Vaccination: A Societal Duty

CHW LogoWhen you go to a beach or a gym or somewhere else with bare upper arms visible, you’ll notice fewer and fewer people with the characteristic scar those of us born before 1972 have.  That’s the year routine smallpox vaccination was stopped in the US.  In 1980, the World Health organization declared smallpox globally eradicated.  I still recall the awe I felt when just a few years later I saw a movie about the effort to wipe out smallpox in my first year of medical school.  A disease that had once been a routine, and terrifying, part of human existence – outbreaks literally changed the course of history, and as recently as the 20th century smallpox caused an estimated 300-500 million deaths – was gone.  Gone.  All thanks to a relatively simple, and inexpensive, vaccine.

Efforts to prevent smallpox were reported as early as the 10th century in China; the modern approach to vaccination was introduced in 1796 by Edward Jenner.  Yet real progress in eliminating this scourge did not occur until mandatory vaccination began to be introduced in England and the US in the mid-19th century.  The reason is that smallpox, like many other highly transmissible infectious diseases, requires only a small number of susceptible individuals to remain viable in a population.  Unless everyone, or nearly everyone, is immune (either from prior infection or vaccination), the disease will persist and rear its ugly head as immunity wanes over time.

Fast forward to 2017.  Smallpox is gone, but other potentially epidemic diseases like measles remain.  And in our current climate of alternative facts and science denial, vaccines are under suspicion, raising the specter of a resurgence of dangerous, yet easily preventable infections.  There are two underlying issues, one scientific, and one philosophical.

First, are vaccines safe?  That’s easy.  Yes.  I’m not saying they are 100% risk-free.  There are rare serious reactions such as allergy or Guillain-Barre syndrome, and common but minor side effects like soreness and fever.  But numerous studies have shown that vaccines are at least as safe as almost every other medical intervention known.  And some of the more sensational claims – such as the link between vaccines and autism – have been utterly and thoroughly debunked.

Second, are mandatory vaccines justifiable?  In a free society, shouldn’t people have the right to refuse to be vaccinated for religious or other reasons?  That’s not as easy a question, but in my mind the answer is no.  In the phrase “free society” we tend, in modern America at least, to put too much emphasis on the “free” and less on the “society.”  Living in community with others always requires a balance between individual rights and societal responsibilities.  We accept that we all have an obligation to obey laws that are justly enacted.  We can’t harass our neighbors with loud noises or noxious odors.  We agree to all drive on the same side of the road, and not to get on the road if we’ve had too much to drink.  Why?  Because, as the saying goes “your right to swing your arms ends where my nose begins.”  By living in civil society, we agree to limitations on our individual rights for the protection of the health and safety of others.  Vaccines are the ultimate example of this.  Vaccines not only protect the health of the recipient, they also protect the health of others in the population as noted above.

Allowing individuals to forego vaccines in the name of personal liberty could be justified if the risk were limited to that individual.  But it is not.  If someone wants to enjoy the benefits of society, they need to bear the responsibilities, including the responsibility not to be a reservoir of illness to others.  To paraphrase Oliver Wendell Holmes, Jr., vaccines are the price we pay for civilization.

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