Table of Contents
Contributors to the Increasing parental hesitancy To Vaccination. 13
Do Parents have a Moral Obligation to vaccinate their children?
Introduction
A vaccine is a biological substance designed to protect human beings from infections caused by viruses and bacteria. Vaccines stimulate an individual’s immune system to produce immunity to a particular disease, helping protect the individual from potential illness (Hadjipanayis et al., 2020). The administration of vaccines is typically through injections, but also through nasal sprays or oral administration. The vaccines are made by weakening the bacteria or the viruses so that they are not able to reproduce themselves (Gostin, Ratzan and Bloom, 2019). Therefore, the children given the vaccines have enough exposure to the bacteria or virus to develop immunity/a strong immune response, whilst (typically) not making them seriously ill. Thus, most dangerous and infectious diseases are prevented through vaccination. Human beings are constantly exposed to several bacteria, microbes, and viruses from birth hence the need for vaccination.
Fig. 1 –Flu Vaccine effectiveness. Source: http://vk.ovg.ox.ac.uk/vk/nasal-flu-vaccine
Vaccination protects children from dangerous childhood diseases, including; Mumps, Varicella, Rubella and so on. These diseases can cause hospitalization, ongoing severe conditions like cancer, deafness, brain damage, and these can also sometimes lead to fatal consequences (O’Connor, 2018). Community immunization against these diseases can lead to significant reduction of disease spreading and some diseases can be irradicated. Nevertheless, some conditions still exist, and the complications from these diseases are destructive compared to the negligible side effects caused by vaccination. Vaccines not only protect an individual, but they also protect the entire community by reducing the transmission of the diseases, which is referred to as herd immunity. Herd immunity occurs when the majority of the population are vaccinated against a particular disease resulting in only a few people left that can be affected by a certain infection. This eventually protects people who are not vaccinated. Therefore, vaccinating the members of a particular population prevents the chances of infectious diseases from taking root and become endemic (Zimmermann and Curtis, 2019). In the UK, vaccines are responsible for eradicating various diseases that were endemic to the region, including diphtheria and smallpox. The consistent immunization of large sections of the population in the UK with diphtheria and smallpox vaccines, therefore, leading to the eventual development of herd immunity and the protection of entire populations from outbreaks related to these diseases (Doherty et al., 2016). According to Desai and Majumder (2020), to achieve herd unity, large proportions of a population have to be fully vaccinated from a given disease. In the modern era there have been growing levels of parental vaccine hesitancy among populations. Some parents have raised concerns that their children are given too many vaccinations that are unnecessary ((Desai and Majumder, 2020). The growing level of vaccine apathy among parents in the UK has therefore resulted in the onset of some diseases that were considered effectively controlled, such as pertussis and measles (Desai and Majumder, 2020). According to Doherty et al. (2016), the resurgence of outbreaks of vaccine-preventable diseases in developed countries such as the UK can, therefore, be attributed to rising parental vaccine hesitancy along with general vaccine hesitancy and apathy[DLS1] . This has resulted in significant proportions of populations refusing to allow the administration of vaccines to their children (Doherty et al., 2016). This has lead to a discussion that has emerged on whether parents have a moral obligation to vaccinate their children. This paper will review whether parents have a moral obligation to vaccinate their children through the four main bioethical principles of autonomy, non-maleficence, beneficence, and justice.
Fig. 2 – How Vaccines Work in the Body. Source: www.immunology.org
Autonomy
According to Garcia (2020), autonomy relates to the concept of independence. Through the principle of autonomy, every person has freedom of action and choice. [DLS2] In healthcare settings, including during the administration of vaccines, health caregivers should therefore encourage and educate patients where necessary so that they can be able to make their own decision and eventually act on their own values (Garcia, 2020). There are two important considerations related to autonomy which include helping an individual to understand their values and how their decisions might or might not be welcomed in the societies they live in as they may infringe on the rights of others (Page, 2016). For instance, related to vaccinating children, health caregiversmight be involved in evaluating the beliefs of parents related to vaccines. Health caregivers can then educate patients extensively related to the benefits of vaccinating their children. In the process of patient education, health caregivers can highlight the various health risks associated with not vaccinating children and the impact of refusing to vaccinate children on the general health of the community. When a significant proportion of the population is not vaccinated from a given infection, the benefits of herd immunity can therefore not occur. Parents who refuse to vaccinate their children are therefore exposing society in general to an increased risk of vaccine-preventable diseases (Doherty et al., 2016). The second issue related to autonomy relates to the ability of an individual to make rational and sound decisions. Individuals who cannot make sound and rational decisions, such as children and mentally handicapped people, should therefore not be allowed to make autonomous decisions as they could harm others and themselves (Garcia, 2020). However, in the vaccination debate, the autonomy of parents who have the ability to make rational decisions is often interfered with by misinformation/conspiracy theories. In developed countries such as the UK, the past two decades have seen a significant increase in groups of people who campaign against vaccination through misinformation and conspiracy theories known as anti-vaxxers (Desai and Majumder, 2020). Conspiracy theories and misinformation related to vaccination can therefore interfere with parents’ ability to make an informed decision on whether to vaccinate their children or not. For instance, parents might be misinformed that vaccines are a health risk to their children despite scientific evidence highlighting that vaccines are made of antigens that only stimulate the immune system but do not lead to infections in the receiver.
