IMMUNIZATION ETHICS 1
EthicalIssue Concerning Immunizations
of the Issue
Immunization has been considered one of the greatest achievements inpublic health. Many common and harmful diseases have been preventedusing vaccination programs. The global coverage of immunization “hasincreased from 75% in 1990 to 83% today” (Goldberg, 2013). Severalsuccess stories can be cited in support of the effectiveness ofvaccination. For example, smallpox has been successfully eradicated.Also, the potency of congenital rubella syndrome has been severelyhampered. Fewer children have been affected by poliovirus infections.Furthermore, vaccination has reduced the incidence of varicella. Inrecent years, new vaccines have been developed to target the humanpapilloma virus in ladies below 25 years of age (El Amin, Parra,Kim-Farley, & Fielding, 2012).
However, the rates of vaccine refusal have increased in many regions.For example, the number of kindergarten children that prefer not touse vaccines has grown by 67% within the last decade. Also, 15 stateshave substandard coverage of the MMR vaccine (El Amin et al., 2012).Recent figures indicate that over 22 million children remainunvaccinated and hence at risk of preventable diseases such astetanus and measles (Goldberg, 2013). In the 1880s, the RoyalCommission in England linked the smallpox vaccine to diseases such assyphilis. A similar stand-off occurred in England in 1905. In thisregard, the mandatory smallpox vaccination law was challenged (ElAmin et al., 2012). It was alleged that the government had knowinglywithheld information about the vaccine`s side effects.
In 1998, a magazine article linked measles, mumps, and rubella (MMR)vaccine to increased incidence of autism. Although the findings werelater invalidated due to fraudulent research, the general perceptionhad already been changed. In fact, the rejection rates of the MMRvaccine increased over 15 years after the article was published.Consequently, the UK experienced new cases of mumps and endemicmeasles. Since the late 1990s, over 10 studies have categoricallydisproved any connection between autism and the MMR vaccine (El Aminet al., 2012).
EthicalDimension of the Issue
The ethical dilemma of vaccination lies in the balance betweenprotecting the public and respecting personal choice and autonomy.The government has the mandate to ensure the well-being of bothindividuals and communities. Public health programs have to bedeveloped and implemented for the sake of civilian populations (ElAmin et al., 2012). Endemics and pandemics lead to catastrophic lossof life and property. The government also incurs plenty of costs inbuilding, staffing, and equipping hospitals. Significant amounts arealso spent in providing health insurance while sustaining pensionschemes. The taxman also loses substantial revenues when a highnumber of the population succumbs to preventable diseases. Therefore,the ruling authorities are compelled to seek disease preventionrather than deal with the aftermath.
On the other hand, physicians are under pressure to acquiesce to theparent’s right to refuse immunization for their child. Over “20%of parents have concerns about the safety of childhood vaccination”(Glanz, Kraus, & Daley, 2015). Besides, 20 states have allowedexemptions to the requirements of school vaccination on the basis ofpersonal beliefs. Other parents have chosen to delay immunization fortheir children. Physicians have also had to deal with parents thatdictate the timing and spacing of their children’s vaccines (Glanz,Kraus, & Daley, 2015). Consequently, health care professionalshave to negotiate with and persuade parents to lessen theirobjections to vaccines.
Relevanceof Issue to Health Professions
Vaccinations play a significant role in stemming the incidence ofpreventable illnesses. Some diseases such as smallpox have beeneradicated owing to the effectiveness of vaccines. Therefore, healthcare practitioners are deeply concerned about the impact of parentsrestraining their children from undergoing immunizations. In fact,the recent measles epidemic in the U.S. has been blamed on thedeliberate denial of vaccination for young children (Glanz, Kraus, &Daley, 2015). Consequently, the community’s health is placed injeopardy.
Maintaining high rates of immunization helps to reduce the spread ofpreventable diseases. For example, 95% of the general population hasto be vaccinated so as to prevent the outbreak of measles (Glanz,Kraus, & Daley, 2015). Furthermore, high rates of immunizationprotect vulnerable members of the community from contractingdiseases. For example, some portions of the population are hinderedfrom receiving vaccinations due to medical reasons. Other individualsface the threat of vaccine failure due to weak immune systems. Someinfants are also considered too young to bear the impact ofimmunization (Glanz, Kraus, & Daley, 2015). The protection ofsuch culpable populations has been of primary importance to healthcare professionals.
Therefore, health professions are particularly adamant on thenecessity of immunizations. In this regard, they have supported theenactment of compulsory laws and guidelines concerning vaccination.In particular, immunization laws have been enforced in variousschools nationwide (Glanz, Kraus, & Daley, 2015). Such measuresaim to control and eradicate diseases that cause plenty of hospitaladmissions and deaths.
Pointsof Consensus & Difference Concerning Issue
The proponents and opponents of child immunization have variouspoints of difference and consensus. Both groups of individuals areprimarily concerned with the safety of their children. Supporters ofimmunization are customarily moved by a desire to protect the futurewell-being of the children. On the other hand, opposers view therisks of immunization as too substantial to overlook. Moreover, bothviewpoints value the need for transparency. Information pertaining toa particular vaccine must be disclosed before approval for use isgranted. Members of the public have the right to be informed of theside effects associated with different vaccines (El Amin et al.,2012). Honest and accurate information will enable each parent tomake a decision as to whether to allow their children to undergoimmunization.
