Self-Determination versus Public Health

Thursday, June 10, 2010
I believe that vaccines are the single greatest medical breakthrough of the last century. They are singularly responsible for the eradication of smallpox, and have prevented the death of hundreds of millions of people world-wide since they went into widespread use.

I firmly believe that those who believe that autism is caused by immunizations are willfully stupid in their belief system. The evidence - the scientific evidence - is absolutely clear regarding the lack of a causal relationship between vaccines and autism. The recent disgrace of that fucktard Andrew Wakefield, and the constant strategy of "moving the goalpost" by the anti-vax movement makes me sick to my stomach. It makes me sick because it results in avoidable sickness and even death in those who count on the adults in their communities to make informed and defensible decisions surrounding public health. As adults, we have an obligation to EXAMINE THE EVIDENCE, and make our decisions based on reality rather than wishful thinking or a desire to "find someone to blame" for our troubles.

I absolutely believe that people who choose not to vaccinate their children because "diphtheria hasn't been prevalent in the United States so I shouldn't have to immunize my child" are criminally stupid. Apparently these yahoos have no idea that people who may be asymptomatic may travel to the United States and actually infect their children. Which, because of their fuckwitted ignorance surrounding "herd immunity and their own complete lack of obligation to their community, will subsequently spread COMPLETELY PREVENTABLE DISEASE through the population like wildfire.

Public health matters. Providing herd immunity through vaccination thresholds protects all members of the community, and I believe informed, educated people should be maintaining their children's immunizations as well as their own. The reason I believe that is because I think we ALL have an obligation to manage preventable disease, and that includes administering vaccinations to our children for the good of the group.

I watched a Frontline special on vaccination the other day while on the Evil Machine of Torture. In it, parents explained their desire to "protect their children" from the risk associated with vaccines. These parents made it pretty damn clear that they thought it was perfectly okay for their kids to skip the risk associated with getting vaccinations, but they were also perfectly happy with their kids enjoying the herd immunity associated with living in a 1st World community. I'm not talking about kids who cannot be immunized due to immune deficiencies and such - I'm talking about people who choose not to expose their children to the risks of immunization, even though they're perfectly healthy. I cannot tell you how reprehensible I find this attitude. It's okay for me to expose MY kids to the (albeit small) risk of vaccination for the good of public health, but it's not okay for YOU to do so, provided you get the benefit?

You can fuck right off with that attitude. Right after I punch you in the throat.

And yet...and yet.

Tax-and-spend liberal that I am, I still place enormous value on self-determination. I believe people should have the right to make their own decisions regarding their health care (or lack of it), and a civilized society should not be permitted to force people to accept health decisions made by the state.

And yet...and yet.

Children are different. Children who have lost the genetic lottery by being born to nutbar parents should have the right to be protected from crazed and irrational ideas that negatively affect their health. In my opinion, that includes vaccination for those children whose health permits it.

So it appears that in spite of my small "L" libertarian, self-deterministic leanings, I do believe in mandatory vaccination for children, even when their parents don't agree with that decision. Our public health depends on it, and I'd rather abrogate the rights of parents on this issue (with adequate safety precautions) than see a resurgence of polio. Hard decision, to be sure, but it sure beats the alternative.

29 comments:

Eric said...

I agree, Janiece.

The old saying is, "Your rights end where mine begin." You don't have a right to tell lies injurious to my reputation, drive like a maniac on a public street I might be using, to randomly fire your gun in the vicinity of my front yard, to walk in my front door and help yourself to whatever's in my refrigerator. It's not a stretch to say that you don't have a right to seriously endanger my health even if it poses a small risk or inconvenience to your own. If it's a consolation, there are things I'm legally or morally required to do for your sake that might make slightly diminish my personal wellbeing for the greater good--indeed, they're largely the same duties and obligations you owe me.

Warner (aka ntsc) said...

I wasn't very old at the time, perhaps 9, but there were no permission slips when polio shots were given at school. It was a flat, get the shot or don't go to public school. (The only private school in the area had the same policy and sent it's kids to the public school that day.)

Since my mother was one of the people giving the shots, it was moot in my case.

neurondoc said...

