August 28, 2008
by Douglas Todd | columnist
The unidentified Christian community's stand against immunizations raises controversial ethical questions about religious freedom and the obligation of an individual or community to both children and the larger society.
A small number of religious groups around the world oppose immunization. That, health officials say, has led in past decades in North America, Africa and Europe to unusual outbreaks of polio, measles and other infectious diseases.
In a related development in the U.S., a growing number of parents worried about possible health side-effects of immunizations are refusing them by claiming a religious exemption - including many who later admit their reasons were not religious.
"I don't think this issue is a small matter. It's best to look at it in its complexity," said Alister Browne, director of ethics and law at the University of B.C. medical school.
The ethical importance of a society protecting the health of children and others against infectious disease, Brown said, must be weighed against a person's right to religious freedom and the level of risk involved to others in refusing immunizations.
He said some infectious diseases are much more dangerous than others. Mumps, which for two-thirds of people is no more troublesome than a cold, can in rare cases lead to sterility, is a less serious infectious disease than, for instance, life-threatening polio, said Brown.
However, the medical ethicist said the relatively low health dangers associated with mumps (which many people over age 50 had as children) should not cause parents to ignore there is some valid moral pressure on them to agree to immunizations.
Even though it's theoretically possible for a tight-knit group of strongly religious adults to refuse vaccinations and not endanger anyone but themselves, Brown said "in the real world today" it's almost impossible to contain such an infectious virus.
Health officials have said the Fraser Valley mumps outbreak appeared to originate with two people from Alberta carrying the mumps to an unidentified Christian community near Chilliwack that has a low rate of vaccinations.
According to the Fraser Health Authority, there have been 116 confirmed cases of mumps and another 74 suspected cases since February. On average, the region has only 10 cases a year of the viral disease, which typically spreads through an exchange of saliva.
Cases have been reported as far west as Burnaby. Vancouver has had only four cases this year, a normal number with no known connection to the valley outbreak.
The Handbook of Religion and Health, edited by Dr. Harold Koenig, reports that in the past several decades there have been outbreaks of infectious diseases, including polio, measles and rubella, among several religious groups that shun immunizations. They have included Christian sects in Nigeria, Old Order Amish and Mennonite communities in the Eastern U.S. and Dutch Reformed churches in the Netherlands.
Despite arguments for religious freedom, Michael McDonald, professor in the Maurice Young Centre for Applied Ethics at UBC, believes adults in the Chilliwack community may be ethically required to accept vaccinations to both protect their children and members of the larger society.
The health and safety of others, particularly children, is a justified "limit to religious freedom," McDonald said Wednesday.
Dr. Elizabeth Brodkin of the Fraser Health Authority said she understands that the Chilliwack religious group, which she would not identify, interprets scripture to believe that agreeing to an immunization shows a lack of faith in God's ability to provide protection.
However, McDonald said adults in the Christian group will now have to do some "sober reflecting" as they face the reality that their community has not been spared from mumps.
Anti-vaccination beliefs in both Canada and the U.S. are not restricted to religious groups.
In the U.S., a growing number of secular parents are refusing mandatory vaccinations for their children out of fears of possible harmful side-effects, including allergies and even autism. (There have been many studies, none of which have found such a link.)
Many of those anxious parents are claiming a religious exemption to keep health officials from vaccinating their children, though some admit neither they nor even their spiritual communities have "deeply held" convictions on the matter.
Mainstream health officials say the parents' health fears are unfounded. And even though the number of parents in the U.S. who are formally applying to avoid vaccinations is growing, in most states they remain less than one per cent of the population.
The laws surrounding immunization are often murky, complex and change region by region, both in the U.S. and Canada. By and large in Canada, immunization against a variety of infectious diseases is not strictly mandatory.
At UBC, Browne said one of the main ethical weaknesses of parents choosing to opt out of society-wide vaccination programs is that their children end up benefiting from the fact the vast majority of parents do agree to immunizations.
Widespread vaccinations help a society develop what is called a "herd immunity" to an infectious disease such as mumps.
"In this way," Browne said, "the parents who refuse vaccinations get an ethical free ride. They get the benefits without taking any of the perceived risks."
To read Douglas Todd's blog, go to www.vancouversun.com/thesearch
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