Regarding the current topic of resistance to vaccination in Montenegro, I would like to refer in this text to the medical and legal side of this increasingly widespread form of "civil disobedience" in our country. Widespread and unfounded fears of the medical consequences of vaccination, as well as appeals to the personal autonomy of citizens, represent the two most common discursive forms through which this resistance is expressed. This text aims to point out the problematic nature of both approaches to the vaccination problem.
Much of the blame for vaccine skepticism lies with a study by Andrew Wakefield published in 1998, which suggested that the MMR vaccine (measles, mumps, and rubella vaccine) or infection with the naturally occurring measles virus could cause autism. Since then, numerous scientific studies have shown that there is no link between vaccines – or any of their ingredients – and autism. Moreover, the research on which the study was based was declared fraudulent, the doctor who wrote it lost his license to practice medicine, and the medical journal that published the study retracted the paper, effectively admitting that it should never have been published.
In Montenegro, in recent years, it is worrying that an increasing number of parents refuse to vaccinate their children because of beliefs that are ultimately connected to the Wakefield study. Such a decision represents a serious threat not only to the health of their children, but also to public health in general. We must make it clear that human rights do not mean the right of an individual to endanger the health of others, especially the most vulnerable members of society - children. We will return to this when we talk about the legal aspect of resistance to vaccination.
Wakefield's idea of a connection between vaccines and autism has been given new life and increased traffic, most of all by social media, where everyone has the right to express an opinion without ever being held accountable for the harm their opinions may cause. I have witnessed many times how someone who saw the laboratory in a picture in a biology textbook teaches those who received their doctorates in those laboratories. What you won't find on social media is talk of the hundreds of studies conducted in different parts of the world, with thousands of subjects, that found no correlation between the MMR vaccine and autism. Most cases of autism today are linked to inherited genetic mutations. Considering the importance of the topic, I think it is not out of place to draw attention here to recent research on the connection between autism and genetics, especially since it can be useful for parents who are afraid of vaccinations to get a more informed picture of the risks.
Scientific evidence indicates that autism develops during fetal development. One of the reasons why we have a better understanding of autism today is the progress in science and significant investment in research. In the last twenty years, scientific methods have become more sophisticated, allowing more precise study of the causes of autism. Perhaps more importantly, the process of mapping human genes has recently been completed. The widest coalition of scientists and researchers from various fields and countries worked on this within the International Consortium for Human Genome Sequencing. The "Human Genome" project had as its primary goal the mapping of the complete set of nucleotides contained in the human haploid reference genome, of which there are more than three billion. In addition, by mapping linkages in the genome, the project investigated how individual genes or groups of genes influence the transmission of disease from parent to child. Mapping also provides clues as to which chromosome contains the gene and exactly where the gene is located on that chromosome. One gene that has been linked to autism is SHANK2. Mutations of this gene act in a dominant way. Mutations in this gene appear to cause hyperconnectivity between neurons. A study of 42.607 cases of autism identified 60 new genes, five of which had a more moderate impact on autism symptoms. Related gene variants are often inherited from parents. In addition to the genetic component, it should be noted that there are also metabolic reasons for the development of autism, as well as epigenetic ones. External factors (eg life circumstances and environment) during conception, embryonic and fetal stages of development also have an impact. Thanks to the advancement of science, today we have better insight into phenomena like autism than ever before. The understanding of the genetic and biological causes of autism has become much clearer, putting an end to many myths that once confused the public. Arguments against vaccination based on the fear of autism have no basis in science: a link between vaccines and autism has never been established, while a link between genetics and autism has been observed. This is information that a responsible parent concerned about their child's well-being should not discard because of misinformation from social networks. This misinformation is spread by unknown or malicious individuals, who often profit from fear and ignorance by selling their "alternative therapies" to frightened people.
The risks of not vaccinating are well known and clearly documented. Measles is a highly contagious disease that can lead to serious complications such as pneumonia, encephalitis, and even death. Before the introduction of vaccination, measles was the main cause of death in children. Today, thanks to the high level of vaccination, this disease is almost eradicated in many parts of the world. However, when the percentage of those vaccinated falls below a certain threshold, the disease quickly returns.
