The Trouble With Distorted Histories

The argument that it’s a violation of medical ethics to make vaccines mandatory for students and faculty is highly questionable, argue Cora Olson, Ashley Shew, Miranda Fleck and Chiara Tartaglino.

September 21, 2021
(Luca Piccini Basile/istock/getty images plus)

In a recent article in Inside Higher Ed, the president of Walsh University, Tim Collins, made the case that vaccine mandates run counter to good policy. He argued that vaccinations should be voluntary, and that it’s a violation of medical ethics to make them mandatory for university students and faculty members. To support his argument, Collins invokes the Nuremberg Code of 1947’s emphasis on voluntary participation in medical trials, saying that it’s a “historical fact” that universities have been “guardians of voluntary participation.”

We’d like to respond to that article and raise two main issues with it: the distorted history that Collins plays off and the disproportional relativism his approach to mandates engages. The fact is that the tale he tells about the history is flawed, and all college attendance is voluntary, so mandating vaccination is not the violation he contends it is.

Medical Ethics and University Responsibility

It’s curious to hinge one’s argument against a mandatory vaccination policy by talking about medical research ethics through the Nuremberg Code. In 1946-47, Nazi medical research practice was scrutinized, and guidelines developed through the code, to promulgate a more ethical approach to human-subjects research and prevent the harms witnessed under that regime. The Nuremberg Code states voluntary consent for human-subjects research is essential, with freedom of choice without any coercion and legal capacity for consent as necessary components. It also speaks to how experiments should be supervised by qualified researchers, avoid unnecessary harm to human participants and be conducted for the purpose of benefiting society in some way.

There’s something off-kilter in how Collins talks about universities as ethical bastions for human-subjects research “since 1947” when programs like the Tuskegee syphilis experiment were run through a research institution, the Tuskegee Institute, with the coordination of the U.S. Public Health Service until 1972. The experiment stopped only because journalists broke the story of the then 40-year-old experiment in which health officials and doctors documented the effects of untreated syphilis on poor Black men in Macon, Ga., long after the medical establishment could treat syphilis with penicillin. That treatment was never offered to those men, nor were they even informed that they had syphilis.

Tuskegee was no secret; many researchers just didn’t see the problem with it. Holding up universities as “the guardians of voluntary participation” since 1947 is an absurd fantasy. Rules have been developed around medical research exactly because of egregious harms, particularly against vulnerable minority populations. We have to keep talking about informed consent because of the looming specter of research misconduct in this arena.

What’s more, the fact is that mandatory vaccination policies are not medical experiments at all, so seeing this through the lens of IRB and Nuremberg is wrongheaded; such policies are not the sort of human-subjects research governed by the infrastructure Collins discusses. Our home university, Virginia Tech, requires students, faculty and staff to submit their vaccine documentation or file for a medical or religious exemption (for which weekly testing is then required). The FDA has now approved the Pfizer vaccine in full, so students should have no reason to refuse vaccination based on how "new" or "untested" it is.

When it comes to the pandemic, vulnerable minority populations have been hardest hit due to systemic and historical racial inequity and ableism. We do better in our protection when we mandate vaccines because we live in communities where presidents of our universities should set a tone of protection for not only their students but also the people in the towns and regions surrounding them.

Vaccination policies are common for universities to have, even pre-COVID. Mitigating the spread of communicable and deadly disease among people in congregate settings, like the dormitories and dining facilities of any campus, is normal, desirable and simply responsible community-forward action on the part of university leaders. We know that COVID was especially deadly in congregate settings like nursing homes and other institutions, and easily spread in dorms. Indeed, many of the sacrifices that students made during the prevaccination phase of the COVID pandemic were to mitigate this spread -- with pivots online, quarantine dorms on some campuses and other interruptions to the normal flow of a semester.

It’s hubris to think that universities are ethical bastions when it comes to human-subjects research, and it’s a stretch to think of what’s happening here as human-subjects research anyway. Universities have had mandates for a long time when it comes to a variety of vaccinations. There is nothing experimental about such a policy, and students already submit to the other policies in place for required vaccinations for campus participation.

Disproportional Relativism

Collins also writes in the article, “My personal acceptance of the vaccination does not mean the risk-reward ratio is the same for everyone, and it does not suggest that arriving at a different selection of prevention or treatment is any less contributory to the common good.” This sort of wacky disproportional relativism allows for “elder” college administrators to implicitly make the claim that students, potentially younger, could have a different amount of risk and reward when it comes to deciding on the COVID vaccine.

But the risks of COVID, while not even between people, are community risks. His rhetoric tries to collapse the collective problem we have -- stemming the spread of COVID -- into one based on an individual calculus of risk that might be affected by age.

From our perspective, it appears that many people, including Collins, irresponsibly turn this matter of public health into a political debate. He wants to cast the university’s role in the community as one with a very particular sense of future public good: one in which we use a range of tools universities have developed to mitigate the effects of COVID-19, combined with a “critical thinking” public that is skeptical of “new” vaccines and their long-term effects. Voluntariness seems to be a premise of his argument, but all college attendance, including at his private university, is already voluntary. Students do have a choice. Don’t want the vaccine? Don’t come on campus.

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Collins’s version of voluntariness seems to translate to a version of libertarian individualism that works poorly as a response to a community problem. And all universities are already communities that require one to adhere to their rules and regulations, whether through academic honor codes, communication of norms, classroom expectations, integrity in research or other standards. His institution also seems hip to this in their COVID testing requirements, which read, “Currently, testing is voluntary. However, we ask that members of our campus community take the test if they are selected. We appreciate your support in helping to serve CAV Nation and our community.” This statement speaks to community mores and norms while also asserting voluntariness.

Likewise, his institution feigns voluntariness while offering lottery chances for vaccinated students to win free tuition for only 30 students or so out of a student body of about 2,650. This type of incentivization undermines his appeal to the IRB and research ethics to make his case -- especially given the coercive force of such an impressive lottery incentive.

We have a moral imperative, each one of us, to mitigate harm in the domains in which we have power. For college and university presidents and other high-level decision makers acting during a viral pandemic, that means putting into practice actionable and responsible public health policies -- and not mischaracterizing the health laws and medical ethical imperatives we do have in place.

As students and faculty members at a large university with international students, an older surrounding demographic and family members more susceptible to COVID-19, we have a responsibility to protect ourselves and others. Vaccine (and mask) mandates are a low bar for morally responsible university planning during our current moment -- one in which the U.S. COVID rates are three times what they were a year ago and hospitals are overflowing.

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The authors are part of the medicine and society minor program at Virginia Tech, hosted in the department of science, technology and society. Cora Olson is an instructional adjunct professor and Ashley Shew is an associate professor in the department. Miranda Fleck and Chiara Tartaglino are students in the program.

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