Should vaccination be a choice of the people or an obligation of the community?

“In medicine the next move is always yours to make and no one else’s”

Historical background

Vaccination is something that has been around for hundreds of years, it was a regularly practiced technic performed by the Brahim cast of Hindus in the 16th century. They did this by introducing dried pus of smallpox pustules into the skin of the patient, a practice known as variolation (S. L. Plotkin & Plotkin, 2004). Vaccination as we know today was discovered with the help of Paul Erlich and his theory of immunity and also the distinction between passive and active immunity (S. L. Plotkin & Plotkin, 2004). In the early 20th century we see that vaccination became important after being proven to have great potential in helping the prevention of diseases. And in 1948 the first combination vaccine became available. The late 20th century also known as the golden age for vaccine development, the ability to grow human viruses in vitro, in a simple and non-evasive manner in single cel cultures, led to a great innovative time in vaccinology that continues unchallenged by any other means (S. L. Plotkin & Plotkin, 2004).

Interest of the individual versus the interest of the public

It is of course the choice of each individual to decide whether or not to be vaccinated. The question is where to draw the line. There are cases in which enough people are vaccinated that you create a type of immunity. In this case, herd immunity, where the majority has received the vaccine therefore being unable to become ill for the vaccinated illness and lastly not being able to transmit that illness to a non-vaccinated individual. The problem arises when several people take this stance and decide not to vaccinate. This form of logic is similar to what is described as the prisoner dilemma. You never quite know whether you will maximize your rewards by going straight for what you want or by asking for a little less, it all depends on what others do. If no one takes the vaccine, everyone gets sick. If everyone vaccinates no one gets sick. If all but one vaccinate still no one gets sick. The risk is that many people with think of the third option (Collins & Pinch, 2008).

The role of the parents and informed decision making

Here the emphasis is set on knowledge. The social background in question is whether or not you belong to a medical group or not. Parents (the majority) do not belong to the medical socialites. Informed decision making is normally talked about when a person wishes to take part in a particular research project and has to be completely informed and give their consent. It is similar in this case where the parent must give consent to let their child be vaccinated(Collins & Pinch, 2008). Unfortunately there have been cases where after receiving the MMR vaccine children started exhibiting symptoms of autism. However after further research, no significant causational relation between the MMR vaccine and autism was found (Taylor et al., 1999). Even though there may be a basis for their concern, it is almost certain that the risk to the children of exposure to a disease such as measles is much greater than the risk associated with the vaccine (Jansen et al., 2003). Other arguments for not allowing vaccinations such as the HPV vaccine have also shown religious and moral roots. It has been advocated that the vaccine is not necessary as the children will practice abstinence and therefor rendering their risk essentially to zero. And the introduction of this vaccine will promote teens to have sex (Charo, 2007). Many parents choose to take information from parenting websites which advocate against vaccination, leading to a one sided view (Collins & Pinch, 2008) 

The politics of vaccination

In 2006 the FDA (Food and Drug Administration) gave the go ahead to the first vaccine that helps against HPV (Human Papillomavirus). The CDC (Centres for Disease Control) and Prevention’s ACIP (Advisory Committee on Immunization Practices) advised that girls aged eleven and twelve receive it. Politics plays a critical role in the formation of health policy, as public preferences, interest group influence, and partisan ideology all shape the specification of policy alternatives and outcomes (Abiola, Colgrove, & Mello, 2013). For more than a century many states have laws that may mandate people to be vaccinated, both federal and state courts decisions have continued to uphold mandated vaccination for children, to the point of denying unvaccinated children from attending school. However, in practice, these mandates may have exceptions that include individual medical, religious, and philosophical objections (Charo, 2007).

The business and profit in vaccination

Vaccines started at a modest price of a few dollars during the 1980’s to a staggering $200 for a vaccine against meningitis and bloodstream infections. The market for vaccines rose gradually over the period of 1982 to 2005, from $2 billion to a bit over $8 billion. Recent developments with the HPV vaccine which delivered $750 million and projected to receive an annual $1 billion in revenue brought the vaccine business back. Many of the top companies involved in manufacturing of vaccines increased their capabilities to do so, either through acquisitions or building new facilities from scratch (Sheridan, 2005). Vaccines take much time to properly develop and with increasing time from early research to licensure increasing. The process used to take approximately 10 years, recently this has become 15 to 20 years to complete. Now also with manufacturers, regulatory bodies and public health officials making it more difficult and even impeding the production of needed vaccines. The majority of vaccine manufacturers are owned by pharmaceutical companies, this means that the production of vaccines must compete with the production of drugs, and drugs have a much bigger chance of yielding profit. Currently it is estimated that vaccines take from $300-$500 million to develop. When only a handful of vaccines delivering agreeable and sustainable profit, it is no wonder that the production of vaccines does not bring enthusiasm to pharmaceutical executives. Lastly the increasing need to have vaccines tested on humans further increasing the already high cost of vaccine development (S. A. Plotkin, 2005).

Fallibility of the vaccination program

There is no other form of fallibility which is more important or less understood than the fallibility of medical practices (Gorovitz & MacIntyre, 1975). The increasing avoidance of the Measles-Mumps-Rubella vaccination (MMR), with a coherent increase in the incidence rates of major measles outbreaks, is proof enough that the fallibility of the vaccination program is a possibility due to public misconceptions of the risks that vaccines may bring (Shim, Grefenstette, Albert, Cakouros, & Burke, 2012). 

