Vaccines have prevented 21 million hospitalizations and 732,000 deaths in the last 20 years (CDC, “Report shows 20-year US immunization program spares millions of children from disease”). according to the CDC. Roughly 95% of children in the United States are currently vaccinated, but what about the other 5%? Vaccination is required in all 50 states to enroll a child in public school, but there are a number of ways in which an individual can receive a vaccine exemption. Some people with weak immune systems have a medical exemption from vaccines, which are allowed every state. There are religious exemptions that are accepted in 47 states. A number of states also accept philosophical exemptions. The second two of these pose a potential risk to public health. Immunocompromised individuals have no choice, they cannot get vaccines even if they want to, but the second two are a choice made by parents to not vaccinate, and they both threaten herd immunity. Herd immunity is an indirect form of immunity. It occurs when a large percentage of a population becomes immune to a disease. Those who are not immune to the disease are protected by the fact that the disease is unable to spread through the population. This is the only method of protection that immunocompromised individuals are protected by. When a large portion of the population makes the choice to not vaccinate, these individuals are at risk. So how do we protect those who cannot protect themselves? Should there be government mandated universal vaccinations? Is the issue of public health large enough to impede upon an individuals right to make decisions about there own body? The only rational answer to this question is: the autonomy of an individual cannot be given priority when it threatens the health, and therefore the autonomy, of others.

The average individual advocating for the anti-vaccination movement is a parent. This parent is often very concerned with their child’s health and well being and is not willing to leave their health up to common practices. This leads these parents to do research often on the internet, where they may be misinformed by ill researched opinions. Contrastingly, the average universal vaccination advocate is a medical or public health professional who is worried about a possible disease outbreak that results from an anti-vaccination movement gaining momentum,

The issue of vaccinations is fundamentally grounded in medicine and science, and to understand the biochemical pathway that leads to the effectiveness of vaccines, one needs to have extensive background knowledge in medicine. However, this issue has been brought into the public sphere in recent years. This has led to an abundance of information that is easily understandable. This movement to the public sphere makes it easier for normal individuals to understand pros and cons of vaccinations, and make informed decisions. Unfortunately, this also has led to a plethora of information that is incorrect, or unsupported by research. Utilization the Internet easily fulfills the necessity for easily accessible information. This ease of accessibility, along with the rise of the authority of the media have made the internet the number one source for vaccination information. Unfortunately, most information is equally accessible. This means that some people will read the CDC’s medically backed views on vaccinations, while others will read the blogs of a soccer mom. Each of these websites has an equal platform to present its opinion, and without further research, could seem equally plausible. Along with the rise of the utilization of information access on the internet, other forms of manipulating the media have also been used by the anti-vaccination movement. This includes celebrity endorsements of the movement. The most notable celebrity anti-vaccination advocate is Jenny McCarthy, and she uses he platform to convince the public to also not vaccinate their children. this is problematic because celebrities are not medical experts. They have no more insight into the issue than the average person, so giving them an infinite platform gives a perception of knowledge and authority, and an ability to convince others, with little concept of the entirety of the issue. This rise in accessibility and authority of the media has led to an unprecedented rise in the anti-vaccination movement.

A general distrust of traditional medicine is common in followers of the anti-vaccination movement. This has lead to a movement and gain in popularity in alternative, or complimentary, medicine. Practitioners in this field of medicine include dieticians, holistic practitioners, acupuncturists, and chiropractic doctors. These specialist are found to have  dramatic lack of confidence in the CDC and vaccinations, when compared to traditional, or allopatric, medicine professionals (Buehing 48). A growth in popularity of alternative medicine has made the opinions of these professionals increasingly relevant in the public sphere.

