UNITED NATIONS – The reemergence of measles in the U.S. after healthy authorities declared it eliminated from the country in 2000 coupled with a deadly form arising in Ebola-stricken West Africa raise the ethical dilemma of whether or not governments should impose vaccination programs on civilian populations.
The United Nations has argued that there may be no alternative when large populations are exposed to highly infectious diseases such as measles.
“Vaccination may be the only practical way to protect people against certain diseases, such as meningococcal meningitis and measles,” concluded a study titled “Ethical considerations for vaccination programs in acute humanitarian emergences” published in the United Nations Bulletin of the World Health Organization.
The paper concluded vaccination “should be voluntary unless it becomes critical to ‘prevent a concrete and serious harm.””
“The degree of risk to communities will determine to what extend individual rights may be restricted,” the paper said. “Where the threat of widespread, serious infectious disease is imminent, individual liberties may be justifiably curtailed.”
The U.N. Economic and Social Council’s Siracusa Principles, adopted at a conference in Siracusa, Italy, in 1984, state: “Public health may be invoked as a ground for limiting certain rights in order to allow a State to take measures dealing with a serious threat to the health of the population or individual members of the population.”
The U.N. principles stipulate the measures “must be specifically aimed at preventing disease or injury or providing care for the sick and injured.”
Disneyland measles outbreak
The Centers for Disease Control and Prevention in Atlanta, Georgia, reported a record number of measles cases in the U.S. were documented last year, with 644 cases developing from 27 outbreaks reported to the CDC’s National Center for Immunization and Respiratory Diseases, NCIRD.
This year, a new record may be set, with 173 measles cases reported in 17 states from Jan. 1, 2015 through March 6.
The CDC further reported the majority of people who get measles in the U.S. are unvaccinated and that travelers continue to bring the disease to the United States.
The CDC stresses the spread of measles can become an outbreak when the disease reaches a community in the U.S. in which groups of people are unvaccinated.
The 2015 measles outbreak most likely started from an 11-year-old unvaccinated traveler who became infected overseas then visited the Disneyland amusement park in California, the CDC reports. The strain of measles virus in the outbreak was identical to the virus type that caused a large measles outbreak in the Philippines last year.
The World Health Organization reported as of Jan. 20, 2015, there were 58,010 suspected cases of measles in the Philippines, including 21,420 confirmed cases and 110 deaths last year. The WHO further reported 25 U.S. travelers who returned from the Philippines in 2014 became sick with measles.
“The World Health Organization and the Philippines Department of Health are working to control the outbreak, including conducting vaccination campaigns,” the CDC reported Feb. 19.
The CDC recommends that infants 6 to 11 months of age should have one dose of measles vaccine if traveling internationally, with children in the U.S. routinely scheduled to receive measles vaccination at 12 to 15 months of age. The CDC additionally recommends that infants vaccinated before age 12 months should be revaccinated on or after the first birthday with two doses, separated by at least 28 days.
A measles outbreak in Canada this year has resulted in 119 cases of the disease in Quebec’s Lanaudiére region, including a student who attends the Ecole integree de Saint-Pierre.
The Canadian Broadcasting Company in Montreal has reported that up to 700 students and staff members of the Quebec school are now at risk of contracting measles, with children as young a 4 attending the pre-kindergarten program in the elementary grades at the school.
School authorities in conjunction with public health officials in Canada have implemented a protocol that indentifies all the unvaccinated people at the school and offers them a vaccine, with the requirement that those refusing to be vaccinated will be required to stay home for two weeks.
“I invite the people, the parents to make sure their children are vaccinated,” said Public Health Minister Lucie Charlebois. “It’s a protection for their child, but for all the people around.”
With 91 percent of the region’s general population estimated to be vaccinated for measles, the risk to the general population in the Quebec outbreak is considered minimal.
Moral debate over mandatory vaccinations
The sentiment to sue parents who choose not to vaccinate their children, known in California as “anti-vaxxers,” has risen in discussions over the Disneyland measles and fears that a seriously deadly virus like Ebola might be transported to the U.S., noted Dan Diamond, a columnist at California Healthline, in an article published in Forbes Jan. 28 titled “Measles Can Kill, and It’s Spreading. Sue Parents Who Didn’t Vaccinate? Absolutely.”
