The ethics of mandatory participation in vaccine trials

Mandatory vaccination is a reality in many countries including in Australia where members of the military, students of mainstream medicine and employees at hospitals in NSW have no option but to accept vaccines or lose their jobs. The AVN is absolutely opposed to forced vaccination because vaccines are neither 100% safe nor is it 100% effective and therefore, it is not the government’s right to insist that people be vaccinated or vaccinate their children if they don’t think it is in their best interest. No government has the right to force a citizen to accept something that may make them ill or even kill them.

Even more chilling however is the idea of mandating that someone participate in a trial of an experimental vaccine. Making someone become a guinea pig or offer up their child for that purpose without the right to say no goes against everything our democratic government should stand for and the idea that a journal of medical ‘ethics’ could even suggest such as thing as a possibility is shocking. To read the original article, reproduced here for the purpose of research and critiquing, please click here.

In recent decades there has been a distressing decline in the numbers of healthy volunteers who participate in clinical trials, a decline that has the potential to become a key rate-limiting factor in vaccine development. …As a result, the risks of developing a health intervention that would benefit the whole population are carried disproportionately by some of society’s most poor and vulnerable. This is a situation few would judge to be fair or ethical.

It really is amazing how “ethics” works in medicine. It isn’t right that one group of people is poisoned so to fix the problem we need to ensure that more groups of people are poisoned to even out the burden. When the people during the French Revolution called for equality did they really mean it to be applied this way?

Compulsory involvement in vaccine studies is one alternative solution that is not as outlandish as it might seem on first consideration.

That’s the problem. There are plenty in the medical profession who wouldn’t consider this to be outlandish. And it is why we should be truly frightened.

Mandatory involvement in vaccine trials is therefore perhaps more akin to military conscription, a policy operating today in 66 countries. In both conscription and obligatory trial participation, individuals have little or no choice regarding involvement and face inherent risks over which they have no control, all for the greater good of society.

Yes. It is more akin to military conscription than organ donation. It is akin to something else too. Slavery.

Indeed I think it would be good to compare mandatory vaccination to both these ideas. Firstly, they are all justified as necessary evils for a greater good – the need to break a few eggs to make an omelette. Secondly, none of them ever actually produce the omelette.

The justification for conscription is that you can have more people fighting for your cause then you otherwise would which should help in the defence of a nation (I will be kind here and assume that conscripts will be used for this purpose even though for the most part historically they are used in aggressive pursuits rather than defensive ones). However, there is a fundamental problem. People who are conscripted don’t actually want to be there. How can you trust a soldier who would rather be smoking weed or diving under the nearest cover in order to protect himself from getting shot than he would to brave enemy fire and haul several wounded men to safety? Such people are more of a liability than they are a help and it was the great economist Milton Friedman who pointed this out (although many had no doubt made a similar argument previously). Conscription doesn’t work because while you can force people to take a plane to some faraway country you can’t force them to care about the cause – or their fellow soldiers. Of course that is not to say that all conscripts are terrible soldiers but they are – all else equal – vastly less reliable than those who want to be there.

So conscription sounds like it should work for the greater good but it simply doesn’t.

Slavery has also been justified as being necessary for the economic development of a country. The reasoning was that even though it wasn’t particularly fair on the slaves there was simply no choice for a developing economy. The simple economic argument is that slaves do work for a below market wage and hence you can “extract” more production without having to place a financial burden on employers. But, just like conscription, the argument was based on a false premise. Slaves only have an incentive to avoid getting beaten and so the work they will do will be only at this level – not a skerrick more. Generally speaking they can’t be promoted or rewarded with more money so they just do the bare minimum and never take any initiative nor do they have any means or incentive to save and invest in productive capital themselves or attempt any sort of entrepreneurship. Why would they? Consequently, slavery actually reduces production all else equal.

Obviously some people gain from slavery (ie slaveholders) but the majority of people lose (when you take into account the welfare of the slaves themselves). The economy as a whole does more poorly then if the workers are free.

Ideas that are justified “for the greater good” invariably only mean the greater good of scoundrels and this is precisely what we would get with mandatory vaccination. The assumption is that vaccines are effective and acceptably safe. Just like the assumption was that conscripts would care about fighting people they had never met in South-East Asia or that slaves would have just as much incentive to work as free labourers. All of these assumptions are wrong. But it is no accident. Sure those who believe in vaccinations – just like those who believe in slavery – do genuinely believe they are in the right, but their beliefs are inextricably linked to their own self-interest. They believe in vaccinations because it is in their best interests to do so. There is no point providing them with counter-arguments because you are asking them to recognise that not only is their pay-packet unjustified but their actions unconscionable.

