Parent Refusal toVaccination
The invention of vaccine for various infectious diseases is one of the greatest medical achievements in human history. The success rate for vaccination throughout history is high to the point that some of the most deadly diseases such as smallpox have been eradicated from the population. Notably, the United States stopped smallpox vaccination in the 1970s after the World Health Organization (WHO) (2014) reported that it had been eliminated from the U.S. population. Other vaccinations scheduled to children have also demonstrated similar success rates; as a result, most vaccine-preventable diseases are seldom seen in the United States. However, the risks associated with immunization programs currently in place have impelled some parents to doubt the necessity of some vaccines. As such, vaccination has turned into a subject of ethical controversies among scholars, health practitioners, and the public health community. In times of increasing hesitation for vaccines, the U.S. and other developed countries are witnessing a resurge of some vaccine-preventable diseases. The ethical implications of this issue are numerous; however, the forefront of recent debates is whether vaccines should be compulsory or left under the discretion of public health to prevent a mass outbreak of infectious disease or whether the parent autonomy should be a primary consideration during immunization.
Children are the most vulnerable to vaccine-preventable infections. The harm that comes from infection is significant. However, since children are not able to decide on their care, it is the parent’s responsibility to decide whether a child should receive particular care based on the potential for harm or the benefits associated with the treatment. The first argument against vaccinating all children is based on this primary responsibility. Largely, parents who refuse vaccination for their children usually defend their position based on the interests of their child. Critics of immunization believe that parental authority and responsibility is sufficient to refuse vaccination of a child.
Many parents believe that the vaccine will harm their children. Such arguments are contrary to the recent success rates of immunization programs. Precisely, existing immunization programs have been reported to have numerous risks prompting some parents to believe the dangers of vaccination are too high for their children, as evident in the case of Hannel Poling. For the first time, the federal government of the United States compensated Hannah Poling, after admitting that her autistic condition was connected to immunization she received as an infant (Anderson, 2015).Hannah poling was a healthy child, but she was ill after receiving vaccination scheduled at 18 months. Although there is no causal relationship established between autism and the vaccine, the federal government agreed to compensate her recognizing that her condition was connected to vaccination. Many parents are concerned with such consequences of vaccination believing that it is for the interest of their child. Thus, critics of vaccination believe that since it is the responsibility of the parent to take care of their child, they should be allowed to decide when and how their child will receive an immunization.
Similarly, critics of vaccination base their argument on the harm of the child. Most parents who refuse to vaccinate their children believe that it can provide an ‘unnatural’ immunity to their children (Barrows et al., 2015). Most parents feel that natural immunity is critical and mostly preferred since it does not subject the child to risks of vaccination. A recent study found that at least 8 percent of parents believed in natural immunity, rather than receiving immunization for protection (Barrows et al., 2015). Also, only a small portion of parents seek an alternative vaccination schedule, and some tend to delay the process until the child is of age. According to Barrows et al. (2015), many parents who delay vaccination claim that the child immune system is immature at the scheduled dates to handle the immunization safely.A recent study on perception of vaccines in the U.S. indicates that at least 20% of parent agrees that there is too many scheduled vaccine that they think can overwhelm a child immune system (Rogers, 2014). Those who support this argument claim that receiving 25 vaccines within two years since birth is too much for a child (Rogers, 2014). Critics of vaccination argue that while some or all these vaccinations are important, the combination of vaccines such as Measles vaccines, MMR, and pentavalent vaccines, tetanus, and others is not safe for the child at an early age (Rogers, 2014). Therefore, if a parent decides that a vaccine is not beneficial or it makes them susceptible to infectious diseases, then critics argue that they should be allowed to decide whether to let go of some vaccines or delay them until their child is safe.
Religion can also have a significant influence in vaccination and some cases; religious objections are often the basis for an excuse to avoid vaccination. The most ethical questionable issue in religion especially Catholicism is the use of cells on a voluntarily aborted fetus to make vaccines. Some of these cells are used in Rudivax, a vaccine used against rubella, or HAVRIX used to prevent hepatitis (Pelčic et al., 2016). Other vaccines such as the HPV vaccine, one of the commonly used sexually transmission vaccines are not accepted in some religious community. If there are no alternative vaccines, critics of vaccination argue that the parent has the right to decide whether a child can receive treatment based on his or her beliefs. For instance, parents belonging to a religion that stresses the importance of abstinence may believe that HPV can contribute to the sexual proximity at a young age. Therefore, critics argue that the parent should be able to decide when a child can receive the vaccines. They emphasize the importance of religious freedom and immunization using vaccines that contradicts with one religious belief should not be allowed.
Many scholars and pundits and the public at large have been made in favor of vaccination. The first argument focuses on the benefits of vaccination and prevention of possible harm to the child. The primary aim of vaccinating is to protect a child from current or future infection; therefore, when a person encounters a person with infectious diseases, their immune system is primed to fight and ultimately avert the deadly virus or infection. According to a recent statistic, more than 162.8 million children are protected from infectious diseases, some of which cause severe illness and even death, and this is only achievable through various vaccination programs (WHO, 2018). For instance, a cohort analysis in different hospital indicated that more than 567,000 hospitalizations of children under the age of 5 years are averted every year.
