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July 19, 2011 / Mark Largent

Public Health Gone Wild

Vaccines. Time for Society to Say Enough is Enough | Risk: Reason and Reality | Big Think.

Smart, well meaning people have done tremendous good for the world.  And tremendous evil.  This recent article on the BigThink blog about vaccines is a perfect example.  David Ropeik, a journalist and an expert on the concept of risk, very forcefully asserts that people who fear vaccines must be somehow coerced into overcoming their concerns and receive (or allow their children to receive) vaccines.  Why?  Because people who are not fully vaccinated are a threat to us all.  Many people – because of particular health reasons or age – cannot be vaccinated.  And even a fully vaccinated person might have weakened immunity because so much time has passed since their vaccination against a particular disease.  So, intentionally unvaccinated people, Ropeik claims, are a danger and should be coerced into receiving the shots.

Ropeik begins by stating that we routinely prevent people from actions that might hurt others – like driving drunk.  It’s true, society does prevent some actions that are especially dangerous to oneself and to others by imposing certain laws.  But the fact is that every day I do dozens of things that may potentially harm or kill others.  Aside from the obvious threat of driving (even perfectly sober drivers are lethal …. last year alone 39,000 Americans died in automobile accidents), I routine serve friends, family, and myself unhealthy foods, I buy products from industries that lead to thousands of deaths worldwide each year, and I plug dozens of electrical devices into outlets supplied by coal fired power plants, which not only kill hundreds of miners every year, but are also pumping tremendous amounts of greenhouse gases into the atmosphere.  Vaccination is only a minor part of the threat I might pose to others.

Perceptions of risk aside, there is another reason why Ropeik is just plain wrong on this issue.  I call it the “White People Shouldn’t Use the N Word” explanation.  Just as the terrible history of slavery and racism in American culture places certain limits on free speech (for example, the use of the N word), the history of medical experimentation, eugenics, and coerced sterilization by Americans on Americans makes any thoughtful person very cautious about violating another person’s bodily autonomy.  Ropeik might be technically right in asserting that everyone who can be vaccinated, should be vaccinated.  But he is horribly wrong in asserting that people should be legally coerced into it by being denied rights or access to public facilities if they don’t vaccinate.  There is more at stake here than health.

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2 Comments

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  1. Daniel Kramer / Jul 25 2011 9:46 am

    Many of the solutions that Ropeik mentions in the article do not strike me as coercion. Was forced sterilization coerced through incentives in the tax code? If this is considered coercion, then the income tax deduction for dependents should also be considered coercion (i.e. no babies, no bucks). I don’t see many people up in arms about the this. You could also argue that the dependents deduction violates a person’s bodily autonomy. Should we categorize the dependents deduction with eugenics and coerced sterilization as well?

    Putting aside the debates over any one particular type of vaccination, there seems to be good economic reasoning to support the solutions that Ropiek mentions. This is an externality. An individual’s decision to not vaccinate has societal costs. Penalties in the tax code could potentially internalize this external cost. On the other had, I don’t see any economic rationale for the dependents deduction.

    What am I missing?

  2. Mark Largent / Jul 25 2011 5:17 pm

    Ropiek is not calling for incentives (as offered by your example of tax breaks for parenthood), he wants to “make them stop.” He’s calling for outright demands for vaccination for all people capable of getting them for all diseases health officials deem appropriate.

    In addition, I think there are a number of problems here:

    First, Ropeik begins strongly, stating that it is time we “regulate the risk created by the fear of vacines,” but then offers solutions that are, at best, either weak or practically impossible (reducing the cost of health insurance for vaccinated people won’t work, nor will limiting access to community facilities for undervaccinated people (sorry sir, you can’t come into the library because you haven’t received your hepatitis B vaccine)).

    Second, Ropeik’s concerns are out of line with actual risk. The number of children who become ill with a vaccine preventable disease in the U.S. is very small and the number of children who die from them is incredibly minute (and dwarfed by accidents (which cause more than a third of childhood deaths)).

    Third, Ropeik’s emphasis on only those parents who assertively choose not to fully vaccinate their kids hides a simple fact: 1% of American parents refuse to vaccinate their children, but on average (across the country and for each mandated vaccine) only about 30% of kids are not vaccinated. Why so few? Most of the unvaccinated kids have fallen through the cracks because they lack adequate health care (no surprise given the problems we have in the U.S. of providing health insurance to citizens). For every one child not vaccinated because a parent chose not to vaccinate him/her, there are 25 unvaccinated kids who lack access to health care or lack a parent capable and willing to vaccinate them.

    Fourth, it’s no longer possible to justify the continual addition of new vaccines on the basis of economics. With the introduction of the vaccine against chicken pox (and continuing with the vaccine against HPV), vaccines are no longer held to an economic standard. Both of those vaccines cost more to create and give than they save in lives, and the public health community admits to that fact.

    And, if all that’s not enough, here’s the kicker: while Ropeik and the other hardline pro-vaccine figures have been calling for every more coercive tools to compel parents to fully vaccinate their children, courts and state legislatures have been moving in the opposite direction (by the way, “fully vaccinated” for a six year old is about 3 dozen shots of 50 vaccines) Over the last decade, legislatures have loosened requirements for parents to receive exemptions for their children and the courts have limited the power of public health officials to compel people to get their vaccines.

    In the U.S., vaccinations are increasingly not a “public good,” they are personal medical decisions. Like obesity, abortion, smoking, nutrition, or drug and alcohol addition, vaccinations are personal medical decisions that have public consequences. Our ability to force people to make the “right decisions” (as technocrats believe them to be), are extremely limited, and rightfully so. Ropeik and other hardliners are trying to be coercive, when they need to be conciliatory.

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