As ever, then, the debate boils down to a consideration of the “greater good” or the “lesser evil.” A key consideration is the risk benefit ratio—risk to the individual volunteer balanced against the benefit to society. Society is unlikely to accept compulsory recruitment to a trial for a vaccine against the common cold if the vaccine causes severe complications in vaccinees. Increase the severity of the disease in question, however, and compulsory recruitment becomes a more palatable option.

An odd wording really. Almost as though the authors wish for the disease to be more severe so their dream of compulsory vaccination can become a reality. But that is probably just the paranoid in me.

In 2009, initial speculation regarding the H1N1 “swine flu” pandemic set mortality estimates high. In Mexico where the outbreak started, authorities closed public and private facilities [11], putting the interests of society above those of the individual. Although millions of people were infected worldwide, mortality rates were quickly revised downwards [12], and a successful vaccine mass-produced [13]. But consider if this had not been the case.

You got that? The only reason that H1N1 didn’t kill billions of people was because of the heroic efforts of the medical authorities and the glories of coercive government action. It wasn’t because the whole thing was completely overblown and these same authorities were simply scaremongering to offload some vaccines and play out their totalitarian fantasies.

The fundamental principles of medical ethics—beneficence, nonmaleficence, respect for autonomy, and justice—are, as always, conflicted on this issue.

They are the fundamental principles of medical ethics? Well I was way off then.

Justice would reason for the fair treatment of all, supporting mandatory enrollment to help ensure that the risks of developing an intervention that could benefit all are equally borne by all.

No. Justice would state that those who seek to profit from these concoctions and especially those who seek to force them upon us should be the sole people to be the test subjects. There is no need for case controlled trials or any sort of statistical shenanigans All that has to happen is for someone to show that even in extremis there is no way these concoctions could hurt anybody. The obvious first cab off the rank could be the mandatory vaccination guru Paul Offit. He claims that 100,000 vaccines given to a child in a single day would be a walk in the park so one can only presume he can’t wait for the honour of proving this to us himself. Those who believe in vaccine safety but make slightly less grandiose claims should at the very least take a weight-adjusted dose of the entire infant vaccination schedule of their respective countries.

But they won’t. Just like slavery advocates were never slaves themselves or conscription advocates generally keep their own sons out of harm’s way those who justify their actions by referencing some greater good are invariably cowards and hypocrites.

Respect for autonomy, on the other hand, would recognize and maintain the right of individuals to self-determination and their corresponding right to refuse a medical intervention. The Universal Declaration of Human Rights upholds the rights, dignity, and freedom of individuals and the need to protect people from “arbitrary interference” [14]—principles that would inevitably be compromised by mandatory enrollment in vaccine trials. Health services depend absolutely on the public’s confidence and trust—compromising on respect for autonomy would undermine this fundamental premise and launch us on a precarious slippery slope that may be difficult to climb back up.

Well I guess we should be thankful for small mercies that at least the authors haven’t gone all the way down the rabbit hole.

A more palatable and realistic option is a policy of “mandated choice.” In this case individuals would be required by law to state in advance their willingness to participate in vaccine trials [15]. The advantage of this system is that it could identify a large cohort of willing volunteers from which participants could be recruited rapidly without jeopardizing individual autonomy. It would encourage an open, noncoercive philosophy for tackling societal challenges without compromising individual freedom or public trust in the health care system.

Ostensibly this is probably a reasonable suggestion. However, it is unlikely to work out in such a benign manner. As I have said, vaccine creators and proponents are the obvious candidates but they are all hypocrites and cowards. So if even they refuse to partake why should anybody tie themselves in like that without a massive incentive to do so? Obviously such a proposal would, initially, go nowhere and hence, lead to a call for the government to provide ‘incentives’ to people to participate. Now, again this could be my paranoia, but I suspect that this is exactly what the authors expect to happen – that the government would make people an offer they couldn’t refuse to be part of the guinea pig group. Of course, this would just lead us back to the old problem: if the government were to entice people with say extra welfare payments we would still be getting much the same socio-economic group of volunteers as we do currently and which the authors say troubles them so.

In short, the only likely effect of this proposal is that trials would be funded by taxpayers rather than pharmaceutical companies. And, this may well be the paranoid in me again, but I strongly suspect that this is precisely where the authors want this to go.

But perhaps most importantly, as a society we need to evaluate our perception of vaccination. Any successful vaccine program by its very nature takes a once-feared illness out of the public eye.

