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“Am I My Brother’s Keeper?”

By Amy Givler, MD | August 18, 2016

by Amy Givler, MD, FAAFP

“Can I ethically immunize my kids with a vaccine that has been produced using cells from an aborted baby?”

The caller asking the question seemed to be sincere. During Stand to Reason’s call-in podcast, the questions vary widely—the nature of God, evangelism, ethics—and host Greg Koukl does a great job thinking on his feet and applying a biblical worldview. Still, I cringed when I heard the questioner was asking about vaccines. If there was ever a subject that divides Christians, it is vaccination.

I am familiar with the caller’s qualms. Several vaccines are produced using one of two cell lines that came originally from the lungs of aborted fetuses. The first time I learned of this was many years ago, when a Christian friend posted on Facebook that she was miserable with the flu. “I’ll bet you wish you had gotten the flu shot!” I commented.

I was not prepared for the flood of negative replies from friends of hers, which included a woman who insisted vaccines were just chopped up aborted babies. That seemed so outrageous that I did some research, and then I tried to explain about “cell lines” and that those two children, who died in the 1960s, were not aborted for the purpose of obtaining their tissue. And besides, the flu shot wasn’t made that way. I’ve always been enthusiastic about vaccines as I much prefer preventing a disease to treating it, so I stayed in the discussion. But I stopped replying when it deteriorated into name-calling and a questioning of my salvation.

In the years since, I’ve continued to discuss vaccination, write about it and make comments on Facebook posts, but only when I have the emotional energy to handle the inevitable mudslinging.

Yet the caller in the Stand to Reason podcast wasn’t being contentious. He was genuinely looking for an ethical opinion from someone who has thought through countless ethical issues. The tone of the ensuing conversation, in which Greg Koukl echoed many of my thoughts on the subject, was civil and logical. Maybe future vaccine debates would be rational. It was like a fresh breeze entering a musty room.

I’ve long thought that this particular issue of using cell lines that came from aborted babies to produce vaccines is something that thinking Christians could legitimately disagree on. But my conversations with people who are refusing vaccinations are so seldom civil and logical that I am reluctant to bring up another debatable issue.

Back in 2005, the Vatican produced a statement in response to a concerned Catholic who asked about this issue. The Vatican said that in cases where an alternate vaccine is not available, the use of these vaccines is acceptable if “necessary in order to avoid a serious risk not only for one's own children but also, and perhaps more specifically, for the health conditions of the population as a whole.” But the statement also stresses the need to advocate for alternate vaccine production that doesn’t use the morally questionable cell lines. Though I’m not Catholic, I appreciate the statement’s coherent reasoning.

Are such alternative vaccines—vaccines not made with fetal cell lines—available? Yes, and all but two of those vaccines are licensed by the FDA, and thus obtainable in the U.S. The two not available here are the Hepatitis A and the rubella vaccines. The Kitasato Institute in Japan makes these two vaccines in cell lines derived from animal organs, but since they are not licensed by the FDA, a patient would have to travel to Japan to obtain them. That would be pricey, but that would be a way to satisfy one’s conscience while protecting one’s own health and the health of the public.

Though I deplore the loss of human life that led to the development of the fetal cell lines now in use, my conscience doesn’t tell me it’s wrong to use them to develop vaccines. The abortions were wrong, but they weren’t done in order to make the cell lines, and so the vaccine production is not morally complicit with the evil of the abortion. But—and here is why this is a subject worth revisiting as time goes by—I am troubled by China’s recent development of a third fetal cell line intending to make vaccines.

What is it about vaccination that sparks polarization and strong emotion? Why would any parent hesitate for a moment to protect their child from diseases that killed or maimed so many millions over the course of history? These were questions I truly didn’t know the answer to until the day I sat in my pediatrician’s office with my precious 2-month-old firstborn. I looked at her intact skin and felt nauseous and repulsed that a nurse would soon walk in with a needle to puncture that creamy softness and my baby would cry. She was about to experience pain I could have prevented. Though I’d been a pro-vaccine family physician for two years by then, my response was visceral. That was the day I stopped being flippant and dismissive of parents who questioned vaccination.

