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Catholic Medical Quarterly Volume 69(3) August 2019

Practical Medical Ethics

Measles, Mumps and Rubella (MMR) Vaccines: The Ethics and the Need for an Alternative Vaccine

Dr Adrian Treloar FRCP, MRCGP, MRCPSYCH

Abstract

Rubella vaccines available in this country are all derived from an abortion carried out in the 1960’s. As a result many Catholics are concerned about the use of the vaccines, and some have avoided the vaccination of their children. In the past others have sought alternative vaccines from
abroad but these are no longer available.

Multiple ecclesial authorities have said that the use of the vaccine is “remote cooperation” with the abortion, and therefore not intrinsically evil. Therefore if alternatives are not available it is legitimate to accept the aborted cell line vaccine.

Failure to vaccinate against rubella risks causing cases of congenital rubella (severe learning disability) in unborn and yet to be conceived children. Parents may therefore be putting their children at risk of grave harm if they do not vaccinate.

Parents therefore have two conflicts in conscience. Firstly, many will wish to avoid a vaccine which is (remotely) linked to abortion.

But secondly, in conscience, they should not be willing to put their (or other peoples) children at risk of grave harm.

The absence of any work by statutory authorities to create ethical vaccines leave parents alone in those conflicts of conscience.

Given that there is currently no alternative vaccine, the au­thor therefore recommends vaccination. It is also noted that Public Health England appears unconcerned about the plight of those who feel they must reject vaccination on ethical grounds.

OUR REPLY

I have divided the reply to your question into four parts.

1. The ethics and acceptability of vaccination with a vaccine derived from an aborted child.
2. The right of employers to require employees to accept medical treatments as a condition of employment.
3. What you might say to the school student
4. The public health ramifications of this problem

The ethics and acceptability of vaccination with a vaccine derived from the an aborted child

Background

The Measles mumps and rubella vaccine (MMR) vaccinates children against three diseases in a single injection. It is given to children at age of 1 year of age with a repeat dose before school at age 3-4. Further doses are given to some teenagers depending upon their vaccination history.[1]

Vaccination is given to both boys and girls and that enables better “herd immunity”. The key benefit of vaccinating everyone, (and of ensuring that health care workers are immune) has been a further reduction in cases of Congenital Rubella to very low levels. About 20 cases have been reported since 1997 with a small number of medical abortions. According to the British Paediatric Surveillance Unit [2] “about half of the recently reported [cases of rubella in] infants had mothers who acquired infection abroad in early pregnancy, generally in their country of origin. Most of the remaining cases were children with mothers who, though they acquired infection in the UK or Ireland, were born abroad”. Therefore as well as enabling herd immunity, vaccination also protects the individual vaccinated mothers from getting infected with Rubella. That in turn means that their children are protected from acquiring Congenital Rubella.

Figure below shows how the incidence of Rubella has fallen since the 1970’s.[3]

Whilst for an infected pregnant woman rubella is a fairly mild illness, it is devastating to her unborn child, causing deafness as well as severe mental retardation. Rubella it is an illness which requires effective vaccination campaigns.

Those of us old enough to have seen children with congenital rubella know how dreadful an illness Congenital Rubella is.

Why the concerns about the vaccine?

The key concern with regard to the MMR vaccines is the fact that the Rubella component was grown by a Russian scientist (Plotkin) in the 1960’s from lung cells taken from an aborted foetus. That vaccine was grown in lung tissue cells at 30 degrees centigrade with the result that the vaccine then only produces a limited infection (enough to immunise) when injected into humans. The vaccine worked well and was adopted because it is more effective than the other strains

Some strains of Mumps vaccine (though not all) are also grown on aborted cell lines. Table 1 shows a list of vaccines based upon the two aborted cell lines in use today. Researchers have estimated that vaccines made in WI-38 and its derivatives have prevented nearly 11 million deaths and prevented (or treated, in the example of rabies) 4.5 billion cases of disease.[4]

Alternatives to WI-38 Rubella vaccine

The Cendehill vaccine strain (Kitasato corporation) is based upon rabbit kidney cells. The author cannot find evidence that compares its efficacy with that of the aborted cell line strain based upon aborted foetal cells. But it is of note that “after testing, the aborted cell line vaccine was licensed in Europe in 1970 and was widely used there with a strong safety profile and high efficacy. In light of that data, and of larger side effect profiles with the other two rubella vaccines, it was licensed in the United States in 1979 and replaced the rubella vaccine component that had been previously been used for Merck’s MMR (measles, mumps, rubella) combination vaccine”. Therefore, there is at least some concern that the rabbit cell vaccine may be less effective.

