Should vaccinations be mandatory? A debate in the New York Times

Sunday’s New York Times had one of those “room for debate” features that feature short essays by a group of people on a single topic, but this one is of special interest to science and woo hounds. The topic was “Making vaccination mandatory for all children,” and four people weigh in with divergent opinions. Surprisingly, only one one favors mandatory vaccination for all, and another—the former Surgeon General of the U.S.—favors mandatory vaccination except for those with religious beliefs against vaccination!

My own view is that vaccination is a social good, and there should be no exemptions save medical ones (i.e., people who are ill, immunocompromised, and so on). Vaccinations protect not only the recipient from disease, but also others in society. Even those who are vaccinated could contract a disease from someone unvaccinated for that disease, as vaccinations don’t always “take”. Further, vaccinations are given to babies and children, who lack the capacity to make that decision for themselves. Religious exemptions, in which children go unvaccinated because of their parent’s faith, should not be granted because in that case the good of society, and the right of others not to be injured by your faith-based decisions, trump religious “freedom.”

This is not just a philosophical argument. As the Religon News Service (RNS) reports, there have been epidemics among unvaccinated children—most recently when 25 children were infected with measles because their Texas megachurch frowns on vaccination. And some of those who were infected had been vaccinated, showing that the vaccine doesn’t always protect you—though of course most of the time it does. That provides even more reason to vaccinate everyone, for that reduces the chance of an unvaccinated person encountering one whose vaccination was ineffective.

A quote from the RNS article:

“This is a classic example of how measles is being reintroduced,” said William Schaffner, an infectious disease expert and professor at the Vanderbilt University School of Medicine in Nashville.

The U.S. has had more than twice as many confirmed measles cases this year than all of last year, when there were just 55, according to the CDC. Flare-ups brought on by foreign travel have caused that number to spike as high as 220 measles cases in 2011.

There have been other cases as well, involving other diseases:

New York City also has battled a measles epidemic this year, with at least 58 cases, mostly in close-knit Orthodox Jewish communities. City officials say the outbreak was started by someone who traveled to the United Kingdom which, along with Europe, has suffered large measles outbreaks in recent years. One of the New York children with measles developed pneumonia. Two pregnant women were hospitalized and one suffered a miscarriage, city health officials say.

Other vaccine-preventable diseases also have broken out in recent years, including whooping cough and mumps. Some whooping cough outbreaks have clustered around private schools with lax vaccination requirements, according to CDC studies.

I see no argument in favor of religious exemption for vaccination when the public safety is at risk.

So how do we ensure mandatory vaccination for all? In the U.S., you usually can’t attend public school without a record of vaccination. This is also true for universities, like the University of Chicago, which still grants religious exemptions from its requirement that entering students show proof of vaccination. But that doesn’t work if you go to a private religious school or are home-schooled:

All of the school-age children infected in the Eagle Mountain outbreak were home-schooled, health officials say. Texas requires children be vaccinated before attending school.

One solution is that birth certificates cannot be made official without vaccination, but that has its own problems, since not all vaccinations are given close to the time of birth. What is clear, however, is that the vaccine-autism connection is now conclusively disproven. And anybody who raises that canard is simply wrong:

In an Aug. 15 statement, Eagle Mountain’s [the Texas megachurch mentioned above] pastor, Terri Pearsons, said she still has some reservations about vaccines. “The concerns we have had are primarily with very young children who have family history of autism and with bundling too many immunizations at one time,” she said.

Sadly, only one of the four commenters in the New York Times agrees with me: Kristen Feemster, “a pediatric infectious diseases physician and health services researcher at the Children’s Hospital of Philadelphia and University of Pennsylvania School of Medicine.” She should know, and she pulls no punches in her piece, “Eliminate vaccine exemptions.”

Personal and religious belief exemptions should be curtailed because some people, whether because of age or compromised immune systems, cannot receive vaccines. They depend on those around them to be protected. Vaccines aren’t the only situation in which we are asked to care about our neighbors. Following traffic laws, drug tests at work, paying taxes — these may go against our beliefs and make us bristle, but we ascribe to them because without this shared responsibility, civil society doesn’t work.

Public health is no different.

Indeed. Suppose there was a religion whose tenets were that members didn’t have to obey driving laws. (Yes, I know that’s silly, but some religions prohibit bicycle helmets!). Would we allow that? Of course not, because they’d endanger others. Why is it different with vaccination, especially when the children who don’t get vaccinated aren’t capable of making informed choices? They go unvaccinated as martyrs to their parents’ faith.

A different opinion is expressed by Jennifer Margulis, described as “a fellow at the Schuster Institute at Brandeis University [and] the author of “The Business of Baby.” In her piece, “Parents deserve to have a choice,” she holds “freedom of choice” above public safety:

There is tremendous evidence showing vaccinations prevent childhood diseases. Should public health officials do everything they can to encourage, inform and facilitate childhood vaccinations? Yes. Do they have the right to force parents to vaccinate their children? Absolutely not.

She argues that instead of following the U.S. Center for Disease Control’s schedule for vaccinations, parents should voluntarily adhere to the procedure used in Norway:

An American parent could reasonably decide not to follow the C.D.C.’s current vaccination schedule by choosing to vaccinate on the schedule they use in Norway, which has one of the lowest infant mortality rates in the world. In Norway no childhood vaccinations are routinely given in the first three months of life whereas a 2-month-old American infant has been vaccinated against at least four diseases. At the same time, 99 percent of Norwegian infants are breastfed when they leave the hospital and generous family leave policies facilitate successful (and exclusive) breastfeeding. For an American mom who is exclusively breastfeeding and not putting her child in daycare, following the Norwegian schedule would be a philosophical, evidence-based, demonstrably better choice.

Well, maybe. There is a case to be made that American children may be vaccinated unnecessarily early, but Margulis’s argument is one for delayed vaccination, not no vaccinaton. Still, she wants vaccination to remain elective:

It is a news media-driven misperception that parents who claim philosophical or religious exemptions are uneducated or misinformed. Most parents who individualize the vaccine schedule are actively educating themselves, continually assessing their family’s specific health needs, and doing everything they can to keep their children safe and healthy.

Unlike in the United Arab Emirates [where breastfeeding is mandatory for two years after birth], in America we believe parents are capable of making their own decisions about their children’s health. We believe in freedom of choice. This freedom of choice extends to when — and even whether— parents vaccinate their kids.

Who cares what reasons parents have for refusing to vaccinate their children?  In fact, Margulis is wrong here. There are plenty of anti-vaxers who are misinformed—who think that vaccines are connected to autism. That is not an “evidence-based” decision. Others have religious beliefs against vaccination, which is also not “evidence-based,” since there’s no evidence for a God who abhors vaccinations.  Clearly, many parents are not capable of making good decisions about their children’s health. I’ve written at length on this site about how religious exemptions for child healthcare—and all U.S. states allow some leeway here—have resulted in the horrible deaths of children in religions that refuse medical care (Christian Science, the Jehovah’s Witnesses, some Protestant sects, and so on; see here and here for two of my posts).

There can be no “freedom of choice” when a.) children are involved who aren’t capable of that choice, and b.) the public safety is endangered by adherence to unevidenced religious dogma or the false promulgation of a connection between vaccines and autism. In such cases the rights of society at large trump religion’s “freedom of choice,” just as they would for any religions whose dictates endanger unbelievers or those of other faiths.

The most shameful opinion is that given by former Surgeon General Jocelyn Elders, once the nation’s chief medical officer. In “Religious beliefs are the only valid reason,” she writes:

When you choose not to have your child immunized you’re cheating other kids. Their vaccinations protect your child. Not getting a child immunized is child abuse, even if you’re not using a strap.

The only exemption from immunization should be for religious reasons. If you feel that strongly that immunization is not a good idea, then don’t send you kids to school. Don’t make other children, or your child, suffer.

At least she implies that kids who aren’t immunized shouldn’t go to public school, but of course can still go to religious schools where unvaccinated kids can spread disease. Further, Further, Elders doesn’t explain why religious exemptions are more important than what she calls “child abuse”. Is it okay to abuse your children if it’s done for religious reasons? (That, in fact, is what virtually every state in the U.S. allows. As described in my pieces above, the exemptions given to parents who withhold medical care from children are horrifying, and all of us are responsible for the laws that allow that.)

Finally, two people from England weigh in: David Elliman, “a community pediatrician at Whittington Health in London and the immunization expert for the Royal College of Pediatrics and Children’s Health,” and Helen Bedford, a “senior lecturer in children’s health at University College London Institute of Child Health.” Their argument is basically that compulsory vaccination wouldn’t work, and that Brits largely get vaccinated voluntarily:

Publicity about the dangers of not being vaccinated, and clinics open at times that suited families, were the key. Would things have been different if any form of compulsion had been introduced? It is very unlikely. Even where immunization is generally mandatory, in a free democracy, there has almost always been the provision for parents with conscientious objections to withhold their children from the immunization program. When smallpox vaccination was made compulsory in the 19th century in the United Kingdom, it was the poor who suffered. If they persisted in refusing immunization, they were fined or even sent to jail, for inability to pay.

But the question is, of course whether parents should be allowed to withhold vaccinations because of “conscientious objections“. If they’re too poor to pay, the government can help. Vaccinations are cheap.

It’s time, in fact, for us to reexamine those exemptions. In my view they are absolutely unconscionable: a sop to religion when that tenet of religion endangers children—both inside and outside the faith. If you have any doubts, simply read “When Prayer Fails,” by Shawn Francis Peters, which recounts the horrible deaths experienced by sick children and others from whom medical care is withheld on religious grounds. And read the two posts I linked to above. There is simply no religious right, as Elders notes, to abuse your children.

In the end, Elliman and Bedford turn out to be the medical equivalent of religious accommodationists; they are “vaccine accommodationists”:

In an era when people are less accepting of authority and do not expect to do something because the government says so, trying to enforce immunization may actually make matters worse and create martyrs. Those who have genuine religious objections are unlikely to allow their children to be immunized, whatever the penalty. Parents who are hesitating about their vaccine decision because of concerns over vaccine safety may change their minds if given time and an opportunity to discuss their concerns with a well-informed health professional.

. . . Indeed one might speculate whether some of the vaccine avoidance in the United States is because it is a requirement rather than because of a genuine objection to the vaccines. If parents are coerced into vaccinating their child, it may not only damage their relationship with their health providers, but be counterproductive. Although very vocal, the truly antivaccine parents are in a very small minority. Now would not seem the time to be more coercive.

