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More on Mandatory Vaccinations

Lots of good comments on the previous thread on vaccination. I found one in Megan McArdle’s comments that I found compelling:

It can only affect other people who have also chosen not to be vaccinated. Your choice not to be vaccinated affects only you and other people who have made the same choice. People who choose to be vaccinated are unaffected by your decision.  There is no externality.

Let me being by clarifying that when we’re speaking of mandatory vaccinations in the United States, we’re generally speaking of children, and “mandatory” being a condition of attending public schools. We’re not, to be clear, talking about strapping people to a gurney and making them take their government injection, nor throwing people in jail. I wouldn’t support any measure that went that far.

The issue I have with the above posters line of reasoning is that often, for various reasons, some people are unable to become vaccinated, either because of being very young, or having other health issues that prevent it. Vaccines are also not always effective for every person, and some people tend to lose immunity after a while. Those individuals can successfully free ride off herd immunity in the case where the vast majority of people are vaccinated against the disease. For herd immunity to work, vaccination rates generally have to hit about 95%.

I fully recognize that US vaccination policy represents a loss of personal liberty, and personal autonomy, and I think that’s unfortunate. But I think we are far better off as a civilization that we’ve effectively eliminated the diseases of smallpox and polio, both of which required very substinative efforts to get everyone vaccinated. Here’s an interesting Harvard Law Review article on the history of mandatory vaccination in the United States, along with information about the late debates.

A purely libertarian solution might be to allow someone infected by another who chose not to be vaccinated to recover damages. Unfortunately, the nature of disease is such that, in most cases, that’s not going to be possible to prove. I do think a case can be made that sexually transmitted diseases are distinct from diseases spread through airborne contact and casual contact. The law review article I linked to above gets into that debate. I tend to agree with Megan’s distinction, that if the disease is spread through engagement in normal human activities, there’s not much of a distinction. Diseases like rabies, tetanus, lyme disease, yellow fever, or certain diseases for which animals are a vector, are for your own good, and I don’t believe the government ought to have the power to mandate those.

10 Responses to “More on Mandatory Vaccinations”

  1. Sage Thrasher says:

    Your reasoning is the same reason I think we need to have needle exchange programs for junkies–fewer infected people overall means fewer vectors overall.

  2. A Critic says:

    “Let me being by clarifying that when we’re speaking of mandatory vaccinations in the United States, we’re generally speaking of children, and “mandatory” being a condition of attending public schools. We’re not, to be clear, talking about strapping people to a gurney and making them take their government injection, nor throwing people in jail. I wouldn’t support any measure that went that far.”

    That’s good…but when they start forcibly immunizing adults it will most likely be too late.

    And those aren’t really “mandatory” vaccinations, they aren’t any more “mandatory” than getting a Social Security Number (completely voluntary, but they will lie to you and coerce you to get your kids into the system, but there is no actual requirement to do so, and once you sell your kids to Uncle Sam, they can’t get out of the system). I think it would be more accurate to say “mandated”?

    “Ford herd immunity to work, vaccination rates generally have to hit about 95%.”

    Typo at the start.

    It might vary from area to area and time to time, but it seems to me that over 95% of people are herd types who will get whatever shots/drugs/tattoos/cars/clothes/etc that everyone else is getting.

  3. Sebastian says:

    Fixed the typo, and the formatting. Sometimes when you paste a passage, it sticks css in there which screws up the post.

  4. alcade says:

    I’m in agreement regarding the issue of communicability. I’ve always been a believer of “the right to swing your fist ends where the other person’s nose begins.” So while I wouldn’t support a vaccine against something like HPV, I would regarding some virulent highly communicable disease. Regarding the comments in the last entry accusing you of not being “libertarian enough,” I think sometimes there are impossible standards presented that one must adhere to in order to be a “true” libertarian. The goal of government in society, in my opinion, should be to strike the balance between totalitarianism and anarchy. I think we should be as close as we can to anarchy as human nature permits to ensure the maximum amount of liberty possible. Vaccinations are one facet of this, or laws against the discharge of firearms in highly crowded urban areas, or drunk driving, etc. It all comes back to the swinging of the fist.

  5. Gaston says:

    As real a problem is with Tuberculosis. On one hand should society isolate an individual diagnosed with TB until they complete a course of treatment? Or on the other hand, should they let the individual decide on their own. Keep in mind, only partially going through the course of antibiotics has been one of the factors in the creation of drug resistant TB. Next time you are crammed on mass transport and you hear hacking while you breath stale recycled air, your opinion might change.

