Skepticism

Afternoon Inquisition 10.8

The controversy surrounding vaccines is rife with BS.  Some people believe that the MMR vaccine (among others) causes autism, and others claim that the HPV vaccine advocates teen sex.  These reasons are not sufficient to reject the practice of vaccination.  Vaccines are an achievement of medical science and have unquestionably done a lot of good, eradicating diseases like smallpox and polio.  But should they be required?

I think one of the hardest political questions is where to draw the line between personal liberty and the greater good.  Although I’m not a libertarian, I do believe we have the right to do what we want with our bodies, as long as we are not harming anyone else.

If individuals are given the choice to be vaccinated or not, and I choose not to, I will only infect others who also choose not to be vaccinated.  Those who choose to have the vaccine will be protected.  Or will allowing the disease to remain in existence allow new, resistant strains to emerge?  And, if vaccines are required, should the small percentage of people that are negatively affected by the shot be compensated?

Should vaccines be a requirement, or a matter of personal choice?

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114 Comments

  1. I draw the line at requiring people to get medical treatment. This is one of those things that I think is best done through public education campaigns. If people have a better understanding of the underlying issues and consequences, they are less inclined to make poor choices.

  2. If you require that individuals be vaccinated for certain diseases, but the vaccination poses certain health risks, you are taking away that individual’s right to weigh those risks for him/herself and make a choice. As such, the individuals who are adversely affected (assuming there is a causal link) should be compensated by all of the rest of us who benefit from the vaccine in the form of higher costs (or higher taxes, if government is providing the vaccine). This would seem to maximize the public good, much like the system of product liability.

    By the way, Stacey, has anyone ever told you that you have the cutest avatar?

  3. Don’t forget herd immunity. Vaccines are “only” 95% or so effective, so if you choose to not get vaccinated, you may infect some unlucky person who did choose to get vaccinated but for whome it didn’t work.

    Also, at what point in general can rules be enforced on children against their parents wishes, when it is in the child’s best interest? Who decides what is best anyway, and how does this all get regulated and administered? It’s not something to be taken lightly.

    I guess that at the end of the day, I’m in favor of requiring vaccines for easily spread diseases, such as those in the MMR. Some kid coughing on your kids toy can’t be helped, and it will protect everyone under herd immunity. You make a good point about including soe kind of care of benefit for those who legitimately suffer a negative effect from a vaccine, rare as that is.

    Although the HPV vaccine is a fabulous idea and I encourage everyone to get it, it’s a little harder to justify it being mandatory because it is related to sex. 12 year-olds are not spreading HPV in the classroom like they can spread a cold, but HPV vaccination is a great idea along with sex education in that it can help kids make better choices down the road. And honestly, if your kids are having unprotected sex, HPV is one of the lower dangers, far below HIV or pregnancy, which are much bigger life-changers.

    Ah crap, I got into ramble mode. *reset*

  4. I support vaccination strongly, but if someone really doesn’t want to have one, then I support their right not to have it. However, I don’t want to have to cover those people with my health insurance group premiums if they come down with a preventable disease that they chose not to prevent. However, I do support the idea of a risk pool to compesate those few that have bad reactions to vaccinations. Having a bad reaction to a vaccine is not a choice the person makes – it’s an almost a random occurrance until we thoroughly understand the human genome and can make accurate predictions.

    It’s the same logic as motorcycle helmet laws and not using a seat belt in your car – Go ahead and risk your life, but don’t stick me with your medical bills via my group insurance for your lack of proper safety equipment use. (For the record – as a trained pilot, you will NEVER see me without a fastened safety belt in a car or plane. EVER. Even just backing the car out to park in the street.)

    By extension, if someone does support mandatory vaccination of everyone, they have also given the government a precedent to intrude into other areas of health care, from forcing people to have an RFID stuck in them to track them, to denying women their rights to their own reproductive freedom.

  5. I spoke to a co-worker about this topic today and he brought up the fact that not requiring vaccinations would put additional (unnecessary) strain on the health care system, costing us all more money in the long run. I think that’s a valid point.

    @Nicole: I also agree with you about the relevence of vaccine efficacy.

  6. Tough question. Can we make the people who don’t get vaccinated walk around with a giant gold Biohazard symbol around their necks? I would suffer the needle to avoid looking like Flava Flav.

    I’m still not sure where I fall on this. It’s only been within the last year that I realized people didn’t want to vaccinate themselves or their kids. Maybe they could make vaccinations a requirement for entering public school? I don’t know.

    Seems like the first twist on the lid on a can of worms though. First manadatory vaccinations, then what? Mandatory hand-washing in bathrooms? Mandatory exercise? Mandatory dental visits and annual physicals? These are all good things to do, but do we really want them as the law? And how long before someone decides that mandatory daily prayer is good for you too?

    And it is more complicated because your non-vaccination can cause problems for others, and the unvaccinated are harder to see than smokers.

    I think this is going to end up inthe pile of nominal risks we have to accept as a price for life/freedom. And I think it highlights how important it is to combat the Jenny McCarthys of the world on issues like this.

  7. Being a part of a society brings privileges but it also requires sacrifices. Your society may offer the benefit of nearly universal literacy, but may require you to underwrite the education of other people. Likewise your society may offer a lower incidence of disease, but it may require you to be vaccinated. I don’t see anything ethically more morally wrong with a vaccination requirement as long as the individuals in the society agree to the conditions.
    In choosing whether to require vaccines, I think that we would need to address each one individually. If the disease is a fatal epidemic like the 1918 flu and the side effects of the vaccine are mild and/or rare, then I would be in favor of mandatory vaccination. Contrarily, if the disease is rarely fatal or the side effects present an undue burden, then I would support making the vaccine available but not required.

  8. @phlebas:

    Seems like the first twist on the lid on a can of worms though. First manadatory vaccinations, then what? Mandatory hand-washing in bathrooms? Mandatory exercise? Mandatory dental visits and annual physicals? These are all good things to do, but do we really want them as the law? And how long before someone decides that mandatory daily prayer is good for you too?

