Vaccines are one of the triumphs of modern medicine. Indeed, I am thankful that my entire family has had the opportunity to be vaccinated against childhood diseases that once brought immeasurable grief, death, and destruction to much of humanity. At the same time, there is increasing interest in mandating the latest COVID vaccines as a condition of participation in society, be it for travel, recreation, or university study.
The path to coerced vaccination is tantalizing in its hope for normalcy. However, like all invasive medical treatments, the COVID vaccines are not free from risk, either known or unknown, and we should not coerce their use, either by force or through inducement.
The Benefits
This pandemic, the medical community has outdone itself in its efforts to protect humanity from the scourge of the COVID-19 virus, culminating in the production of several vaccines that protect against the savage disease symptoms. Little about these vaccines is ordinary - they were produced at break-neck speed within one year (versus the typical 10-15 years), at fantastic cost, and two of them use a novel mRNA-based approach. That these shots are increasingly available throughout the world is nothing short of an amazing feat of science and engineering that may eventually protect the lives of billions of human beings.
Supporters of mandatory vaccination note that the COVID vaccines appear to lower viral loads in their recipients, which could result in a reduction of viral transmission (although this has not been demonstrated yet). Even if transmission were not reduced, the COVID vaccines reduce symptoms among the healthy adults in trials, and this may reduce the load on hospitals and enable the infection to pass more safely through the population toward a “herd immunity”.
Finally, private institutions are entitled to implement the restrictions they feel necessary for their own proper functioning and their perceived “greater good”. Indeed, many private universities already require students to provide evidence of certain common vaccinations, in accordance with state laws.
The Concerns
The current crop of COVID vaccines have already demonstrated amazing efficacy against a common strain of the virus, and, though there are reports of some mild and serious reactions among the tens of millions of people who have been vaccinated, they have not generally troubled health authorities. So ... why the concern?
Well, first and foremost, the current COVID vaccines have only been granted Emergency Use Authorization by the Food and Drug Administration, meaning that the
... COVID-19 Vaccine has not undergone the same type of review as an FDA-approved or cleared product...
Indeed, the world has only short-term data regarding the potential risks of these vaccines, and there are some theoretical concerns for long-term risks. Moreover, the risk profile for the disease appears to be heavily skewed toward the elderly, making the cost/benefit analysis less obvious for those not at high risk for complications, especially in the face of promising treatments.
Of course, we all take risks every day, whether it be driving to work or crossing the street, and it would be foolish to live life in a paranoid fear of all possible risks, known or unknown. At the same time,
if the scientific community has missed any significant long term or rare risk related to the COVID vaccine, this mistake is being amplified over much of the world population!
The History
Though the history of medicine is full of hope and healing, it is also not without misjudgements. The list of public medical failures is quite long, including:
(1860’s) medicinal Cocaine – used for years before its addictiveness was realized;
(1900’s) X-rays - used for years before the relationship to cancer was realized;
(1930's) DES - prescribed against miscarriages until 1971, but caused rare cancers for mother and child;
(1940’s) oxygen for premature infants – blinded about 10,000 infants over 12 years;
(1950’s) Cutter incident – a vaccine that gave polio to thousands of recipients, resulting, in more than a hundred paralyzed and several dead;
(1960’s) Thalidomide – widely used as a “safe” sedative, but led to severe birth defects;
(1970’s) Swine flu – a fast-tracked vaccine caused sickness with little benefit;
(1980’s) Blood transfusions – hemophiliacs were given high-risk HIV-tainted blood;
(2010’s) Dengvaxia – a vaccine for dengue fever may have increased risk of sickness.
Unfortunately, the failures of medicine are often borne hardest by the most vulnerable in society. In the most egregious cases, the effects are even more devastating.
The "feeble-minded"
In 1927, with the reasoning that "society can prevent those who are manifestly unfit from continuing their kind", Supreme Court Justice Oliver Wendell Holmes sided with Dr. John H. Bell to force the eugenic sterilization of Carrie Buck, who was deemed "feeble-minded" - a catch-all term that included everything from psychosis to persistent masturbation. This approach led to other mistreatments, with the support of many in the medical community, including frontal lobotomies (where a non-descript part of the brain was blithely scraped away), deep sleep, and insulin shock "therapy".
Syphilis Study at Tuskegee
In 1932, Public Health Service researchers worked with the Tuskegee Institute to examine the effects of untreated syphilis on some 600 black men. Under the guise of treatments for "bad blood", participants were monitored regularly but not provided appropriate medical care. The study lasted for 40 years during which doctors watched their subjects die of a condition for which there was known medical intervention.
Nazi human experimentation
During World War II, Nazi doctors performed all sorts of sadistic medical experiments on their captives. Recalled Dr. Fritz Fischer in his defense after the war, "the whole position in 1942 had become that of a life or death struggle ... We could only do our duty as responsible people by our compliance with instructions". The sadistic experiments were necessary to identify the breaking point of human beings, so that pilots and soldiers could better protect the German homeland from attack.
The silver lining behind these public fiascos is that we know about them because, over time, the medical community has identified and corrected them.
Take-away
The hard-earned lessons of our historical medical failures were enshrined in the Nuremberg code and also echoed by the American Medical Association's Code of Medical Ethics, with text such as:
· "The voluntary consent of the human subject is absolutely essential." (Nuremberg)
· "During the course of the experiment the human subject should be at liberty to bring the experiment to an end..." (Nuremberg)
· "Informed consent to medical treatment is fundamental in both ethics and law.” (AMA)
Voluntary vaccination is a great boon of modern medicine that may well protect us from horrible diseases from our past. However, coerced or pressured vaccination is a moral anathema, and especially so for the new COVID vaccines whose risks are still being evaluated.
Our medical doctors and scientists work tirelessly on behalf of humanity ...but they are also human beings, and the hard-earned lesson of history is that humans can make horrible mistakes.
Free societies recognize these risks and allow individuals to choose to accept them.
Indeed, it is precisely during times of great distress, like the current international pandemic that has claimed and continues to threaten millions of lives, that our ethics face their greatest challenge.
We must never concede our soul
to protect our body.
A note about the author: Ari Trachtenberg is not a medical doctor, ethicist, or historian. He is writing in his capacity as a rational human who is affected by the current COVID-19 pandemic.