Ethics in Vaccine Development & Production: Transforming Health Care
Executive Summary: Immunization efforts in the USA are being challenged for several reasons, including new ethical questions. Responding appropriately to the fact that several common vaccines rely on cell lines derived from elective abortions can provide an occasion for Catholic health care institutions and providers to transform medical practice and research.
John F. Brehany, Ph.D., S.T.L.
Winter 2006
Childhood immunization is widely recognized as one of the most important factors in reducing death, disease and suffering over the last century. However, the social consensus that has supported universal immunization has been eroding. Continuing concern, since the disclosure in the late 1990s that cell lines used to develop and produce many childhood vaccines have their origins in elective abortion, threatens to further undermine this support.
In the United States, vaccines for hepatitis A, (some) rabies, rubella, chicken pox, (varicella), shingles, and bivalent or trivalent combinations of these (such as MMR), depend on human diploid cell lines (MRC-5, WI-38, HEK-293, IMR-90, RA273) derived from elective abortions for their development and ongoing production. The ethical debate that arose after this discovery has focused on whether or not parents were obligated to accept vaccinations for their children if they objected in conscience to the nexus with abortion. The terms of the debate shifted somewhat in 2005 with an intervention by the Pontifical Academy for Life (PAFL).
The PAFL declaration, Moral Reflections on Vaccines Prepared from Cells Derived from Aborted Human Foetuses, recognized the complex ethical situation faced by parents and health care professionals. The PAFL highlighted the importance of vaccination for protecting the public (particularly against rubella) and the remote, material, passive cooperation involved for parents and children seeking vaccination. The PAFL recognized that parents could abstain in accord with Catholic moral conscience, but said it must be done in such a way as to avoid significant risk to the population. At the same time, the PAFL called for those involved in the preparation, distribution and marketing of these vaccines to denounce their unethical origins and work expeditiously to develop alternative vaccines. Similarly, PAFL enjoined physicians and parents to use alternative vaccines whenever possible, and to put pressure on health systems, pharmaceutical companies and politicians to make available, or develop, alternative vaccines. In July 2005, the Catholic Health Association issued a statement summarizing the PAFL declaration and providing resources to member organizations to address the issue.
After initial discussion by Catholic health care organizations, significant follow-up actions have failed to materialize. There might be several reasons for this. First, some who took steps to identify currently available, equally safe vaccines might think they did enough. Second, some might hold that the unethical actions (i.e., the elective abortions from which the cell lines were derived) are sufficiently remote, in years and causal nexus, from current vaccinations as to obviate any moral concern. Third, some might hold that the ethical issue, while real, is negligible when compared to other pressing challenges, and when compared to the good achieved by universal immunization. Fourth, some have noted that the PAFL is not binding Church teaching. I contend, however, that the issue is significant enough to warrant further reflection and action.
First, the nexus between elective abortion and vaccine development does not belong exclusively to the past. New cell lines for current vaccines will be required because the original cell lines are nearing the end of their natural lifespan, and new vaccines continue to be developed. In both cases, pharmaceutical companies show every indication of resorting to cell lines derived from elective abortions. In fact, a new cell line for vaccine research and development, PER C6, derived from an elective abortion in the late 1980s, was introduced into the U.S. in 2003.
Second, ethical analysis can and should be refined. The analysis to date, both among moral theologians and by the PAFL itself, has taken place in the framework of the principle of legitimate cooperation. Within this framework, there is general consensus that the element of “cooperation” involved for parents seeking immunization of their children is mediate, remote, and passive. However, this analysis does not take account of an important recent development in ethical analysis. In 2000, M. Cathleen Kaveny called for the principle of legitimate cooperation (PLC) to be supplemented by the principle of appropriation of evil (PAE). For Kaveny, recognition of PAE better deals with the fact that more ethical dilemmas today involve a moral agent deciding to make use of the fruits of unethical action performed in the past. Drawing on the renewal of virtue theory, PAE analysis focuses renewed attention on the character of the moral agent and the dangers that come with too-easy an acceptance of evil performed in the past and/or by others.
Third, the debate over the nexus between abortion and vaccines is quickly becoming subsumed into the debate on the permissibility of human embryonic stem cell research (HESC). Politicians on both sides of the political spectrum and issue, e.g., Sen. Harry Reid, D-NV and President George W. Bush, have appealed to the historical role of abortion in vaccine development to justify some forms of HESC. This is where the application of Kaveny’s principle of appropriation of evil becomes salient. American society, and Catholics in particular, should re-examine the extent to which they are comfortable appropriating the evil that was done in the recent past in the name of healing, for such appeals will only strengthen in the face of efforts to legitimize HESC and other forms of destructive research on human beings.
The analysis above shows the need for renewed consideration of the nexus between vaccines and abortion, and expanded efforts to address all the recommendations of the PAFL. Catholic health care organizations and providers are uniquely positioned to assist in this analysis and action. Several possibilities suggest themselves immediately. First, Catholic institutions and providers are well-positioned to educate patients and the public at large about the scientific and ethical issues involved. Indeed, they could view this education as a dress-rehearsal for the kinds of education they will need to do when therapies based on HESC are proposed. Moreover, a thorough educational effort could help to avoid grass-roots campaigns to opt out of immunization regimens. Second, Catholic institutions and providers are well-positioned to help make alternative vaccines available in a timely manner. Safe, effective alternatives for all vaccines (except for varicella) already exist in Europe or Japan. By using the purchasing power they possess, Catholic health care institutions and providers could quickly create a “market” for alternative vaccines that pharmaceutical companies could not ignore. Finally, this same market power, combined with professional and political pressure, could help persuade pharmaceutical companies to develop alternative cell lines for many future vaccines.
Taken together, these efforts could not only transform current trends in medical research and therapy, but future developments as well.
Sources:
Chris Feudtner & Edgar K. Marcus, “Ethics and Immunization Policy: Promoting Dialogue to Sustain Consensus,” Pediatrics 107(1) (Jan. 2001): 1158-64.
Pontifical Academy for Life, Moral Reflections on Vaccines Prepared from Cells Derived from Aborted Human Foetuses (June 5, 2005) http://www.academiavita.org/
M. Cathleen Kaveny, “Appropriation of Evil: Cooperation’s Mirror Image,” Theological Studies 61 (2000): 280-313.