    I agree that giving away personal freedoms is a potentially slippery slope. But I really think that, generally, a cost/benefit analysis is done and reasonable decisions are made. Not always, but generally. Like @durnett: said,

    In choosing whether to require vaccines, I think that we would need to address each one individually. If the disease is a fatal epidemic like the 1918 flu and the side effects of the vaccine are mild and/or rare, then I would be in favor of mandatory vaccination. Contrarily, if the disease is rarely fatal or the side effects present an undue burden, then I would support making the vaccine available but not required.

  9. Personally I think they should be required, at least in urban areas, there are a number of conventions that people agree to in order to live in a civilized society, you can’t just drive on the side of the road you prefer I don’t think this is too much different. I understand that this is a person’s body, but ultimately you are not free to live your life completely as you choose, if you don’t like it go and live in a country that doesn’t have vaccines … chances are it won’t have fresh running water either.

  10. Required. Personal freedom extends only so far as it doesn’t impinge on other’s health and well-being. Being able to destroy the herd immunity and put me and my family at risk because you are a flaming wacko is not something that should be tolerated in the name of freedom.

    Why? Because your choice compromises my freedom in a way that is physically harmful. I’m sorry, but people should be free to make health-care decisions that affect themselves, they should NOT be free to make decisions that affect others.

  11. @Stacey:

    I’m not really disagreeing with you here. I just don’t think you could make a law requiring vaccinations enforceable enough to do any good — unless you made it REALLY strong, in which case it would do harm.

    If a law requiring vaccinations were passed, how many milliseconds would it take before someone claimed that medicine was against their religious beliefs? What would we do to people who simply refused to get the shots?

    I’m all for periodic aerial spraying. Surely all that equipment we used to spray DDT on everything is still around someplace.

    OTOH, by not requiring vaccines, are we giving the big middle finger to people with autoimmune issues? Even the minor diseases can cause problems for someone whose immunity system has been compromised.

  12. @phlebas: Christian, I’m not arguing with you either. I completely saw your original point – I just doubted that it would actually go that far.

    I also see your point about enforcement, but when I was considering that, I saw it as more of a schooling issue than a religious issue. Vaccines can be a requirement for kids attending school, but what about those that are home schooled. Enforcement would be tricky on a lot of levels.

    Regarding autoimmune disease, I think the immune systems of most people with autoimmune dsorders is healthy, just confused (attacking healthy tissue). Though, the drugs administered to combat the disorder weaken the immune system to combat the effect, so in the end, they would be at risk, like you said.

  13. As a registered Libertarian I say this:
    You are allowed to do what you want with your body or your life as long as you aren’t affecting society. This is where herd immunity comes into play, and why the anti-vax are nothing but selfish people.

  14. @Stacey: Actually, in my state, vaccines are NOT required to enter school or child care. Under AAC R9-5-305, a parent can fill-out an exemption certificate for one of the following reasons – (a) medical (which must be explained); (b) laboratory evidence of prior vaccinations or exposure; or (c) “religious beliefs” (which do not need to be explained). I would not be surprised to find many other states have similar exemptions.

  15. Absolutely a requirement. Furthermore, if it would be a personal choice, it should be the kids personal choice not the parents’ and the kids are too little to be in a position to make an informed choice.

    Nevertheless, it is not strictly a personal issue. Herd immunity suffers if lots of people don’t vaccinate, so it is a public issue, kinda like drinking and driving. People can drink all they want as long as they don’t drive. People can also refuse to be vaccinated as long as on the other hand they can’t go out in public.

  16. @phlebas: apparently i’m wrong, but i thought it was a requirement to get certain vaccinations by certain ages to enter public school. Though if you had a religious objection and wanted to document it with the school/state you could get out of it rather easily. but to not get it just because you ran the risk of the school saying you couldn’t come to school.

  17. This will sound silly, but do veterinarians have this problem? Rebecca was talking recently about alternative meds for pets. Are the people who are against vaccines for themselves or their kids also not giving them to their dogs?

    When I board my dogs because masala_skeptic and I are traveling (or she is traveling and I don’t feel like putting up with their shit alone :) ) they always check to be sure they are vaccinated against kennel cough, because they don’t want a kennel cough epidemic sweeping through the crates.

    So the vets are enforcing the kind of thing we’re talking about for the animals left in their care. Could humans do the same? I mentioned public schools, but I got thinking — I had to pass a drug screen before I got this job. Could a private employer force me to be vaccinated against certain communicable things before I work in their closed office environment?

    I’m not sure what the law is here.

    Seems like a good compromise. If my antivaxxer ethics are that strong, I can willfully limit my career options to something solitary like truck driver or lighthouse operator.

  18. About 1,000 kids in my county got their DTP booster last month to avoid being suspended. A new state law requires that sixth-graders provide booster records at the start of the school year. It wasn’t that their parents were anti-vax or anything. Most of them just forgot. As far as I know, the law allows exemptions for medical or religious reasons, provided you fill out the paperwork.

    Personally, I think this is a reasonable approach. For behaviors that benefit the greater good, make compliance the default behavior and allow a slightly inconvenient opt-out path. Most people will follow the path of least resistance but those who choose not to are not unduly penalized.

    Makes me wonder what’d happen if people had to get an exemption to buy junk food. (“Sir, do you have a permit for that Twinkie?”)

  19. When it comes to your body, it must be a personal choice. However, I think that parents should be required to get their children vaccinated (and I think this is a requirement when they go to school). But other than that, it should be personal choice. If people choose to not get vaccinated, they are taking the risk of possibly catching something from other un-vaccinated folks. If they care enough, they will choose to get vaccinated.

  20. here’s a link to the Pennsylvania Department of Health web page regarding immunizations required for schools http://tinyurl.com/3otsb6.
    section 23.82.a reads “The following immunizations are required for entry into school for the first time at the kindergarten or first grade level, at public, private or parochial schools in this Commonwealth, including special education and home education programs”

    i thinks it’s interesting that they include home school programs. i haven’t read the whole thing so i didn’t notice if there is a easy religious out, or not.

  21. damn here it is section 23.84.b ” (b) Religious exemption. Children need not be immunized if the parent, guardian or emancipated child objects in writing to the immunization on religious grounds or on the basis of a strong moral or ethical conviction similar to a religious belief.”

    so really this law means nothing.