I. Will. Not. Join. In.

I will not start up my usual foaming at the mouth anti-anti-vaxxer rants. I will not. (Actually I won't because I am behind on something at work, so I don't have time right now.)

But, Janiece, you are welcome to carry on, carrying a bazooka and blow all of their fuckwad arguments. I've got your back mentally at least.

::goes back to work thinking "rassafrassin' dickheaded morons"::

Phiala said...

I agree with all of you.

And most of all with neurondoc.

Janiece said...

One of the things that really resonated with me when I was watching the Frontline special was the assertion by one of the vaccine defenders that one of the reasons the anti-vax folks are so vociferous (and ignorant) is that vaccines are the victims of their own success.

People in my generation have never seen cases of polio, and smallpox, and diptheria. Instead of looking at the historical record and making a decision based on the evidence, they committing the logical fallacy of extrapolating their own personal experience to the larger world, completely ignoring the fact that the reason they've never seen smallpox, or polio, or diptheria is because everyone in our generation was vaccinated.

I'm not sure how you overcome that kind of willful ignorance, and it's completely unrelated to the artificial controversy regarding autism.

neurondoc said...

I can't help myself. I must comment.

Janiece -- dingdingding! I graduated medical school in the early 90's and I have never seen smallpox, diphtheria, mumps, tetanus, or acute polio. I have seen one case of acute maasles. As I have mentioned before, I have seen 2 cases of subacute sclerosing panencephalitis. I would prefer never to see another. I am not sure I would even recognize chicken pox at this point.

This is not an issue of individual health; it is an issue of public health. VACCINES WORK! They do their job! But they only continue to work when people (adults and children) continue to get vaccinated. People who choose not to get themselves or their children vaccinated (as opposed to being unable to get vaccinated for medical reason) put many more people at risk than themselves.

Foam, foam, foam...

Janiece said...

Neurondoc, I'm sorry to get you wrapped around the axle this fine Thursday. I, too, feel strongly about this, and I hadn't talked about it in a while. The recent disgrace of Andrew "I kill kids for money" Wakefield inspired me.

The ultimate irony: Wakefield was probably vaccinated, and protected thereby.

Go figure.

Eric said...

I agree with you (again!) Janiece that anti-vaxxers wouldn't exist if our generation had more experience with seeing victims of polio and other illnesses, or even things as simple as public pool closings, quarrantines and other similar measures that were still facts of life even a generation ago.

But I also think the more fundamental proud historical ignorance that plagues Americans is also a factor. Knowing what polio looked like then and now is as simple as a Google Image Search for the word "polio" (and you may not want to click that link, though there's certainly a moral argument that every human being should; at any rate, I've warned you). You don't have to know a polio victim firsthand to be aware that it was historically a blight, and most educated people (including everyone here, I think) knows that polio was awful. True, it's more intimate and personal if you've met an older family member who was crippled by a mild exposure or have heard family stories of family members who were stricken or killed by the disease, and more personal still to have lived through an epidemic; but how uninformed do you have to be to not know of the disease's ravages and the miracle of near-eradication from history books, if nothing else?

Ignorant enough to take medical advice from a former nude model turned cable-TV hostess instead of a physician, I guess.

Americans are appallingly ignorant of history and science in general, would be my point, and vaccine-ignorance is in some ways merely yet-another-symptom of this sad fact.

Janiece said...

Ignorant enough to take medical advice from a former nude model turned cable-TV hostess instead of a physician, I guess.

Ba-ZINGA. Amen, brother.

Phiala said...


Americans are appallingly ignorant of history and science in general, would be my point, and vaccine-ignorance is in some ways merely yet-another-symptom of this sad fact.


That.

It doesn't shape my opinions on the antivaxxers, except perhaps to think them even stupider than I would otherwise, but my father had a mild case of polio as a child and is both crippled and subject to possibly-related long-term health effects.

Warner (aka ntsc) said...

My older brother had polio, I had many of the childhood diseases neuron doc mentions. Most, if not all of my classmates did. And the small pox vaccine of the time left a dime sized scar on my right arm that is still visible.

You can bet mine got vaccinated.

