COMMENTARY

Your Kid Has No Right to Make My Kid Sick!

Arthur L. Caplan, PhD

Disclosures

March 26, 2014

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No Daycare Without a Flu Vaccine?

Hi. I am Art Caplan, at the Division of Medical Ethics at the New York University (NYU) Langone Medical Center. How far can we go to make people avoid having their kids and other people get sick from the flu? In Rhode Island, a bill has been proposed that says a child can't go to daycare or pre-kindergarten (pre-K) unless he or she has had a flu shot. To me that seems like a very reasonable and sound idea, but to the American Civil Liberties Union (ACLU) of Rhode Island it seems like a horrific intrusion into personal liberty.

When legislation was proposed to mandate flu shots or to have children stay home during flu season and not go to daycare or pre-K, the ACLU jumped in and said, "This is a bad idea." Here were their arguments: A flu shot isn't that effective. They cited a figure of 40% efficacy. They also said it really should be up to parents as to whether they want to take the risks associated with flu shots for their young children, and it's a burden on people to have to keep their kids home if that is the option that they pick, rather than send them to daycare if they are unvaccinated.

Each one of those arguments is a poor argument. The efficacy of flu shots, on average, is 40%-50%, but in children it is closer to 65%-75%. Kids of pre-K age build a much better immune response than people older than 65. The average of 40%-50% includes elderly people and other people with immune problems, but in a healthy, young population like that which would be found in a daycare or pre-K environment, you are going to get a pretty good rate of response.

Remember, too, that flu shots work better when more people get vaccinated because of so-called "herd immunity"-- the more people in a group who get flu shots, the less likely it is that they will transmit influenza, so it isn't just the per-person efficacy. It also matters what proportion of people in that pre-K group or daycare center have been vaccinated (including teachers). If you can get the rates up high, you can get much better protection than what the ACLU in Rhode Island was worried about.

The Wrong Moral Calculation

It is true that it is a burden on families to keep their kids home, but if you send a child to school who is not vaccinated, and your child makes my kid sick, then I have to stay home with my sick kid with the flu, and so will many others. It's one thing to say that it's a burden on me to have to keep my child home should I choose not to vaccinate, but why should I be free to make other kids sick and make other parents stay home with their sick kids? Isn't that more of a burden than asking the few families who don't want to vaccinate to keep their kids home during flu season?

There, the ACLU didn't make the right moral calculation. Burdening others is not fair when it can be lessened by vaccinating everybody, and although the flu shot isn't perfect, it is pretty safe. I don't know of too many problems with flu shots, and the Centers for Disease Control and Prevention doesn't either. Some issues come up with egg allergies, but you are going to know whether your child is allergic to eggs by the time they come up for a flu shot, and we have vaccines now that aren't made with eggs, so you have an option there too.

The safety profile is very strong. It is not sufficient to say, "I'm not going to do this," because the risks associated with not vaccinating (death, stroke, and making others sick) are greater. If a pregnant woman comes to the daycare center with her child and her fetus is harmed because she is exposed to the flu, or the grandfather who visits and dies of the flu because he brought his grandchild to daycare -- those risks are much greater than any safety issues that have been associated with the flu shot.

The ACLU, as much as I admire their stance for liberty, is not making the right ethical equation. Places like New York City and a few other states already require flu shots to get your child into daycare or pre-K. At the end of the day, you get your children vaccinated not just to protect them, but also to protect others, and that is the crucial moral difference. Flu shots are not just good for your child; they are good for the community.

I am Art Caplan, at the Division of Medical Ethics at the NYU Langone Medical Center. Thanks for watching.

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