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Vaccine Skepticism and the Ethical Dilemmas of Mandated Vaccination

  • Sarah Croog
  • Mar 29
  • 2 min read



Graphic by Sonali Patel
Graphic by Sonali Patel

The recent turnover of administration, particularly the confirmation of Robert F. Kennedy Jr. as the United States Secretary of Health and Human Services, has reignited the already intense debate over vaccines. RFK Jr. is well known for his strong opposition to vaccines, having founded Children’s Health Defense, an organization that promotes vaccine skepticism and sells merchandise with slogans such as “Unvaxxed Unafraid” and “No Vax No Problem” [1]. His appointment as the nation’s top health official has brought renewed attention to the ethical concerns of vaccine mandates – an issue that has been contentious long before his confirmation. 


Vaccines were first developed in 1796 by Edward Jenner, yet rampant skepticism surrounding their safety persists more than two centuries later [2]. A 2021 conference at Stanford focusing on identifying the causes of vaccine hesitancy concluded that misinformation and mistrust in the medical community are at the core of this issue [3]. This reluctance to vaccinate poses a significant challenge to public health, since vaccines are most effective when a large portion of the population is immunized, thereby reducing disease transmission and decreasing the risk of viral mutations [4]. To ensure this outcome, the State of Massachusetts enacted the first vaccine mandate in 1855, requiring smallpox vaccination for children to attend school [5]. 


Ever since, vaccine mandates have remained a particularly tenuous subject. Supporters argue that they are necessary to protect public health and prevent disease outbreaks, while opponents claim that they infringe upon personal freedom and rights protected in the constitution [6]. Concerns include the lack of informed consent when vaccination is required, the questionable ethics of conducting clinical trials of vaccines in children, a particularly vulnerable population, and the gray areas of whether and when to permit religious exemptions [7]. While vaccine mandates certainly have the potential to decrease disease prevalence and improve public health, the ethical implications cannot be ignored. 


High-ranking officials in the United States government play a crucial role in shaping both health policy and public perception of vaccines. The balance between public health interests and individual rights will continue to be a focal point of debate going forward, and we must have broader discussions on medical ethics and government intervention in healthcare.


Reviewed by Radhika Subramani


References

[1] CHD Store. Children’s Health Defense. Retrieved February 25, 2025 from https://chdstore.org/Category

[3] Conger, K. (2021, September 2). How misinformation, medical mistrust fuel vaccine hesitancy. Stanford Medicine News Center. https://med.stanford.edu/news/all-news/2021/09/ infodemic-covid-19.html

[4] Shachar, C. & Reiss, D.R. (2020, January). When Are Vaccine Mandates Appropriate? AMA Journal of Ethics. https://journalofethics.ama-assn.org/article/when-are-vaccine- mandates-appropriate/2020-01

[5] History of vaccine requirements and vaccine research highlights. Mayo Clinic. Retrieved February 25, 2025 from https://www.mayoclinic.org/diseases-conditions/history-disease- outbreaks-vaccine-timeline/requirements-research

[6] Mosvick, N. (2024, February 20). On this day, the Supreme Court rules on vaccines and public health. National Constitution Center. https://constitutioncenter.org/blog/on-this-day-the- supreme-court-rules-on-vaccines-and-public-health

[7] Ethical Issues and Vaccines. History of Vaccines. Retrieved February 25, 2025 from https://historyofvaccines.org/vaccines-101/ethical-issues-and-vaccines#Source-3




 
 
 

The Political Neglect of South Asian Mental Health in U.S. Healthcare

  • Abida Chowdhury
  • Mar 3
  • 4 min read

Graphic by Jackie No
Graphic by Jackie No

South Asian Americans face significant mental health challenges, yet systemic barriers within the U.S. healthcare system hinder their access to appropriate care. The South Asian American population is large, with about 5.4 million South Asians living in the United States today. South Asian Americans have higher rates of depression, anxiety, and suicide than the general U.S. population but the lowest rates of seeking mental healthcare (5). Despite these alarming trends, U.S. mental health policies fail to address South Asian-specific needs due to a lack of research, cultural and linguistic barriers, and inaccessible insurance structures. This blog examines these challenges and proposes policy solutions to address these disparities. 


South Asian Mental Health in the U.S.: A Political Blind Spot


South Asians are one of the fastest-growing ethnic groups in the U.S. yet remain largely invisible in mental health research. Mental health studies rarely disaggregate data on South Asians, grouping them under the broad "Asian American" label, which lumps identity-specific issues under one large group and erases disparities (1). Federal mental health initiatives dedicate little effort to studying or addressing South Asian struggles, despite suicide being a leading cause of death among South Asian youth. High rates of anxiety, depression, and PTSD—often stemming from immigration stress, racism, and family pressures—persist, yet South Asians are the least likely to seek mental health care due to stigma and systemic barriers. The Affordable Care Act expanded mental health coverage, but failed to address racial and cultural disparities. State-level mental health programs, such as Medicaid expansions, often lack language-accessible services, further limiting care for South Asian communities.


The Insurance and Access Crisis


Many South Asian immigrants are on visa-dependent healthcare plans, limiting their access to affordable therapy. Even for those with insurance, therapy and psychiatric services are often not covered, making out-of-pocket costs ($100–$250 per session) prohibitively expensive. This disproportionately affects low-income South Asians, for whom mental health services become an unattainable luxury. (4). 


