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This post is a part of our Bioethics in the News series
By Sabrina Ford, PhD
In the advent of the novel coronavirus (COVID-19) pandemic, there is an underlying belief in the United States that a COVID-19 vaccine may be the Holy Grail, the silver bullet to assuage the pandemic and open up the quarantine doors. Yet, there is a divide in the United States regarding vaccination acceptance. The Centers for Disease Control and Prevention (CDC) reports less than 50% of adults receive the vaccine for influenza (flu). In the 2017-2018 flu season, 37.1% received the vaccine, the lowest rate in ten years. The rate increased to 45.3% in 2018-2019. In a recent study reported in The Boston Globe, authors Trujillo and Motta found that 23% of persons surveyed said they would not get the COVID-19 vaccination. The study breaks it down further regarding anti-vaccination attitudes (also known as “anti-vaxxers”) and found that 16% of respondents identified themselves as anti-vaxxers, and of those, 44% said they would not get the COVID-19 vaccine. The researchers contend that anti-vaccine sentiment still exists in spite of the deadliness of COVID-19.
Vaccine debate
As Americans, we want what we want how we want it. For some of us, the vaccine cannot come fast enough, and it better be effective. Others don’t plan to get it even when it is available. I have set up a dichotomous choice, but indulge with me in thinking through the debate. Many philosophical and ethical discussions occur in academic research—and particularly in mainstream and social media—highlighting opposing views of those who choose to vaccinate and those who do not. Often, these two positions fall along partisan lines, but not in the way that we might expect. The anti-vaccine movement began with the political left, but spread to the religious right, conservatives, and libertarians.
Approximately 20 years ago, a flawed but influential study linked the Measles, Mumps, Rubella (MMR) vaccine to autism. It started a hot debate fueled by staunch supporters of anti-vaccination from both sides of the aisle. The anti-vaxxer movement took hold with powerful liberal voices, but in recent years has become convenient for the religious and far-right who aim to keep government out of personal decisons. A 2015 Pew Research Center Study found that 12% of liberals and 10% of conservatives are opposed to vaccination. Herein lies my question: to what can we attribute the strong stance that anti-vaxxers take regardless of political position? Why does this question matter? America is a free country. However, the movement warrants an understanding in the midst of a pandemic of an extremely deadly disease whereby science tells us that a vaccine may mitigate infections and death.
Facts are stubborn things
One commonality between the liberal and conservative anti-vaccine stance is a lack of trust in science and medicine, and belief in “alternative facts.” This is particularly true within the anti-vaxxer movement. Some don’t trust science based on real life experiences or notable past deceptions in public health interventions, such as the Tuskegee Experiments, Havasupai Diabetes Project, Henrietta Lacks, etc. Antithetically, the autism study was deceptive by negating the lifesaving MMR vaccine as harmful. This myth has persisted over time, fueled by the anti-vaxxer movement and the discount of science as faulty, dangerous, driven by big government, and against individual choice. Facts versus feelings further complicates the human cognitive decision-making process. For example, in the case of vulnerable children with autism for whom science has not fully unraveled a cause or treatment, anti-vaxxers feel they can place blame on the MMR vaccination. Feelings contribute to the uptake of faulty information and fake news via social media, in turn drowning out the facts.
Herd immunity
Vaccines have been one of the greatest public health successes in the world due in large part to herd immunity. Herd immunity comes with centuries of science resulting in the reduction of deadly diseases. The cursory explanation for herd immunity is: if a large proportion of a community is vaccinated, the lower the collective risk to the community. The algorithm suggests at least 80-90% of a community needs to have immunity to a disease and/or be vaccinated to protect the proportion of persons with compromised health conditions who cannot be vaccinated. The range in vaccination rates is dependent on the effectiveness of the vaccine. We have seen the eradication of smallpox and polio because of a highly effective vaccine delivered to most of the children in the U.S. This was achieved through mass immunization and extremely effective public health messaging. Most recently, buy-in to herd immunity has devolved from a fear of deadly disease to a fear of the very thing that prevents deadly disease. As a result, we have seen a resurgence in measles, which can be deadly for children with compromised immune systems. The science of herd immunity is powerful but relies on collectivism and social responsibility. The requirement that a large proportion of a community needs to be vaccinated to protect others cuts across American values of individuality and freedom of choice.
