Navigating the MMR Vaccine Dilemma: Ethics, Nursing Roles, and Potential Solutions - Report Example

Identification of the Issue and its Evolution

Autism, commonly known as Autism Spectrum Disorder (ASD), is a developmental ailment that affects the social and interaction skills of an individual, mainly affecting the nervous system. The disease is associated with communication difficulties, inability to interact with others effectively, and poor social and behavioral skills (Khalifeh et al., 2016). In countries like the USA, Italy, and France, the prevalence of autism is still high, with the USA having a prevalence rate of 1.9% (1 in every 54 children have ASD). Autism in most parts of the World was considered a developmental disorder like any other until the year 1998, when Wakefield et al. (1998) linked ASD with the Measles, Mumps, and Rubella vaccine, commonly known as the MMR vaccine. Their study revealed that the MMR vaccine administered to children for protection against measles and related diseases had a preservative known as thimerosal, which is mercury-based.

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The study became controversial, and most of the authors retracted their contributions and arguments following increased criticism across the World. This, however, was done only after the claims from the study had traversed across the World, and as a result, most parents started their doubts about the vaccine and any other form of vaccine administered to children. The doubts and confusion among the parents increased in 2001 when the study was retracted, and coincidentally, thimerosal was removed from MMR and other vaccines administered to children (Bazzano et al., 2012). Currently, as noted by Holroyd et al. (2020), there are a significant number of people in most countries across the World who still perceive ASD to be linked to vaccines, particularly the MMR vaccine.

As a result of some parents perceiving autism to be caused by the MMR vaccines and deciding not to have their children immunized, there has been an increase in the number of children infected with measles and other related diseases, and this has continually captured the attention of the policymakers and other stakeholders. Despite the retraction of the study that ignited this debate, it still remains hard to convince individuals that the vaccine is safe for children, especially in relation to autism. It therefore calls for further interventional measures and investigation to clear the doubt since continuous overlook of the matter is causing more harm than good.

Policymakers Involved in the Issue

As autism continues to deprive the ability to socialize, communicate, and effectively feel like members of society, major interventions have been undertaken, including early diagnosis and treatment by stakeholders in different capacities. Despite these efforts, the perception of the disorder (ASD) to be caused by the MMR vaccine still remains. In the early stages of ensuring the retraction of the paper, some of the major policymakers involved included legislators and regulators from different countries across the World, health practitioners, and human rights groups. In December 2002, a committee drawn from the House of Representatives in the US deliberated on the Issue of the MMR vaccine causing autism. The committee indicated that as much as there could be some cases of the vaccine causing harm to those immunized, there is no vaccine that is 100% accurate.

The members further recommended that it is the mandate of the government to ensure vaccines are as safe as possible for human health and ensure effective compensation of any individual who is affected by the extremes of the vaccine. Their position was that the paper claiming MMR vaccine caused autism should be retracted based on the increased criticism, the decision by some of the authors to disown the findings, and the general welfare and health of the public owing to the fact that the benefits from the vaccines were way above the risks. The issue was also investigated by the UK's General Medical Council (GMC), which wanted to establish whether the findings of Wakefield's paper were valid and free from biases.

Upon investigation, the Council established that Wakefield had misinterpreted and misrepresented the data in pursuit of personal interests (Dyer, 2010). As a regulator, the General Medical Council made the decision to strike off Wakefield, who was the main author, from the medical practitioners registry. The Council's position was that the findings by Wakefield et al. on the link between autism and the MMR vaccine were misleading and against the general interests of the general public. Wakefield was accused by GMC of professional misconduct, and the position taken by the Council led to the full retraction of the paper by Lancet in 2010.

Nursing's Involvement in the Issue

Medical practitioners, especially nurses, are crucial in the provision of healthcare services, including the administration of vaccines. In the issue of autism and MMR vaccine, the nurses were among the most involved persons (Brown et al., 2012). They were tasked with creating awareness and changing the attitude and perception of parents against the MMR vaccine and other vaccines. Owing to the harm caused by infectious diseases such as measles, whose main intervention is vaccination, the nurses find themselves at the center of conflicts between those who claim to support the findings by Wakefield et al. and those who are against the findings. The parents who have the interests of their children at heart always demand to know the truth, and the immediate person they trust of this truth is the nurse. On the other hand, nurses are also eager to know the truth as well as meet their professional duty, which includes educating the parents on the pros and cons of vaccination. While nurses struggle to encourage more parents to uphold vaccination as a way of preventing their children from killer diseases such as measles and polio, the tussle between those who support the vaccine and the anti-vaccine movements increases, and this affects the nurses the same way it affects the parents. As parents continue to resist the administration of vaccines to their children, the prevalence of the diseases increases, and this is against the will and professional commitment of nurses.