The position of ecclesial authorities

People who value and understand the humanity of the unborn child frequently raise ethical questions about the use of aborted cells lines in vaccines. Some protect their children from being vaccinated as a result. The Vatican, as we describe below, has supported the used of aborted cell vaccines as the constitute remote cooperation with evil. Some members of the Catholic Church do not agree with the Vatican line and have asked for its moral guidance on the use of vaccines developed using cell strains started with foetal cells. As we have already said, this includes the vaccine against rubella as well as those against chickenpox and hepatitis A, and some of the rabies and mumps vaccines.

US National Catholic Bioethics Centre (NCBC), established in 1972, conducts research, consultation, publishing and education to promote human dignity in health care and the life sciences, and derives its message directly from the teachings of the Catholic Church. The (NCBC): states that in its view individuals should, when possible, use vaccines not developed with the use of these cell strains.[5] However, in the case where the only vaccine available against a particular disease was developed using this approach, the NCBC notes

“There are a number of vaccines that are made in descendent cells of aborted fetuses. Abortion is a grave crime against innocent human life. We should always ask our physician whether the product he proposes for our use has an historical association with abortion. We should use an alternative vaccine if one is available.”

The NCBC then suggest that if a physician recommends one of these vaccines “Sometimes alternative products, which are not associated with these cell lines, are available for immunization against certain diseases. For example, there is a rabies vaccine (RabAvert) and a single dose mumps vaccine (Mumpsvax) without any association with abortion that are equally safe and effective. If doing so is practical, you should ask your physician to use an alternative vaccine, but there is no moral obligation to use products that are less effective or inaccessible. Parents should check with their physician regarding the efficacy and availability of these and any other vaccine.”

But they go onto note that there are currently no alternatives for rubella (German Measles), Varicella (Chickenpox), and Hepatitis A.

In 2005 the Pontifical Academy for Life [6] , in a letter signed by Cardinal Sgreccia stated that

• “there is a grave responsibility to use alternative vaccines and to make a conscientious objection with regard to those which have moral problems;
• as regards the vaccines without an alternative, the need to contest so that others may be prepared must be reaffirmed, as should be the lawfulness of using the former in the meantime insomuch as is 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 - especially for pregnant women;
• “the lawfulness of the use of these vaccines should not be misinterpreted as a declaration of the lawfulness of their production, marketing and use, but is to be understood as being a passive material cooperation and, in its mildest and remotest sense, also active, morally justified as an extrema ratio due to the necessity to provide for the good of one's children and of the people who come in contact with the children (pregnant women);
• “such cooperation occurs in a context of moral coercion of the conscience of parents, who are forced to choose to act against their conscience or otherwise, to put the health of their children and of the population as a whole at risk. This is an unjust alternative choice, which must be eliminated as soon as possible

Thus Cardinal Sgreccia, on behalf of the Pontifical Academy for Life affirmed the use of vaccines derived from aborted cell lines as being remotely and not proximately partaking in the evil of abortion. An alternative example of this remote responsibility is paying one’s taxes which in the UK fund the majority of abortion/ sterilizations etc.

Are we morally free to use vaccines based upon aborted cell lines if there is no suitable alternative?

The NCBC state that “One is morally free to use the vaccine regardless of its historical association with abortion. The reason is that the risk to public health, if one chooses not to vaccinate, outweighs the legitimate concern about the origins of the vaccine. This is especially important for parents, who have a moral obligation to protect the life and health of their children and those around them.”