There are a number of additional external factors that affect the popularity of the anti-vaccination movement. One of these factors is the lack of a perceived threat. The success of vaccines has lead to near eradication of disease preventable diseases. Most parents are too young to have seen the effects of polio, the mumps, the measles, or rubella first hand. They have not experienced the pain or suffering caused by a large epidemic of one of these diseases. This makes the possibility of an outbreak much less scary. Without a perceived major threat, there is no incentive to go through the steps to protect the community’s health. The effect that this perceived safety has on the anti-vaccine movement is evident when you look at countries that lack it. There are many countries where vaccine preventable diseases are still very prevalent. This is more often than not due to a lack of access to vaccines. Lack of access to vaccines is of course closely related to poverty of a country, and its individuals, as well as development of its medical and scientific fields. For instance, India has only recently eradicated polio, through large and universally supported vaccination programs. This means that there is still a significant portion of the population that has contracted the disease. Polio is a devastating disease that often leads to paralysis and often disfiguration of its victims. These factors are very visible. People believe what they see first hand, so India has no problems conveying the possible dangers of not getting vaccinated. A country in a similar situation is Nigeria. With little access to health care and rampant poverty, it is no surprise that a majority of the population does not have access to vaccines. Similar to India, the question that Nigeria is not whether or not to vaccinate, but rather what is the most effective way to employ a vaccination campaign (onyemelukwe, "Can Legislation Mandating Vaccination Solve the Challenges of Routine Childhood Immunization in Nigeria?." ). In these countries, there is no debate over an individual’s right to choice, because every individual sees the risk they are putting themselves in, making the choice unanimous. The lack of an anti-vaccination movement in countries that still have a prevalence of vaccine preventable disease, leads to the assumption that the near eradication of the same diseases is an integral factor for such a movement to gain momentum.

These factors ad the resulting movement put society at risk. If there was an outbreak of a serious and prolific vaccine preventable disease, the disease would spread rapidly among the community of people who are unvaccinated.as the anti-vaccine movement gains momentum, and the number of unvaccinated individuals rises, the number of individuals at risk for contracting vaccine preventable diseases rises as well. This gives diseases more opportunities to mutate. Mutation is when a virus’s genetic makeup is changed, and the process is usually random. The genetic mutation of these viruses could render current vaccinations obsolete. This makes it the responsibility of all individuals to vaccinate in order to prevent the reproduction, and possible resulting mutations, of these of these viruses.

The issue comes down to a debate of autonomy versus responsibility. Autonomy is an inherent right that every person is born with, the right to make decisions on behalf of one’s self. In medicine this is a two-part concept. One of these parts is to give a patient access to all possible options, while the other is letting a patient make decisions for their body and respecting the choice made (Thomson). This is an ideal that is fundamental to most abortion debates. Support of abortion is more often than not rooted in the idea that a woman has the right to make decisions on behalf of her own body. Widespread support for respecting autonomy has lead to societal acceptance and the passing of legislation in support of a woman’s right to receive an abortion. Theoretically this could be used as an argument in opposition to universal vaccination. It follows that if a woman has the right to make a choice on behalf of herself and an unborn fetus, then parents should have the right to make a choice on behalf of their children to not vaccinate. However, such an argument is short sighted. 

In the case of abortion, a woman is only making a decision for herself and an unborn fetus, who’s life she is inherently responsible for. There is no fault in this reasoning. However, in the case of a parent choosing not to vaccinate, they are not making a decision for just their child, they are making a decision for every person who is at risk of contracting vaccine preventable diseases. Already discussed are the immune compromised, those with immune systems too weak to even consider vaccination, but in addition to these individuals are the elderly and infants. The elderly also have weakened immune systems, making them more susceptible to the spread of disease, while infants cannot yet be vaccinated. Most vaccines are not administered until a child is 18 months old. This is months after most children become active, and additionally when most children are socialized. 

