Opinionista Ivo Vegter 16 July 2013

Vaccinations: when the state stabs the people

The question of mandatory childhood vaccinations raises thorny philosophical questions, if you’re inclined to liberty. Does the desirability of “herd immunity” to dangerous diseases justify imposing coercive measures upon parents and their children? Is it just a plot to keep Big Pharma in business? Can a libertarian answer this question any better than a Playboy model?

Some people won’t vaccinate their children because they are religious folk. They hold that their God made them responsible for their children, but that responsibility does not extend to using the brains that same God gave us to save said kid from dying of a preventable disease. Presumably, they also don’t make children wear seat belts, do let them walk on high ledges, don’t feed them from sterilised bottles, do let them play in traffic, and don’t potty train them on water-borne flush toilets.

This group is hard to persuade, because faith is immune, if you’ll excuse the pun, to reason. However, in the Netherlands, where a strictly religious “Bible belt” exists that doesn’t believe in vaccination, the authorities have tried to convince preachers to recommend vaccination to their flocks. This seems a sensible approach, especially when civil disobedience can make mandatory rules ineffective.

Other people won’t vaccinate because they believe a single fraudulent study, and have disbelieved all science since. A sensationalist media and fearful green movement taught them to fear chemicals they don’t understand. Primed, they latched onto an infamous 1998 study published in the medical journal The Lancet by Andrew Wakefield. It didn’t actually find a link between mumps, measles and rubella (MMR) vaccines and autism in children, but he told the media there was a strong case for such a link. Happily, almost every autistic child has at one point or another been vaccinated, so every case can be held up as evidence. After all, only nerds and pedants know what post hoc ergo propter hoc means.

What Wakefield didn’t tell the media was that he was paid £400,000 by the plaintiffs in a class-action lawsuit to provide expert evidence that vaccines had harmed their children. And, as is so common with journalists, few bothered to even read the study, let alone question it, and his inappropriate financial ties.

The notable exception was a lone investigative reporter, Brian Deer of the UK’s Sunday Times, who tackled Wakefield and the journal that published him. It took twelve years, but in 2010, The Lancet retracted the study, and Wakefield was struck off the UK medical register for dishonesty and unethical conduct. For his lone crusade against media sensationalism and the corruption of science, Deer won several journalism awards.

During that time, however, actor Jim Carrey and Playboy model Jenny McCarthy, who have an autistic child, founded a lobby group, Generation Rescue, to spread the word about the supposed dangers of vaccination. Once the tabloid rags screamed their alarmist headlines, with full Hollywood endorsement, the battle was lost. Millions of people stopped believing doctors and scientists, and stopped vaccinating their children.

The upshot was that years of astonishing success with vaccinations were reversed. In the 19th century, it was said that mothers counted their children only after they’d had smallpox. But Edward Jenner’s experiments with cowpox-based vaccines worked, and after a concerted ten-year effort by the World Health Organisation, the disease was declared eradicated in 1980. Rinderpest was similarly wiped out in 2011. Polio is also very rare now, and medical science followed up those successes with great progress against hepatitis A and B, rubella, chickenpox, tetanus, shingles, yellow fever, measles, human papillomavirus (a potential precursor to cervical cancer), Lyme disease, mumps, rotavirus, typhoid fever and tuberculosis.

However, as a consequence of Wakefield’s fraudulent study, MMR vaccination rates declined alarmingly. According to Bill Ahearn, director of research at the New England Centre for Children, the media had a lot to answer for: “The impact of the media’s coverage of this issue has had a significant and detrimental influence. Unfortunately, highly improbable events, extraordinary claims implying a conspiracy, and steadfast beliefs with little support beyond anecdote tend to be given more coverage than sound information based upon empirically valid and peer reviewed research.”

As a result, many diseases are rearing their ugly heads again. Take measles, as just one example. Johannesburg saw an outbreak of this disease in 2009, in which several people died. South Africa is one of 28 African countries that have experienced measles outbreaks this century. Recent cases in Canada and Britain have once again trained the global media spotlight on vaccination, but the real tragedy is on our own doorstep, in developing countries. The south-Asian sub-continent and southern Africa together account for 90% of all the world’s measles deaths in children under five. In Pakistan alone, over 25,000 cases were reported just last month.

Any complex medical issue that involves dozens of diseases, thousands of doctors and millions of people can’t easily be boiled down to a simple rule. However, that a fraudulent quack like Wakefield, his celebrity supporters and his tabloid media enablers can influence public opinion to the extent that he has, is an excellent lesson in the fallibility of public opinion.

The answer, then, is to tell the gullible, the fearful, and the conspiracy theorists to stop their silliness and submit to vaccination programmes that do little or no provable harm, and that do provably work. After all, it is a minor imposition, with very great benefits. Any risks associated with vaccination are far smaller than risks associated with non-vaccination.

But, my libertarian friends might respond, what about the problem that people should not be coerced into subjecting their bodies or those of their children to invasive prodding by the government?

This is a diverting philosophical discussion over a bottle of red, but it is also one of the reasons libertarians so often get painted with the same brush as religious nuts, conspiracy nuts, and health nuts. They’re doing themselves no favours by taking an anti-scientific position, and calling it pro-liberty. If nothing else, they’re undermining their own standing to challenge politicised science that give governments cover to expand their power.

The usual way to dodge the issue is to say that private schools can perfectly legitimately require vaccination, and insurance companies can charge exorbitant premiums to those who do not vaccinate. This would solve the problem. In addition, people can choose not to associate with the non-vaccinated, or even sue them should their recklessness cause disease or even death. True, all this would work, in a totally free world. But if state schools or national healthcare systems were to impose equally sensible measures, it would amount to government coercion again. It seems silly to watch people die of easily preventable diseases while you work on the bigger task of dismantling the tyrannical machinery of the socialist state.

Besides, just like there are sensible laws against reckless behaviour of all sorts when it might place the lives, limbs or property of another at risk, shouldn’t non-vaccination be classed alongside reckless driving or discharging firearms in suburbia?

Mandatory vaccination might be a galling nod to collectivism for those of us who love freedom as a matter of principle, but one can make a perfectly good case for it. If we can argue water-borne sewerage is a technical public good that is better provided collectively, then why can’t we say the same for vaccination, which is so unusually dependent on the compliance of others to achieve the vaunted “herd immunity”?

I’ll grant that libertarian principles make better arguments against vaccination than religion or quackery do, but I’m not at all eager to find myself on the same side of this issue as religious fundamentalists, medical frauds, conspiracy theorists and new-age hippies who clearly don’t know what “homoeopathic” means.

Preventing reckless actions that cause clear harm to others does not contradict any principles of liberty, as far as I know. This, the scientific evidence that it works, and the unusual fact that it can only confer “herd immunity” if as many people as possible are vaccinated, seem like perfectly sound reasons to support mandatory vaccination.

I’m sure you’ll tell me why I’m wrong, but if you don’t vaccinate your kids, I’m going to judge you like you’re still wearing a Power Balance bracelet. DM


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