Ethical Concerns Related to the Issue

The main accusation laid against Wakefield is that he was biased, and his study was driven by personal interests against the interests of the general public. This is an ethical concern, especially in matters dealing with human health. Professional misconduct, as it was reported in Wakefield's case, implies a lack of morality and general humanity to be mindful of other people's health. By causing confusion and increasing parents' resistance to vaccination despite the known effects of diseases such as measles, it evidences an ethical concern about the future of medical research and its viability. Deer (2020) accuses Wakefield of bribing the respondents in his study and taking biased blood samples from paid children. Moreover, Wakefield was accused of receiving payments from advocates who wanted to win a case against the MMR vaccine and had also applied for a patent for his vaccine. These are all fraudulent and unethical concerns that saw the retraction of Lancet's study, among other disciplinary actions against Wakefield.

Options for Resolving the Issue

The confusion and unending debate caused by Wakefield's paper on the relationship between autism and the MMR vaccine has increasingly put parents in an awkward position on whether to have their children vaccinated or not. Therefore, resolving this issue becomes a matter of urgency if curbing the spread of infectious diseases such as measles and enhancing children's safety is to be achieved. One of the options to resolve the issue is upholding political goodwill, especially among the lawmakers who are critical icons in influencing people's decisions. The political class and policymakers should put the interests of the people at heart and order a thorough investigation to establish whether the MMR vaccine is linked with ASD or not.

Availing the necessary resources for independent researchers is also another way in which the matter can be resolved. The government and other stakeholders should stand firm and facilitate the investigation by individual/independent researchers and closely monitor the investigation process to ensure viability and integrity. Availing the data will also help solve the tussle where independent researchers can find an unbiased trend of autism in relation to the MMR vaccine.

Preferred Solution to the Issue

The preferred solution to the resistance by parents to have their children vaccinated for fear of autism is that adequate awareness should be created to ensure that parents are aware of what is happening. Most parents just make decisions by virtue of overhearing from unverified sources and refuse to take their children for vaccination. Setting records clear by informing them of the right position they should take and justifying why would curb this resistance. A thorough research should be carried out on the relationship between autism and the MMR vaccine, and the findings of the research made available to the members of the public through media and other channels. This will counter any rumors and unverified information that could be influencing the parents' resistance to vaccination. Moreover, the government and other stakeholders should uphold the vaccines' safety and defend any vaccine out of adequate investigation rather than just assumptions. This will create public trust in the government's stand on contentious issues such as autism and its relationship with the MMR vaccine.

References

Bazzano, A., Zeldin, A., Schuster, E., Barrett, C., & Lehrer, D. (2012). Vaccine-related beliefs and practices of parents of children with autism spectrum disorders. American journal on intellectual and developmental disabilities, 117(3), 233-242. https://doi.org/10.1352/1944-7558-117.3.233

Brown, K. F., Long, S. J., Ramsay, M., Hudson, M. J., Green, J., Vincent, C. A., ... & Sevdalis, N. (2012). UK parents’ decision-making about measles–mumps–rubella (MMR) vaccine 10 years after the MMR-autism controversy: A qualitative analysis. Vaccine, 30(10), 1855-1864. https://doi.org/10.1016/j.vaccine.2011.12.127

Deer, B. (2020). The Doctor Who Fooled the World: Science, Deception, and the War on Vaccines. JHU Press.

Dyer, C. (2010). Lancet retracts MMR paper after GMC finds Andrew Wakefield guilty of dishonesty. British Medical Journal, 340(7741), 281.

Holroyd, T. A., Sauer, M. A., & Limaye, R. J. (2020). Vaccine decision-making among parents of children on Medicaid with and without autism spectrum disorder. Vaccine, 38(43), 6777-6784.

Hussein, A. M., Pellicano, E., & Crane, L. (2019). Understanding and awareness of autism among Somali parents living in the United Kingdom. Autism, 23(6), 1408-1418.

Khalifeh, S., Yassin, W., Kourtian, S., & Boustany, R. M. (2016). Autism in review. Lebanese Medical Journal; 64 (2): 110-115. http://www.lebanesemedicaljournal.org/articles/64-2/review1.pdf

Wakefield, A. J., Murch, S. H., Anthony, A., Linnell, J., Casson, D. M., Malik, M., ... & Valentine, A. (1998). RETRACTED: Ileal-lymphoid-nodular hyperplasia, non-specific colitis, and pervasive developmental disorder in children. The Lancet, 351(9103); 637-641. https://doi.org/10.1016/S0140-6736(97)11096-0