This reminds me of religious accommodationists who tell scientists to keep quiet about atheism, for that would make the religious more resistant to accepting evolution. There’s no evidence for that, and there’s none for the contention that compulsory vaccination will make people more resistant.

But, even granting Elliman’s and Bedford’s thesis, when is the time to be more coercive? This argument simply seems silly since they provide no evidence that pressure to vaccinate will be counterproductive.

It is time to get rid of every religiously-based exemption from medical care for children. We cannot allow our children to sicken and die on the basis of superstitions. If an adult Jehovah’s Witness wants to die from refusing blood transfusions—and that happens quite a bit—that’s fine: an adult can make an informed decision, silly as it is. But children indoctrinated in faith aren’t in the same boat. And yes, child Jehovah’s Witnesses do die from this indoctrination: read this chilling article about how those dead, transfusion-refusing children are held up by coreligionists as martyrs to the faith, “youths who put God first.” It is disgusting to every civilized person.

When is the time to be more “coercive”? Now. For a single dead child is one too many.

167 Comments

  1. Posted March 25, 2014 at 6:17 am | Permalink

    Anyone interested in starting a new religion with me? Car insurance, waiting in line and paying taxes would all be against our religion so we’d be exempt from them of course

    • Posted March 25, 2014 at 7:40 am | Permalink

      Oooh… Will we be able to run red lights? Having to wait for green is an abomination!

      • Newish Gnu
        Posted March 25, 2014 at 10:26 am | Permalink

        Only if you are red-green color-blind.

        Which, ahem, I am.

  2. Daoud
    Posted March 25, 2014 at 6:18 am | Permalink

    My argument with anti-vax people, particularly mothers, is a brief history lesson in the 99.99+% of all human history where most children died before reaching adulthood. And stating that the anti-vax movement is basically returning the world to a place where most children die, and is this what they (usually a new or expecting mother) want? We (at least in the West), are living in a bubble where almost all children live to adulthood.

    • Daoud
      Posted March 25, 2014 at 6:21 am | Permalink

      Oh, and being Canadian, most of these anti-vax people I meet are less motivated by religion than by “natural childbirth/rearing” type of nonsense. Just have to get through their thick skulls that for humans, “natural childbirth/rearing” = lots of dead children and mothers (during childbirth). That’s nature.

      • gbjames
        Posted March 25, 2014 at 6:35 am | Permalink

        Yes. Lots of western anti-vaxers are not motivated by religion but victims of broken critical-thinking modules. And Andrew Wakefield’s fraud.

        • gbjames
          Posted March 25, 2014 at 6:35 am | Permalink

          and sub

          • Darrin M Carter
            Posted March 25, 2014 at 6:50 am | Permalink

            sub

      • Diana MacPherson
        Posted March 25, 2014 at 9:14 am | Permalink

        Yes and it’s sad really. I have a friend that because of circumstances wasn’t well educated and she was updating her facebook page with what we are eating and vaccinations are causing autism. It is suspected her child has autism. I politely pointed her to the excellent Khan Academy video that goes over blow by blow why Wakefield was discredited. I think I made a difference though I made a smart ass remark on my Facebook page that I just received my MMR vaccination along with pertussis & tetanus so I’ll let everyone know if I get autism and she put a :( in my status.

        • gbjames
          Posted March 25, 2014 at 9:26 am | Permalink

          I suppose it is too much to hope for that she’s just unhappy at the thought of you acquiring autism.

          • Diana MacPherson
            Posted March 25, 2014 at 11:31 am | Permalink

            Could be but I had a LOL after.

      • nlgirl
        Posted March 25, 2014 at 1:18 pm | Permalink

        Here in the Vancouver area (Fraser valley actually) we have had 228 cases of measles due to religious affiliation…never say never.

        • Diana MacPherson
          Posted March 25, 2014 at 3:27 pm | Permalink

          Yep – I link to the Vancouver Sun articles somewhere in this thread, including the one where a reverend told his flock not to vaccinate & leave it up to god.

          Fraser Valley’s vaccination rate, according to the Vancouver Sun, is 60%-70% — way too low for herd immunity.

          • boggy
            Posted March 27, 2014 at 12:21 am | Permalink

            This is the same attitude as the Muslim mullahs in Afghanistan to polio vaccine. It is likely that polio could have been eliminated were it not for this.
            Is there really any difference between the two religions once you boil the bullshit out?

            • Posted March 27, 2014 at 10:58 am | Permalink

              At least statistically, Muslim societies are much more likely to throw acid in the faces of schoolgirls and to wrap women in burlap sacks.

              Theologically, there’s no discernible difference, sure. But practically? As much as I’d ideally like to live in a rationalist society, I’d take a modern Christian society over a modern Muslim one any day.

              Of course, once one looks back in time, there’s no practical difference between Christianity of the Dark Ages and modern Islam, so it’s nothing inherent in either religion. It’s just that today’s Christians are much less Christian and much more Enlightened (as in, “Enlightenment,” c.f.) than today’s Muslims, on average.

              b&

    • Timothy Hughbanks
      Posted March 25, 2014 at 6:28 am | Permalink

      Do you convince any of them?

      • Daoud
        Posted March 25, 2014 at 7:31 am | Permalink

        I hope I’ve sparked a few anti-vax doubts. Since their motivation is not religious but “natural” because “natural is always best for their children”, it should be a bit easier to sway minds. It’s infuriating though. These are people who, if you ask them, only want what is best for their children. Great, then DO WHAT’S BEST FOR YOUR CHILDREN!!!

        • Sastra
          Posted March 25, 2014 at 7:58 am | Permalink

          Technically, belief in a benevolent Nature is a form of supernaturalism and thus a kind of religion. Like other religions, “Benevolent Nature” engenders mental storytelling and conspiracy thinking which immunize the True Believer against both science and reality.

          • darrelle
            Posted March 25, 2014 at 8:53 am | Permalink

            Going in “whole hog” with the Naturalistic Fallacy.

            Defintely in the same woo category as reiki crystals and homeopathy. No evidential standards required and the reasoning is just like theology. Make stuff up and the best sounding just so story becomes popular and is therefore “believed.”

            Also “buyer beware” and “there’s a sucker born every minute.”

  3. Timothy Hughbanks
    Posted March 25, 2014 at 6:27 am | Permalink

    The only exemption from immunization should be for religious reasons. If you feel that strongly that immunization is not a good idea, then don’t send you kids to school. Don’t make other children, or your child, suffer.

    Wow. So a parent can refuse to immunize their child and keep their child out of school for religious reasons? Can they lock the child in a closet? Deprive the child of food?

    • Posted March 25, 2014 at 9:50 am | Permalink

      In many places, beating your child is allowed, which is pretty close.

    • Michael
      Posted March 25, 2014 at 10:56 am | Permalink

      Many states have failed to press charges against parents who failed to provide medical treatment for their children.

      Of course, if they were to charge them then it would infer a states interest and perhaps responsibility to provide medical treatment for the children of poor families.

      On the main topic, I dd a search and found that the anti vaccination crowd has become so effective that 25% of kindergarten children are unvaccinated in British Columbia, Canada.
      I was mortified to learn BC school system don’t require children to be vaccinated and of the two provinces that do require vaccinations, they can be exempted based on conscience or religious grounds (as well as medical), which pretty much makes the requirement moot.

      Imagine if all our laws had exemptions for conscience or religious reasons. It would be anarchy.

      I’m going to ensure my own vaccinations are up to date. I can see this going to a very bad place.

      What frightens me is not just children and adults will die or suffer life long complications from preventable diseases, but the very real chance of these viruses having a large enough population to mutate to a more dangerous organism, like the Spanish flu did.

      Except this time it could mutate and spread over the globe in a few months instead of a year.

      Humans are the prey of very efficient often deadly organisms. The anti vaccine crowd is sticking their fingers in their ears, closing their eyes and pretending these organisms don’t exist or pose us no harm. Eventually they will be proven wrong. I hope the lesson is not too expensive in human life and suffering.

      • tomh
        Posted March 25, 2014 at 11:16 am | Permalink

        @ Michael

        Imagine if all our laws had exemptions for conscience or religious reasons. It would be anarchy.

        Many, if not most, areas of US laws do include religious exemptions. Taxes, land use, civil rights, employment, pensions, copyrights, health and safety, child abuse, these are just some of the laws that include religious exemptions. This does not result in anarchy, it merely results in privileges for the religious that don’t extend to the non-religious.

        • Michael
          Posted March 25, 2014 at 12:05 pm | Permalink

          First, I also said “conscience”, so your comparison does not work. Does the US have laws that allow you to murder people because of “conscience”? I’m not aware of any. Perhaps burglary law exemptions because I hold deep abiding feelings that your stuff should be mine? Shoplifting for God and conscience?

          Second, I believe children dying of treatable illnesses for religious reasons or other reasons is a bad thing. I believe parents not being charged for such neglect is also a bad thing and has moved well beyond religious privilege.

          Third, I stated “all our laws”. Not a subset of copyright laws and or regulations.

          But if you want to live in a society where all laws are optional, your welcome to lobby for that change. I personally think that even the partial religious privilege to be destructive to society.

          You may consider the wrongful death of children to be religious privilege. I consider it to be a fundamental miscarriage of justice and a crime against every member of society.

          But then the US healthcare system allows children to die of treatable illnesses, yes? The only difference is some die of being poor, rather then from having religious parents.

          Finally, one definition of anarchy is a state of lawlessness. If all laws are optional, subject to conscience, then by definition there would be anarchy.

  4. Posted March 25, 2014 at 6:46 am | Permalink

    If you hunt around on anti-vax sites, you will see specific instructions on how to feign religiosity to get around having to have your child vaccinated.

    Allow religious exemptions… say, only for adherents of Ásatrú, and you will see a jump in the numbers of those particularly enlightened individuals, guaranteed. It’s a stupid loophole, nothing more.

    And speaking of the Norse… epidemiology is person, place and time. What works in Norway does not necessarily work in the 3rd-most populous nation on the planet (the USA). Vaccine recommendations, like any other disease control measure, needs evaluation and regular reevaluations in light of the populations involved – who, where, and when. It really doesn’t get any more basic than that. You can all pick up your Jr. Epidemiologist badges now; you’ve graduated. It’s not rocket surgery.

    • Posted March 25, 2014 at 6:52 am | Permalink

      PS – and I’m not at all surprised that a former Surgeon General has an advanced case of cranio-rectal swelling. I’d be only mildly surprised if it was the head of the CDC.

  5. Posted March 25, 2014 at 6:49 am | Permalink

    ‘drug tests at work’
    What a bizarre comparison – unless you are a driver or similar, or operating dangerous equipment, your employer should have no right to check what you do to your own central nervous system.
    If your drug use affects your work, it should be picked up by your boss if it is a problem. Otherwise, none of their business.

