Monday, July 18, 2011

Personal liberties versus public harm

David Ropeik, about whose excellent work on risk perception I have written before, recently offered some additional perspectives on the issue of vaccinations -- making us think about the cost of personal liberties to public harm. He wrote this Op-Ed, entitled, "Public health: Not vaccinated? Not acceptable," in the Los Angeles Times. The subheading is: "What should we do about people who decline vaccination for themselves or their children and put the public at risk by fueling the resurgence of nearly eradicated diseases?"

Here are some excerpts:

What does society do when one person's behavior puts the greater community at risk? We make them stop. We pass laws, or impose economic rules or find some other way to discourage individual behaviors that threaten the greater common good. You don't get to drive drunk. You don't get to smoke in public places. You don't even get to leave your house if you catch some particularly infectious disease.

Then what should we do about people who decline vaccination for themselves or their children and put the public at risk by fueling the resurgence of nearly eradicated diseases? Isn't this the same thing: one person's perception of risk producing behaviors that put others at risk? Of course it is. Isn't it time for society to say we need to regulate the risk created by the fear of vaccines? Yes, it is.

David keys in on examples of the growing threat to public health caused by people worried that vaccines will cause autism and other harms, despite overwhelming evidence to the contrary.

In many places, particularly in affluent, liberal, educated communities . . . unvaccinated people are catching diseases that vaccines can prevent, like measles, whooping cough and meningitis. In 2010, as California suffered its worst whooping cough outbreak in more than 60 years (more than 9,000 cases, 10 infant deaths), Marin County had one of the lowest rates of vaccination statewide and the second-highest rate of whopping cough. A 2008 study in Michigan found that areas with "exemption clusters" of parents who didn't vaccinate their kids were three times more likely to have outbreaks of whooping cough than areas where vaccination rates matched the state average.

He offers the follow ideas for our consideration, "each fraught with pros and cons and details that require careful thought and open democratic discussion:"

• Perhaps it should be harder to opt out of vaccination. (Twenty-one states allow parents to decline vaccination of their children simply for "philosophical" reasons; 48 allow a religious exemption, but few demand documentation from parents to support claims that their faith precludes vaccination.)

• Perhaps there should be higher healthcare and insurance costs for unvaccinated people, or "healthy behavior" discounts for people who do get vaccinated, paid for from what society saves by avoiding the spread of disease.

• There could be restrictions on the community and social activities in which unvaccinated people can participate, like lengthy school trips for kids, etc.

David expands on these thoughts on his blog and in Psychology Today and provides a full context in his most recent book: How Risky Is It, Really?: Why Our Fears Don't Always Match the Facts.


Anonymous said...

Of course in a superficial evaluation, an unvaccinated child is primarily a danger to other unvaccinated children, not the larger vaccinated population. However, although this is not my field, I have read there are other risks such as whether we old people's vaccinations of many years ago will still protect us from disease should these 'old' diseases take hold again. In addition, immunosuppressed contacts and infants may be put at risk.

But I think the larger question is the very poor job we do in this country of educating the public on such public health questions (or ANY health questions). We leave it to the media, which is well known to be largely inaccurate, or to agents with an ulterior agenda - precisely the situation which led to the current vaccine hysteria due to the debunked fraudulent 'study' linking vaccines to autism.

Public health has been long neglected. We need to do better.


GreenLeaves said...

State laws require that children be schooled and yet they will allow people to opt out without providing additional protection to the children that are required to attend. It is understood that no vaccination is 100% effective and that requiring vaccinated and unvaccinated children to occupy the same facilities is inviting problems. Why can we let people opt out without liability for their actions?
My position is that if an adult decides to opt out of a vaccination for their child, which I do believe they have the right to, they also must assume a level of legal liability for their child (negligence) and for other people’s children (civil or criminal). If they do not subscribe to taking responsibility they always have the option of placing their child in a private school of their choosing which accepts unvaccinated children.

Trbobitch said...

If you have been vaccinated, and your children have been vaccinated, how am I putting you at harm by not vaccinating? If you have been vaccinated, you are supposedly not at risk of contracting said disease, so if *I* get the disease, you shouldn't be able to get it from me. Isn't that the entire POINT of vaccines? Besides all of that, you have ZERO right or authority to force medicate me or my children.

Was the government to prescribe to us our medicine and diet, our bodies would be in such keeping as our souls are now. - Thomas Jefferson

Pamela Ressler, MS, RN, HN-BC said...

Thanks for posting David's perspective on vaccinations, Paul. I find it curious that many of the unvaccinated are children of upper middle class, highly educated parents with access to health insurance and quality health care. These are not the underserved populations who often lack access to adequate prevention and treatment measures in our society.

We, in the U.S., have a very short historical memory of the devastating effects of childhood illnesses that once killed or severely disabled children in our country. In the early part of the last century it was common for families to lose multiple children before the age of 5 to illnesses which are now preventable by vaccination. We only need to look as far back as the 1960's, before the MMR vaccine became available in 1969, to see many cases of stillbirths, and babies born with congential birth defects such as growth and mental retardation, malformations of the heart and eyes and profound hearing loss because their mothers were exposed to rubella during their pregnancies.

As David would know better than anyone, our perception of risk is often not based in reality. The trend in witholding childhood vaccinations is certainly an instance where the risk of death or disability from the disease is exponentially greater than the risk of vaccination.

Anonymous said...

Public education of biological processes, including pathogen evolution and transmission is pretty appalling; and the public health 'system' (or lack thereof) should not be confused with the medical industrial complex. In either case, pre-germ theory civil liberty arguments will do nothing protect an unvaccinated child nor the community on whom they are dependent from shifts in viral behavior.

If you want to argue the right to be an entirely selfish player in the social game: consider that the greater threat to parental 'rights' are the scary asexual pathogen parents who are happy to use your child as a larder for rapid reproduction (e.g. ~15 minute generation time for influenza) and evolution. The measles virus smiles at a good fisticuffs for individual rights at the expense of responsibility. Tuberculosis is thrilled that we ignore those our social margins. Cholera loves human disaster, and polio is greatly relieved that religious objection helped it dodge extinction again. In a world rapidly approaching seven billion highly mobile humans - slashed public health budgets, pools of health improvement free-loaders, and seas of neglected poor are just the prime real-estate pathogen families are looking for.

We've enjoyed the fruits of low child mortality so long, we can't imagine what it is like to be unable to fend off predators more powerful than the common cold. Spend one day holding a dying child frozen with tetanus or an infant exhausted by whooping cough. You may not have to travel as far as you think. And I can attest that it is infinitely more horrifying than the school nurse with a needle and laws which protect others from our own poor judgement.

On the lighter side, it's like the cartoon with the doctor who says to his patient, "Do you want to be treated with real science or creation science?"