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?
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.
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?
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*
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.
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.
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.
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.
@TheSkepticalMale: No, no one has mentioned that. Though I have been told that I don’ t look like my avatar. Wait a minute, it might have been you that told me that.
@phlebas: Isn’t Jenny McCarthy advocating alterations to the recommended scheduling and the use of “green” vaccines, rather than simply opposing vaccinations in general?
@Stacey: [Embarrassed look on my face as I sink down into my chair] … In my defense, your hair is not really orange.
@phlebas:
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,
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.
@TheSkepticalMale:
You may be right. Sometimes her nonsense is hard to parse :) I may have been improperly using her to represent the antivaxxer collective.
I’ll use Bill Maher instead :)
@phlebas: No problem … My mission in life is to defend former playboy centerfolds :)
@TheSkepticalMale:
Your mission is to defend playboy centerfolds? My mission is to perfect the ham and cheese sandwich.
I think that I got screwed over when the missions were being handed out.
@TheSkepticalMale: Oh, SkepticalMale, I’m just giving you a hard time. You are right about my avatar. Yours is much more accurate.
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.
@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.
@Lox: I agree with your observations about vaccines being one of many tradeoffs in choosing to live in a civilized society.
@Stacey: Ssshhh.
@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.
as long as we’re genetically altering all our food, can we hide the vaccines in there? (Shhhhhhhhhhh ;) )
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.
@Michael Barry: Yep.
@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.
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.
@phlebas: Good idea! Milk would be a good choice. (Ssshhh … Oh boy, this is getting ridiculous)
@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.
@TheSkepticalMale: That’s her PR spin, and in all likelihood it’s a crock. She just wants “green” vaccines like creationists just want to “teach the controversy.”
@TheSkepticalMale: But you are saying that vaccines are requires unless the parents file an exemption that meets one of those criteria, no?
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.
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?”)
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.
@Stacey: Yes … I mean, no … Oh, you know what I mean.
Actually Jenny McCarthy is antivax, she just couches it in other terms. For a lot of info (and actual science) check out http://scienceblogs.com/insolence/medicine/antivaccination_lunacy/.
I think it should be up to the person, but that there should be consequences. No public school, no drivers license, etc. Maybe a $10 tax credit for each immunizations granted that year.
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.
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.
@Frankiemouse: Yes … and §23.84.b says: “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.”
“others claim that the HPV vaccine advocates teen sex”
Y’know, I don’t recall anyone ever saying that the tetanus vaccine advocates playing with rusty nails.
@trumpetess: like in Chilliwack/Vancouver.
@Steve: I think we dumb down our kids too much … The argument assumes that teens do not know the difference between HIV and HPV.
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.
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.
@TheSkepticalMale: You should be careful to distinguish that your “no” doesn’t mean “yes” and vice versa. That could be exploited.
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.
@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).
@SkepGeek: I think the analogy to refusing medical treatment in lieu of something like prayer for your child is weak here.
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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”.
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.
@Stacey: Well, “no” always means “yes” with you, Stacey … Also, “yes” means “yes”.
@ halincoh
Boy do we appreciate your efforts.
required and absolutely no exemptions for religious reasons.
People in the States who are adversely affected by vaccines can already get compensated thru the National Vaccine Injury Compensation Program.
@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 vaccin