  22. No choice, it has to be a requirement (exceptions for medical reasons). To do otherwise is to risk our herd immunity and the health of those who cannot be safely vaccinated. And yes, vaccines are safe, they don’t cause autism. Because it poses a public risk when individuals decide not to get vaccinated it is perfectly acceptable for the government to get involved and make it mandatory.

  23. Jenny McCarthy is anti-vax. She’s bought into the idea, that no matter what the science says, vaccines are bad. The Green Vaccine thing is a front.

    This discussion is currently going over at Science blogs book club: http://scienceblogs.com/bookclub/

    Also check out Orac over at Respectful Insolence, he’s dealt with this pretty thoroughly.

    As far as a choice or not, I tend to think there isn’t one. It’s part of the social contract and that requires a give and take. Vaccines are safe, the science is in. We should do what we can to help people understand that, but the public health is at stake.

    The parents who choose not to vaccinate aren’t just potentially hurting their children. There are kids that for various medical reason cannot be vaccinated and they are dependent on the herd immunity to be safe from these diseases.

    In England and some small communities that reject vaccination, vaccine preventable diseases are coming back and wrecking havoc. These are serious diseases and can lead to death or severe life long disabilities.

    Should people who have a bad reaction to a vaccine get comped? Yes, if it can be shown it’s the cause, they should be. These cases are pretty rare and we have a system in place in the US just for that.

  24. As a double boarded primary care physician ( both internal medicine AND pediatrics ) I must gently yet firmly counterattack anti-vaccine propoganda on a weekly basis to those directly influenced by Oprah and Jenny ( and others ), and though I have only failed once to sway them to the rational side using concepts of herd immunity as well as reviewing the lack of evidence regarding autism, while at the same time discussing the real, but rare, side effects associated with vaccines compared with the overwhelming benefits, I still would not like to see the population forced into mandatory compliance.

    I gladly accept the burden of teaching my patients, for it’s not a burden, it’s an opportunity to educate.

    The problem is that , and this is very sad, that very often, the media’s portayal of any message is often difficult to deconstruct in so brief a time as an office visit. If my rapport with my patient is excellent, I can easily guide them. But that too is sad. I’d rather teach them the facts and let them come to the logical conclusion rather than to merely rely on my authority and our good standing with one another.

    Alas, life often doesn’t work like that.

  25. @TheSkepticalMale: So anybody can reject it in practice.

    If it weren’t for herd immunity, I would consider this all way too much interference with personal choice and parental decisions.

    I think the analogy to refusing medical treatment in lieu of something like prayer for your child is weak here. We are talking about something preventative, and still low risk (only because most people still do get vaccinated, I suppose).

  26. @SkepGeek: I think the analogy to refusing medical treatment in lieu of something like prayer for your child is weak here.

    —————–

    This is a pet peeve of mine. If people can claim a “religious exemption” from vaccination, or from treating their child’s cancer, or whatever, that crosses a line: rather than being merely figurative child abuse, their decision to label their child with their religion becomes literal child abuse.

    I fail to see why “my religion said” is any more valid of a reason than “cause I felt like it”.

  27. Require vaccination, but make exemptions for religion or medical needs. I generally like the “required unless” approach. Especially when, to qualify for exemption, there is a mound of paperwork to fill out.

  28. @phlebas:

    Yes, the anti-vaxxers have gotten to the pet owners as well. I used to work at a pet hotel and people would call me all the time wanting to know how I could DARE make their dog get vaccinated if they didn’t want to vaccinate him.

    I’d explain to them that I couldn’t make them vaccinate their dog, just that I would not board him if they don’t. They would insist that if it’s the “policy” that all dogs are required to be vaccinated then I shouldn’t be concerned if their one dog isn’t. If I used the argument that vaccines are not 100%, they’d get pissy with me and ask why we bother with them at all.

    I went through this at least once a month. Pet anti-vaxxers are probably worse than parent anti-vaxxers… the people who don’t want to give their pets shots generally don’t even understand why they are against it.

    I’m not sure what the laws are, but no one should ever board an animal at a facility that does not require, at the very least, bordatella (kennel cough) and rabies… preferably they should also require a distemper shot as well.

  29. @phlebas: I work in health care and I am required to be “fully” vaccinated (Hep B, MMR, polio, flu, etc) in order to go on work placements during school and to get a full time job after I graduate. As I’ll often be working with people who are injured or weakened in some way, I think that’s perfectly reasonable. I understand health care is a special case, but I wouldn’t want to make some old guy I sat next to on the bus die of a preventable disease any more than I’d want to make a client die of the same thing. I do tend to have negative reactions to vaccines (lightheadedness, fever, etc), but they’re temporary and my minor discomfort is nothing compared to the long term benefits for me and the people around me. (I recognize that my situation and experiences are not representative of everyone — I’m just sharing as an example. PS: I live in Canada and our rules may be different.)

    @trumpetess: So you think children should be forced to get vaccinated, but people should have a choice? Forgive me, but that sounds contradictory. Perhaps I’ve misunderstood you. Most vaccines, except for boosters and the weird ones you get for going on exotic trips, are given in childhood, so where does this “choice” come into play?

    @ Everyone: I consider not vaccinating children against preventable and possibly disfiguring diseases a form of child abuse. The risks to most people are very low and the benefits are many and long-lasting. There’s no excuse to not vaccinate except being successfully fear-mongered (save a LEGITIMATE medical reason).

  30. @Nicole:

    To be full effective the HPV vaccine has to be administered several years prior to exposure, i.e. before having sex, so it has to be give around 11 or 12. If Boys as well as Girls were given the vaccine the spread of HPV would be reduced, but I suspect our good friends at “Health Economics” may have calculated that the giving it to everyone “won’t pay”

  31. @slxpluvs: Absolutely no to religious reasons and absolutely yes for medical ones. I would hope that medical exemptions would not require mountains of paperwork–healthcare already requires too much.

    Most people lie about the religious reasons and that is not a loophole that I think should be open. Those that don’t, i.e. Christian Scientists, are abusing their children.

    It is probably better to require only a subset of vaccines–those where the risks are low and/or the benefits are high–but people should not be exempt, for any reason other than a reasonable expectation of harm. And by reasonable I mean a verifiable, medical risk such as an inadequate immune system.

