Immunization and global ecology
CMAJ 1997;156:1698
It is the task of physicians to treat and prevent diseases in their patients. In this physicianpatient relationship, the interests of each patient are foremost.
A reading of "Global immunization: Is a child's life worth $15?" (CMAJ 1996;155:1492-4 [full text]), by Dr. Edward Ragan, leads one to ask, Does this also apply in the global arena? Western medicine's success in eliminating many potentially fatal diseases of childhood is largely responsible for a population growth that may correctly be termed a "population explosion." If the rising number of people on the planet achieves a Western lifestyle (which all peoples seem to strive for), this would be incompatible with the maintenance of global ecology. In this scenario, global immunization programs are of questionable value for mankind as a whole and for all life on this planet unless they are accompanied by equally effective birth control programs.
As physicians, we face a significant ethical dilemma. Successful vaccination programs without concurrent and successful birth control are apt to shift human suffering from disease to famine or ecologic disaster.
If one argues that this is not physicians' concern but someone else's, and that we as physicians are responsible for only 1 side of the coin, one would be taking a moral stance similar to that taken by the scientists who developed the means for building the nuclear bomb and yet claimed that they were free of responsibility for the consequences of its use.
Klaus D. Teichmann, MD
King Khaled Eye Specialist Hospital
Riyadh, Saudi Arabia
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