In Montenegro, where vaccination with the MMR vaccine has decreased drastically in the last few years, the risk of a measles epidemic is increasing. Recent examples from Europe, where there has been an increase in measles cases, confirm how quickly unvaccinated communities can become hotbeds of outbreaks. Unvaccinated children are not only at risk of contracting measles, but also of spreading the disease to others, including infants and immunocompromised individuals who cannot receive the vaccine because of their condition. The result of misinformation is resistance to vaccination. This resistance finds protection in the right to autonomy. And here we come to the legal aspect of this problem.
The right to autonomy refers to the individual's ability to freely make his own decisions, without external interference, especially in matters that directly affect his life and body. Autonomy is rooted in the concept of personal freedom, allowing individuals to manage their choices according to their own values and beliefs. This right forms the basis of many other human rights and is central to ethical debates in fields such as medicine, law and politics.
Autonomy is important because it is crucial for human dignity and personal freedom. It empowers individuals to take control of their lives, make informed decisions and take responsibility for their consequences. In legal and ethical terms, respect for autonomy means allowing individuals to consent to or refuse medical treatments, choose their educational and professional paths, and express their identities without coercion. Particular emphasis is placed on autonomy in healthcare, where patients have the right to make decisions about their own bodies and treatments. Recognition of autonomy varies across cultures and legal systems. In Western liberal democracies, autonomy is often considered a fundamental right, and legal frameworks support personal freedom and the right to choose. In some collectivist cultures, however, greater importance is placed on shared decision-making and the welfare of the group over individual autonomy. One of the most prominent examples of the right to autonomy is found in medical ethics. Patients have the right to give or withhold informed consent to any medical procedure, including life-saving ones.
A variant of that argument is exactly what the opponents of mandatory vaccination are referring to. Or, to quote something I witnessed myself recently: "I have human rights, so I will protect them before the courts, all the way to Strasbourg." As someone who deals with medical ethics, I would say that the short answer to that argument would be the following: the right to autonomy, although the basis of the modern body of European human rights, can be limited when the choice of an individual is in direct conflict with the rights or well-being of others. As children cannot make decisions for themselves, harmful decisions about non-vaccination are made by their parents, risking not only health consequences but also the death of their children, as well as epidemics. Therefore, limiting personal liberties is a prerogative of the government – individual autonomy to refuse vaccination can be interpreted as endangering public health and community safety.
The European Court of Human Rights is, using the doctrine of discretion, gave states the right to regulate the issue of mandatory vaccination. This doctrine allows states to adopt measures that are in the best interest of public health in accordance with specific social, cultural and health needs. In the case of measles vaccination, it is clear that it is about protecting society from serious diseases that can have tragic outcomes.
If you do not believe what you read, you can find the judgment of the Court (Vavrička and others against the Czech Republic) from 2021, in which the Court found that the Czech Republic did not violate the European Convention on Human Rights by imposing mandatory vaccination of children. The lawsuit was originally filed by Czech national Pavel Vavrička, who was fined for refusing to vaccinate his children against tetanus, hepatitis B and polio. The court found that the public health interest in achieving community immunity from infectious diseases outweighed the individual right to privacy and that Czech law contained sufficient provisions to exempt those who for medical or religious reasons could not receive the vaccine.
The bottom line is this - while your individual right to choose is guaranteed, so is the community's right to be protected from your choice which, especially now that we have a better understanding of autism, is solely based on misinformation. When you refuse to vaccinate your children, you also expose children who cannot be vaccinated due to existing health problems. So the key question is: can the right to bodily autonomy prevail over the right of others to health and safety? The scientific and legal framework clearly shows that the answer is negative. The right to freedom of choice ends where endangering the health of others begins. Vaccination is a moral, health and social obligation, perhaps the only thing parents can do for their children in a country whose health, education and natural environment have been destroyed.
The author is a research associate - postdoctoral fellow, Hertie Center for Human Rights, Berlin
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