  32. I usually avoid making comments because a lot of these issues get me too worked up to even think about, but I found it so shocking that no one has mentioned this that I am forced to comment.

    A lot of you are working on assumptions that are specific to privileged classes in the first world. What absolutely kills me about the whole antivax movement is that it takes people in this position of privilege and legitamizes the choices that make that put the disadvantaged at risk.

    It is not, as Stacey implies in her opening statements, only those who “choose” not get get vaccinated who are at risk. There are plenty of people in the US alone who do not have regular access to medical care, who cannot afford doctors visits, who for reasons of negative cultural history mistrust the medical establishment, who may not be vaccinated. These are overwelmingly among ethnic minority communities, and is especially true among the native population.

    When the largely wealthy white woo community refuses to be vaccinated, they put at risk the health of those who are underprivileged, not just children who can’t make their own children or adults who make poor decisions based on a culture of anti intellectualism.

    These communities are also least likely to have the resources to deal with an outbreak of disease if it should occur, causing it to spread more quickly beyond those few who are exposed.

    The above argument also ignores the possibility of travel. While most traveling does require certain vaccines and proof thereof, this does not cover all possible illnesses and is not a fool proof method of stopping the spread of disease (and is also primarily focused on keeping first world travelers from catching “third world” disease). When you take your unvaccinated and potentially infected wealthy self to a poor country, you risk infecting those who have almost no recourse to health services and further promoting poverty, underdevelopment and infant and child death.

  33. People should be made to be vaccinated.

    Whatever crazy ideas Joe Public may have floating about inside his head as he waddles his sweaty way from McDonald’s to Witherspoons on a Saturday afternoon are irrelavent.

    60% of the work of Government is to prevent people from satisfying whatever whim pops up in their minds.

    How many people have you heard claim that speed limits are bad “becwas I want to dwive faster”? Most of the population are children of various ages, who need to be protected from themselves.

    So simply make the choice clear, vaccination or have you NHS card taken away

  34. @kaiyote: I agree with most of what you say, but I’d imagine that the possibility of an unvaccinated wealthy wooist bringing disease into a poor country is vanishingly small. On the other hand, the probability of bringing the disease back to their unvaccinated wooist rich friends is much higher.

  35. No one has the right to tell you what you can or can’t put into your body, so no one has the right ti make you put anything into your body.

    And Stacey, I’m not saying you can’t have that position and not be a Libertarian, but I will tell you that, at least at the present time, the Libertarian Party is the only party dedicated to this principle. The Democrats and Republicans violate it every chance they get.

  36. Where does the problem of overpopulation fit into the equation of to vaccinate or not?

    I’m strongly for vaccinations, but don’t think it is the end of the world if people CHOOSE here and there not to be vaccinated. Then again, almost all vaccination decisions are made by parents, so can non-vaccination be defined as a form of neglect (assuming a vaccination is available and affordable).

  37. @shanek: I do, in general, believe that we should be able to do whatever we want to our bodies as long as we’re not harming anyone else, but I actually don’t have that position regarding vaccines. I originally had this conversation last night and took the position that vaccines should be required. The person I was talking to brought up some interesting points, some of which I put in my post, but I posted this as the AI largely because I don’t have a solid position on this issue and wanted to read all of your wonderful thoughts.

  38. This is a little off topic, but I need HELP!

    My coworkers (other elementary teachers) keep repeating the woo about full moons, curing autism, and sugar=hyper. At this point, anytime I mention science they scoff at me as though I were saying, “well, my mother told me…”

    I realize this is the same thing we all struggle with – but, seriously – teachers?? Why is science viewed as some unreliable source and Jenny McCarthy is a tome of wisdom on medicine??

    ARG!

    (I think I should drink more, srsly.)

  39. Stacey:

    Okay, fair enough; consider this:

    A person who is not vaccinated poses a slight but nonzero risk to those who are vaccinated (since they aren’t 100% effective), so he must be forced to have a vaccine.

    A person with a contagious disease treatable by antibiotics poses a slight but nonzero risk to those without the disease, so he must be forced to take antibiotics.

    A person with schizophrenia poses a slight but nonzero risk to others if he goes out of his mind, so he must be forced to take medication.

    A person who gets angry poses a slight but nonzero risk to others if he gets violent, so he must be forced to take sedatives.

    A person with strong hands poses a slight but nonzero risk to others if he uses them to punch or strangle, so he must be forced to wear handcuffs whenever he’s in public.

    I think you get the idea; I can keep going with all sorts of things. So, my question for you is, if you agree with all of these, where does it stop? And if you agree with some but not others, then what is the logical difference?

  40. Amanda: I think it’s because science is so unfamiliar to the layman. Your teacher friend knows his* mother and trusts her, but if he doesn’t have a comparable familiarity with science he has no reason to trust it. It’s human nature. Do we not trust science only because we possess at least some degree of familiarity with it and how it works and why it is so reliable? This, I think, is the problem, and the solution obvious.

    (*No, I’m not being male-centric here; the -man suffix was gender neutral long before any male-specific use, and the masculine personal pronouns in English double as the gender-unspecified pronouns. So let’s not get into that, okay?)

  41. @shanek:

    Vaccinated– Yes, especially since the risk to that person is minimal.

    Contagious disease–maybe, or depending on the disease forcibly quarantined. Ex: Multidrug resistant TB.

    Schizophrenia–yes, if the person poses a danger to others–or locked up.

    Anger–not specific enough. Lots of people get angry. Violently angry ones get justifiably sent to prison.

    I’d stop at strong hands. Every argument can have a slippery slope, the bottom of the slope does not negate taking action nearer the top. The point is there is a place to stop. Mandatory vaccines are on one side. People with strong hands on the other.

  42. @shanek: To be fair, your alternate examples are ones that are already dealt with within the criminal justice system and affect a few people at most. A whole population could be wiped out by a preventable disease because people were being uppity about a generally non-harmful (except in certain medical conditions) vaccine being put in their bodies.

    Do you also oppose the fluoridation and chlorination of water? I’m just curious, because that is also a general safety/health measure that people don’t get a say in.