Furthermore, both clusters favor the application of procedural anddistributive justice. In this respect, all civilians shouldexperience equal benefits from the deployment of public healthmeasures. Vaccines should be made accessible to people from variousbackgrounds. Immunization and other measures of safeguarding publichealth should be applied in both marginalized and affluent areas.Members of the public should be free to seek legal redress if avaccine resulted in unexpected side effects (El Amin et al., 2012).The personal choices and actions made with regards to refusing oraccepting immunization must be respected.
Parents and guardians have provided several reasons so as to explaintheir aversion for vaccines. Firstly, they have been concerned aboutan infant’s immunology. Some parents have doubted whether theirchild’s immune system could withstand vaccination (Fernbach, 2011).Nevertheless, supporters have highlighted the lack of researchsubstantiating such claims. The immediate immunosuppression due tovaccination does not increase the risk of infection (Fernbach, 2011).Some parents have also been discouraged by the relatively high costsassociated with immunizations. The insufficiency of public healthprograms has rendered vaccinations as unaffordable for some children(Fernbach, 2011). Additionally, many forms of private insurance donot cover the cost of immunizations.
Some parents have developed skepticism towards vaccination due to amisrepresentation of facts in the media (Fernbach, 2011). The sideeffects of vaccines have been exaggerated while the potentialbenefits have been understated. As mentioned, the MMR vaccine waserroneously linked to autism. Preventable diseases occur lessfrequently with the increase in vaccination rates. Subsequently, itis expected that the incidence of side effects will also increase.Sensational media reports are more likely to publish such informationas opposed to the benefits (Fernbach, 2011). Consequently, someparents have concluded that vaccines would harm their children whilegovernments and health care professionals have emphasized thebenefits of immunization.
Healthcare practitioners are guided by several ethical principlessuch as beneficence, nonmaleficence, and autonomy. The standard ofhealthcare practice requires physicians to make treatment decisionsin harmony with ethical principles. The parent’s viewpoints must befairly considered before proposing a way forward. Althoughvaccinations have prevented morbidity and mortality, they have alsocaused severe side effects in rare cases (Fernbach, 2011). Ethicalprinciples may be less applicable to children due to their limitedunderstanding.
The principle of autonomy upholds the personal right to choosebetween various courses of action. Infants lack the mental competencerequired to make logical decisions. Therefore, parents have the legalauthority to decide what is best and proper for their children.Parental authority also includes the mandate to make judgments onwhether to accept or refuse immunization. The principle ofbeneficence enforces the physician’s moral obligation to “benefitand help others” (Fernbach, 2011). On the other hand, the principleof nonmaleficence prioritizes the avoidance of harmful actions.
The healthcare provider has to examine the potential harm and benefitof immunizing the child vis-à-vis the effects on the community. Inthe first instance, the benefits of immunization the child mustsupersede the potential side effects. The second scenario evaluatesways in which the community will benefit at the expense of theindividual (Fernbach, 2011).
Immunization has beneficial effects on both the individual and thesociety. Failing to perform vaccinations could lead to the spread ofcontagious, deadly diseases. Each person would be at a great risk ofcontracting infections. Immunization does not alter the function,appearance, and structure of body parts. Therefore, an individualshould not be spared of vaccination. Besides, the pain experiencedduring immunization can be alleviated using painkillers and mildanesthetics (Fernbach, 2011). Therefore, a physician would be guidedby such ethical principles to make a consensual decision.
PersonalNursing Professional Response to Issue
Vaccination is an essential factor in reducing morbidity andmortality. The gaps in immunization rates can be addressed by usingsocial media to increase awareness. They can also be used to buildtrust in vaccines while allaying the fears of concerned parents.Parental refusal to immunization has been enhanced by theproliferation of misleading information over the Internet. Therefore,it is crucial to counter the false claims by making reference tofactual information.
Besides, providing detailed and truthful information concerningvaccinations may not suffice to increase immunization rates. In thisregard, it would be proper to use influential members of the societyto add a sense of cultural appeal. Vaccination campaigns mustidentify the most recognizable members of the community and use themto spread the positive message. It may also suffice to learn howsocial cues are enforced in a particular community.
The acceptance or refusal of a vaccine has been determined by thepublic’s awareness of the risk and seriousness of contractingdiseases. For example, pertussis was previously prevented using thewhole cell pertussis vaccine. However, several reports were presentedso as to inform the public of the adverse side effects such asfebrile seizures and hypotonic episodes (El Amin et al., 2012).Consequently, the refusal rates increased despite the vaccine’shigh levels of effectiveness. Therefore, the media plays a criticalrole in the perception of vaccines and public health. Physicians andother stakeholders can take advantage of social media and otherInternet platforms so as to increase the rates of immunization.
El Amin, A. N., Parra, M. T., Kim-Farley, R., & Fielding, J. E.(2012). Ethical Issues Concerning Vaccination Requirements. PublicHealth Reviews, 34(1), 1-20.
Fernbach, A. (2011). Parental rights and decision making regardingvaccinations: Ethical dilemmas for the primary care provider. Journalof the American Academy of Nurse Practitioners, 23, 336–345.doi: 10.1111/j.1745-7599.2011.00627.x
Glanz, J.M., Kraus, C.R., & Daley, M. F. (2015). AddressingParental Vaccine Concerns: Engagement, Balance, and Timing. PLoSBiol 13(8): e1002227. doi:10.1371/journal.pbio.1002227
Goldberg, A. B. (2013). Leveraging Social Networks to Immunize EveryLast Child. Journal of Health Communication, 18, 1399–1401.