Thursday, February 5, 2015

Vaccinations and Human Rights, American Style

With the outbreak of measles in the U.S., traceable to unvaccinated Disneyland visitors, the "anti-vaccine" movement has gained new attention.  A survey of anti-vaccine websites and blogs indicates that one of the arguments frequently made by defenders of the movement is that refusing vaccines is a human rights issue.

But while many can appreciate that mandating vaccinations against a patient's will can raise medical ethics concerns regarding patient decisionmaking and autonomy, the human rights issues seem to cut in the other direction.  

It is worth remembering that the movement to refuse vaccines is a phenomenon largely limited to those places where people are fairly certain that the medical infrastructure in place ensures that they will not actually get the serious diseases (e.g., mumps, measles, rubella) that the vaccinations address.  In contrast, in most parts of the world, where measles alone threatens more than twenty million people each year, it is access to health- and life-saving vaccinations that is the human rights issue.   For example, a General Comment recently issued by the UN Committee on the Rights of the Child emphasized the affirmative government obligation to ensure that the benefits of immunizations reach "all children who need them."  Similarly, the UN Social Forum to be held in Geneva later this month will focus on "access to medicines in the context of the right of everyone to the enjoyment of the highest attainable standard of physical and mental health."

Researchers at the World Health Organization, balancing the individual right to refuse vaccines with the collective right to health, have concluded that:    

  "Parent's refusal to get vaccinated or to vaccinate their children can cause collective harm by       incrementing the pool of unprotected, susceptible individuals in a community.  With herd       immunity compromised, devastating disease outbreaks can occur.  In these settings, individuals       are morally obligated to accept vaccination to prevent harm to others."

Some experts, sensitive to individual autonomy issues, have suggested that governments should comply with their health-related obligations through education and encouragement -- i.e., "nudges" -- rather than attaching punishment to vaccination refusal.  If "nudges" are as, or more, effective than other approaches, then this would certainly be an appropriate route.  

Whatever mechanism a government adopts for promoting vaccination, however, it is clear that the weight of the human right arguments fall on the side of promoting the right to health.  The right to refuse vaccine may be compelling when considered in isolation, but people who refuse vaccines do not do so in isolation, and the collective human right to health prevails.

Health, Martha F. Davis | Permalink


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