“Resolved: Public health concerns justify compulsory immunization.” 2
SECTION 1. CONCEPTUAL OVERVIEW 2
A. BACKGROUND ON IMMUNIZATIONS 2
B. TOPIC STRATEGIES 5
SECTION 2. RESEARCH GUIDE 7
DEFINITIONS AND DISCUSSIONS 7
SELECTED BIBLIOGRAPHY 9
A.BIBLIOGRAPHY FOR ESSAYS 9
B.BIBLIOGRAPHY FOR ONLINE SOURCES 11
SECTION 3. A. SAMPLE AFFIRMATIVE 14
VOLUNTARY IMMUNIZATIONS DO NOT WORK 18
PARENTAL AUTONOMY IS A WEAK ARGUMENT 19
PUBLIC SAFETY OUTWEIGHS INDIVIDUAL LIBERTY 21
COMPULSORY IMMUNIZATIONS DO NOT HARM INDIVIDUAL LIBERTY 22
UNIVERSAL ACCESS THROUGH COMPULSION IS THE ONLY JUST OPTION 23
VACCINES ARE COMPLETELY SAFE 24
COMPULSORY IMMUNIZATION WAS KEY TO ENDING SMALLPOX DEATHS 25
COMPULSORY IMMUNIZATION WAS KEY TO ELIMINATING POLIO 26
COMPULSORY HPV VACCINE IS JUSTIFIED 27
SECTION 3 B. SAMPLE NEGATIVE 29
STATISTICS ABOUT VACCINATIONS ARE SKEWED 32
COMPULSORY VACCINATIONS VIOLATE FREEDOM OF RELIGION 33
VACCINATIONS DO NOT WORK 34
MANY VACCINES HAVE HARMFUL SIDE-EFFECTS 35
SANITATION IS RESPONSIBLE FOR DECLINES IN DISEASES – NOT IMMUNIZATION 36
“Resolved: Public health concerns justify compulsory immunization.”
Whitman College From a swine flu outbreak in Mexico to mad cow in Washington and SARS in China, public health concerns are a growing issue of global importance. Although public health has been a key issue since ancient Romans explored the benefits of proper sewage disposal, recent innovations have brought public health to the forefront. In an increasingly globalized world, where people make trips from Tokyo to Buenos Aires to Toronto daily, formerly exotic diseases have the capacity to spread from country to country rapidly. Likewise, modern science can create new ways of dealing with both known and new diseases. Given these issues, organizations like the Center for Disease Control (CDC) and World Health Organization (WHO) routinely set public health guidelines and regulations in the effort to control disease; however, these guidelines have far-reaching effects. After an outbreak of swine flu in Mexico, the WHO might recommend ceasing the trade of certain items with Mexico, which could seriously disrupt the Mexican economy. Likewise, the CDC might recommend preemptively distributing a new drug in the United States, or even mandating people in high-risk groups take certain drugs. The key controversy with regard to public health, therefore, concerns individual liberty and choice: to what extent should modern scientific concerns for disease prevention be allowed to affect and possibly disrupt people’s daily lives? Debates between the value of individual liberty and choice and the importance of societal well-being lie at the center of this topic.
This brief intends to introduce some of the key issues with this resolution and provide some resources for further exploration. By exploring the development of immunization as a practice, the first section will offer some insight into historical concerns and examples of successful and unsuccessful immunization policies. This historical analysis will examine key figures and arguments on both sides of the debate and serve to clarify many of the positions held by key authors today. After this conceptual overview, this brief will discuss some of the resolutional concepts and definitions. The third section will include a selected bibliography of available resources which can provide guidance in your own resolutional research. Finally, this brief will include a sample affirmative and negative positions, with extensions, which will make clear how central issues will play out in debate rounds.
