Compulsory Immunization Topic 50

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Unformatted text preview: Whitman College Tournament 2008 1 File Title Index Index..................................................................................................................................................................... 1 Index.....................................................................................................................................................1 Topic Overview..................................................................................................................................................... 5 Topic Overview...................................................................................................................................5 Affirmative Case................................................................................................................................................... 6 Affirmative Case.................................................................................................................................6 Affirmative Case................................................................................................................................................... 7 Affirmative Case.................................................................................................................................7 Affirmative Case................................................................................................................................................... 8 Affirmative Case.................................................................................................................................8 Affirmative Case................................................................................................................................................... 9 Affirmative Case.................................................................................................................................9 Negative Case..................................................................................................................................................... 10 Negative Case....................................................................................................................................10 Negative Case..................................................................................................................................................... 11 Negative Case....................................................................................................................................11 Negative Case..................................................................................................................................................... 12 Negative Case....................................................................................................................................12 Negative Case..................................................................................................................................................... 13 Negative Case....................................................................................................................................13 Definition: Public Health..................................................................................................................................... 14 Definition: Public Health................................................................................................................14 Definition: Justify................................................................................................................................................ 15 Definition: Justify.............................................................................................................................15 Definition: Compulsory Immunization................................................................................................................ 16 Definition: Compulsory Immunization.........................................................................................16 Majority Support Compulsory Vaccination.......................................................................................................... 17 Majority Support Compulsory Vaccination................................................................................17 Compulsory Immunization Empirically Works.................................................................................................... 18 Compulsory Immunization Empirically Works..........................................................................18 Compulsory Immunization Prevents Diseases...................................................................................................... 19 Compulsory Immunization Prevents Diseases.............................................................................19 Compulsory Immunization Better Than Alternatives........................................................................................... 19 Compulsory Immunization Better Than Alternatives................................................................19 Whitman College Tournament 2008 2 File Title Public Safety Is More Important than Individual Liberty..................................................................................... 20 Public Safety Is More Important than Individual Liberty........................................................20 Voluntary Immunization Fails............................................................................................................................. 21 Voluntary Immunization Fails.......................................................................................................21 Voluntary Immunization is Discriminatory.......................................................................................................... 22 Voluntary Immunization is Discriminatory.................................................................................22 The Supreme Court Supports Compulsory Immunization.................................................................................... 23 The Supreme Court Supports Compulsory Immunization.......................................................23 Broad Exemptions Are Dangerous....................................................................................................................... 24 Broad Exemptions Are Dangerous................................................................................................24 Broad Exemptions Are Dangerous....................................................................................................................... 25 Broad Exemptions Are Dangerous................................................................................................25 Limited Exemptions Are Dangerous.................................................................................................................... 26 Limited Exemptions Are Dangerous.............................................................................................26 Beneficence Demands Compulsory Vaccination.................................................................................................. 27 Beneficence Demands Compulsory Vaccination.........................................................................27 Utilitarianism Demands Compulsory Vaccination............................................................................................... 28 Utilitarianism Demands Compulsory Vaccination.....................................................................28 A2 Individual Liberty.......................................................................................................................................... 29 A2 Individual Liberty......................................................................................................................29 A2 Individual Liberty Social Contract.............................................................................................................. 30 A2 Individual Liberty Social Contract......................................................................................30 A2 Individual Liberty Multiple Checks............................................................................................................. 30 A2 Individual Liberty Multiple Checks.....................................................................................30 A2 Parental Autonomy........................................................................................................................................ 31 A2 Parental Autonomy....................................................................................................................31 A2 Parental Autonomy........................................................................................................................................ 32 A2 Parental Autonomy....................................................................................................................32 A2 Safety............................................................................................................................................................ 33 A2 Safety............................................................................................................................................33 A2 Safety............................................................................................................................................................ 34 A2 Safety............................................................................................................................................34 A2 Safety............................................................................................................................................................ 35 A2 Safety............................................................................................................................................35 A2 Safety............................................................................................................................................................ 36 A2 Safety............................................................................................................................................36 Whitman College Tournament 2008 3 File Title A2 Freedom of Religion...................................................................................................................................... 37 A2 Freedom of Religion...................................................................................................................37 A2 Freedom of Religion...................................................................................................................................... 38 A2 Freedom of Religion...................................................................................................................38 A2 Nature of Disease Test................................................................................................................................... 39 A2 Nature of Disease Test...............................................................................................................39 A2 Human Rights Test........................................................................................................................................ 39 A2 Human Rights Test....................................................................................................................39 Neg Evidence...................................................................................................................................................... 40 Neg Evidence.....................................................................................................................................40 Individual Freedom............................................................................................................................................. 40 Individual Freedom.........................................................................................................................40 Individual Freedom............................................................................................................................................. 41 Individual Freedom.........................................................................................................................41 Religious Freedom.............................................................................................................................................. 41 Religious Freedom............................................................................................................................41 Relgious Freedom................................................................................................................................................ 42 Relgious Freedom.............................................................................................................................42 Parental Autonomy Works................................................................................................................................... 43 Parental Autonomy Works.............................................................................................................43 Parental Autonomy Empirically Works............................................................................................................... 44 Parental Autonomy Empirically Works.......................................................................................44 Parental Autonomy is Supported By Experts....................................................................................................... 44 Parental Autonomy is Supported By Experts..............................................................................44 Compulsory Immunization Damages Freedom of Religion.................................................................................. 44 Compulsory Immunization Damages Freedom of Religion.......................................................44 Compulsory Immunizations Fail.......................................................................................................................... 44 Compulsory Immunizations Fail...................................................................................................44 Voluntary Immunization Works.......................................................................................................................... 45 Voluntary Immunization Works...................................................................................................45 Voluntary Immunization Works.......................................................................................................................... 46 Voluntary Immunization Works...................................................................................................46 Vaccines Are Harmful......................................................................................................................................... 47 Vaccines Are Harmful.....................................................................................................................47 Flu Vaccines Are Dangerous............................................................................................................................... 48 Flu Vaccines Are Dangerous..........................................................................................................48 Whitman College Tournament 2008 4 File Title HPV Vaccines are Unjust.................................................................................................................................... 49 HPV Vaccines are Unjust................................................................................................................49 A2 Supreme Court............................................................................................................................................... 50 A2 Supreme Court...........................................................................................................................50 A2 Vaccines Work.............................................................................................................................................. 51 A2 Vaccines Work............................................................................................................................51 A2 Vaccines Work.............................................................................................................................................. 52 A2 Vaccines Work............................................................................................................................52 A2 Public Risk.................................................................................................................................................... 52 A2 Public Risk..................................................................................................................................52 Whitman College Tournament 2008 5 File Title Topic Overview General Information: Compulsory immunization refers to the practice of state actors requiring individuals to receive vaccinations in order to receive certain benefits. The most common form of compulsory immunization in the United States today is required vaccination for public or private school entry. The practice is justified by lawmakers through citations of historical success, such as the elimination of Small Pox in the United States over the course of the nineteenth century, and substantial Supreme Court case law protecting the constitutionality of compulsory immunization. Challenges to compulsory immunization rely on claims that the practice undermines religious and philosophical freedoms. Many vaccines are tested human fetuses and the invention of HPV Vaccines and AntiAddiction vaccines raise potent questions about individual liberty. Others question the safety of vaccines by citing numerous examples of dangerous vaccinations and arguing that medical studies proving the safety of vaccinations are biased. Central Question: Is individual liberty more important than public welfare? Affirmative Strategies: -Values/Criteria: Public welfare, public safety, beneficence, and nonmaleficence / utilitarianism, social contracts, democracy -Majority of Americans support compulsory immunization -Historical examples of successful immunization -What constitutes Public Health? Most affirmatives will want a narrow interpretation -Supreme Court case law protects compulsory immunization -Objections to Vaccines are overhyped and based on irrational fear -Medical exemptions prevent plausible dangers of vaccines -Extensive studies ensure the safety of vaccinations -Definition of compulsory immunization: The affirmative must win a narrow definition of the term. This means the affirmative must allow for some exemptions to vaccination. State definitions would be effective. Negative Strategies -Values/Criteria: Individual liberty, freedom / social contracts, deontology -Broad definitions of public health allow the negative to demonstrate that compulsory immunizations aren't Justified -Broad definitions of compulsory and compulsory immunization may convince judges that the violations of individual liberties are large. For example, arguing compulsory implies punishment could add weight the case -Argue about specific vaccinations. New vaccinations such as HPV and Anti-Addiction vaccinations raise several moral issue that already eradicated diseases do not -Other strategies are successful -Malthus vaccines prevent natural die off of populations that prevent larger extinctions in the future. -Parental autonomy is more important than state sovereignty -Religious freedom is a d-rule issue -Vaccines are dangerous cite historical examples and new trends -Capitalism bad criticism Vaccines are promoted by multinational drug companies that should be rejected for maintaining and enforcing capitalism -Technology bad criticism Technology converts populations into standing reserves that are only valuable insofar as they could benefit the state -Biopower criticism Compulsory vaccination is a force of state control and absolute sovereignty that can justify mass extermination Whitman College Tournament 2008 6 File Title Affirmative Case Compulsory Vaccinations have eradicated multiple infectious diseases in the United States. Few Americans ever think about the devastating effects of lethal epidemics like Small Pox or Polio because compulsory vaccination has been so successful. One hundred years of modern medical research have removed many of the harmful side effects of vaccines that were present during the eighteenth century. Multiple Supreme Court decisions and countless state court decisions have repeatedly found that the individual autonomy violated by compulsory vaccination is far outweighed by the benefits to Public Health and welfare. Multiple legal and medical safeguards are in place to protect those that could be harmed from compulsory immunization. Therefore I stand resolved: that public health concerns justify compulsory immunizations. I will define three terms in the resolution. First: Public Health, from the Oxford English Dictionary, 2008: The health of the population as a whole, esp. as monitored, regulated, and promoted by the state (by provision of sanitation, vaccination, etc.) Second: Justify, from the Oxford English Dictionary, 1989: To show or maintain the justice or reasonableness of (an action, claim, etc.); to adduce adequate grounds for; to defend as right or proper. Third: Compulsory Immunization: the state interpretation of compulsory immunization is the best for this debate. Immunizations or legal exemptions from immunization are required of children before entering public and private school. This definition is based both upon the use of compulsory immunization in the United States today and the Supreme Court decision in Prince vs. Massachusetts (1944). My value for the debate is Public Welfare or the wellbeing of the public. 1. Public welfare is a prerequisite to all other social values. Neither individual autonomy nor justice can be achieved unless a society is generally healthy and capable of creating, participating in, and protecting social institutions. Public welfare is essential to quality of life. There is no quality of life without public welfare in societies and quality of life is a necessary precondition to happiness and value to life. 2. My criterion is Utilitarianism or the ensurance of the greatest good for the greatest number of people within society. This is the best way to ensure public welfare because it maximizes both quality of life and well being of the public in general. Further, it is the most clear ethical framework to deal with issues that involve some level of state coercion, like Public Health. Contention 1: The Majority of Individuals Support Compulsory Vaccination 1. Only 12% of parents with at least one child under 18 oppose compulsory vaccination. Allison M. Kennedy, MPH, Cedric Brown, MS, and Deborah A. Gus, PhD, MPH, "Vaccine Beliefs of Parents Who Oppose Compulsory Vaccination," Public Health Reports, Vol. 120, No. 3 (May - Jun., 2005), pp. 252-258 Of respondents with at least one child aged 18 years living in the household (n1,527), 12% were opposed to compulsory vaccination. Survey results indicate that a parent's belief regarding compulsory vaccination for school entry is significantly associated with beliefs in the safety and utility of vaccines, as well as intention to have the youngest child fully vaccinated. Residence in a state that permits philosophical exemption to vaccination also was significantly associated with a parent's opposition to compulsory vaccination for school entry. Whitman College Tournament 2008 7 File Title Affirmative Case 2. Only a vocal minority opposes compulsory vaccination James G. Hodge, Adjunt Professor of Law at Georgetown University Law Center, and Lawrence O. Gostin, Professor of Law at Georgetown University Law Center, "School Vaccination Requirements: Historical, Social, and Legal Perspectives," Kentuck Law Journal, 2002, 90, 848-850 Despite sincere and aggressive campaigning against vaccination, most of the general public chose to be vaccinated when it became available, especially when smallpox outbreaks occurred. The fear of contracting smallpox and the assurance of public health authorities that vaccination prevented the disease sufficiently swayed most individuals to be vaccinated. 