Year: 2011

Lots of good comments on the previous thread on vaccination. I found one in Megan McArdle’s comments that I found compelling:

It can only affect other people who have also chosen not to be vaccinated. Your choice not to be vaccinated affects only you and other people who have made the same choice. People who choose to be vaccinated are unaffected by your decision.  There is no externality.

Let me being by clarifying that when we’re speaking of mandatory vaccinations in the United States, we’re generally speaking of children, and “mandatory” being a condition of attending public schools. We’re not, to be clear, talking about strapping people to a gurney and making them take their government injection, nor throwing people in jail. I wouldn’t support any measure that went that far.

The issue I have with the above posters line of reasoning is that often, for various reasons, some people are unable to become vaccinated, either because of being very young, or having other health issues that prevent it. Vaccines are also not always effective for every person, and some people tend to lose immunity after a while. Those individuals can successfully free ride off herd immunity in the case where the vast majority of people are vaccinated against the disease. For herd immunity to work, vaccination rates generally have to hit about 95%.

I fully recognize that US vaccination policy represents a loss of personal liberty, and personal autonomy, and I think that’s unfortunate. But I think we are far better off as a civilization that we’ve effectively eliminated the diseases of smallpox and polio, both of which required very substinative efforts to get everyone vaccinated. Here’s an interesting Harvard Law Review article on the history of mandatory vaccination in the United States, along with information about the late debates.

A purely libertarian solution might be to allow someone infected by another who chose not to be vaccinated to recover damages. Unfortunately, the nature of disease is such that, in most cases, that’s not going to be possible to prove. I do think a case can be made that sexually transmitted diseases are distinct from diseases spread through airborne contact and casual contact. The law review article I linked to above gets into that debate. I tend to agree with Megan’s distinction, that if the disease is spread through engagement in normal human activities, there’s not much of a distinction. Diseases like rabies, tetanus, lyme disease, yellow fever, or certain diseases for which animals are a vector, are for your own good, and I don’t believe the government ought to have the power to mandate those.

She takes a look at the whole Gardisil controversy tripped up Rick Perry during the debates. In addition to that she asks whether libertarians can be in favor of mandatory vaccination.

I am not against public health efforts when the behavior of one person puts another at direct physical risk.  You cannot drain your toilet directly into the local water table even if it all happens on your property, and you do not have a right to expose others to tuberculosis.  Similarly with vaccines.  The government does not have a right to mandate vaccination for your own good.  But it does have a right to do so when being unvaccinated is a physical threat to others who engage in normal behavior.

This is one area I wander way off the libertarian reservation on, since I generally understand the requirement that children be vaccinated against communicable diseases before they enroll in public schools. I wouldn’t even, on principle, have an issue with mandatory vaccination in the middle of an outbreak of a communicable disease that was killing large number of people.

So I don’t hold it against Perry that he required the Gardasil vaccine for Texas school children. HPV is a communicable disease, and no matter how much social conservatives fret about it, high school aged, and sometimes even middle school aged kids have sex. The consequences of HPV for women is cervical cancer, which can be quite deadly. This is a disease which is bad enough that our goal, from a public health viewpoint, ought to be its eradication, much like what happened with smallpox. In order to accomplish eradication, everyone has to be immunized.

Libertarians would argue that the state can’t force individuals to subject themselves to even the extremely rare risks posed by the vaccine. In regards to most other subjects, or in regards to diseases that also rarely kill people, or are uncommunicative, I would agree. I would not, for instance, want to see mandatory flu vaccines, unless it was a particularly deadly strain of flu. But when you are potentially heading off a disease that can you could potentially spread to other people, which stands a strong likelihood of killing them, I think the public need outweighs the individual’s sovereignty.

It’s much the same principle that underlies the government’s power to compel military service, which is another area I wander off the libertarian reservation over.