    People behave in irrational ways and it is NOT the role of Government to impose rational behavior.

  6. LauraB says:

    Actually, I think that comment that those who don’t get vaccines affect only others who don’t get vaccinated is incorrect. I’ve read that vaccinations are not 100% effective, so someone who did not get the disease may give it to someone who did get the vaccine. Also, there are people who are unable to get a particular vaccination. I had a roommate in college who was allergic to eggs and could not get a flu vaccination, although she was also prone to respiratory infections and really needed one. Her boy friend and I got vaccinated just to insure that we wouldn’t give her the flu, our own little herd. If all the people who can get the vaccine do, they help protect those who cannot for valid medical reasons. Society can accept a certain number of “free riders” and still maintain the herd immunity; too many and it breaks down.

    It’s a difficult issue, but I favor what other commenters referred to as mandated rather than mandatory. Require kids to have them before entering school. If they don’t get them, they don’t go to school, but nobody straps them down and injects them. If you have the right not to get vaccinated, the rest of society has a right to protect themselves from the consequences of your actions.

  7. dustydog says:

    Immunodeficient people also benefit from other people being vaccinated. For example: baby who got HIV from his mother. Kids with leukemia. Adults with leukemia. Anyone with a transplanted organ. Bubble boys and other kids with rare congenital disorders.

    Adults susceptible to shingles benefit from kids being vaccinated against chicken pox.

  8. Diomed says:

    As a person with rather libertarian leanings and a public health background (have a MPH, among other things), this is really an ethical quandry. A lot of the ideologically pure dismiss the science behind public health as some sort of conspiracy, which is silly. Enlightened self-interest is great in theory, but when it comes to matters of public health, it just doesn’t work. Most people don’t get vaccinated against anything of their own accord. Most people don’t take the full course of treatment for infections, as alluded to in the TB example above. Without the state using the police power to make vaccination compulsory, or to quarantine infectious people, or to regulate (for example) sanitary sewers, public health is nothing but an empty hope. You have to face the fact that what you do or do not do with regards to disease and associated factors can and does affect others. It’s not all about you.

    If you want to live in a society where communicable disease is rampant and unstoppable, by all means insist on ideological purity. That will be of great comfort to you while you’re shitting your guts out with cholera or hacking up your lungs from MDRTB. It sucks, but that’s reality, not theory. We’ve been there before, it’s called “most of human history”. Do you really want to go back?

    On the other hand, it’ll sure thin out the population. Which is the goal a lot of the tin-foil hat anti-vax crowd ascribes to certain other conspiracy theories. Hmmm…

  9. NUGUN says:

    First off. It’s not just the right to public school. It’s the right to ANY schools.

    Second. It’s ceased to be just infectious highly contAgious diseases. And has been extended to STDs and more.

    Third. There are significant questions into the safety and risk factor. As such I accept the risk factor for deadly contagious diseases that have plagued humanity for centuries. But see NO justification in taking that risk in regards to something like HepB when a 2-10 year old has essentially a zero risk factor. It’s akin to giving a man a woman’s birth control pill to ensure he doesn’t get pregnant.

    Fourth, this is a big money game. Mandating hundreds of millions of vaccines is making some political bed-fellows some BIG $$$.

    Lastly, for most of you. This is a non-issue. But my life and family have been personally royally FUCKED by this matter. And until one has to deal with this bullshit you have no fucking idea how much it can fuck your life up.

    So seriously. Take from someone who has personal found himself on the wrong end of this law. It’s a BAD FUCKING LAW.

  10. NUGUN says:

    And I apologize for my language. But deem it necessary for people to understand how much this law affects people. How many tears I’ve had to wipe away from my wife’s eyes. How stressed she gets. We have three little ones and they were going to start pre-school. But on the first day we got turned away thanks to not having HepB.

    And for those who think it’s safe. Look at the number of SIDS cases. SIDS is death without cause or diagnosis. Truth is there is usually a cause. A few years ago children’s cough medicine was pulled from shelves because even after it had been repeatedly proven by study after study to be safe – it was not.

    And the only reason we know this is because one mom fought the doctors and refused to accept a SIDS diagnosis. Read up and you can find a tremendous number of SIDS cases occur within 48 hours of vaccinations.

    I accept it for highly infectious diseases. But for those that common transfer is rare. It should not be mandated.

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