The
advent of vaccines has dramatically changed the public health landscape by
eliminating the threat of communicable diseases. However, vaccines have come
under recent scrutiny with false claims linking vaccines to autism, sterility,
etc. Despite the abundance of scientific evidence and benefit-risk ratios to
disprove these claims, it has not been enough to quell the distrust of
vaccines. Enforcing vaccinations should not involve a “one-click” paternalistic
approach; acceptance and trust is a complex act. Confronting any threat of
disease presents us with choices of liberty, dignity, and protection. These
questions cannot be resolved with more science or data; it requires an
encounter with the ethics. Our ethical beliefs underlie personal, political and
cultural values in which we base our decisions and perceptions of trust.
Vaccine
backlash in the US can been partly attributed to the absence of a serious
outbreak in recent history (Larson et al, 2011). When vaccines were first
introduced, there was widespread disease and suffering. Today’s lack of
familiarity with vaccine-preventable diseases has led to some questioning its
purpose. Furthermore, the public is surrounded with a culture of celebrities who
are refusing to vaccinate their children, which has spurred a trend among other
parents to withhold vaccines as well. Similar to the tobacco ads in the 1950s,
foregoing vaccines is seen as glamorous and a symbol of choice among wealthy
parents. The concept of a social movement may help change this “culture” around
vaccination. Choosing key figures, that are seen as trustworthy and admirable
in the community, to advocate for the benefits of vaccination may help counter
these harmful portrayals. This “advertising” also drowns out the harmful
evidence of refusing vaccination, and raises the question of whether
individuals are making decisions with a lack of informed consent, violating the
core of ethical guidelines outlined in the Belmont Report. If so, what role
does the government play to increase trust?
Implementation
of vaccine programs has been characterized by a series of paternalistic nudges,
such as mandatory vaccination for school enrollment or providing cost-benefit
analyses. However, these government interventions are not fully effective,
particularly in a country characterized by personal liberties and freedom of
choice. Non-compliance is most importantly exacerbated by the lack of
transparency in the government and their contradictory actions (Eliot and
Resnick, 2014). In 1999, the AAP and CDC asked vaccine makers to remove
thiomersal from childhood vaccines as precaution, but the action only fueled
the proposed link between vaccines and autism (Larson et al, 2011). While many
studies since then have failed to demonstrate a causal link between the two,
the public still remained distrustful. These actions have eroded the trust in
government decisions. Promoting transparency could include incorporating
scientists from a range of different stakeholder groups on government advisory
boards or disclosing financial/non-financial interests (Eliot and Resnick,
2014). Before taking such precautionary measures in moments of scientific
uncertainty, these perverse consequences should be taken into account. Research
ethics should be fully consulted before allowing such claims to be initially presented.
