Usually the Wednesday Afternoon Inquisition is brought to you by the most recent winner of Comment o’ the Week! However, winner Kaylia didn’t send in her question. So! Here’s something nice and topical for you.
Recently, a 17-year old British girl was denied US citizenship on the basis that she refused to get the HPV vaccine Gardasil, which became mandatory for all immigrants last year. She says that as a devout Christian, she has no plans to have sex before marriage and therefore is not at risk. Plus, none of her American classmates are required to take it and she fears the side effects.
So I put it to you:
Should vaccinations be required of immigrants, even if they aren’t required of citizens? Should any vaccinations be mandatory for all people?
The Afternoon Inquisition (or AI) is a question posed to you, the Skepchick community. Look for it to appear daily at 3pm ET.
No.
No.
I am a Hedge
Immigrants and those seeking citizenship have always had different laws and requirements applied to their circumstance as opposed to someone born a citizen. Certainly with regard to health and quarantine issues entry into this country and occasional expulsion has been a common practice related to health issues. The HPV seems a bit different because of the nature of disease; however if HPV is identified as a communicable disease that national health authorities have identified as needing to be addressed by a potential citizen or immigrant than one should deal with it and get the shots.
To specifically answer the questions, yes and perhaps in some situations.
@James Fox: You had me right up until the last sentence. There are times when mandatory vaccinations might be appropriate. This not remotely one of them. Mind you, she was not seeking residency. She was not contemplating coming into the country to spread a real or imagined illness. Notwithstanding the possibility that this vaccine might reasonably be considered valuable for her own health, the mere act of becoming a citizen, having lived here and been sexually active or inactive for several years does not point to the need for her to be treated differently from other women of an age that suggests the possibility of sexual activity. What is the public health benefit of such a regulation?
No. Yes.
No and No
But they should be required of their children to enter school – as per the state guidelines. Personal autonomy is essential. As far as quarantining someone who is currently infected, I think this is appropriate. They should be educated and encouraged to get their vaccinations, but it should not be a requirement to enter or emigrate to the country.
Yes.
For her own good. Even if she “knows” she won’t have sex before marriage, how can she know what her future husband’s been up to? The average person has had indirect sexual contact with more than 7 million people
http://www.independent.co.uk/life-style/love-sex/men-women/pharmacy-launches-sexual-partners-calculator-1791847.html
and you can calculate your figures
http://calculators.lloydspharmacy.com/sexdegrees/
I’m not that suprised to be honest given the appalling state of sexual health education in the UK. Universities are returning after the summer over the next few weeks and there’s been the usual panic to explain to the nation’s 18 year olds that being a “good jugde of character” is no defence against STIs and that the pill doesn’t protect against STIs.
1) No.
2) Currently, no. If there is ever a preventive HIV vaccine that is minimally 70-ish% effective, yes. Just as polio vaccine and smallpox was mandatory, so this should be.
@russellsugden:
Is that a sufficient condition for invalidating someone’s right to make their own decisions regarding their body?
What other things may be forced upon someone once deemed to be for their own good?
I am a Hedge
@Old Geezer: For me sexual activity is not the issue here, that’s simply the avenue this particular disease is spread. It could just as well apply to a contagion spread through sneezing.
No and no.
@James Fox: This vaccine is not intended to stop the spread of disease as I understand it. It is to prevent her from contracting cancer secondary to infection from an outside source. Again, if she (or any other applicant) has been in the country for more than twenty minutes, how is she different from those who are not applying for citizenship? Do we classify immigrants as sole carriers of this disease?
I am, as ever, wishy washy (I also have evidence that I am a late-generation star, but that is neither here nor there).
On the one hand, she should be denied citizenship at this time; there was a legal requirement to citizenship that she refused to meet. Not was unable to… refused to.
However, should vaccinations against diseases be required? I think yes. STIs? A little bit more difficult to argue a public need for it by an avowed Frigidaire.
It depends on what the vaccination is for. As far as I know, HPV can’t be spread through casual contact. How does the disease spread? How deadly is it? How fast does it mutate? Are there drug resistant strains. How available is the vaccine? Can it be feasibly provided to a large population? And yes: what are the potential side effects?
As for immigrants, is there a chance of importing a disease into a largely immune local community?
The decision should be made based on these kinds of factors. It can’t be made for a blanket term like “vaccines”.
@Old Geezer: I may be wrong but I thought that part of the benefit from the vaccination was to prevent HPV infection which could lead to cancer. If you do not have a HPV infection then you can not spread it to other sex partners and on an on.
And identifying and treating immigrants differently than citizens with regard to disease prevention is common practice from my understanding.
Aren’t vaccines by defenition things that prevent future exposure? It would seem reasonable to deny immigration based on the posession of a particular disease (because it might infect current citizens) but to deny immigration based on a lack of innoculation (which would require current citizens to already be infected) seems strange to me.
As far as mandatory vaccination. Sure. If the virulence of a disease is bad enough, then it is certainly correct to make innoculation mandatory. The right to infect others with life threatening disease is within the range of things I’m comfortable with the government impinging on.
@James Fox: As I understand the vaccine, it protects against a few of the several common strains of HPV, so it wouldn’t necessarily protect future partners from HPV. If we think the spread of HPV, (whether of the cancer-causing variety of or not) is a public health problem, then let’s require EVERYONE to be vaccinated, cauterized or whatever. If not, then let’s start thinking about what a rational approach should be,
As to the “common practice” the question was not “do we?”; it was “should we?” Do we?Yes. Should we? No. IMO.
@James Fox:
In these cases, there must be a justification for treating the immigrants differently. If someone is currently infected with something, it is reasonable to provide for quarantine for the duration of the infectious stage prior to allowing entry into the country. If the infectious stage is indefinite, then it is reasonable to deny entry altogether. This is protecting the current population from the introduction of a new danger.
In the case of vaccination, we are not dealing with a current infection and the introduction of a current danger. The goal is to prevent future infection, and thus future transmission to other members of the population. Any justification for requiring vaccination for immigrants would equally apply to current members of the population.
I am a Hedge
Yes and yes, but the latter yes comes with caveats. There are some groups that should not receive some vaccines because they have compromised immune systems and there is a significant likelihood they will be injured by it. Such people (as determined by competent medical authorities) should be exempt from mandatory vaccines.