SECTION 1. CONCEPTUAL OVERVIEW
A. BACKGROUND ON IMMUNIZATIONS
In western medicine, the history of immunization begins with Edward Jennifer an English doctor who pioneered vaccinations through work on smallpox. An infectious disease characterized by intense rash, skin ulcerations and blisters, smallpox was responsible, by many estimates, for 200-500 million deaths throughout history.1 In the 1770s, Jennifer observed that local milkmaids, who had routine exposure to a similar but non-fatal disease known as cowpox, rarely suffered from smallpox.2 Jennifer theorized that exposure to the cowpox somehow prevented the contraction of smallpox. In 1796, Jennifer exposed an eight-year-old boy to cowpox. After a weak bout of cowpox, the boy recovered. Jenner then exposed the child to smallpox, but nothing happened. Jennifer went on to publish Inquiry into the Causes and Effects of the Variolae Vaccine and famously form the start of modern immunology.
After Jennifer’s successful publications, vaccinations against small pox became increasingly common. By 1800, 100,000 people in Europe had been vaccinated, and vaccination programs were beginning in the United States.3 Mandatory vaccinations soon became common within the United States, despite some dissent. During this period, most of the dissent centered on laws which demanded individuals infected with smallpox be confined to specialty hospitals.4 Despite the negative views, campaigns against smallpox continued. By 1897, smallpox had largely been eradicated in the United States.5 Throughout the 1950s, global efforts to eradicate smallpox increased. Although the disease had largely been eliminated in the United States and Continental Europe, smallpox continued to kill millions elsewhere. In 1950 the Pan-American Health Organization undertook the first hemisphere-wide effort to eliminate smallpox, which proved relatively successful.6 In 1958, the USSR called upon the World Health Organization to eliminate the disease globally. Although the UN adopted the resolution, the effort had limited success in Africa and portions of India. Efforts improved, however, when in 1967 the World Health Organization contributed $2.4 million additional dollars to the project.7 By the 1970s, with major contributions from the United States and the USSR, smallpox had been completely eliminated. To date, smallpox is the only disease to ever be eradicated, although many other efforts have started on other diseases.
Since most diseases like polio do not have a naturally weaker sister-disease like cowpox, modern vaccination differs significantly from the vaccines employed by Jennifer. Not until the work of the French microbiologist Louis Pasteur did immunology as we know it today really begin. While working with chicken cholera, Pasteur accidentally let a culture of cholera spoil.8 The spoiled culture failed to infect the chickens Pasteur intended it to. When reusing the healthy chickens in a secondary test, Pasteur discovered they could not be infected. Pasteur discovered that by weakening an otherwise deadly disease, he could infect an animal non-fatally and induce immunity from future contractions. In honor of Jennifer’s discovery almost a century earlier, Pasteur named his method of artificially weakening a disease, vaccination (a term which had previously only described exposure to cowpox).
Today, many, especially in the scientific community, see the eradication of smallpox as one of the greatest triumphs in medical history. The success of the smallpox program led to similar global efforts to eradicate other diseases, most significantly poliomyelitis. Commonly known as polio, the crippling disease once affected thousands of Americans. By now polio has largely been eliminated in the US, largely due to compulsory immunizations, but continues globally. Nonetheless, efforts which resemble the eradication of smallpox continue with polio and as of May 2009, only 17 countries have reported outbreaks.9 Other similar cases in the United States include mumps, measles, rubella, and hepatitis B. In an effort to eradicate these diseases, public schools require vaccinations before entry. Likewise, immunization records are required for many other government (and many private) services. Although most such services have an option for opting out of specific vaccines, failure to be “properly immunized” results in severe limitations on many US services.
Perhaps the most recent example of mass compulsory immunization in the United States came in 2006, with the FDA approval of Gardasil, a vaccine for human papillomavirus (HPV). In September of that year, just three months after the FDA approved the drug, Michigan became the first state to require that all girls entering the sixth grade receive be vaccinated for HPV.
