The ethical negligence of parents who refuse to vaccinate their children

June 26

(Photo illustration by Joe Raedle/Getty Images)

Most parents see vaccinations as a medical necessity to protect their children from what are now preventable diseases, including measles, mumps, rubella, whooping cough and chicken pox. Others are steadfast in their belief that vaccinations are a danger to their children, and choose not to immunize them. In fact, a study published in the journal Pediatrics showed that 1 in 10 parents in the United States now forgo or delay vaccinations for their kids.

The anti-vaccination movement is a relatively new one that has taken hold over the past decade. Started by a small community of parents, it is based on myths that have been perpetuated by the power of the Internet and endorsements from celebrities such as actress Jenny McCarthy, who has suggested that vaccinations may have caused her son’s autism.

But what began as a small movement is now powering a full-blown health crisis. In May, the U.S. Centers for Disease Control and Prevention (CDC) announced that the number of people with measles had reached a record for any time since the disease was declared eliminated in this country in 2000. According to the CDC, much of the outbreak is attributable to unvaccinated people who acquired the disease during travel abroad.

Although medical facts show there is no evidence to support the argument that vaccinations aren’t safe, they aren’t enough to persuade those who are committed to their beliefs. The real problem is that the medical community is a victim of its own success: We’ve been lulled into a false sense of security when it comes to disease and vaccinations. People under the age of 50 didn’t come of age in an era when these now-preventable infections were deadly. So it’s very easy for them to believe that there aren’t any ramifications to not vaccinating their children.

Hard scientific facts and trends show that couldn’t be farther from the truth. In addition to the measles outbreaks, nearly 10,000 cases of pertussis (whooping cough) have been reported to the CDC since the beginning of the year. With the rise of antibiotic-resistant bacteria, it’s even more important to make sure children are immunized. Some vaccines protect against viruses that can lead to secondary bacterial infections. Other vaccines protect against bacterial diseases themselves. In both cases, the threat of antibiotic resistance hovers over the vaccine controversy. Well-meaning parents don’t understand the risk of this deadly combination. The potential synergy between vaccine refusal and antibiotic resistance can have lethal consequences.

Clearly there is a public-health reason to vaccinate your child, but as a medical ethicist, I’m even more concerned with the ethical ramifications, and they’re simple: Children will die unnecessarily when they are not vaccinated. We live in a society with access to the best medicine in the world. This should never happen.

Some parents believe that vaccinating their children is a decision that only affects them and their families. Not true. Vaccinations are based on the premise of “herd immunity.”  A certain percentage of the population must be immunized to fully protect against the disease. Once that number falls below a certain level, people are at risk, especially children too young to be immunized, pregnant women and immuno-compromised individuals such as those being treated for cancer.  Parents who choose not to vaccinate their children also are putting other peoples’ children at risk along with their own younger children, whose immune systems may not be developed enough to fight off these infections.

Simply put, parents who choose not to immunize their children are ethically negligent. They contribute to the loss of innocent lives.

Some doctors choose not to care for families who refuse to vaccinate their children. This is something that we discouraged during my time on the ethics committee of the American Academy of Pediatrics about 15 years ago. Rather than “firing” these families, pediatricians should think of this moment as an educational opportunity. Some doctors keep such families in their practices in the hope of being able to provide enough evidence and gain enough trust to eventually persuade the parents to vaccinate their children.

The medical community can’t do this alone. Schools must insist that children cannot start kindergarten without being vaccinated. This approach has been phenomenally successful in states such as West Virginia and Mississippi, where there haven’t been measles outbreaks since 1994 and 1992, respectively. State and local governments also need to beef up their education campaigns to dispel the fears that autism and learning disabilities are caused by vaccines. And people will listen to community leaders they trust, including clergy and lay leaders. They must help.

After decades of medical progress toward eradication of deadly infectious diseases, we are losing ground. With outbreaks of preventable infections on the rise, it has never been more urgent that we create a well-rounded education movement to support vaccinations. It will require partnership, patience and understanding on all sides—and it’s our best hope to preserve the health of our children and our society.

Eric Kodish is a physician and director of the Cleveland Clinic’s Center for Ethics, Humanities and Spiritual Care.

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