  43. A requirement. Someone choosing not to immunize their children puts my children and myself at risk. We are seeing recent outbreaks of measles, mumps and ruebella among communities that refuse to vaccinate. What is next outbreaks of polio? Smallpox?

    Fuck, these are 19th century diseases. They shouldn’t exist anymore. What’s next? Ricketts?

    I don’t want to regulate peoples private lives in most cases. Drink, fuck, use drugs, mutilate yourself, crawl on your knees up long flights of stone stairs I don’t care. But when your stupidity places my family at risk then your ability to make stupid decisions ends. Also, the parents who are making these decisions have, in all likelyhood, benefited from the scientific wonder that is vaccination. They aren’t having the vacines removed from their bodies. They are denying their children the protection that vaccination offers.

    Why do so many of the groups that want to avoid vaccination seem to hold children and women in such disdain?

  44. It’s a complicated issue but at least with small children, babies, toddlers, etc., I think we have every right to impose vaccination against parents’ wishes. And I think if a parent doesn’t get their kid vaccinated and that kid dies, the parent should be charged with negligence. With adults, there’s not much you can do unless it’s a real emergency. If a guy is walking around with a deadly airborne virus that has the power to kills thousands or millions, yeah, we’re throwing him in quarantine and vaccinating the hell out of him whether he likes it or not.

    As for Jenny McCarthy, yeah, the green vaccines stuff is just rhetoric and she’s as antivaccine as they come. Speaking of which, there’s a great new site on this: stopjenny.com

  45. In this part of Australia, a child is not allowed to start school unless they either have their full schedule of immunisations or have explicitly arranged to opt out for legitimate medical or conscientious objection reasons.

    I think this is a reasonable compromise. Requiring a proactive step either way at least, eliminates the case of kids not getting vaccinated because their parents just didn’t bother, and tying it to starting school emphasises the safety aspect.

  46. When I first read the question, I thought I was going to get in trouble with my response. Then I started reading the comments, and I relaxed. I’m apparently not alone in this.

    I think not getting vaccinated is a stupid decision. The risks are small and the benefits are large. Parents that are anti-vax really really upset me. I generally avoid the topic, because I do not have sufficient trust in my self control. I think it is completely absurd that some idiot is going to voluntarily leave their child exposed to potentially deadly diseases because they are too lazy to do a little bit of honest research into the topic. If some moron thinks celebrity babble boxes have more (and better informed) concern for the well-being of their child than thousands of highly intelligent people who have devoted their lives and careers to the health and safety of children, then… (this is when my eyeballs bulge out and veins stick out on my neck and I get a strong urge to become violent).

    So I mostly stay away from the topic.

    But it’s their choice. It’s not mine. I think they’re stupid idiot moron evil lazy poopy heads, but that’s their right.

    Herd immunity comes up. While that is a legitimate issue, we don’t require one person to undergo a medical treatment for the benefit of another person. You can use the herd immunity argument to try to guilt someone into changing their mind about getting vaccinated, or getting their children vaccinated, but I don’t think you can legitimately use it to take away their right to make that choice themselves.

    Increased health expenses comes up. Same as with herd immunity, you can use this as a means of persuasion, but it doesn’t justify removing someone’s right to make their own medical decisions. The same logic behind this argument could also be used to outlaw motorcycles, rock climbing, hamburgers, left turns, sex, non-carpeted bathroom floors, etc.

    The rights of the children vs the rights of the parents comes up. I’m a bit more sympathetic to this. I think we would mostly agree that there are instances of medical neglect that warrant some type of legal intervention to protect children from their parents. I’m not convinced that failing to get routine vaccinations qualifies. Possibly, if there is an actual outbreak underway, there may be an argument here. However, I think there need to be a very high bar when it comes to the State intervening in the rights of a parent to make medical decisions regarding their children.

    (Those people really do get me mad. I’m going somewhere else so I don’t keep thinking about them. It’s bad for me. bunch of lazy morons ready to let their kids die just because they’re lazy morons. I’m going.)

    I am a Hedge

  47. Possibly, if there is an actual outbreak underway, there may be an argument here.

    Devil’s advocate alert: Why should we wait for an outbreak? Why do innocent people have to be infected before something is done? The point of vaccines is to be preventative.

  48. I just want to look at the herd immunity from another angle. I agree with what’s been said about needing herd immunity to protect those few who don’t get full protection from the vaccine, and those who genuinely can’t be vaccinated because of a high risk of a bad reaction, the common good, and I want to add an extra view, that of selfishness on the part of the anti-vax.

    Imagine a hypothetical disease that would kill lots of people without a vaccine, but is easily kept at bay by herd immunity. Suppose that the vaccine carries a moderate risk of moderate side effects.

    Now, in an unvaccinated population, it is in everyone’s personal interest to get vaccinated. The risk of dying from the disease is much greater than dying from the vaccine. In a fully vaccinated population, it is in everyone’s personal interest to not get vaccinated, as long as they are the only one (or a few) that don’t, since herd immunity will protect them from the disease, plus they don’t run the risk of side effects from the vaccine.

    So, the people who are vaccinated are shouldering all the risk in this case. They run the risk of side effects. The anti-vax is letting other people put themselves in danger to protect the anti-vax, and isn’t that the sole reason they give against having vaccines, to avoid the risk of side effects? People who choose to not get vaccinated are being incredibly selfish by accepting all the benefits of herd immunity without accepting any of the risk. Do they feel guilty about putting other people in danger for their own benefit? Hell no, they cast ridicule instead. I think that people who choose to not get vaccinated at the very least should express gratitude to those who do for shouldering that risk, or else I can only say that they are selfish and morally lacking.

  49. @Kimbo Jones:
    Kimbo, it’s not very nice making me come back here and think about this more ,you know. But I suppose I have some obligation to respond.

    This is in the context of neglect when a parent fails to vaccinate a child. When an outbreak is in progress, the risk to the child increases (perhaps greatly). So I see this as tipping the balance more towards the ‘criminal neglect’ side of the scale. I think I see the validity of legal intervention if a child has a bacterial infection with a high probability of death, but the parents fail to give the child antibiotics that have a high probability of curing the infection (maybe Shane can help explain if I’ve gone wrong here). The same principle would apply if the risk of infection gets high enough, and the prognosis once infected is severe enough, but the parents fail to get the child vaccinated with a highly effective and readily available vaccine. So the reason I hedged on that particular case was that it’s entering into what I see as the grey area.

