With vaccine hesitancy being targeted by the World Health Organization as one of the top ten threats to human health in 2019, the role of ethics in our collective responsibility for infectious disease requires a redefinition. I will start with the acknowledgment that vaccines are safe and effective. Though some policymakers are typified by their reliance on alternative facts, we should not concern ourselves with whether or not vaccines cause autism or any other claims not founded in reality. With that preface, the scope of this article will not be an evaluation of decades of scientific data regarding the medical efficacy of vaccine use; rather it will be a discussion on the ethics, centered in the claim that all individuals within the U.S. ought to be federally mandated to receive vaccines and renew them as is congruous with current medical data. By stating that all individuals should be required to be vaccinated, this would exclude those who are immunocompromised, have documented allergenicity to any ingredient in a vaccine series, or who would fall into any other category that would be indicative of legitimate medical concern.
The anticipated outcome of making vaccines required by law is to increase the aggregate well-being of the populace by negating as much infectious disease as is possible within the limit of scientific knowledge. Having less suffering brought on by disease and more healthy people in a society is an objectively good thing, and the claim is that a legal requirement to be vaccinated in order to achieve this, does not require a sacrifice of comparable moral importance; rather, one could say that requires no sacrifice of moral importance. By being vaccinated, one is increasing the likelihood, through the mechanism of communal immunity, that an immunocompromised individual does not contract a disease. He is also ensuring that he himself does not become infected by that disease that he is vaccinated against, raising the well-being of both himself and the most medically vulnerable of society. If he and others like him choose not to be vaccinated, they allow a greater propensity for contagion to occur; which for those who are immunocompromised, often entails a strong predisposition for those diseases to be fatal. This is a call for the raising of our collective consciousness.
When anti-vaccine sentiment is propagated the justification is often unscientific, underinformed, or centered in illegitimate reasoning. Currently, forty-eight states allow for religious exemptions from vaccination, and seventeen states allow for vaccine exemption on a philosophical basis. The category of philosophical exemptions includes personal beliefs, moral claims, or any other conscientiously-held beliefs that are not explicitly religious in nature.
To begin with religious exemptions, the most defensible objection that some utilize begins with the fact that some vaccine schedules were originally synthesized using human cell lines from fetal fibroblasts harvested in the 1960s from two elective abortions, WI-38 and MRC-5. With that knowledge comes the claim that using the specific vaccines derived from these fetal cell lines is immoral because their synthesis resulted from abortion. In response, there is no reason to believe that the two fetuses that were killed, at their respective points of development, had the capacity to suffer their destruction in any way and thus considerations for their well-being ought to have little impact on vaccine usage today. Also, note that the fetal tissue used would have been discarded and otherwise serve no utility if it had not been used for vaccine synthesis research. Even if one were to grant that using fetal tissue derived from abortion is immoral, it still does not mean that refusing to reap the social health benefits of that research and instead of decreasing overall health is morally permissible.
The primary philosophical objection to mandatory vaccination is likely the concern for autonomy: both individual autonomy and the autonomy parents exercise over their children. The concept of rights can be intangible and abstract, and the assumption that utility is more fundamental and conducive to well-being than rights must be a stand-alone here, for the sake of not becoming entrenched in a philosophical argument that never ceases. One cannot use the guise of parental autonomy to justify not using a seatbelt on a child when traveling on the interstate, or in any other example involving preventative measures to prevent as much harm as possible. The state, as well as society in general, has a compelling interest and moral obligation to structure a system that prohibits parents from allowing unnecessary harm to occur to themselves and others, and to not allow the concept of autonomy to be used as a crutch to veil negligence or irresponsibility.
The concept of universal vaccination seems as obvious as the medical evidence supporting vaccination and vaccine-conferred immunity. There are many other related issues to the prevalence of infectious disease and our collective responsibility to it and many other avenues through which solutions can be discovered, such as placing a disincentive tax on meat produced with antibiotics, which has a demonstrable effect on the appearance of antimicrobial-resistant infections; or the beneficial effects that vaccination has on non-human animals and their well-being, another related positive that is outside the scope of this article. But these are smaller concerns than having a fully-vaccinated populace and the generationally compounding benefits that can be acquired. The quintessence of the claim is that universal vaccination will bestow an increase in social health for quite literally no sacrifice of moral importance in return, while not doing so can reduce the well-being of many. When making ethical decisions, one must account for the interests of all who would be impacted by any one decision, and the confluence of a positive outcome from universal vaccination makes the decision unambiguous.