Janiece said...

Warner, I don't recall anyone in my family having those diseases, but me (and my own kids) were fully vaccinated.

Quite frankly, it never occured to me not to vaccinate my kids. When the manufactured controversy that is the imaginary vaccine/autism link became prevelent, I did MORE research, and I feel even more strongly about it now.

Random Michelle K said...

I feel like I'm jumping on the bandwagon here, but I think Eric answered your question the best in his first comment.

Just as your right to swing your fist ends at my nose, so does your right to do as you like with your body end when those actions affect others.

You can drink as much as you want, but you cannot drive after drinking because you place the life and health of others at risk.

You don't wanna get vaccinated? Fine. But you don't get to enter public spaces--ever. No schools, no parks, no grocery stores.

Janiece said...

I like Michelle's solution - no public exposure. Hard to enforce, to be sure, but I LIKE IT.

WendyB_09 said...

My grandmother had polio as a child, and for her entire life walked with a marked limp because one leg was smaller & shorter than the other. She had to buy 2 pairs of shoes in order to make a pair of shoes she could wear. They had to be heavy, sturdy shoes, she preferred various colors of classic saddle shoes.

She was one of the lucky ones.

I remember getting all my shots, mostly at our family doctor's office, but a couple through the school. Didn't start getting oral boosters until at least jr. high. Unfortunately, my bother & I had rip-roaring cases of both kinds of measles AND chicken pox well before the vaccines came out. We still have visible scars from then.

On the other hand, neither of us ever had mumps. Our doctor called all his patients as soon as the mumps vaccine got to his office and we all trooped in to get shot. I think those did have oral boosters and we got dosed at the appropriate times.

If I had children, they would have followed the same drill... shot or oral or whatever dose to protect them.

I equate failure to protect your child from preventable things child abuse.

mom in northern said...

I am of the generation who lived through the polio out breaks…Had the mumps and the chicken pox and the measles…I am deaf in on ear due to the measles and because I had the chicken pox I run the risk of getting shingle…except I sprung for the vaccination against that plague….very expensive too by the way. I can tell you that as soon as the polio serum became available my Mom made sure all of us got it. At that time the gov’t picked up the check…it was all about public health and not cost…

John the Scientist said...

Michelle's solution would not be hard to implement. An "anti-vax fucking moron" tattoo on the forehead would do nicely.

Eric said...

Michelle's solution would not be hard to implement. An "anti-vax fucking moron" tattoo on the forehead would do nicely.

Especially if the tattoo needle just happened to "somehow" get dipped in polio vaccine.... :D

nzforme said...

I can't approach this from any perspective other than a legal one. From which I raise two hypothetical questions:

1. Would your position be different if someone chose not to vaccinate out of religious reasons rather than stupidity?

and

2. If vaccinations are mandatory as a public health measure, should the public pick up the tab for those unlucky few who do suffer unfortunate reactions to the vaccines?

Janiece said...

nzforme, those are both excellent questions, and deserve thoughtful answers.

1. I do not believe religious exemptions should be permitted. The end result of an infected community is the same regardless of the reasons for failure to vaccinate. While I recognize my own bias on this score as a non-theist, the yardstick provided by Eric still applies - their religious rights end where my right not to be exposed to deadly pathogens due to their belief begins. If a religious community wants to indulge in strict isolationism in order to support their beliefs without endangering others, then I have no issue. But if a member of that community wants access to the larger society, then they should be forced to submit to the vaccination schedule.

2. Yes. Not only should the government provide the support you describe (as they do today, through the vaccine court), the government should also pick up the tab for the vaccines themselves if getting them is a mandatory public health measure.

Juan Federico said...

I'm having a stupid attack. It's 4Am and I'm hard at work on some servers God Knows Where. But What's with the no public exposure thing? I mean we get vaccinated right? My family and I certainly are. No public exposure...hmm...Funny Hats, Armbands and maybe some Concentration Camps might be in order next, hey? Oh and let's base the isolation of these people on religion too. Since we all know that religious people are the craziest humans of them all, hey? Freedom of Religion, Freedom of Speech, let's just dump it. Who needs it anyway?
Well back to my real problem of the day.