Lack of Culturally Competent Care


Many U.S. mental healthcare professionals lack cultural training on South Asian issues such as family honor and the “what will people say?” stigma, religious-based interpretations of mental health struggles, intergenerational trauma, migration stress, and the pressure of the "model minority" myth (2). Traditional beliefs within South Asian communities often view mental health issues as private matters, discouraging individuals from seeking external help (2). Additionally, the shortage of South Asian mental health professionals in the U.S. leaves many patients without therapists who understand their language, culture, or values.


The Political Path Forward: What Needs to Change?


The CDC and NIH have the responsibility to fund research on South Asian mental health disparities. This will be even more difficult due to the recent presidential executive orders to cut NIH fundings and federally funded research budget cuts. There is already a disparity in this research area, and with recent funding cuts, these disparities will unfortunately broaden. Mental health screenings should also be included in primary care for South Asian patients. This helps track and diagnose patients who need support in this field. 

State governments should also expand Medicaid to cover therapy for visa-holders and immigrants. Mental health clinics should provide services in South Asian languages to make therapy accessible. States with large South Asian populations should fund South Asian-focused mental health programs, setting funds aside for identity-specific mental health care services. 

South Asian advocacy groups should push for policy changes at the local and federal levels. There should also be training for non-South Asian therapists to understand South Asian-specific issues, just as there should be for other ethnic minority groups. We also have to break the stigma within South Asian communities through education by integrating mental health awareness into South Asian community centers, temples, mosques, and gurdwaras where multiple generations of South Asian populations can receive and share this knowledge. 


Conclusion


The U.S. healthcare system’s failure to recognize South Asian mental health needs is not just a cultural problem, it’s a policy failure. Without federal and state policy interventions, South Asians will continue to suffer silently, navigating a system that wasn’t built for them. South Asian communities must demand political action, from better data collection to culturally inclusive policies, to ensure that mental health care is truly accessible for this vast population.


Reviewed by Alec Vazquez-Kanhere


Resources

[1] Okazaki S, Lee CS, Prasai A, Chang DF, Yoo N. Disaggregating the data: Diversity of COVID-19 stressors, discrimination, and mental health among Asian American communities. Front Public Health. 2022 Oct 19;10:956076. doi: 10.3389/fpubh.2022.956076. PMID: 36339147; PMCID: PMC9627279 

[2] Goel NJ, Thomas B, Boutté RL, Kaur B, Mazzeo SE. "What will people say?": Mental Health Stigmatization as a Barrier to Eating Disorder Treatment-Seeking for South Asian American Women. Asian Am J Psychol. 2023 Mar;14(1):96-113. doi: 10.1037/aap0000271. Epub 2022 Jan 10. PMID: 37283957; PMCID: PMC10241369.

 
 
 

A Brief Spotlight on the Politics and Ethics of Prescription Drug Pricing

  • Matthew Ahlers
  • Mar 3
  • 2 min read

Graphic by Nancy Chen
Graphic by Nancy Chen

Recent national polls reveal that 80% of adults believe the cost of prescribed medication is unreasonable [1]. The prices of many lifesaving drugs have skyrocketed; for instance, Mylan’s EpiPen, an emergency treatment for severe allergic reactions, has seen a 600% increase in cost [2]. Unfortunately, such cases are not uncommon as the U.S. government spends around $1,200 per person on prescription drugs—the highest amount globally and 2.56 times higher than comparable countries [1]. The majority of Americans want lower drug prices, yet pin-pointing the exact cause of price inflation is challenging due the complex nature of the problem.


Developing new drugs is a costly endeavor; it is estimated that creating a new drug therapy costs ​​$172.7 million on average and, when factoring in the cost of failure, this average rises to a staggering $515.8 million [4]. While it is a common belief that high drug costs are solely due to research and development (R&D) costs, many researchers contest this claim. A recent study published in the Journal of American Medical Association examined this idea by investigating the correlation between market prices and R&D costs. Analyzing 60 new therapies approved by the FDA from 2009 to 2018, the study found no association between the two variables, suggesting that variations in drug prices could not be explained by R&D investments [5]. However, it's essential to consider that there are two sides to this issue, and maintaining high profit margins might be a plausible explanation.


Another facet of the issue that has captured public attention is the role of middlemen between drug manufacturers and consumers, particularly Pharmacy Benefit Managers (PBMs). PBMs act as intermediaries, negotiating between drug companies, insurers, and pharmacies. Recently, Republicans, Democrats, and drug companies have all pointed fingers at PBMs for raising drug prices [6]. PBMs negotiate rebates from drug manufacturers on behalf of insurance plans and then secure a spot on an insurance plan’s formulary list, which outlines the drugs covered by the plan and suggests safe, cost-effective treatment options. In return for their role in promoting the drug, manufacturers provide rebates that eventually benefit the consumer [7]. However, PBMs keep a portion of these savings as their profit. Lawmakers are currently focusing on the lack of transparency in this process and its contribution to price hikes. PBMs take "a slice of the pie," which could be avoided in a more straightforward system. Furthermore, the PBM market is dominated by three major players—Express Scripts, CVS Caremark, and OptumRx—which control about 80% of the market, thereby stifling competition, according to critics [7].


Overall, the question of why prescription drugs are so expensive is complex. It is easy to point fingers, and the numerous actors in the system blame each other. Surveys of the American public have shown that 65% of Americans are extremely or very concerned about the issue. Additionally, 88% believe that lowering medication costs should be a top priority for candidates running for Congress [8]. This data illustrates that reducing prescription drug prices is a cross-party issue that would benefit the majority of Americans.


Reviewed by Abby Winslow


References

 
 
 

DMEJ

   Duke Medical Ethics Journal   

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