16 Many abandoned their antivaccinationist views in the face of compelling medical, and public health, proof of the effectiveness of the smallpox vaccine. A 1915 editorial in the Times stated: "only the wildest of the anti-vaccinationists now deny the efficacy of the Jenner [vaccine] as a protection from smallpox." 17 By 1942, less than 1000 new cases of smallpox emerged in the United States. 18 Antivaccinationist sentiment largely remained the view of a vocal minority, although the fervor with which it was expressed remained influential. Antivaccinationists appealed to interests close to individuals with facts and opinions that were both rational and irrational. They portrayed vaccines as foreign substances, or poisons, capable of causing more harm than good. 19 Vaccinations were described as a "surgical operation," 20 not routine medical care. The effectiveness of the vaccine itself led to a progressive, albeit apathetic, argument: since the vaccine has worked, why should individuals continue to be subjected to the harms of vaccination unless there exists an actual threat of disease in the community? [*849] Public health authorities were characterized as abusive, untrustworthy, and paternalistic. 21 Resisting public health efforts was equated with fighting government oppression. Antivaccinationists asserted that vaccinations (and even medical treatment for smallpox) 22 were contrary to their sacred religious beliefs. 23 As discussed in Part IV.B, these and other sentiments continue to be expressed today. 24 Contention 2: Utilitarianism Demands Compulsory Vaccination 1. Utilitarianism Demands Compulsory Vaccination Robert I. Field, Ph.D. and Professor of Health Policy at the University of the Science in Philadelphia, and Arthur L. Caplan, Ph.D.and Professor Bioethics at the University of Pennsylvania, "A Proposed Ethical Framework for Vaccine Mandates: Competing Values and the Case of HPV," Kennedy Institute of Ethics Journal, 18.2, June 2008, p. 115 Utilitarianism takes the external judgment one step further to consider the best ultimate outcome for society, as a whole. It implements an explicit balancing of relevant factors to determine the optimum result for the greatest number of people regardless of competing individual needs. Utilitarian concerns can be consistent with those of beneficence, but they can also conflict, as when the best interests of some individuals are at odds with those of the majority. Utilitarianism supports mandating a vaccine to prevent the harm to society that could be caused by the presence of unvaccinated individuals. This is the most prominent and longstanding justification put forth [End Page 114] by mandate proponents. The Supreme Court relied on this principle in upholding a vaccine mandate against smallpox more than 100 years ago, setting a precedent that remains in effect today (Jacobson v. Massachusetts. 1905. 197 U.S. 11). Much of the harm to society results from the loss of an effect known as "herd immunity." Most infectious agents must reside in a sufficient number of susceptible individuals to maintain their presence. Eradication can occur when the proportion of the population that has been vaccinated is sufficiently large to deny the infectious agent such a reservoir of unimmunized hosts. For most diseases, herd immunity is achieved when the proportion of the population vaccinated is in the range of 90 percent. When the proportion of vaccine declinations exceeds this threshold, the infectious agent can lurk in the population to threaten not only those who are unvaccinated but also many who chose the vaccine but whose immune systems generate insufficient levels of antibodies to confer full protection (May and Silverman 2005). In this situation, a small number of vaccine declinations can have a devastating impact on a community, so the greatest medical benefit for the greatest number of people is achieved by requiring that everyone receive the vaccine. This is true regardless of whether a mandate is in the best interests of every individual or whether it ignores the interest in autonomy. It is an example of government coercion in the service of a competing ethical consideration. It also reflects an implicit hierarchy of public goods in which health takes precedence over rights. Whitman College Tournament 2008 8 File Title Affirmative Case 2. Compulsory vaccination was integral in the eradication of devastating diseases like smallpox, polio and measles. Andraz Melansek, student of Intenational Relations at the University of Ljubljana, Slovenia, February 1, 2004 "Vaccination, Compulsory?" http://www.idebate.org/debatabase/topic_details.php?topicID=260 Compulsory vaccination has eradicated or greatly reduced the impact of some of the world's most devastating diseases, such as small pox, polio, measles, etc. The numbers of people with the diseases decreased dramatically after the vaccine was introduced. With better vaccines, and more comprehensive and effective vaccination programmes, even more suffering and deaths could be prevented. Even if they do not trust their particular governments, people should believe the overwhelming weight of medical opinion and the backing of the World Health Organisation in favour of vaccination. 3. Broad Exemptions threat herd immunity and the public in general Steve P. Calandrillo, Associate Professor at the University of Washington School of Law, University of Michigan Journal of Law Reform, Winter 2004, 37, p. 419-422 Many antivaccinationists argue, "Who is the state to tell me what I must do with my (or my child's) body? If other parents vaccinate their kids, they will be protected, so why should you worry what I do with mine?" Other vaccineopponents might feel, "If everyone else vaccinates, then I don't have to because their immunity protects me." Because so much focus in America is placed on individualism, it is easy to lose sight of the communal benefits of vaccines. Not only does each person who receives an immunization benefit, but all those around her do as well - the classic positive externality. 13 As exemption rates increase, however, it is not merely the individuals opting out whose lives are endangered. Rather, the safety of the entire community is jeopardized when overall immunization rates fall below a critical threshold. 14 [*420] This idea is based on the concept of "herd immunity." 15 Most vaccine-preventable diseases are transmitted from person to person. When a large percentage of a given population is immunized against a disease, that "herd community" serves as a protective barrier against the spread of infection to others in the group who are not immunized or whose immune systems are suppressed due to age or infirmity. 16 Because herd immunity occurs at a level below a 100% immunization rate, 17 it is not necessary for every single person in a community to be vaccinated. However, herd immunity can exist only if a sufficiently high proportion of the population is immunized such that the transmission of the disease is effectively interrupted. 18 Therefore, society cannot allow every one of its members (or even a sizeable minority) to rely on the indirect protection afforded by other vaccinated members of the herd - because then community protection unravels as all try to "free ride" off of the benevolent acts of others. 19 With this reasoning as a backdrop, compulsory vaccination laws were enacted to ensure that all in the population received immunizations, thereby serving the wider public good by creating a herd community capable of protecting the weak within its borders. 20 This protection is crucial because inevitably there will be individuals in society who cannot be immunized due to HIV, cancer, pregnancy or other serious medical conditions. Additionally, it takes several years for infants and young children to complete the [*421] ACIP recommended childhood immunization schedule. 21 During this time, they count on the herd community to protect them from contracting serious illness. If an older sibling brings home a virus in the meantime because friends at school were not immunized, his little sister's life may be threatened. 22 Antivaccinationists do not bear these negative externality costs or harms directly, and therefore may not take them into account in making their decision not to be immunized. Those who opt out of immunizations may unintentionally place those with weakened immune systems due to age or infirmity in harm's way. As others emulate the practice, vaccination levels drop across the population, threatening overall herd protection and allowing disease hot spots to emerge. 23 Whitman College Tournament 2008 9 File Title Affirmative Case Contention 3: Vaccines are neither dangerous nor do the violate individual liberty 1. Vaccines are some of the safest preventative treatments available Linda E. LeFever, J.D. Candidate at the Dickinson School of Law of the Pennsylvania State University, Penn State Law Review, 2005, 110, p. 1049-1050 Vaccines are considered one of "the best-tested things we put into our bodies," and possess a safety record better than vitamins, cold remedies, and antibiotics. 3 With the exception of purified drinking water, no other preventative program has had such a major impact on public health. 4 Before the inception of vaccine usage, diseases such as smallpox, polio, diphtheria, measles, mumps, and rubella infected and killed millions of Americans. 5 At that time, a parent in the United States could expect that, each year, three thousand of the four million children infected with measles would die; fifteen thousand children would be paralyzed from polio; eight thousand children less than one year of age would die from pertussis; and diphtheria would be one of the most common causes of death in school aged children. 6 Due to vaccination, these diseases are virtually nonexistent today. 7 2. Opt-outs allow for parents to refuse vaccinations approximately 3% or parents choose to opt-out. James Colgrove, Ph.D., M.P.H. assistant professor in the Center for the History and Ethics of Public Health at Columbia University's Mailman School of Public Health, December 7, 2006 "The Ethics and Politics of Compulsory HPV Vaccination," The New England Journal of Medicine, http://content.nejm.org/cgi/content/full/355/23/2389 During the past two decades, in the face of a sharp increase in the number of recommended pediatric vaccines, unproven theories alleging connections between vaccines and illnesses including autism, diabetes, and multiple sclerosis have been spreading. A social movement involving diverse participants has challenged the safety of vaccination and mounted attacks in courtrooms and legislatures on compulsory vaccination laws. Forty-eight states allow parents who object to vaccination on religious grounds to excuse their children from requirements, and 20 of those states also allow exemptions for parents who have secular philosophical concerns. Approximately 1 to 3% of U.S. children are excused by their parents from vaccine requirements, though the rate varies from state to state; schools in a few communities have exemption rates as high as 15 to 20%. Activists have sought to liberalize the circumstances under which parents may opt out of vaccine requirements, a trend that reflects the wide variation in people's reasons for rejecting vaccines: devotion to "natural" or alternative healing, libertarian opposition to state power, mistrust of pharmaceutical companies, belief that vaccines are not as safe as experts claim, and conviction that children receive more shots than are good for them. 3. Fear of vaccines can only occur because they are so effective Linda E. LeFever, J.D. Candidate at the Dickinson School of Law of the Pennsylvania State University, Penn State Law Review, 2005, 110, p. 1053-1054 At the start of the 2003-2004 flu season, the announcement of a flu vaccine shortage had many Americans, most of them elderly, scrambling to get one of the few available flu shots. 1 As members of a high-risk [*1054] group, it was not surprising that seniors were the majority of individuals waiting in line demanding flu shots. But this highrisk status may not have been the only reason. Today's seniors are part of a generation that embraced vaccination as nothing short of a "medical miracle." 2 Some of these individuals were alive during the influenza pandemic of 1918 when three waves of the Spanish Flu killed more than five hundred million Americans and resulted in twenty million deaths worldwide. 3 These seniors also witnessed the devastating effects of other infectious diseases like polio, diphtheria and measles, which prompted people at that time to get vaccinated, regardless of the risks associated with the vaccine. 4 Fortunately, vaccines and the implementation of effective immunization programs have shielded recent generations from witnessing death and suffering from diseases. 5 However, the success of vaccination has caused some parents to question whether certain immunizations are still necessary. 6 According to public health officials, because many of today's parents have not experienced or even heard of many of the diseases currently vaccinated against, they do not understand the need for continued vaccination. 7 Parental skepticism has been reinforced by fears that the risk of a child experiencing a severe adverse reaction due to vaccination is much greater than the risk of a child contracting the disease. 8 Vaccines, like all medical therapies, can cause adverse events, but serious risks are rare. 9 Although numerous published studies provide medical and scientific support for vaccine safety, misperceptions about the danger of vaccination persist. n70 Whitman College Tournament 2008 10 File Title Negative Case Compulsory eradication may have eliminated harmful infectious diseases from the United States. Nevertheless, the past success of the Smallpox and Polio vaccination campaigns do not justify continued compulsory vaccination. Countries throughout Europe, such as Great Britain and Italy, show that compulsory immunization is no longer necessary to ensure herd immunity. Powerful pharmaceutical interests have dominated both mainstream ethical and medical research on vaccines in order to maintain their profits. Compulsory vaccinations are potentially dangerous and always violate an individual personal autonomy, freedom of religion, and freedom of philosophy. Therefore, I must stand opposed to the resolution and stand resolved: that public helath concerns do not justify compulsory immunizations. I will define two terms from the resolution: First: Justify, from Webster's Unabridged Dictionary, accessed through dictionary.com: To prove or show to be just; to vindicate; to maintain or defend as conformable to law, right, justice, propriety, or duty. Second: Compulsory from the Oxford English Dictionary, 1989: Depending on or produced by compulsion; compelled, forced, enforced, obligatory. My value for this debate is individual liberty. Individual liberty is a prerequisite to public welfare because it is the basis of freedom. Public welfare can only be protected in societies where members enjoy individual liberty. No rights are possible, including the individual right to a healthy body, unless individual liberties are protected. Further, if individual liberty can be violated than there is no check on any violation of other rights. Quality of life is impossible without these rights and individual liberty because people will not have the rights to do what makes them happy. My criteria for assessing individual liberty is Locke's Social Contract. He argued in his Second Treatise of Civil Government that: "Freedom of Men under Government is, to have a standing Rule to live by, common to every one of that Society, and made by the Legislative Power erected in it; a Liberty to follow my own Will in all things, where the Rule prescribes not; and not to be subject to the inconstant, uncertain, unknown, Arbitrary Will of another Man: as Freedom of Nature is, to be under no other restraint but the Law of Nature.." Liberty is most clearly shown in an individual's control over his or her property. The body is the most basic example of personal property, if an individual lacks control of his or her body than the individual cannot control any of his or her property. The roleof the government in Locke's social contract is to protect individual liberty and serve as a neutralarbiter. The government cannot have the right to control an individual's body. Contention: Compulsory Immunization is Violates Freedom of Religion Compulsory vaccinations threaten religious freedom Mathew D. Staver, "Compulsory Vaccinations Threaten Religious Freedom," Liberty Counsel, 2007, https://www.liberty.edu/media/9980/attachments/memo_vaccination.pdf In addition to the problem of some vaccines derived from aborted tissue, there is a larger problem with mandatory vaccines. Many people have a sincerely held religious belief regarding vaccines in general. These individuals believe that God created the human body as a temple and that the body should not be destroyed by injecting a virus into it. Take, for example, Joseph and Heyde Rotella and Maja Leibovitz of New York City. Both families have a sincerely held religious belief against vaccinations. When the Rotellas had a seventh-grade daughter and Ms. Leibovitz had a second-grade daughter, the school system required that these children receive a mandatory Hepatitis-B vaccination. Hepatitis-B can only be transmitted in one of three ways. Either you are born to a mother with Hepatitis-B, or you contract it by drug use through the sharing of needles, or you contract it through sexual contact. Injecting their children with Hepatitis-B is like the state forcing the parents to give their children clean needles or condoms. In both cases, the children were expelled from school, and in one case, Child Protective Services was called to the scene because the child was not in school. After several weeks of expulsion and threats of removing the children, Liberty Counsel filed a federal lawsuit. A court order allowed the children back in school and prohibited the school from overriding the parents' religious beliefs. Whitman College Tournament 2008 11 File Title Negative Case Contention 2: Compulsory Immunization is Harmful 1. Vaccines are harmful and can lead to death Mathew D. Staver, "Compulsory Vaccinations Threaten Religious Freedom," Liberty Counsel, 2007, https://www.liberty.edu/media/9980/attachments/memo_vaccination.pdf The chicken pox vaccine is known as Varivax. This vaccine was also developed with the use of aborted fetuses. It uses the human cell lines known as WI-38 and MRC-5. The chicken pox vaccine also contains MSG (monosodium glutamate). According to the Food and Drug Administration, MSG is not advised for use in infants, children, pregnant women or women of child-bearing age, and people with affective (mental/emotional) disorders. Dr. Arthur Lavin of the Department of Pediatrics at St. Luke's Medical Center in Cleveland, Ohio, strongly opposes the chicken pox vaccine. Studies show that up to 3% of chicken pox vaccine recipients actually contract chicken pox from the vaccine, and some chicken pox cases may be contracted from recently vaccinated children. Some studies suggest that chicken pox in a vaccinated child may be milder than in an unvaccinated child. However, some experts also believe that this may be due to the vaccine suppressing the illness, which can actually signal a more serious underlying chronic condition. "Atypical measles" is a disease that occurs only in people previously vaccinated for measles, and it is far more serious than regular measles. It is yet unknown if "atypical chicken pox" cases will appear as a result of the use of Varivax. 2. Statistics about the efficiency of compulsory vaccinations are skewed and are unrepresentative of true facts. Andraz Melansek, student of Intenational Relations at the University of Ljubljana, Slovenia, February 1, 2004 "Vaccination, Compulsory?" http://www.idebate.org/debatabase/topic_details.php?topicID=260 Through different techniques the figures on the efficiency of vaccines are kept artificially high. Statistics are shown partially, diseases are falsely diagnosed and re-diagnosed, public scarce campaigns are organised by the protagonists of compulsory vaccination, etc., all of which results in unrepresentative data. After the CJD-BSE health disaster in the UK, and tragedies connected to the contamination of blood products in several countries, people no longer trust either governments or the scientific establishment to tell them the truth. Contention 3: Vaccines Violate Individual Liberty 1. Compulsory Vaccinations violate individual freedom Steve P. Calandrillo, Associate Professor at the University of Washington School of Law, University of Michigan Journal of Law Reform, Winter 2004, 37, p. 394 In addition to the potential safety risks associated with immunizations, antivaccinationists raise the classic American values of freedom and individualism as grounds for their objections to compulsory vaccination laws. Groups opposed to government interference in personal lives vociferously argue that no one, especially not the state, can dictate what they can do with their body (or their child's body for that matter). Mandatory vaccination is therefore an unwarranted interference with basic human autonomy and liberty. 69 In fact, nearly 4 out of 5 websites opposing vaccination [*394] argue that current U.S. immunization laws are a violation of civil liberties. 70 In particular, many cite newly created electronic vaccine registries as an example of "Big Brother" intruding into private lives. 71 Antivaccinationists further characterize public health authorities as abusive, untrustworthy and paternalistic. 72 Resisting forced immunization, on the other hand, is equated with the noble fight against government oppression. 