ETHICAL REFLECTIONS ON VACCINES PREPARED FROM CELLS DERIVED FROM ABORTED HUMAN FOETUSES 

Angel Rodríguez Luño*

From different sides ethical reservations have been rising on the use of vaccines whose production is somehow connected to voluntary abortion. Several authors have studied this problem in recent years, sometimes induced by the doubts raised by those who could use them. Even the Pontifical Academy for Life has dedicated a study day to this problem. The present reflections intend to be a concise comment of the ethical guidelines emerged in such occasion, even if the formulation that they receive now is my exclusive responsibility.

The problem under consideration

Let us see, first of all, which are the terms of the moral problem on which we intend to reflect about.
The first point to consider is that common vaccines against diseases such as German measles, hepatitis A, chicken pox etc., have been developed through stocks of virus obtained from voluntary aborted human foetuses (this is the case of the stock RA 27/3 of rubella virus), and/or have been elaborated attenuating the virus from subsequent passages in cultures of human diploid fibroblasts, principally WI-38 or MRC-5, that come from voluntary abortions as well. 
They are part of this category, for example:
 -	the monovalent vaccines against rubella such as Meruvax®II (Merck, U.S.), Rudivax®
(Sanofi Pasteur, France) and Ervevax® (RA 27/3) (GlaxoSmithKline, Belgium);
 -	the combined vaccines against rubella, measles and mumps: M-M-R®II (Merck),
Trimovax® (Sanofi Pasteur) and Priorix® (GlaxoSmithKline), etc.;
 -	the vaccine against chicken pox Varivax® (Merck, U.S.);
 -	the vaccines against hepatitis A produced by Merck and by GlaxoSmithKline, etc.
A second element to take into account is that some of these diseases, for example German measles, have been and in some places of the world and still are, epidemic. The contagion of pregnant women cause serious damages and can even lead to the foetus' death. The epidemic originated in Europe at the beginning of the 60s, reached the United State in 1964 caused 20,000 cases of congenital rubella in this country. Epidemics of rubella keep being reported every 4-5 years in developing countries, that have not implemented the vaccination campaign. From an epidemiological point of view, the large scale vaccination represents an absolutely necessary mean in the struggle against this or other contagious diseases. With regard to this subject, it has to be said the vaccine RA 27/3 against rubella turned out to remarkably secure and effective, and that its side effects are of little importance. 
The third element of the problem is that in Japan have been developed and authorized vaccines against rubella and against hepatitis A, in which preparation have not been used human cell coming from aborted foetuses. These vaccines represent an alternative that can be carried out, but so far, have not been authorized by the Food and Drug Administration, so they have not been put on the market of the United States, and for what I know, are not much present on the world market. The only disease for which does not exist, to date, a vaccine free from any connection to abortion is the chicken pox. 
The ethical problem raised both by physicians engaged in the vaccination campaigns and by those who have to use the vaccines, especially by the parents who are to vaccinate their children, is if the use of the vaccines listed before, and of others that have been prepared following the same procedures, is not in contradiction with the ethical refusal of any form of voluntary abortion. Would not their us be a form of real cooperation in evil? In order to answer to this question is necessary to consider previously which are the conditions and the degrees of cooperation in evil. 

Conditions and degrees of cooperation in evil

	Generally for cooperation in evil is understood the action of someone who participates or collaborates in any form to the realization of an action ethically negative by another one, who is the principal agent.
	This idea is true, but partial, because answers to only one modality of cooperation, while in reality there are many others. Let us think, for example, to the ways of cooperation in counterfeiting currency: participating to the printing of counterfeited banknotes, providing the principal agent with the suitable paper and the ink knowing how they will be used, putting the banknotes into circulation, accepting consciously to be paid or however using the counterfeited banknotes. Even we can say that cooperates the one who would accept the counterfeited banknotes without as a donation, because it would be contradictory to affirm that: "I do not approve of you producing counterfeited banknotes but, once they have been produced, if you give them to me, I take and use them". Exists then the passive cooperation, that is to say through the culpable omission from someone who, even knowing all, does not denounce or does not obstruct it, although having the moral duty or at least being able to do so. It could exist another form of cultural and social cooperation, that would happen if in a given social environment the counterfeiting of money would be justified or at least considered as an admissible social use. 
	In all these procedures cooperation can have different levels. We have to make a distinction above all, between formal cooperation and material cooperation. Formal cooperation takes place when someone approves the negative action of someone else, so he freely concurs to it. Material cooperation, instead, does not imply in any way the approval of the action ethically negative performed by someone else. He receives help from me either because I am obliged to collaborate or because this help derives as an inevitable side effect from an action that I have to perform for another important reason.
	Material cooperation can be immediate or mediate. Is an immediate cooperator who participates to the accomplishment itself of the negative action; for example: the surgical nurse who helps the surgeon to perform an abortion. Is a mediate cooperator who places tools at disposal or who creates favorable conditions for the negative action. Mediate cooperation can be proximate or remote, depending on physical or moral closeness and on the univocity of the relation existing between the action of the one who cooperates and the action of the principal agent. 
	The formal cooperation in an ethically negative action is always morally illicit. Material cooperation is generally to be avoided, even though it can be morally acceptable if in order to perform an action exist reasons proportioned to the entity of the evil in which one cooperates, and if moreover, are present the conditions that make licit the accomplishment of an action that have a negative side effect (indirect voluntary). Nevertheless it is generally admitted that the immediate material cooperation to a grave attempt against life or against justice is not morally licit; the same, for example, a soldier has to invoke conscience objection if he was commanded to perform an action which is clearly a war crime (genocide, direct execution of innocent civilians, etc.)

