Welcome to Scribd, the world's digital library. Read, publish, and share books and documents. See more
Download
Standard view
Full view
of .
Look up keyword
Like this
3Activity
0 of .
Results for:
No results containing your search query
P. 1
Public Health and Private Choice

Public Health and Private Choice

Ratings:

5.0

(1)
|Views: 33|Likes:
Published by Ian Bertram
Parents withholding their children from MMR vaccine are underestimating the risk of contracting the diseases against which it protects, are probably not factoring in at all the increased risk due to loss of herd immunity, and are almost certainly overestimating the risk of adverse reaction to the vaccine. It is easy to say they are acting irrationally, but the essence of this sort of decision is not just about risk, but also about where that risk falls. If they overestimate the risk of an adverse reaction it is a risk nevertheless that affects their child, while the risk of contracting the disease is a risk spread across all children. The choice of perspective on the decision affects the decision itself.
Parents withholding their children from MMR vaccine are underestimating the risk of contracting the diseases against which it protects, are probably not factoring in at all the increased risk due to loss of herd immunity, and are almost certainly overestimating the risk of adverse reaction to the vaccine. It is easy to say they are acting irrationally, but the essence of this sort of decision is not just about risk, but also about where that risk falls. If they overestimate the risk of an adverse reaction it is a risk nevertheless that affects their child, while the risk of contracting the disease is a risk spread across all children. The choice of perspective on the decision affects the decision itself.

More info:

Published by: Ian Bertram on Mar 27, 2008
Copyright:Attribution Non-commercial

Availability:

Read on Scribd mobile: iPhone, iPad and Android.
download as DOC, PDF, TXT or read online from Scribd
See more
See less

09/06/2012

pdf

text

original

 
Quite a few of myblogposts – all tagged I think ‘Reclaim the State’ – have been based around the idea of personal choice and self-ownership and thedegree to which these ideas should be pre-eminent. Some claim I know – andnot just individualist anarchists - that individual rights do indeed trump allothers. Where conflict arises between individuals this argument seems to meto rely on the principle that defence of those rights by all means necessary islegitimate – ultimately therefore on armed force. I’ll perhaps come back to thatanother time.Most however, me included, accept that some limitations on individual actionsare essential, while continuing to disagree on what those limitations might beand their extent. For example, if someone has a highly contagious andpotentially fatal disease like smallpox, most would think it a very severe viewof liberty not to accept that the infected person should be isolated from societyto prevent that disease spreading. The loss of liberty for this person is surelyessential for the avoidance of a much greater evil, namely the spread of thatdisease to many others and does them no lasting harm.Even so, this is still a complex issue. While isolation is a fairly neutral term, itstill means imprisonment; moreover imprisonment for reasons beyond thecontrol of the infected person. While there isprecedent, this must always be adifficult decision. It raises serious questions about the balance between thecollective rights of people in society against those of individuals. In the case of Mary Mallon– otherwise known as ‘Typhoid Mary’, she knowingly placedothers at risk, even though she had been repeatedly been told of the threatshe posed to others. She was kept in a hospital away from society for threeyears until she promised not to work with food. She broke that promise andwas confined again, this time until her death. It is known that she wasresponsible for the deaths of at least 3 people, possibly as many as 50.In Mary’s case, transmission of the disease did not occur except through poor hygiene in the handling of food. It is possible to imagine however much morevirulent diseases where an asymptomatic carrier is at large. As a thoughtexperiment, imagine a highly virulent, perhaps genetically engineered diseasewhich somehow turns 1% of those infected into symptom less carriers. Thesepeople show no symptoms but if allowed to wander around would infect therest of the population and spread the disease further. Assuming some test isavailable to identify them, should they be confined? Perhaps more to the pointhow do we administer the tests required? Blood tests for example are invasiveand in themselves require consent. Is it legitimate therefore to requireeveryone to submit to a blood test in order to identify the 1% who arecarriers?What happens if the percentage is not 1% but 10%, 20%, 30% or 40%? Isthere a threshold point at which the risk to society at large, perhaps tohumanity itself makes such an intrusion acceptable? What happens if thesepeople choose not to be tested or confined? Can the state use deadly force toprotect others? Some of the implications of this are dealt with in a sciencefiction context in Greg Bear’s book ‘Darwin’s Radio, or in the films28 Days Later and ‘28 Weeks Later ’ but the potential threat posed by Bird Flu reminds us that there are real dangers.
 
Immunisation takes us into even more difficult territory. Unlike confinement,immunisation depends on an ‘invasion’ of the person. It also depends on ‘herdimmunity' to be fully effective. In other words when the proportion of vaccinated people in a population exceeds a given percentage, the spread of the disease is effectively stopped - to the benefit of the unvaccinated as muchas the vaccinated. This percentage depends on the disease and the vaccine,but 90% is not uncommon. Failure to take up immunisation thus places at risknot just that individual, but also every other un-immunised person – includingpeople who may be allergic, too young or too old.The classic recent example of this was the debate over MMR, where becauseof fears about a relationship between the vaccination and autism, vaccinationlevels in some areas of the country have fallen well below the herd immunitylevel, with consequent increase in infection rates.Even with high vaccination levels those affected by measles are notevenlydistributed.
Where vaccination is widely practiced, as in the United States since1962, measles has continued to occur in poorly immunized subgroupsthat are characterized by low educational level and economic status,very young age, or religious beliefs forbidding acceptance of vaccine.Ultimate success of a systematic immunization program requiresknowledge of distribution of susceptibles by age and subgroup and maximal effort to reduce the concentration of susceptibles throughout the community rather than aiming to reach any specific proportion of the overall population.
The vulnerable sub-groups described above presumably do not choose to bevulnerable and the low take up of MMR vaccine in these groups is not ingeneral related to concerns about side effects. By contrast parents who dochoose not to immunise their children are doing so because of specific fearsabout the MMR vaccine. In doing so they are effectively deciding that the riskof adverse effects to their child from the combined injection outweighs the riskof contracting Measles, Mumps or Rubella including the
increase
in that riskas a result of the decline in herd immunity.If these fears are unfounded, as is almost certainly the case, then thesecalculations are erroneous and are increasing the general risk of infection for all children. Setting those particular concerns aside for the moment however,it must be recognised that there will still be some cases of an adversereaction. In those circumstances would it be legitimate to make vaccinationcompulsory?It seems to me that for low levels of adverse reaction the case can be madebut it is by no means clear-cut. The number of children aged 10 and under inthe UK in 2001 was slightly over 8m. Assuming for the moment an adversereaction rate of 1 in 100,000 children, this would mean 80 children wouldsuffer across the country as a result of the MMR injection if every one of the8m were given the vaccine. An outbreak of measles triggered by thevaccination rate falling below the herd immunity level would almost certainlylead to many more than that suffering serious illness including blindness.

You're Reading a Free Preview

Download
scribd
/*********** DO NOT ALTER ANYTHING BELOW THIS LINE ! ************/ var s_code=s.t();if(s_code)document.write(s_code)//-->