Thursday, February 5, 2015

"The Needs of the Many Outweigh the Needs of the Few"

Vaccination and the Common Good:  The Limits of Individual Rights

I start with two facts and a belief: 
1) I do not have children.
2) I have been vaccinated. 
 3)    The measles vaccine is safe and very effective.    
     The recent measles outbreak which started at Disneyland and is spreading daily to more and more states, brings back a disease declared almost eliminated in 2000 in the United States.  It is so rare that many health professionals don’t know how to recognize it.   
        Several Republican presidential candidates have jumped on this issue, pandering to their anti-government base, by saying this is an issue of individual and  parental rights. Chris Christie first said, “parents should have some measure of choice about vaccination” although later came out in favor of vaccination.  Rand Paul claims to know many normal children who “wound up with profound mental disorders after vaccines.” Is he referring to his Republican colleagues?  Seriously,  they want to let people make their own decisions about vaccination but not about abortion.  Sometimes I wonder if they even listen to themselves.       
       There was no vaccine for measles when I was a child.  Getting measles, mumps and chickenpox was part of childhood. It was better to get these diseases as kids and then be immune to them as adults.  Measles was particularly scary because it is so contagious and can be quite dangerous.  When I was nine, I wound up having measles and chickenpox at the same time.  I lay in my bed for many days, taking baths in oatmeal to soothe the itching from the chicken pox (I can still hear my mother say, “don’t scratch or you will be scarred for LIFE!”).  The doctor came to our house and made clucking noises.  There was nothing to do but live through it.   And I did!   The measles vaccine was introduced the following year, in 1963. 
       Wikipedia says,  “The benefit of measles vaccination in preventing illness, disability, and death has been well documented. The first 20 years of licensed measles vaccination in the U.S. prevented an estimated 52 million cases of the disease and 5,200 deaths. During 1999–2004, a strategy led by the World Health Organization and UNICEF led to improvements in measles vaccination coverage that averted an estimated 1.4 million measles deaths worldwide.”  
You get vaccinated for two reasons: 
1) to prevent getting the disease yourself;
2) to help prevent others from getting it, particularly those people who cannot be vaccinated.
     The first reason falls clearly into the camp of individual choice—I can get vaccinated or not, or I can make this decision on behalf of my children who cannot make it for themselves.  

        The second is about the common good.  If you have decided not to get vaccinated and you catch a disease that is preventable by a vaccine, you live with the decision you made. Your choice, and none of my business.  But the problem is that you put everyone around you who cannot get vaccinated (babies, people with suppressed immune systems, the elderly) at risk of catching the disease from you.   When the vast majority of people are vaccinated, it creates what is called a “community” or “herd” immunity.  According to Dr. Robert Siegal, a professor immunology at Stanford, herd immunity brought about by large scale vaccination contains the spread of an infectious pathogen to one or two people.  It is essentially a firewall.  When one person gets sick with measles, the virus bumps harmlessly off those who are vaccinated.   This is particularly important with infectious diseases that can be symptomless.  For example, most people infected with the polio virus have no signs of illness and are never aware that they have been infected. These symptomless people carry the virus in their intestines and can unknowingly spread the infection to thousands of others before the first case of polio paralysis emerges. This is why even one case of polio is considered an epidemic.(  Because of the Salk vaccine, we have not had a case of polio in the United States since 1979. ( 
     From a commons point of view, the limits of individual rights are very clear in the arena of public health.  A person acting alone cannot achieve hygiene and sanitation, clean air and surface water, uncontaminated food and drinking water, safe roads and products, and control of infectious disease.  And yet, everyone needs these.   Each of these collective goods, and many more, are achievable only by organized and sustained community activities. 
     Or, as Spock says in Star Trek II:  The Wrath of Khan, “The needs of the many outweigh the needs of the few.  Or the one.”  

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