73 Whitman College Tournament 2008 12 File Title Negative Case 2. The government will incarcerate some that choose to refuse compulsory vaccination Dr. Rima E. Laibow, Natural Solutions Foundation, 7/11/2009, http://www.fourwinds10.com/siterun_data/health/vaccinations/news.php?q=1247333429 The White House is proposing vaccination for both seasonal flu and H1 flu, although the total number of US fatalities to date from H1 has reached a total of about 2. State Emergency Medical Powers Acts and Federal legislation, including the Patriot Acts I, II and III, BARDA and others provide for mandatory vaccination or drugging. No exemptions (religious or otherwise) are provided. Those who refuse will be classified as felons at the State level, subject to immedate incarceration and quarantine of indefinite length in jails or other facilities reserved for such "vaccine refusers." In a frightening "Big Lie" propaganda move, those who doubt the effectiveness of unproven, uninsurable vaccines are being called " Vaccine Resisters" and being equated to a new form of "terrorism." Those who refuse at the Federal level will be subject to immediate incarceration and quarantine of indefinite length, probably in FEMA camps set up across the US. 3. Autonomy demands individuals have the right to reject life saving medical treatment Robert I. Field, Ph.D. and Professor of Health Policy at the University of the Science in Philadelphia, and Arthur L. Caplan, Ph.D.and Professor Bioethics at the University of Pennsylvania, "A Proposed Ethical Framework for Vaccine Mandates: Competing Values and the Case of HPV," Kennedy Institute of Ethics Journal, 18.2, June 2008, p. 113-114 When stripped of its emotional charge, the debate over vaccine mandates can be framed as a contest between competing ethical values (see Beauchamp and Childress 2001, pp. 168, 173, 251, 313, for discussion of the application of ethical values in the context of vaccination decisions). Both sides accept all of these values in isolation. Disagreement arises over the primacy of each when they conflict. In trumpeting autonomy, mandate opponents rely on an ethical pillar of the U.S. Constitution (Amendment XIV) and on the foundation in law and ethics of a right of competent adults to decline even lifesaving medical treatments (Bartling v. Superior Court. 1984. 163 Cal.App.3d 186, 209 Cal.Rptr. 220 (Cal. App. 2 Dist.)). In essence, autonomy recognizes the right of individuals to govern their own behavior. To exercise this right, it is necessary to be free from outside influences and limitations, which are the essential elements of liberty, and to have the ability to comprehend the action to be taken, the alternatives, and the consequences, which are the components of agency. Liberty requires, at a minimum, noninterference with personal affairs. Agency requires more complex considerations of an individual's capabilities, particularly in the context of health care, as [End Page 113] it assumes competence to make a decision. Assessing competence can be particularly challenging with regard to adolescents, because of individual variations in developmental maturity. 4. Individual level risks of vaccines outweigh their benefits James G. Hodge, Adjunt Professor of Law at Georgetown University Law Center, and Lawrence O. Gostin, Professor of Law at Georgetown University Law Center, "School Vaccination Requirements: Historical, Social, and Legal Perspectives," Kentuck Law Journal, 2002, 90, 888 Though at times sensational and misinformed, antivaccinationist sentiment among a minority of the American public is understandable. Individuals assess risks to their children very differently than public health officials gauge the public risks of vaccination. A statistically insignificant chance of an adverse reaction to a vaccination may not ultimately shift public health policy underlying its use, but it means everything to the parents whose child is injured. Such children become sympathetic examples of what every parent seeks to avoid. These risks are especially difficult for individuals to absorb where they occur as a result of the administration of a vaccine for diseases which no longer proliferate among children. "Most people can't remember a time when polio, measles, diphtheria, and smallpox killed tens of thousands of children each year." 15 Risks of not being vaccinated greatly outweighed the countervailing risks of vaccination in prior times. Still, the public health "defeat" of multiple diseases in modern times has led to increased calls for the elimination of the vaccine for these diseases. Whitman College Tournament 2008 13 File Title Negative Case Contention 4: Compulsory Immunization is Unnecessary England demonstrates that voluntary immunization is effective P Bradley, Northhamptonshire Health Authority, "Should childhood immunization be compulsory?" Journal of Medical Ethics, 1999, p. 330 Immunisation is offered to all age groups in the UK, but is mainly given to infants and school-age children. Such immunisation is not compulsory, in contrast to other countries, such as the United States. Levels of immunisation are generally very high in the UK, but the rates of immunisation vary with the public perception of the risk of side effects. This article discusses whether compulsory vaccination is acceptable by considering individual cases where parents have failed to give consent or have explicitly refused consent for their children to be immunised. In particular, the rights of: a parent to rear his/her child according to his/her own standards; the child to receive health care, and the community to be protected from vaccine-preventable infectious disease are considered. The conclusion of the article is that compulsory vaccination cannot, with very few exceptions, be justified in the UK, in view of the high levels of population immunity which currently exist. Whitman College Tournament 2008 14 File Title Definition: Public Health Oxford English Dictionary, Mar. 2008 The health of the population as a whole, esp. as monitored, regulated, and promoted by the state (by provision of sanitation, vaccination, etc.). Also: the branch of medicine dealing with this (including hygiene, epidemiology, prevention of infectious diseases, etc.). A Dictionary of Public Health, Oxford Reference Online, Jul. 2000 An organized activity of society to promote, protect, improve, and, when necessary, restore the health of individuals, specified groups, or the entire population. It is a combination of sciences, skills, and values that function through collective societal activities and involve programs, services, and institutions aimed at protecting and improving the health of all the people. The term "public health" can describe a concept, a social institution, a set of scientific and professional disciplines and technologies, and a form of practice. It encompasses a wide range of services, institutions, professional groups, trades, and unskilled occupations. It is a way of thinking, a set of disciplines, an institution of society, and a manner of practice. It has an increasing number and variety of specialized domains, and it demands of its practitioners an increasing array of skills and expertise. Random House Dictionary, Dictionary.com, 2009 Health services to improve and protect community health, esp. sanitation, immunization, and preventive medicine. The American Heritage Dictionary of the English Language, Dictionary.com, Fourth Edition, 2009 The science and practice of protecting and improving the health of a community, as by preventive medicine, health education, control of communicable diseases, application of sanitary measures, and monitoring of environmental hazards. The American Heritage Stedman's Medical Dictionary, Dictionary.com, 2002 The science and practice of protecting and improving the health of a community, as by preventive medicine, health education, control of communicable diseases, application of sanitary measures, and monitoring of environmental hazards. Whitman College Tournament 2008 15 File Title Definition: Justify Oxford English Dictionary, Second Edition, 1989 1. trans. To administer justice to; to try as a judge, to judge; to have jurisdiction over, rule, control, keep in order; to do justice to, treat justly. b. absol. To administer justice, to judge. Obs. 2. trans. To execute justice upon (a malefactor); to condemn to punishment; to punish, esp. (Sc.) to punish with death, execute. Obs. 3. To show (a person or action) to be just or in the right; to prove or maintain the righteousness or innocence of; to vindicate (from a charge). b. Of a state of things, circumstance, or motive: To afford a justification of. (Often in passive.) 4. To absolve, acquit, exculpate; spec. in Theol. to declare free from the penalty of sin on the ground of Christ's righteousness, or to make inherently righteous by the infusion of grace: see JUSTIFICATION 4. Also absol. 5. To make good (an argument, statement, or opinion); to confirm or support by attestation or evidence; to corroborate, prove, verify. {dag}Formerly with complementary obj., obj. and inf., or subord. clause. (Now coloured by 6.) b. To maintain as true, affirm, aver. Obs. c. To acknowledge as true or genuine. Obs. 6. To show or maintain the justice or reasonableness of (an action, claim, etc.); to adduce adequate grounds for; to defend as right or proper. b. To make right, proper, or reasonable; to furnish adequate grounds for, warrant. c. To render lawful or legitimate. Obs. 7. Law. intr. and trans. a. To show or maintain sufficient reason in court for doing that which one is called upon to answer for; to show adequate grounds for (that with which one is charged). b. to justify ({dag}oneself) as bail, to justify bail: to show, by the oath of a person furnishing bail or other surety, that after the payment of his debts he is of adequate pecuniary ability. 8. To account just or reasonable; to approve of; to ratify. Obs. 9. To make exact; to fit or arrange exactly; to adjust to exact shape, size, or position. Now only in technical use; esp. (Type-founding), To adjust a `strike' or `drive' by making the sides level and square, and keeping the impression at the proper depth, so as to form a correct matrix; (Printing) To adjust types of smaller and larger bodies together, so that they will exactly fill up the forme; to space out the line of type in the composing stick properly; also intr. of type. Whitman College Tournament 2008 16 File Title Definition: Compulsory Immunization Prince v. Massachusetts. 321 U.S. 158 (1944) But the family itself is not beyond regulation in the public interest, as against a claim of religious liberty. And neither rights of religion nor rights of parenthood are beyond limitation. Acting to guard the general interest in youth's well being, the state as parens patriae may restrict the parent's control by requiring school attendance, regulating or prohibiting the child's labor and in many other ways. Its authority is not nullified merely because the parent grounds his claim to control the child's course of conduct on religion or conscience. Thus, he cannot claim freedom from compulsory vaccination for the child more than for himself on religious grounds. The right to practice religion freely does not include liberty to expose the community or the child to communicable disease or the latter to ill health or death. (Compulsory) Oxford English Dictionary, Second Edition, 1989 1. a. Depending on or produced by compulsion; compelled, forced, enforced, obligatory. In special collocations, as compulsory education, games. b. Of an agent: Acting under compulsion; compelled; involuntary. 2. Involving or exercising compulsion; compelling, coercive. B. n. A compulsory agency or means; a legal mandate compelling obedience. (Immunization) Oxford English Dictionary, March 2009 1. Med. (and Biol.). The production of immunity in an organism; esp. inoculation or vaccination against a disease. Also: the administration of a vaccine, antiserum, antigen, etc.; the state of having been immunized. Cf. IMMUNIZE v. 1. 2. fig. a. The action or fact of rendering someone or something insusceptible to a perceived threat; protection, defence. b. Finance. A technique for eliminating interest-rate risk in fixed-income portfolios by making the duration of the assets and liabilities equal. Whitman College Tournament 2008 17 File Title Majority Support Compulsory Vaccination Only a vocal minority opposes compulsory vaccination James G. Hodge, Adjunt Professor of Law at Georgetown University Law Center, and Lawrence O. Gostin, Professor of Law at Georgetown University Law Center, "School Vaccination Requirements: Historical, Social, and Legal Perspectives," Kentuck Law Journal, 2002, 90, 848-850 Despite sincere and aggressive campaigning against vaccination, most of the general public chose to be vaccinated when it became available, especially when smallpox outbreaks occurred. The fear of contracting smallpox and the assurance of public health authorities that vaccination prevented the disease sufficiently swayed most individuals to be vaccinated. 16 Many abandoned their antivaccinationist views in the face of compelling medical, and public health, proof of the effectiveness of the smallpox vaccine. A 1915 editorial in the Times stated: "only the wildest of the anti-vaccinationists now deny the efficacy of the Jenner [vaccine] as a protection from smallpox." 17 By 1942, less than 1000 new cases of smallpox emerged in the United States. 18 Antivaccinationist sentiment largely remained the view of a vocal minority, although the fervor with which it was expressed remained influential. Antivaccinationists appealed to interests close to individuals with facts and opinions that were both rational and irrational. They portrayed vaccines as foreign substances, or poisons, capable of causing more harm than good. 19 Vaccinations were described as a "surgical operation," 20 not routine medical care. The effectiveness of the vaccine itself led to a progressive, albeit apathetic, argument: since the vaccine has worked, why should individuals continue to be subjected to the harms of vaccination unless there exists an actual threat of disease in the community? [*849] Public health authorities were characterized as abusive, untrustworthy, and paternalistic. 21 Resisting public health efforts was equated with fighting government oppression. Antivaccinationists asserted that vaccinations (and even medical treatment for smallpox) 22 were contrary to their sacred religious beliefs. 23 As discussed in Part IV.B, these and other sentiments continue to be expressed today. 24 Only 12% of parents with at least one child under 18 oppose compulsory vaccination. Allison M. Kennedy, MPH, Cedric Brown, MS, and Deborah A. Gus, PhD, MPH, "Vaccine Beliefs of Parents Who Oppose Compulsory Vaccination," Public Health Reports, Vol. 120, No. 3 (May - Jun., 2005), pp. 252-258 Of respondents with at least one child aged 18 years living in the household (n1,527), 12% were opposed to compulsory vaccination. Survey results indicate that a parent's belief regarding compulsory vaccination for school entry is significantly associated with beliefs in the safety and utility of vaccines, as well as intention to have the youngest child fully vaccinated. Residence in a state that permits philosophical exemption to vaccination also was significantly associated with a parent's opposition to compulsory vaccination for school entry. Whitman College Tournament 2008 18 File Title Compulsory Immunization Empirically Works Compulsory vaccination was integral in the eradication of devastating diseases like smallpox, polio and measles. Andraz Melansek, student of Intenational Relations at the University of Ljubljana, Slovenia, February 1, 2004 "Vaccination, Compulsory?" http://www.idebate.org/debatabase/topic_details.php?topicID=260 Compulsory vaccination has eradicated or greatly reduced the impact of some of the world's most devastating diseases, such as small pox, polio, measles, etc. The numbers of people with the diseases decreased dramatically after the vaccine was introduced. With better vaccines, and more comprehensive and effective vaccination programmes, even more suffering and deaths could be prevented. Even if they do not trust their particular governments, people should believe the overwhelming weight of medical opinion and the backing of the World Health Organisation in favour of vaccination. Compulsory vaccination was neccesssary to small pox eradication Micheal Willrich, Brandeis University, 2008, "The Least Vaccinated of Any Civilized Country: Personal Liberty and Public Health in the Progressive Era" Journal of Policy History, Volume 20, Number 1 "It is a fact of common knowledge," the Supreme Judicial Court of Massachusetts declared in 1902, "that smallpox is a terrible disease whose ravages have sometimes swept away thousands of human beings in a few weeks. It is equally well known that a large majority of the medical profession and of people generally consider vaccination, repeated at intervals of a few years, a preventive of the disease."Health officials viewed the mere fact of a smallpox epidemic as, at best, a failure of public resolve, and, at worst, a sign that the United States had yet to enter the ranks of modern "civilized" nations. American officials pointed with admiration to Germany and Japan, where compulsory vaccination and revaccination were universal. They noted as a cautionary tale Great Britain, where Parliament, in the face of massive working-class resistance to compulsory vaccination, had in 1898 created an exemption for "conscientious objectors"--the first official use of that term. The U.S. Marine Hospital Service, the federal public health agency, had no patience for citizen objections or official foot-dragging. "The spread of the disease . . . is so easily prevented under proper management," it declared, "that it is a disgrace to the sanitary authorities of any State, municipality or locality, whenever this disease is permitted to get beyond control." Compulsory polio vaccination was key to eliminating polio Joseph E. Balog, P.h.D, MSHYG, "The Moral Justification for a Compulsory Human Papillomavirus Vaccination Program," Framing Health Matters, http://docs.google.com/gview? a=v&pid=gmail&attid=0.2&thid=1225c371d80eaa74&mt=application%2Fpdf Early in the 1950s, polio hysteria erupted across the United States in the wake of a rash of new cases. Thousands of people, mostly young children, were crippled. In 1952, more than 58 000 cases of polio were reported, including 21000 cases of paralytic polio and more than 3000 deaths. Terrified parents, worried that polio would render their children unable to walk or force them into iron lungs, kept their children away from beaches and movie theaters. Medical researchers conducted experimental studies in public schools. Polio became one of the most feared and studied diseases in the mid-20th century. In retrospect, the decision to implement a compulsory vaccination program for polio was an effective, legal, and ethical use of public health authority. The vaccine was effective: the incidence rate for polio was 3.6 times higher for unvaccinated than vaccinated children, the Salk vaccine was 80% to 90% successful in preventing paralytic poliomyelitis, and over the 2- to 3-year period after the Salk vaccine was introduced, an overall 60% to 70% prevention rate was achieved. As a result, the elimina- tion of poliomyelitis has been called one of the 10 great public health achievements of the 20th century in the United States. Whitman College Tournament 2008 19 File Title Compulsory Immunization Prevents Diseases Linda E. LeFever, J.D. Candidate at the Dickinson School of Law of the Pennsylvania State University, Penn State Law Review, 2005, 110, p. 1047 Declared on of the greatest public health achievements of the twentieth century, vaccination has played a pivotal role in preventing disease outbreak and reducing mortality in the United States. Initiatives such as mandatory school immunization laws have safeguarded nearly three generations of school-age children from diseases that once crippled and even killed thousands of American. Although national immunization rates among children remail high and most parents recognize the importance of vaccines, a small but growing number of parents are refusing to vaccinate their children. Compulsory Immunization Better Than Alternatives Compuslory school-based immunization policies work substantially better than persuasion and other policies, as proven by recent hpv vaccination studies James Colgrove, Ph.D., M.P.H. assistant professor in the Center for the History and Ethics of Public Health at Columbia University's Mailman School of Public Health, December 7, 2006, "The Ethics and Politics of Compulsory HPV Vaccination," The New England Journal of Medicine, http://content.nejm.org/cgi/content/full/355/23/2389 A large body of evidence demonstrates that school-based laws are an effective and efficient way of boosting vaccine-coverage rates. Requiring HPV vaccination by law will almost certainly achieve more widespread protection against the disease than will policies that rely exclusively on persuasion and education. In the view of advocates, this effectiveness provides a clear justification. "The only way to ensure that as many girls as possible receive the HPV vaccine is to require it before they enter middle school," said Beverly Hammerstrom, the Michigan state senator who introduced the legislation. Whether such a mandate might extend to boys, should the product be approved for such use, remains uncertain. Whitman College Tournament 2008 20 File Title Public Safety Is More Important than Individual Liberty Compulsory hpv vaccines are justified to prevent the harm of others. Joseph E. Balog, P.h.D, MSHYG, "The Moral Justification for a Compulsory Human Papillomavirus Vaccination Program," Framing Health Matters, http://docs.google.com/gview? a=v&pid=gmail&attid=0.2&thid=1225c371d80eaa74&mt=application%2Fpdf A compulsory HPV vaccination program also appears to be ethically permissible according to the harm principle proposed by John Stuart Mill in On Liberty. Mill argued that ``the only purpose for which power can be rightfully exercised over any member of a civilized community, against his will, is to prevent harm to others.'' In the polio vaccination campaign, the diminution of individual autonomy and liberty was justified by the collective interest of the public in preventing harm from disease and promoting the common good. The ethical principles of beneficence and nonmaleficence and the desire to prevent harm overrode the ethical principles of autonomy and liberty. The state takes into consideration individual rights, but compulsory immunization is the right choice for five reasons. Daniel A Salmon, Department of Epidemiology and Health Policy Research, College of Medicine, University of Florida and Saad B Omer, Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, 2006 Emerg Themes Epidemiol., http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1592474 Irrespective of the circumstances, when the state acting as an agent of the society-curtails individual freedoms for the collective good, the state assumes certain responsibilities and should address the following issues. First, how great a risk does a particular health behavior entail for the individual and the community? Moreover, a distinction should be made between vaccine refusal among adults versus parental vaccine refusal, as a parent does not have an absolute right to put a child at risk even if the parent is willing to accept such risk for him or herself. Second, consideration needs to be given to the strength of the individual's conviction. The infringement upon autonomy is related to how strongly the individual opposes the intervention. Non-compliance with a public health intervention should at least be a function of conviction not laziness. Third, policies that restrict individual rights to forgo a public health intervention must keep sight of the wider and long-term consequences of restricting individual autonomy. A draconian approach to vaccine policy risks public backlash and undermining the sustainability of vaccine programs. Fourth, public authorities should not be reflexively dismissive of concerns regarding the efficacy and safety of the intervention raised by the individuals whose rights are being restricted. Effective risk communication including clear and coherent description of the reasons for restricting individual rights