    • qlz
      Posted March 25, 2014 at 7:04 am | Permalink

      Completely agree, there is no legitimate rationale behind drug testing at work (except in cases such as you have identified). Similarly, the practice of drug testing welfare recipients that has been proposed in some states, is unreasonable and unconstitutional (4th amendment: unreasonable search), as determined by the recent district court ruling against a Florida law.

    • Kevin
      Posted March 25, 2014 at 10:05 am | Permalink

      I am in favor of legalizing drugs, but if an employer wants to drug test its employees then that should be their right, even if it is a federally run organization.

      • John Scanlon, FCD
        Posted March 25, 2014 at 10:16 am | Permalink

        Because that’s the Libertarian way: the bosses’ freedoms take precedence.

      • Scote
        Posted March 25, 2014 at 10:28 am | Permalink

        Is there anything more personal than your body or more invasive that requiring you to surrender body fluids to an employer?

        Many drug screens require you to urinate in full view of a tester to prevent cheating. Saying that every employer should be free to require suspicionless testing for “drugs” is essentially the same as saying that every employer has the right to look at your genitals whenever they want. If you went to a job interview and the interviewer said “I want to look at your penis and watch you urinate” would you think that is a valid job criteria? I don’t.

        • Kevin
          Posted March 25, 2014 at 11:27 am | Permalink

          Having someone look at my privates while I urinate is actually humorous and if it is demeaning it would be to the voyeur, not me. Still, one does not have to work for those kinds of organizations, but it would be nice if they did the testing based on reasonable suspicion, rather than ‘random’.

          • Scote
            Posted March 25, 2014 at 11:35 am | Permalink

            One thing that would help would be if all suspicionless drug testing policies had to be implemented company wide, starting with top management, under the same “stare at your genitals” testing standards, and the same consequences for results. If there were a law requiring policies to be completely fair in that way I think we’d find almost all suspicionless testing programs were suddenly “no longer needed.”

            • darrelle
              Posted March 25, 2014 at 11:58 am | Permalink

              What a splendid idea.

          • eric
            Posted March 25, 2014 at 12:30 pm | Permalink

            Do you think it would be fair for an employer to drug test only its black employees? Or its female employees? Or its atheist employees? Presumably your answer is no. And to defend that ‘no,’ you’d probably articulate some rational basis or reasoned basis test: the choice of whether to test or not to test must be made on some reasoned basis by the employer. They can’t just arbitrarily test, that infringes on the employee’s constitutional freedoms. Right?

            Well, that same logic applies to employment drug testing as a whole. For most jobs, testing your entire employee pool is just as arbitrary as testing only the black employees, because off-the-job drug use will be unrelated to on-the-job performance. Unless there is some rational basis for thinking off-work drug use will significantly impact on-work performance, employers have no reasoned basis for testing at all.

            And to show I’m not just anti-testing, I’ll defend it in cases where there IS a rational basis. If someone is getting a TS clearance and the government is worried their illegal drug habit may be a potential wedge for blackmail? Okay, be my guest – test’em. You want to test athletes for drugs because perfromance enhancers are illegal? Sure, go for it. Someone is a multi-ton crane operator and you want to breathalyze them before they start swinging a wrecking ball in an urban environment? Absolutely, I’ll defend that.

            But your run of the mill white collar worker? No, there is no rational basis for testing them for off-work drug use.

            • Kevin
              Posted March 25, 2014 at 1:23 pm | Permalink

              I think you’ve hit on the major justifications:

              blackmail/exploitation – one mitigation for employee weakness (as seen from outside) to disclose proprietary, export controlled, or classified information

              safety – pilot, train/boat conductor, WMD operator or coordinator, etc.

              fairness – teenagers on steroids: Is this a competitive edge we want in society?

        • Diana MacPherson
          Posted March 25, 2014 at 11:36 am | Permalink

          That is none of my employers business. Are they worried I’m not getting enough fibre too – should they check that?

          • Posted March 25, 2014 at 12:59 pm | Permalink

            That’s actually an huge problem with employer-sponsored healthcare insurance. Once you open that can of worms, a very reasonable argument could be made for the employer only hiring healthy people and doing all sorts of unreasonable things to continue to hire only healthy people. Drink too much soda and you’re fired; can’t risk having to pay those extra diabetes premiums.

            …which is why I’d favor making it illegal with harsh penalties to offer anything other than strictly-accounted time-for-work pay. No health benefits, no retirement benefits, no company housing; nothing but cash on the barrelhead. Anything else creates an (additional) asymmetrical balance of power between employer and employee. It’s quite common, for example, for people to put up with incredibly abusive situations at work simply because the boss can kill the worker’s children by withholding insurance and thus critical medical care.

            (And, yes, that means both that we need to treat healthcare and basic retirement funding as we already do other forms of critical social infrastructure like military and police protection and that employers would have to pay higher wages in lieu of the other perks they’re no longer offering.)

            b&

      • Posted March 25, 2014 at 11:11 am | Permalink

        I have no interest in consuming more than a cup of tea (or, rarely, coffee) with breakfast or the occasional glass of wine or beer with dinner. I eschew even over-the-counter medication and was frustrated when I had to resort to single doses of diphenhydramine for several nights over the past couple weeks in order to be able to sleep through the night with what’s been a bad case of seasonal allergies this year (basically over by now, fortunately).

        But I will absolutely refuse to work for anybody who requires any sort of drug testing. And I would strongly favor making any such testing illegal save for when reasonable suspicion exists of people working with heavy machinery or in other safety-critical functions — and, even then, said testing should be performed by the police, not the employer.

        You’re getting paid to do a job, not to be the boss’s slave or surrogate child. If you can do that job without endangering others or creating a disruptive work environment, it’s none of the boss’s fucking business what you do with your life off the clock. If your life habits prevent you from doing the job, the boss has every right to fire you — but for incompetence, not for the cause of the incompetence.

        …and, as a practical matter, I’m pretty sure right now I’d test positive for opiate usage. Not because of any drugs; rather, the past few mornings breakfast has been an absolutely marvelous poppyseed challah-style Polish bread from that deli up in Scottsdale.

        Drug testing for employment is a gross violation of civil liberties, and every bit as pointless and humiliating and degrading and irrelevant as being forced to take a lie detector test about your sex life. That shit has no place in civilized society.

        Cheers,

        b&

        • Kevin
          Posted March 25, 2014 at 11:20 am | Permalink

          I have been tested almost ten times in less than seven years, though it does not feel like an infringement, but I guess that is just me.

          I agree that reasonable suspicion should exist prior to any drug testing. Why they drug test me is a complete waste of money and time and a complete mystery.

          • Richard Olson
            Posted March 25, 2014 at 12:21 pm | Permalink

            Testing should be for cause only, with threat of penalty for the organization if negative test results.

            Mandatory random testing in an organization requires that all people are subject to it to satisfy the legal hurdle necessary to contractually require it of employees. I wonder how “randomly” high level management and/or ownership names are selected during the draw compared to the rest of the force.

            I served some of my military career before testing was implemented. In the 14 or so years after implementation of urinalysis, I was subject to the draw once each month and only selected four times.

            Three of my 4 tests occurred on the morning random draw in succeeding months. The base CO was picked each of those days, also, so at least I could be sure nobody on the base was exempted. We wound up in the head at the testing facility, carrying our little flasks, at the same time all three days. I worried people would start to talk.

        • Diana MacPherson
          Posted March 25, 2014 at 12:03 pm | Permalink

          +1 exactly my thoughts!

        • darrelle
          Posted March 25, 2014 at 12:27 pm | Permalink

          It is not my intent to defend employers, or anybody, but only to aim some blame at those that have earned it.

          To wit, as with so many things this issue is a complex variety of factors that have evolved over time. The big gorilla in the room isn’t employers though, it is insurance companies. More generally, as with so many things it all starts with money and power. Whoever has more money and power makes the rules. Relevant here is that those with more money and power rig things so that liability flows downhill, like the shit it so often resembles.

          Like many such complicated issues there is also a kernal of truth in there near the center of the mess. There are occasionally serious problems caused by employees that are impaired by drugs that impact other people and property. Merely another category of accident. When that happens the costs to clean up the mess have to come from somewhere. Managing accident risks is what insurance is for but, the insurance companies don’t like to actually pay out on claims so they require the employer to drug test, else no coverage.

          In this environment what is the average employer supposed to do? I can tell you that, having seen this from the employer side, a lot of employers can’t stand drug testing either. For one thing, it costs a lot of money. It also limits your choices, and when you have to go through ten or more people to find a reasonably decent employee, that really sucks too.

          • Scote
            Posted March 25, 2014 at 3:29 pm | Permalink

            “In this environment what is the average employer supposed to do?”

            By that reasoning, the average employer should also contractually require employees houses to be randomly searched – you never know what unsavory things they may be doing at home that could affect their work. Keep in mind that employer drug screens do not test for *impairment* only for detectable use, so my analogy isn’t as far fetch as it seems. Perhaps drug paraphernalia would be found at there homes? Or, shudder, terrorism. Or who knows what. But I think that non-safety oriented suspicionless drug testing is unwarranted and should be illegal.

            • darrelle
              Posted March 25, 2014 at 4:03 pm | Permalink

              Pure bullshit. That is your reasoning, not mine. I asked a question, and it was meant as one. It was meant to perhaps spur people that, like you, seem to think that “BIG BAD EMPLOYER” came up with drug testing just to keep employees down to consider that it might be a little more involved than that.

              Do you suppose that so many businesses would spend the resources, which are considerable, to drug test if there weren’t compelling reasons to do so? I’ve been there. The reason your typical business drug tests is because if you don’t you can’t get insurance. No insurance and you can’t legally operate your business. If an employee is involved in an accident and you don’t have them drug tested, the insurance company will not cover it. If an employee is in an accident and subsequently tests positive, the insurance company will not cover the claim. There are ways around it, you can go self insured, put up a bond. That is very expensive and out of reach for most businesses. It is also a big gamble. You lose once and your out.

              If you want to fix the problem you’d be better off starting were the problem actually starts. That would be with how liability is dealt with, economically and legally. You need to tell insurance companies that they can no longer require drug testing or penalize businesses for not testing. Your typical employer would purely love to get rid of the whole mess.

              • gbjames
                Posted March 26, 2014 at 5:17 am | Permalink

                Wait.. all you are doing is shifting responsibility for bad policy from one business to another (the insurance company).

                I don’t know what types of business you are referencing, darrelle, but my company has no problem getting insurance without drug testing.

