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whiteflame

DebateIsland.com July 2018 Tournament | Quarter Finals - Debate 2

whiteflame

Looking forward to debating this topic with you, YeshuaBrought. Let's start started with some housekeeping.

Some basic definitions:

Vaccine: a preparation of killed microorganisms, living attenuated organisms, or living fully virulent organisms that is administered to produce or artificially increase immunity to a particular disease.

The MMR vaccine: the acronym stands for measles, mumps and rubella, three single-stranded RNA viruses, and the vaccine is meant to impart a protective immunologic response to those who take it. The vaccine is composed of live attenuated viruses, meaning that their virulence has been strongly reduced, but the virus is still viable. This ensures that the vaccine will have the strongest and longest-lasting effect, meaning that the vaccine only has to be taken in its two-shot series once over a person's lifetime.

Should be mandatory: it is net beneficial that these injections required for individuals under the law. I will note that, so long as I am meeting the threshold of requiring some vaccinations by mandating that individuals receive them, it meets the threshold for this debate. I am not required to argue for mandating all vaccinations, though my argument may be applicable to others.

I will stress two terms in that last definition: net beneficial. This is the criteria on which the burdens for each side in this debate are based. While I carry the burden of proof, that only means that I must show that my case is net beneficial over whatever alternative Con provides, whether that's the status quo or a counter plan. Con can either show that my case is not net beneficial, or outweigh my case with whatever alternative she presents.

With that out of the way, let's kick this thing off with the case.

The U.S. Federal Government will require that all individuals before attending school receive the MMR vaccination. All individuals who are beyond schooling age and under the age of 65 would have to get the vaccine within 5 years. These will be subsidized on an as-needed basis, ensuring that it is broadly affordable. Failure to vaccinate oneself or one's family results in a fine that scales with income. There would be other exclusions based on allergies, pregnancies, and those individuals who are immunocompromised.

Before I transition into some contentions, I'll start with some general overview of this issue.

This debate is fundamentally a comparison between individual choice and public good. I will aim to establish that vaccines are efficacious and that their efficacy leads to substantial benefits to the public good, whereas Con is welcome to counter these claims or introduce negative elements that overwhelm the benefits. Again, this is a net benefits debate, ergo Con will have to argue that the harms of mandating this specific vaccination.

So, how do we balance freedom vs. health?

As a society, we do this quite often. Think about traffic laws. We require people to follow certain rules of the road because not doing so makes them a danger to both themselves and others. And this isn't the only instance where our government goes against basic beliefs in the general population. Despite widespread acrimony over drug tests, workplaces are still allowed to require them. We are taxed despite the protestations of individuals who don't like certain taxes. All of this is allowed not because the government is being overbearing, but because we've accepted an aspect of shared responsibility for our actions. We accept that individual rights do not always trump that responsibility, particularly when doing so could cause harm to others.

So, when is it justified to subvert individual choice to the public good?

That requires that two conditions to be met. Whatever is being regulated or mandated must be safe and effective, and the risk of not participating in said behavior must outweigh any risk from the behavior itself. I would argue that vaccines meet these criteria. Vaccines are both safe and effective, and they have a track record of reducing illness and death from the diseases they prevent. 

All of this puts Con in a difficult position. She's going to try and argue that vaccines are markedly different from other issues that encounter the liberty vs. public good question, and she will have to show that the personal freedoms lost outweigh the widely evidenced good that vaccines provide. To do that, she will have to counter life and quality of life lost, which comes with numerical weight, with a vaguer conception of impact, as personal freedom isn't clearly quantifiable. I look forward to seeing what she comes up with.

With that, onto my contentions.

1. Disease Spread

We must recognize that vaccination is not a choice that solely affects the individual being vaccinated. The decision to get the MMR vaccine affects everyone around you. Measles, mumps and rubella are all transmitted through droplets that are sprayed into the air, making them airborne pathogens with a high likelihood of transmission to those around the infected.[1, 2, 3] The mere fact that others are put at risk by people who refuse to take these vaccines creates a substantial societal harm in the status quo, as many are allowed to refuse to get the vaccine.