is the responsibility of the entity imposing the restrictions. Fifth, all related decisions should be grounded in science. It is important that the decision-making process be dynamic and must be designed to be constantly informed by the emerging scientific evidence even if the new evidence is contrary to the current scientific wisdom. Moreover, the decision making process should be transparent. Whitman College Tournament 2008 21 File Title Voluntary Immunization Fails Voluntary vaccinations do not reach large segments of the population. Joseph E. Balog, P.h.D, MSHYG, "The Moral Justification for a Compulsory Human Papillomavirus Vaccination Program," Framing Health Matters, http://docs.google.com/gview? a=v&pid=gmail&attid=0.2&thid=1225c371d80eaa74&mt=application%2Fpdf In theory, both compulsory and voluntary vaccination programs allow all individuals access to treatment. However, as Saraiya et al. pointed out, racial and socioeconomic inequalities exist in incidence patterns of cervical cancer and in cervical cancer screening rates. For example, these researchers found that in the United States, incidence of cervical cancer was 50% higher among African American women and 66% higher among Hispanic women than among White women. These groups not only have greater risk for cancer but also have lower rates of screening, do not receive the same benefits from screening as do other populations, and are at greatest risk of being missed by vaccine initiatives. Voluntary vaccinations do not reach populations a disproportionate burden of the disease Joseph E. Balog, P.h.D, MSHYG, "The Moral Justification for a Compulsory Human Papillomavirus Vaccination Program," Framing Health Matters, http://docs.google.com/gview? a=v&pid=gmail&attid=0.2&thid=1225c371d80eaa74&mt=application%2Fpdf Raffle suggested that an uneven distribution of risk and resources could affect uptake of an HPV vaccine in certain socioeconomic and ethnic groups. He further suggested that a high uptake of vaccinations in lower socioeconomic groups is important because these groups are at the greatest risk of developing cervical cancer. It is likely that the populations with a disproportionate burden of disease are the hardest to reach with a voluntary vaccination program. Consequently, if justice is to be served by a voluntary program, then special attention, as provided by such efforts as the Vaccines for Children program, should be given to marketing, delivery, and accessibility of vaccinations to impoverished or underserved adolescent girls. Voluntary vaccinations are unjust Robert I. Field, Ph.D. and Professor of Health Policy at the University of the Science in Philadelphia, and Arthur L. Caplan, Ph.D.and Professor Bioethics at the University of Pennsylvania, "A Proposed Ethical Framework for Vaccine Mandates: Competing Values and the Case of HPV," Kennedy Institute of Ethics Journal, 18.2, June 2008, p. 115 Justice calls for the fair, equitable, and appropriate distribution of scarce goods. It requires a reasoned system of allocating resources based on an underlying principle such as egalitarianism, fair opportunity, or underlying need. Health care is a scarce resource, so justice demands such a system for determining access. Under most analyses, relying solely on individual wealth to purchase access when life and well-being are at stake would not meet the requirements of fairness. Therefore, a program to encourage widespread use of a health care resource, such as a vaccine, whether through a mandate or otherwise, cannot be just if only those with financial means could comply. Justice requires an equitable means of access (see Daniels 1985; 2008; Daniels and Sabin 2002). Whitman College Tournament 2008 22 File Title Voluntary Immunization is Discriminatory Voluntary vaccinations are discriminatory and do not provide justice Joseph E. Balog, P.h.D, MSHYG, "The Moral Justification for a Compulsory Human Papillomavirus Vaccination Program," Framing Health Matters, http://docs.google.com/gview? a=v&pid=gmail&attid=0.2&thid=1225c371d80eaa74&mt=application%2Fpdf In all probability, however, voluntary vaccination programs will preserve the disparity between advantaged and disadvantaged populations, and the groups at greatest risk will continue to have the highest rates of HPV infections and cervical cancer. A compulsory vaccination program will better serve populations that are at greatest risk and in most need of health care and social justice. A utilitarian costbenefit approach may lead to the greatest good for the greatest number of people, but a compulsory approach may produce the greatest utility for populations who are at greatest risk of disease. A compulsory vaccination program, therefore, appears to be a better alternative for ensuring justice and a fair opportunity for all in reducing harm caused by HPV infections. It is wrong to provide vaccines according to biases about age, race, gender etc. Universal access is the only just way. Joseph E. Balog, P.h.D, MSHYG, "The Moral Justification for a Compulsory Human Papillomavirus Vaccination Program," Framing Health Matters, http://docs.google.com/gview? a=v&pid=gmail&attid=0.2&thid=1225c371d80eaa74&mt=application%2Fpdf The risks of polio, STIs, and cancer are present in society, and all people, regardless of age, are exposed to these health problems, albeit at different rates during different stages of life. It would be wrong, according to Rawls's principle of justice, to provide health care to one group and withhold health care from another group because of a bias about age, race, gender, socioeconomic status, religion, or other factors. The opportunity for justice, according to Rawls, should be provided to all impartially. This principle implies that an HPV vaccine should be made available to everyone in need. Universal access is fair, and withholding the vaccine on grounds of age, potential sexual behavior, or competing values about sexual engagement among youths is unfair. Basing decisions to administer vaccines on "risk-factors" is discriminatory universal access is just. Joseph E. Balog, P.h.D, MSHYG, "The Moral Justification for a Compulsory Human Papillomavirus Vaccination Program," Framing Health Matters, http://docs.google.com/gview? a=v&pid=gmail&attid=0.2&thid=1225c371d80eaa74&mt=application%2Fpdf Making age, marital status, or sexual activity a criterion for receiving health care is discriminatory. That the mode of HPV transmission is sexual in nature and that youths choose their sexual behaviors are inconsequential to the correctness of an action to reduce harm in adolescents and young adults. Causes of death or disease--whether polio or smoking, AIDS or cancer--should never enter into decisions about access to health care, regardless of whether human behavior is a factor. Society best provides health care justice by offering all citizens the opportunity to receive health care, such as HPV vaccination. Justice is not served by limiting opportunity to vaccination because of age, social views about sexual behavior, the mode of transmission of a disease, or a desire to blame the victim for harmful consequences of sexual activity. Only compulsory vaccinations allow for universal access. Joseph E. Balog, P.h.D, MSHYG, "The Moral Justification for a Compulsory Human Papillomavirus Vaccination Program," Framing Health Matters, http://docs.google.com/gview? a=v&pid=gmail&attid=0.2&thid=1225c371d80eaa74&mt=application%2Fpdf STIs and cancer are real risks in society, and they should not be exacerbated by an unequal distribution of health resources. Withholding vaccination would be unjust, and making HPV vaccination voluntary would significantly reduce the number of youths who would benefit from it. As several public health professionals have pointed out, mandates are the most effective way of ensuring accessibility for young people and achieving widespread protection against disease. Charo, noting the dis proportionate burden placed on certain races and socioeconomic groups, stated that compulsory vaccinations are the most effective means of protecting poor and disadvantaged women from the scourge of cervical cancer. In addition, Saraiya et al. suggested that these populations, which are at the greatest risk for cervical cancer, are being missed by current vaccine initiatives. Therefore, compulsory vaccinations would be a more effective means of protecting poor and disadvantaged women from cervical cancer. Whitman College Tournament 2008 23 File Title The Supreme Court Supports Compulsory Immunization The SCOTUS affirmed the government's right to protect public health with compulsory immunization in Jacobson v. Massachusetts Lawrence O. Gostin, J.D. and Professor at the Center for the Law and the Putlic's Health at Georgetown University Law Center, April 2005, American Jounal of Public Health, 95(4), p. 576 A century ago, the US Supreme Court in Jacobson v Massachusetts upheld the exercise of the police power to protect the public's health. Despite intervening scientific and legal advances, public health practitioners still struggle with Jacobson's basic tension between individual liberty and the common good. In affirming Massachusetts' compulsory vaccination law, the Court established a floor of constitutional protections that consists of 4 standards: necessity, reasonable means, proportionality, and harm avoidance. Under Jacobson, the courts are to support public health matters insofar as these standards are respected. If the Court today were to decide Jacobson once again, the analysis would likely differ--to account for developments in constitutional law--but the outcome would certainly reaffirm the basic power of government to safeguard the public's health. The SCOTUS has repeatedly affirmed the Jacobson decision Lawrence O. Gostin, J.D. and Professor at the Center for the Law and the Putlic's Health at Georgetown University Law Center, April 2005, American Jounal of Public Health, 95(4), p. 576-581 The validity of Jacobson as a sound modern precedent seems, at first sight, almost too obvious. The federal and state courts, including the US Supreme Court,27 have repeatedly affirmed its holding and reasoning by describing them as "settled" doctrine.40(p176) The courts have upheld compulsory vaccination in particular on numerous occasions.41 Even the rare judicial reservations about compulsory vaccination focus on religious exemptions and do not query states' authority to create a generally applicable immunization requirement.42 During the last several decades, the Supreme Court has recognized a constitutionally protected "liberty interest" in refusing unwanted medical treatment. The Court accepted the principle of bodily integrity in cases that involved the rights of persons who had terminal illnesses43 and mental disabilities.44 Outside the context of reproductive freedoms,45 however, the Court has not viewed liberty interests in bodily integrity as "fundamental." Instead of heightened scrutiny, the Supreme Court balances a person's liberty against state interests.46 In fact, when it adopts a balancing test, the Court usually sides with the state.30 The Court has held that health authorities may impose serious forms of treatment, such as antipsychotic medication, if the person poses a danger to himself or others.44 The treatment also must be medically appropriate.47 The lower courts have used a similar harm-prevention theory and have upheld compulsory physical examinatio 8 and treatment49 of persons who have infectious diseases. Whitman College Tournament 2008 24 File Title Broad Exemptions Are Dangerous Broad exemptions to compulsory immunization are dangerous to the public welfare M. Craig Smith, "A Bad Reaction: A Look at the Arkansas General Assembly's Response to McCarthy v. Boozman and Boone v. Boozman," Arkansas Law Review, 2005, 58, p.276-278 Over the past century, the great success of the immunization movement, a drastic reduction in rates of sickness [*276] and mortality, can be credited to the commitment of lawmakers making compulsory immunization a prerequisite to school attendance. 93 However, if the legislature abandons such a commitment or reduces the ability of the respective school districts to carry out that commitment, the great strides of the twentieth century could be lost in the twenty-first century. Exemptions based upon religious or philosophical reasons may detract from the public health benefit of immunization by mixing a potentially smaller pool of immunized children with an increasingly larger pool of children whose parents have qualified for exemptions. 94 In a way, school vaccination laws serve as a type of safety net for children who would otherwise be placed in a school environment where risks of spreading and contracting disease are heightened. 95 Arkansas's newly enacted, broadly worded exemption undermines the strength of this safety net. The ultimate success of a compulsory immunization program requires that the immunization rate remain high in the population at large and in its various sub-groups. 96 The newer, broader exemption risks that a greater percentage of school children will be more vulnerable to disease and transmit those diseases to the larger, nonexempt population. 97 For example, a 1994 multi-state measles outbreak began when a religiously exempt Christian Science high school student transported the disease, contracted while on vacation in Colorado, to her home in Illinois, and then to her boarding school in Missouri. 98 The [*277] disease spread among persons both inside and outside of the Christian Science community. 99 If a religious exemption is sufficiently broad, as in the case of Arkansas's newly enacted exemption, the numbers of unimmunized children necessarily will increase, as those who were previously denied religious exemptions from the state for their children, as in the cases of Dan McCarthy and Cynthia Boone, now qualify. If more unimmunized children attend Arkansas public schools, they risk their own exposure to such diseases as diphtheria, pertussis, measles, mumps, rubella, and poliomyelitis, which have become so uncommon that, to the general public, they can be considered eradicated. In turn, they risk spreading these diseases to immunized children if the strain of the disease is virulent enough. Under the present Arkansas statute, it is easier for an applicant to claim an exemption, by mailing an exemption request signed by a notary public, to the Arkansas Department of Health, than it is to comply with the compulsory immunization requirements by making a doctor's appointment for the child and taking her to the doctor's office. 00 It seems logical that more parents will take advantage of this new broad exemption. To qualify under the new religious or philosophical exemption, parents need merely "indicate some degree of spirituality in their life and stick to their story" until the exemption is granted. 01 This low burden of proof to gain a waiver from immunization requirements makes it "difficult, if not impossible, for a school district to deny one belief and accept another." 02 For this reason, exemptions are now available virtually on demand in Arkansas. In practice, in states offering both religious and philosophical exemptions, the [*278] number of philosophical exemptions exceeds the number of religious exemptions. 03 Arguably, since the new exemption lacks a process by which public health authorities may protect the general public against fraudulent claims of qualification, the effectiveness of public health protections available through mandatory childhood immunizations is undermined and places those who comply with the immunization requirements at a greater risk. 04 Whitman College Tournament 2008 25 File Title Broad Exemptions Are Dangerous Exemptions threaten herd immunity Steve P. Calandrillo, Associate Professor at the University of Washington School of Law, University of Michigan Journal of Law Reform, Winter 2004, 37, p. 419-422 Many antivaccinationists argue, "Who is the state to tell me what I must do with my (or my child's) body? If other parents vaccinate their kids, they will be protected, so why should you worry what I do with mine?" Other vaccineopponents might feel, "If everyone else vaccinates, then I don't have to because their immunity protects me." Because so much focus in America is placed on individualism, it is easy to lose sight of the communal benefits of vaccines. Not only does each person who receives an immunization benefit, but all those around her do as well - the classic positive externality. 13 As exemption rates increase, however, it is not merely the individuals opting out whose lives are endangered. Rather, the safety of the entire community is jeopardized when overall immunization rates fall below a critical threshold. 14 [*420] This idea is based on the concept of "herd immunity." 15 Most vaccine-preventable diseases are transmitted from person to person. When a large percentage of a given population is immunized against a disease, that "herd community" serves as a protective barrier against the spread of infection to others in the group who are not immunized or whose immune systems are suppressed due to age or infirmity. 16 Because herd immunity occurs at a level below a 100% immunization rate, 17 it is not necessary for every single person in a community to be vaccinated. However, herd immunity can exist only if a sufficiently high proportion of the population is immunized such that the transmission of the disease is effectively interrupted. 18 Therefore, society cannot allow every one of its members (or even a sizeable minority) to rely on the indirect protection afforded by other vaccinated members of the herd - because then community protection unravels as all try to "free ride" off of the benevolent acts of others. 19 With this reasoning as a backdrop, compulsory vaccination laws were enacted to ensure that all in the population received immunizations, thereby serving the wider public good by creating a herd community capable of protecting the weak within its borders. 20 This protection is crucial because inevitably there will be individuals in society who cannot be immunized due to HIV, cancer, pregnancy or other serious medical conditions. Additionally, it takes several years for infants and young children to complete the [*421] ACIP recommended childhood immunization schedule. 21 During this time, they count on the herd community to protect them from contracting serious illness. If an older sibling brings home a virus in the meantime because friends at school were not immunized, his little sister's life may be threatened. 22 Antivaccinationists do not bear these negative externality costs or harms directly, and therefore may not take them into account in making their decision not to be immunized. Those who opt out of immunizations may unintentionally place those with weakened immune systems due to age or infirmity in harm's way. As others emulate the practice, vaccination levels drop across the population, threatening overall herd protection and allowing disease hot spots to emerge. 23 Whitman College Tournament 2008 26 File Title Limited Exemptions Are Dangerous Limited Exemptions lead to disease hotspots Steve P. Calandrillo, Associate Professor at the University of Washington School of Law, University of Michigan Journal of Law Reform, Winter 2004, 37, p. 422-426 The clustering of exemptions in these hot spots can lead directly to disease. 30 Religious exemptions to vaccination in Amish, Mennonite and Christian Science communities are responsible for the last two major outbreaks of polio in America. 31 During the resurgence of mumps that began in 1986, large outbreaks were for the most part confined to states that did not have comprehensive (i.e., [*423] kindergarten through grade 12) vaccination laws. 32 Whooping cough outbreaks have occurred every year since 1995 on Vashon Island. 33 Worse, pertussis cases have actually been increasing nationally since the early 1980s with peaks every three to four years. 34 In 1991, lack of widespread immunizations in Amish areas resulted in 890 cases of rubella and over a dozen permanently deformed children. 35 These examples are just drops in the ocean compared to the devastating American measles outbreak of 1989-91, which disproportionately affected urban areas and recent immigrants in Southern California who lacked sufficient immunization coverage. 36 Measles cases had plummeted nationally after the vaccine became available in 1963, as the 400,000 individuals afflicted in 1962 had dropped to just over 1,000 per year by the mid-1980s. 37 The incidence of measles was low even among non-vaccinated individuals so long as a sufficiently high percentage of the surrounding herd community was immunized. 38 While nationwide measles vaccination rates among schoolaged children appeared adequate, the level of immunization was as low as 50% among two-year old children in some black and Hispanic communities. 39 A devastating measles epidemic resulted, afflicting primarily unvaccinated minority [*424] children in urban areas, many in Los Angeles County. 40 In total, over 50,000 children nationwide contracted measles and 11,000 hospital days were required for treatment. 41 132 children died and over $ 100 million in health care costs were incurred. 42 Other less devastating but still significant measles outbreaks occurred in an Illinois Christian Science school in 1985, and among Amish communities in 1987 and 1988. 43 Exemptions to immunization on religious grounds played a large role. 44 Elsewhere around the globe, countries with low vaccination rates continue to suffer from devastating disease outbreaks. In Russia, diphtheria cases jumped from 900 in 1989 to 50,000 in 1994 after a drop in immunization coverage. 45 Japan and England witnessed a tenfold increase in hospitalizations and deaths after the pertussis vaccine was discontinued in their countries. 46 Both South Korea [*425] and Japan experienced major measles epidemics in recent years due to low vaccination rates. 