Living in a society imposes demands on some individuals. I still have my draft card. The US doesn’t have a draft now, but at one time it did, and young men were drafted into the armed forces and sent overseas to kill and be killed. If the government can mandate that, it certainly can mandate taking of vaccines.
The thinking behind the idea of drafting young men to fight in wars was that it was “better†to use young and able-bodied young men to fight so as to protect those who were not young and able-bodied young men, women, children and old men (and the rich too, but that is a flaw in the argument). Similarly vaccinating those with able immune systems protects those without able immune systems via herd immunity.
The vaccine under question is not a live vaccine. There is zero chance of her getting an infection from it. If she doesn’t want to take the vaccine, she shouldn’t have to, but if the requirements for emigration require vaccination, she should not be allowed to become a US citizen without it.
I don’t want any more anti-vax loonies in the US and able to vote. We have too many already. My preference is that she stay away. I don’t want her teaching children in the US. I would rather that she was vaccinated for her own protection, but if she is going to vote according to her anti-vax loony ideas, I would rather she didn’t become a citizen.
Couple points-
-The argument seems backwards. By vaccinating her, we would only indirectly be protecting citizens from infection. We’d be directly protecting HER from infection from US.
-I’m uncomfortable with forcing someone to be injected with something, especially when it’s something that hasn’t been on the market very long and we probably don’t know the long-term effects of. While I’m sure it’s perfectly safe and should be highly encouraged (I got it), I don’t think it should be forced.
@daedalus2u: I am concerned by your logic. I, too, registered for the draft. I did so because ALL able-bodied males were required to do so, not just those who had special circumstances. To equate this with universal vaccination might be appropriate, but it is not the same when you decide that the draft (or vaccination) only applies to certain people because of national origin or some similar dividing criteria.
The vaccination in question does not apply in the same sense as the MMR vaccination might. There is little chance of a herd immunity issue arising here. Think in these terms: If you do not intend to leave your house or answer the door for the next nine months do you really need to get a flu shot? You have little or no chance of infecting, or being infected by, other people. This is the situation she considers herself to be in. We can debate the validity of her self-assessment, but she should not be lumped into the class of “anti-vax loonies” who might be voting “according to her anti-vax loony ideas…” She’s simply looking for equal treatment under the law. You know. Like the constitution guarantees you and me.
I missed my chance!
Epic Fail!!!!!
@daedalus2u:
Do you think a military draft is a good idea?
I am a Hedge
I think it makes the most sense to mandate the same needle love for everyone… so if a 17 year old American citizen isn’t being forced to have this vaccine, then the 17 year old immigrant shouldn’t be forced to either… unless it is a disease that she is more likely to carry by virtue of being an immigrant. (If that makes sense).
Now, should vaccines be mandatory for everyone? Well.. aren’t we working on that? Aren’t there certain ones you must get in order to go to school?
The special case of this one is that it is a STI thing so there is different baggage than say, polio or measles. This begs the question… should it matter what the vaccine is for?
Like, umm… the flu shots. Should they be mandatory/ If so, should we have to pay for them?
@Im a Hedge: While the question was not directed to me, I’d like to say its less of a “this is a good idea” statement, and more of a “if they can do this, then why can’t they do that”. An argument based on consistency.
This is an awkward subject. While I’m a government noninterventionalist, I understand that sometimes in order to protect the public, you have to mandate things that aren’t cool. Before I make a call, I’d have to know if the vaccines that immigrants are made to take before coming into the country are the same ones that all the people have to take. I don’t like the idea of immigrants being subjected to different rules and regulations.
There are so many different “what if”s that I can’t make a general call.
@leahlou:
Maybe you missed this detail, but the girl is British. It’s common knowledge that British girls are total sluts, so she’d be spreading this around everywhere.
I am a Hdge
@infinitemonkey:
I can appreciate that, although it seemed to be added as an argument supporting mandatory vaccination. I see it like this:
1. A is an acceptable reason to violate individual rights
2. B is a lesser violation than A
therefore,
3. B is an acceptable reason to violate individual rights
The argument is only sound if A actually is an acceptable reason to violate individual rights. I don’t think it is, so I don’t accept this argument. I am curious whether daedalus2u accepts proposition 1, because if he does not, then he may reconsider his position.
I am a Hedge
The thing that gets me about this particular case isn’t so much the vaccine question as the epic immigration fail that got the situation to this point. The girl in question moved here with her guardian 10 years ago. She should have already been an American citizen by the time any of this rolled around, she just got caught in some ridiculous nationalist clause that didn’t recognize British adoption.
When I applied for permanent residence, I had to jump through a lot of hoops, including the MMR vaccine, beloved of the anti-vaxers. I also had to be tested for HIV and a lot of other things. I wasn’t happy about it. Nor was I happy about having to jump through all the other hoops. But, you know, whether I like it or not, it’s fair for a country to ask that of people.
If you look at the hoops that they make you jump through, the main issue doesn’t appear to be contagion – rather, it’s a concern that this person won’t become a burden on the taxpayers. Since she’s applying for citizenship, they’re stuck with her. So why not ask her to reduce the chance of the taxpayers having to pay for her medical treatment?
@Old Geezer
I’d love to have “equal protection under the law”. But I don’t. Why? Because I’m not a US citizen. I can get deported if I commit a crime. I can’t apply for federal assistance until I have contributed 40 quarters of payroll taxes. Even if I became a citizen, I could never run for President. US and non-US people are treated differently.
@leahlou
No one is forcing her to get vaccinated. She isn’t required to become a citizen. She wants to become one. Contrary to what they are suggesting, you don’t need to be a US citizen to apply to Pensacola Christian College. (It’s entirely beside the point to note that she’d almost certainly get a better education at a non-fundie school.) My guess is that they want Federal grants and loans to attend the school.
Should vaccines be mandatory for everyone? You’d have to allow the obvious exceptions for people with compromised immune systems, and similar issues. If so…maybe. It depends on the public health risk. Since to lifetime risk of HPV infection is, iirc, around 80%, and since it can cause a potentially deadly disease, a safe HPV vaccine would be a very good idea.
If smallpox was still endemic, if polio was still widespread, then I’d support mandatory vaccination against them. So why not this?
Yes,
Yes.
But they should be paid for through taxes.
Surely the only reasonable answer to that question depends on what it is, quite specifically, that the vaccination is guarding against and what degree of public health risk may be involved, and what, if any, specific diseases exist in the place of origin that may not exist in the new locale?