              • darrelle
                Posted March 26, 2014 at 6:20 am | Permalink

                No, I don’t think that is all I am doing. I am someone who has been dealing with this issue, to one degree or another, for many years and I am relating my direct experience. I am a business owner. I have worked for other similar businesses in the past. I am knowledgable about the industry I am in. I have been involved with this for the past 35 years or so, and with respect to my business it is just as I described. I have no doubt that there are variations due to jurisdiction, types of business and other factors.

                It must be nice that your business is not required to drug test in order to maintain insurance coverage. That being the case do you have any urges to implement a testing program for your business? If not, why not? Aside from ethical concerns why spend the time, effort and money, right? In my experience whether it be for ethical concerns or merely squeezing every last cent possible motivated purely by greed, or anywhere in between, businesses don’t like drug testing and wouldn’t do it if left soley to their own discretion.

                Granted, there’s drug testing, and then there’s drug testing. A business can get a break on their insurance if they do what is necessary to achieve drug free work place status. That is even more expensive to maintain than basic drug testing requirements and the majority of businesses can’t or choose not to do that because they can’t make it work anyway. Large corps do that and save a bit.

                Plenty of blame to go around I’m sure, but how is this solely or even mostly an employer caused problem? And no, the fact that insurance companies are also employers is not relevant. But, the fact that insurance is regulated, Worker’s Comp in particular, by various levels of government (which it should be) is another relevant aspect of this issue.

              • gbjames
                Posted March 26, 2014 at 6:49 am | Permalink

                To be fair, I don’t own the business although I am part of the management team. We have no urge to implement drug testing because there is no reason to do so. No heavy equipment, etc.

                Now, there are businesses with owners that have no problem mucking around in the private lives of their employees: Hobby Lobby comes to mind. In my opinion, employers like that should not be authorized to impose drug testing without demonstrating a real need for it.

                It is an employer-caused problem to the extent that employers require it without good reason. It is a larger social problem to the extent that political figures impose drug testing on poor people for no good reason. We’ve already all agreed (I think) that drug testing for good cause is legitimate. But fishing expeditions looking for general drug use is not good cause.

              • darrelle
                Posted March 26, 2014 at 7:01 am | Permalink

                I agree completely.

                For anybody reading, in case I’ve caused confusion, I pretty much despise drug testing. I wouldn’t care to argue against any of the critical statements I’ve seen here about the merits or ethics of drug testing. Seems to me to be just one more aspect of the “Drug War” mentality that has gotten way out of line.

        • Filippo
          Posted March 25, 2014 at 5:51 pm | Permalink

          Every month at least one of us in my U.S. navy reserve unit was picked to participate in “Operation Golden Flow.”

          • Posted March 25, 2014 at 6:38 pm | Permalink

            I could go along with that type of testing for active duty military or other “first responder” types who’re either on call or otherwise must be reasonably ready at a moment’s notice.

            But unless reservists can be activated and in critical positions in less time than it takes to sleep off a night of drunken debauchery, I couldn’t support nor respect such a policy.

            b&

        • infiniteimprobabilit
          Posted March 26, 2014 at 12:17 am | Permalink

          I absolutely agree with you Ben. Unfortunately it seems to be creeping in here (NZ) on construction sites under the guise of ‘Health & Safety’ which nobody dares question – it’s a bit like a religion in that respect. And as prone to being exploited by unscrupulous promoters of unnecessary ‘services’ to industry. Of course they don’t test the managers who hand out contracts to these con-men – and the spineless managers see it as ‘risk avoidance’ which is the prime motivation of all management these days. After all, it’s not their own money they’re spending and it’s tax deductible…

  6. Posted March 25, 2014 at 6:53 am | Permalink

    No religion gives you the right to harm your children. It’s sad that we still have to argue about this. Religion also doesn’t give you the right to “weaponize” your body by making it a vector for preventable diseases that you may pass to others (especially to young children!). I think the term “social good” is too weak; each of us has the right to be free from exposure to preventable viruses.

    It’s challenging to make vaccinations mandatory while still preserving medical privacy. I would suggest trying the criminal liability approach: if someone chooses not to vaccinate themselves or their child, and an outbreak occurs, it should be a crime. If an infant dies from whooping cough, it should be considered a form of manslaughter.

    • gbjames
      Posted March 25, 2014 at 7:37 am | Permalink

      That’s an interesting strategy (liability) but I think it would be often hard to prove in court which individuals in the unvaccinated part of the population were responsible for this or that particular illness or death.

    • Sastra
      Posted March 25, 2014 at 8:03 am | Permalink

      Another challenge to making vaccines mandatory is the nuts ‘n bolts reality of dragging a kicking, screaming child out of the arms of a kicking, screaming parent. If the normal sanctions (no public school) don’t work, then that could be what we’d have to deal with.

      How many people will it take to hold the mother down? Or do we adopt a temporary kidnap strategy, with anti-vaxxers then adopting paranoid surveillance tactics and underground networks of secret safe hiding places?

      Shouldn’t be done. Obviously.

      • Posted March 25, 2014 at 9:01 am | Permalink

        That’s the job of Child Protective Services.

        Failure to vaccinate should be considered as serious as sexual abuse, as far as I’m concerned; failure to vaccinate carries a very significant risk of death and disfigurement, and to many more children than just the direct victims. Rape your own children and they’re the only ones who suffer; fail to vaccinate your own child and you could kill the neighbor’s children.

        Children suffering from this form of violent neglect — and, make no mistrake, that’s exactly what it is, just as if you forcibly played a nightly game of Russian Roulette with vials of plague virus — need to be rescued by the police and placed in foster care while the parents are dealt with by the criminal justice system.

        Not going to happen, I know, but that’s my take on it.

        b&

        • Diana MacPherson
          Posted March 25, 2014 at 9:16 am | Permalink

          Not to mention the immuno-compromised and the elderly!

          • Kevin
            Posted March 25, 2014 at 10:08 am | Permalink

            Agreed, a lot of elderly are potentially at much higher risk than they once were with unnecessarily sick children, likewise their liberties to go to public places, like libraries and grocery stores becomes limited.

        • infiniteimprobabilit
          Posted March 26, 2014 at 12:24 am | Permalink

          I think on the whole snake-handling is more defensible – after all snake-handlers are only going to kill themselves, not endangering somebody else. You can call ‘Darwin [awards]‘ on them.

          On the whole I tend to be fairly relaxed about people who do stupid things that only endanger themselves. If only vaccination was 100% effective (for those who take it) and safe for anybody to take, then the anti-vaxxers would be a lot less reprehensible.

          • Posted March 26, 2014 at 7:04 am | Permalink

            The problem is that, even if vaccines were perfectly effective (which they’re never going to be), there’ll still be plenty of people unable to take them — and it’ll be exactly those people most vulnerable to infection. If you’re healthy, you might (though probably not) be able to shrug off some infectious diseases. But if your immune system is compromised through young or old age or AIDS or chemotherapy or whatever, catching a vaccine-preventable disease is a death sentence.

            The only way to protect those people is through herd immunity — and herd immunity requires basically everybody for whom vaccination isn’t contraindicated to be vaccinated for full effectiveness.

            I’d also have much more respect for the snake handlers if they left the poor snakes alone and did the other two things that verse says they’re supposed to do: drink deeply of deadly poisons and heal the sick by calling upon Jesus. That, and the verse clearly doesn’t indicate that they won’t get bitten if they believe, but that the bites won’t cause them harm; they should be able to get their fix by having a qualified and responsible herpetologist milk the snakes and then injecting the venom into themselves with an hypodermic.

            …but, of course, any of those alternate options would instantly demonstrate that they don’t, in fact, have true faith. That is, by the way, the whole point of the passage: to provide an unambiguous empirical test whereby non-believers can identify those who truly believe.

            Cheers,

            b&

            • infiniteimprobabilit
              Posted March 27, 2014 at 12:16 am | Permalink

              I do agree with you including about the welfare of the snakes, by the way.

      • John Scanlon, FCD
        Posted March 25, 2014 at 10:21 am | Permalink

        Conduct any not-previously-obtained vaccinations during school hours, on school property, in the first week of school, no parents allowed. Medical exemptions only. No charge.

        • Posted March 26, 2014 at 2:19 pm | Permalink

          If you vaccinate enough children, some will have a bad reaction to a vaccine. How would this situation be dealt with under your scenario?

          • John Scanlon, FCD
            Posted March 28, 2014 at 1:17 am | Permalink

            Free universal health care.

            But no, that’s evil, isn’t it?

            • Posted March 28, 2014 at 5:43 am | Permalink

              Actually, I support free universal health care. I wasn’t asking about the treatment for a reaction, but about informing parents when they had not given permission for the vaccination? Not telling them means if the child suffered a delayed reaction, they wouldn’t know the cause which would have implications for how they should respond. They might be inclined to sue if their child suffered a serious life-altering reaction to the vaccination.

    • Matt G
      Posted March 25, 2014 at 8:16 am | Permalink

      Children cannot give informed consent. If it can be demonstrated that parents who don’t want their children to be vaccinated are not acting in the child’s best interest, then the state should intervene.

  7. abrotherhoodofman
    Posted March 25, 2014 at 7:04 am | Permalink

    Why is God not making these vaccines work?

    What the hell is wrong with that omnipotent asshole?

    • Daoud
      Posted March 25, 2014 at 7:36 am | Permalink

      Hey, he found my car keys the other day, I was pretty happy about that. Cut the man some slack.

      • Dave
        Posted March 25, 2014 at 9:53 am | Permalink

        God isn’t a man, or so the massed ranks of Sophisticated Theologians (TM) keep telling us.

        You really need to keep up with the latest developments in this exciting field!

  8. Diana MacPherson
    Posted March 25, 2014 at 7:37 am | Permalink

    What impeccable timing for this post. Right now in my doctor’s office getting vaccinated. I’m getting the MMR just in case. I will let you all know if I end up autistic :P.

    There was a measles outbreak in BC that started with a religious prohibition but in no time those unvaccinated kids spread measles to the rest of the pop!

    • Posted March 25, 2014 at 9:04 am | Permalink

      Well, judging from what you’re doing with the 5DIII, I’d say you’re already artistic. But how is the vaccine supposed to change that?

      b&

  9. BKsea
    Posted March 25, 2014 at 7:38 am | Permalink

    The comment from Terri Pearsons is rather telling. She quotes medical concerns not religious ones. The religious exemption is supposed to be for sincerely held religious beliefs. Is she giving the game away?

