The ongoing news reports of measles outbreaks in the United States and my concurrent readings for a course in Theories of Justice has gotten me thinking. A lot.
I’m thinking about the undoing of medical progress and the unfortunate damage done by the now debunked Lancet study about a purported link between the MMR (measles/mumps/rubella) vaccine and autism. I’m thinking about how measles was eradicated in the U.S. 19 years ago, but now it is making an altogether unnecessary comeback. I’m thinking about the ethics of parents opting out of life-saving vaccinations for their children who have no voice in the matter. I’m thinking about the preventable fetal deaths and disabilities from the rubella virus crossing the placenta in unvaccinated mothers. I’m thinking about the fact that measles eradication still has not been achieved in developing countries even though a vaccine exists and has eradicated it in developed countries. I’m thinking about infectious diseases as a whole contributing to significant worldwide mortality, especially in the current era of travel and globalization. I’m thinking about the difference between too much care in developed countries versus too little care in impoverished countries.
This Vox article does a great job in explaining how recent measles outbreaks in the U.S. began due to contraction overseas and then spreading it to unvaccinated people here, namely children. Per the World Health Organization, the countries most afflicted with measles are Ukraine, Madagascar, India, Pakistan, Philippines, Yemen, and Brazil. Several of these countries have cases numbering in the tens of thousands. The difference between these nations and the U.S., however, is the reason for their lack of vaccinations. Mix together corrupt governments, money going into the wrong pockets, poor infrastructure making access to medical care difficult, extreme poverty limiting access to vaccines, and the underlying sociopolitical systems that contribute to all of these injustices, and it is no wonder that measles (and other curable/manageable infectious diseases like TB and HIV, respectively) is so rampant.
I am currently reading Dr. Paul Farmer’s Pathologies of Power, and I urge everyone to pick up this book even if you are not in the medical field. Farmer is a physician and anthropologist who has worked in Boston, Haiti, Russia, and Peru. His extensive writings reveal SO MUCH about the roots of social and health inequity in the world. It might make you uncomfortable, but that is how you SHOULD feel when you realize certain truths about our societies and governments. One of the themes of his book is the application of medical ethics. As many know, medical ethics largely came about as a result of the Nazi medical experiments which led to the Nuremberg Trials and subsequent codes of ethics in medicine and research. Though these are highly important, they seem to still serve the privileged members of society. They aim to protect vulnerable populations, but the fact that certain medical experiments occurred (and still occur) since the codes of ethics were written reveals that invisible people remain invisible until/unless they can be adequate research subjects. Take for instance the 40-year Tuskegee Syphilis Study, or the intentional infection of Guatemalan patients with syphilis (by the U.S.), or the incredibly costly study of HIV transmission rates in Ugandan patients without offering them treatment. Because the research population are effectively invisible minorities, the usual codes of ethics do not apply as stringently to them.
Returning to my point about measles, the thing that angers me the most is that while people in developing countries suffer the disease due to the reasons listed above contributing to lack of access to vaccines, the people in the U.S. who contract measles did so because of a scientifically unfounded opposition to vaccines. This is a prime example of the U.S. enjoying “too much medical care” while the majority of the world suffers from too little. The unbridled focus on individualism and autonomy (a highly regarded ethical principle) in the U.S. only kindles the fires, for patient choice often trumps good care. As the measles outbreak here proves, this can be a dangerous, and in fact life-threatening, path to go down.