William Biddle

To the editor - Do we have an ethics issue?

April 24, 2015
My intent in this letter is not to convince readers about what is ethically right or wrong, but rather to take a look at a tough ethical issue within health care and perhaps challenge their position by providing a different perspective.

There are many definitions of ethics, but here is one I like: that branch of philosophy dealing with values relating to human conduct, with respect to the rightness and wrongness of certain actions and to the goodness and badness of the motives and ends of such actions.

However, determining what is right or wrong is not always a straightforward process. Most have heard about the 2015 measles outbreak, which is thought to have started in Disneyland in southern California. At the time of this writing, there have been 84 measles cases spread across 14 U.S. states and Mexico from this one incident, according to the Centers for Disease Control & Prevention.

The outbreak has thrust the debate about vaccination into the headlines and into the “ethics arena.”

According to the CDC, during the decade prior to when the measles vaccine became available, nearly all children were infected with the measles by the time they were 15 years of age. It is estimated three to four million people in the United States were infected each year. Of those infected, an estimated 400 to 500 died, 48,000 were hospitalized, and 4,000 suffered encephalitis (swelling of the brain) from measles.

In 1963 the first live measles vaccine was licensed. In 1971 the measles, mumps and rubella (MMR) vaccine was introduced and a second booster was introduced in 1990. The CDC noted that in 2000, 86 cases of measles were reported in the U.S. As a result of this decrease in cases, measles was declared eliminated – the absence of continuous disease transmission for greater than 12 months – from the United States. And, of course, today there is a vaccine against measles that is virtually 100 percent effective.

Now the CDC has reported that the United States experienced a resurgence in the number of measles cases during 2014, with 644 cases from 27 states reported to CDC’s National Center for Immunization and Respiratory Diseases. This is the greatest number of cases since measles elimination was documented in the U.S. in 2000. Alongside the history of the measles vaccine, we must consider the history of the vaccination movement. Two distinct camps, pro and con, have formed around measles vaccination.

The pro-vaccination group argues that the incidence of measles is currently on the rise due to pockets of individuals who choose not to vaccinate their children. They also emphasize that in the recent measles outbreak, many of the infected have not been or were only partially vaccinated. They argue that the MMR vaccine for young children prevents them from experiencing a devastating illness and provides herd immunity that serves to protect individuals who cannot receive the vaccine because they’re too young, or for medical reasons, for example, if they have compromised immune systems due to the effects of chemotherapy.

The anti-vaccination group argues that the MMR vaccine can lead to autism along with unknown long-term effects that any vaccine might have on the body. It is estimated that about one in 68 children are diagnosed with some form of autism today according to the CDC’s Autism and Developmental Disabilities Monitoring (ADDM) Network. That is an increase of more than 100 percent since the condition started to receive heavy documentation in medical literature during the 1940s.

Measles-related deaths decreased significantly even in the years immediately preceding mass vaccination efforts, likely due to better nutrition and improvements in health care. The anti-vaccination group believes that very little of the decrease in the death rate has anything to do with medicine and in fact, believe the vaccine can cause significant harm. Some of this belief is founded in a paper originally published in the Lancet in 1998, but retracted by the publication 12 years later, after ethical violations against the doctor that researched and authored the study were brought to light, including practicing unneeded invasive procedures on children and getting funded, in part, by lawyers representing parents who were seeking to sue vaccine manufacturers. Yet, the misinformation continues. There continue to be studies with results that researchers can’t replicate, linking vaccines to autism and more.

Which camp is ethically right and which is wrong? Individuals feel that they should be able to choose not to vaccinate because of their concerns about the MMR vaccine’s possible effect on their children; on the other hand, there are people young and old whose lives depend on herd immunity to protect them, because they themselves cannot be vaccinated.

For herd immunity to be effective, a large percentage of that given population has to be immunized, either through vaccines or through having already acquired the disease in question. The percentage of the population having immunity differs from disease to disease, but across the board, it requires the vast majority to be immunized. Ideally, every healthy person in a population would be immunized, helping to provide a level of protection for the aforementioned individuals who, for whatever reason, can’t be vaccinated.

Having pockets of unvaccinated individuals basically leads to a breakdown in this group protection. For example, in this current measles outbreak the majority of those affected have not had the MMR vaccination.

The ethics dilemma is clear: parents have the say about whether to vaccinate their own children, but in doing so, for those who choose not to vaccinate, their decision can impact other children. A child who is not vaccinated because of their parent’s choice puts those who do not have a choice at risk.

I was raised in a generation before and during the advent of the first measles vaccine. I have had the measles, rubella, and I was born with asymptomatic polio. When my father was stationed overseas we received the measles vaccine before we traveled to be with him. I have four healthy children each of whom received the MMR vaccine. For me, the ethical choice is to have all of my relatives who can receive the MMR vaccine inoculated against these life-threatening diseases.

About the writer: William Biddle is a health care M&A consultant. He is also a public business speaker as well as a member of ACG (Association of Corporate Growth) and a corporate mentor for the Wayne Brown Institute.