    Also, Margulis’ statements about Norway are just a giant non sequitur. Are we supposed to believe that lower infant mortality is caused by a later vaccination schedule? Are we also supposed to believe that higher rates of breast feeding are caused by later vaccination?

    • eric
      Posted March 25, 2014 at 11:06 am | Permalink

      I’d be fine if the US adopted Norway’s vaccination schedule…AFTER we adopt Norway’s point of service health care system and very generous/socialized support for new mothers. Point being, the former works in part because of the latter, and if the US doesn’t adopt the latter, we cannot expect the former to work as well.

      • Diana MacPherson
        Posted March 25, 2014 at 12:00 pm | Permalink

        You still get dumb assery. Canada has free vaccines (I just got a whack today) and a generous maternity leave (1 year) but look what happened in Chilliwack, BC and the vaccination level is 60-70% in the Fraser Valley. That’s bad! You need 95% to maintain herd immunity.

        Stupid is everywhere!

  10. Posted March 25, 2014 at 7:40 am | Permalink

    Reblogged this on CancerEvo.

  11. Posted March 25, 2014 at 8:00 am | Permalink

    Reminds me this outrage does: “And yes, child Jehovah’s Witnesses do die from THIS INDOCTRINATION: … … how those dead, transfusion – refusing children are held up by coreligionists as martyrs to the faith, “youths who put God first.” It is disgusting to every civilized person. When is the time to be more “coercive”? Now. For a single dead child is one too many.” —- this O.U.T.R.A.G.E. does, of the parents and their adult friends of one particular, other child .shot dead. at Columbine High School on 20 April 1999, its 15th “anniversary” in ~a month’s time from today.

    These adults [her parents, Misty Bernall (“author” of She Said Yes: The Unlikely Martyrdom of Cassie Bernall) and Bradley Bernall, and their religionist cohorts] termed themselves very, very soon after, and now, “at peace” with this child’s death. The death of a child which they all in America conspired … … to perp.

    Mr Christopher Hitchens personally stated to me and my friend on Wednesday evening, 31 October 2007: “Religious education .IS. child abuse.”

    It IS disgusting to any and to all C.I.V.I.L.I.Z.E.D. persons.

    http://www.google.com/#q=%22cassie+bernall%22+foundation&safe=active

    http://www.cassierenebernall.org

    Blue

  12. Ken Pidcock
    Posted March 25, 2014 at 8:01 am | Permalink

    Not surprised to learn that Kristen Feemster’s with Children’s Hospital of Philadelphia. They take vaccination seriously there. It’s Paul Offit’s address.

  13. Posted March 25, 2014 at 8:12 am | Permalink

    On the Norwegian breastfeeding argument: American mothers are more diverse and their situations are different. Yes, there is still cultural reluctance but that isn’t the main issue. American mothers do not have free health care, very few have any kind of paid maternity leave, many have prescription medications, health conditions or jobs that preclude breastfeeding, and some rely on public assistance which covers baby formula but not food for the mother. So it makes sense to vaccinate babies as early as possible.

    Vaccination should be mandatory, easily accessible, widely available, and free.

    We had a whooping cough outbreak in our neighborhood this winter. The public school system banned unvaccinated children, although they were allowed back after two weeks if they got the shot. This was a draconian measure since our state allots funding by daily enrollment, so schools risk cuts or even closure if they have a lot of absentees. It was even more surprising because this school system is small and heavily Christian, including the administration.
    Parents of the banned elementary school kids set up “school” for a few weeks in a church across the street. Judging from the number of cars, we have a lot of antivaxxer neighbors.

    • The Curious Monkey
      Posted March 25, 2014 at 8:48 am | Permalink

      The rationale behind the Norwegian program is largely based on the fact that the country has very low burden of disease with regards to these diseases. In countries where the burden of disease is hight, the number of doses and time of administration of the vaccines will have to be considered.

      As an aside, the “no vaccines before 3 months of age” will soon no longer apply, as a change in the vaccination program will introduce a new vaccine (the rota-virus vaccine) at 6 weeks of age. In addition, the hepatitis B and BCG vaccines are routinely administered right after birth to children of parents from high endemic countries.

      Finally, all vaccines in the child vaccination program in Norway are optional, and yet the country has a vaccination coverage of about 95% in children. While this model might not work for the US, it seems obvious that making something mandatory will estrange a certain number of people, simply because they do not like being told what to do…

      • eric
        Posted March 25, 2014 at 11:15 am | Permalink

        Your last point is very relevant, IMO. As a citizen (and parent), I am primarily concerned about the % of the population that gets vaccinated. The ‘mandatory vs. voluntary’ debate is a secondary concern. When a voluntary system yields a high (enough) % vaccination, I’m fine with it. When it dosen’t, I’m not fine with it. And in disease cases where our population is so psychologically perverse that making vaccination mandatory would actually lower the % vaccinated, I’m going to support voluntary-ness. Because, again, it’s the vaccination rate I’m concerned about, not some meta-ethical issue of whether the system is fair enough or respects people’s freedom enough or whatever. Mandatory vaccination is a means, but when it doesn’t result in the social good end I want, I have no problem ditching it.

  14. Paul Spence
    Posted March 25, 2014 at 8:19 am | Permalink

    I regard myself as reasonably well educated about pathogens (viruses especially) as I have a doctorate in virology and have spent many years working in the field. Why did I choose virology? Largely because my father contracted polio back in the 30s when vaccines weren’t available and lost the use of his legs. People just don’t understand how devastating vaccine preventable diseases can be, largely because vaccines have (until now at least) made them very rare.

  15. Sastra
    Posted March 25, 2014 at 8:21 am | Permalink

    An accomodationist approach to this problem would involve funding various forums where ministers and priests explain how vaccination is consistent with both religion and being religious, with passages from the Bible and other holy texts scoured for confirmation. Forget the science: concentrate instead on encouraging the religious to think God works through vaccination.

    In fact, an accomodationist approach wouldn’t stop at the traditional religions but would go after the New Age/Spiritual ones as well and deal with the pseudoscience. Gather together homeopaths, reiki masters, naturopaths, holistic healers, mystics, and people who channel spirit beings from the Pleiades and get them to explain that vaccines are very natural and spiritual and perfectly consistent with alternative medicine, UFOs, and the Vortex.

    Seth agrees: vaccinate your baby! Rope in Deepak Chopra for the explanation of how vaccination is imbedded in the Field of Consciousness. Dana Ullman can assert that vaccines are just another form of homeopathy.

    Harping endlessly on real science and facts will miss the Big Picture here: compliance. Get the irrational and unreasonable to do the right thing by using bullshit in a positive way! Maybe it could be funded by the Templeton Foundation — assuming we’re lucky and there are enough Spiritual Pro-Vaccine folks in there.

    • Diana MacPherson
      Posted March 25, 2014 at 9:27 am | Permalink

      I always like to bring up, “I thought God helps those who help themselves”. Vaccines help us – God isn’t going to help you if you just sit there & let yourself get sick.

  16. Stephen
    Posted March 25, 2014 at 8:51 am | Permalink

    I’m completely in favor of vaccination, but I don’t really like the idea of physically FORCING people to have their kids vaccinated.

    While there are some who will never consent, especially those who think they have religious reasons, I suspect there are many people who could be convinced, if given solid information.

    What all can be done to curtail the sources of willful misinformation? If a talk show host states as fact “vaccines cause autism” despite current research, what can we do to counteract that statement, other that just running our own publicity campaign? Are the legally liable?

  17. Richard Olson
    Posted March 25, 2014 at 8:54 am | Permalink

    Reason vs ignorance + motivated reasoning.

    Bet on the Cubs to win the Series, too.

    • Richard Olson
      Posted March 25, 2014 at 8:58 am | Permalink

      Is there a vaccination available that prevents forgetting to click the little notify circle?

      • Diane G.
        Posted March 25, 2014 at 10:20 pm | Permalink

        I know, right?

  18. uglicoyote
    Posted March 25, 2014 at 8:59 am | Permalink

    Reblogged this on The Road.

  19. Jim Cliborn
    Posted March 25, 2014 at 9:28 am | Permalink

    It would seem Syria in the last few years is a major fail for anti-vax. The conflict has stopped vaxs and they are now seeing polio come back.

  20. AlanF
    Posted March 25, 2014 at 9:38 am | Permalink

    I think you’re right, Jerry, that as a public health issue no one should be able to refuse vaccinations except for valid medical reasons.

    The article you referenced about Jehovah’s Witnesses is indeed chilling, because it shows how much a destructive cult can influence its members. Indeed, certain religions like the JWs are viewed as cults, and as destructive, precisely because of their negative effects on their members’ health and well-being.

    I have been involved in many actions and online discussions with the goal of showing people how destructive the Watchtower Society’s position on blood transfusions has been. The sad thing is that the reasoning they used to come up with this position was abandoned sixty years ago. Sadder still is that, due to medical advances and policy changes within the Watchtower organization itself during the past four decades, JWs are for all practical purposes allowed to have what once would have gotten a JW excommunicated (disfellowshipped). In the case of children, courts always side with the child’s medical interests. In the case of adults, it is now unofficial policy for local Watchtower officials to look the other way if they find out that a member has taken one of the forbidden forms of transfusion. Only if a baptized member becomes vocal about taking a transfusion will he be excommunicated, and even then only if he refuses to “repent”.

    Today, whole blood and the fractions that can be separated by centrifugation (plasma, red cells, white cells, platelets) are rarely used as is. It is these that are forbidden to JWs. Rather, these fractions are further broken down and/or purifed or treated so as to produce a more viable product. JWs are allowed all of these products, even when to a normal person the Watchtower policy governing this makes no sense. For example, a product called “Hemopure” is made of about 99% red blood cells from cows, which have been treated to break down the cell walls and extract the hemoglobin. This is explicitly allowed by Watchtower policy. Yet untreated red blood cells extracted from human blood are explicitly forbidden. Although the Watchtower has repeatedly been asked to give clear reasons for this, they steadfastly refuse — “it’s our religious policy.”

    The Watchtower is between a rock and a hard place here. I have it on good authority that the blood transfusion policy would have been abandoned more than 20 years ago were it not for their fear of lawsuits. After all, since the 1940s JWs have been coerced to die for this doctrine, and if it were abandoned the families of the dead JWs would immediately understand that this was yet another “doctrine of men” rather than “divine teaching” (to use JW jargon). That would precipitate not only a rash of lawsuits but a fairly large exodus.

    The Watchtower banned vaccinations until the early 1950s. Until then they taught that a vaccination was a violation of “the law of God”. But when top Watchtower officials wanted to begin world travel to expand their little empire, they found that they could not get travel permits because they were not properly vaccinated. So of course, they changed their interpretation of “the law of God” and presto! they could travel. Such cynicism clearly permeates their policy on blood.

