Wednesday, April 22, 2009

Vaccines and Religious Exemption

In February, two OU freshmen were diagnosed with bacterial meningitis. In brief, meningitis refers to an inflammation of the protective membranes covering the brain and spinal cord, known collectively as the meninges. Left untreated, bacterial meningitis is almost always fatal.

In other words, it’s nothing to kid around about.

As it turns out, both students had been vaccinated for meningitis—but that vaccine covers only four of the five main strains of the disease. Though they are a startlingly effective preemptive measure, most vaccines cannot promise 100% immunity.

I bring this up nearly three months later in light of a new development. As reported by the Post last Thursday, three Ohio state senators have introduced a bill that would require all students to receive a vaccine for bacterial meningitis and hepatitis B if living on campus at any college or university in Ohio. I applaud the efforts of these senators to ensure the health and safety of Ohio students—that’s us—but a particular detail of the report caught my eye. Perhaps unsurprising, a stipulation of the bill is that students should be able to waive the requirement on grounds of religious exception.

I will note here that the article also reports that students should be able to forgo vaccination on grounds of risks to their personal health. The safety of vaccination is a can of worms that I’m not particularly interested in discussing in this post, but I will state first and unequivocally that these sorts of appeals bear little weight in my mind. Vaccines are safe and effective. And any portion of the population which remains unvaccinated is a risk to public health. Period.

That’s that. But for students to resist vaccination and consequently become a risk to the health of innocent bystanders—and I want to make it clear that the following thoughts are directed specifically to students in dorm, as they will be the ones affected by this pending legislation—on grounds of religious conviction? For me at least, this is where things get interesting.

The Rules of Exemption

How exactly is religious exemption defined? According to Florida “vaccine awareness group K.N.O.W., “religious exemption is for anyone who has a sincere religious conflict with vaccination.” I’m particularly amused by the idea that exemption might only be granted on the basis of “sincere” religious conflict. I’ve yet to come across any litmus test or gold standard for religious sincerity. The wording is especially interesting to me because the K.N.O.W. FAQ also states that no agent may have the authority to request proof of the dissenter’s religious belief, nor are they able inquire about or discriminate between religious denominations.

In other words, you’re “sincerely religious” if you say you are. And why not? I have no problems there. I certainly don’t doubt the religious sincerity of many of my friends and family members. What I am troubled by is this: by these rules, it follows naturally that you can, as a dorm-dwelling student, forgo vaccination if you feel like it— and that’s all the reason you need.

Equally interesting is the group’s attempt to list the reasons that constitute a religious conflict, which reads as follows:

All vaccines are made in violation of God's Word. Vaccines are made with toxic chemicals that are injected into the bloodstream by vaccination. All vaccines are made with foreign proteins (viruses and bacteria), and some vaccines are made with genetically engineered viral and bacterial materials.

A conflict arises if you believe that man is made in God's image and the injection of toxic chemicals and foreign proteins into the bloodstream is a violation of God's directive to keep the body/temple holy and free from impurities.

A conflict arises if you accept God's warning not to mix the blood of man with the blood of animals. Many vaccines are produced in animal tissues.

A conflict arises if your religious convictions are predicated on the belief that all life is sacred. God's commandment "Thou Shall Not Kill" applies to the practice of abortion. When you believe that the practice of abortion should not be encouraged or supported in any way, a conflict arises with the use of vaccines produced in aborted fetal tissue even though you did not have any other connection with the abortions from which the vaccines are derived.

While I find these particular appeals mundane, it is interesting at least that they might try to distill a finite set of religious incompatibilities, and with an obvious bias toward the dogma of conventional fundamentalist Christianity. It almost seems that, for a moment, they’ve forgot their self-imposed rule—that they remain open to any and all convictions and creeds. Where are the rules to protect dissenting Pastafarians?

The Dangers of Exemption

All of that is interesting, but I’ve yet to get to the real heart of my concern. This new law in the Ohio senate was proposed for a reason—the measures therein are important, maybe even vital, to ensuring the future health and safety of students. Disease is dangerous. Disease kills.