    (exhaling and rapidly exiting the room before thinking about it too much more…)

    I am a Hedge

  50. From what I’ve read, it seems that the best argument against forcing vaccination is that society cannot tell a person what to do with their own body. On the other hand, it is harmful to society at large if we don’t force it.

    What if society forced those who want to opt out of vaccinations an alternate means of giving back? Society is a give and take contract after all. But if not vaccinating yourself or your child causes measurable, significant harm to society at large, those in society harmed by your decision are entitled to demand something back. A good example of this is taxing cigarettes in a country where health care is free for everyone.

    The trick is coming up with a means of compensation. A tax may work in some areas, but it doesn’t seem to quite fit. Perhaps a law that punishes unvaccinated people who infect others by compromising herd immunity. Yet another alternative would be for insurance companies to raise premiums for those who choose not to vaccinate. Really I don’t know what’s best.

  51. @stacy: “I spoke to a co-worker about this topic today and he brought up the fact that not requiring vaccinations would put additional (unnecessary) strain on the health care system, costing us all more money in the long run. I think that’s a valid point.”

    This argument is actually a little dangerous. Allowing the government into our health decisions is ultimately dangerous. As for ways to encourage vaccines are education, preventing children into schools, etc. For example, at my college, you must have up-to-date shot records and pass a TB test, even if you come from a foreign country.

  52. Kimbo: That’s just the point–they’re dealt with by the justice system. You don’t force-medicate just any schizophrenic, just the ones that are most likely to cause problems, and they get their day in court. That won’t be the case with forced vaccination.

    It’s also ridiculous that a “whole population” would be wiped out where the majority have vaccines.

    As for the water thing, I think the problem is that the government has a monopoly. Let people choose their water suppliers, and they can decide for themselves if it’s fluoridated or not.

    By the way, I have a well. My water isn’t fluoridated. What do you propose be done with me?

    Hedge: I’ve been speaking of adults solely here. Obviously children are a different situation.

  53. @shanek: Your slippery slope is a fallacy. A person with strong hands makes a conscious decision how to use them. If they hurt people, there are consequences in the law. A person who gets angry can make a conscious decision to walk away and calm down, or to vent anger in a non-violent way. A person with mental illness with violent tendencies can make a conscious decision to continue taking meds and if they choose not to, they can be and often are locked up again. A person with a contagious disease of any kind can not make a conscious decision to stop shedding infectious particles or droplets (depending on the disease). A person with a contagious disease often becomes contagious well before there are clear signs of the disease, so often cannot make a conscious decision to avoid infecting other people until after they already have. They CAN make a conscious decision to either isolate themselves from other people permanently, or to get vaccinated and significantly lower their risk, or to accept a disease as normal and unpreventable. The latter is a communal, societal decision such as how we accept the common cold or pimples, and how we used to accept polio, smallpox, and whooping couch before we had vaccines for them. If you choose permanent isolation, then feel free to wander up to a cabin in the woods for the rest of your life.

  54. Forget outbreaks for a moment. What about the case of a newborn whose mother has a contratable disease, which can be prevented if the newborn gets an immunisation early enough? Even if you have a right to say what goes into your own body, do you have the right to harm the child?

    This situation is particularly interesting because it really happened a couple of months ago. I’d be interested to know how others would have handled that case.

  55. @shanek: You can drink water from your well all you like, and I won’t stop you or even waste time trying to convince you of the health risks.

    Heck, why not make all water treatments optional, and let people decide on the free market if they really need all those expensive tests for arsenic levels, sterilisation against toxic algae growth, and responsible disposal of sewage into watercourses?

    *note sarcasm*
    *apologies for the sidetrack away from vaccines* :)

  56. @ Michael Barry

    Tis deeply appreciated.

    The most remarkable thing about working with the public in such an intimate matter is my constant amazement at the complexity of life’s normal curves.

    More than likely most who post here are are on the the right side of the curve regarding intelligence no matter what their socioeconomic status. But imagine a young couple with an infant , of limited finance, opportunity, and intellect. The TV is often ( though not always )their book, their classroom, their world view.

    And I must undo what they consume as gospel. It’s one thing if the person or couple making the decision is in an advantaged position either by intellect or opportunity – these people, I too agree, are the selfish underminers of herd immunity – but it’s those to the left of normal, the disadvantaged, that are blameless. It’s these people who HOPEFULLY I can reach.

  57. @shanek: It’s about whether or not an individual can make a conscious decision to do or not do something which harms others. There are already ways to deal with people who choose to harm other people, and regulations to prevent people taking inaction that leads to harm. Choosing to not get vaccinated is akin to crapping on a street corner, in my book.

  58. @shanek: By “population” I meant in statistical terms. For instance “a population of weakened individuals” or “a population of poor people”. Or in the case of a new disease, perhaps the whole population if many people “choose” not to be vaccinated. (Where would we be with polio or smallpox if we’d had that attitude years ago?) Also notice that I said “could” and not “would”. And I think my point stands about the potential number of individuals being affected, so I don’t think you’ve provided good analogies in your slippery slope argument.

    Also most vaccinations are given in childhood so if it’s ok to force vaccinations on them, isn’t the argument about adults relatively moot? They’re already vaccinated (presumably) by that time. And which adults? Should all adults be given a free pass or do certain adults have to be forced due to circumstance?

    What about health care workers? I’d rather my doctor/nurse/EMT/… be vaccinated. What about day care workers? What about teachers?

    Or what about university students? Students should be properly vaccinated when they could be forced as children, but now that they’re adults they can choose not to get vaccinated? This seems silly given that they are still a high risk population for infection because they attend public schools and live in university residences.

    PS: My water example was not to say that people be “dealt with” is they didn’t drink treated water, my question was regarding the principal of treating municipal public water with protective chemicals without the “consent” of the general population. It was just a curiosity, I don’t want to get derailed on it.

  59. @shanek:

    What Angus Prune said.