The Pontifical Academy for Life was founded by Pope John Paul II in 1994 to address contemporary bioethical issues. In the previously quoted Cardinal Sgreccia document, the Pontifical Academy for Life states that

• “We find, in such a case, a proportional reason, in order to accept the use of these vaccines in the presence of the danger of favoring the spread of the pathological agent, due to the lack of vaccination of children. This is particularly true in the case of vaccination against German measles.” [6]

To sum up on the ethics of vaccines derived from aborted cell lines

It is absolutely understandable and right that those who value and respect human life will feel uneasy and many will be offended by the use of aborted cell line vaccines. The reality that the vaccines were derived from the killing of a can unborn child is neither trivial nor pleasant. And it must in no way be seen to justify or minimize the wrong of that abortion.

It is important to re emphasise that there are many devout Catholics who wish to faithfully serve God and His Church and after studying the issue have arrived to the view not to vaccinate themselves and their children using the MMR vaccine. This is because the rubella component is derived from an aborted cell line. The author wishes to acknowledge their desire to make the right decision and do the right thing for them and their children.

But the use of vaccine is remote cooperation and not proximate cooperation with abortion. Having the MMR vaccine neither causes nor justifies the abortion which was done in the 1960s. It is also important to acknowledge we live in a very broken world in which abortion is regarded as if not morally neutral even as a good act. It would seem that were the cells from a baby who had died and whose parents had left some of his organs for donation and medical science, it might be possible to have a cell line which does not have this association with abortion. We should therefore seek and ask for alternatives to these vaccines, which do not cause us to be remotely cooperating with evil, in the same way we pray for an end to abortion. Fr Hugh Thwaites once reminded us that “Good can come from the bad deeds of others”. That does not justify or excuse the bad deeds but we should not reject the good that can be brought. Thus it is true that the sacrifice of that child has helped many people. That child can also be remembered and prayed for by many.

Two conflicts of conscience

Parents therefore have two conflicts in conscience.

• Firstly, many will wish to avoid a vaccine which is (remotely) linked to abortion.
• But secondly, in conscience, they should not be willing to put their (or other peoples) children at risk of grave harm.

The absence of any work by statutory authorities to create ethical vaccines leave parents alone in those conflicts of conscience.

It follows therefore that,

With regard to the ethics of aborted cell line vaccines such as Rubella, I feel bound to agree with the Pontifical Academy for Life.

• It is clearly offensive to some to use aborted cell lines to create vaccines.
• And that offence is causing some people to avoid vaccination.
• We should therefore seek and ask for suitable alternatives to these vaccines.
• But, the use of the vaccine is not of itself, intrinsically evil. Using these vaccines neither causes nor justifies the abortion that was done in the 1960’s.

But I also feel bound to go a little further.

• We must (and I do) respect the views of those who find aborted cell lines offensive and feel they cannot use them.
• The avoidance of vaccination risks grave harm to unborn (or yet to be conceived) children.
• One unnecessary case of congenital rubella as a result of failure to vaccinate is a serious and grave harm.
• It is therefore wrong to avoid using the current vaccine strain because that risks a grave harm to unborn and yet to be conceived children.

Sadly, despite such encouragement, until an alternative vaccine is produced, some parents who value life will find that conclusion hard and may still avoid vaccination. Which remains a significant problem.

By far the best solution to this problem would be ethical vaccines which do not use aborted cell lines.

2 The right of employers to require employees to accept medical treatments as a condition of employment.

Your original question involved the right of an organization to insist that one of their workers has a particular medical procedure (vaccination against measles, mumps and rubella).

Hospitals have good reason to require that people are immune to key illness as they are to protect the patients whom they serve. Therefore, there is a separate question about whether or not organizations can impose vaccina­tion upon their staff. It is clear that to some degree they can. HIV positive surgeons may be unable to work, as may those who are acutely infected with Hepatitis B for example. The governance arrangement around practicing in any healthcare profession all require that the employee must be fit to perform their duties. There is, therefore, an entitlement for trusts to insist upon some tests and upon immunity to some infections. However, I am aware that many health Trusts have found themselves unable to require their staff to have an influenza vaccine.

The key duty of healthcare organizations is to ensure that those who work for them are immune.

3 Advice for your friend

It is wonderful that your friend wants to have a career in healthcare. To do that, he needs to be well and should be expected to be immune to Rubella as well as other infections such as Hepatitis B. It should be possible to demonstrate immunity with blood tests for hepatitis, rubella, mumps and measles. Sometimes, those tests might only be available privately, although that is of concern in itself because it would disadvantage poorer applicants to healthcare positions.