    I think that in many cases cults need only the right incentive to give up their bans or negative views of vaccinations. The trick for responsible people is to find that incentive.

    • Posted March 25, 2014 at 11:16 am | Permalink

      Indeed, certain religions like the JWs are viewed as cults, and as destructive, precisely because of their negative effects on their members health and well-being.

      In practice, that applies to pretty much every significant modern religion and denomination.

      Catholic positions on reproductive rights are far more damaging to public health, of their own members and the rest of society, than anything a minor little fringe group like the Witlesses could ever hope to be. Just look at the ongoing biowarfare genocide the Church is waging in Africa with their propaganda disinformation campaign to spread AIDS as much as humanly possible.

      And even the most liberal of denominations still encourages practices such as group prayer which have been clinically demonstrated to have deleterious effects.

      Cheers,

      b&

  21. Ken Phelps
    Posted March 25, 2014 at 9:42 am | Permalink

    Margulis: “Most parents who individualize the vaccine schedule are actively educating themselves… ”

    In the same sense that creationists are educating themselves at AIG. Margulis lives in a fantasy world if she actually believes this.

  22. Posted March 25, 2014 at 9:43 am | Permalink

    I can only think of one compelling reason to not make them mandatory: that doing so might actually lead more parents to not take their children for well-baby visits and so on, and might even lead some parents who would otherwise vaccinate to refuse to do so out of protest, or as a reaction against a perceived trampling of their liberties. However, it’s not clear to me to what extent either would actually occur.

  23. DiscoveredJoys
    Posted March 25, 2014 at 9:50 am | Permalink

    Anything involving childrens’ safety is emotive. The science says that vaccination is on the whole a good thing but it kicks up the emotions because it is a thing deliberately done to your own child, and if there were side effects… still, my children were vaccinated because it is accepted as ‘normal’ in the UK.

    But if you do consider compulsory vaccination as a social good, aren’t there more pressing issues in the US, like reducing gun ownership? Or is that a social good too far?

    • gbjames
      Posted March 25, 2014 at 9:56 am | Permalink

      False choice. Many of us advocate for sane gun policies AND compulsory vaccination. Is there some reason you think these two goals are mutually exclusive?

    • Kevin
      Posted March 25, 2014 at 10:17 am | Permalink

      As an engineering control vaccinations are easily administered in society. It is a system that works and will continue to work better. We are working on guns (slowly), but ultimately solutions for gun control are ultimately going to be engineering controls as well.

      How do you think planes fail? Look it up…its not humans, it is engineering controls (even terrorism). What saves lives in our society are knowing how to manage predictable risks.

    • darrelle
      Posted March 25, 2014 at 10:55 am | Permalink

      Well, gbjames covered the false choice issue very well, so I’ll go on to something else.

      For the sake of argument let’s posit that there is a choice to be made. What is the body count calculus? How many people die anually because of the craptastic gun laws we have in the US? According to CDC numbers about 32,000 a year over the past few years, including all categories from accidental, to murder, to law enforcement, to unkown.

      Now the number to compare that with is how many lives are saved by vaccinations. Going by past history an order of magnitude more, at least, than gun deaths.

      From those starting points you would then need to try and predict how many less deaths you’d get with stricter gun control laws, and how many more deaths you’d get by not doing anything to stem the tide of anti-vacc wooists. So far this does not bode well for your implied claim that gun ownership is a significantly bigger problem.

      • DiscoveredJoys
        Posted March 26, 2014 at 2:05 am | Permalink

        Google for cases&deaths.pdf from the CDC, title “Reported Cases and Deaths from Vaccine preventable Diseases, United States, 1950-2011*” The number of deaths is comparatively trivial, and not even reported for most diseases from 2006.

        Alternatively see http://en.wikipedia.org/wiki/List_of_preventable_causes_of_death for a different take on the figures (although vaccine preventable deaths are not teased out).

        And yes I was (deliberately) being provocative with my post. Doe it not strike you as disproportionate to reach for compulsion so quickly when there are other far bigger preventable causes of death?

        • gbjames
          Posted March 26, 2014 at 5:22 am | Permalink

          Do you know how epidemics/pandemics work?

        • darrelle
          Posted March 26, 2014 at 5:26 am | Permalink

          I’m not sure I understand the “reach for compulsion” comment, so this might be of target. But, are you characterizing this OP and the following comments as compulsive? I disagree with that, and it seems a bit indulgent to argue that. This is a discussion about a real problem that if left to fester may result in serious problems down the road. It also involves child rights issues. It is one of many real problems all of which it is in everyone’s best interests that some effort is made to counter. gbjames already said it better and shorter.

          Regarding your links, the issue is not how many deaths can currently be attributed to people refusing to be vaccinated. The fact that deaths from preventable diseases have been few compared to pre-vaccination times is a relevant comparison though. The issue is how many deaths could, at some point in the future, be attributed to people refusing to be vaccinated if vaccination levels fall below “herd immunity” levels, or lower.

          • DiscoveredJoys
            Posted March 26, 2014 at 2:31 pm | Permalink

            Jerry’s own words:

            My own view is that vaccination is a social good, and there should be no exemptions save medical ones (i.e., people who are ill, immunocompromised, and so on).

            and

            When is the time to be more “coercive”? Now. For a single dead child is one too many.

    • Diana MacPherson
      Posted March 25, 2014 at 11:34 am | Permalink

      Those who think harm is being done to their child through vaccination should be prepared to face the parents if their unvaccinated child kills a baby too young to be vaccinated. It’s happened more than once.

      When I’ve reminded people who are soft on vaccination and feel sorry for people who are against them, the see things in a different light.

    • eric
      Posted March 26, 2014 at 6:58 am | Permalink

      Ironically, gun ownership is only a more pressing concern today because vaccination has been so incredibly successful in the past. And if we want to keep death-from-disease a minor social concern, we need to keep up a high percentage of vaccination.

  24. Michael
    Posted March 25, 2014 at 10:03 am | Permalink

    More schools are allowing personal exemptions for unvaccinated children.

    It doesn’t really matter though since all they have to do is claim the exemption, personal or religious the result is the same, and there is no checking.

    I agree only medical exemptions should be allowed, but I certainly don’t see that happening.

    I just don’t understand how so many people can be so ignorant of what is in essence recent history. 1950’s for polio, 1912 for the Spanish flu. Never mind the sixties for measles, mumps and whooping cough.

    Unfortunately the level of woo and disinformation in the anti vaccine camp is rampant. Many have worked themselves into frothing at the mouth conspiracy theorists who claim pharmaceutical companies are evil incarnate.

    I can only believe that this requires either people who are very young, or willfully blind, since it’s likely we all know many people who are alive because of the intervention of modern drugs.

    It’s impossible to prove but I would think untold millions are alive now because of vaccines, especially smallpox, polio, diphtheria, and other diseases.

    The anti vaccine crowd says these are harmless childhood diseases. Measles causes brain swelling in 1 out of 1000 cases.
    World wide more than 100,000 children die each year because of the measles.

    I think there are few people more reprehensible then those who spread misinformation about vaccines.
    The people who distribute false and misleading anti-vaccine information should be sued into oblivion for the very real harm they cause.

    • gbjames
      Posted March 25, 2014 at 10:26 am | Permalink

      I agree about the reprehensible nature of spreading misinformation about vaccines.

      You have to be a bit of a silver-haired person at this point to remember things like family members getting polio. People have grow up without experiencing the horrors of many communicable diseases. Ignorance runs rampant and framing public policy to allow opting-out lets people think it is just a personal choice.

      This probably won’t change until we get a few devastating epidemics.

      • Posted March 25, 2014 at 11:38 am | Permalink

        There’re still lots of people AARP-aged in crutches with the characteristic limp. One such lady lives across the street from my parents; until she retired, she was one of the secretaries at the front desk of the ASU School of Music. I don’t think anybody has to go very many degrees of separation to find such a person, and almost everybody that age is going to know of some kid at their school who died in an iron lung.

        b&

        • gbjames
          Posted March 25, 2014 at 11:40 am | Permalink

          “…lots of people AARP-aged in crutches with the characteristic limp.”

          Jeeze. Did you have to come out and point directly at me?

          • Posted March 25, 2014 at 12:45 pm | Permalink

            If the foo shits….

            b&

            • Filippo
              Posted March 25, 2014 at 6:26 pm | Permalink

              You do hope to live to at least Bro. James’s age, eh? ;)

              • Posted March 25, 2014 at 6:40 pm | Permalink

                Physical, mental, emotional, or theological age?

                b&

              • gbjames
                Posted March 26, 2014 at 5:09 am | Permalink

                I have a theological age? How’s that work?

              • Posted March 26, 2014 at 7:16 am | Permalink

                That’s the great part — however you like! Theologically, you can even simultaneously be ancient of days and a babe in the reeds, if that’s what you want.

                b&

        • Diana MacPherson
          Posted March 25, 2014 at 12:47 pm | Permalink

          Yeah, my parents remember polio. Also, people from other countries that don’t vaccinate know all about diseases like this. My Indian friends get every vaccine going and can’t believe people would choose not to vaccinate because they’ve seen first hand what these diseases are like.

          • gbjames
            Posted March 25, 2014 at 1:40 pm | Permalink

            One of my cousin-sets (9 kids of my father’s sister and her husband) (yeah…. Catholic) got hit by polio. Two of them were severely crippled by the disease in the 50’s. One of them still lives in constant pain from the effects. (The other died 20 years ago).

            How can anti-vaxers think we’re going to avoid the return of these plagues if they get their way?

            • Diana MacPherson
              Posted March 25, 2014 at 4:04 pm | Permalink

              I know your question is rhetorical but I almost feel there needs to be a public awareness campaign on what these diseases look like – there are real cases in the developing world that don’t have vaccines.

              • gbjames
                Posted March 26, 2014 at 4:54 am | Permalink

                Can’t do that. It would be disrespectful of deeply held religious beliefs.

              • gbjames
                Posted March 26, 2014 at 4:54 am | Permalink

                Can’t do that. It would be disrespectful of deeply held religious beliefs.

    • eric
      Posted March 26, 2014 at 7:04 am | Permalink

      I just don’t understand how so many people can be so ignorant of what is in essence recent history. 1950′s for polio, 1912 for the Spanish flu. Never mind the sixties for measles, mumps and whooping cough.

      The average age of a first-time mom in the US (in 2008) was 25. So the parents we are talking about were born in the late 1980s or early 1990s. They don’t even remember grunge rock, let alone polio.