47 Europe has also not escaped the ravages of measles when immunization coverage has dropped, as evidenced by outbreaks in Sweden in the late 1990s. 48 These disease hot spots will continue to emerge as long as exemptions to vaccination laws proliferate unchecked, putting children's health in danger. Further, individuals afflicted with vaccine-preventable diseases today find themselves in a particularly unfortunate state since few healthcare resources are dedicated to curing diseases that are easily preventable on the front end. Whitman College Tournament 2008 27 File Title Beneficence Demands Compulsory Vaccination Beneficence Demands Compulsory Vaccination Robert I. Field, Ph.D. and Professor of Health Policy at the University of the Science in Philadelphia, and Arthur L. Caplan, Ph.D.and Professor Bioethics at the University of Pennsylvania, "A Proposed Ethical Framework for Vaccine Mandates: Competing Values and the Case of HPV," Kennedy Institute of Ethics Journal, 18.2, June 2008, p. 114 Government by its nature exercises coercive authority. This is the essence of law enforcement. Such coercion violates the right to autonomy in the interest of promoting a competing value. A government action of this sort can take the form of a restraint on behavior, for example on use of illicit drugs, or of a positive compulsion to engage in a behavior, such as the acceptance of a vaccine. The ethical challenge in these cases is to assess the relative importance of the competing value that is being overridden and of the characteristics and circumstances of those subject to the government action. In seeking to protect public health, mandate advocates rely on the values of beneficence, utilitarianism, justice, and nonmaleficence. Beneficence is the moral imperative to act for the benefit of others. It is recognized as a positive obligation to act in certain circumstances, for example, to prevent harm, to help persons with disabilities, and to rescue those in danger. Beneficence can be specific to defined categories of individuals, such as children, the disabled, or the poor, or it can be a general obligation toward all others. In the case of medicine, physicians accept an ethical obligation to act with specific beneficence toward patients upon entering the profession. General public health programs, such as universal mandatory vaccination, reflect general beneficence for which the conceptual underpinning is somewhat less straightforward. The application of beneficence to overrule autonomy in the case of particular individuals represents paternalism. This describes the attitude of a physician who provides or withholds a treatment in contravention of a patient's wishes based on a perception of the patient's underlying best interests. Paternalism reflects an external judgment of the best ultimate outcome for the patient. Whitman College Tournament 2008 28 File Title Utilitarianism Demands Compulsory Vaccination Utilitarianism Demands Compulsory Vaccination Robert I. Field, Ph.D. and Professor of Health Policy at the University of the Science in Philadelphia, and Arthur L. Caplan, Ph.D.and Professor Bioethics at the University of Pennsylvania, "A Proposed Ethical Framework for Vaccine Mandates: Competing Values and the Case of HPV," Kennedy Institute of Ethics Journal, 18.2, June 2008, p. 115 Utilitarianism takes the external judgment one step further to consider the best ultimate outcome for society, as a whole. It implements an explicit balancing of relevant factors to determine the optimum result for the greatest number of people regardless of competing individual needs. Utilitarian concerns can be consistent with those of beneficence, but they can also conflict, as when the best interests of some individuals are at odds with those of the majority. Utilitarianism supports mandating a vaccine to prevent the harm to society that could be caused by the presence of unvaccinated individuals. This is the most prominent and longstanding justification put forth [End Page 114] by mandate proponents. The Supreme Court relied on this principle in upholding a vaccine mandate against smallpox more than 100 years ago, setting a precedent that remains in effect today (Jacobson v. Massachusetts. 1905. 197 U.S. 11). Much of the harm to society results from the loss of an effect known as "herd immunity." Most infectious agents must reside in a sufficient number of susceptible individuals to maintain their presence. Eradication can occur when the proportion of the population that has been vaccinated is sufficiently large to deny the infectious agent such a reservoir of unimmunized hosts. For most diseases, herd immunity is achieved when the proportion of the population vaccinated is in the range of 90 percent. When the proportion of vaccine declinations exceeds this threshold, the infectious agent can lurk in the population to threaten not only those who are unvaccinated but also many who chose the vaccine but whose immune systems generate insufficient levels of antibodies to confer full protection (May and Silverman 2005). In this situation, a small number of vaccine declinations can have a devastating impact on a community, so the greatest medical benefit for the greatest number of people is achieved by requiring that everyone receive the vaccine. This is true regardless of whether a mandate is in the best interests of every individual or whether it ignores the interest in autonomy. It is an example of government coercion in the service of a competing ethical consideration. It also reflects an implicit hierarchy of public goods in which health takes precedence over rights. Whitman College Tournament 2008 29 File Title A2 Individual Liberty Opt-outs allow for parents to refuse vaccinations approximately 3% or parents choose to opt-out. James Colgrove, Ph.D., M.P.H. assistant professor in the Center for the History and Ethics of Public Health at Columbia University's Mailman School of Public Health, December 7, 2006 "The Ethics and Politics of Compulsory HPV Vaccination," The New England Journal of Medicine, http://content.nejm.org/cgi/content/full/355/23/2389 During the past two decades, in the face of a sharp increase in the number of recommended pediatric vaccines, unproven theories alleging connections between vaccines and illnesses including autism, diabetes, and multiple sclerosis have been spreading. A social movement involving diverse participants has challenged the safety of vaccination and mounted attacks in courtrooms and legislatures on compulsory vaccination laws. Forty-eight states allow parents who object to vaccination on religious grounds to excuse their children from requirements, and 20 of those states also allow exemptions for parents who have secular philosophical concerns. Approximately 1 to 3% of U.S. children are excused by their parents from vaccine requirements, though the rate varies from state to state; schools in a few communities have exemption rates as high as 15 to 20%. Activists have sought to liberalize the circumstances under which parents may opt out of vaccine requirements, a trend that reflects the wide variation in people's reasons for rejecting vaccines: devotion to "natural" or alternative healing, libertarian opposition to state power, mistrust of pharmaceutical companies, belief that vaccines are not as safe as experts claim, and conviction that children receive more shots than are good for them. Compulsory vaccination has opt-out options. Joseph E. Balog, P.h.D, MSHYG, "The Moral Justification for a Compulsory Human Papillomavirus Vaccination Program," Framing Health Matters, http://docs.google.com/gview? a=v&pid=gmail&attid=0.2&thid=1225c371d80eaa74&mt=application%2Fpdf Compulsory vaccination of children for polio seems to be legally compatible with a precedent established by the 1905 Supreme Court ruling in Jacobson v. Massachusetts. Bayer and Moreno point out that the Court in this case decided that a compulsory vaccination program that addressed a smallpox outbreak was legal. According to the authors, The Supreme Court held the U.S. Constitution permits states to enact ``such reasonable regula- tions [to] protect the public health and public safety'' as long as such efforts did not ``contra- vene the Constitution of the United States, nor infringe any right guaranteed or secured by the instrument.'' Thus, the Court set a precedent for allowing compulsory vaccination programs to control epidemics and prevent the spread of infections. Any implementation of a compulsory human papillomavirus (HPV) vaccination program should follow legal precedents that include the right of states to allow exceptions for individ- uals with medical, religious, and philosophical objections. Individuals should not have the liberty to indiscriminately spread infectious diseases The New York Times, Editorial, February 22, 1905. The contention that compulsory vaccination is an infraction of personal liberty and an unconstitutional interference with the right of the individual to have the smallpox if he wants it, and to communicate it to others, has been ended [by the US Supreme Court]. . . . [This] should end the useful life of the societies of cranks formed to resist the operation of laws relative to vaccination. Their occupation is gone. Whitman College Tournament 2008 30 File Title A2 Individual Liberty Social Contract Social contract theory justifies compulsory immunization Lawrence O. Gostin, J.D. and Professor at the Center for the Law and the Putlic's Health at Georgetown University Law Center, April 2005, American Jounal of Public Health, 95(4), p. 576-581 The Jacobson Court's use of social-compact theory to support this expansive understanding of police powers was unmistakable. Justice Harlan preferred a community-oriented philosophy where citizens have duties to one another and to society as a whole: [T]he liberty secured by the Constitution . . . does not import an absolute right in each person to be . . . wholly freed from restraint. . . . On any other basis organized society could not exist with safety to its members. . . . [The Massachusetts Constitution] laid down as a fundamental . . . social compact that the whole people covenants with each citizen, and each citizen with the whole people, that all shall be governed by certain laws for the `common good,' and that government is instituted `for the protection, safety, prosperity and happiness of the people, and not for the profit, honor or private interests of any one man.1(p2627) The Court's opinion is filled with examples of the social compact that ranged from sanitary laws and animal control to quarantine and thereby demonstrated the breadth of police powers. Justice Harlan granted considerable leeway to the elected branch of government by displaying an almost unquestioning acceptance of legislative findings of scientific fact.1 He also was a federalist and asserted the primacy of state over federal authority in public health.1 The distinct tenor of the opinion was deferential to agency action. A primary legacy of Jacobson, then, is its defense of social-welfare philosophy and police power regulation. Although the progressive-era appeal to collective interests no longer has currency, most of the 69 cases that have cited Jacobson did so in defense of police power (Table 1 [triangle] ). PostJacobson courts affirmed states' authority to (1) regulate individuals and businesses for public health and safety (8 cases), (2) limit liberty to achieve common goods (34 cases), (3) permit legislatures to delegate broad powers to public health agencies (5 cases), and (4) defer to the judgment of legislatures and agencies in the exercise of their powers (13 cases). A2 Individual Liberty Multiple Checks Necessity standards prevent gross violations of individual liberty Lawrence O. Gostin, J.D. and Professor at the Center for the Law and the Putlic's Health at Georgetown University Law Center, April 2005, American Jounal of Public Health, 95(4), p. 576-581 Justice Harlan insisted that police powers must be based on the "necessity of the case" and could not be exercised in "an arbitrary, unreasonable manner" or go "beyond what was reasonably required for the safety of the public."1(p28) The state must act only in the face of a demonstrable health threat.1 Necessity requires, at a minimum, that the subject of the compulsory intervention must pose a threat to the community. Reasonable means standards prevent gross violations of individual liberty Lawrence O. Gostin, J.D. and Professor at the Center for the Law and the Putlic's Health at Georgetown University Law Center, April 2005, American Jounal of Public Health, 95(4), p. 576-581 Although government may act under conditions of necessity, its methods must be reasonably designed to prevent or ameliorate the threat. Jacobson adopted a means/ends test that requires a reasonable relationship between the public health intervention and the achievement of a legitimate public health objective. Even though the objective of the legislature may be valid and beneficent, the methods adopted must have a "real or substantial relation" to protection of the public health and cannot be "a plain, palpable invasion of rights."1(p31) Proportionality standards prevent gross violations of individual liberty Lawrence O. Gostin, J.D. and Professor at the Center for the Law and the Putlic's Health at Georgetown University Law Center, April 2005, American Jounal of Public Health, 95(4), p. 576-581 Even under conditions of necessity and with reasonable means, a public health regulation is unconstitutional if the human burden imposed is wholly disproportionate to the expected benefit. "[T]he police power of a State," said Justice Harlan, "may be exerted in such circumstances or by regulations so arbitrary and oppressive in particular cases as to justify the interference of the courts to prevent wrong . . . and oppression." 1(p38,39) Public health authorities have a constitutional responsibility not to overreach in ways that unnecessarily invade personal spheres of autonomy. This suggests a requirement for a reasonable balance between the public good to be achieved and the degree of personal invasion. If the intervention is gratuitously onerous or unfair, it may overstep constitutional boundaries. Whitman College Tournament 2008 31 File Title A2 Parental Autonomy Parental autonomy is dangerous to the community and history proves it is a flawed option Linda E. LeFever, J.D. Candidate at the Dickinson School of Law of the Pennsylvania State University, Penn State Law Review, 2005, 110, p. 1056-1057 Although vaccines have successfully prevented major disease outbreaks, there are risks associated with a parent's decision not to vaccinate a child. n84 When a portion of the population refuses vaccination, herd immunity is threatened. n85 For example, when doctors in Sweden suspended vaccination against pertusis (whooping cough) from 1979 until 1996 to test a new vaccine, researchers later discovered that sixty percent of the country's children became infected with whooping cough before the age of ten. n86 While it is unclear how low immunization levels can drop before herd immunity is entirely lost, health officials are concerned by recent trends in the United States. n87 In fact, more cases of whooping cough [*1057] were recorded in the United States in 2004 than any time in forty years. n88 Boulder, for example, has the lowest school vaccination rate in Colorado, and one of the highest per capita rates of whooping cough in the United States. n89 Whooping cough starts with an uncontrollable cough, which often causes an infected person to gasp for air. n90 It is particularly dangerous for newborns who are too young to get vaccinated, because it can cause breathing problems, pneumonia, and even death. n91 Diseases can also be imported into the United States through travel or immigration. Recent measles outbreaks in Pennsylvania n92 and Iowa n93 were traced to individuals who returned from visiting countries where measles was known to be circulating. A study revealed that out of more than one hundred reported measles cases in 2000, fifty-four were acquired abroad and transferred into the United States by travelers, and sixty-two of the cases acquired in the United States were linked to the foreign contracted cases. n94 This resurgence of measles in the United States demonstrates that because infectious diseases are usually not contained geographically, the chance of an outbreak occurring in the United States is only a plane ride away. n95 Whitman College Tournament 2008 32 File Title A2 Parental Autonomy Studies conclude that hpv vaccinations and abstinence programs do not change rates of behavior Joseph E. Balog, P.h.D, MSHYG, "The Moral Justification for a Compulsory Human Papillomavirus Vaccination Program," Framing Health Matters, http://docs.google.com/gview? a=v&pid=gmail&attid=0.2&thid=1225c371d80eaa74&mt=application%2Fpdf From a public health perspective, treating and reducing real harm should be preferred over adhering to a belief about interventions that do not exist or are not effective. For ex- ample, studies--including a major research project that analyzed 4 abstinence programs-- have found that teaching abstinence from sexual activity outside marriage has no statistically significant effect on eventual behavior. In addition, studies of communication between parents and children have documented that such communications have a positive effect; however, research has also shown that not all parents discuss sexuality issues with their children and that the rate of this communication varies greatly and is affected by such factors as the parents' gender, religious affiliation, and self-efficacy in communication; the topic of discussion; and the risk-taking behavior of the child. Research also has found that perception of the quality of communication between parents and children differs depending on whether the parent or the child is interviewed. Furthermore, studies have demonstrated that parents frequently lack adequate sexual knowledge and communication skills to effectively deal with personal and human sexuality issues. The rights of children to have access to preventative medicine overrides parental autonomy Joseph E. Balog, P.h.D, MSHYG, "The Moral Justification for a Compulsory Human Papillomavirus Vaccination Program," Framing Health Matters, http://docs.google.com/gview? a=v&pid=gmail&attid=0.2&thid=1225c371d80eaa74&mt=application%2Fpdf An important question is, whose autonomy should have a higher priority, the child's or the parent's? It is reasonable to consider who is at greater risk and who stands to gain a greater benefit. In the case of HPV vaccination of youths who have not yet been exposed to HPV, the right of the child to receive the preventive measure should override respect for the parents' autonomy and the parents' desire to teach social beliefs that restrict health care action, because the health threat directly involves the life of the child. The rights, autonomy, and desires of parents are important, but the con- sequences of the decision affect them indirectly. If respect for parental autonomy leads to denying children access to effective health care, the probability of harm and the loss of benefits are much greater for the children than for their parents. Disease, disability, and loss of life are burdens--for both individuals and society --that outweigh the benefits derived from upholding parental rights and authority. Furthermore, the availability of a voluntary or compulsory vaccination program does not deprive parents of the opportunity, or the right, to teach their own values to their children. It simply helps to ensure health care for all. As Colgrove pointed out in his essay on ethics and politics associated with an HPV vaccine, Minors have a right to be protected against vaccine-preventable illness, and society has an interest in safeguarding the welfare of children who may be harmed by the choices of their parents and guardians. Parental autonomy and exemptions threaten public health Linda E. LeFever, J.D. Candidate at the Dickinson School of Law of the Pennsylvania State University, Penn State Law Review, 2005, 110, p. 1048-1049 Although non-medical exemptions enable states to recognize the rights of parents who sincerely oppose vaccinations, such accommodations pose a serious threat to public health. Studies show that unvaccinated children may be twenty-two times more likely to suffer from measles than their vaccinated peers. n8 In addition, unvaccinated children increase the risk of disease exposure and transmission to the national community by causing a decline in the overall immunization levels in the United States. n9 Because high immunization levels indirectly protect the community through a process know as "herd immunity," a decline in vaccinated children may lead to disease resurgence. 0 This is particularly dangerous for individuals who are susceptible to infection such as the elderly, newborns and pregnant women. 1 Parents who refuse to vaccinate their children are not only placing their children at risk, but they are also threatening the community health. The Supreme Court has stated that, "the right to practice religion freely does not include the liberty to expose the community or the child to communicable disease or the latter to ill health or death." 2 Based on the overriding interest in the community's health and safety, nonmedical exemptions to school immunization laws should be challenged and revised. Whitman College Tournament 2008 33 File Title A2 Safety Vaccines are some of the safest preventative treatments available Linda E. LeFever, J.D. Candidate at the Dickinson School of Law of the Pennsylvania State University, Penn State Law Review, 2005, 110, p. 1049-1050 Vaccines are considered one of "the best-tested things we put into our bodies," and possess a safety record better than vitamins, cold remedies, and antibiotics. 3 With the exception of purified drinking water, no other preventative program has had such a major impact on public health. 4 Before the inception of vaccine usage, diseases such as smallpox, polio, diphtheria, measles, mumps, and rubella infected and killed millions of Americans. 5 At that time, a parent in the United States could expect that, each year, three thousand of the four million children infected with measles would die; fifteen thousand children would be paralyzed from polio; eight thousand children less than one year of age would die from pertussis; and diphtheria would be one of the most common causes of death in school aged children. 6 Due to vaccination, these diseases are virtually nonexistent today. 7 There is no link between vaccinations and autism. Daniel A Salmon, Department of Epidemiology and Health Policy Research, College of Medicine, University of Florida and Saad B Omer, Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, 2006 Emerg Themes Epidemiol., http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1592474 A divergence between individual and community benefits may also exist when there are ideological beliefs incongruent with vaccination or individuals are unaware of or do not accept available scientific evidence. Ideological beliefs that may influence persons to forgo vaccination include religious issues (i.e. the use of cell lines from aborted fetuses to make vaccine) and a general belief that 'natural' disease is preferable to vaccines. Recent controversy surrounding association between the MMR vaccine and autism exemplify situations where some individuals perceive the individual risks of vaccination to outweigh the benefits. Despite carefully designed epidemiological studies and reviews by external groups finding no association between MMR vaccines and autism, a substantial proportion of parents maintain a belief that vaccines cause autism. From the perspective of these parents, the benefits of MMR vaccination may not outweigh the (perceived) autism risk. The community risk/benefit analysis is likewise dependent on one's knowledge base and perception of the science undoubtedly individual vaccine refusal can lead to resurgence of disease. Harm avoidance standards prevent damage to individual's health Lawrence O. Gostin, J.D. and Professor at the Center for the Law and the Putlic's Health at Georgetown University Law Center, April 2005, American Journal of Public Health, 95(4), p. 576-581 Those who pose a risk to the community can be required to submit to compulsory measures for the common good. The control measure itself, however, should not pose a health risk to its subject. Justice Harlan emphasized that Henning Jacobson was a "fit person" for smallpox vaccination, but he asserted that requiring a person to be immunized who would be harmed is "cruel and inhuman in the last degree." 