And if those blood tests are positive the he will not need immunization. If those blood tests are negative, it may be that if you share this reply with the person who is seeking work, he will feel able to accept the rubella vaccine. If he is not immune, he may put others at risk of a serious and devastating illness.
While we are bound to sympathize with the concerns about the origin of the vaccine, a deliberate decision to put others at risk is a serious matter when the remedy required (vaccination) is not, according to multiple ecclesial authorities, intrinsically evil.

4 The public health options

So what are the options for public health?

At the present time, both the originator of the question and the author are aware of families who have refused vaccination because of the aborted cell line issue. In the past, alternatives were available with difficulty.[7] Some people went to Ireland where the rabbit Cell line was available (personal communication). That decision to refuse vaccination is deeply understandable and it is to be expected that the arguments presented above will not persuade many or all of those families to change their view.

Public Health England’s view is robust. Public Health England [8] states that single vaccines lack an evidence base, will lead to delayed protection and reduced uptake and will therefore lead to an increased incidence of measles mumps and rubella. Without quoting any evidence base to substantiate this claim they state that “Single vaccines imported into this country haven’t been independently tested for potency and toxicity. We have evidence that some of the single vaccines are less effective or less safe than MMR.”

Public health England concludes that “There’s no reason to make single vaccines available and every reason not to. Exhaustive research has provided very strong evidence that MMR is not linked to conditions like autism.”

Alarmingly, the entire document does not mention the issue of aborted cell lines at all. It is an issue simply ignored. That is despite the fact that we and others have previously corresponded on this issue with the Department of Health (and been dismissed).

Finally, as if to dismiss any concerns the document states that “Parents are free to choose whether to protect their children, as no vaccination is compulsory in the UK.” This final statement puts parents into a difficult position. They can decide not to vaccinate their children, but that does leave them at risk of having a child with congenital rubella and it may also make them unemployable in the NHS and elsewhere.

As well as all that, the single rubella vaccine is no longer available and as far as the author is aware the Kitasato Rabbit Cell vaccine is no longer available. Even from pri­vate healthcare. There is therefore, no alternative to the aborted cell line vaccine.

Are we dealing with a special group of people?

People who value life and who object to the use of aborted cell lines often meet together as a group. They tend most often to do so in Church on Sundays and in Mosques etc., at other times. Given that they meet together, there is an increased risk of mini epidemics arising within that population. As a group of young Christians, pregnant women will often be part of that population. Therefore the risks of congenital rubella may be amplified. Religion is a protected characteristic under the Equalities Act and should lead to reasonable accommodation of people’s views.

In 2016 the Bank of England produced a new, plastic £5 note. It turned out that the notes were made with small amounts of animal fat (Tallow). A petition with 100,000 signatures stated that tallow, “is unacceptable to millions of vegans & vegetarians, Hindus, Sikhs and Jains in the UK”. The amount of Tallow is very small. The amount used is less than 100 parts per million which means that each note contains less than 0.07mg of Tallow. As a result of the controversy the Bank of England are exploring non-animal fats for when the £20 note is launched in 2020. [9] So the amounts of tallow, which is a by-product of cattle production for meat, is miniscule. And of course no cow was ever killed for tallow. Tallow is a by-product of the meat industry.

For those who see the humanity of each unborn foetus, the issues of animal tallow simply do not compare with the use of tissue products from a human child which was deliberately killed in the womb.

Therefore, the opportunity (which has previously failed and been rejected by the department of Health) is to ask that those who object to the use of aborted cell lines are offered an alternative. If the Bank of England can change, then so too should Public Health England. But we must note that at the present time the alternatives to Rubella, and Rabies vaccines are not available.

What that means is that Public Health England’s rather glib statement that “Parents are free to choose whether to protect their children, as no vaccination is compulsory in the UK.” leaves parents and their children in a very difficult position. If single vaccines were available, better off parents could pay for these vaccines. But poorer parents will struggle to pay for such vaccines. As I have already said, the single rubella vaccine is no longer available.

Their only options appear to be to accept the aborted cell vaccine or to put their children and others at risk. For Public Health England to put people in such a position appears (to the author) to be wrong.