Again, surely the only reasonable answer to that question depends on what it is, quite specifically, that the vaccination is guarding against and what degree of public health risk may be involved?
In the specific case used in this AI, I have no answer. I neither know enough about the disease being guarded against, nor enough about the individual concerned.
And in regard her words that
Well, is that really any more meaningful, or have more substance than the general claims of your run of the mill anti-vaxer?
@iramjohn: “If smallpox was still endemic, if polio was still widespread, then I’d support mandatory vaccination against them. So why not this?”
The difference here is that she does not pose any more of a health risk to the community because of her citizenship than she does now as a resident alien. We can debate the validity of mandatory vaccination for any number of diseases, but that will not change the fact that she is being asked to accept vaccination as a condition, not of residency or her risk to those with whom she consorts, but solely under the assumption that foreigners who seek to become citizens then, and only then, become a health risk to the community. And a health risk that is not implicit in those who were born here.
That’s both a very fine and irrational line to draw.
No.
Hmmmm. The second is more difficult. I’ve had all my shots, as far as I know. So have my children, although I was iffy about a few of shots offered in the 1980s when my children were small I finally decided the protection outweighed the dangers. However, the only times I’ve ever had the flu were the 2 times I got a flu shot, so I probably won’t get another flu shot.
Should vaccinations be required of immigrants when they are not required of citizens? In certain cases, yes. There are still communicable diseases in third world countries that have been eradicated, or nearly so, from the US population. To vaccinate against such diseases in order to protect the population as a whole seems pretty self-evident.
Should any vaccinations be mandatory for all people? This is even more difficult to answer. I am highly in favor of keeping the populace healthy via science-based medicine. However, forcing someone at virtual gunpoint to be vaccinated against their will just screams police state. People should be free to weigh the evidence and choose for themselves what is right.
Hedge, I don’t like the idea of a military draft. But I do know that if we had one now, we wouldn’t be fighting in Iraq. It was the draft that drove the opposition to Vietnam.
I don’t think the draft is coming back. If it does, it will have to be for men and women, and I don’t think those in favor of a draft would support that.
She isn’t being forced to get vaccinated. She wants to become a US citizen, the rules require her to get vaccinated, either she complies with the rules or she doesn’t become a US citizen. There are plenty of illegal aliens who would take her place in a heart beat and who would be better citizens.
After reading this and thinking about it and reading the comments and thinking some more… as usual, I’m confused.
I don’t understand why immigrants should have different vaccination requirements than US citizens do. After all, it is about preventing what they don’t have yet, not protecting the local citizenry against what they might bring in. Now, I understand requiring a vaccination before someone, citizen or not, leaves the country to visit a part of the world where they may pick up a disease that is prevalent there and not here… but that’s not the case for an immigrant. If the issue is herd immunity, then the same rules should apply to everyone in the area.
I’m torn, as always, on the issue of requiring vaccinations in general. I can’t imagine forcing every child to get a shot, against their parents’ will. It is much more sensible to deny them acceptance into a school or day care because they aren’t vaccinated, especially since that is where the issue of contagion is most important, and it’s enforceable.
Anyway, looking forward to my next shot in the Gardasil series. Intellectually at least. It actually did hurt quite a bit! But I was pleased, in a geeky way, to find that the university clinic where I was receiving the vaccine was one of the first trial locations.
That karma is a bitch. Rebecca goes to the UK to live with Sid in wedded bliss, and we get this anti-vax wacko fundamentalist Christian who has taken a virginity pledge. Is that proof of Divine Justice or what?
Yes (for consistency, even absent the citizenship question) and Yes (with caveats).
HPV can be found on many people’s skin and under fingernails, and the resultant disease can be fatal in either sex. Even if the rationale were to protect her future husband(s), if any, it would be advisable, just in case her moral sense (or some man’s) fails or has failed or if her husband had inadvertently infected himself. Since men typically infect women (and vice versa), the vaccine should be mandatory for both sexes between 11 and 26 years of age.
All FDA-approved vaccines for endemic diseases should be required of all people (except those for whom it is medically inappropriate) so as to increase herd immunity for infectious diseases. Public schools can act as gatekeepers for vaccines. Free-riders endanger the provident because no vaccine is 100% effective. Nobody has the right to expose anybody else to an easily preventable disease. If the no-vax types endangered only themselves, we needn’t care.
And gwenny@33: You can’t get flu from the shot; the shots most likely protected you from those years’ strains–you probably had a different strain of flu or some other respiratory illness. Please join me in getting a flu shot and, when available, a swine-flu shot.
@SicPreFix:
and
@FledgelingSkeptic:
@Nicole already covered this, but I’ll also point out that this is not relevant to the vaccine issue. Vaccines are to prevent getting a disease, and have no bearing (in general) on what diseases one already has.
(I think there are some vaccines that have a minor effect on an existing infection).
I am a Hedge
@daedalus2u:
So we agree that the (previous) existence of the draft has no bearing on the legitimacy of mandatory vaccinations for citizens, because we agree that the draft is not an acceptable violation of individual rights.
Are all requirements on immigrants acceptable, because they can choose not to become citizens? Or are there some limitations? For example, would it be acceptable to require candidates for citizenship to be sterilized? If not, what is the principle that distinguishes between the two requirements?
I am a Hedge
@daedalus2u:
When I graduated high school, the US had a lottery, for those males born in the year I was, to see who would get drafted to be sent to Viet Nam. I always lose lotteries so it turned out good because if you “won”, you lost. They had a random drawing by birthdays and people were called up in the order drawn. My birthday was close to the 300th drawn so I felt relatively confident that I wouldn’t be drafted (which I was not).
Phil Plait has a similar viewpoint to me and unlike me is able to speak in a sensible coherent manner so I’ll link to what he said:
http://blogs.discovermagazine.com/badastronomy/2009/09/17/massachusetts-to-require-flu-vaccines/
Key point being: “In my ideal world, people do the right thing for the right reasons, and that means they would all get vaccinated… But I’m not sure requiring everyone to be vaccinated is the right way to go.”
I still think education programs are the best way to counter the antivax movement but we may eventually reach a point where we have to give up trying to convince people to save their own children’s lives and start forcing them too.
Something no-on else has brought up; only taking in vaccinated immigrants seems to be a good way to keep people who are batshit crazy out of your country.