  25. Richard Bond
    Posted March 25, 2014 at 10:07 am | Permalink

    If parents who do not vaccinate their children are relying on herd immunity, they are free-loading.

  26. Kevin
    Posted March 25, 2014 at 10:12 am | Permalink

    The solution should be simple: grassroots. Doctors, if a kid comes into your office at any point and you have no record of vaccination…then start at whichever kinds you think are reasonable to administer at that point for the kid. No questions. No choice. And no doctor should be reprimanded for giving a vaccination, assuming they follow correct procedures.

    • Posted March 25, 2014 at 11:33 am | Permalink

      There might even be a simpler and more effective method, now that the Federal government is meddling in health insurance: require proof of compliance with all vaccination protocols for payment of claims; policies without such a clause would not be considered valid for Obamacare.

      It would have to wait until coverage is more universal, such that threatening to yank coverage for the unvaccinated would cause more people to get vaccinated than the false “burden” of vaccination would prevent the uninsured from signing up…but it would pretty much end the nonsense.

      b&

      • gbjames
        Posted March 25, 2014 at 11:36 am | Permalink

        That sounds pretty good. Now… how to get Congress to allow this to happen.

        • Posted March 25, 2014 at 12:44 pm | Permalink

          First, throw the bums out….

          b&

      • Kevin
        Posted March 25, 2014 at 1:27 pm | Permalink

        Really good idea. I am in favor.

  27. tomh
    Posted March 25, 2014 at 10:32 am | Permalink

    The scope of religious exemptions features prominently in the Hobby Lobby case being argued before the Supreme Court today. The owners claim that their religious beliefs justify an exemption from the Affordable Care Act’s requirement that employers include contraception coverage in their employee health plans.

    The religious exemption for vaccinations has its roots in the heavy lobbying done by the Christian Science church in the 1970’s. When the Child Abuse Prevention and Treatment Act was passed in 1996, lobbying again succeeded, and the law stated that the Act did not include, “a Federal requirement that a parent or guardian provide a child any medical service or treatment against the religious beliefs of the parent or guardian.” Sen. Dan Coats, (R-IN), argued that parents have a First Amendment right to deny medical care to their children.

    There will be no substantive change until the law is changed at the federal level. In spite of opposition by organizations such as, CHILD, INC., the religious exemption from medical care has been retained each time the Act has come up for reauthorization. Our laws are heavily influenced by lobbyists, and religious lobbying is some of the most difficult to counteract.

    • Diana MacPherson
      Posted March 25, 2014 at 11:39 am | Permalink

      The question becomes can corporations believe in god? They’re oddly people so now the decision becomes do they have freedoms and can their freedom trump others’ freedoms?

      I wrote a bit about it.

      • eric
        Posted March 26, 2014 at 7:12 am | Permalink

        I don’t think it really matters whether they can or can’t, because there are several lines of argument against HL’s case even if they can. There’s the Rastafari dope response (just saying some behavior is a deeply held religious belief doesn’t mean you get to break the law to do it. The law says you have to provide coverage).

        There’s also the argument that HL isn’t providing anything. Companies like Kaiser or Aetna are the ones doing it. And, ironically, HL’s defense would apply to them too. Leading to something of a wierd paradox or self-refutation – if HL wins, then doesn’t that mean that Aetna has the religious right to follow their beliefs and distribte contraception to its health care purchasers?

  28. Scote
    Posted March 25, 2014 at 10:38 am | Permalink

    “When is the time to be more “coercive”? Now. For a single dead child is one too many.”

    While I agree with pretty much everything in your post, I find that to be scaremongering. The “single dead child” metric can be used to justify pretty much anything no matter what the larger, more complex and complete analysis of the situation is, and it is what *anti-vaxers* sometimes use as a metric to justify their position.

    Although vaccines have perhaps the highest risk/benefit ratios of all medical treatments, there are still some rare risks, and I’d think it likely that given the millions and millions of vaccines given that rare complications will contribute to the death of at least one baby. So your own advice breaks the “one baby” standard. But it passes the saves more than it kills standard, the risks/benefit ratio, by a wide margin.

    I think we should be wary of using metrics that are simplistic and polemic when it comes to something as complex as modern medicine. Vaccines are the greater good, but the full story is complex.

  29. boggy
    Posted March 25, 2014 at 10:48 am | Permalink

    Re: MMR vaccine. I worked with a woman whose son was autistic. He had had the vaccine so when she became pregnant again she decided against vaccination. The second son was more severely autistic than the first.
    Polio could have been eliminated had mullahs in Afghanistan not prevented parents having their children vaccinated.

    • Posted March 25, 2014 at 1:09 pm | Permalink

      I hope the younger son has since been immunized….

      b&

  30. Posted March 25, 2014 at 11:15 am | Permalink

    in the case of vaccinations, the needs of the many outweigh the needs (or desires) of the few, or the one.

    • Diana MacPherson
      Posted March 25, 2014 at 12:05 pm | Permalink

      Yeah, Spock was right! ;)

      • Scote
        Posted March 25, 2014 at 12:17 pm | Permalink

        So, where do we draw the line between rights of individuals vs. the good of the hive? I think vaccination wins this one based on the merits, but if you use the “needs of the many” as your standard then all sorts of individual rights, if not all of them, can be discarded. It is one of the problems with Sam Harris’ “I swear it isn’t Utilitarianism” greater good standard of morality.

        • gbjames
          Posted March 25, 2014 at 12:22 pm | Permalink

          Is this really hard (in principle)? How about “when it harms or kills other people”?

          • Scote
            Posted March 25, 2014 at 12:30 pm | Permalink

            Well, then. No more cars. They kill 30,000 people a year. And privately owned swimming pools? They cause of 30% of all accidental death in children 1-4. So no more of them. And selling high fat food? That definitely hurts people. So that’s got to stop.

            Sorry, but “harms or kills other people” isn’t as simple a standard as you make it out to be.

            • gbjames
              Posted March 25, 2014 at 1:33 pm | Permalink

              My error. I should have added “without significant countering benefits to the general social welfare”.

              We can argue about specifics, so if your point is that there will always be edge cases to argue about, fine. But the Spock Rule, if I may call it that, is a pretty sound principle to have at the base of the argument.

        • Diana MacPherson
          Posted March 25, 2014 at 12:39 pm | Permalink

          I think we’re doing okay now as a society. The needs of the many in this case also offer low risk to the many.

          • Scote
            Posted March 25, 2014 at 12:48 pm | Permalink

            I agree, I’m just wary of general statements that seem self-evidently good but are actually aren’t.

            • Diana MacPherson
              Posted March 25, 2014 at 12:51 pm | Permalink

              Well sure, but we’re applying that statement to this particular case. I certainly can’t speak for everyone, but we’d probably be hard pressed here on this site to find people who thought that way – that’s going a little too close to fascism where the needs of the individual were secondary to the needs of the state.

              • Scote
                Posted March 25, 2014 at 1:06 pm | Permalink

                Why invoke it if it isn’t generally true?

              • Diana MacPherson
                Posted March 25, 2014 at 3:20 pm | Permalink

                Because it was evoked within the context of vaccination. Why evoke anything if it’s not generally true – don’t you think context matters in discussions and all statements are not general statements about society?

              • gbjames
                Posted March 25, 2014 at 1:56 pm | Permalink

                Because it is relevant in the context of the conversation?

              • Scote
                Posted March 25, 2014 at 3:24 pm | Permalink

                “Because it is relevant in the context of the conversation?”

                Sure, in a potentially misleading way, because you don’t actually believe that it is always true.

              • gbjames
                Posted March 25, 2014 at 3:27 pm | Permalink

                There are lots of things I say that I don’t think are always true.

                You aren’t making a sensible argument. And I am reasonably confident that this situation is not always true.

      • Posted March 25, 2014 at 1:43 pm | Permalink

        and thank you for getting that ;)

        • Diana MacPherson
          Posted March 25, 2014 at 4:19 pm | Permalink

          :)

      • Filippo
        Posted March 25, 2014 at 6:39 pm | Permalink

        In “Star Trek II: The Wrath of Khan,” Spock told Kirk, “The needs of the many outweigh the needs of the few.”

        In “Star Trek III: The Search for Spock,” Kirk told Spock, “The needs of the one outweigh the needs of the few.”

        • Diana MacPherson
          Posted March 25, 2014 at 7:23 pm | Permalink

          And I think they do that line all over again in the latest Star Trek.

  31. Filipe
    Posted March 25, 2014 at 11:50 am | Permalink

    I don’t like Kristen Feemster’s posture that much. Tetanus isn’t contagious yet vaccination needs to be mandatory. More than a societal thing it’s a basic children rights issue.

  32. Posted March 25, 2014 at 12:02 pm | Permalink

    Suppose a religion reemerged that believed in human sacrifice to appease a deity that controls earthquakes and volcanos. Are we to exempt believers from murder laws out of deference to their religious beliefs? The religious would counter that such an example is too far fetched and therefore the argument is null. Whatever they may say, the Bible commands animal sacrifice so it isn’t as far fetched as they might claim.

  33. Posted March 25, 2014 at 12:13 pm | Permalink

    I’d rather see a decent education in science being made mandatory. Informed people won’t make the dumb decision. Other coercive tactics such as charging higher health insurance premiums for non-vaxinated families would probably make people think twice about embracing this nonsense.

    • Posted March 25, 2014 at 2:36 pm | Permalink

      I like that. Unless (of course) there’s a legitimate medical reason to avoid vaccination, you get to pay through the nose for your religious privilege.

  34. Pete
    Posted March 25, 2014 at 3:17 pm | Permalink

    I’m afraid I made the mistake of browsing the first set of comments by NYT readers. It is a display of profound ignorance and misplaced priorities. Very depressing.

    • Diana MacPherson
      Posted March 25, 2014 at 4:40 pm | Permalink

      You have to be in the right mood when braving comments on sites like that.

  35. Posted March 25, 2014 at 3:41 pm | Permalink

    Yes.

    /@

  36. Filippo
    Posted March 25, 2014 at 4:57 pm | Permalink

    “The most shameful opinion is that given by former Surgeon General Jocelyn Elders, once the nation’s chief medical officer.”

    (Someone may have mentioned this; haven’t read the comments yet.)

    If I recall, Bill Clinton pressured Elders to resign because she recommended (perhaps as a “coping mechanism”?), as part of a birth control (/abstinence) strategy, masturbation. That appeared to so “offend” (the inner Catholic in) Clinton.

    I can’t help but think that she later took some quiet, deep retributive satisfaction in Clinton’s subsequent Oral Office Ordeal.