Criticism of the vaccination policy was widespread and covered many issues. Many Christian-right organizations, among the most vocal of critics, criticized compulsory vaccinations for HPV as undermining non-abstinence methods.10 Though many of these organizations supported the availability of the vaccine, they felt that mandating girls receive a vaccine for a sexually transmitted disease blatantly contradicted their pro-abstinence message. Compulsory immunizations therefore constituted a secular state attempting to impose restrictions on religious beliefs.
Nonetheless, as this brief will discuss further, it is a mistake to assume that the controversy surrounding Gardasil (and the controversy in the topic more broadly) boils down to a religion vs. science argument.
Other groups and individuals, basing their criticisms on unproven links between vaccinations and autism, diabetes, and multiple sclerosis, have spurred distrust in state vaccination requirements.11 Although their criticisms of compulsory immunizations were based on false scientific linkages, their opposition was theoretically grounded in parental autonomy. In their minds, parents ought to have option to weigh the risks and benefits of vaccinations before giving it to their child.
Some bioethicists, who held no such delusions about possible risks, argued that because HPV is not casually communicable (that is it can only be transmitted sexually) the state has no right mandating immunizations, since the public is only at risk if they engage in risky sex behavior.12 Like other opponents, these bioethicists believed that autonomy ought to dictate the discussion: those people who wish to engage in risky behavior should have the option of the vaccine; those who do not engage in said behavior should likewise have the option of not receiving treatment.
In large part, state legislatures and advocates responded to these criticisms with sociological studies which indicated that compulsory immunizations drastically reduced instances of illness. These studies found that roughly 12% of parents opposed compulsory immunizations. They also found that of the remaining 88% who favored vaccination, few would actually vaccinate their child due to a number of factors. Other studies found that mandating the use of Gardasil would dramatically reduce the rates of HPV and cervical cancer.13 Using this information, advocates of mandatory immunization against HPV argued that compulsion was the only way to effectively eliminate the risk of HPV.
Although many of the controversies surrounding compulsory HPV vaccination also surrounded other vaccination programs such as smallpox and polio, the HPV debate is unique in a few ways: although HPV is relatively common (about 80% of American women will contract some form by the age 50)14 it is not casually communicable; and mandates for Gardasil became common only 3 months after FDA approval, a relatively short time. Additionally, the relative recentness of the HPV debate will make it particularly relevant for this topic. (add something about not beign approved for boys??)
B. TOPIC STRATEGIES
As we have already discussed, the central question of this resolution is individual liberty versus public safety. The historical example of smallpox, considered by many one of the greatest triumphs of modern medicine, without question represents the potential benefits of compulsory vaccinations: prior to the smallpox eradication program, smallpox claimed millions of lives annually. The more recent discussion over compulsory HPV vaccinations provides clear examples of some of the negative strategies such as undermining the right to religious educations and encouraging specific life styles. Although these particular issues may be clear, the types of arguments on each side can be deployed in a multitude of different ways. This section will introduce some of those ways and make clear some fundamental strategy issues.
To many people, this topic has a strong affirmative bias. For the majority of Americans (recall about 88% of parents), compulsory immunizations seem to be a good thing. Likewise, history seems to indicate that immunization programs are widely successful – in addition to the eradication of smallpox, diseases like rubella and hepatitis B are practically unheard of in the United States. Debating on the affirmative largely means playing off of these widespread beliefs and effectively utilizing historical examples to support the case for compulsory immunizations.
Since the topic fundamentally asks a question about public safety versus individual liberty, the majority of affirmatives will in some way defend public safety as their value. However, there are many ways to define public safety. Most affirmatives will want to define public safety in the narrowest sense of the word. Many negatives will argue that compulsory vaccinations go too far and disrupt lives in order to prevent relatively minor diseases. Citing examples like the HPV vaccine, negatives will argue that individuals should have the choice to engage in risky behaviors, rather than having a vaccine forced upon them. In order to avoid this debate, affirmatives should define public safety as something with particularly far reaching consequences. By arguing that public safety means freedom from preventable casually communicable diseases, affirmatives can avoid debates regarding HPV all together. Using a limited definition of public safety allows affirmatives to focus the debate on the successes of the smallpox and polio eradication programs. Negatives will have a particularly difficult time arguing that the United States should not have undertaken the polio eradication program.