John the Scientist said...

Juan, vaccination is not an on or off thing. Most vaccinations have a "take" rate of 80 - 90%. That menas that the 10 - 20% of people for whom the vaccine is ineffective rely on the other 80 - 90% being immune and not getting the disease. Add to that people who have diseases that prevent them from getting vaccinated. Then think about booster schedules. They make those so that most people are still covered, but not all are. Then the 10 - 20% non-covered but vacinated figure starts creeping up to 15 - 25%.

You've been vaccinated, but do you know if you're covered? How lucky do you feel today? Do you want me to roll you around in some pertussis germs and do the experiment to find out? I thought not.

Every idiot who does not get vaccinated is lowering the immunity of the herd. And those who are vaccinated but not covered (for whatever reason) are then put at risk.

Janiece said...

Juan, involuntarily quarantining someone for willfully posing a public health risk is not the moral equivalent of an internment camp.

You know better.

Juan Federico said...

"Never tell me the odds!" - Han Solo Giving me 1 in 5 to 1 in 10 that I can still get some serious funk after I've been immunized valdates my stance. That comment implies risks. Risks, I understand. You know that
entire species have been wiped out by carelessness, by design or by chance. Why should humanity be different? I know people and, my knowledge of history isn't horribly shabby. It would take much, remember the Avian Flu thing awhile back? Sheesh what a show! We were just a step or two from getting the planet locked down. Crap. I'm rambling. Basically, let those who want shots take them and, those that don't not. It's evolution at work my friends. "Bring out your dead! Bring out your dead!" - Monty Python

Janiece said...

Juan, it's a good thing I care about you for other reasons. Because such willful ignorance would be fighting words for almost anyone else.

The error in your assumption is that those who get immunized are less likely to get Darwinized than those do not. Since the issue here is herd immunity versus individual choice, the logical fallacy in your position should be obvious.

When it comes to evolution, humanity ISN'T different - that's the point. As reasoning, intelligent beings, we can decrease the risk associated with communicable disease to our species. Such an ability is in fact one of our competitive advantages, and to suggest we just throw it away for reasons you seem unable to articulate is not an acceptable outcome.

Eric said...

The error in your assumption is that those who get immunized are less likely to get Darwinized than those do not.

Indeed, Juan, Janiece's comment bears reading twice: if you're as aware of history as you say you are, you're aware that one of the worst possible epidemiological threats is the asymptomatic carrier who infects others without suffering many (if any) of the worst effects of her illness (c.f. Typhoid Mary, the most notorious example).

Let's reflect on Darwin a little more deeply for a moment: an infectious agent that kills its host before its descendants can invade another ecological niche (i.e. another host) is, from a Darwinian POV, fairly unsuccessful. E.g. as nightmarish as ebola is, it's actually not that effective a predator, since the virus can burn through a population of hosts faster than hosts outside the population can be exposed. HIV, on the other hand, is an extremely effective virus for a variety of reasons including the perverse fact that it's not always fatal. An HIV carrier can walk around as a viral repository, infecting as many others as she or he can spread bodily fluids to, for decades.

The point being, we should be so lucky as for an anti-vaxxer to be killed quickly by his or her beliefs. A plausible and horrifying scenario, however, is that an anti-vaxxer refuses vaccination, contracts a non-fatal case of some preventable-but-awful disease, and spends days, weeks, months, years or even decades as a Patient Zero everywhere he goes, killing or harming others who haven't been or can't be vaccinated, or whose vaccinations haven't taken (an occasional event, as John says).

Mandatory vaccinations decreases the risks for everyone, not just the person receiving the vaccine.

Juan Federico said...

I really need to take a writing course. you guys are overthinking my simplicity. :)

Really, I'm just barely smarter than a rock.

Janiece said...

Juan, that "aw, shucks, I'm just a dumb Mexican/Indian" persona may work in lowering others expectations of you, but I know better. If you choose to comment here, you must be able to defend your position logically.

Stirring things with a stick (and then walking away) isn't permitted.

The Mechanicky Gal said...

Yeah, Juan.
I'm the Court Jester 'round here.
Step away from my gig!