Specific ethical considerations on the use of tissues obtained through voluntary abortion

	With reference to isolated actions, considered illegal by the state, and disapproved by general public, the cooperation to them can be conceived in a quite strict sense. We limit ourselves to identify accomplices, that is to say the ones who took part in the action or had a decisive role so that it could happen. 
	Today things as regards abortion and the use of tissues coming from aborted foetuses are different. Today abortion is not an isolated or not much relevant fact from a quantitative point of view, it is considered from the state and from large areas of the general public a non-punishable phenomenon and even a right, it is performed by professional men that should be guardians of health and life, can make use of imposing structures of cultural, political and social support, etc. To this we have to add the fact that the techniques of artificial procreation leads to the deposit of thousands of frozen embryos, that after a period of time are destroyed or destined to scientific experimentation or to industrial uses. It has been created a culture for which human being at an embryonic stage is a sort of "pre-thing" ("pre-embryo", etc.) completely available for the most varied purposes, with the additional advantage that generally it is not admitted its commercialization, and so it is obtained free of charge or almost. 
	In front of such a culture, acquire a great ethical significance the modalities of cooperation that previously we called passive and the ones of cultural and social character, as well as some precise modalities of remote cooperation. It is not possible anymore to limit ourselves to avoid the modalities of immediate active cooperation ("do not soil someone's hands directly"). Working in favor of the culture of life implies an active application in order to heal the structures in which each one is integrated for professional or other types of reasons, opposing in a licit and reasonable way to the attempts against life and against culture that support them. Citizens, medical doctors, researchers etc., can not consider themselves as mere passive observers of injustices committed by others, feeling satisfied with not becoming themselves their immediate cause, or accomplices in an active and close sense.
	There are practices that take place in the silence of scientific or industrial laboratories, that common citizens do not know and that not even would be able to understand in their real terms, because they concern very complexes and highly specialized procedures. Only other researchers know and understand them, so these ones have the ethical duty to denounce them to the public opinion and to oppose themselves to them the way it would be possible to do so. It follows, among other things, the ethical unlawfulness of accepting and receiving for one's own researches, even for free, the material obtained from the destruction of embryos from colleagues or from other laboratories or research institutes. On this subject, is completely insufficient the criterion of independence formulated by some ethical committees, that is to say, affirming that would be ethically licit the use of such biological material if exists a clear separation between the medical personnel or the health institution that practice abortion and the researchers or the research institute that develop the scientific experimentation. The criterion of independence is not enough to avoid the moral contradiction of who affirms: "I do not approve what you do, because I consider it a grave injustice, in which I do not want to be personally involved in any way", and immediately after adds: "but I accept for my work the biological material that you obtain through such injustice". For the same reason, it will be avoided the participation to the commercialization (both selling and buying) of products obtained through immoral means, to contribute somehow to create a demand of these products, as it has to be avoided the promoting of a social climate of approval that would make the abuses and injustices chronic. 