1(p39) If there had been evidence that the vaccination would seriously impair Jacobson's health, he may have prevailed in this historic case. Jacobson-era cases reiterate the theme that public health actions must not harm subjects. Notably, courts required safe and habitable environments for persons subject to isolation or quarantine on the grounds that public health powers are designed to promote well-being and not punish the individual.36(p22),37 The facts in Jacobson did not require the court to enunciate a standard of fairness under the Equal Protection Clause of the 14th Amendment, because the vaccination requirement was generally applicable to all inhabitants of Cambridge, Mass. Nevertheless, the federal courts had already created such a standard in Jew Ho v Williamson in 1900. A quarantine for bubonic plague in San Francisco, Calif, was created to operate exclusively against Chinese Americans. In striking down the quarantine, the federal district court said that health authorities had acted with an "evil eye and an unequal hand."36(p23) Several of these standards for protecting liberty have been discernable in cases that have cited Jacobson between 1905 and 2004 (Table 1 [triangle] ). Some cases cited Jacobson for the simple, albeit important, proposition that bodily integrity is a constitutionally protected liberty interest (6 cases); others cited Jacobson to require that the state have an important interest (real and substantial [6 cases], compelling [1 case], or fairly balanced with individual interests [4 cases]); and still others cited Jacobson to prevent the state from acting arbitrarily or unreasonably (7 cases). Federalism also is used as a tool to reign in the national government, with 1 court arguing, probably incorrectly, that the federal government lacks police power. Whitman College Tournament 2008 34 File Title A2 Safety Fear of vaccines can only occur because they are so effective Linda E. LeFever, J.D. Candidate at the Dickinson School of Law of the Pennsylvania State University, Penn State Law Review, 2005, 110, p. 1053-1054 At the start of the 2003-2004 flu season, the announcement of a flu vaccine shortage had many Americans, most of them elderly, scrambling to get one of the few available flu shots. 1 As members of a high-risk [*1054] group, it was not surprising that seniors were the majority of individuals waiting in line demanding flu shots. But this highrisk status may not have been the only reason. Today's seniors are part of a generation that embraced vaccination as nothing short of a "medical miracle." 2 Some of these individuals were alive during the influenza pandemic of 1918 when three waves of the Spanish Flu killed more than five hundred million Americans and resulted in twenty million deaths worldwide. 3 These seniors also witnessed the devastating effects of other infectious diseases like polio, diphtheria and measles, which prompted people at that time to get vaccinated, regardless of the risks associated with the vaccine. 4 Fortunately, vaccines and the implementation of effective immunization programs have shielded recent generations from witnessing death and suffering from diseases. 5 However, the success of vaccination has caused some parents to question whether certain immunizations are still necessary. 6 According to public health officials, because many of today's parents have not experienced or even heard of many of the diseases currently vaccinated against, they do not understand the need for continued vaccination. 7 Parental skepticism has been reinforced by fears that the risk of a child experiencing a severe adverse reaction due to vaccination is much greater than the risk of a child contracting the disease. 8 Vaccines, like all medical therapies, can cause adverse events, but serious risks are rare. 9 Although numerous published studies provide medical and scientific support for vaccine safety, misperceptions about the danger of vaccination persist. n70 Studies proving vaccines dangerous have ulterior motives Linda E. LeFever, J.D. Candidate at the Dickinson School of Law of the Pennsylvania State University, Penn State Law Review, 2005, 110, p. 1054-1056 These misperceptions have harmful implications when they result in parents deferring or refusing to vaccinate their children. The public [*1055] response to the alleged link between the Measles Mumps and Rubella (MMR) vaccine and autism provides an illustration of the harmful effects. In 1998, the British medical journal, The Lancet, published a study alleging a possible link between the MMR vaccine and autism. n71 This study, based on twelve autistic children, attracted immediate widespread media attention and resulted in many parents refusing MMR vaccinations for their children. n72 In February 2004, The Lancet learned that the study's lead researcher, Dr. Andrew Wakefield, received funding from solicitors suing the vaccine manufacturer on behalf of parents alleging injuries to their children. n73 Following this discovery, ten of the twelve other researchers signed a formal retraction of the study's conclusion and declared that no causal link between the MMR vaccine and autism was established. n74 New information emerged about Wakefield at the end of 2004, disclosing that, not only had he been developing his own commercial rival to the vaccine, but that he also had filed for a patent nine months prior to his 1998 announcement. n75 As a result of the autism scare, Britain's immunization rates have dropped from over ninety-two percent in 1995 to seventy-nine percent at the start of 2004, with the number of actual reported cases more than tripling. n76 As this example demonstrates, groups who speak out against vaccine safety may have an alternative agenda. n77 Advances in technology and communication have made it difficult to contain the spread of faulty information about vaccination and enabled antivaccination groups to have a much greater reach then in the past. n78 For example, twelve websites opposing childhood vaccinations were identified in 2002, and those sites linked to at least ten additional sites. n79 A survey of the content of these websites revealed that the predominant reasons for opposing vaccination among current antivaccination groups [*1056] involved concerns for vaccine safety and effectiveness, concerns about government abuse, and a preference for alternative health practices. n80 Whitman College Tournament 2008 35 File Title A2 Safety All states allow for medical based exemptions M. Craig Smith, "A Bad Reaction: A Look at the Arkansas General Assembly's Response to McCarthy v. Boozman and Boone v. Boozman," Arkansas Law Review, 2005, 58, p.266 The earliest exemptions to compulsory immunization statutes were for medical contraindications, such as the exemption provided by the Pennsylvania statute in question in Duffield which provided an exclusion for those "not at present in a condition to undergo vaccination." 18 Similarly, in Abeel, California citizens were statutorily exempted from vaccination, provided they could not be successfully vaccinated. 19 Where the statutes did not contain them, citizens were refused exemptions 20 because it was thought that to do so would "strip the legislative department of its function to care for the public health and the public safety ... ." 21 Today, all fifty states and the District of Columbia allow for such medical exemptions by their compulsory immunization statutes. 22 The media over reports the dangers of vaccines and underreports the benefits Steve P. Calandrillo, Associate Professor at the University of Washington School of Law, University of Michigan Journal of Law Reform, Winter 2004, 37, p. 357-359 So far the United States has been extremely lucky: most outbreaks of preventable disease in recent years have been confined to dozens or hundreds of people (excluding the 55,000 victims of measles between 1989 and 1991 5). Measles, mumps, polio, diphtheria and other now easily preventable diseases no longer cause mass deaths in America, although the rest of the world is not nearly as fortunate. 6 Consequently, media coverage has largely passed over this lurking danger in America, often giving greater coverage to the risks posed by vaccines or the controversial link between immunizations and autism. Today, however, with exemption rates pushing higher and the new omnipresent threat of [*358] bioterrorism, 7 this threat to public health cannot be ignored any longer. Fears of vaccines are motivated by determined but inaccurate groups Steve P. Calandrillo, Associate Professor at the University of Washington School of Law, University of Michigan Journal of Law Reform, Winter 2004, 37, p. 359-361 Part II analyzes the reasons for the growing antivaccination sentiment in America. Vaccines have become a victim of their tremendous success - as horrific diseases like smallpox and polio have all but disappeared in America, today's generation no longer fears them as our grandparents did, allowing complacency towards immunization requirements to build. 1 Vaccines do pose health risks - most minor but some serious - that lead parents to have cause for concern. Immunization opponents also raise deeply held beliefs in individualism and freedom from government regulation and medical intervention as justifications for their decision to opt out. The internet fuels this opposition, with dozens of websites spreading information and sometimes misinformation about vaccine safety. 2 Additionally, well-meaning parents may overperceive the true risks that exist, influenced by widespread media coverage of the highly controversial link between vaccines and autism. 3 All [*360] of these factors combine to spur lawsuits against vaccine manufacturers, producing upward pressure on prices and vaccine shortages as makers leave the market. 4 Congress responded to some of these concerns in the mid-1980s with the National Childhood Vaccine Injury Act, which limited liability of producers and set compensation rates for Americans who are legitimately harmed by the inevitable side effects of vaccines. 5 Still, no action has stemmed the tide of legally sanctioned exemptions to vaccination requirements, or the implications that a parent's decision to opt out presents for her child. Whitman College Tournament 2008 36 File Title A2 Safety The internet fuels fears of the dangers of vaccination Steve P. Calandrillo, Associate Professor at the University of Washington School of Law, University of Michigan Journal of Law Reform, Winter 2004, 37, p. 402-403 While the claims detailed above are alarming enough, the rise of the internet as a means for communicating medical information has generated increased fear and uncertainty regarding immunization safety. Last year, Robert Wolfe and colleagues published an eye-opening account of the content contained on a dozen antivaccination websites. 13 All of the webpages examined stated that vaccines cause illnesses themselves, including autism, SIDS, immune dysfunction, diabetes, neurologic disorders (seizures, brain damage, learning disabilities, and attention deficit disorder), and atopic disorders (allergic rhinitis, eczema, and asthma). 14 Over 90% reported that vaccines erode immunity, that adverse reactions [*403] are underreported, and that vaccination policy is motivated by profit. 15 A majority stated that homeopathy is a viable option to vaccination, 16 that vaccine immunity is temporary, and that diseases have declined on their own without vaccination. 17 Moreover, the design attributes of antivaccination websites added to concerns regarding immunization risks. Anecdotal, emotionally charged stories of children who had allegedly been killed or harmed by vaccines could be found on a majority of sites. 18 These personal accounts, often accompanied by heartbreaking pictures, encourage "false consensus bias" - the tendency to rely on personal experience rather than systematic, scientific evidence. 19 Additionally, all of the websites provided access to fellow antivaccination proponents, including links on how to legally avoid immunizations and links to lawyers who will help parents file claims against vaccine manufacturers. 20 The problem is compounded by the fact that over 137 million American adults are now online, 21 and that 80% of those individuals use the internet to seek out health information. 22 Over half who have visited online health sites consider "almost all" or "most" of the health information reported to be credible. 23 This is of particular concern since many of the claims made on antivaccination websites have not been peer-reviewed in published medical literature. 24 In this environment, parents must exercise extreme caution regarding the vaccination information they find on the web, and make sure there is a scientific basis for the claims being asserted. Whitman College Tournament 2008 37 File Title A2 Freedom of Religion The constitution does not guarantee exemption as freedom of religion Linda E. LeFever, J.D. Candidate at the Dickinson School of Law of the Pennsylvania State University, Penn State Law Review, 2005, 110, p. 1058-1059 Although the Court has conferred broad discretion to the states to enact laws protecting public health, 03 the inclusion of non-medical exemptions to school immunization laws arguably hinders the effectiveness of these laws. The Court has traditionally favored protecting public health over individual interests. In Jacobson, the Court [*1059] stated that: the liberty secured by the Constitution of the United States to every person within its jurisdiction, does not import an absolute right in each person to be, at all times and in all circumstances, wholly freed from restraint. There are manifold restraints to which every person is necessarily subject for the common good. On any other basis, common society could not exist with safety to its members. 04 Similarly the Court has held that the right to free exercise of religion does not include the right to place the health of the community at risk. 05 While the constitutionality of school immunization laws without religious exemptions is well supported, the provision of a religious exemption arguably violates the Fourteenth Amendment of the Constitution. Based on the societal risks associated with an increase in unvaccinated children, the forty-eight state laws with religious exemptions must be challenged. The First Amendment does not protect exemption Linda E. LeFever, J.D. Candidate at the Dickinson School of Law of the Pennsylvania State University, Penn State Law Review, 2005, 110, p. 1059-1060 The First Amendment Does Not Require Religious Exemptions to Compulsory School Immunization Laws The Establishment and the Free Exercise Clauses of the First Amendment provide that, "Congress shall make no law respecting an establishment of religion, or prohibiting the free exercise thereof." 06 Although these provisions share the same goals, namely to protect religious beliefs and acts, the Religion Clauses of the First Amendment are frequently in tension. 07 In order to establish the proper relationship between religion and government, government action must be "permitted by the Establishment Clause, but not required by the Free Exercise Clause." 08 Exemptions to mandatory school immunization laws illustrate how difficult it is to reconcile these provisions. For example, if a state recognizes an exemption to an immunization law based on religion, it potentially violates the Establishment Clause as an endorsement of religion. 09 However, if the government fails to establish a religious exemption, it arguably infringes on the right to free exercise of [*1060] religion. 10 Equal protection should not justify state sanctioned exemptions Linda E. LeFever, J.D. Candidate at the Dickinson School of Law of the Pennsylvania State University, Penn State Law Review, 2005, 110, p. 1063-1064 The Mississippi Supreme Court recognized the unfairness inherent in permitting religious exemptions to school immunization laws. [*1064] Excluding certain children from the requirements solely based on their parents' religious beliefs forces immunized children to bear the burden of keeping overall protection levels high and increases their risk of disease exposure through association with unvaccinated children. Religious exemptions do not afford the non-religious the same opportunity to refuse vaccination. Although the United States Supreme Court's equal protection analysis has evolved since the Mississippi Court declared the religious exemption unconstitutional, it is unlikely the outcome would change. The prevailing view today generally recognizes three levels of scrutiny by which a court should review discriminatory state action. 40 Whether a court reviews the regulation under the strict scrutiny, intermediate scrutiny, or rational basis standard is based on whether the discrimination is against a "suspect" or "quasi-suspect" class and whether the violated right is one that is fundamental. 41 If an individual is not of a suspect class and the right in question does not appear to be fundamental, state action will be upheld if it is related to a reasonable state purpose. 42 Although children have not been classified as a suspect class, under the doctrine of parens patriae, "state courts and the United States Supreme Court have repeatedly regarded governmental actions specifically affecting the welfare of children with special care." 43 Accordingly, consistent with the special role traditionally afforded children, a proper equal protection analysis should require states to provide compelling reasons for denying immunized children the full protection against disease that school immunizations laws are intended to provide. Due to the overriding interest in the child's right to health and safety, and the overwhelming support for compulsory immunization, it is unlikely the state could meet such a burden. Whitman College Tournament 2008 38 File Title A2 Freedom of Religion While freedom of religion is absolute, freedom of exercise is not Linda E. LeFever, J.D. Candidate at the Dickinson School of Law of the Pennsylvania State University, Penn State Law Review, 2005, 110, p. 1060-1061 Under the Free Exercise Clause, the freedom to hold religious beliefs and opinions is absolute, 11 but the freedom to act in accordance with those beliefs "remains subject to regulation for the protection of society." 12 The Free Exercise Clause has been invoked when the government requires conduct that a person's religion prohibits or when a law burdens an individual's religious observances. 13 Laws burdening the free exercise of religion have not been reviewed under a single, uniform standard, despite the strict scrutiny test articulated by the Supreme Court in 1963. 14 In the 1944 case of Prince v. Massachusetts, the Court held that a state could prohibit children from being used in solicitations for the Jehovah's Witnesses religion under the direction of the child's parents. 15 In rejecting a free exercise claim, the Court also addressed the parents' right to control the upbringing of their children, stating that, "the family itself is not beyond regulation in the public interest, as against a claim of religious liberty... . And neither the rights of religion nor rights of parenthood are beyond limitation." 16 The Court also stated that a parent "cannot claim freedom from compulsory vaccination for the child more than for himself on religious grounds." 17 Following Prince, the Court articulated a "compelling state interest" standard for evaluating free exercise claims. 18 Despite the seemingly stringent language of the compelling-interest test, the Court generally sided with the government when individuals claimed that laws restricted their free exercise of religion. 19 One of the few cases in which the Court found a free exercise violation involved the application of a compulsory school attendance law to fourteen-and fifteen-year-old Amish children. 20 In Wisconsin v. Yoder, the Court held that the free exercise of religion required an exemption from compulsory school attendance [*1061] laws due to the "the traditional way of life of the Amish" that is "one of deep religious conviction, shared by an organized group, and intimately related to daily living." 21 The Court stated that this exemption will not "impair the physical or mental health of the child ... or in any other way detract from the welfare of society." 22 In 1990, the Supreme Court retreated from the strict scrutiny standard and stated that a law is valid under the Free Exercise Clause as long as it is religion neutral and generally applicable. 23 In Employment Division, Department of Human Resources of Oregon v. Smith, the Court stated, "we have never held that an individual's religious beliefs excuse him from compliance with an otherwise valid law prohibiting conduct that the State is free to regulate." 24 The opinion in Smith suggests that there is not a strong historical basis for exempting religion. 25 Although mandatory school immunization laws are neutral laws of general applicability and clearly do not violate the Free Exercise Clause under Smith, the Court's reasoning in Prince and Yoder indicates that it is unlikely such laws would have violated the Free Exercise Clause prior to 1990. Whitman College Tournament 2008 39 File Title A2 Nature of Disease Test The nature of disease test is inadequate Alexis Osburn, J.D. from Cleveland State University, "Immunizing Against Addiction: The Argument for Incorporating Emerging Anti-Addiction Vaccines Into Existing Compulsory Immunization Statutes," Cleveland State Law Review, 2008, 56, p. 176-178 While the nature of the disease test appears reasonable at first glance, a more detailed analysis reveals this test is too narrow to encompass all nine of the vaccines currently required by most states, including varicella, tetanus, and hepatitis B. The varicella vaccine is used to combat chickenpox which, although highly contagious, does not satisfy either the second or third factor of the test. 77 Chickenpox does not result in significant morbidity and does not pose a major heath risk to the individual or the community. 78 Likewise, the tetanus vaccine, although accepted by many parents and included on the recommended vaccination schedule, also fails to satisfy two of the three factors of this test. 79 Tetanus infections are not at all contagious and do not pose a major health risk to the general population. 80 Like varicella and tetanus, hepatitis B also fails to satisfy two of the three factors of the nature of the disease test. 81 Prior to the addition of the HPV vaccine, the hepatitis B vaccine was the most controversial on the ACIP recommended schedule. 82 Hepatitis B, a liver disorder, is the leading cause of cirrhosis and chronic liver disease. 83 Intravenous drug use and sexual contact with an infected person are the primary methods of transmitting the virus. 84 The CDC recommended the vaccine be added to the immunization schedule in the mid-1990s after determining that many adults with a high-risk of contracting hepatitis B were not being vaccinated. 85 The attributes and symptoms of hepatitis B make the vaccine analogous to the anti-addiction vaccines being developed by university research teams. Hepatitis B fails the nature of the disease test because it is not highly contagious, nor does it have a high mortality rate. 86 Small concentrations of hepatitis B can be found in saliva, but the virus is generally not passed by casual contact. 87 [*178] Furthermore, the mortality rate for hepatitis B is just 0.1%. 88 Thus, while some statutorily-mandated vaccines "protect against highly contagious diseases that cause significant morbidity and mortality," not all widely-administered vaccines do so. 89 But in spite of their failure to satisfy all three factors of the nature of the disease test, the varicella, tetanus, and hepatitis B vaccines are rightfully included in the list of state-mandated vaccines for most school-aged children. A2 Human Rights Test The Human Rights Test is Inadequate Alexis Osburn, J.D. from Cleveland State University, "Immunizing Against Addiction: The Argument for Incorporating Emerging Anti-Addiction Vaccines Into Existing Compulsory Immunization Statutes," Cleveland State Law Review, 2008, 56, p. 179-180 The four remaining factors of the human rights test are also invalid because they are based on standards not established by the Supreme Court in Jacobson v. Massachusetts. 