Let me repeat that. Disease kills.

If you are not vaccinated, you’ve been negligent in regards to your own health. But worse-- because even those who have been vaccinated are still susceptible, you’ve become a danger to everyone around you. You are a risk to public health.

Most people reading have probably lived in a dorm at some point or another, and could attest to their relative filthiness. When you’ve got this many 18 year-olds living together in such close proximity, and sharing so much of their living space, what else could you expect? In dorms, kids get sick—and the sickness spreads.

Here’s the crux of the problem: Admission into a public university is a privilege, not a right. If you cannot adhere to the basic health standards of that university, for any reason, you do not deserve a free pass. If you cannot attend a university--and especially be admitted to live in its dormitories--because you refuse vaccination, how unfortunate for you. And if you’re really smart? How unfortunate for academia.

But how fortunate for everybody else.

This isn’t a matter of respect or tolerance or sensitivity. These things are all important—incredibly important—but their significance drops proportionately in the face of such a serious health risks.

Consider for a moment that the courts have successfully outlawed cigarette smoking in all public buildings in Ohio. While I support those laws for personal reasons, let’s be frank—the primary health concerns that sparked that legislation is dubious at best. Living with a smoker may be a danger to your health. Eating dinner next to one is simply unpleasant.

So I wonder why we aren’t able to seek religious exception to that law? “Pardon me sir, but I really must light up—it’s my religion, you see.”

I think a compelling parallel could be drawn here to the student who is admitted into a university dorm and chooses not to be vaccinated—and in this case the health concerns are very real.


Anonymous said...

Medical procedures should not be forced on anyone. Informed consent and freedom of choice on health issues is necessary.
If vaccines really worked, perhaps those 2 that were already vaccinated would not have gotten meningitis.

Andres said...

While I too shudder at the thought of government forcing me to inject anything in my bloodstream that I may not want, it seems to me like it is justified. The government isn't requiring every Ohio citizen to get this shot, they are requiring Ohio State University students who live on campus to take the shot. If they don't like it, then said university is simply not the place for them to be.

I think a better case can be argued on behalf of personal freedom (and that freedom does include the right to refuse medical treatment, even if it leads to your death). The religious aspect of the story is ridiculous. Why is a religious exemption the only one they talk about? One need not have a religious conviction in order to say 'no, you have no right to force me to take this vaccine.'

Regardless, I do applaud the senators for trying to get this bill through. It should be interesting to see what happens.

David said...

Great post Brett.

And, yeah, singling out religious reasons is a bit absurd. Why not continue to include it in the set of personal reasons?

Also, one of the most important components to all of this is those who can not receive vaccinations due to real health hazards. Vaccines are certainly imperfect, but they are imperfect with incredible precision. The x factor that throws this off is an individual's immune system. Everyone's immune system is practically as specific as finger prints. So, sometimes the an individual's immune system fails to work in conjunction with the vaccine in such a way that leads to immunity.

So, what about those who can't receive vaccines? They rely on herd immunity. This is incredibly important. If all of the high to medium to low-medium risk people are vaccinated (risk in terms of contraction), then those everyone else is at such a low risk that the 'herd' is immune despite the fact that a small percentage of the constituents of the herd are not immune themselves.

So, those refusing to have vaccines fall into that area where they are still covered by herd immunity. However, there is a tipping point beyond which there are enough people not vaccinated that they become a high risk demographic.

Essentially, refusing vaccination for nit-picky or fickle reasons has the potential to increase the risk of disease to those who would otherwise receive vaccination.

Some of these people who rely on herd immunity have already compromised immune systems - and a religious person could actually unknowingly infect them without becoming infected themselves.

Drunk driving almost comes to mind.

However, there is no good way to deal with this sort of externality. This is especially true when those refusing treatment are doing so on the basis of a false belief. One example of this would be believing that vaccines cause autism (which they absolutely do not).

Another case is for religious reasons. However, if one of the, for lack of a better term, duties of religion is provide humanity with a world view that instill morality or some sort of ethics, then I argue it is failing here.