Considering patient autonomy, it is therefore evident parents have a moral obligation to vaccinate their children. This is because by choosing not to vaccinate their children, parents will expose whole communities and societies to vaccine-preventable diseases and therefore infringe on the right of other community members to health(Page, 2016). On the other hand, an individual can only be considered to be truly autonomous through sound and rational thinking. Influence from external sources such as misinformation and conspiracy theories which is prevalent when it comes to vaccinations, can therefore greatly undermine the principle of autonomy. Parents who decide not to vaccinate their children as a result of conspiracy theories and misinformation can, therefore, not be treated as being truly autonomous [DLS3] (Desai and Majumder, 2020).
Nonmaleficence
The principle of non-maleficence relates to the concept of causing no harm to others. The principle of non-maleficence is therefore represented by the statement ‘above all do no harm’ (Heston and Pahang, 2019). In healthcare settings, health caregivers should never be involved in any activity that causes undue harm to their patients. The principle of non-maleficence also applies to stakeholders in healthcare, including parents and children and elderly people and those who make decisions for them (Garcia, 2020). Just as health caregivers avoid making decisions that might bring direct harm to their patients, it is the duty of parents to avoid making decisions that may bring direct harm to their children, especially with healthcare issues (Garcia, 2020). For instance, through the principle of non-maleficence, parents are not allowed to opt out of treatment when their children are in danger of severe adverse outcomes/death. In such cases, health care providers are allowed to provide interventions that can help save lives or even prevent negative outcomes on minors (Heston and Pahang, 2019). The principle of non-maleficence can therefore be applied in the issue of vaccination. By deciding not to vaccinate their children, parents, therefore, expose their children to harm by vaccine preventable diseases, including measles, diphtheria, and other conditions such as polio that may bring permanent impairment to the children (Doherty et al., 2016). Parents who decide not to vaccinate their children are therefore going against the principle of non-maleficence that requires them to do no harm, especially to minors who do not have the ability to make their own informed decisions (Garcia, 2020). Utilizing the principle of non-maleficence and considering the grave health risks that deciding not to vaccinate children exposes them to, it is therefore evident that parents have an ethical obligation to vaccinate their children, at least under this tenant of doing little/no harm. Parents who decide against vaccinating their children are potentially exposing their children to the risk of vaccine-preventable diseases, and can therefore be viewed as outrightly unethical and potentially immoral,- in that they go against the best interests of their own children (Heston and Pahang, 2019). Parents who have legitimate concerns related to the safety and efficacy of vaccines can therefore rely on scientific data to determine that the benefits of vaccines far outweigh the risks of vaccination. By relying on scientific evidence, parents can follow the principle of non-maleficence and avoid doing any harm to their children by allowing vaccinations. According to Desai and Majumder (2020), opting out of vaccines that are backed by scientific evidence is essentially immoral and potentially malicious, especially in cases where parents are making decisions that might have a significant impact on the future of their children.[DLS4]
Fig. 3 – Four bioethical principles. Source: https://clipboardhealth.com/how-the-4-principles-of-health-care-ethics-improve-patient-care
Beneficence
Beneficence represents healthcare providers’ responsibility to contribute to the positive welfare of patients. Beneficence simply means to do well and to remain proactive in the prevention of harm where possible (Beauchamp and Childress, 2019). The principle of beneficence, therefore, extends to all stakeholders included in healthcare, such as parents. The principle of beneficence is used in the development of different health interventions such as treatment plans, diagnostic pathways and the formulation of public health policies (Beauchamp and Childress, 2019). All interventions in health care, including the administration of vaccinations, aim to accomplish the goal of benefiting the recipients as opposed to harming them, and benefitting others[DLS5] . In consideration of various treatment interventions, the benefits of the interventions are therefore explored against the harms that such interventions might have (Beauchamp and Childress, 2019). For instance, in the issue of vaccination, nearly all vaccines that are administered to children take many years to develop, with thorough procedural development and trials being conducted before approval. Vaccines are further evaluated for any side effects or unintended risks they might have on patients before being approved by authorities such as the NHS (Desai and Majumder, 2020). All vaccines are therefore provided for the benefit of preventing the onset of severe diseases by boosting the immunity of the recipients through controlled exposure to given viruses (Desai and Majumder, 2020). Relating to the principle of beneficence, parents have a responsibility to prevent any harm to their children and to ensure that all the decisions they make related to their children’s health and welfare are for the benefit of such dependents. Following the principle of beneficence, parents, therefore, have a duty to ensure that their children receive medical interventions that benefit them and prevent them from harm in the future where possible (Beauchamp and Childress, 2019). Vaccines protect children from severe diseases in the future and therefore follow the principle of beneficence. By deciding not to vaccinate their children, parents are therefore going against the principle of beneficence and choosing to actively expose their children to harm in the form of severe illnesses in the future. Following the principle of beneficence, it is therefore evident that parents have a moral obligation to vaccinate their children deciding not to vaccinate may cause direct harm to such children. As a medical intervention, vaccines also follow the principle of beneficence in that their benefits related to disease prevention far outweigh the risks of side effects (Beauchamp and Childress, 2019).