Final thoughts
Before COVID-19, we lived in a different era with some generations never experiencing or witnessing extremely contagious, deadly diseases, confirming a belief that we can individually control our own disease states. Now, we are faced with a history making, highly infectious, deadly disease. Will we adopt a philosophy of sacrificing a bit of comfort by quarantining, wearing masks, or experiencing the pinch of a vaccination to save the lives of others? The jury is still out on that debate. We have witnessed segments of our society rebel and even retaliate against the idea of vaccination. Yet, scientists are working faster than ever to develop an effective COVID-19 vaccine, and the U.S. government has promised to enable the Food and Drug Administration (FDA) to relax clinical testing protocols to push the vaccine out in order to save lives. No, the vaccine will not be the silver bullet, but it has the potential to augment natural immunity to work as a tool of collective protection. Is the deadliness of COVID-19 enough to override the need for anti-vaxxers to hold onto personal choice?
This is not an indictment on one’s personal choice not to be vaccinated, but an opportunity to ponder individuality versus social responsibility for the greater community benefit. COVID-19 has been a game changer on human behaviors, requiring us to social distance and wear masks for the greater good. Will we embrace social responsibility and be vaccinated to save lives? How do we reconcile our individualism with the adoption of collectivism?
Sabrina Ford, PhD, is an Associate Professor in the Department of Obstetrics, Gynecology and Reproductive Biology and the Institute for Health Policy in the Michigan State University College of Human Medicine. Dr. Ford is also adjunct faculty with the Center for Ethics and Humanities in the Life Sciences.
Join the discussion! Your comments and responses to this commentary are welcomed. The author will respond to all comments made by Monday, June 1, 2020. With your participation, we hope to create discussions rich with insights from diverse perspectives.
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More Bioethics in the News from Dr. Ford: Contemplating Fentanyl’s Double Duty
References
- Centers for Disease Control and Prevention, National Center for Immunization and Respiratory Diseases (NCIRD). Flu vaccination coverage, United States, 2018–19 influenza season. September 2019. https://www.cdc.gov/flu/fluvaxview/coverage-1819estimates.htm.
- Trujillo KL, Motta M. 23 percent say they won’t get a COVID-19 vaccine ‘Anti-vaxxer’ sentiment could jeopardize efforts to build immunity. Boston Globe, May 7, 2020. https://www.bostonglobe.com/2020/05/07/opinion/23-percent-say-they-wont-get-covid-19-vaccine/.
- Campbell H. Science left behind 2014: the anti-vaccination update. Science 2.0, October 16, 2014. https://www.science20.com/science_20/science_left_behind_2014_the_antivaccination_update-146746.
- Berezow AB. Are Liberals or Conservatives More Anti-Vaccine? Real Clear Science, October 19, 2014. https://www.realclearscience.com/journal_club/2014/10/20/are_liberals_or_conservatives_more_anti-vaccine_108905.html.
- Pew Research Center. 83% say measles vaccine is safe for health children: No partisan differences in views of vaccine safety. February 9, 2015. https://www.people-press.org/2015/02/09/83-percent-say-measles-vaccine-is-safe-for-healthy-children/.
- Joslyn M, Sylvester SM. The determinants and consequences of accurate beliefs about childhood vaccinations. American Politics Research. 2017;47(3):628–649. https://doi.org/10.1177/1532673X17745342.
- Chou WS, Oh A, Klein WMP. Addressing health-related misinformation on social media. JAMA 2018;320(23):2417–2418. doi:10.1001/jama.2018.16865. https://jamanetwork.com/journals/jama/article-abstract/2715795.
- Roose K. Get Ready for a Vaccine Information War. The New York Times. May 13, 2020. https://nyti.ms/3fKbHXz.
- D’Souza G, Dowdy D. What’s herd immunity and how can we achieve it with COVID-19. Johns Hopkins School of Public Health Expert Insights, April 10, 2020. https://www.jhsph.edu/covid-19/articles/achieving-herd-immunity-with-covid19.html.
- van Schaik D. Expert comments about herd immunity. Science Media Centre, March 13, 2020. https://www.sciencemediacentre.org/expert-comments-about-herd-immunity/.
- Giubilini A, Douglas T, Savulescu J. The moral obligation to be vaccinated: utilitarianism, contractualism, and collective easy rescue. Medicine Healthcare and Philosophy. 2018;21(4):547-560. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6267229/.
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