98 The Jacobson Court did not demand the effectiveness of the vaccine in protecting the majority of the public must be well-established 99 and specifically rejected the fourth factor principle that intervention must be the "most appropriate, least invasive, and most conservative means of achieving the desired public health objective." 00 On the contrary, the Court stated that vaccination requirements imposed by a state legislature need only bear a "real or substantial relation" to a public health threat. 01 To satisfy the means-ends test in Jacobson, vaccines do not have to be the most effective, least invasive, or most appropriate method of combating the public health risk. 02 The standard set out by the Jacobson Court is a lower standard that only requires the legislature to believe vaccination has a substantial relation to eliminating a public health risk. 03 Thus, the third and fourth factors of the human rights test are invalid because they impose stricter standards than are required by the Supreme Court. The fifth and sixth factors of the human rights test are essentially an inquiry into whether vaccination should be avoided to preserve individual liberties. 04 Supporters of the test claim a presumption in favor of individual freedoms when the disease being vaccinated against can be largely avoided by certain behavioral choices. 05 This argument is analogous to those raised by parents who claim vaccination requirements usurp their due process rights to make parental decisions on behalf of their children. 06 The Supreme Court addressed these individual liberty concerns in [*180] Jacobson when it said, "[T]he liberty secured by the Constitution of the United States . . . does not import an absolute right in each person to be, at all times and in all circumstances, wholly freed from restraint." 07 The Constitution does protect many freedoms, but "all rights are subject to such reasonable conditions as may be deemed by the governing authority of the country essential to the safety, health, peace, good order and morals of the community." 08 Whitman College Tournament 2008 40 File Title Neg Evidence Individual Freedom Compulsory Vaccinations violate individual freedom Steve P. Calandrillo, Associate Professor at the University of Washington School of Law, University of Michigan Journal of Law Reform, Winter 2004, 37, p. 394 In addition to the potential safety risks associated with immunizations, antivaccinationists raise the classic American values of freedom and individualism as grounds for their objections to compulsory vaccination laws. Groups opposed to government interference in personal lives vociferously argue that no one, especially not the state, can dictate what they can do with their body (or their child's body for that matter). Mandatory vaccination is therefore an unwarranted interference with basic human autonomy and liberty. 69 In fact, nearly 4 out of 5 websites opposing vaccination [*394] argue that current U.S. immunization laws are a violation of civil liberties. 70 In particular, many cite newly created electronic vaccine registries as an example of "Big Brother" intruding into private lives. 71 Antivaccinationists further characterize public health authorities as abusive, untrustworthy and paternalistic. 72 Resisting forced immunization, on the other hand, is equated with the noble fight against government oppression. 73 The government will incarcerate some that choose to refuse compulsory vaccination Dr. Rima E. Laibow, Natural Solutions Foundation, 7/11/2009, http://www.fourwinds10.com/siterun_data/health/vaccinations/news.php?q=1247333429 The White House is proposing vaccination for both seasonal flu and H1 flu, although the total number of US fatalities to date from H1 has reached a total of about 2. State Emergency Medical Powers Acts and Federal legislation, including the Patriot Acts I, II and III, BARDA and others provide for mandatory vaccination or drugging. No exemptions (religious or otherwise) are provided. Those who refuse will be classified as felons at the State level, subject to immedate incarceration and quarantine of indefinite length in jails or other facilities reserved for such "vaccine refusers." In a frightening "Big Lie" propaganda move, those who doubt the effectiveness of unproven, uninsurable vaccines are being called " Vaccine Resisters" and being equated to a new form of "terrorism." Those who refuse at the Federal level will be subject to immediate incarceration and quarantine of indefinite length, probably in FEMA camps set up across the US. Even if experts agree that vaccines are safe, compulsory vaccination is still coercive Michael Willrich, Associate Professor of History at Brandeis University, "`The Least Vaccinated of Any Civilized Country': Personal Liberty and Public Health in the Progressive Era," Jounal of Policy History, 20.1, 2008, p. 79 This essay argues that principled demands for personal liberty against the growing power of the state were at the forefront of constitutional conflict in the Progressive Era--nowhere more so than in the skirmishes over the "vaccination question."12 With the passage of time, the ideas and actions of the early twentieth-century antivaccinationists may seem quaint. Indeed they were savagely ridiculed in their own time by the mainstream press.13 But opposition to compulsory vaccination was not as unreasonable as it may seem, and it had significant consequences. Although public health authorities and the medical profession were almost unanimous in their support of vaccination, they failed to win hearts and minds. Coercion only intensified concerns about the procedure, resulting in per capita vaccination levels that were, in the eyes of the authorities, disgracefully low. The foes of compulsory vaccination also left an enduring mark on American law. Although the courts usually sided with public health authorities, judges were sufficiently moved by the plaintiffs' constitutional claims to carve out new standards for reviewing and restraining public health authorities. Whitman College Tournament 2008 41 File Title Individual Freedom Autonomy demands individuals have the right to reject life saving medical treatment Robert I. Field, Ph.D. and Professor of Health Policy at the University of the Science in Philadelphia, and Arthur L. Caplan, Ph.D.and Professor Bioethics at the University of Pennsylvania, "A Proposed Ethical Framework for Vaccine Mandates: Competing Values and the Case of HPV," Kennedy Institute of Ethics Journal, 18.2, June 2008, p. 113-114 When stripped of its emotional charge, the debate over vaccine mandates can be framed as a contest between competing ethical values (see Beauchamp and Childress 2001, pp. 168, 173, 251, 313, for discussion of the application of ethical values in the context of vaccination decisions). Both sides accept all of these values in isolation. Disagreement arises over the primacy of each when they conflict. In trumpeting autonomy, mandate opponents rely on an ethical pillar of the U.S. Constitution (Amendment XIV) and on the foundation in law and ethics of a right of competent adults to decline even lifesaving medical treatments (Bartling v. Superior Court. 1984. 163 Cal.App.3d 186, 209 Cal.Rptr. 220 (Cal. App. 2 Dist.)). In essence, autonomy recognizes the right of individuals to govern their own behavior. To exercise this right, it is necessary to be free from outside influences and limitations, which are the essential elements of liberty, and to have the ability to comprehend the action to be taken, the alternatives, and the consequences, which are the components of agency. Liberty requires, at a minimum, noninterference with personal affairs. Agency requires more complex considerations of an individual's capabilities, particularly in the context of health care, as [End Page 113] it assumes competence to make a decision. Assessing competence can be particularly challenging with regard to adolescents, because of individual variations in developmental maturity. Religious Freedom Compulsory vaccinations threaten religious freedom Mathew D. Staver, "Compulsory Vaccinations Threaten Religious Freedom," Liberty Counsel, 2007, https://www.liberty.edu/media/9980/attachments/memo_vaccination.pdf In addition to the problem of some vaccines derived from aborted tissue, there is a larger problem with mandatory vaccines. Many people have a sincerely held religious belief regarding vaccines in general. These individuals believe that God created the human body as a temple and that the body should not be destroyed by injecting a virus into it. Take, for example, Joseph and Heyde Rotella and Maja Leibovitz of New York City. Both families have a sincerely held religious belief against vaccinations. When the Rotellas had a seventh-grade daughter and Ms. Leibovitz had a second-grade daughter, the school system required that these children receive a mandatory Hepatitis-B vaccination. Hepatitis-B can only be transmitted in one of three ways. Either you are born to a mother with Hepatitis-B, or you contract it by drug use through the sharing of needles, or you contract it through sexual contact. Injecting their children with Hepatitis-B is like the state forcing the parents to give their children clean needles or condoms. In both cases, the children were expelled from school, and in one case, Child Protective Services was called to the scene because the child was not in school. After several weeks of expulsion and threats of removing the children, Liberty Counsel filed a federal lawsuit. A court order allowed the children back in school and prohibited the school from overriding the parents' religious beliefs. Many vaccines rely on fetal tissue which violates freedom of religion and is under-reported Mathew D. Staver, "Compulsory Vaccinations Threaten Religious Freedom," Liberty Counsel, 2007, https://www.liberty.edu/media/9980/attachments/memo_vaccination.pdf You may be surprised to learn that some vaccinations are derived from aborted fetal tissue. Vaccines for chicken pox, Hepatitis-A, and Rubella, which are produced solely from aborted fetal tissue, do not have alternative, ethical versions. Even most physicians who oppose abortion do not realize that these three vaccines are made from aborted fetal tissue. The wife of one of our Liberty Counsel attorneys confronted her family doctor who wanted to inject her son with the chicken pox vaccine. When she told her doctor, who is Catholic, that the chicken pox vaccine contains aborted fetal tissue, he was surprised. The doctor was even more surprised when he skimmed through his medical book and found that she was right. He then proclaimed that he was faced with a dilemma which he must now confront. Whitman College Tournament 2008 42 File Title Relgious Freedom Compulsory vaccination violates freedom of religion Mathew D. Staver, "Compulsory Vaccinations Threaten Religious Freedom," Liberty Counsel, 2007, https://www.liberty.edu/media/9980/attachments/memo_vaccination.pdf In addition to the problem of some vaccines derived from aborted tissue, there is a larger problem with mandatory vaccines. Many people have a sincerely held religious belief regarding vaccines in general. These individuals believe that God created the human body as a temple and that the body should not be destroyed by injecting a virus into it. Take, for example, Joseph and Heyde Rotella and Maja Leibovitz of New York City. Both families have a sincerely held religious belief against vaccinations. When the Rotellas had a seventh-grade daughter and Ms. Leibovitz had a second-grade daughter, the school system required that these children receive a mandatory Hepatitis-B vaccination. Hepatitis-B can only be transmitted in one of three ways. Either you are born to a mother with Hepatitis-B, or you contract it by drug use through the sharing of needles, or you contract it through sexual contact. Injecting their children with Hepatitis-B is like the state forcing the parents to give their children clean needles or condoms. Compulsory vaccination kills freedom of religion Mathew D. Staver, "Compulsory Vaccinations Threaten Religious Freedom," Liberty Counsel, 2007, https://www.liberty.edu/media/9980/attachments/memo_vaccination.pdf Liberty Counsel also filed a federal lawsuit against the state of Arkansas. There, the state requires mandatory vaccinations. Our clients have sincerely held religious beliefs opposing these mandatory vaccinations, including the chicken pox vaccination. One of our clients has actually received a letter from the Vatican stating that the Church opposes abortion and it would be a sin for the parent to allow her child to be injected with aborted fetal tissue. Despite the strong evidence of a religious belief which opposes the chicken pox vaccination, the state of Arkansas insisted that the parent vaccinate her child. Our federal lawsuit challenged the state's law on religious freedom grounds. As a result, the Arkansas legislature promptly acted to provide exemptions for philosophical and religious objectors, as well as objectors who claim medical necessity. Whitman College Tournament 2008 43 File Title Parental Autonomy Works Giving parents an informed choice leads to the right decision and maintains parental autonomy MED India, June 04, 2009, "Support for Compulsory Vaccination Grows in Wales as Measles Spreads," http://www.medindia.net/news/Support-for-Compulsory-Vaccination-Grows-in-Wales-as-Measles-Spreads-523911.htm Dr Richard Lewis, the BMA's Welsh secretary, said: "Parents must be able to have a choice. So long as parents have access to the necessary information and facts, they will continue to make the right choices for their families, as they always have done. "Doctors working in partnership with their patients, is the best way to access the appropriate healthcare and this is no less important in the field of immunisation." "Now is the time for a concerted public awareness campaign led by the Welsh Assembly Government, that dispels any myths and misunderstandings about the MMR jab, so immunity levels can be raised to the levels needed to protect our children," he said. Parental autonomy is a persuasive argument P Bradley, Northhamptonshire Health Authority, "Should childhood immunization be compulsory?" Journal of Medical Ethics, 1999, p. 331-332 Here it is argued that the parental right to rear is based on a duty of parents to care for their children to an acceptable level. If they fail to care for their children, they relinquish the right to rear. It is felt that a child has a right to be cared for and this includes a right to receive life-saving vaccination when the child already has an easily curable condition, no matter what the views of the child's parent(s). Several writers state that generally in law the presumption is that parents will make good choices for their children.'2"'" Others explain that parents have to bear the emotional and financial consequences resulting from health care intervention. However, other writers point out that the children bear the direct consequences of health care, not their parents.'2 This means parents may not be morally free to make all choices for their children if this acts against the children's interests as perceived by society. In contrast, some people argue that parents have a right to raise their children according to their own standards without interference. There are several arguments to support this view: I shall consider the most persuasive ones.12 First, it is argued that parents are entitled to rear their own children because they are genetically related to them or because the mothers declared an interest in the children by bearing them. This may mean that parents are best suited to bond with their children and give them the best care. Unfortunately the bonding process is not inevitable between a parent and a child. Sometimes another carer may form a more suitable relationship with the child. Although genetic relationship is seen as important in our society, it is not automatically enough to entitle a parent to raise his/her child.'2 16 Second, families are seen as valuable social institutions, which provide emotional security and foster intimacy and familiarity in children. It is argued that the family needs to be free from interference to fulfil these roles.'6 This means the family may have a right to privacy. The right to privacy is derived from the claim that families are intimate entities. 13 However, Archard suggests that the family relationship is not intimate in the same manner as, for example, a sexual relationship where a third party's interference will prevent the development of the relationship.'6 If a parent is asked to attend an immunisation for his/her child, so the child's health can be protected, this does not necessarily prove detrimental to the fostering of family relationships. Archard suggests that the person who has a right to care for the child earns this right by caring for the child.'6 I make the assumption that most people expect the parent or guardian to provide food, shelter and nurture for the child if s/he is able to do so. Nurture would include parental duties to maintain a child's health to a reasonable level by accessing available health care. Whitman College Tournament 2008 44 File Title Parental Autonomy Empirically Works Parental autonomy leads to the right decision given information denmark and netherlands prove BBC, June 4, 2009, http://news.bbc.co.uk/2/hi/uk_news/wales/8080681.stm New leaflets outlining the risks from measles will be distributed to all parts of Wales and all secondary schools will receive a copy of an immunisation DVD during the next two weeks. Conservative health spokesman Andrew Davies said: "If parents are given access to all the facts about MMR then hopefully they will make the informed choice to get their children vaccinated." Ms Hart said some states in the US had a requirement for children to be vaccinated before they started school. The country has a 99% uptake of MMR among school entry children. But she added: "This has not been necessary where high coverage has been achieved through other approaches and efforts, such as in Sweden, Norway, Denmark and the Netherlands." Parental Autonomy is Supported By Experts Parental autonomy should be overrided only in dire situations america academy of pediatrics agrees Daniel A Salmon, Department of Epidemiology and Health Policy Research, College of Medicine, University of Florida and Saad B Omer, Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, 2006 Emerg Themes Epidemiol., http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1592474 Modern public health strives for maximizing benefits for the highest number of people while protecting individual rights. Restrictions on individual rights are justified for two reasons-for the benefit of the individual or the benefit of the community. In extreme situations there may be a need to protect the health of an individual and particularly a child; even by overriding individual/parental autonomy. However, The American Academy of Pediatrics recently concluded that "Continued (vaccine) refusal after adequate discussion should be respected unless the child is put at significant risk of serious harm (as, for example, might be the case during an epidemic). Only then should state agencies be involved to override parental discretion on the basis of medical neglect". Compulsory Immunization Damages Freedom of Religion Compulsory immunization destroys freedom of religion Andraz Melansek, student of Intenational Relations at the University of Ljubljana, Slovenia, February 1, 2004 "Vaccination, Compulsory?" http://www.idebate.org/debatabase/topic_details.php?topicID=260 Many people have sincerely-held religious beliefs regarding vaccines in general. These individuals believe that God created the human body as a temple, and that the body should not be destroyed by injecting a virus into the body. By making vaccination compulsory, people's freedom to choose is curtailed and that is an infringement on human rights. In any case, it doesn't matter if a few people choose not to be vaccinated, as if the large majority of the population is protected from a disease, there will be too few carriers for it to become endemic, so the risk to those opting-out is very small. Compulsory Immunizations Fail Compulsory immunizations should only be used when absolutely necessary Daniel A Salmon, Department of Epidemiology and Health Policy Research, College of Medicine, University of Florida and Saad B Omer, Institute for Vaccine Safety, Johns Hopkins Bloomberg School of Public Health, 2006 Emerg Themes Epidemiol., http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1592474 In summary, there may be situations where there is an ethically valid public health justification for restricting individual rights both in circumstances where such actions benefit the community and in situations where the actions only benefit the individual. However, restrictions should only be placed after meeting certain conditions to ensure judicious use of this power. Whitman College Tournament 2008 45 File Title Voluntary Immunization Works Their studies can't prove causality, voluntary immunization alone solves James G. Hodge, Adjunt Professor of Law at Georgetown University Law Center, and Lawrence O. Gostin, Professor of Law at Georgetown University Law Center, "School Vaccination Requirements: Historical, Social, and Legal Perspectives," Kentuck Law Journal, 2002, 90, 880-881 Yet, as with some other public health programs, 66 whether school vaccination laws are solely responsible for increasing childhood immunization rates and lowering disease incidence 67 is questionable. Other factors may also substantially contribute to these positive developments. Since the inception of school vaccination laws, for example, public attitudes have changed. Public health initiatives have increasingly turned to non-compulsory methods of compliance to encourage public participation. Parents may willingly have their children vaccinated based on better public education or the recommendation of their pediatricians, instead of the law. "School laws work," suggest Orenstein and Hinman, "because parents . . . rely on physicians recommendations in making their immunization decisions and most physicians . . . are supportive of compulsory immunization." 68 Furthermore, the effectiveness of school vaccination requirements is challenged in some states and locales because of (1) prevailing low [*881] vaccination levels of some school-age children 69 and (2) threats to the public health due to "exemptors," (i.e., persons who voluntarily choose to avoid vaccination on religious or philosophical grounds). 70 Although coverage of school age children for most vaccines has been equal to or greater than ninety-five percent for over two decades, 71 and the number of exemptors is small (around two percent nationally), 72 varying factors contribute to sometimes unacceptably low rates of childhood immunizations. 73 These factors include (a) lack of resources, access to services, or sufficient national monitoring; (b) increased costs of vaccines; 74 (c) difficulties in administering some vaccines; (d) the complexity of the childhood immunization schedule; 75 and (e) poor record keeping among some schools systems. 