Another important question for affirmatives is how to best access values of public safety. Many possible criteria exist for accessing public safety. Perhaps the most immediately evident criterion is utilitarianism. Since the resolutional term “public health” definitionally discusses the public, it makes sense to use a criterion which emphasizes maximizing good for the most people. Utilitarianism will prove a particularly important affirmative value on this topic, since it allows affirmatives to argue that communities have a right not to risk widespread infections, even if that means minor infringements upon certain minority groups which oppose compulsory immunization programs. By citing statistics demonstrating the effectiveness of compulsory vaccinations versus other possible options, affirmatives can effectively argue that the extreme positives of eradication smallpox outweigh the risks posed to individual rights.
Secondary important criterions on this topic will be those of social contracts. Although there are many social contracts (some of which provide criteria for the negative), many theories of social contract will prove particularly good criteria for affirmatives.
A useful social contract, which occurs on many topics, will be that of Thomas Hobbes. Hobbes, an English political philosopher established a social contract theory in his work Leviathan. Fundamentally believing that human beings were irrational, Hobbes argued that the purpose of the state was to protect humans from themselves. He argued that individuals sacrificed some aspects of individual liberty and freedom by maintaining citizenship under a state sovereign. Although Hobbes argued in favor of an absolute monarch and most of his analysis discussed external and violent threats (ie warfare), much of his work still applies. Using Hobbes’s social contract, affirmatives can argue that human beings do not always act rationally and therefore oppose vaccinations for diseases like smallpox. The state has a responsibility to protect its citizens from the threat of diseases, and as citizens they have naturally forgone some of their individual liberties, and therefore compulsory immunizations are just.
Another social contract which will likely prove useful for affirmatives comes from the French political philosopher Jean-Jacques Rousseau. Rousseau famously argued in his 1762 treatise The Social Contract, Or Principles of Political Right that society ought to be governed by the “general will.” Rousseau, like Hobbes, believed that individuals entered into a social contract upon participating in a society and therefore abandoned some of their individual liberties. Unlike Hobbes, however, Rousseau argued against an absolute monarch. Rather Rousseau felt that a free society would involve governing by a consensus of the people. Summarizing his theory of social contract, Rousseau wrote: “The heart of the idea of the social contract may be stated simply: Each of us places his person and authority under the supreme direction of the general will, and the group receives each individual as an indivisible part of the whole...” Rousseau argued that the law was not a limitation of people’s freedom, but rather the expression of people’s freedom; that is, the general will of the people decided upon the rules and therefore the rules are to be followed as the individuals of a society agreed upon them. Using Rousseau’s social contract theory, affirmatives can argue that since the majority of persons agree with the concept of compulsory immunizations, they represent the general will. Rousseau famously argued that people must “be forced to be free;” his analysis no doubt favors compulsory immunizations as just.
A final social contract which may prove useful for affirmatives is that of John Rawls. Unlike Hobbes and Rousseau, Rawls makes no claims about the state of nature. He makes no comment on human nature or a pre-societal life. Rather, Rawls bases his political philosophy on what he refers to as the veil of ignorance. Summarizing this concept, Rawls wrote in is work, A Theory of Justice, “no one knows his place in society, his class position or social status, nor does anyone know his fortune in the distribution of natural assets and abilities, his intelligence, strength, and the like. I shall even assume that the parties do not know their conceptions of the good or their special psychological propensities. The principles of justice are chosen behind a veil of ignorance.” According to Rawls, these aspects of human life cloud humanity’s judgment and prevent the creation of a legitimate social contract. Therefore, society should form the social contract from behind the veil of ignorance. Rawls theory works for the affirmative by stating that the aspects of individual liberty which inspire the negative all pertain to parts of human life that ought to be excluded from thought. For example, without knowing one’s religion, one would likely favor compulsory immunizations. Evidence of this fact comes from the fact that Christian-right organizations which opposed compulsory HPV vaccinations nonetheless supported the widespread availability of Gardasil for others. Since the only legitimate way to determine just actions is from behind the veil of ignorance, Rawls would argue that compulsory immunizations are just.