No and yes. Also I found the first question confusing, it makes a lot more sense without the word “even”, or reworded as “even though they aren’t…”. I suspect you meant the latter.
But this is to gain citizenship. they have all sorts of rules that is not manatory for natural born citizens.. it is not a requirement for anybody to know anything here (if you ever watch “Jaywalking”) I bet alot of people couldnt pass a citizenship test…
@Im a Hedge:
Yes quite. Thanks. I stand corrected, and feeling a wee bit foolish.
@Im A Hedge
Of course. I understand that vaccines are preventative measures. I should have been more clear. An unvaccinated immigrant can visit home and contract something from residents of their home country then bring it back here to the US population. That’s what I was trying to say so badly.
I’ll pilfer from @Nicole again:
I think that’s a separate issue, and I’m not sure if we want to go down that path here. If we do go there, I’m afraid I’ll have to think more before I can add anything. (I know, not thinking first doesn’t usually stop me from commenting)
I am a Hedge
@Im a Hedge: “(I think there are some vaccines that have a minor effect on an existing infection).”
In all the Gardasil literature that was heaped upon me at the gyno clinic, they make sure to state that the vaccine does not help with an existing infection. I don’t know for sure if that means that they tested it and found there was no effect, of if they are assuming that and it needs further study. Considering how so many of us have had to deal with an HPV infection at some point in our lives, I’m sure many of the Gardasil study participants had at least one strain and could be monitored.
But if you once had an infection and are now cleared, it will protect you from re-infection.
Agh, and, one of my friends just tonight told me she was avoiding the vaccine for fear of “unknown long term effects.” I tried to persuade in the little time I had, pointing out that right here at UVa is where one of the long-term studies was done! But I don’t know…
It would have been possible to attain a waiver for the vaccination requirement on religious grounds, but she hasn’t stated that the vaccination (or any vaccination) is against her religion, only that she’s “not at risk”, which is not the same thing (on top of being factually incorrect). Immigration officers are picky, picky, picky. If you’re not fluent in legalese, and are unable to take directions absolutely literally, you should get a lawyer.
Anyway, I’m an immigrant myself, but I don’t necessarily agree that immigrants and citizens should have the same vaccination requirements. I might not *like* it, but I didn’t have to move here, and it’s unreasonable for me to expect to have a say in the matter.
Other things that can cause an immigrant to be inadmissible to the United States (even for a vacation) that aren’t necessarily problems for natural born citizens: membership in any Communist party, prostitution, polygamy, being poor, being physically or mentally ill, getting stuck with an immigration officer who’s having a bad day, etc…
On top of that, some things that can make you ineligible for citizenship: poor knowledge of US history or geography, inability to speak English, failure to swear allegiance to the Constitution, not being a person of “good moral turpitude”.
Some (most?) of these things would be impossible to enforce if applied to natural born citizens, and some of them would be extremely inappropriate (i.e. kicking the sick and poor out of the country). But when it comes to immigration, I think it’s definitely a good policy to make sure new citizens aren’t likely to say… sign up for welfare the second they get their passport, shoot the president, or infect healthy Americans. A country can’t choose what sort of people are born there (just like you can’t pick your family), but they have every right to control who moves in.
@Old Geezer:
“We can debate the validity of mandatory vaccination for any number of diseases, but that will not change the fact that she is being asked to accept vaccination as a condition, not of residency or her risk to those with whom she consorts, but solely under the assumption that foreigners who seek to become citizens then, and only then, become a health risk to the community. And a health risk that is not implicit in those who were born here.”
No, not quite. She’s allowed to stay in the US, as are any visitors and tourists. She’s not allowed to become a citizen and enjoy the benefits that brings with it until she’s taken the vaccine.
It’s a no free lunch kind of thing. Sure, you get to enjoy the benefits of US citizenship, but only if we can be assured that you submit to a $30 (?) vaccination which will be 100% effective at protecting you from HPV and the potentially resulting cervical cancer with a much higher price tag.
This is the state saying we’ll give you $30 (or whatever the cost is) so we don’t risk having to shell out thousands of dollars for your medical expenses several years from now.
You can’t require American children to take the vaccine before granting them US citizenship because, duhh, they’re already US citizens.
It’s similar to insurance companies not wanting to insure your car, or at least hiking up the premium, if it’s not properly safe-guarded against theft, like, you know, locks on your doors for example.
@Nicole:
Minor point, but I suspect the reason to vaccinate against a disease before allowing entry is the habit of new citizens, or those under application, to travel to and from the country. It is disease spread by this coming and going that could be prevented.
@Im a Hedge:
I think the idea of ones rights ending where anothers begins applies here. I’m sure you’d agree that someone with aids or some other deadly disease should not be allowed to spread it freely and I would put refusal to be vaccinated in a similar, but less severe, catagory. If there are genuine comparible risks to the individual then it is more of a difficult issue but in cases where refusal is due to some form of ignorance then no allowance should be made and access to services should be denied until compliance is acheived, ideally through education. I’m not a U.S. resident but demanding vaccination of immigrants seems reasonable. I don’t demand that everyone in the street bathe regularly, but if they want to come into my house then I feel justified in demanding a higher standard. As for whether citizens should also be forced, I again say denial of services, such as entrance to school, is the way to go in areas where public health is threatened.
@Nicole:
“But if you once had an infection and are now cleared, it will protect you from re-infection.”
I was under the impression that once you have HPV, it’s there to stay, and no amount of innoculation is going to be of any use.
And once you’ve had it, you’re destined for regular check-ups to make sure you don’t have cancer (yet).
I don’t think that the HPV vaccine should be mandatory for immigrants if, as in this case, her peers are not required to have it. To require it before allowing entry in school for ALL girls (and boys when/if it is available for them) is one thing (because there ARE alternatives to public school), but to require it for some teenage girls and not others? I don’t think so.
But I can say that if I were of the age for it, I certainly would have gotten it for myself and will argue strongly in favor of it for girls in my family.
And no, while I think that everyone who is able to get their vaccines should get them, they should not be mandatory for everyone. Maybe a requirement for school attendance and certain high risk jobs, but not across the board.
Rather, I think we should mandate brains, so that everyone is smart enough to know that they should indeed get their shots.
@neverclear5: “Minor point, but I suspect the reason to vaccinate against a disease before allowing entry is the habit of new citizens, or those under application, to travel to and from the country. It is disease spread by this coming and going that could be prevented.”