76 Alternatives work just as well as compulsory immunizations Andraz Melansek, student of Intenational Relations at the University of Ljubljana, Slovenia, February 1, 2004 "Vaccination, Compulsory?" http://www.idebate.org/debatabase/topic_details.php?topicID=260 Researches show that alternative approaches towards diseases such as better nutrition, homeopathy, etc. give very positive results. Healthier populations would not need vaccines to fight a disease. High profits that are now reserved only for the pharmaceutical industry would be spread to other areas of the economy, such as agriculture and the service sector, and more people would gain. Herd immunity means exemptions and individual decisions not to use vaccines won't effect the community's health Alexis Osburn, J.D. from Cleveland State University, "Immunizing Against Addiction: The Argument for Incorporating Emerging Anti-Addiction Vaccines Into Existing Compulsory Immunization Statutes," Cleveland State Law Review, 2008, 56, p. 173-174 High levels of herd immunity allow some individuals to be exempt from immunization requirements without seriously jeopardizing the health of the individual or the safety of the general public. 45 All exemptions can be classified into three categories: medical exemptions, 46 religious exemptions, 47 and philosophical exemptions. 48 Medical exemptions have been required for all vaccination statutes [*174] since Jacobson v. Massachusetts. 49 The original compulsory vaccination statutes, however, did not include religious or philosophical exemption provisions. 50 Such provisions did not become popular additions to immunization statutes until the 1970s. 51 Some states take an "all or nothing" approach, forcing parents to reject all vaccinations before they will receive an exemption. 52 Other states allow parents to object to individual vaccines. 53 Regardless of how the exemption is worded, religious exemptions to compulsory vaccination statutes have been a source of significant controversy since the 1970s. 54 The recent surge in philosophical exemptions is quickly becoming a controversial issue, as well. 55 In spite of their controversial nature, however, these exemptions could serve as an important "safety net" for incorporating anti-addiction vaccines into existing school-based compulsory vaccination schemes. Whitman College Tournament 2008 46 File Title Voluntary Immunization Works England demonstrates that voluntary immunization is effective P Bradley, Northhamptonshire Health Authority, "Should childhood immunization be compulsory?" Journal of Medical Ethics, 1999, p. 330 Immunisation is offered to all age groups in the UK, but is mainly given to infants and school-age children. Such immunisation is not compulsory, in contrast to other countries, such as the United States. Levels of immunisation are generally very high in the UK, but the rates of immunisation vary with the public perception of the risk of side effects. This article discusses whether compulsory vaccination is acceptable by considering individual cases where parents have failed to give consent or have explicitly refused consent for their children to be immunised. In particular, the rights of: a parent to rear his/her child according to his/her own standards; the child to receive health care, and the community to be protected from vaccine-preventable infectious disease are considered. The conclusion of the article is that compulsory vaccination cannot, with very few exceptions, be justified in the UK, in view of the high levels of population immunity which currently exist. Italy proves voluntary immunization is effective Dr. N Moran, M.D. University of York, "Fromp compulsory to voluntary immunization: Italy's National Vaccination Plan (2005-2007) and the ethical and organizational challenges facing public health policy-makers across Europe," Journal of Medical Ethics, 2008, 34, p. 669 Increasing geographical mobility and international travel augment the ease and speed by which infectious diseases can spread across large distances. It is therefore incumbent upon each state to ensure that immunisation programmes are effective and that herd immunity is achieved. Across Europe, a range of immunisation policies exist: compulsion, the offer of financial incentives to parents or healthcare professionals, social and professional pressure, or simply the dissemination of clear information and advice. Until recently, immunisation against particular communicable diseases was compulsory in Italy. The Italian National Vaccination Plan (NVP) (20057) paved the way for regions to suspend the sanctions associated with compulsory vaccinations for children when certain criteria are met--for example when immunisation coverage is high and when effective monitoring/surveillance systems are in place--and thus marked a milestone in the move from compulsory to voluntary immunisation. The forthcoming NVP for 200810 confirms the liberal approach to vaccination in Italy as it entrusts to the regions responsibility for the achievement and maintenance of herd immunity. This paper reviews the arguments for and against compulsory and voluntary immunisation in relation to the Italian NVP (20057) and in the context of the diverse immunisation policies that exist across Europe. It concludes with cautious support for the NVP and an associated shift from compulsory to voluntary immunisation in Italy, and draws similarities between issues concerning regional variation in immunisation policy in Italy and national variation in immunisation policy across Europe and beyond. Whitman College Tournament 2008 47 File Title Vaccines Are Harmful Vaccines pose many healthy risks Steve P. Calandrillo, Associate Professor at the University of Washington School of Law, University of Michigan Journal of Law Reform, Winter 2004, 37, p. 390-391 A source of particular concern in the last few years regarding vaccination risks is the use of the ethylmercury-based preservative thimerosal. Mercury is a known neurotoxin, and some antivaccinationists have raised alarming allegations that thimerosal causes not only allergies but autism as well. 58 Other critics contend that immunizations can lead to multiple sclerosis, sudden infant death [*391] syndrome (SIDS), diabetes, asthma and bacterial infections. 59 The risk of autism and these other dire complications has never been confirmed conclusively and remains the subject of much controversy and debate. 60 Further study is now underway as many antivaccinationists have presented studies linking mercury poisoning to symptoms exhibited by immunized children. In the interest of caution, thimerosal has been removed from all routinely-given vaccines to prevent any further potential risk. 61 Vaccines are harmful and can lead to death Mathew D. Staver, "Compulsory Vaccinations Threaten Religious Freedom," Liberty Counsel, 2007, https://www.liberty.edu/media/9980/attachments/memo_vaccination.pdf The chicken pox vaccine is known as Varivax. This vaccine was also developed with the use of aborted fetuses. It uses the human cell lines known as WI-38 and MRC-5. The chicken pox vaccine also contains MSG (monosodium glutamate). According to the Food and Drug Administration, MSG is not advised for use in infants, children, pregnant women or women of child-bearing age, and people with affective (mental/emotional) disorders. Dr. Arthur Lavin of the Department of Pediatrics at St. Luke's Medical Center in Cleveland, Ohio, strongly opposes the chicken pox vaccine. Studies show that up to 3% of chicken pox vaccine recipients actually contract chicken pox from the vaccine, and some chicken pox cases may be contracted from recently vaccinated children. Some studies suggest that chicken pox in a vaccinated child may be milder than in an unvaccinated child. However, some experts also believe that this may be due to the vaccine suppressing the illness, which can actually signal a more serious underlying chronic condition. "Atypical measles" is a disease that occurs only in people previously vaccinated for measles, and it is far more serious than regular measles. It is yet unknown if "atypical chicken pox" cases will appear as a result of the use of Varivax. Vaccines have many potential health risks Steve P. Calandrillo, Associate Professor at the University of Washington School of Law, University of Michigan Journal of Law Reform, Winter 2004, 37, p. 395-396 Frightening information concerning vaccine safety and risks is becoming commonplace in America today. Anecdotal reports of vaccine-related harms that have affected particular individuals can quickly lead to tall tales and myths about immunization safety. 80 Some of the most prevalent claims include: 1. Vaccines can overwhelm an infant's immune system 2. Vaccines erode immunity 3. Vaccine immunity is temporary and ineffective 4. Diseases have declined without immunizations [*396] 5. Homeopathy is a viable alternative to vaccination 6. "Hot lots" of vaccines have more adverse events 7. Giving multiple simultaneous vaccines increases risk 8. U.S. vaccination policy is motivated by profit 9. Cell cultures from aborted fetal tissue are used to grow vaccine viruses. 81 Whitman College Tournament 2008 48 File Title Flu Vaccines Are Dangerous Industry insider says mercury in flu vaccines All Natural Cures, "Mercury in Flu Shots," 12/17/2007, http://www.allnaturalcures.net/health-freedomfight/mercury.htm "Without mercury, flu vaccines are less effective than one cup of herbal tea. With mercury, the vaccine is very effective at killing nerve cells and more effective than one cup of herbal tea in preventing the flu. In fact almost as many vaccinated people get the flu as the normal population...." "Mercury kills nerve cells. When the nerve cells in the brain are die, the result is attention deficit, autism, behavioral disorders, bipolar, brain tumors and cancer, decreased intelligence, hyperactivity and memory problems. Flu doesn't cause any of these things. Before mercury was added to flu vaccines all of these conditions were very rare...." "Immediately after we started adding mercury to the vaccines, the number of reports claiming children were developing asthma post vaccine increased several hundred-fold. The current odds are 13 out of every 100 children vaccinated with anything containing mercury will report asthmatic symptoms within thirty days. Once reported, these symptoms rarely remit. One out of eight children being vaccinated for flu will develop asthma, asthma-like symptoms and cystic fibrosis that remains with them for life. That's the current odds. This would make a very good court case except for one thing. "M" is immune to lawsuits for their flu vaccines thanks to the FDA. You can't sue "M" for any side effect of their flu vaccine - no matter how gross their negligence. Here's a sample of what happens because they add mercury to their flu vaccines and that's grossly negligent and should be criminal. But it isn't." Whitman College Tournament 2008 49 File Title HPV Vaccines are Unjust Autonomy outweighs public health in the case of HPV vaccinations Robert I. Field, Ph.D. and Professor of Health Policy at the University of the Science in Philadelphia, and Arthur L. Caplan, Ph.D.and Professor Bioethics at the University of Pennsylvania, "A Proposed Ethical Framework for Vaccine Mandates: Competing Values and the Case of HPV," Kennedy Institute of Ethics Journal, 18.2, June 2008, p. 121 The call to mandate the HPV vaccine offers an opportunity to apply the graphic framework in a practical context. Cervical cancer is a serious and often fatal disease that produced an estimated 9,710 new cases and 3,700 deaths in the United States in 2006 (American Cancer Society 2006). Incidence and mortality are much higher in the developing world. The annual treatment cost in the United States is approximately $1.7 billion (Brown et al. 2002). However, early detection through Pap smear screening can reduce the mortality rate considerably, a factor that is partially responsible for a drop of almost 50 percent in the death rate between 1982 and 2002 (National Cancer Institute 2006). The disease is contagious but only through sexual relations. Casual contact is not sufficient. Males as well as females can carry and transmit HPV, although a consequent clinical pathology in males has not been definitively identified. Autonomy concerns regarding HPV vaccination are particularly complex. In addition to apprehension over possible side effects, some mandate opponents contend that offering protection against a sexually transmitted disease implies permission for, or at least acquiescence in, the behavior. At the least, it may interfere with family prerogatives concerning when and how to discuss sexual issues with children. Moreover, unlike diseases such as polio to which there is almost no defense in the face of a contagious patient, HPV transmission can be interrupted behaviorally through abstinence, and even if it is transmitted, the risk to health can be controlled through regular screening. The graphic framework balances the four ethical values that compete with the autonomy of schoolgirls and their families to make decisions regarding administration of the vaccine. Beneficence is compelled by the [End Page 120] potential severity of cervical cancer, but the case for its application to HPV is limited by the availability of alternative control techniques. The issue that it raises for policy is whether the incremental value of a mandate in preventing disease is substantially greater than that of less coercive measures that promote risk reducing behaviors and vaccination on a voluntary basis. Considerations of justice apply, because the vaccine's cost, more than $300 for a course of three required doses, could limit access for those who are poor and uninsured. Nonmaleficence in relation to the HPV vaccine is respected when vaccine safety can be assured, which is not yet possible in terms of long-term effects. This value militates in favor of waiting to impose a mandate, perhaps by applying the two-years recommended by the Institute of Medicine before accepting a new drug as safe. (The recommendation is contained in Committee on the Assessment of the U.S. Drug Safety System (2006). Requiring HPV vaccinations is not justified Lawrence O. Gostin, JD, Catherine D. DeAngelis, MD, "Mandatory HPV Vaccination: Public Health vs. Private Weatlh," The Journal of the American Medical Association, 297.17, May 2, 2007, http://jama.amaassn.org/cgi/content/full/297/17/1921 Given that the overall prevalence of HPV types associated with cervical cancer is relatively low (3.4%)4 and that the long-term effects are unknown, it is unwise to require a young girl with a very low lifetime risk of cervical cancer to be vaccinated without her assent and her parent's consent. Consider the information a clinician can honestly provide to a 12-year-old girl to obtain her assent: "The 3 injections will probably protect you from an infection that you can only get from sexual contact, but research has not shown how long the protection will last or whether it might have rare bad effects on your health." Although many clinicians who have spent most of their professional lives caring for children and adolescents would probably recommend the vaccine, they would be troubled if the patient and her family felt pressured or coerced. Making the HPV vaccine mandatory contributes to long-standing parental concerns about the safety of school-based vaccinations.15 The use of compulsion, therefore, could have the unintended consequence of heightening parental and public apprehensions about childhood vaccinations. It also does not help to offer generous religious and conscientious exemptions for HPV vaccination because legislators may extend these to other childhood vaccinations, which would be detrimental to the public's health.16 Whitman College Tournament 2008 50 File Title A2 Supreme Court Recent case law supports exemptions Steve P. Calandrillo, Associate Professor at the University of Washington School of Law, University of Michigan Journal of Law Reform, Winter 2004, 37, p. 387 However, the common law is not absolute in its support of states' rights to require vaccinations absent reasonable accommodations, and the trend may be expanding in recent years. A New York federal district court upheld a Jewish parent's "sincere religious belief" opposing immunizations even though nothing in the Jewish religion prohibits vaccination. 34 Furthermore, in Wyoming, the Department of Health has no authority to insist that a student provide a medical reason for seeking a waiver from immunization, 35 or even to inquire into the sincerity of a parent's religious objection to vaccination. 36 Finally, despite the rise of new religions which oppose immunization laws, a New York appellate court found that parents who followed the practices of the "Temple of the Healing Spirit" were entitled to a religious exemption. 37 Whitman College Tournament 2008 51 File Title A2 Vaccines Work Statistics about the efficiency of compulsory vaccinations are skewed and are unrepresentative of true facts. Andraz Melansek, student of Intenational Relations at the University of Ljubljana, Slovenia, February 1, 2004 "Vaccination, Compulsory?" http://www.idebate.org/debatabase/topic_details.php?topicID=260 Through different techniques the figures on the efficiency of vaccines are kept artificially high. Statistics are shown partially, diseases are falsely diagnosed and re-diagnosed, public scarce campaigns are organised by the protagonists of compulsory vaccination, etc., all of which results in unrepresentative data. After the CJD-BSE health disaster in the UK, and tragedies connected to the contamination of blood products in several countries, people no longer trust either governments or the scientific establishment to tell them the truth. No comprehensive studies have demonstrated vaccines are effective Ingri Cassel and Dewey Duffel, "Why the compulsory vaccination laws must berepealed NOW, Idaho Observer, Ocotber2006, http://proliberty.com/observer/20061018.htm Some reasons the compulsory vaccine laws must be repealed: Each vaccine is licensed based solely upon the its ability to produce antibodies to a particular antigen. No vaccine that is currently licensed in the U.S. has been tested scientifically by comparing the total health status of a completely unvaccinated population versus a vaccinated population. Although independent scientists, researchers and independent journalists have encouraged the NIH and CDC to conduct such a study, there is no interest on the part of our government to conduct such an important study.1 The 1905 Supreme Court decision authorizing mandatory vaccines based its decision on the prevailing "belief that vaccines worked" without any scientific evidence. This amounts to a violation of the principle that our federal government cannot force participation in a specific religion. Public heath officials and pharmaceutical employees are graduates of medical schools and colleges that must bow to pharmaceutical company pressure to only present pro-vaccine propaganda. Graduates from alternative medical schools and anyone critical of the lack of science supporting vaccine mandates are barred from participating on the CDC's Advisory Committee on Immunization Practices (ACIP). It is the ACIP that determines which vaccines will be on the schedule of recommended vaccines--the schedule used by the states' departments of public health in developing state laws increasing vaccine requirements for participation in daycare and schools. Claims that vaccines work are motivated by drug company skewed education and studies Ingri Cassel and Dewey Duffel, "Why the compulsory vaccination laws must berepealed NOW, Idaho Observer, Ocotber2006, http://proliberty.com/observer/20061018.htm Voices of Safety, International (VOSI) is a standards development organization (SDO) that writes consensus standards for public safety, public health and the environment. Current laws--the U.S. National Standards Strategy (USNSS) and the National Technology Transfer and Advancement Act of 1995 (NTTAA)--require the incorporation of standards from recognized SDOs in our country, at both the state and national levels, for the benefit of the health and safety of people and the environment. To date, VOSI standards have not been considered by any public health agencies though they are required by law to do so. VOSI board members sent a letter/questionnaire to the 49 members of and advisors to the ACIP notifying them of their public health standard of administering the hepatitis B vaccine to all newborns needs to be changed based upon the science-based standard developed by VOSI "The practice of immunizing newborns with Hepatitis B should be discontinued based on the immune system not being fully developed until age 2 (Ref. 4.2 V50.3A) and screening their mothers for Hepatitis B." The response was shocking and is, in itself, a strong justification for repealing the compulsory vaccination laws in your state.2 Health departments and doctors get their information from the vaccine manufacturers themselves, leaving consumers with the very difficult job of finding accurate information and unbiased scientific studies with which to make informed healthcare choices for their families. Whitman College Tournament 2008 52 File Title A2 Vaccines Work Vaccines are harmful and do not work Michael Willrich, Associate Professor of History at Brandeis University, "`The Least Vaccinated of Any Civilized Country': Personal Liberty and Public Health in the Progressive Era," Jounal of Policy History, 20.1, 2008, p. 78 Americans had many objections to compulsory vaccination. The procedure carried well-known health risks-- including pain, sickness, disabled arms, and, in a cluster of well-publicized cases, death. A vocal minority in the medical profession disputed the efficacy of vaccination, favoring sanitation as the sounder policy. To its critics, such as the radical New York lawyer Harry Weinberger, compulsory vaccination was an unconstitutional act of "medical oppression."5 On the basis of questionable scientific claims, made by self-interested physicians and vaccine manufacturers, the state invaded fundamental rights of parental authority, bodily autonomy, and individual conscience. Another critic commented, "The law under which [the vaccinators] operate should carry a clause providing that all sections of the Constitution guaranteeing the security of person or property are hereby repealed."6 A2 Public Risk Individual level risks of vaccines outweigh their benefits James G. Hodge, Adjunt Professor of Law at Georgetown University Law Center, and Lawrence O. Gostin, Professor of Law at Georgetown University Law Center, "School Vaccination Requirements: Historical, Social, and Legal Perspectives," Kentuck Law Journal, 2002, 90, 888 Though at times sensational and misinformed, antivaccinationist sentiment among a minority of the American public is understandable. Individuals assess risks to their children very differently than public health officials gauge the public risks of vaccination. A statistically insignificant chance of an adverse reaction to a vaccination may not ultimately shift public health policy underlying its use, but it means everything to the parents whose child is injured. Such children become sympathetic examples of what every parent seeks to avoid. These risks are especially difficult for individuals to absorb where they occur as a result of the administration of a vaccine for diseases which no longer proliferate among children. "Most people can't remember a time when polio, measles, diphtheria, and smallpox killed tens of thousands of children each year." 15 Risks of not being vaccinated greatly outweighed the countervailing risks of vaccination in prior times. Still, the public health "defeat" of multiple diseases in modern times has led to increased calls for the elimination of the vaccine for these diseases. ...
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Compulsory Immunization Topic 50 - Whitman College...

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