Beyond your choice of a criterion, there are several other important considerations for debating as the affirmative. One important one is how to define compulsory immunizations. Although this will be discussed more thoroughly in the definitions section, the affirmative will want to define compulsory immunizations in a very loose sense. One definition, which works well with most theories of social contracts, is the way that most states define compulsory immunization. Although immunization from many diseases is mandated prior to access of many state institutions, opt-out programs allow individuals to decline immunizations for their children. By using the state definition of compulsory, affirmatives can subsume most of the negative’s offense by arguing that compulsion maintains individual liberties.
On this topic, negatives have a more difficult task than affirmatives. Many negatives will have a difficult time convincing judges that the damage done to individual liberties during the smallpox eradication program outweighed the benefits of eradicating smallpox and saving millions of lives. Therefore, most negatives will have to take a different approach.
As a given, negatives will want to define “public health” as broadly as possible and “compulsory immunizations” as narrowly as possible. By defining public health to include relatively minor health concerns, negatives will have an easier time convincing judges that compulsory immunizations are a step too far. Likewise, by defining compulsory in a particularly brutal way (such as publishable by jail time), negatives will have more ground to argue against their use or justice.
One way to approach the topic is to argue for a slippery slope. Although arguing against smallpox eradication may be difficult, it is important to consider that the smallpox eradication program is now successfully over. A potentially effective strategy negatives can employ is to concede the value of smallpox eradication but argue that new diseases and new eradication programs do not warrant compulsion. Using the litany of evidence regarding HPV, negatives can argue that as a result of the smallpox program, compulsory immunizations have become too common and therefore are unnecessary. As the scientific community pushes for more compulsory immunizations, they begin pushing for immunizations of diseases which are of relatively low and risk to certain populations, populations which deserve a right to choose. Once public health concerns completely eclipse individual liberties, the consequences could be devastating.
Another possible strategy for negatives involves merging individual liberties and public health concerns by discussing other possible routes for eliminating disease threats. Many states, in response to concern over HPV vaccinations have implemented a system wherein girls between certain age ranges have access to free vaccinations. Through these and other incentives, governments can encourage vaccination without using compulsion. By pointing out alternative methods and emphasizing the word “justify,” negatives can argue that even if compulsion is a successful method, the presence of other options mean compulsion is not justified. (add that examples can be drawn from European nations that don’t use conpulsion????)
A more radical strategy, which some teams will no doubt employ involves to policy standard argument of called “Malthus.” Named after Thomas Malthus, this argument states that a population crunch is coming and that it is morally better to let people die now rather than cause mass extinction later. Although seemingly preposterous, this strategy allows negatives to use a criterion of utilitarianism and subsume much of the affirmative’s offense. By arguing that allowing diseases to run rampant now prevents mass extinction later, negatives can argue that “public health” concerns mandate not using compulsory immunizations.
Although the “Malthus” strategy may seem radical and relatively obscure, it represents an important aspect of negative strategy on this topic: subsuming affirmative offense. Rather than outright arguing that individual liberties outweigh such significant medical achievements as smallpox eradication, negatives should try to concede as much of the affirmatives position as possible and make minor distinctions that offer enough to earn a negative ballot.
This section has hopefully provided you with a history of immunizations sufficient enough to start your own research. Likewise, this has demonstrated how some of that history can be applied and how some of the historical perspectives on immunization fit into the topic. Finally, this section has provided a brief strategy piece which explains broadly some of the strategies that will be most helpful on the affirmative and negative.