunized will carry the full risk to their health (both if there are complications from the vaccine or if they choose not to vaccinate, the risk of procuring the disease), so as long as there is even the slightest possibility of risk – it is unethical to force someone to input a substance into their body, even under the guise of the ‘greater good.’
Addressing the Counterarguments
The fact that vaccine efficacy and safety are being debated 20 years into the 21st century is astonishing, considering the long history of vaccine use and research which has proven to be the opposite. Unfortunately, due to the availability of technology and the Internet, the role of misinformation on such sensitive and controversial topics as vaccines have increased and is becoming extremely difficult to counteract. The 1998 study published which linked MMR vaccines to autism has been retracted and the lead author has lost their medical license due to proven fraud as it became evident that the study’s results were falsified heavily. All national health agencies have stated that there is no associated risk between vaccines and any long-term disorders of any kind (Lemons 173). The concern of the immune system overload was addressed by a multi-agency case control study in the United States, identifying no immunological differences between vaccinated and non-vaccinated children (Yoo 3), while a ten-year study of over 800,000 children showed no immunological deterioration (Newman 3). Meanwhile, all ingredients located in the vaccines are safe, and the ethyl mercury present in MMR vaccines is a completely different substance from the toxic methylmercury. Ethyl mercury is quickly removed from the body as waste, does not accumulate, nor does it cause harm (“Vaccines” 2).
Overall, all vaccines are carefully developed and undergo a rigorous testing process on animals and eventually human volunteer studies which in most cases takes years (for the mandatory vaccines). The vaccine is then examined independently by other researchers as well as health agencies. In the United States, all vaccines must receive approval from the Food and Drug Administration (FDA). Most vaccines (other than in cases of public health emergency) undergo a licensure process where they are also closely studied and all their effects both positive and negative are noted. Only after a tedious process are the vaccines approved for medical use, with the FDA licensure process viewed as the gold standard in the world (Lemons 174).
All medical processes and procedures carry a risk of side effects, as it is impossible to full predict how a human body will react. Each human organism is extremely complex and inherently different, each with their own past medical history and complications. While trials attempt to consider most possibilities, just like with taking medication, there are risks of side effects or adverse reactions (Lemons 191). Just as antiretroviral drugs are used despite several potential effects, their benefits outweigh the risks in the large majority of humans. All involved stakeholders including the pharmaceutical company, the CDC, and the healthcare providers administering the vaccines are always transparent and clear regarding potential risks, and constantly update guidelines if new data emerges regarding which groups, when, and how to administer the vaccine. The safety precautions are overwhelming and warrant the potential risk, as the adverse effects from a vaccine are most likely going to be inconsequential, but the protection is significant and safer than naturally encountering the disease.
While the ethical issues are justifiable more than potentially other reasons for non-mandatory vaccinations, the reasoning can be disproved. In the context of health immunity, vaccination is used for the common greater good. The well-being of the majority of individuals is linked to the stability and health of their community (Yoo 3). This was clearly seen in the context of the Covid-19 pandemic when safety measures and lockdowns had to be implemented due to the virality of the disease, and as more people were infected, services such as basic healthcare provision was overwhelmed. From an ethics perspective, philosophers Hobbes and Locke proposed the well-known social contract theory which indicates that if one is to live in a society, certain agreements and rules have to be established for social benefits, one of which is to sacrifice individual freedoms for state protection. Therefore, each person has a social responsibility to act accordingly as to safeguard the well-being of the community. When vaccines have been proven safe and effective for centuries and there are multiple safeguards in place to ensure that everything is being done to avoid potential risks to the population from the immunizations – it is both logical and ethically correct to ensure vaccination for the substantial protection it can offer.
Public Opinion (Survey)
A 2017 widespread survey by the Pew Research Center found that there is overwhelming support for mandatory vaccinations, particularly for childhood immunization requirements. Approximately 82% of respondents suggest that healthy children should be required to vaccinate, while 88% suggest that benefits outweigh potential risks. While the overwhelming majority does support the mandatory vaccination, certain groups have greater vaccine hesitancy than others. For examples, among conservatives and White evangelical Christians there is one of the highest rates suggesting that decision should be up to families and individuals hovering around 22-25% (Funk et al.). As well known, political and religious beliefs are some of the primary influences driving perceptions and attitudes toward vaccinations, particularly in regard to public institutions and governments mandating it. Conventional and alternative practices also align with perceptions of risks and benefits of vaccination, with those which use alternative medicine more likely to oppose vaccination.
As noted by the survey, the large majority of Americans see the long-term preventive health benefits from mandatory vaccines, but there are a few subgroups demonstrating concern about vaccine-associated risks. Most noted concerns on the issue are vaccine safety/adverse events, both in short- and long-term, as well as the concept of personal freedom that parents and individuals should have the right to choose. Another important aspect is the public trust in medical scientists and research on vaccines. Here, there are significant differences, with only 55% of U.S. adults suggesting that practically the whole scientific community supports vaccines and understands its risks, while 28% suggest more than half of the scientific community. Meanwhile, 15% argue that less than 50% of the scientific community supports vaccinations (Funk et al.). While there are evident divisions among Americans regarding mandatory vaccinations, the large majority generally supports policy for them when it comes to the well-established childhood immunizations required to attend educational institutions.
