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Major Ethical Dilemma:
Mandatory Vaccination Laws
Introduction and Background Information
The topic of mandatory vaccination laws is not a new subject, the controversy over the
ethical dilemma of mandatory vaccines has been around for about two centuries. Vaccines are
one of the greatest accomplishments in the public health sector, which aims to improve the
overall health of targeted populations. Vaccination has become readily available in most parts of
the world, but is highly debatable when concerning legal mandates and school entry. There are
many good reasons to consider mandates, an example would be to effectively increase vaccine
coverage. When discussing mandatory vaccination laws, there exists a need to balance personal
autonomy and freedom with public health and social responsibility, but there are other
considerations to be examined. The broader social and political costs of invoking a new
governmental power on people not only changes the relationship between the individual and
state, but it changes the dynamic of how states enforce their power.
There are no federal laws in the United States that regulate vaccination because it is done
at a state level, which varies from state to state. A major technique used by states to enforce
vaccination is mandating that students receive vaccination prior to enrolling them in school.
States allow exemptions to the law in three ways, which are medical, religious, and philosophical
exemptions. Parents who take use of the exemptions are allowed to enroll their children in school
without certain vaccinations. States such as Minisota and California do not accept religious or
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philosophical exemptions for vaccine refusal. This poses the question, how aggressively can
states use their power to mandate vaccines? States have obligations to ensure that all non-exempt
children are fully immunized and their intervention is justifiable in times of epidemic when
non-immunization poses a risk and threat to many. This is called “herd immunity” when vaccine
coverage is too low, now making the vaccines ineffective in preventing wide disease spread. The
herd immunity debate is about searching for ways to respect sound decisions that individuals
wish to make while protecting those who are not capable of making the decision to vaccines
themselves. What policy makers must do is take into ethical consideration is the perspectives of
the patients and the guardians of patients because they may not be aware of the social
responsibility and how their choices can affect the health of others. There is a responsibility for
policy makers, practitioners, and researchers to be compassionate towards individuals who refuse
vaccines. As a result, professional ethics emerge when deciding how to best approach an
individual who repeatedly refuses vaccines or is hesitant. How do policymakers, public health
personnel, and researchers communicate to vaccine-hesitant individuals regarding the overall
greater good public health and immunization? Is it ethically appropriate to leverage or persuade
individuals to take action and get their vaccines?
School-entry Mandates
Moreover, there are strengths and weaknesses to be argued about the mandatory vaccination
laws. To reduce common illnesses and eliminate harmful diseases, medical and public health
personnel created mandates that enforce all kids to be vaccinated as a condition to enroll in
school. The goal is to raise vaccination rates among children because they are most vulnerable
and susceptible to illnesses. In 1999, the Task Force on Community Preventive Services
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reviewed studies on the effectiveness of school-entry vaccination laws. Finding that studies
supported the effectiveness of school-entry laws in reducing disease rates and disease outbreaks
and improving vaccination coverage and immunity, the task force recommended laws or policies
that require vaccinations in schools as a strategy to improve immunization coverage (Horlick, et
al., 2007).
The argument demonstrates that when parents are compliant with the school-entry laws,
disease and illness in the community decreases. Laws that require parents to ensure vaccination
of their children as a prerequisite for school entry are consistent and necessary for the common
good. Without the school entry-laws, many diseases prevented by vaccines would find their way
back at much higher rates. Moreover, states with school-entry laws have higher coverage of
vaccination than states who do not have school-entry laws. The principal justification for a law in
this setting is not to build herd immunity or prevent free-riding but simply to protect the child
against an infection (Horlick at el., 2007).
The mandates regarding children vaccination before entering school is appropriate for a
number of reasons. For example, schools have many germs that a child comes in contact with.
Hundreds of children are exposed to coughing, sneezing, and touching other students. The most
common phenomenon is known as whooping cough. According to the Centers for Disease
Control and Prevention, since 2010, states report tens of thousands of whooping cough cases
each year in the United States (CDC, 2017). Whooping cough can be serious in infants and
children, which makes it important to ensure children are not spreading it around. Getting your
child protected before starting schools will prevent them from getting sick, other children, and
vulnerable individuals in a community.
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Saving Time and Money
Another strength to mandatory vaccination laws is that it not only saves children’s lives, but it
also saves their parents time and money. Vaccine-preventable diseases can be costly resulting in
doctor’s visits and hospitalizations and by getting children vaccinated on time, parents are able to
save time and money. The Center for Disease and Control (CDC) estimates children who were
vaccinated between 1994 and 2018 has saved the United States nearly $406 billion in medical
costs and $1.88 trillion in total society costs (CDC, 2020).
When children get sick with a vaccine preventable illness, the parent will then seek
treatment for the child, which will cost time and money. If the child’s vaccine preventable illness
were to have further complications, the child will be spending time in a hospital, which include
hospital bills, prescriptions drugs, and plenty of doctor’s visits. One study in the journal called,
Pediatrics, conducted an experiment that examined the total costs of different vaccine
preventable diseases and the savings that occurred by vaccinating. The results were astonishing,
showing that the cost per hospitalization for an infection with Haemophilus Influenza type B (a
bacterial illness that results in meningitis) can cost $43,000 and over. An estimated $1.8 billion
in costs will be saved from 19,000 cases being prevented for children born in 2009 because of
routine vaccination. The results, from both direct cost and societal perspectives, vaccinating
children as recommended with these vaccines results in substantial cost savings (Zhou et al.,
2014). Furthermore, under the Affordable Care Act many vaccines are available to children and
adults without copays and deductibles.
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Vaccination is Necessary
In addition to arguments strengthening the mandatory vaccine laws, vaccine preventable diseases
have not fully disappeared so vaccination is still necessary. Many vaccine preventable diseases
are still apparent in the United States. Thanks to vaccination, the paralytic form of polio has
astonishingly vanished, but the virus still exists in certain parts of the world. The symptoms of
polio can be incubated within an individual for years without showing any symptoms and that
person can easily infect an unvaccinated child or adults who are vulnerable. The virus then has a
chance of mutating into its original paralytic state and spread among more unvaccinated
individuals.