    An endless slippery slope is a fallacy. Society must make decisions on what is acceptable and what is not acceptable. Some things are not OK. Some things are.

    The line is set by law and circumstance. Sure the dividing line is fuzzy, but that is where judgement calls are made. The decision on where to draw the line should be a careful weighing of the consequences. In this instance the good of society is better served by mandatory vaccinations.

    I agree with Kimbo Jones, wouldn’t mandatory vaccinations of children make the question of adult vaccination largely moot?

    If you want to be a hermit, far off the grid, then the case can be made against forcibly vaccinating you. But to take advantage of the benefits provided by society, such as schools etc., then you must ‘do you part’ of being in society. That includes getting yourself and children vaccinated for the common good.

    There are, I’m sure, many things where the line is less clear. Not this one.

  60. It’s late and I haven’t had time to read all the comments so this may have already been addressed. I’ll be brief.

    There are people who cannot get vaccinated because their immune systems are compromised or, as someone mentioned, the vaccine was not affective. These people deserve some protection as well.

    Microorganisms, especially viruses, are VERY good at mutating. If a virus infects enough unvaccinated people, it will eventually find a way around the human immune system and possibly be able to infect those that are vaccinated. Immunization reduces the prevalence of some really nasty diseases and prevents the organism from “learning” how to infect better.

    The idea that you would only be infecting others who are not vaccinated is not true. Even immunized individuals can get sick. While they do provide a high level of protection, vaccines are not always 100% effective. Symptoms may not be as severe, but you would still be able to infect others who are immune compromised or perhaps a child who has not yet had the vaccine.

    Also, we don’t know how long protection lasts. I think this became an issue when there was a concern that terrorists would use smallpox. Not only was there concern about the unprotected, but it was unknown if those that were inoculated would still be protected. So just because you were vaccinated as a child does not necessarily mean that you will be protected for life.

    This antivax movement is dangerous, selfish, and socially irresponsible. There are risks when is comes to vaccines, but the risks are much greater without them.

  61. ,blockquote>This argument is actually a little dangerous. Allowing the government into our health decisions is ultimately dangerous. As for ways to encourage vaccines are education, preventing children into schools, etc. For example, at my college, you must have up-to-date shot records and pass a TB test, even if you come from a foreign country.

    1) The government is not the originator of vaccines. Scientists and doctors are.

    2) I don’t want my govt in my health decisions, nor do I want my genius Libertarian neighbor in my health decisions, which is what happens the day he sends is ‘free’ kid to school with smallpox. Its ok of course that my kid is dead, as is my other kid, half the town and myself. My wife who is the sole survivor (in NYC in the 70s they were still immunizing) can always ‘arbitrate’ to compensate her.

  62. @shanek:

    As for the water thing, I think the problem is that the government has a monopoly. Let people choose their water suppliers, and they can decide for themselves if it’s fluoridated or not.

    …who is forcing anyone to buy a house that’s on city water?

    For well water drinkers: Who owns the water table? In the absence of an owner, who will complain with the arsenic levels in the water rise to the point where they kill everyone?

    The remedy in either case comes from govt. If you don’t like poison in your water, legislate it out.

    That legislation could be forcing them to stop fluoridating. It could be to return to an era where contaminating the water table with arsenic is illegal.

  63. Kimbo:

    “What about health care workers? I’d rather my doctor/nurse/EMT/… be vaccinated. What about day care workers? What about teachers?”

    Couldn’t we leave that up to the hospital, the day care, the school? They all require vaccines even without any government rules in place. Yes, even private schools and day cares.

  64. rh1no: It’s not a fallacy to ask where the line should be drawn and why. Besides, look at the history of government intervention in this country and tell me it’s a fallacy!

    wytworm:

    Someone who doesn’t get a vaccination doesn’t do it with the intent of infecting others.

    Re your #2: aren’t you going to send your kid to a school that requires vaccines, even without it being a government requirement?

    As for the water thing, yes, they do, at least around here. If the pipes run by your home, you are forbidden by law from drilling a well into your own aquifer on your own property. And then they turn around and piss and moan about how the system can’t take the capacity. Only government can take a plentiful resource like water and make it scarce. Every summer, they go on and on about how we’re in a “drought.” I ask them how they think rural areas of Nevada or Arizona manage! We don’t know what a drought is here…

  65. Okay, new question:

    Let’s say we get all of these government-mandated vaccines, and then scientists come up with a much better way of doing this (the way phages may end up being a more effective replacement for antibiotics). What then? Look at how slow government works and responds to things. Shouldn’t I be allowed to choose the newer, better treatment? Why should I be tied into an archaic regulation which may take ten years to change?

  66. @shanek: Aha, I see. So it’s ok to force adults to get vaccines as long as it’s private sector and not the big bad government. So your position has nothing to do with personal freedom and everything to do with distrust in the government.

    @shanek: Is the private sector any faster? Do you have evidence that says a private company forcing people to be vaccinated will be any quicker in updating their practices to conform to new technologies? Is there some reason the law couldn’t be general enough to allow for effective immunization against common diseases by any demonstrably effective method?

  67. It’s not force if it’s the private sector, Kimbo. You have the choice of whether or not to deal with them. That choice isn’t there with government.

    And yes, the private sector is much faster. They don’t have anywhere near the bureaucracy the government does. Look how quickly UL can adapt to testing new technologies.

  68. @ shanek

    I haven’t read all your posts so excuse me if I am off here. Your question:
    “Let’s say we get all of these government-mandated vaccines, and then scientists come up with a much better way of doing this (the way phages may end up being a more effective replacement for antibiotics). What then? Look at how slow government works and responds to things. Shouldn’t I be allowed to choose the newer, better treatment? Why should I be tied into an archaic regulation which may take ten years to change?”

    This answer to this is simple, fix the problem. There is no need to stop one thing because the system is broken. The system being broken is a separate issue. My answer to that is to fix the system.

  69. @shanek: 10 years? To progress from concept to proven product, 10 years is optimistic, but that’s unavoidable and has nothing to do with government. Unless you’re advocating removal of all those pesky regulations on medicines and letting the free market decide whether new treatments need to be tested to make sure they work and are safe…

    BTW, I meant no hatred towards well-water-drinkers. I just would consider it prudent to make sure about what’s in it. But if you want to drink it regardless, go ahead.