Recent events

Recently with the COVID-19 pandemic we are bombarded with pressure from all sides to get vaccinated. To know more about vaccines specificically regarding the COVID vaccine please refer to the article “RE: het vaccin” by my colleague Joris van Buul on https://www.msvpulse.nl/het-vaccin/?fbclid=IwAR3-DphGe5Kvk5YdbeJ9SUA-Mn3PZrpIi-5Px2von5KzGRFxRSDqArEKo30

The question at hand is whether or not the current pressure placed by stakeholders is ethical. There are doubts, uncertainties and fear. The individual is constantly put into a situation which it is almost impossible to express that you do not wish to take the vaccine. The sheer peer pressure being exuded by your fellows may seem even suffocating. On t.v. it is almost impossible to miss commercials that are promoting vaccination and not truly giving any actual information on the vaccines themselves. Recently the E.U. informed that people that are not fully vaccinated have to be tested (and we know how unappealing those tests are) to be able to travel and possibly even before going to events. A slippery slope towards the ‘mandating of medical intervention’ in my opinion and it does worry me. 

Final thoughts

This paper was to illustrate the different factors that play major roles in the current vaccination program and what drives this program. These factors were public and individual interest, parental interest, political interest and monetary interest. Lastly the fallibility of the vaccination program was briefly examined. The findings are as such. The goal of the vaccination program is to prevent all preventable disease. There are and will always be those who decide not to allow vaccination for any particular reason that may be at that time of concern (Charo, 2007). The subsequent goal is to achieve a herd immunity, a community in which the majority are inoculated and immune to a particular disease and the carrying and contracting of the disease is nearly impossible for those that are and or are not inoculated (Collins & Pinch, 2008). There is definite political interest when it concerns policy making. Vaccine policy making forms no less a health issue than it is a political issue (Charo, 2007). With the majority of people of substantial influence (voters) taking different stances on vaccine policies, it is assured that there is political gain to be made for deciding on certain policies that benefit this majority when it concerns vaccination. The monetary gain has proven itself to be unsubstantial. There is no big monetary gain by big pharmaceutical companies when it comes to the development and purchase of vaccines. Companies refuse to do research and development of certain diseases for certain countries because of the fear of not being able to sell enough vaccine to recover their expenses (Kremer, 2001). This program consists of making individuals take a treatment that could be beneficial to the group. This is of course in consideration to the fact that every individual has the right to deny the treatment. The population could in 100 years suffer greatly from vaccination programs; it may not even take that long. The people that denied receiving it and their children and grandchildren will reap the benefits. Medicine can be wrong. It can be believed for centuries that a certain hypothesis is correct to only be proven wrong by a simple observation. The law of induction by Karl Popper, if only white swans are observed it will always be believed that all swans are white yet with the observation of one black swan will disprove this belief (Allen, 2001). In the case of the vaccine we have yet to find the black swan, the link that proves that vaccination is not the way to go. As a person who believes in medicine and is pro-vaccination, I hope this black swan is never found or better yet that all the swans are found and proven to be white. However, I also believe sole-heartedly in the autonomy of the individual. So, look at your own pro’s and con’s, think for yourself because the choice is yours to make.

Sahil Sabnani

Foto van pexels

References

Abiola, S. E., Colgrove, J., & Mello, M. M. (2013). The politics of HPV vaccination policy formation in the United States. Journal of health politics, policy and law, 38(4), 645-681. 

Allen, J. F. (2001). Bioinformatics and discovery: induction beckons again. BioEssays, 23(1), 104-107. 

Charo, R. A. (2007). Politics, Parents, and Prophylaxis — Mandating HPV Vaccination in the United States. New England Journal of Medicine, 356(19), 1905-1908. doi: doi:10.1056/NEJMp078054

Collins, H., & Pinch, T. (2008). Dr. Golem: how to think about medicine: University of Chicago Press.

Gorovitz, S., & MacIntyre, A. (1975). Toward a theory of medical fallibility. Hastings Center Report, 5(6), 13-23. 

Jansen, V. A., Stollenwerk, N., Jensen, H. J., Ramsay, M., Edmunds, W., & Rhodes, C. (2003). Measles outbreaks in a population with declining vaccine uptake. Science, 301(5634), 804-804. 

Kremer, M. (2001). Creating markets for new vaccines-part I: rationale Innovation Policy and the Economy, Volume 1 (pp. 35-72): MIT Press.

Plotkin, S. A. (2005). Why certain vaccines have been delayed or not developed at all. Health Affairs, 24(3), 631-634. 

Plotkin, S. L., & Plotkin, S. A. (2004). A short history of vaccination. Vaccines, 5, 1-16. 

Sheridan, C. (2005). The business of making vaccines. Nat Biotech, 23(11), 1359-1366. 

Shim, E., Grefenstette, J. J., Albert, S. M., Cakouros, B. E., & Burke, D. S. (2012). A game dynamic model for vaccine skeptics and vaccine believers: Measles as an example. Journal of Theoretical Biology, 295, 194-203. doi: http://dx.doi.org/10.1016/j.jtbi.2011.11.005

Taylor, B., Miller, E., Farrington, C., Petropoulos, M.-C., Favot-Mayaud, I., Li, J., & Waight, P. A. (1999). Autism and measles, mumps, and rubella vaccine: no epidemiological evidence for a causal association. The Lancet, 353(9169), 2026-2029. 

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