To put this into perspective, most children begin to walk when they are about 1 year old. As a child begins to play and explore a parent brings him to the park. At the park is a 5 year old who has been exposed to the measles virus. This five year old’s parents chose not to vaccinate him. In many cases this child’s immune system will be able to fight off the virus with little to no complications. However, this 5 year old has brought the virus with him to the park. He unknowingly passes this virus to the one year old child in question. This child has not yet had the opportunity to be vaccinated. Infants have much less immune function due to their lack of exposure to pathogens, or disease causing entities. The 12 month old is unable to fight the virus and dies, or at least experiences serious complications. In this case the parents of the infant did not choose not to vaccinate. They did not choose to expose their son to a vaccine preventable disease, however he was exposed based on the decision of the five year old’s parents to not vaccinate. The parents of the 12 month old had their decision taken away from them by the decision made by the parents of the five year old. This is where the arguments between abortion and vaccination, in reference to autonomy, must fundamentally diverge. The autonomy of an individual cannot be respected, or protected, as an inherent right if it threatens the autonomy of others. therefore it is every individuals responsibility to protect public health in spite of their own autonomy.

The brunt of the anti vaccination movement began in 1998, when an English physician, named Dr. Andrew Wakefield, published a study linking the measles mumps and rubella (MMR) vaccine, to autism in children. The publication of the study lead to an outpour of parents claiming that their child had started exhibiting symptoms of autism within months of receiving an MMR vaccine. This was originally attributed to the chemical composition of vaccines, and the presence of mercury in the form of Thimerosal, a commonly used preservative (FRONTLINE “The Vaccine War.”). 

Mercury is a neurotoxin, meaning that it affects and damages the brain. Reasonably, people assumed that this ingredient that has been known to cause brain damage, was causing autism in children by damaging their brains during development. However these theories were disproved in a number of ways. First, if mercury was causing brain damage in these children, it makes sense that their symptoms would mimic the symptoms of mercury poisoning. This was not the case. Although both mercury toxicity and autism both affect the brain, there is no overlap in clinical presentation of the two diseases. A more likely explanation for the correlation of the time frame between the time period of vaccination, and onset of autism is cognitive function. As stated earlier, vaccines are generally given around the age of 18 months old. This is around the same time period that children start to display cognitive function. In other words this is the time period in which children start reacting and interacting with their environment. Since there are no physical signs of autism, this is the time in which symptoms are first noticeable. As state in a summary of autism spectrum disorder by the center for disease control and prevention (CDC) “Even though ASD can be diagnosed as early as age 2 years, most children are not diagnosed with ASD until after age 4 years”(CDC, “autism Spectrum Disorder”) This timeline supports the idea that vaccines likely are not the cause of autism, they may just occur in the same time period as the first display of symptoms. 

Andrew Wakefield’s study was replicated on multiple occasions, but no subsequent study produced the same result. His methods and results were scrutinized leading to the loss of his medical license in Britain, and retraction of his study from all major medical publications. Regardless of the medical field’s rejection of his findings, the anti-vaccination movement has accepted and held on to them. In order to placate worries, thimerosal, the mercury containing vaccine preservative, was removed from vaccines. However, followers of the anti-vaccination movement took its removal as an admission of guilt, by vaccine manufacturers. This played into the general distrust of traditional medicine and pharmaceutical companies, commonly held by followers of the anti-vaccination movement. 

This is an issue that affects everyone. Neither side of the aisle has malicious intents; everyone is just acting with the purpose of protecting those around them. Parents who are followers of the anti-vaccine movement are trying to protect their children. they have a general, and often deserved, mistrust of the medical and pharmaceutical system, and believe that they are more able to  determine what the best choices for their child are, above doctors. On the other hand parents who support vaccination are acting in the interest of their children in an effort to minimize their exposure to pathogens. In addition, public health officials are trying to protect the community, and specifically those in the community that are inherently weak, such as infants, the elderly, and the immune compromised. 

The debate of Mandated vaccinations is a controversial and common one in our society. It is an issue of public health, and cannot be ignored. the fundamental argument is one of autonomy versus responsibility to the public. When it comes down to it, autonomy must be secondary to public health. Those who have the ability to be vaccinated must do so out of responsibility to maintaining a safe public environment for those who cannot.  In summary, the autonomy of an individual cannot be prioritized, or protected, when it threatens the autonomy (and health) of those around them.
