Ethically Confronting the Measles Outbreak
Before I had children, I was upset to discover that some vaccines were problematic from a Catholic perspective because they were derived from fetal cell lines. As someone who considers herself pro-life, I certainly hesitated at the thought of giving them to my future children. Obviously, it would be ideal for all the available vaccines to be ethically sourced. How was I to weigh the problematic origins of the fetal cell lines with the public health good of vaccines, not to mention the health of my children? But since the United States declared measles eliminated in 2000, the need for the vaccine didn’t feel so urgent; it seemed very unlikely that my future children would come into contact with the disease.
But even before I had my first child in 2009, small- and not-so-small outbreaks of vaccine-preventable diseases, such as measles and pertussis, caused me to reconsider my stance. It made sense that high vaccination rates had kept many of these infectious diseases at bay and that falling vaccination rates were allowing them to return and wreak havoc. I also realized that my child would be very vulnerable to many of these diseases in his first year of life when his immune system would not be fully developed. I understood the importance of vaccinating to protect my vulnerable infant, as well as other babies.
The Pontifical Academy for Life’s (PAL) 2005 statement resonated with me–it explained why we should be uneasy and conflicted about the source of the fetal-cell line vaccines. But what ultimately convinced me to use the vaccines in question licitly was their assertion that our ideological opposition to the unethical vaccines should not “put the health of [our] children and of the population as a whole at risk.” Without vaccinating my children against diseases such as mumps and rubella, could we truly know that our family had done everything possible to avoid endangering vulnerable populations and, equally importantly, our children?
While I will breathe a sigh of relief when my youngest gets his MMR vaccine in a few days, I worry terribly about the many babies and immune-compromised individuals who cannot be vaccinated in the midst of this current measles outbreak. An infected person can spread the virus from four days before a rash appears until four days after the rash starts. Measles is so contagious that the virus can survive in air droplets up to two hours after an infected person leaves a room. 9 out of 10 unvaccinated individuals coming into contact with the virus will contract the disease. 2-3 out of every thousand infected will die, and 25% will require hospitalization. Other serious consequences of measles are brain, vision, and hearing damage, as well as pneumonia.
Measles in pregnant women can cause miscarriage, preterm labor, and low birth weight (as recently as May 2013, a Brooklyn woman suffered a miscarriage as a result of contracting measles). After birth, babies are not completely protected by passive immunity from their mothers, contrary to some pervasive misinformation. While antibodies and white cells pass through the placenta during the third trimester, as well as through colostrum (and to a lesser extent breastmilk), antibody levels in the baby fall in the first couple months of life, and immunity usually disappears within 6 months. Considering that 12 months is the earliest* that children can receive the MMR vaccine, there is a sizeable length of time when they are particularly vulnerable to the disease.
Another point to consider is that the first MMR dose is 85-90% effective. The second dose, usually administered between the ages of four and six, will usually provide immunity for those whom the vaccine did not initially take, leaving 1% of vaccinated children who do not develop immunity. This vulnerable 1%, as well as a small number who cannot receive the vaccine due to medical issues, rely on others to vaccinate in order to protect them.
Besides pregnant women, babies, and the vulnerable immunized, immune-compromised individuals are at a greater risk to contract measles. Those with cellmediated immunity deficiencies are susceptible to more prolonged, serious, and deadly cases. This group includes those with HIV, congenital immunodeficiencies, and those who need chemotherapy and immunosupressive therapy. Cancer treatments suppress the immune system and can eliminate previous immunity to measles. In addition, those with weakened immune systems (including infants) are more likely to develop pneumonia and bacterial infections as a result of measles. The case-fatality rate has been reported at 70% for cancer patients contracting measles. It is unacceptable to put these populations at risk when there is a safe vaccine.
While some may disagree with me when it comes to compelling reasons to receive the vaccines for rubella, hepatitis A, and varicella, I believe that the current circumstances of this measles outbreak warrant using the MMR vaccine. Considering that a single infected college student unknowingly exposed numerous Amtrak passengers, this circumstance could very easily occur in your own geographic area. In my own community, I know of children and adults undergoing chemotherapy; I know many families with young babies; I know several pregnant women. I worry about how susceptible my own parish and homeschooling circles would be should the measles come to my area. As the Pontifical Academy for Life explains, “As regards the diseases against which there are no alternative vaccines which are available and ethically acceptable, it is right to abstain from using these vaccines if it can be done without causing children, and indirectly the population as a whole, to undergo significant risks to their health.” I would argue that this measles outbreak presents a “significant risk” to children and the population as a whole.
By all means, make it clear that you are not happy to use a problematic vaccine. Let pharmaceutical companies know that “[i]f [they] or other agencies derive fetal cell lines from elective abortions, those companies or agencies … are guilty of immoral cooperation in the evil of abortion.” [Fr. Tadeusz Pacholczyk, Ph.D, National Catholic Bioethics Center] You can sign this change.org petition, write to Merck and the CDC, as well as your congressional and state representatives. Likewise, let your concerns be known to your doctor; I had no problems discussing my ethical qualms with my children’s pediatrician.
While I would gladly welcome an ethical MMR vaccine for my future children, we also live in a fallen reality. In a little over a month, the Disneyland measles outbreak has spread to 14 states and Mexico and shows no signs of stopping. Thank God, there have been no deaths thus far, but as the number of cases rises, that likelihood rises as well. I certainly do not want to dismiss or belittle the ethical conflict we parents face when we have to confront evil. We live in a world where we regularly interact with evil, and this conflict is something good people have struggled with for centuries. We regrettably cooperate with evil if we pay taxes, have a 401K, and even when we purchase almost anything. These are real conflicts we struggle with, but even in these circumstances, Christ clearly indicated our limited moral culpability. But our actions do have concrete real-world consequences, not just for our families but also our brothers and sisters in Christ.
Circumstances vary to determine whether cooperation with evil is licit or not. Guided by the Vatican teaching and the current medical knowledge concerning measles, I cannot justify forgoing a life-saving vaccine if the authority of our Church herself deems it permissable. Because not using the vaccine could make me the cause of another’s suffering and death, whether my own child’s or someone else’s, the vaccine’s use is “morally justified as an extrema ratio due to the necessity to provide for the good of one’s children and of the people who come in contact with the children.” [PAL]
How many measles deaths are needed before it’s acceptable to let go of an uncompromising and unsound ideological purity? Is there a magical number of cases before we can stop playing brinksmanship with a pharmaceutical company to make ethical vaccines available? I personally believe even one child developing measles encephalitis or any of the tragic complications of these preventable diseases is one too many. Fighting for an ethical vaccine should not be an either/or. We can certainly hope and pray that continued pressure on pharmaceutical companies and public health officials will result in an ethical option–but in the meantime, it is unacceptable to hold the lives of innocent, vulnerable human beings hostage for that agenda. As the Pontifical Academy for Life most clearly states, “the burden of this important battle cannot and must not fall on innocent children and on the health situation of the population – especially with regard to pregnant women [emphasis mine].”
Related Rational Catholic posts:
Science, Superstition, and the Duty to Vaccinate
You Can Be the Pro-Life Parent of a Fully-Vaccinated Child
Am I my brother’s keeper? or “Why should we care if other children are unvaccinated?”
*After six months, a child may receive a dose of MMR if traveling to areas where measles is endemic, but it does not provide full immunity and does not count toward the two doses specified in the standard vaccine schedule. In most cases, insurance also will not cover early vaccination.