Ethical considerations on the use of vaccines 

	People and institutions that have risen ethical reservations on the use of the vaccines which we are considering, understand well what it has just been said. Their reservations do not come from an overvaluation of the effective causal relation existing between today's use of vaccine and the abortions occurred 40 years ago, from which come the stock of the isolated virus and the cell lines used to attenuate it. It is clear that today's use of vaccine has not been determinant for the decision to make abortion, nor for its execution, happened long time ago. But it is equally clear that accepting pacifically the systems and procedures connected with abortion of the pharmaceutical industries, buying their products, etc., is a form of approbation or at least of acquiescence of their conduct not compatible with their commitment if favor of culture of life, among other things because it will socially consolidate and will make more and more customary the pharmaceutical and industrial procedures connected to abortion.
	For these reasons, in my opinion it can certainly be affirmed that physicians and parents have the ethical duty to use alternative vaccines, exercising every kind of pressure on political authorities and on health systems so that vaccines would be available without moral problems. They should invoke, if necessary, the conscience objection as regards the use of vaccines coming from embryonic human cells. Equally they have to oppose themselves with any means (in writing, through the different associations, the mass media etc.) to the vaccines that have not alternatives yet without moral problems, making pressure so that are manufactures alternative vaccines and asking a rigorous legal control of the pharmaceutical industry. 
	If instead they made a habitual and pacific use - without rising any difficulty - of vaccines which production is connected to abortion and always in the supposition that there is no approbation of abortion from them, they would incur in a form of mediate material cooperation very remote, therefore very weak, as regards abortion, a mediate material cooperation as regards the commercialization of cells coming from abortions, and an immediate material cooperation as regards the commercialization of vaccines produced with such cells. Cooperation is stronger from authorities and national health systems that accept the use of vaccines. Moreover, taking into account that it is up to the right conscience citizens (parents, physicians etc.) to oppose themselves to the more and more wide spread attacks against life and to the "culture of death" that support them, the use of these vaccines without raising difficulties would constitutes a form of passive material cooperation, as regards the behaviours that we have just indicated, and it would be without any doubt a form of cultural and social cooperation, because the pacific use of vaccines contributes to create a general social consensus to the activities of the pharmaceutical industries that produce them in an immoral way.
	Does it mean that we have to refrain absolutely from using the vaccines we are talking about, renouncing to the vaccination if vaccines free from ethical problems should not be available? Since it is involved the health population, it seems clear that, if the vaccines without ethical problems would not be available yet, it is dutiful to refrain from using existing vaccines only if this can be done without incurring in health risks, especially children's health. If these ones would be exposed to considerable dangers, then temporarily even the vaccines with moral problems can be used. The reason is, from one side, that the duty to avoid passive material cooperation is not urgent if there is a grave inconvenience and, from the other side, that the danger to favor the diffusion of contagious diseases constitutes a reason proportionally grave to accept the forms of active material cooperation, to which we referred before. 
	In any case, there remains a grave moral duty to continue to fight and to employ every lawful means in order to oppose ourselves to the activities of the pharmaceutical industries which act without any moral scruples. The burden of this important battle must not fall on the health situation of the population, even less on innocent children.
	It seems that all the question can be summarized in the following 4 points:
 1.	There is a grave responsibility to use alternative vaccines, if existing, and to make conscience objection with regard to those which have moral problems.
 2.	As regards the vaccine without an alternative, the duty to contest so that others my be prepared should be reaffirmed, as should be the lawfulness of using the former in the meantime insomuch as it is necessary in order to avoid a serious risk for the health conditions of the population.
 3.	The lawfulness of the use of these vaccines should not be interpreted 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 them (especially pregnant women).
 4.	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.

We want to mention as well another aspect of the problem, that is implicit in what we said so far. The preparation and commercialization of vaccines realized with the use of biological material coming from voluntary abortion are to be considered in many cases ethically illicit, cause of the concrete circumstances in which they are realized. Nevertheless it has to be recognized that, within the chain of production, distribution and marketing, the different cooperating agents - both active and passive - can have different moral responsibilities. Equally it seems guilty to us the conscious decision not to undertake in the research and promotion of alternative forms, without ethical problems, for the production of these vaccines. 

A final observation

	In the reflection that has been concluded we have tried to show as clearly as possible, the ethical motivations that support the affirmations made. There is no doubt that who uses today vaccines available in the market or provided by health systems, do it with an exclusively therapeutic intention that deserves praise and is to be encouraged. What's more, most of people do not know how these vaccines have been developed. In any case we consider completely irresponsible any conduct that would endanger the health of the population or prevent to fight adequately the epidemics of infective and contagious diseases. We deny any interpretation in this sense that could be given to what we wrote.
	We tried to show only that the ethical reservations put forward by many petitions about the use of the above mentioned vaccines, have a serious basis. It has been asserted, and it is still reaffirmed, that who works in favor of the culture of life, can not pacifically accept that in our societies human beings at embryonic or fetal stage are considered and treated as a "pre-thing" without any value. Such conducts deserve the firmest opposition, and towards them is not morally possible any form of acquiescence. The biomedical research respectful of life deserves praise, and everyone has to play his part so that the medicine and public health should continue to progress in the most absolute respect of life and human dignity.