Vaccines are prepared for students during a pop-up immunization clinic at a school in Louisville, Ky., on Aug. 8, 2024.Mary Conlon/The Associated Press
Earlier this month, the U.S. dramatically altered its childhood vaccine schedule, dropping the number of diseases for which vaccines are recommended to 11 from 17.
Apparently, that was only the beginning.
Last week, Dr. Kirk Milhoan, head of the U.S. Advisory Committee on Immunization Practices, said all vaccines, including polio and measles, should perhaps be optional.
Meaning no more mandates, no more requirement that children be vaccinated against a host of preventable illnesses before attending daycare or school. (Currently all 50 U.S. states have such mandates; in Canada, only Ontario and New Brunswick do.)
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Childhood vaccination is one of the most effective medical interventions in history. At least 154 million lives have been saved over the past 50 years, most of them in children under the age of 5, according to an analysis by the World Health Organization.
So why does Dr. Milhoan, a pediatric cardiologist and pastor, want to scrap vaccine mandates? Because, he says, a person’s right to refuse a vaccine outweighs concerns about illness or death from infectious disease.
“If there is no choice, then informed consent is an illusion,” Dr. Milhoan said, according to The New York Times. “Without consent, [vaccination] is medical battery.”
In an interview on the podcast Why Should I Trust You?, Dr. Milhoan described school vaccine mandates as “heavy-handed” and “authoritarian,” and repeated his ideological belief that “individual autonomy” is paramount.
It would be easy to dismiss Dr. Milhoan as a quack. After all, he has previously claimed that COVID-19 was a “bioterror weapon” and that the vaccine caused cancer, miscarriages and heart disease (all false), and compared COVID vaccination passports to the Holocaust.
But the ACIP chair has an influential role and has raised an important issue: Should childhood vaccines be mandated?
Ideally, no. In a perfect world, every parent should want to protect children (their own, and others) from illness and death, and understand that the benefits of vaccination far outweigh the risks.
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There’s an argument to be made that voluntary programs should be sufficient; with effective communication, transparency and adequate information, everyone should be onside. (In Canada, 69 per cent of those polled support mandatory childhood vaccination.)
But that’s not the case, in large part because of organized campaigns of disinformation by vaccine opponents. The result is children being harmed.
Children do not have the competency to make their own decisions on vaccination. We mandate vaccines – and restrict parental autonomy – for the child’s own good, and the public good. We have a legal and moral obligation to do so.
We restrict parental autonomy in a host of ways: We don’t allow childhood marriage, or for parents to opt out of enrolling their kids in school, or putting them in car seats.
The “health freedom” zealots like Dr. Milhoan argue that vaccine mandates are coercive. But coercion is not always ethically objectionable. People are routinely compelled to do things they don’t like, from paying taxes to stopping at red lights.
Mandatory vaccination and informed consent are not incompatible. Nobody is getting forced injections. The shots are a condition for access to school, and in other cases, employment or travel. Again, we have many “conditions” in daily life.
Contrary to Dr. Milhoan’s claims, individual rights are not absolute. Even the American Civil Liberties Union endorses vaccine mandates, saying they protect the rights of the most vulnerable among us, including children and people with disabilities.
We won’t even mention the hypocrisy of those who are selectively proponents of choice. To wit, parents can choose whether or not to vaccinate, but women can’t choose whether or not to terminate a pregnancy.
None of this means that every vaccine should be mandatory all the time. But childhood illnesses such as polio and measles are a real threat, and the vaccines have proven records of safety and efficacy.
We have to balance self-interest with our duty to others, and liberty with usefulness of policies.
Another argument put forward by Dr. Milhoan is that abandoning vaccine mandates will provide us with real-life data on what happens to the unvaccinated, and that advances in medicine and sanitation likely mean the potential harm is not as great as in the past.
However, the fact that we are better at treating children after they get sick is not a justification for abandoning protective vaccines.
Public health must be practised in a way that is guided by science, but also with a moral compass, compassion and in the service of humanity.
Sick and dead kids are too high a price for “medical freedom.”