Justice
According to Heston and Pahang (2019), justice demands that resources are fairly distributed to all people in a community and that no member of a community is discriminated against by virtue of their gender, race, religion, age, sexual orientation or cultural background. Instances of moral injury will therefore occur when different ideas related to justice come into conflict with different realities of medical care (Heston and Pahang, 2019). In this case, according to Heston and Pahang (2019), the principle of justice emerges when it comes to vaccine development and distribution across communities. The development, testing, approval, and distribution of vaccines in communities will consume a lot of resources. Such resources include time, human resources, and money that could have been utilized in different medical interventions (Doherty et al., 2016). As resources are normally scarce, government and healthcare agencies such as the NHS logically have to sacrifice some elements of health care to priorities the development and distribution of vaccines. The significant resources utilized in the development and distribution of vaccines, therefore, raise issues related to justice when some members of a population decide against taking such vaccinations (Doherty et al., 2016). People who decide not to take vaccines expose a larger population and those that cannot vaccinate themselves, to vaccine preventable diseases that governments and other agencies have already spent a lot of resources to prevent (Doherty et al., 2016). Moral injury related to justice, therefore, occurs as a result of the onset of vaccine-preventable diseases despite the utilization or significant proportions of resources to prevent such outbreaks. Parents who refuse to vaccinate their children go against the principle of justice because they contribute to the wastage of medical resources (Heston and Pahang, 2019). Vaccinations that are already developed and are not utilized will eventually expire, leading to the wastage of resources. Considering the principle of justice, it is a moral obligation of parents to vaccinate their children so as to ensure that all members in society are protected from vaccine-preventable diseases, including vulnerable and marginalized groups.
Contributors to the Increasing parental hesitancy To Vaccination
The continued parental hesitancy to vaccinate has mainly been due to historical issues related to vaccines, such as tainted batches and unknown side effects as a result of Vaccination. Some experts have also revealed that during the development of some vaccines, members of marginalized groups such as black people were experimentally vaccinated. Such negative connotations have therefore increased vaccine reluctance in the UK population. However, such issues cannot be used to defend the decisions of parents not to vaccinate their children as scientific evidence has clearly shown that the benefits of vaccines far outweigh the risks
Conclusion
In summary, vaccines are important to prevent societies from vaccine preventable diseases. Vaccines lead to the eventual development of herd immunity and the protection of entire populations from outbreaks related to preventable diseases. To achieve herd immunity, large proportions of a population have to be fully vaccinated from a given disease. Parents who refuse to vaccinate their children are therefore placing entire populations at risk as they may interfere with the eventual development of herd immunity. Parents who refuse to vaccinate their children can therefore be viewed as going against the ethical principle of autonomy in that they risk the well-being of whole communities while their ability to make autonomous decisions is greatly compromised by conspiracy theories and misinformation. Parents who decide against vaccinating their children also defy the principles of beneficence and non-maleficence, which require them to always perform actions that benefit their children directly and to never make decisions that may harm their children. By deciding not to vaccinate their children, parents refuse to take action to protect the health of their children while actively exposing such minors to preventable diseases in the future. Finally, vaccine development consumes a lot of resources and vaccines are normally produce as per population estimates. Individuals who do not take the allocated vaccines contribute to significant losses of medical resources that cannot be relocated to other important areas. This wastage of health resources goes against the principle of justice. Utilizing the bioethical principles of justice, non-maleficence, beneficence and autonomy, it is therefore evident that parents have a moral obligation to vaccinate their children.
References
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[DLS1]Why might there be more general worry about vaccines, and other reasons parents may be worried of the impact of vaccinations on their children?
[DLS2]Not always true- those who can’t decide their own autonomy due to mental deficiency, for example, or children
[DLS3]Questionable – and also does not mention the issue of parents that do not want to risk adverse reactions that do exist with vaccines or those children who cannot be vaccinated due to external reasons such as autoimmune conditions or reactions
[DLS4]As before, perhaps mention when vaccines actually COULD cause actual harm, and the reliance on health-care providers to provide information and intervention in these cases
[DLS5]Could be worth mentioning societal beneficence here – saves public money through diseases not being needed to be treated, hospital beds, more children surviving vaccine preventable diseases to contribute to society, etc