Figure 1: A graph of Rotavirus hospitalization prevented by Vaccination in the U.S from 2007-2018 (Payne et al., 2018).
The risk of harm when parents fail to vaccinate their child is significant. Thus, those in favor of vaccination argue that the decision does not lie on the parent but the public health. They believe that any intervention carries its own risk. Therefore, vaccination supporters contend the argument on the risk of vaccination. Precisely, they feel that the risks of any intervention need to be weighted fairly against the benefits; therefore, it is not right to decide on the presumption of avoiding any possible risk. They believe that an argument that refusal to immunization based on the reason of potential harm is incoherent because doing nothing about prevention carries risks.
Another moral consideration of vaccination is the responsibility of causing harm to others. Immunization supporters argue that a parent has the responsibility of their children health. However, their decision or discretion should not harm the child or the community at large. The general ethical principle of medical practitioners and many other professionals is that a person has the freedom to do as they wish unless their action can cause harm to others. Failure to vaccinate a child means exposing an infectious disease to the public; as such, vaccination cohorts believe that the decision should be left to the responsible public health bodies. It is hard to locate the causation of any harm, however, the probability of spreading an infectious disease impost an obligation of public health and the government to act (Barrows et al., 2015). Besides, the community immunity is essential to the protection of a given group. Precisely, the immunity of a child is a critical consideration, but it goes beyond the benefit of one direct vaccination. If a particular member in a relevant group does not have the required immunity, they may be a reason a specific immunization program fails, and this means that the entire community health is compromised.
In a discussion of vaccination, another critical argument used to appeal to those against it is the question of whether refusal is in the child’s best interest. In most cases, the decisions about child health care are left to the parent presumably because people believe that a father or mother will always act in the child’s best interests. However, those in support of vaccination argue that it is possible for a parent to make a decision that is not in the child’s best interest. If the infectious disease is widespread and the only treatment available compromised with the religious belief of the parent, it is important to determine the balance between their interest and that of the child. Of course, religious or philosophical belief is relevant, and may also have an impact on the welfare of the child after a forced vaccination. However, the test of the best interest should always be on the child’s health and not what a parent thinks is right or wrong.
When analyzing an ethical dilemma of vaccination, it is essential to consider the responsibility of the public health and health care professional to the child. Certain ethical principles bind these professionals, and they only make treatment decision based on these doctrines. One of the responsibilities in this regards is the protection of children from harmful diseases, for example through vaccination. Also, it is essential to respect the autonomy of those given the legal responsibility of protecting the child. As such, if a parent perceives vaccination as potential harm on a healthy child, a health professional has the moral obligation to respect their decision. However, in modern medicine, it is challenging for health care professionals to apply certain ethical principles to a child. In this case, a child may not understand the importance of immunization, and the decision to vaccinate falls into the hands of the parents, a health care provider, or the court. While a parent may not have the autonomy to decide on vaccination, they have a parental authority of what is good and right for the child.
Some of the main concern associated with parent hesitation to vaccinate their children is fear of the side effects, philosophical or religious beliefs, or the number of immunization an infant received. Although some of these arguments are valid, it is crucial for health professional to addresses the misinterpretation of vaccination. Similar to any other intervention, treatment is associated with several risks. However, these risks do not outweigh the benefits of vaccination. Besides, given the effectiveness of vaccination in preventing the spread of infectious diseases, failure to immunize children exposes them to more harm. Thus, the responsibility of whether a child should be vaccinated goes beyond a parent. However, parents have an obligation to their children; they must be involved in the vaccination decision. Nevertheless, this does not mean that a parent’s opinion should be the sole consideration for vaccination. Every case must be examined uniquely, and the ultimate goal should be the best interest of the child and the community.
Pelčić, G., Karačić, S., Mikirtichan, G. L., Kubar, O. I., Leavitt, F. J., Cheng-Tek Tai, M., … Tomašević, L. (2016). Religious exception for vaccination or religious excuses for avoiding vaccination. Croatian Medical Journal, 57(5), 516–521.
Rogers, C. (2014). Parents’ Vaccine Beliefs: A Study of Experiences and Attitudes Among Parents of Children in Private Pre-Schools. Rhode Island Medical Journal, 97(4), 27.
Payne, D., Umesh D., & Parashar, D., (2 018). Manual for the surveillance of vaccine-preventable diseases. Atlanta: Centers for Disease Control and Prevention, 4. https://www.cdc.gov/vaccines/pubs/surv-manual/chpt13-rotavirus.html
World Health Organization- WHO (2018, Jun 18). Immunization Coverage. Retrieved from https://www.who.int/news-room/fact-sheets/detail/immunization-coverage
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