Is it ethical to refuse to have one’s child vaccinated for measles?

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About John Hooker

T. Jerome Holleran Professor of Business Ethics and Social Responsibility Tepper School of Business Carnegie Mellon University

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  1. John Hooker says:

    By the year 2000, measles had been eliminated in the U.S., due to almost universal vaccination of children. However, the disease resurfaced in late 2014 with an outbreak involving unvaccinated persons at Disneyland in California.

    There has been a growing movement among some parents to refuse vaccination for their children, due in part to concern over the safety of vaccines. In the case of measles, a 1998 article in The Lancet sparked fears in the U.K. that measles/mumps/rubella vaccine is linked to autism and colitis. The article was retracted, and subsequent larger studies found no connection between MMR and autism. The lead author of the study was discredited for fraudulent research and conflict of interest, leading to the loss of his license to practice medicine. Doubts about MMR vaccine nonetheless spread to the U.S. and persist.

    Some libertarians, such as Rand Paul, argue that vaccination should not be mandatory. However, this is not the issue raised here. The issue is the more immediate question of whether parents should have their children vaccinated.

    Vaccines pose a classic free rider situation. If others are vaccinating their kids, then my own kids will be largely protected without vaccination, because the disease won’t spread. I am free riding on the prudence of others.

    This kind of free riding is unethical because it is not generalizable. The precise argument goes like this. My reason for refusing vaccination is to avoid its inconvenience and perceived risk while still benefiting from the protection of widespread vaccination. If everyone else acted on this reason, I would no longer be protected. So my reason is not generalizable.

    Vaccine opponents may insist that they have a different rationale. They want to protect their kids from the risk of MMR vaccination, even if this means the kids will get measles. Some view measles and other childhood diseases as a natural part of growing up. Such a rationale is certainly generalizable, but it runs afoul of the utilitarian principle. Failure to vaccinate exposes children to the possibility of getting measles. About 8% of American kids are not vaccinated, and the disease is carried by persons from abroad (this is apparently how the Disneyland outbreak started). One exposure to airborne particles in a plane or airport is enough, because measles is even more contagious than the flu. Now that we have an anti-vaccine movement, the probability of exposure could become even greater. If the kids contract measles, they expose still others to the disease, some of whom may not be vaccinated or may have depressed immune systems, as when taking cancer drugs.

    Furthermore, the risks associated with measles are greater than those of vaccination. Of kids under 5 who get measles, 14% also get an ear infection, 12% get diarrhea, 9% pneumonia, 5% croup, 1% convulsions, 0.3% bleeding disorders, 0.2% encephalitis, and 0.001% fatal brain damage. Of kids who are vaccinated, 5% get a faint rash, 4% a fever, 1% swelling of salivary glands, and 0.0026% bleeding disorders. Given these odds, I will go for the vaccine any day. As for the link between MMR vaccine and autism, there is no evidence for it. The original Lancet study that “found” a link involved 12 children and manipulated the data. Several more recent studies, including one that involved half a million children, found no link.

    Some parents may distrust the medical establishment and give no credence to published studies, even those in top journals. There are too many reports of medical researchers who have conflicts of interest resulting in fraudulent studies. However, the anti-vaxxers choose to believe the Lancet study, which likewise was produced by the medical establishment and appeared in a top journal. The contradictory studies demonstrate that the medical establishment is fallible, but we knew this already. It recommended bloodletting for centuries. The relevant question is whether, given the evidence at hand, it is rational to believe one retracted study or several larger studies. The answer seems clear.

    Skeptics also point to stories they have heard of kids who became autistic after vaccination, and perhaps even personal experience. Many of these stories can be found on the Web, and some in dramatic Youtube videos. However, 92% of kids in the U.S. receive MMR vaccine. Due to this and the age at which autism usually appears, any child who develops autism will probably have recently had the MMR vaccination. This doesn’t prove a causal link. In addition, anyone who seeks medical advice on the Web knows that people propound all kinds of strange theories that seem confirmed anecdotally. The stress and fear of disease can cause people to jump to conclusions, in search of some kind of assurance or certainty. It is irrational to trust these stories rather than a fallible but self-correcting medical establishment.

    I conclude that the utilitarian principle favors vaccination, except in cases where a child’s particular health condition could indicate a higher risk. Because vaccination is clearly generalizable, it is ethically obligatory in most cases. Furthermore, if I refuse vaccination partly because widespread vaccination of others will largely protect my kids from measles, then my refusal is unethical even if it is consistent with the utilitarian principle.

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