Saturday, April 19, 2014

Compulsory child vaccination and the conscientious objection business

Ontario’s health minister Deb Matthews announced this week that she is adding three further diseases to the list of illnesses against which children in the province must be vaccinated. It’s mandatory. Her move has been widely lauded by public health experts and medical ethicists. We have seen in recent months outbreaks of preventable illnesses in communities with unusually low vaccination rates. You might recall the most recent outbreak of measles in BC’s Fraser Valley where more than 200 children came down with the measles. The situation seems directly linked to a community objecting to vaccines on religious grounds. Don’t think of measles as a harmless kind of infection. More than 100.000 children die each year worldwide of this entirely preventable disease.

Why on earth would parents not wish to protect their children against a serious infectious but preventable disease? Well, some parents likely will simply forget, or think that it’s not that important. After all, if we have herd immunity you can with reasonable confidence become a non-vaccinated free-rider on your responsibly vaccinated fellow citizens. However, if lots of us choose to become such free-riders the risk of a disease outbreak increases quite dramatically. It’s simple maths really. In any case, it is probably fair to say that not getting your children vaccinated simply because you were too lazy or too selfish, aren’t terribly good ethical justifications for your omission to get your kids vaccinated.

Another possibility is that you belong to those misguided parents out there who have decided, typically based on conspiracy websites that I won’t even be mentioning here, that vaccines do all kinds of evil things and really you mean to protect your child from these evils. No doubt you’ll mention autism as an example of the evils caused by vaccines. Well, let me just tell you that the only peer reviewed research output supporting these claims has since been withdrawn by the journal that published it initially. The researcher who wrote the piece was found guilty of misconduct by a statutory medical council. Shown to be a fraudster he was barred from ever practicing medicine again in Britain. He still remains the posterboy of current-day anti-vaccine activists. What better hero than a medical researcher ‘censored’ by the ‘establishment’. In light of this, to my mind, it makes perfect sense for governments to protect children from parents prone to listening to conspiracy theorists. This is so because if you choose to run with the views of one convicted fraudster against the rest of the biomedical and public health research establishment you haven’t quite done your due diligence. It is that simple.

Let’s assume you’re neither too lazy to have your kids vaccinated nor prone to buying into, however ludicrous, conspiracy theories. What’s left? Funny enough, there is a reason left to you that our health minister (no doubt based on good legal advice) thinks is an acceptable reason. Deb Matthews notes that it could be acceptable for you to object on grounds of conscience, or, as she describes it: religious or philosophical reasons. Fair enough, you need to make your case and apply for an exemption. But, what kind of religious reason could that be? That your god kind of had it in for your kids and that if they catch the measles (and pass them on), it’s ‘God’s will’? Or is the idea that because your imaginary friend in the sky is defined as ‘perfect’ by you, and that that perfect being would not create us as anything other than perfect. So, why bother with vaccines then? Is that it?

I’m flabbergasted about the tolerance we show toward folks objecting – against all the available evidence – to the compulsory vaccination of their children on religious grounds. They are not only risking their children’s health, they are also risking other people’s children’s health. There are always kids who suffer from a weakened immune system or who suffer from illnesses (such as cancer) that do not permit us to vaccinate them. They are put at grave risk by conscientiously objecting anti-vaccine parents.

What’s bothersome here is that, as a society, we ultimately prioritize the value of the parents’ religious convictions over their children’s well-being. I cannot see how that could possibly be ethically defended. Are we really saying that people’s clearly mistaken views about the universe matter more than the well-being of their children – and, indeed, that of other children? That’s what Minister Matthews’ religious and philosophical exemption clause ultimately boils down to. It is one thing to permit legally competent adults to make such choices for themselves, provided they are the only ones seriously affected by the consequences of their actions. Adult Jehovah’s Witnesses come to mind. If they wish to refuse life-preserving blood transfusions and bet on their imaginary friend in the sky, we should respect their choices, however, if they wish to place that bet for their vulnerable children, then surely society needs to step in and protect those children. The same holds true for children whose health is gambled with by their anti-vaccine parents. We should not tolerate religious cop-outs anymore than we tolerate parental convictions based on nonsensical conspiracy theories. Irresponsible parental conduct that is putting their children’s well-being at risk does not deserve societal accommodation.

Udo Schuklenk teaches bioethics at Queen’s University, he tweets @schuklenk.


  1. I have to say that in the same line, we have parents who feed their kids junk food instead of fresh food because it's more convenient, and who do not insist they attend school every day (I'm a teacher and too many parents let their children stay home and watch TV once or twice a week), and let them play video games in most of their free time. However, the consequences of an ill-educated and badly-fed society affects us all: adults who just marginally read and cannot hold jobs; kids who are sickly because their immune system is weak and drain resources from the health care system, etc. We let these be parental decisions, just like vaccination. To which extend do we want to let the state decide these matters?

  2. The main concern I have with the vaccination debates is that there is little room for moderation. If I had children, I would let them receive the same childhood vaccines I received, plus selected others, but definitely not HB (at least until puberty, because HB is primarily transmitted sexually) or Gardasil (perhaps ever, due to concerns about safety and efficacy). Also, I would very likely insist on a 1970s vaccination schedule.

    I once read that the real danger of vaccines is not preservatives but adjuvants; someone claiming to be a vaccine researcher wrote that a very small percentage of the population is known to be dangerously hypersensitive to vaccine adjuvants and considered "collateral damage." However, I realize anyone online can claim to be anything and that this may be nonsense.

    Parents may refuse vaccines for reasons other than religion or antigovernment skepticism, such as personal experience. I know very well that the plural of anecdote is not data, but in college I had a friend who was seriously physically disabled from what she described as a "bad lot" of a vaccine received at age three. Her parents brought her to a well-known tertiary/quarternary medical center, where her acute illness was almost immediately diagnosed as vaccine-related and they were informed she would almost certainly die. She survived and grew to be a well-adjusted, apparently happy person, but I know her overall opportunities in life were significantly limited compared to those of her peers. I do not know if her life expectancy was limited as well, and did not ask.


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