I still urge my patients to be fully immunized because what the good vaccines do is far greater than the harm. In fact, unless I include “clean water” under the umbrella of medical care, I think vaccination is the best thing we do in medicine. It has saved the most lives. And what is the harm in vaccination? Anaphylaxis, though rare, is certainly the most dangerous. But otherwise, not much. The Institute of Medicine’s extensive review of 2011 could find no clear evidence linking any other adverse events to vaccines in a causal relationship. This was the product of 18 medical experts examining 12,000 peer-reviewed articles for more than two years.

But this kind of thinking—considering risk-benefit analyses by experts—is the road we as healthcare professionals walk on every day, and it is not often the path our patients travel. When I first became a mother, I grasped this implicitly. Before, I was only responsible for myself with my health decisions. Now I had another life to think about, and I was willing to sacrifice my comfort for hers. So introducing something that might harm her—no matter how slight the possibility—seemed unacceptable. I had to reason with myself on an intellectual level to get past my emotional reluctance.

In On Immunity, Eula Biss writes on the struggles so many mothers have with vaccination with clarity and a poet’s touch. A mother herself, she acknowledges the fear she feels knowing about all of the dangers her son could potentially face. She writes, “As mothers, we must somehow square our power with our powerlessness. We can protect our children to some extent. But we cannot make them invulnerable any more than we can make ourselves invulnerable” (p. 152).

For any parent who is struggling to think through the conflicting information on the internet and is trying to make a loving choice, I highly recommend On Immunity. Voices for Vaccines is another resource, and it is a website written by parents and for parents, providing accurate and understandable information. And for any patient, or healthcare professional for that matter, seeking information on any iota of minutiae about vaccines, I recommend Immunization Action Coalition’s excellent and comprehensive website.

As a nation, the U.S. has a stake in encouraging a healthy population. An epidemic sweeping through a country leads to economic consequences in addition to the suffering of the citizenry and the loss of life. But there is no federal compulsory vaccination law. The U.S. leaves it up to the individual states. Vaccination is a requirement for school entry in every state, though which vaccines, and for which ages or school level, varies widely by state. Immunization Action Coalition has compiled that information, a daunting task.

All U.S. states allow medical exemptions for school immunization requirements. A total of 18 states allow “philosophical exemptions,” though the definition of “philosophical” is not uniform. Almost all states allow religious exemptions, though there’s a difference between Connecticut, which requires an annual notarized statement detailing the religious objections for each child, and most other states, which often only ask a parent to check a box on a school entry form. This summer California joined West Virginia and Mississippi as the only three states not allowing any religious or philosophical exemptions.

Though Americans tend to see themselves as independent individuals, the fact is that we are all interconnected. One family’s decision not to vaccinate, when multiplied by a critical number, puts the most vulnerable among us in jeopardy. Eula Biss puts this well:

“One of the mercies of immunity produced by vaccination is that a small number of people can forgo vaccination without putting themselves or others at greatly increased risk. But the exact number of people this might be—the threshold at which herd immunity is lost and the risk of disease rises dramatically for both the vaccinated and the unvaccinated—varies depending on the disease and the vaccine and the population in question. We know the threshold, in many cases, only after we’ve exceeded it” (On Immunity, p. 122).

Much of the rest of the world—now, and throughout history—has an easier time than Americans in thinking of themselves as a part of a community, a tribe, a group. Paul’s first letter to the Corinthians expounds on the importance of the body of Christ to the individual members, as well as the importance of the individual members to each other. Even though he is talking about the church as a whole, I think it is applicable to all larger societies. “For the body does not consist of one member but of many…If one member suffers, all suffer together; if one member is honored, all rejoice together” (1 Corinthians 12:14,26, ESV).

After Cain killed his brother Abel, God asked Cain where his brother was. “He said, ‘I do not know; am I my brother’s keeper?’” (Genesis 4:9b, ESV). Cain was asking a rhetorical question, the answer being “no.” He was assuming, or maybe hoping, God didn’t know what he had just done. Cain was saying, essentially, that he was only responsible for himself. But even without the fratricide, the answer to Cain’s question is plain. The answer is “yes.”

We are our brothers’ keepers.


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