But I also know a number of US citizens that travel to and from other countries constantly, with international collaborations and all that. So I think I already mentioned that point in my original comment, saying that it makes sense for international travelers, whether they are citizens or not.
@exarch: “Sure, you get to enjoy the benefits of US citizenship, but only if we can be assured that you submit to a $30 (?) vaccination which will be 100% effective at protecting you from HPV and the potentially resulting cervical cancer with a much higher price tag.”
It’s $375 for the whole series, though many insurance companies are covering it. Also, the vaccine covers for two types of HPV which cover 70% of the cervical cancer cases (as well as two more types that cause 90% of genital warts.) Better than nothing! But not 100%.
“I was under the impression that once you have HPV, it’s there to stay, and no amount of innoculation is going to be of any use. And once you’ve had it, you’re destined for regular check-ups to make sure you don’t have cancer (yet).”
And that’s what I thought, too. In fact, that’s what my first doctor told me. I’ve recently switched to a new one that follows CDC recommendations a little more closely. I can’t find the specific link now, but after a certain amount of time having normal pap smears after your first HPV infection, you can return to the normal yearly schedule. Apparently, without further exposure to the virus, there is not reoccurance. It’s the 10% of women whose bodies don’t clear them of the infection within a couple of years that are then at risk for cervical cancer.
Also, just looking at the CDC numbers for infection rates at http://www.cdc.gov/STD/HPV/STDFact-HPV.htm#common :
“Approximately 20 million Americans are currently infected with HPV, and another 6.2 million people become newly infected each year. At least 50% of sexually active men and women acquire genital HPV infection at some point in their lives. ”
So if half of most Americans have had it, but 20 million have it now, most people’s bodies have cleared themselves of the virus after a period of time.
In the end, I’m proud of my cervix for kicking virus butt.
Sorry for another long comment, it’s obviously a pet interest of mine :-)
@Nicole:
Sorry about that, I think I was responding to only a part of your post which had been quoted by someone else. I shall retire chastened and promise to do my reading next time. I suppose you might make the case that immigrants are simply one group that this makes sense for, another being frequent travellers as you said, but immigrants are easier to control as the government has them very much ‘over a barrel’ as it were. I would support a programme like this for all frequent travellers, although I would hate to do anything that might encourage people to get less exposure to the rest of the world. I sometimes find it frustrating that there isn’t a large scale well executed study on all issues, all the time.
@neverclear5: “I sometimes find it frustrating that there isn’t a large scale well executed study on all issues, all the time.”
DUDE, tell me about it. But I guess that’s why we have to be skeptical because all the evidence isn’t out there all the time. At the tip of our fingers. On Google. Damn you Google, you have spoiled us!
Don’t feel chastened! I don’t do well with chastity… :-P
@neverclear5:
One’s rights may end where another’s begin, but that doesn’t imply that one acquires new obligations in the process. What rights of Person A are infringed by Person B not getting vaccinated? A right to be free from risk of infection? In what way does Person B acquire an obligation to incur costs or risks in order to support the (supposed) right of of Person B to be free from risk of infection?
If someone intentionally attempts to infect someone else, as in your example, that would be assault. Is it assault if it is not intentional? If you get a cold from a coworker, have you been assaulted? Has the coworker violated a right that you have to be free from risk of infection by failing to observe proper hand-washing protocols?
You can get vaccinated, at your own cost and risk, to reduce your risk of infection. In every case I am aware of, this is the rational thing to do, as the benefits outweigh the costs. You can use all of your persuasive powers to convince other people to make this same decision. I think there is a very high threshold that must be met before you can forcibly remove someone else’s right to make this decision, and impose your own decision against their will.
I am a Hedge
I think vaccinations should be mandatory for everyone, including the HPV vaccine. I have no sympathy for people’s stupid beliefs on this subject.
@Nicole:
I’ve definitely been spoiled by google. I sometimes catch myself feeling personally affronted if someone somewhere hasn’t made an easy to use page to describe whatever it is I’m looking for.
Also message received, ixnay on the astity-nay. Hmm, I like how that second part sounds.
@Im a Hedge:
I would disagree. Being part of a society includes costs and benifits. I might not accuse someone of assault if they came to work and infected me, but if they came to work with an infectious disease they knew they had then I would expect the management to discipline them in some way for doing so and jeopadising the entire office’s productivity with their selfish actions. That’s how epidemics become pandemics. I would use this same rational to say that, for the sake of herd immunity, if you wish to be part of a group and gain the benifits of that group then it is not unreasonable to insist on a level of care and respect for the other members.
Perhaps it’s because I tend to focus less on an individual’s rights as unassailable and sacred and more on what’s best overall, giving large but not absolute weight to the rights of those involved. When people ask if you would kill a stranger to save ten others I answer yes immediately. My natural reaction is not to ask whether the rights of one outweight the rights of the others or whether I have the right to make the decision. I see 1 vs. 10 and 10 wins. Consequently I would say that if you wish to take advantage of the benifits of the school system or U.S. citizenship (assuming you weren’t born with it and thus, denied the choice) you must pay the costs and respect it’s other members by ‘getting your shots’.
Perhaps it’s simply because I’m a white male from England and have, thus far, not had to call on my rights or felt them deeply infringed that I don’t give them as much weight as others. I simply see them as a negotiated set of rules we have all agreed to abide by, which I might not if I’d actually had to rely on them.
@Nicole:
“It’s $375 for the whole series, though many insurance companies are covering it. Also, the vaccine covers for two types of HPV which cover 70% of the cervical cancer cases (as well as two more types that cause 90% of genital warts.) Better than nothing! But not 100%.”
No, that’s not what I said. The vaccine IS 100% effective at preventing whatever strains of HPV they’re targetting. For the rest of your life.
That those strains are only responsible for 70% of cervical cancer is not the point I was making.
Not to mention that even $375 (which, when mandatory, should be on the government’s expenses) is still a lot less than exhorbitant hospital expenses, surgery, chemo, whatever else that befalls someone with cervical cancer.
Imagine being able to cut that number in 3 by making HPV vaccination mandatory.
@neverclear5:
The owner of an office setting rules for who may enter the office, and under what conditions, is a different issue from the government forcibly violating individual autonomy. The employee enters into a voluntary agreement.