Discussion
In the context of mandatory vaccines, for those that oppose them, the issue typically boils down to safety. Whether it is the risk of side effects, the potential connection to autism, the presence of harmful materials inside the vaccines, or the simple presence of too many shots – the reasoning offered by those demonstrating vaccine hesitancy seems rational but is in fact based on fear. One can argue that it is a normal occurrence, but each one of those reasons has been debunked as discussed previously. Immunizations are some of the strongly tested, planned, and effective medications, reviewed by everyone ranging from the pharmaceutical companies to independent researchers to medical professionals, and finally, government agencies. Each vaccine has a purpose as to how it is developed and implemented, including the recommended schedule and dosages (Lemons 174).
Notably, the case for mandatory vaccines is one of the few instances where government authority takes a hard stance (supported by the medical community as well as the Supreme court) in Western Democracy. The issue of balancing individual rights with the public good is inherently complex in public health. However, the government’s right to require immunization has been supported time and time again because in the context of the existence of vaccines, not immunizing is dangerous. The issue involved goes beyond individual choice and personal health but affects the overall social good (Lemons 174). As presented in the article by Lemons, immunization is comparable to child car-seats and seatbelts. These are mandatory and required to be used for children’s protection. However, no one complains about the use of seatbelts because they are proven to be safe. While yes, mandatory vaccines are communitarian and potentially restrictive oppressive, but they are done so for the clearly (both anecdotally and mathematically) defined “social good” (Lemons 174).
Those that oppose mandatory vaccinations, even if they agree with the science, attempt to make the argument about individual rights and the ability of parents to make informed medical decisions for themselves and their children. Many conservatives argue that the oppressive policies, such as in California that ignores religious and philosophical examinations, turn the concept into a civil rights issue. They argue the oppression will generate resistance since people believe that their health is on the line (Lemons 175). In defense of this, libertarians cite the utilitarian philosopher John Stuart Mill, “The only
purpose for which power can rightfully be exercised over any member of a civilized community, against his will, is to prevent harm to others. His own good, either physical or moral, is not sufficient warrant” (El Amin et al. 3) Furthermore, most national governments implement the so-called ‘precautionary principle’ which was partially the foundation of the 1905 Supreme Court decision, which suggests that in public health the government has the role to protect populations against reasonably foreseeable threats even under conditions of uncertainty. If the costs of inaction are considered, the failure to implement preventive measures must be justified (El Amin et al. 4).
While these are potentially purely ethical discussions, they are the foundation of the legal policy for governments when the vaccine mandates are implemented. Governments and public health officials do not and ultimately should not think about the individual, but about the population as a whole. When examining data and evidence over the course of decades on public health, vaccination uptakes, and other relevant elements – it oftentimes becomes clear that mandatory vaccinations lead to higher immunization rates, and in turn, lower infection rates of these preventable communicable diseases.
In the modern world, choice is understandably an essential value, particularly when there is inherently more choice than ever before in virtually all areas of life, including healthcare. Any mandate is seen as a violation of that key freedom. The debate and evidence sides with the pro-vaccination supporters, but to achieve optimal outcomes it may be necessary to listen to the opposition as well. Social and political experts agree that regulation is useful but absolute mandates may have a detrimental effect. Instead, the focus should be aimed at public health media campaigns, combating disinformation, education, and transparency. Arguably, some vaccines for deadly diseases should remain mandatory such as measles and polio but for vaccines such as the COVID-19 immunization, there are no mandates yet due to its newness and unique circumstances of rapid development. Yet, with the government actively campaigning for it and offering education, there is significant voluntary update. This goes to show that other tools exist to encourage vaccine uptake and mandatory policies should be put in place only as a last resort.
Conclusion
Vaccines are a critical public health tool in preventing disease transmission, reducing morbidity and mortality, and building herd immunity. They are a relatively safe, highly effective, easily utilized, and accessible, as well as ah ethical medical procedure which has been implemented for more than two centuries. This paper offers extensive evidence on the benefits and reasons for mandatory vaccination and disproves the several counter arguments offered by the vaccine hesitant community based on fear and misinformation. Overall, mandatory vaccinations are legal, ethical, and increase vaccine uptake, but in the modern world of individual rights and choice, it should be used carefully and in combination with other tools which can potentially increase the trust of the population in this method of protection for public health.
Works Cited
El Amin, Alvin N., et al. “Ethical Issues Concerning Vaccination Requirements.” Public Health Reviews, vol. 34, no. 1, 2012, pp. 1-20. Web.
Funk, Cary, et al. “Vast Majority of Americans Say Benefits of Childhood Vaccines Outweigh Risks.” Pew Research Center, Web.
Lemons, Jane F. “Vaccine Controversies.” CQ Researcher, vol. 26, no. 8, 2016, pp. 169-192.
Newman, Alex. There Is Evidence That Vaccines Promote, Rather than Eradicate Disease. Edited by Noël Merino, Gale, 2012.
“Vaccines.” Gale, 2020. Gale in Context: Opposing Viewpoints, Web.
Yoo, Jung Kim. The Anti-Vaccine Movement Disregards the Great Success of Vaccines. Edited by Roman Espejo, Gale, 2014.