Individual rights vs the public health: The problem of the Asian hepatitis B carriers in America

The influx of Asians into the United States (both as refugees and immigrants) presented American public health authorities with a significant challenge because many of them were chronic hepatitis B carriers. The carriers posed a real, but undetermined level of risk of spreading the infection to the larger community. Of special importance was the danger that susceptible children would be infected in day-care centers, because the earlier the age of exposure, the greater the risk of developing chronic carriership; which in turn is associated with cirrhosis and cancer of the liver in later life. The Asian carriers presented both a health problem, and a moral dilemma. If the carrier situation became a subject of public debate, there was danger of a racist and discriminatory reaction to the newcomers. Faced with this problem, American public health authorities opted to protect the Asian carriers by assuring the medical profession and concerned members of the public that there was either no health risk, or the risk was easily controllable, despite the lack of evidence to support such positions. In their attempt to protect a vulnerable group from discrimination, they functioned as humanitarians, but abrogated their duty as scientists and thereby undermined the long-term credibility of those charged with protecting the public health. Thus, despite achieving some immediate benefits for a defenceless group, the price they paid for that protection was too high.