I am less willing to negotiate the fundamental principle that one owns one’s body. I suggest considering the logical implications of accepting the proposition that you own your body, and the logical implications of accepting that you do not own your body. Include in your considerations the question, “who does own your body if you do not?”. Does no one own it? Does the State own it? Does Society own it? What would be the implications of each of these?
I am a Hedge
As to the specific question of the quickie:
Yes, and yes, for the basics.
But I’m still undecided about the HPV myself. I looked into it when my daughter was the recommended age to start receiving it and found a) my insurance wouldn’t cover it and b) there hadn’t been enough (IMHO) long-term testing. IF a vaccine becomes mandatory for citizens there should be programs to help defray the costs for those who cannot afford it.
But if people chose to come here, they should be required to follow all the rules. Who knows what the future holds for this particular woman? We’ve all said “I’ll never do whatever” and after time circumstances change. She could be raped (welcome to America) and have that choice taken from her, she could succumb to the charm of freedom and make different life choices. Better to take all possible precautions when entering a new situation. Like birth control, just because you’re on it that doesn’t mean you HAVE to go out and have sex.
@Im a Hedge:
As does someone choosing to enter their child into the school system or become a U.S. citizen. I mentioned that things are different if you find yourself a member of a group by default rather than choice.
I own my house but that doesn’t mean that the police won’t, or shouldn’t, kick in the door if I’m mistreating others within it, or using it. I own my car but I am strictly restricted from doing with it as I will, particularly if I am harming others by doing so. I am also rewquired to maintain it in a condition that it will not harm others during normal use. I can’t have bull bars on the front of my car because, although removing them slightly increases the risk to me, it greatly reduces the risk to pedestrians and other vehicle drivers.
As a disclaimer I should point out that, as a grad student the above were examples and I do not in fact own anything but some clothes and a computer. Actually on that point, my computer is my own, but I must have adequate virus protection software to connect it to the university network. The risk is not just mine and I don’t have the ‘right’ to increase the vulnerability of everyone else by failing to take care of my own.
The first question in the AI is whether there should be additional requirements for immigrants, not the same requirements.
I am a Hedge
@spellwight:
Ha. I’ve never said that. And I never will.
I am a Hedge
@neverclear5:
God damn it.
@Im a Hedge:
I say that all the time.
The indecision is killing me.
@neverclear5:
For the record, just because police do something doesn’t mean it is just. Police do many unjust things, and this fact should not be used to rationalize additional injustices.
But you didn’t say that. You said they should kick down your door, not just that they do. I would agree that they should, when you are actually committing a crime (i.e. actively violating someone else’s rights). What if the police decided you are the type of person that might be abusing someone in your house. Would it be right for them to break down your door and search your house? Even more effective than these labor-intensive door kickings would be to require every home to be equipped with surveillance equipment that can be monitored from the police station. This would be likely to have a great impact on domestic crime. Would that be a justifiable violation of your rights?
It is not just to violate someone’s rights because you think they might do something in the future that inadvertently harms someone else. It’s conceivable that the potential for harm, and the level of harm, would be sufficient to outweigh this concern. It is my opinion that that is a very high standard to meet, and that the default position is to affirm the rights of the individual.
I hope you will still consider my earlier question about whether you own yourself. I am not trying to pull a rhetorical trick on you with this. I won’t try to demand a response from you, or anything like that.. I just think it’s a valuable perspective from which to consider many questions, including the ones we are covering here.
I am a Hedge
@exarch:
“No, that’s not what I said. The vaccine IS 100% effective at preventing whatever strains of HPV they’re targetting. For the rest of your life.”
We don’t know that. Even the doctors admit they don’t know how long the vaccines will work. When my children were young measles, mumps etc vaccinations were supposed to be “forever” but when my daughter was working in childcare a few years back she was required to get boosters because her immunity had faded.
It’s very naive of her to assume that no man could ever rape her or even to assume that her husband will be perfectly faithful throughout the marriage and will be as “pure” as she is when he enters the marriage. It’s sad that some women could end up with cancer because they didn’t prepare for the worst case.
However, even though I think she should choose the vaccine and is naive to refuse it, I don’t think that vaccines should be mandatory for immigrants if they are not mandatory for citizens.
I might have missed it, but has anyone brought up the refusal of vaccines because of religious reasons? Such as the Christian Scientists who refuse to go to the doctor etc? They are citizens right? This girl didn’t fall back on a religion to keep her from the shot, she is falling back on the “I don’t want to be treated differently than my classmates.†But she IS different… she ISN’T a citizen…
(Side note, if the US health reform bill passes saying that all Americans have to have insurance, will this affect the people who refuse to have anything to do with medical practices?)
@Im a Hedge:
The house example was simply to point out that ownership does not imply complete freedom of use. Of course the situations you laid out are unacceptable misuse of police power, and in fact my own country is getting worryingly comfortable with massive CCTV deployment. I do agree that you own your own body which I perhaps didn’t make completely clear.
I’d like to bring you back to the computer example though. If I wish to connect to the university system and gain the benifits of doing so I must get virus protection, so as not to put others at risk. That is what I am proposing here. The same with the bullbars on a car. I don’t think that a negligable risk to myself outweighs a significant risk to the general populous from loss of herd immunity. Pinning people down and injecting them is also not what I proposed (which I realise you didn’t say), rather if you wish to join a group, such as the puplic school class or U.S. citizenry, you must get the neccessary virus protection. If you wish to be selfish (a general ‘you’, not meant to be you in particular) then you have every right to do so, and will be denied admission.
As an englishman my national passtime calls to me, so I may be down the pub by the time you reply but I’ve found this discussion interesting and will happily continue it tomorrow if you wish.
Some states require blood tests for syphilis before issuing a marriage license. Indiana requires serological tests for rubella or proof of vaccination for rubella for women under 50 (or proof of sterility).
I got an email from the Health Freedom Alliance today. One of the articles contained a video from a woman claiming that the California military and police are training to intern people who refuse the H1N1 vaccine. Those that DO get the vaccine will supposedly be fitted with an RFID bracelet.
Yeah, I know. Sounds like total whack-jobbery to me, too. But since we’ve been talking about mandatory vaccinations, I thought I’d throw this in just to get comments.
http://bit.ly/3xgDdH
@neverclear5:
Sorry, I neglected to deal with your computer and bullbars examples. (I’ve never heard of bullbars, but I think I get the gist from your context). Before I go into it, I want to be sure were not ping-ponging on the two different questions. There’s the question on whether immigrants should be treated differently from citizens. Then there’s the separate question about whether vaccines should be mandatory for everyone.