  70. @shanek: It is naive to think that all people have a choice in what jobs they do and where they work. So, yes, you pretty much are “forced” if the only place you can work requires vaccinations.

    Could you provide a link to illustrate some statistics about the private sector being “much faster”? Also, you didn’t address my point about the wording/nature of an immunization law which would make the concern of changing technologies in the government vs. private sector moot anyway.

  71. @shanek:

    No, it’s not a fallacy to ask where the line should be drawn. It’s a fallacy to say there should be no line at all simply because there is an extreme.

    Quote: “Shouldn’t I be allowed to choose the newer, better treatment? Why should I be tied into an archaic regulation which may take ten years to change?”

    In general people are poor judges of what medical treatments work, relying on anecdote and instinct to make decisions. That is why there is regulation in the first place.

    I agree with Michael Barry–if the system is not efficient enough, fix it. Allowing the free market to control medicine is terrible folly. I think we can look at the prevalence of so-called alt-med to realize that people are not good at making informed choices. If society is asked to bear the burden of bad decisions, society should have some ability to mitigate this effect. Alternatively we can let people die of their decisions in the street.

    …and no, you should not necessarily be allowed to tap the aquifer beneath your property as if you own it. Aquifers aren’t limitless and are a community resource that need management.

    Anyway… moving on now… there’s new posts to discuss!

    Thanks all for a fun first discussion here for me.

  72. @shanek: Some of your examples are “reasonable” and some are not. One uses rational discussion and the law making process to make that determination. One does not make public policy as an extrapolation of logical arguments and their end points.

  73. I favor restrictive laws rather than enforced dictums regarding issues like vaccinations. No vax’s no day care or preschool. No vax’s no school. No vax’s no attend public higher education. No vax’s no work in a setting that involves contact with other employees or the public. No vax’s no payment for any medical problem associated with that choice. No vax’s no interview with Opera. Larry King or The View. Other than those legal stipulations feel free to not get vaccinated and home school your children in your home office.

  74. Don’t get me wrong, I had my well water tested; I’m not an idiot. But from what I’ve seen, you’ve got a much bigger likelihood of there being crap you don’t want in your government water than you do in any given aquifer (unless there’s some certain geological concern, naturally).

  75. rh1n0: “In general people are poor judges of what medical treatments work,”

    Oh, and governments are any better? Me, I’d put much more stock into the findings of a UL-like organization than any government.

  76. Kimbo: No, they have a choice. It might not be a choice they like, and they might want a better choice that’s not available, but there are always choices.

    As for the statistics, I’m just going to point you to UL again. Also, you might note how many local building codes say essentially “Just use the UL-approved stuff” instead of trying to do it on their own. They know that UL is reliable and can keep up with changing technology much better than they can.

  77. @shanek:
    “Someone who doesn’t get a vaccination doesn’t do it with the intent of infecting others.”

    I don’t care one bit about intent. They still compromise herd immunity and selfishly risk the health of the people around them. Sure, the people who have immune system problems have a legitimate excuse. If these were the only individuals not vaccinated their weakening of herd immunity wouldn’t be significant. But, that’s not what happening. Cities have been quarantined due to measles outbreaks (cite below). MEASLES! That’s what happens when herd immunity is broken. This is a PUBLIC health risk. Not vaccinating is putting other people at danger, I don’t give a damn what their intent is because they are putting ME at risk with their actions. Or are my rights less important?

    *As promised:
    http://children.webmd.com/vaccines/news/20080519/cities-get-grip-on-measles-outbreaks

  78. Mandatory. Being an obvious disease vector (yes, there’s no hard line. There is a nominal one formed from good sense and balance.) would seem to be the mother of all externalities-you don’t bear the cost of your spreading of disease. Government regulations solves externality problems. Ergo, mandatory vaccinations. As a matter of practical enforcement and to give the truly batshit a sanctuary, requiring vaccinations to attend public schools, or use a public hospital, would seem to be a sensible balance.

    Given that most vaccination decisions are made by parents on behalf of their children for outstandingly bad reasons, I’d also argue that it makes sense from the standpoint of protecting children from the externalities of their parents really poor decisions.

    Sure, I’m not fond of telling people they have to do something. Non-coercion, non-initiation of force, all excellent principles, which must be perpetually considered and must inform all decision making-but they make for terrible rules. It doesn’t take much game theory, hatched out on graph paper, played out with monopoly money in the psychology lab, observed in the primate house or simulated on computers (much less, say, examining real-world organizational dynamics) to realize that the equilibrium reached by selfish operators is often suboptimal to all, and getting to a superior equilibrium requires enforcement-someone has do something they rather wouldn’t, and in a lot of cases, the pool of players is an entire citizenry, and government has a job to do. Often badly, often over enthusiastically, but that’s why democracies are important-systems with feedback loops find healthy equilibriums, in this case, between recognizing that letting people do their own thing behooves everyone, both from a “biodiversity” (memeodiversity?) standpoint and an ethical one, and also recognizing that allowing you to pee in all of your neighbor’s ponds (or your child’s) is not a hallmark of high ethics, either.

  79. Mandatory with well-documented medical exemptions only.

    I’ve read too much evidence of harm caused by the unvaccinated, especially over at Orac’s blog (www.scienceblogs.com/insolence). The saddest tales are those of babies too young to be vaccinated who are permanently damaged by preventable diseases when exposed to unvaccinated kids carrying said diseases into their pediatricians’ offices.

  80. If individuals are given the choice to be vaccinated or not, and I choose not to, I will only infect others who also choose not to be vaccinated.

    False. Vaccines are very effective, but not 100%. Some people who are vaccinated will not develop an immunity to the disease in question, and instead must rely on herd immunity not to get sick.

    Additionally, if enough people “opt out” of vaccinations, herd immunity can be compromised. If that happens, even people who have been vaccinated may not have sufficient immunity to prevent sickness.

    I’m a huge fan of personal liberty, but your freedom ends where my rights begin. Refusing to be vaccinated for any reason, save sound medical grounds, is a public health risk.

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