That is actually true in a sense. The definition of “success” for a vaccine is when the disease is relabelled and even though the number of people who suffer from the same symptoms stays the same (or increases) the original disease label is taken from the public eye to be replaced with a bunch of new conditions or increases in others. The only exceptions to this are things like influenza for which even the epidemiological evidence doesn’t show a protective benefit from vaccination – and still the doctors tell us to take them! Remember what I said previously about how it doesn’t matter what data you show them – even if it is their own? They will never accept that their pay-packets are unjustified, let alone that their actions are unconscionable.

This means that the benefits of immunization become forgotten while side effects in small numbers of individuals fill the headlines. It is all too easy for sensationalist and unfounded stories such as that claiming a link between the MMR (measles-mumps-rubella) vaccine and autism [16] to instead take root in society’s collective psyche.

Note the hypocrisy. Suggesting that we should split the MMR up before further research is done is “sensationalist” but claiming the whole world needed to take a poorly tested vaccine (H1N1) because a few unrelated people suffered flu-like symptoms is calm, rational policy-making.

Ultimately such a crucial public health intervention as vaccine development may become devalued—and only revalued once a drop in vaccination rates leads to resurgence of severe disease.

We can only hope! I don’t know why they are so concerned though – manufacturing panic is their greatest talent. Well, other than the sheer chutzpah to turn around and accuse us of ‘scaremongering’ – they certainly have that in spades too.

Perhaps lessons can also be learned from organ donation, where apathy and ignorance may be as much to blame for low donation rates as conscientious objection. If a concerted effort were made to increase public awareness of the success of vaccination, the potential of novel vaccines to improve global health drastically, and the important contribution that individuals can make by volunteering for studies, perhaps mandatory enrollment would not even need to be consider

Yes I suppose. One thing I have always noticed about vaccinations is that very few people have ever heard about them or their astonishing success rates. Clearly more children need to be told about them at school and government websites need to stop downplaying their benefits and the media need to be more one-sided when they are covering the risks vs the benefits…. I’m sorry, but do we live in the same world? Who the hell hasn’t been brainwashed from the day they were born about the miracle of vaccines? I remember in 3rd grade sticking 50 cent coins (it might have been 20 cents) on to a board at school because each one of those coins was going to save a child from measles apparently. I can’t imagine my upbringing was significantly different in that respect to anybody else’s.

The thing is though, that there are a significant and growing group of people on this planet who have been able to recover from this brainwashing. It isn’t easy of course. Most people find it extremely difficult to imagine that something they have been taught from the day they are born and backed by very serious government appointed experts who are particularly adept at using big esoteric words could possibly be wrong. It usually starts from making an observation that the great minds of the medical world swore was only a one in a zillion shot ie a severe reaction after a vaccine. But for many it branches out into reading about the completely farcical data that the so-called vaccine miracle is predicated on.

Indeed, it is probably the fact that the vaccine data is so appalling that holds it all together. Joseph Goebbels famously said that the bigger the lie the more credible it will be. Nobody ever thinks that somebody (particularly somebody in authority) would deny the bleeding obvious so the massive lies, ironically, go by with the least scrutiny. The type of evidence used to demonstrate the efficacy and safety of vaccines wouldn’t be acceptable to a Year 10 maths student if it was used to support anything other than this most sacred of cows.

For example, how do they get away with not using real placebos in their safety trials but other vaccines? How do they get away with ignoring the fact that deaths due to infectious disease had all but disappeared from Western countries long before vaccines for those diseases had been invented let alone become widely used? How do they get away with using notification data in place of incidence data? How do they get away with claiming that “you never see any more polio victims” when, according to government data, rates of physical disability have actually risen since the polio vaccine? How do they get away with claiming that the diphtheria and pertussis vaccines are worth their weight in gold when hospitalisations due to respiratory conditions are a dime a dozen despite a near universal vaccination rate? How do they get away with claiming that these toxoid vaccines will promote herd immunity when they don’t even aim to prevent the bacteria? How did they get away with claiming that small pox was eradicated when no mere mortal could have possibly known such a thing? How do they get away with multiplying a completely made up number (rates of measles deaths in developing countries) with another completely made up number (efficacy of vaccine in preventing measles deaths) by a real number (number of measles vaccines given) and use this to “prove” that the measles vaccine saves millions of lives? It truly is extraordinary the extent of the fraud. But the majority of people find it almost impossible to believe that so many intelligent and respected people could get it oh so wrong. After all, if it is obvious to us vaccine critics, then surely it must be obvious to the experts who must have subsequently given adequate explanations for them right? Now if only someone could find these damned explanations.

Article review by Punter

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