For the immigrant issue, I agree that placing additional requirements on immigrants can be minimally justified for the reasons that you, and others in the thread, have given. Specifically, someone can choose not to come to the country, or not to become a citizen. I still don’t think it’s a good idea. The same way I think a store owner can minimally justify not selling to short people (after all, it’s a voluntary exchange on both sides, so either party can freely refuse to participate for whatever reason), but I think it’s a bad idea for a store owner to do so. In a addition to harming the store owners profits, it is distasteful for other, probably obvious, reasons. The US government can require whatever it decides to require, and potential immigrants can take it or leave it. I want to see a reasonable standard applied to determine what those requirements should be. I don’t think mandatory vaccination for immigrants, when that vaccination is not mandatory for native citizens is a reasonable requirement.
I’m not sure if you mean your computer and bullbar examples to be for the immigrant question or for the more general question. WIth the computer network, you are required to take certain precautions as a precondition of using the network. You don’t have a prior right to use the network, so there is no problem with imposing the requirement. It also seems to me to be a reasonable requirement. I’m not aware of any additional risk that you incur by installing virus protection software.
The car example is a bit more dicey, I think. Here I will assume similarity with the US, and you may correct me if my assumptions are false. You can argue that use of the roads is voluntary, and that it is only when using the roads that the restrictions apply. The problem with that argument is that the State has a de facto monopoly on roads. For almost everyone it is simply not feasible to choose not to use the roads. The main distinction I see between this and the mandatory vaccine issue is that in one case you are forbidden to take some positive action (installing the bullbars), while in the other you are required to take some positive action (get vaccinated). I’m not sure how much significance I care to give to that distinction.
I think the real issue in both cases is how much additional risk can you be required to assume for the sake of some amount of decrease in someone else’s risk. I need to think about this some more.
Likewise. I’ve enjoyed this thread. Thanks for providing more perspectives and giving me something to think about.
I am a Hedge
@Im a Hedge:
“I’m not aware of any additional risk that you incur by installing virus protection software.”
Actually, I think the virus protection software is the perfect simili for vaccinations. It essentially does exactly the same, and the risks are probably alike as far as the odds go.
So 99,99% of the time, people just install their anti-virus application, and everything works fine.
But as with everything concerning computers, there’s always a chance of some unexpected stuff happening. Other software malfunctioning, Windows freezing up and giving you BSOD.
And that’s just when things go badly wrong. Virus scanning software does put an extra burden on the system. It may be running in the background, practically invisible, but it’s still costing you some processing power to run it, and it needs to launch during startup, wich also takes extra time.
And if it’s been a while since you used your computer, your AV-app wants to get updates as soon as possible, and scan your system, etc…
All in all, these are some of the more reasonable explanations as to why people might opt to not install AV-software on their system and use other ways of protecting it from infection.
And then we haven’t even gotten to the loonie conspiracists who may think the software has hidden spy-ware that’s going to harvest all your personal info and send it to … whoever they think is in charge of the planet or something.
So while you could keep these folks off the university intranet, they’re already all over the world wide web, their computers being used as bots to spam people’s mailboxes and crash websites with denial of service attacks.
Mandatory vaccination? Think about it …
@Im a Hedge:
“You said they should kick down your door, not just that they do. I would agree that they should, when you are actually committing a crime (i.e. actively violating someone else’s rights). What if the police decided you are the type of person that might be abusing someone in your house. Would it be right for them to break down your door and search your house? Even more effective than these labor-intensive door kickings would be to require every home to be equipped with surveillance equipment that can be monitored from the police station. This would be likely to have a great impact on domestic crime. Would that be a justifiable violation of your rights?”
Hey Im a Hedge, since you like putting all the gradations of the grayscale on the table, I’ll offer you one for consideration:
You obviously think vaccines shouldn’t be mandatory, or at least not the ones we have now. But I’m sure there are some which you’d probably agree should be mandatory, like, say, if there was a vaccine against AIDS, or cancer. Or perhaps some other disease we haven’t encountered yet but ravages the earths human population in a global pandemic. Essentially a situation where it becomes safer to the human race to just lock up or shoot a person who doesn’t want to be innoculated rather than allowing them to roam freely.
Or what about a disease that causes a birth defect which yields offspring that is effectively sterile? Another disease that, when left unchecked, could mean the end of the human race. Or perhaps the offspring can survive but needs lots of special care to survive.
What if a woman can’t have the vaccine administered any more the moment she’s pregnant, but she can still catch the disease and pass on the birth defect.
I’m sure nobody’s suggesting people HAVE TO BE innoculated against every little inconvenience that plagues us, but some vaccines are perfectly safe and the diseases they protect against place a significant enough burden on the rest of the population to consder making them mandatory.
Where would you draw the line?
@Im a Hedge:
Bullbars are what we call the big heavy metal bars sometimes fitted over the top of the front of a 4×4. In countries with large animals roaming about they mean that if you hit one on the road you’re much less likely to incur serious damage to the car. They were outlawed here as, in an english town they provided, at best, a slight advantage to the driver in a collision while being very dangerous to the driver in the other car and ridiculously so for pedestrians that get hit.
To clarify my positions, I think everybody should be vaccinated against everything they can be. I think that where it’s possible to compel people to do so, such as when entering the school system, it should be done. I think that when immigrants arrive they provide an opportunity to insist that they take all the measures we wish we could get everyone else to take so, yes, I do think it’s okay to have different requirements, so long as they are the requirements we would implement nationwide if we could.
Exactly my thoughts. I think the reasonable standard should be used to devise the recommendations for current citizens, and those applying for citizenship should have to comply with those recommendations as requirements.
I didn’t intend to use this as you’ve laid it out. Sorry If I was confusing.
I really don’t think this is the same thing. Denying voluntary membership of a group due to actual risk increase of doing so really doesn’t equate to denying service in a retail outlet without logical reason.
Exarch has mentioned a few problems which may arise. I feel that this example is apt whenever the risk or cost of taking the preventative action is small enough to be negligable on an individual level.
