Abstract
This article examines an argument which may negatively influence measles vaccination uptake. According to the argument, an individual child in a highly vaccinated society may be better off by being non-vaccinated; the child does not risk vaccine adverse effects and is protected against measles through herd immunity. Firstly, the conclusion of the argument is challenged by showing that herd immunity’s protection is unreliable and inferior to vaccination. Secondly, the logic of the argument is challenged by showing that the argument is inherently self-defeating and therefore logically inconsistent. In practice the argument cannot be used to protect children against measles. Measles vaccination is undoubtedly best for children, even in highly vaccinated societies. Only if a medical contraindication to vaccination exists should vaccination be waived in favour of reliance on herd immunity. This places obligations on those who stand in care relationships with the child: parents, healthcare providers, and the state.
Similar content being viewed by others
References
Bellini, W.J., J.S. Rota, L.E. Lowe, et al. 2005. Subacute sclerosing panencephalitis: More cases of this fatal disease are prevented by measles immunization than was previously recognized. The Journal of Infectious Diseases 192(10):1686–1693.
Bester, J.C. 2016. Measles and measles vaccination: A review. JAMA Pediatrics 170(12): 1209–1215.
Bester, J.C. 2015. Vaccine refusal and trust: The trouble with coercion and education and suggestions for a cure. Journal of Bioethical Inquiry 12(4): 555–559.
Brown K.F., J.S. Kroll, M.J. Hudson, et al. 2010. Factors underlying parental decisions about combination childhood vaccinations including MMR: A systematic review. Vaccine 28(26): 4235–4248.
Buchanan, A.E., and D.W. Brock. 1990. Deciding for others: The ethics of surrogate decision making. Cambridge: Cambridge University Press.
Centers for Disease Control and Prevention. 2015. Measles. In Epidemiology and prevention of vaccine-preventable diseases, 13th ed. http://www.cdc.gov/vaccines/pubs/pinkbook/meas.html
Clemmons, N.S., P.A. Gastanaduy, A.P. Fiebelkorn, S.B. Redd, and G.S. Wallace. 2015. Measles—United States. Morbidity and Mortality Weekly Report 64(14): 373–376.
Dallaire, F., G. De Serres, F.W. Tremblay, F. Markowski, and G. Tipples. 2009. Long-lasting measles outbreak affecting several unrelated networks of unvaccinated persons. The Journal of Infectious Diseases 200(10): 1602–1605.
Deehan, H., and A. Shane. 2014. Measles activity in Canada: January–June 2014. Canada Communicable Disease Report CCDR 40(12): ISSN 1481–8531.
Demicheli, V., A. Rivetti, M.G. Debalini, and C. Di Pietrantonj. 2012. Vaccines for measles, mumps and rubella in children. The Cochrane Database of Systematic Reviews 2012(2): CD004407.
Diekema, D.S. 2005. Responding to parental refusals of immunization of children. Pediatrics 115(5): 1428–1431.
Diekema, D.S. 2011. Revisiting the best interests standard: Uses and misuses. The Journal of Clinical Ethics 22(2): 128–133.
Diekema D.S., and E.K. Marcuse. 2007. Ethical issues in the vaccination of children. In Public health ethics, edited by R. Bayer, L.O. Gostin, B. Jennings and B. Steinbock. New York: Oxford University Press.
Eurosurveillance Editorial team. 2008. Measles once again endemic in the United Kingdom. Eurosurveillance 13(27): pii=18919.
Fefferman N.H., and E.N. Naumova. 2015. Dangers of vaccine refusal near the herd immunity threshold: A modelling study. Lancet Infectious Diseases 15(8): 922–926.
Gay, N.J. 2004. The theory of measles elimination: Implications for the design of elimination strategies. The Journal of Infectious Diseases. 189(S1): s27–235.
Goldacre, B. 2008. Bad science. Toronto: McClelland & Stewart.
Insurance Information Institute. 2013. Mortality risk: Odds of death in the United States by selected cause of injury. http://www.iii.org/fact-statistic/mortality-risk. Accessed October 27, 2016.
Knol, M.J., A.T. Urbanus, E.M. Swart, et al. 2013. Large ongoing measles outbreak in a religious community in the Netherlands since May 2013. Eurosurveillance. 18(36): pii=20580.
Krantz, I., L. Sachs, and T. Nilstun. 2004. Ethics and vaccination. Scandinavian Journal of Public Health 32: 172–178.
Lesko, A.M., and A.A. Mitchell. 1999. The safety of acetaminophen and ibuprofen among children younger than two years old. Pediatrics 104(4): e39.
Lievano, F, S.A. Galea, M. Thornton, et al. 2012. Measles, mumps, and rubella virus vaccine (M-M-RTMII): A review of 32 years of clinical and postmarketing experience. Vaccine 30: 6918–6926.
Omer, S.B., K.S. Enger, L.H. Moulton, N.A. Halsey, S. Stokley, and Salmon D.A. 2008. Geographic clustering of nonmedical exemptions to school immunization requirements and associations with geographic clustering of pertussis. American Journal of Epidemiology 168(12): 1389–1396.
Omer, S.B., D. Salmon, W.A. Orenstein, P. deHart, and N. Halsey. 2009. Vaccine refusal, mandatory immunization, and the risks of vaccine-preventable diseases. The New England Journal of Medicine 360(19): 1981–1988.
Pope, T.M. 2011. The best interest standard: Both guide and limit to medical decision making on behalf of incapacitated patients. The Journal of Clinical Ethics 22(2): 134–138.
Majumder, M.S., E.L. Cohn, S.R. Mekaru, J.E. Huston, and J.S. Brownstein. 2015. Substandard vaccination compliance and the 2015 measles outbreak. JAMA Pediatrics 169(5): 494–495.
Mina, M.J., C.J. Metcalf, R.L. de Swart, A.D. Osterhaus, and B.T. Grenfell. 2015. Long-term measles-induced immunomodulation increases overall childhood infectious disease mortality. Science 348(6235): 694–699.
Moss, W.J. and D.E. Griffin. 2012. Measles. Lancet 379: 153–164.
Moss, W.J., and P. Strebel. 2011. Biological feasibility of measles eradication. The Journal of Infectious Diseases 204(S1): S47–S53.
Sheather, J. 2013. Should childhood MMR vaccination be compulsory? Rights, duties and the public interest. Human Vaccines & Immunotherapeutics 9(6): 1389–1391.
Simone, B., P. Carrillo-Sanisteve, and P.L. Lopalco. 2012. Healthcare workers’ role in keeping MMR vaccination uptake high in Europe: A review of evidence. Eurosurveillance. 17(26): pii=20206.
van den Hoven, M. 2012. Why one should do one’s bit: Thinking about free riding in the context of public health ethics. Public Health Ethics 5(2): 154–160.
Wood-Harper, J. 2005. Informing education policy on MMR: Balancing individual freedoms and collective responsibilities for the promotion of public health. Nursing Ethics 12(1): 43–58.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Bester, J.C. Measles Vaccination is Best for Children: The Argument for Relying on Herd Immunity Fails. Bioethical Inquiry 14, 375–384 (2017). https://doi.org/10.1007/s11673-017-9799-4
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11673-017-9799-4