Why do so many people think vaccines should be voluntary?
Our normally fractious media and political world has reached an item of consensus: vaccines against deadly diseases are good, and kids should get them. As the Disneyland measles outbreak has brought new attention to the issue of vaccine refusal, prominent politicians have been asked to state their views for the record. Most have obliged with unambiguous statements that vaccines—including the MMR shot, which was linked by a totally discredited study to the incidence of autism—are safe and should be universal.
One outlier was Rand Paul, the libertarian senator from Kentucky, who has a tendency to shoot from the hip in just such situations. Paul appeared to give credence to the notion that vaccines have caused “severe mental disorders” and that, in any case, they should be voluntary, not mandated by the government. He concluded with a perhaps unnecessary appeal to principle: “The state doesn't own your children. Parents own the children, and it is an issue of freedom.”
Paul swiftly tugged these comments back a bit, affirming the wisdom of vaccination and distancing himself from the view—again, totally without evidence—that they cause mental disorders. But he didn’t revise his statement that vaccines should be optional.
In this Paul may stand apart from most of his Washington colleagues. But the nation appears to be trending his way. A January YouGov poll drew headlines with its finding that 9 percent of Americans aged 19-29—far more than older generations—believe vaccines “definitely” cause autism. More concerning, however, was the question of whether vaccines should be mandatory. Of those 65 and older, 73 percent said yes; among those 45–64 it was 64 percent. Half of the Gen-Xers agreed. Only 42 percent of the under-30 cohort, however, agreed that vaccinations should be required for all children.
Small sample sizes in the sub-groups should be kept in mind when we draw conclusions, but with that said: what the hell? Is it really possible that well under half of the rising generation—and only half of my own—thinks that a safe, basic, incredibly effective measure that has saved countless lives when practiced widely in a population should be strictly voluntary?
Perhaps this steady decline in pro-vaccination sentiment reflects a deeper decline in trust of public institutions, especially government and the media. Perhaps it reflects a background cultural assumption, more prevalent each decade, that pure optionality is an obvious good—more important, at any rate, than the basic duty of solidarity with fellow humans that is expressed by vaccines and the unlovely phrase “herd immunity.” It may or may not be relevant that people my age and younger have never been encouraged to be part of any herd. It may simply be that the bad science of the vaccine “debate” reached more of us than our elders, and has burrowed into the discursive gopher tunnels more and more of us live in these days.
Whatever the causes of this laissez-faire attitude, it suggests that our public health problems are likely to get worse rather than better. We are increasingly accustomed to the idea of “external costs” in economics—that our actions have costs (and benefits) that fall on other people. But our words and ideas can have external costs, too. That is most obviously true of the assumption that everything possible should be an option rather than a requirement. Vaccinations, like any other measure of social solidarity, depends on an ethic. Getting the science of vaccines right while losing the ethic may prove to be as dangerous as any conspiracy theory.