Overall I would say that my answers to the questions originally posed are that upon finding oneself a member of a group by default (i.e. being born a U.S. citizen) then one should not be forced into anything. I would then say that if you then wish to gain the benefits of membership of that group you must do your best to ensure that you do not damage the group by doing so. Thus, entry to the school system or anything of the sort can be denied if you do not do this. If you wish to join a group then I think it is reasonable to demand that the recommendations for those who find themselves in the group without choice, become requirements for entry. The stipulation for both of these points is that the recommendations/requirements are rationally determined and reasonable with regard to the risk/benefit of each.
Whether this stipulation has been met in each individual case is a whole other discussion.
With the computer virus example, it’s a voluntary arrangement. You choose to use the university network, and there are requirements that accompany that agreement. Simply existing is not in the same class of voluntary arrangements. I don’t see how you acquire obligations to (potentially) harm yourself simply as a result of existing.
Computer viruses and virus protection software may be a good analogy for pathogens and vaccines, but it’s not a good analogy for the ethical considerations.
A reason I find these issues (not just this issue, but many issues) to get difficult is that there are two competing approaches to ethical questions. One is a utilitarian approach, that attempts to maximize total benefits and minimize total harm. The other is a rights-based approach, that attempts to minimize violations of the rights of individuals. There are other approaches, but I see these two as dominating for most people. Most people tend to take one of these as their default position, and only switch to the other in extreme cases. Many of our disagreements come down to which of these approaches we prefer, and where we draw the line for switching from one to another.
I tend to start with the rights-based approach. I think we have to recognize that either approach has limits. If you take the rights approach to an extreme, you would end up supporting something like personal ownership of nuclear weapons. Surely there’s some point prior to this where one has to agree that the rights of the individual must be violated. If you take the utilitarian approach to an extreme, you would end up supporting something like slavery (as long as the slave population is significantly smaller than the non-slave population). Again, there must be some point prior to this where we agree that the good-of-the many must take a back seat.
In some of the thought-experiment examples given by @exarch, I would agree that the line has been crossed, and that a forced vaccination program would be better than the alternative. I don’t think we currently face anything closely approaching those scenarios, and I don’t think we are likely to at any time. The reason I don’t think we’ll get to that point is that a situation similar to those described would result in very high rates of voluntary vaccination. The minority that refuses to be vaccinated would likely be too small to be decisive.
I’ll see if I can give a pretty clear summary of my response. There are conceivable circumstances in which mandatory vaccination would be the less-bad choice. I do not think these circumstances will actually arise, but it is possible. As things are now, I think mandatory vaccination is not justified. We are nowhere near the conditions that would justify violating the right of the individual to determine what to do with their body.
I am a Hedge
I’m late answering this question, but it’s an easy one for me. It doesn’t matter the relative merits of vaccinations. If we’re not going to make it mandatory for our own citizens, we should not make it mandatory for immigrants. Leaving aside the fairness issue, it doesn’t help to immunize legal immigrants if we don’t immunize our own people, any illegals we catch or visitors.
As to whether we should make vaccinations mandatory for our citizens, no. As much as I like the idea of stamping out certain diseases, it is a freedom issue, and we have to take the good with the bad.
For the same reason I am against the rabid security checkpoints in airports and against rounding up everyone who speaks out against the government. Will it make the country safer? There are valid arguments that say ‘yes’. Should we, as a people do it? Absolutely not. It’s not about making us as safe as possible. It’s about us making our lives better. There IS a tradeoff between security and freedom. We like to err on the side of freedom. I think that’s a good thing, even if it makes us a tad more unsecure. This is what was lost after 9/11. We need to get it back.
I apologize for preaching a little, but that’s how I feel.
@Im a Hedge:
I think you’ve summed our positions up fairly well there. I would point out that I said those who find themselves in a group without choosing don’t get forced to vaccinate and only those looking to join things like schools or countries would be required to do so. I didn’t say what you seem to be implying below
I said that the obligations begin when you start making, as you put it, voluntary arrangements.
Anyway, interesting discussion. I’m sure there will be more.
@neverclear5:
Sorry if I misrepresented you. I trust you will accept that I did not intend to.
Things get messy when there are some semi-voluntary things. Strictly speaking, using the public streets is voluntary. However, in practice, it is essentially impossible to avoid it. This is partly brought about by the de facto monopoly that governments have on roads. This is why it is generally viewed as not acceptable for the police to randomly stop and search vehicles with no cause, even though you could avoid using the roads.
In the US, school attendance is typically compulsory. The homeschooling movement has produced some significant changes in this, and it is becoming easier in most places to decline the opportunity for public schooling. It is still the default position that children at a certain age must attend school. So any requirements imposed on students are in some grey area between strictly voluntary and mandatory.
I am a Hedge
I suppose the difference between rights and privileges is about to rear its head.
Using the road is a right. Using a car on the road is a privilege. You need to at least at some point have shown your ability to safely navigate a vehicle an those roads, and you get a drivers license as proof that you passed that test.
While you can’t force people not to use the roads unless …
You can in fact force them not to use their cars unless …
There are alternatives to cars available.
The same applies to US citizenship. It is a privileged status that itself comes with additional privileges. You don’t HAVE to be a citizen to live here, but you can add some requirements (like a test) to become one. A test that many US-born people never have to take (and lots would apparently fail if they did). One of those privileges is healthcare, so it stands to reason that the government tries to minimize the impact of new immigrants on this system by not allowing people into it who’d potentially draw more out of the system than they would put in. That by no means implies that every immigrant is going to leech, but at least the vaccination shows some willingness to not do so.
@exarch:
Fair enough.
Would you agree that an applicant for citizenship can avoid the vaccine requirement if they also decline the privilege of health care at the public expense?
I am a Hedge
Of course she shouldn’t be required to get the vaccine.
However there is a MOUNTAIN of evidence that she likely won’t be abstaining from sex until marriage, despite her religion-fueled teenage delusions. She’ll just feel guiltier about it, and be more likely to forsake protection in her haste to get the sin over with.
@Im a Hedge:
“Would you agree that an applicant for citizenship can avoid the vaccine requirement if they also decline the privilege of health care at the public expense?”
It’s a possibility. But the applicant’s burden on the system is not just his own, but also that of the other people s/he might potentially infect if/when getting sick. People who could not be vaccinated for medical reasons. Or US citizens who declined nopt to be vaccinated because they weren’t required. Etc…
And out goes the herd immunity …
Like any social contract, it only works if everyone sticks to it. The moment somebody decides they’ll take advantage of everyone else because they can, and because everyone else wasn’t expecting it, then everyone else loses.