Prior to the implementation of the measles vaccine in 1963, the rate of infection for measles was close to twice that for polio, noted Richard Epstein, a senior fellow at the Hoover Institute.
He said the Disneyland measles outbreak put on the table the issue of mandatory vaccinations in the U.S.
“From the earliest times, therefore, the police power has always been construed to allow public officials to take strong action against individuals who posed threats to the health of others by the spread of communicable diseases,” Epstein wrote in a Hoover Institution opinion piece published in Newsweek Feb. 3 titled “Measles Vaccine: Whose Rights Are at Risk?”
He argued the legal question is not whether compulsory vaccination statutes could be found to be constitutionally acceptable but how far such laws could go.
He concluded compulsory vaccination statutes could require, for instance, being kept from public places, including from attending school, on the grounds that unvaccinated people create a public health risk.
“Yet agonizing choices will arise if the number of serious measles cases continues to rise inexorably,” he said.
“The blunt truth is that even libertarians and other defenders of small government should support the basic constitutional framework that gives public officials extensive powers to control against infection and disease by devices such as quarantine and vaccination,” he concluded. “Apart from the forced vaccination of compromised individuals, it is difficult to carve out some enduring constitutional island of individual rights from the general principle of state control.”
Measles to follow Ebola in West Africa
The Ebola epidemic in the West African countries of Guinea, Sierra Leone and Liberia has disrupted health care services, including childhood vaccinations, creating a second public health crisis, warns a new study.
The study, scheduled to be published Friday in the journal Science, is authored by an international group of medical scientists headed by Saki Takahashi, a Ph.D. student at the Department of Ecology and Evolutionary Biology at Princeton University, working under a grant from the Bill and Melinda Gates Foundation.
Takahashi and his associates project that after six to 18 months of disruptions, an estimated 400,000 children unvaccinated for measles are susceptible to a regional outbreak of the disease.
It could result in between 127,000 to 227,000 cases, producing somewhere between 2,000 and 16,000 deaths, creating a morbidity and mortality crisis that could equal or even exceed the health crisis caused by the now-contained Ebola outbreak that began in 2014.
“Last fall, reports coming out of Liberia, Guinea and Sierra Leone were indicating that not only was Ebola taking a huge toll but healthcare systems in the affected areas were being severely disrupted,” Justin Lester, assistant professor of infectious disease epidemiology at the Johns Hopkins Blumberg School of Public Health, one of the study’s authors, explained to an international teleconferenced press conference WND attended.
“Many facilities were closed, and for those that were open, people were often not coming during fear of the – due to fear of Ebola,” he stressed. “This prompted concern in the global health community about the effect that this eruptions might be having on vaccination for measles and other childhood infections.
“Measles in particular is known to show up during or after humanitarian crises, because it’s so infectious,” Lester explained.
The solution recommended by the study is to begin as soon as possible a crash vaccination program in West Africa to reach children that have been neglected due to the disruption caused by Ebola to routine immunization services.
In response to media questions, Takahasi recommended the inoculations should include “a bundle of vaccines,” so that in addition to measles, children would receive a polio vaccine, perhaps coupled with other public health interventions, including Vitamin A supplementation known to reduce childhood morbidity and mortality from various childhood diseases as well as measles, with the possible inclusion of anti-malaria drugs.
“Measles vaccine is just one of several childhood vaccines for which distribution may be limited by the Ebola outbreak,” the study published Friday in Science warned, noting that disruptions caused by Ebola in administering to children the oral polio vaccine and various anti-malarial drugs was also a cause of serious concern.
“However, childhood vaccine-preventable diseases are an area where there is a clear, relatively inexpensive, and one-time intervention that could erase the impact of Ebola-related health care disruptions,” the study concluded.
“Coordinated campaigns across the three Ebola-affected countries (and possibly neighboring countries) targeting those children who likely missed critical routine vaccinations during the Ebola epidemic with measles and polio vaccines, and potentially other life-saving childhood vaccines, could thwart a second public health disaster and avoid nearly 12,000 deaths from measles alone.”