We're living this harm today, seeing a resurgence in these entirely preventable diseases in the U.S. and abroad.[4] This resurgence is most marked with measles, a disease that the U.S. had eliminated by the year 2000, but which returned in 17 outbreaks among 222 people just in 2011.[5] Mumps has had 4 reported outbreaks this year alone, and has had several small and two large outbreaks in the last 5 years, encompassing thousands of people.[6] Rubella has also returned from a long absence, appearing in three cases in the U.S. in 2012 after being eliminated back in 2004.[7] This change resulted mainly from a false public perception that vaccines have been linked to autism.[8]

In order to understand why vaccinating a large portion of the population is necessary, we have to understand the term "herd immunity." This has been defined differently by different authors, but I will use the term in this fashion: "a particular threshold proportion of immune individuals that should lead to a decline in the incidence of infection."[9] What that means is that if someone becomes sick with a given disease, herd immunity would ensure that that person is so much more likely to run into someone vaccinated against that disease than someone who is vulnerable that they would be extremely unlikely to infect other people. We cannot possibly vaccinate everyone and achieve absolute immunity because of the necessity of the exclusions I listed in my case, but we can seek to achieve herd immunity.

What does that threshold look like for these diseases? For measles, this is 95%.[10] For mumps, it's at least 88%, though it "may need to be higher" than this previously established threshold.[11] For rubella, it sits at 90%.[12] Only through mandatory vaccination could we ever hope to reach those numbers.

2. Disease Impact

My first contention established a threshold for harm in status quo, but I will now show that that threshold has a tremendous impact on society. In order to understand that, we have to know what the impact of these three diseases is.

Measles:

"Prior to the vaccine, 3-4 million people were infected in the U.S. each year, resulting in 48,000 hospitalizations, 400-500 deaths and approximately 1,000 who developed chronic disabilities.

Even with modern medical care, the disease can lead to serious complications, including blindness, pneumonia, otitis media and severe diarrhea. Despite the availability of a vaccine it remains a leading cause of death among young children worldwide, with deaths mainly attributable to the complications of the disease...

More than 90 percent of susceptible people, usually unvaccinated, develop the disease after being exposed. There is no treatment except to make the patient as comfortable as possible by keeping them hydrated and trying to control the fever. Unvaccinated young children and pregnant women are at the highest risk for measles and its complications, including death."[13]

Mumps:

"Mumps is not normally a fatal disease, and up to 30% of mumps infections are asymptomatic. There can be serious complications, however, including aseptic meningitis, orchitis, oophoritis, mastitis, pancreatitis, and deafness. Meningitis occurs in up to 10% of mumps cases; it is usually subclinical and self-limiting. Symptoms of mumps-related meningitis include fever, headache, vomiting, and neck stiffness, which peak for a period of 48 hours before resolution and might appear up to 1 week before parotid swelling. More serious neurologic symptoms are rare and are due to encephalitis. Hearing loss following mumps infections is rare (1 in 2000 to 30,000 cases) and usually results in mild to moderate hearing loss.

Orchitis [swelling of the testicles] occurs 4 to 8 days after the onset of parotitis and is a common complication, affecting 20% of men who develop mumps after puberty. Of those cases, 40% will develop testicular atrophy and 30% will have lasting changes in sperm count, sperm motility, and sperm morphology."[14]

Rubella:

While the disease usually only results in a light fever and small rash, this disease is mainly problematic for pregnant women. "In 1964-65, America had a major rubella epidemic, with more than 12 million cases and 20,000 babies born with congenital rubella; of these, 13,000 were deaf, 3,500 were blinded by congenital cataracts, and 1,800 more suffered severe cognitive impairment."[7] Since pregnant mothers are among the few who cannot get the vaccine, every single person who decides not to get the vaccine is putting these mothers at risk.

Taken together, this means these three viruses present as enduring, broad threats to public health that are made dramatically worse in the absence of herd immunity. As we have clearly not reached a level of herd immunity in the absence of a mandate to vaccinate with the MMR vaccine, my plan solves for this harm.

With that, I await Con's argument.

1. http://www.cdc.gov/measles/about/transmission.html
2. http://www.cdc.gov/mumps/about/transmission.html
3. http://www.cdc.gov/rubella/about/index.htm
4. http://www.npr.org/blogs/health/2014/01/25/265750719/how-vaccine-fears-fueled-the-resurgence-of-preventable-diseases
5. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6115a1.htm
6. http://www.cdc.gov/mumps/outbreaks.html
7. http://www.thedailybeast.com/articles/2013/03/30/why-rubella-s-scary-comeback-should-convince-vaccine-deniers.html
8. http://online.wsj.com/news/articles/SB10001424127887323300004578555453881252798
9. http://cid.oxfordjournals.org/content/52/7/911.full
10. http://www.theguardian.com/society/2013/apr/25/measles-mmr-the-essential-guide
11. http://jid.oxfordjournals.org/content/202/5/655.full
12. http://www.ncbi.nlm.nih.gov/pubmed/23099870
13. http://guardianlv.com/2014/07/measles-resurgence-in-u-s-after-development-of-vaccine-in-1966/
14. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3135444/