Richard H. Carmona, MD, MPH, FACS, served as the 17th Surgeon General of the United States from August 2002 through July 2006. He currently serves as Chief of Health Innovations at Canyon Ranch, a life-enhancement company, is a distinguished professor at the University of Arizona, and is a member of Prevention's Advisory Board.
The World Health Organization (WHO) characterizes vaccine hesitancy-the reluctance or refusal to vaccinate-as one of the greatest global health threats in 2019. Vaccines are the greatest advancement of medical science in history, and not getting vaccinated will put society at serious risk for disease and death.
And yet, certain groups have been in the news for opting out of vaccinations recently. Because of this, we've seen a significant national rise in preventable diseases, such as measles and whooping cough. Although measles was declared eliminated in 2000, our current disease outbreak is largely due to children not being vaccinated. The Centers for Disease Control and Prevention (CDC) reports that measles is experiencing the highest rate of disease since 1992 with 1,044 confirmed individual cases of measles in 28 states.
Medical exemptions for vaccines are necessary but rare
The WHO reports that there are 26 vaccinatable diseases globally that people should be vaccinated against, unless there are specific reasons to object to vaccination. People's reasons for rejecting vaccination include religious, medical, philosophical, and safety.
It's true that medical exemptions are necessary, but they should be relatively rare. If there is a documented allergy or previous adverse reaction to vaccines or components of a vaccine, then it would be unethical to force someone to take a vaccine. The challenge is that many people have used this exemption to opt out of getting vaccines without a true medical reason. Holding physicians and health practitioners accountable to be able to justify the exemption should assist in eliminating those that don't have a legitimate medical reason.
However, I do not support arbitrary political revoking of a medical practitioner's order unless there is fraud or abuse by the practitioner alleged. If a person legitimately opts out of vaccines because of prospectively determined and agreed upon medical criteria, then those persons should be entered into a confidential data base. So if they are exposed to a communicable disease of concern, health officials can geographically find them quickly and decide how and what should be done to prevent the unvaccinated from becoming vectors for disease. Consideration should be given to isolation or quarantine in some cases.
Despite the complex reasons for objecting to vaccinations, the result will always bring the potential of creating disease in people who aren't vaccinated-and spreading disease. This places society at increased risk for preventable morbidity and mortality and increased cost of care at a time of mounting disease, economic burden, and an ever-expanding national debt.
The government has a responsibility to protect the health of society as a whole
With science rapidly advancing and the internet constantly evolving, vaccines went from being readily accepted to-at times-questioned, albeit sometimes through anecdotal or celebrity-driven opinions that ironically went “viral.”
The immunity against this type of “virality” should be scientific evidence. However, in an accelerated digitalized world of true and fake news, the public is often uncertain and confused about what course of action to take regarding vaccination. Our citizens sometimes exercise their individual rights to reject vaccination. Because of this, the rights of the individual are now colliding with the collective right of the society to prevent all vaccine-preventable disease.
Of course, in a democracy, immunization is not the only challenge of the individual right versus the collective right of the larger society. In these cases government may intervene to challenge the individual right of a decision that may bring harm to society-at-large. Some examples are people who choose to smoke-their secondhand smoke is harmful to others-and persons who engage in voluntary high-risk behaviors that may result in high health care costs that society may have to absorb.
In a democracy, we all have certain "unalienable" rights, however, when an individual's right encroaches on the health, safety, and security of society as a whole, then the government has a responsibility to investigate and possibly take appropriate action to protect society.
If we allow random unjustified exemptions, we will see a resurgence of vaccine-preventable diseases, like measles, tetanus, whooping cough, and many others, which we are witnessing now.
Why health concerns over vaccines are complete myths
Most of the anti-vaccine activists I have encountered aren't armed with the facts, but rather have non-scientific anecdotes, philosophical, or other concerns. As Surgeon General, in order to allay public fears of vaccinations during a period of uncertainty with the location of lost smallpox virus that was housed in the former USSR, I was re-vaccinated for smallpox publicly in front of the media. I did it to dispel any scientific or conspiracy myths generated in the early part of the 21st century.
In addition, I often had to address the media and Congress about unfounded accusations of government cover-ups regarding vaccines and a supposed association with autism. The truth is vaccines don't cause autism. Despite widespread health concerns, studies have shown that there is no such link between receiving vaccines and developing autism spectrum disorder.
I have also had to address accusations that the government allegedly pushes vaccines to support the profits of the pharmaceutical industry. When in fact, most companies lost money or barely broke even when producing vaccines.
There's no legitimate comparison between abortion and vaccines. The issue with vaccines is prevention of the spread of vaccinatable, communicable disease that can cause significant morbidity and mortality, and add to our ever-expanding economic burden.
Bottom line is that we need to reconcile religious interests and safety concerns against the greater good
The world is now safer, healthier and more secure due to the evolution of vaccinology, but also more challenged due to the intersection of science, democracy, and politics in a sometimes confused and misinformed hyper-connected citizenry in our democracy. Our grand challenge as a nation now is to reconcile the important interests of a few against the greater good of society.
This is nothing short of a health diplomacy challenge, which will require a scientifically informed public discussion, along with respect and empathy for legitimate religious and safety concerns expressed by a minority of citizens.
However, the extreme polarity of our politics will require scientifically informed nonpartisan leadership in order to demonstrate the strength of our democracy in creating a solution for the greater good of the nation. As Winston Churchill stated, “it has been said that democracy is the worst form of government except for all those other forms that have been tried from time to time.”
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