The flu season is just about upon us. Soon flu shots will be
available to virtually everyone free of charge. And yet, if past years are
anything to go by, some 20,000 Canadians will be suffering so severely from the
flu virus that they will end up in hospital. The rest of
us will foot the bill for their by and large avoidable health care costs. Public
Health Canada reports on its website that between 2,000 and 8,000 Canadians die
every year of the flu or its complications.
Strangely only those of us in possession of a valid health
card will be able to access the flu vaccine free of charge through our health
care system. That obviously makes no sense at all. Because of this policy those
amongst us without a health card will be more likely to contract the flu, and, quite
a few of them will pass it on to others. Any sensible public health strategy
would offer these shots to anyone to increase the level of protection for
everybody.
There are, of course, as with
every pretty obvious issue, a large number of people out there who won’t get
the flu shots even though they are entitled to receive them free of charge.
They encompass conscientious objectors as well as people simply too lazy to
bother. People who do not get immunized themselves pose a higher risk to
others, both those who are also not immunized as well as those who are
immunized. The latter are also subjected to a higher than necessary risk,
because while the flu vaccine offers a higher degree of protection, it is not
100% efficacious (few things in modern medicine are).
What is the morality of our behavior in the age of influenza?
Are we ethically obliged to get vaccinated? Should it be
compulsory for people who have contacts with large numbers of customers,
clients or even patients to get vaccinated? Should employers be permitted to
fire or remove temporarily from work those employees who refuse to get
vaccinated? And what about those of us who catch influenza, should we stay at
home, or should we drag ourselves to work or school regardless? Seeing that we
would be carriers of a highly infectious illness that has the habit of killing
thousands of us every year, should we be yanked off
trains, buses and planes to protect members of the public that otherwise would
be stuck with us?
Let’s start with the easy one: Yes, we should get
vaccinated. It does not take a degree in public health or in bioethics to
figure out why this is so. In important matters that affect only ourselves or
predominantly ourselves it needs a very good reason for the state to override
our decisions. When it comes to influenza vaccination the issue is not only
about ourselves but also about potential harm to others.
Now, you could say that there wouldn’t be any risk to those who got vaccinated,
and whoever does not get vaccinated and decides to venture out during flu
season kind of consents to the risk of catching it. That isn’t quite correct.
The risk of catching the flu is only reduced by about 60% for those who got
vaccinated, and even this figure varies depending on one’s age group and other
factors. So, those of us who choose not to get vaccinated not only pose risks
to others who also have not been vaccinated
but also to those of us who did what they could to protect ourselves and
others by getting vaccinated. Basically the negative impact of a single person
who decides not to get vaccinated quickly cascades through society. The more
people there are who don’t get vaccinated the more people we will see ending up
in hospitals and, unfortunately, in the morgues.
That does seem an unreasonably high price to pay for individual laziness or unfounded
ideas about vaccines and autism.
Autism and vaccines? Oh, in case you have not heard, like
with all good things, there are always some people (like ex Playboy model and actress
Jenny McCarthy) who make wild public claims about matters they know little
about. In the case of vaccines, a quite efficient grassroots campaign has got
off the ground irresponsibly misinforming us that we should not get vaccinated
lest we wish to increase the risk of developing autism. Health
authorities around the planet, including
Health Canada and the
Centers for Disease Control in the USA have declared
categorically that vaccines do not cause autism. There is zero evidence for the
claim that autism is linked to vaccines. Will that stop the fans of conspiracy
theories from claiming the opposite? Likely not. Is that a good reason to
refuse getting vaccinated? Not really.
Well, back to our questions. What if you failed to get
vaccinated or you got vaccinated and you realise the vaccine doesn’t quite do
the trick for you. Should you drag yourself to work or school and show that
you’re not a wimp? Well, the long and short of it is that you should stay at
home to protect others as good as you can. The best you can do is to limit the
number of people you interact with while you are highly infectious. The primary
aim of your actions should be societal harm minimization. It follows that if
you can avoid going on the journey you booked, do not board buses, train and
planes as it is very likely that while you and the other passengers are stuck
in these confined spaces for a couple of hours, you will infect a whole bunch
of others who in turn will infect a whole bunch of others, etc.
Should we require health care professionals who see patients
as part of their daily work routine to get vaccinated? Of course we should.
Health care professionals typically see people in an already weakened health
state. The last thing these patients need is to be treated by professionals who
think nothing of passing a dangerous virus on to them. First do no harm remains
one of the foundational principles of medical practice. It would behoove health
care professionals refusing to get vaccinated against influenza to keep this
one in mind. Even though influenza vaccines do not grant 100% protection, at
least they dramatically decrease the likelihood of a vaccinated health care
professional catching and passing the virus on to their patients. Working in
the healing professions both comes with special rights as well as special
obligations.
Udo Schuklenk is a bioethics professor at Queen’s
University, he tweets @schuklenk
