A good friend and doctor once narrated a story about a neighbor, a young boy who contracted Polio after being vaccinated. He went on to explain, in a matter of fact manner that in some rare cases the small dose of the virus that is used for vaccination is enough for a few people to be stricken with polio. This he knew from what he was taught in medical school. But he reassured all the intent listeners to yet another of his medical nightmare stories, that this was a far off shot with the probability being something like one in a million. The discussion then moved on.
Most people around the world today are vaccinated for a number of diseases and with good reason. Vaccination has dramatically reduced the infant mortality rate around the world and has been the main cause for the reduction in new cases of mental and physical disabilities. In India, vaccination is an ongoing drive, a mission which mobilizes large armies of doctors, nurses and resources with the objective of eradicating diseases which much of the world has already conquered. Actors and sportsmen are roped in to promote the vaccination drive. The government machinery visibility at these drives is next only to the general elections. A successful series of drives means that a generation is saved from the scourge of disease. Almost everybody is satisfied. Almost.
Coming back to earlier story of the boy. His condition is known as Vaccine Associated Paralytic Poliomyelitis(VAPP) and the statistics from the US show that the risk of VAPP is 1 case in 1.4 million first doses (according to Brown University [1]). It might be true that without the Oral Polio Vaccination the boy might well be jumping and kicking like most other kids of his age today. In his eyes, he has paid the price for a society to achieve its ambition. And as my friend had assured me, this is a risk that is considered 'acceptable'.
Utilitarianism and Medical Ethics
In other words, the gamble (for lack of a more potent word) for the government is laid out with the odds in favor being 1.4 million to 1. Odds which the Government of India through its Pulse Polio Campaign seems to have enthusiastically embraced since 1994. But the question remains, is it the government's role to gamble, especially with people's lives? The argument for such immunization campaigns have their origins in Utilitarianism; when the sum of all the benefits outweigh the losses that are incurred then such actions are acceptable. I suspect this is the same 'acceptable' as the medical literature prescribes in the previous paragraph.
I am sure that the subject of Medical Ethics is teeming with such predicaments. The profession of medicine dictates a certain disconnect from such philosophical issues for effective delivery of care. But it is important to note that these tough questions remain to be answered at some point and with some conviction. To attempt to answer these issues, the society and therefore the government have to reach a consensus on how to tackle such difficult matters. Thus the bargain for a better life for most (if not all) might lead to sacrifices by a few. These sacrifices might be voluntary or forced. A government or society functions because certain liberties of the citizens are withheld and controlled by it. A democracy conceals this fact better than any other form of government. In this regard, the politics of medical ethics is no different from politics in general.
The Solution
But as with everything else in a nation such as India (as opposed to say China), a sense of dharma somehow prevails even in the most difficult of moral decisions. In the case of Vaccination Campaigns, the solution has always been presented along with the question: Pulse Polio Vaccination in India is Voluntary. Therefore the gamble is passed on by the government/society to the parents - the people with the most to gain or lose and hence the apt decision makers.
Interesting Reading:
Most people around the world today are vaccinated for a number of diseases and with good reason. Vaccination has dramatically reduced the infant mortality rate around the world and has been the main cause for the reduction in new cases of mental and physical disabilities. In India, vaccination is an ongoing drive, a mission which mobilizes large armies of doctors, nurses and resources with the objective of eradicating diseases which much of the world has already conquered. Actors and sportsmen are roped in to promote the vaccination drive. The government machinery visibility at these drives is next only to the general elections. A successful series of drives means that a generation is saved from the scourge of disease. Almost everybody is satisfied. Almost.
Coming back to earlier story of the boy. His condition is known as Vaccine Associated Paralytic Poliomyelitis(VAPP) and the statistics from the US show that the risk of VAPP is 1 case in 1.4 million first doses (according to Brown University [1]). It might be true that without the Oral Polio Vaccination the boy might well be jumping and kicking like most other kids of his age today. In his eyes, he has paid the price for a society to achieve its ambition. And as my friend had assured me, this is a risk that is considered 'acceptable'.
Utilitarianism and Medical Ethics
In other words, the gamble (for lack of a more potent word) for the government is laid out with the odds in favor being 1.4 million to 1. Odds which the Government of India through its Pulse Polio Campaign seems to have enthusiastically embraced since 1994. But the question remains, is it the government's role to gamble, especially with people's lives? The argument for such immunization campaigns have their origins in Utilitarianism; when the sum of all the benefits outweigh the losses that are incurred then such actions are acceptable. I suspect this is the same 'acceptable' as the medical literature prescribes in the previous paragraph.
I am sure that the subject of Medical Ethics is teeming with such predicaments. The profession of medicine dictates a certain disconnect from such philosophical issues for effective delivery of care. But it is important to note that these tough questions remain to be answered at some point and with some conviction. To attempt to answer these issues, the society and therefore the government have to reach a consensus on how to tackle such difficult matters. Thus the bargain for a better life for most (if not all) might lead to sacrifices by a few. These sacrifices might be voluntary or forced. A government or society functions because certain liberties of the citizens are withheld and controlled by it. A democracy conceals this fact better than any other form of government. In this regard, the politics of medical ethics is no different from politics in general.
The Solution
But as with everything else in a nation such as India (as opposed to say China), a sense of dharma somehow prevails even in the most difficult of moral decisions. In the case of Vaccination Campaigns, the solution has always been presented along with the question: Pulse Polio Vaccination in India is Voluntary. Therefore the gamble is passed on by the government/society to the parents - the people with the most to gain or lose and hence the apt decision makers.
Interesting Reading:
- http://www.brown.edu/Courses/Bio_160/Projects2000/Polio/PoliovirusVAPP.htm
- http://mutiny.in/2008/04/25/dangers-of-polio-vaccination/
- medind.nic.in/ibv/t05/i6/ibvt05i6p571.pdf
- http://timesofindia.indiatimes.com/Chennai/Rumours_on_pulse_polio_deaths_spark_violence/articleshow/3871494.cms
- http://timesofindia.indiatimes.com/Bangalore/Schoolkids_used_in_polio_campaign/articleshow/4060813.cms
- http://www.hindu.com/2009/02/01/stories/2009020155070700.htm
- http://en.wikipedia.org/wiki/Medical_ethics
- http://en.wikipedia.org/wiki/Utilitarianism