Destroy the herd immunity and destroy the ones that rely it - all for unimportant gripes. If this portion of vaccine is not figured into the decision to refuse treatment, then the moral implications of the action are being ignored or overlooked. So, from a religious aspect, the pious must choose between infecting those who can't receive vaccinations against their will or suck it up and get the shot.

If you still refuse to out of principal, well, despite how much I disagree with your position, I can not disagree with your right to autonomy. If you feel your religious conviction truly outweighs the slow painful deaths of those who want vaccines but can't have them, then I disagree with you whole-heartedly.

Also, if a portion of the population who is not immune gets large enough AND infected, this increases the chances of mutations in viral strains and could lead to infecting even more of the population, despite treatment.

So, I think those who do not like the idea of getting vaccines need to truly evaluate their position. Ultimately I'd say suck it up. Still, do what you want - put people's lives at risk all your want.

Andres said...

I'd also say that the number of people who would actually forgo these vaccine treatments doesn't seem to be that big to begin with.

The religious justification may be stupid, yet I am glad its there. Like Brett said, anyone can just claim to have a religious reason for not taking it; even if it is a loophole, I personally am glad there is a way for people to say no if they truly wanted to.

I don't think I've ever met any christian who honestly believes vaccines are evil. The type of mentality used to justify not taking a vaccine is the type of mentality you find in extremist circles, like, say, Westboro Baptist Church. Most Christians I know believe that God can work through science, so there's no need to get in the way of it.

David said...

True. The biggest problem, I think, lies with the denier crowd. The CDC has already found an increase in vaccine preventable diseases since the conspiracy theorists started promoting their ideas.

Just as an anecdote - I once worked with a woman who told me her daughter wasn't going to vaccinate her son because she feared he'd get autism. From what I understand they have pretty normal family - they're aren't necessarily conspiracy theorists themselves - but they had been influenced by Jenny McCarthy and the like.

To gain a better idea of this, check out this site:

It basically attaches a body count to Jenny McCarthy related influence, based off of the CDC studies.

Brett Nuckles said...

Y'know Andres, I think the fact that dissenters are forced to jump through loopholes is what really bothers me. As if religious conflict exists on a higher plane and must be respected in ways that any other personal conflict is not. If you're going to honor religious exemption, you'd better honor any philosophical or ideological exemption. You'd better honor "Me no like needles."

Anonymous said...

If vaccines really work, then vaccinated people have nothing to fear from vaccinated people.

Adam Lane said...

I agree. That's why we should all be vaccinated if we're required to. Who really likes being jabbed with a needle? No one I know. But requiring as many people as possible to be vaccinated within an institution (e.g. dorm dwellers within a university ), is necessary to prevent the widespread outbreak of disease. We do need to remember that some people can't receive certain vaccinations for various reasons, so it's that much more important that we attempt to ensure that as few people as possible simply rely on the herd immunity that the vaccinations establish in the first place. Again, if you don't like the rule, you can use religion as an out, whether it's a sincere attempt or not, or there's always the option of not attending the college. Which would be shame. I'm not sure how many ways it can be said that the vaccination of a population to prevent the spread of communicable illnesses is gravely serious.

david said...

I disagree with 'anonymous', vaccinated people do have reason to fear unvaccinated people. The more hosts in which the virus can reside, the more chances it has to mutate further - thus rendering the vaccinations useless faster. Also, they are hurting those who genuinely cannot get vaccinations - and I do fear those humans who are willing to slowly, agonizingly kill their fellow humans because they either a.) refuse to look at the facts objectively, or b.) feel squeamish.

Anonymous said...

I did not read through all the comments, so I am sorry if this is a repeat.

The biggest thing I have to say here, is that if people are so sure of thier vaccines, that they will protect them from the disease, then why are they worried they will "catch" a disease from someone who has not been vaccinated? That makes absolutely no sense at all. Vaccines are harmful and they are not effective. If you look into it, you will see that several "outbreaks" are more than 75% vaccinated individuals, and a very small amount of individuals are unvaccinated.