Do the societal, health, and economic benefits of mandating vaccines justify violating one’s autonomy?

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Should vaccines be mandated in developing countries?

Vaccines are a miraculous invention that have the capacity to prevent over 1.5 million deaths every year. Unfortunately, many children in developing nations are under vaccinated in part due to lack of access, but also due to misinformation. This project will take a deep dive into the benefits of mandating vaccines specifically in Gavi eligible countries versus the violation of one’s autonomy. This project will also demonstrate how vaccines are beneficial beyond health. In order for vaccines to be mandated, access needs to be available, so this project will also show where this money to pay for the vaccines can come from. 

Every 2 minutes a woman dies from cervical cancer—a disease largely preventable by the HPV vaccine.

Economic Benefits

  • According to the Bill and Melinda Gates Foundation, “Experts estimate that eradicating polio would generate US$14 billion in cumulative cost savings by 2050 when compared with the cost to countries controlling the virus indefinitely.”
  • When kids are not sick, the parents are able to go to work and contribute to household income and the overall economy.

Every $1 of money that goes to immunization saves $16 in healthcare and lost productivity.

Societal Benefits

  • Not only is the individual protected by being vaccinated, everyone around them is protected.
  • Since more people are healthier, more people are able to work and help out other people.
  • When kids are not sick, they are able to go to school and become educated leading to a more educated population.

Health Benefits

  • Less sick people, less preventable deaths
  • In just over 20 years, the number of polio cases worldwide decreased from 350,000 to under 200, thanks to a worldwide effort to vaccinate.
  • Decreasing polio cases leads to less deaths and less people being sick (short and long term). Polio can lead to permanent paralysis which would affect a child’s health for the rest of their life.

The measles vaccine will save over 13 million lives in the next decade.

The cycle above shows an example of how disease influences the cycle of poverty as well as how vaccines can help break the cycle of poverty.
Credit: Template by Slidesgo and Freepik
This chart shows the sharp drop in polio cases that have occurred in the past few decades as a result of a worldwide vaccination effort.
Through a heartbreaking story, this video demonstrates the power of vaccination.

Why don’t people want to vaccinate? Why is their autonomy being violated?

Some people are tentative to vaccinate due to the possibility of adverse effects. WHO says, “The fact is that a child is far more likely to be seriously injured by one of these diseases by any vaccine.” Although there have been serious side effects reported, the CDC warns they may only be correlations not causations. 

The argument that vaccines cause autism has be disproven by several studies on countless occasions. Epidemiological studies in Denmark showed that the percentage of vaccinated kids with autism is equal to the percentage of unvaccinated kids with autism. 

The graph above shows the rapid decline of polio in the last few decades. Some people may attribute this to better sanitation. WHO refutes this point by arguing that sanitation has not changed in the past three decades, yet cases have steadily declined. 

Some people may not want to vaccinate due to their religious and spiritual beliefs that are in opposition to Western medicine. People have the freedom of religion and beliefs. By mandating vaccines, people’s rights are restricted. An example of a religious belief possibly preventing someone from getting vaccinated is people not wanting to take the vaccines that contain gelatin (made from pork) because their religion refrains from the consumption of pork. 

How should this be implemented?

This is a big question with no correct answer as resources continue to be limited. I would like to propose that there would be widespread vaccination efforts by organizations like WHO and Gavi that aim to communicate to people the value of being vaccinated. Once people understand that vaccines are important, they can be mandated (people are more likely to respond well to a mandate if they understand the reason). Then comes the question of how we will make sure everyone gets vaccinated. Luckily, there are many organizations like Gavi, The Bill and Melinda Gates Foundation, WHO, and UNICEF that are working towards ensuring every child is vaccinated. Also, if governments understand how much money can be saved through immunization, they may be more willing to start paying for the vaccines as they understand there is a bigger and better return. Vaccines are not as expensive as one might expect especially compared to the healthcare cost of someone with the disease. The measles, mumps, and rubella vaccine costs approximately 22 USD; on the other hand, the cost of measles case is on average 680 USD. In 2002-2003, the national health service of Italy paid over 23 million USD for measles related cases. 

Bioethical Analysis

Bioethical Principle
BeneficenceThe vaccinated individual is prevented from a variety of fatal and or life altering diseases and is therefore given the potential for a longer and better quality of life. Also, in developing countries, diseases are spread more rapidly due to increased prevalence and overcrowding, so chances of contracting a fatal disease can get quite high in some areas. People are also benefited by the fact that they will be able to go to work resulting in money for food and shelter to help keep them healthier in the future and prevent things such as malnutrition from occurring.
NonmaleficenceThe chance of serious adverse effects from vaccines is always a possibility, but the chance is minimal.
JusticeMandating vaccines would result in equal access to vaccines.
AutonomyThe individual’s autonomy is taken away since they are not given the choice about what is put in their/child’s body. Therefore, the individual’s rights and freedoms are restricted.
These bioethical principles explore the ethicality of of mandating vaccines on an individual level.
Utility:

In bioethics, utility is the action that has the most positive impact in a medical point of view. So yes, there is the very very very rare chance of an adverse effect from vaccinations, but there is a very very very strong chance that vaccines will prevent a person contracting a possibly fatal or life altering disease that permanently affects their health. In a medical sense, vaccines will allow provide the way more positive impact than negative impact so they fall under the concept of utility. 

Final Analysis:

Mandating vaccines aligns very strongly with the principles of beneficence and justice.  On the other hand, at times it may not fit into nonmaleficence in the very tiny chance that an adverse effect. However, the data in this project has demonstrated that the principle of beneficence far outweighs nonmaleficence since the chance of benefit is extremely high compared with the chance of harm. The main bioethical principle that is violated through mandating vaccines is autonomy. This project has shown that many of the reasons people choose not to vaccinate are in fact based on myths which would mean that it could be argued that when they are making the decision not to vaccinate, they are not making informed consent. Informed consent requires adequate understanding which the person may not have if their information is fake news. However, there are other personal reasons that would cause mandating vaccines to violate the principle of autonomy. From a purely bioethical lens, there are many medical benefits to the individual and those around them (not to mention the economic and societal benefits not taken into consideration in bioethics). These benefits are so big (look at the data in the project) that they outweigh the principle of autonomy meaning that from a bioethical perspective, vaccines should be mandated in developing countries. 

What can you do?

Credit: “Education” by Sean MacEntee is licensed under CC BY 2.0

EDUCATE PEOPLE!

VACCINES ARE IMPORTANT FOR THE ECONOMY, SOCIETY, AND HEALTH!

Studies have shown that children with parents who are more educated are more likely to be vaccinated. According to a report by the Swiss Tropical and Public Health Institute that focused on increasing the number of children immunized, “Knowledge of the importance of vaccination is key.” Therefore, educating people across the world about the multitude of benefits that vaccines have has the potential to decrease disease. Help educate! Debunk the myths!

Your Turn: What do you think?

https://forms.gle/cgzTnntXKbnDDUvD6

Works Cited

https://docs.google.com/document/d/1VCbbJoqe6Q20GQKgMRC5f1DCwm6bNopy-DQf98ItxEM/edit?usp=sharing

2 Comments

2 comments

  1. Keila M Santos

    This was very a very engaging and informative topic. I think this is especially important because of the Covid-19 vaccines right now and so it’s such a relevant topic. So many people are misinformed and don’t understand how vaccines work. You should try to spread this information around as much as possible!

  2. Aria

    Thank you for your great comments @Keila!

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