    • gbjames
      Posted March 26, 2014 at 5:18 am | Permalink

      I’m sure it was only his inner politician that was offended.

  37. nicky
    Posted March 25, 2014 at 7:21 pm | Permalink

    Jerry covered it pretty comprehensively, there is little to add, a part from the question of accountability.
    Jocelyn Elders is spot on with the first part of her comment:”…Not getting your child immunised is child abuse. …”, indeed it is. Her second part is completely topsy turvy: religion should not be exempt from accusations of child abuse, on the contrary.
    It follows that those preachers and reverends (and Dr Wakefields, let us not exempt the secular either) advocating anti-vax should be prosecuted for incitement to child abuse. I’m no lawyer, and I’m even less conversant with US law, but I would be surprised if that were not a prosecutable offence.

  38. Jimbo
    Posted March 25, 2014 at 7:29 pm | Permalink

    I remember Jocelyn Elders–she promoted condom distribution at schools and masturbation instruction as a safe sex practice. In short, Elders is suggesting that rubbers, rubbing one out, and rubbing alcohol on a child’s arm for inoculation all get religious exemptions. :-)

  39. Posted March 28, 2014 at 7:50 am | Permalink

    The Hippocratic dictum, “Do no harm,” is a widely accepted ethical principle, yet proposals that advocate mandatory vaccination for all except medical exemptions fail this test because they privilege the people who might be harmed by failure to vaccinate over the people who might be harmed by vaccination. The potential harms to these two groups of people creates an ethical dilemma that is not easy to resolve but one that most proponents of mandatory vaccination rarely address. First, mandatory vaccination proponents tend to dismiss the possibility that vaccines can cause unintended injuries and death by conflating claims of vaccine-induced autism with vaccine-induced injuries. Second, they claim that those with medical exemptions will be able to keep their exemptions, and those exemptions will be sufficient to prevent vaccine-induced injuries. Third, they make general statements that scientific studies have demonstrated vaccines to be safe. I’ll address each of these in turn.

    Ignoring the purported association with autism, there is substantial scientific and anecdotal evidence that vaccine-induced injuries do occur. The scientific literature that has conclusively established a causal link between vaccination and unintended injury has been reviewed by the Institute of Medicine (IOM) on numerous occasions, and their findings have been used by the National Vaccine Injury Compensation Program (VICP) (http://www.hrsa.gov/vaccinecompensation/index.html) to compensate those who have been injured or died. In 2012 the IOM published a report, “Adverse Effects of Vaccines: Evidence and Causality,” that “concluded the evidence convincingly supports 14 specific vaccine–adverse event relationships.

    Since the first VICP claims were filed in 1989, the US Court of Federal Claims has issued compensation awards for 3,540 of the 13,274 claims filed (26.7%). Approximately 7.4% of the awards were for deaths, or 265 people. Over $2.7 billion in compensation awards have been paid to petitioners, and over $109.3 million have been paid to cover attorneys’ fees and other legal costs. As these data show, people are injured and killed by vaccines every year, and medical exemptions to vaccines are insufficient to prevent these injuries. Medical exemptions are granted only AFTER adverse reactions to vaccines have occurred. The requirements for medical exemptions are very stringent, and many doctors are reluctant to grant them because of the potential professional consequences. Consequently, they tend to err on the side of not granting them, meaning that some people who should have been granted them are not.

    A second source of evidence comes from reports contained in the national Vaccine Adverse Event Reporting System (VAERS) (http://wonder.cdc.gov/vaers.html) which contains many thousands of reports of illnesses, health problems and/or symptoms following vaccination. Adverse events range from pain and swelling at the injection site, fever, and headaches to anaphylaxis, encephalitis and other serious neurological disorders such as seizures and paralysis and even death. Although the VAERS database contains unverified reports that could have been submitted by anyone, the majority of reports are submitted by physicians and presumably contain factually accurate information. Although VAERS data cannot be used to establish a causal relationship between vaccination and a temporally associated adverse event, VAERS data is used by the CDC and FDA for signal detection and hypothesis generation. Causal relationships between vaccination and adverse event is established during pre-licensure clinical trials and through the CDC-funded Vaccine Safety Datalink project.

    A second medical ethics principle that mandatory vaccination proposals violate is the principle of informed consent, which is particularly important when medical interventions such as vaccination can cause serious injury and death. Informed consent is a process for getting permission before conducting a healthcare intervention on a person. It involves open disclosure and a discussion between the health care provider and patient that results in a clear understanding of the facts, risks, benefits and likelihood of various consequences of an action (or inaction), and the need for informed consent applies to both medical treatments provided as part of routine clinical practice as well as research. In cases where individuals are unable to render informed consent, other persons, such as parents or legal guardians, are allowed to provide informed consent on their behalf. There is no US Federal legal requirement to establish informed consent prior to the administration of vaccines; however, that does not dismiss the ethical requirement for health care providers to provide care consistent with such principles. Mandatory vaccination for all but medical exemptions would violate this ethical requirement because there would be no requirement to obtain consent, informed or otherwise.

    Proponents of mandatory vaccination (to include existing vaccination requirements) argue that informed consent is not necessary because vaccination is for the greater good of society, and the risks of adverse reactions are so rare to virtually be non-existent. This is a classical example of utilitarianism, whose fundamental axiom is, “It is the greatest happiness of the greatest number that is the measure of right and wrong” (Jeremy Bentham, A Fragment on Government). Utilitarianism is a complex group of philosophical theories for which there are many supporting arguments. However, there are also many criticisms of it, not least of which it can lead to an “ends justify the means” mentality. Other criticisms include that it could ignore justice for individuals (innocent people could be punished for the greater good); it’s difficult and time-consuming to calculate utility; it’s nearly impossible to predict consequences or to maximize utility without favoritism; and it aggregates happiness, which is meaningless, because it is individuals who are happy, not mankind.

    Mandatory vaccination is a clear-cut example of many of these criticisms. The means is used to justify the end of protecting society from vaccine-preventable diseases, regardless of the harm it might cause to some people. Clearly one group of people is favored over another. Currently, there are few, if any, ways to reliably predict who will be harmed by a vaccine prior to its administration. For example, there is no test that can be given to determine if someone would be harmed—-vaccine administration itself is the test, and sometimes, the adverse reaction doesn’t immediately happen, so linking the test to the result is difficult. In its 2013 report on The Childhood Immunization Schedule and Safety, the IOM stated, ““The committee found that evidence from assessments of health outcomes in potentially susceptible populations of children who may have an increased risk of adverse reactions to vaccines (such as children with a family history of autoimmune disease or allergies or children born prematurely) was limited and is characterized by uncertainty about the definition of populations of interest and definitions of exposures and outcomes. Most children who experience an adverse reaction to immunization have a preexisting susceptibility. Some predispositions may be detectable prior to vaccination; others, at least with current technology and practice, are not . . .”

    Finally, it is all too easy to misuse utilitarian ethics. Nazi Germany justified euthanasia, medical experiments, and the Holocaust based on the greater good of the German people, bolstered by the latest German scientific evidence. Even in the US, utilitarianism has been used partly to justify conducting scientific studies without informed consent, such as the Tuskegee syphilis experiment.

    In addition to the utilitarian argument, scientific studies are often used to justify mandatory vaccination. Vaccination proponents point out that that no scientific studies have yet determined that vaccines can cause autism, and that vaccines are generally regarded as safe. This argument is a weak one for several reasons. First, just because no studies definitively show that vaccines can cause autism doesn’t mean that none ever will. Plenty of studies have already linked vaccination with brain damage and disorders, of which autism is one, and the VICP has awarded a number of claims that include autism among the alleged injuries. In addition, as the 2013 IOM report pointed out, “Most vaccine-related research focuses on the outcomes of single immunizations or combinations of vaccines administered at a single visit. Although each new vaccine is evaluated in the context of the overall immunization schedule that existed at the time of review of that vaccine, elements of the schedule are not evaluated once it is adjusted to accommodate a new vaccine. Thus, key elements of the entire schedule – the number, frequency, timing, order and age at administration of vaccines – have not been systematically examined in research studies . . .”

    Scientific facts are revised all the time based on new research. For example, the CDC has revised the amount of lead considered to be safe five times since 1970, from 60 micrograms per deciliter of blood to 5. It is the very nature of scientific knowledge to change; as Samuel Arbesman points out in his book, all facts have a half-life. Furthermore, the nature of scientific knowledge is probabilistic, because most scientific conclusions are based on probabilities, with p > .05 being the gold standard. That still leaves room for false positives and false negatives. And even though medical researchers try to base their conclusions on statistical evidence, the researchers are inherently biased by their background, training, experience, and affiliations. The peer review process is an attempt to eliminate bias, but reviewers and editors themselves are biased. Wakefield’s MMR-bowel disease study in autistic children was peer reviewed and published—until it was retracted. As the UK House of Common pointed out, there is “little solid evidence on the efficacy of pre-publication editorial peer review,” and John P. A. Ioannidis went so far as to say, “It can be proven that most claimed research findings are false.”

    Lastly, lest you should think I’m just some anti-vaxxer nut, I am a military retiree with 20 years of service and 3 deployments to war zones who received every major vaccine plus some, like anthrax. As a service member, I was subject to a mandatory vaccination policy; refusal would have resulted in court martial and punishment. In any case, at the time, I implicitly trusted that the government wouldn’t treat me with anything that was unsafe. I should have known better, because of the Agent Orange and other debacles, but after many Gulf War veterans began to experience symptoms that came to be known as Gulf War Syndrome, I began to doubt that the government had our best interests in mind. About 10 years after the first Gulf War, my wife and I had our first child. We followed the well-baby check-up schedule to a T, to include the required vaccines. At 4 months of age, our baby had an adverse reaction to her second DTaP injection. At that point, we researched the required vaccines and their potential side effects because our doctor failed to inform us of any potential side effects (and we had just assumed they were safe). I agonized over whether to give any more vaccines or to vaccinate our second child, given my general acceptance of government proclamations of safety, but I was also fearful of worse reactions, especially since our nephew is permanently disabled following the severe reaction to the seven vaccines he received at his 15-month well-baby visit which included DTaP. However, every parent cares more about their own child than all others, so my wife and I decided to forgo any further vaccines. We obtained a medical exemption for the DTaP vaccine for our first child but were not able to obtain one for any other vaccines.

    I firmly believe that every human being has a basic right to decide whether something goes into their body or not. And until there’s a test that can identify with 100% accuracy who would be harmed by receiving a vaccine, I am opposed to mandatory vaccination as being unethical and not fully justified by current scientific evidence.

    • gbjames
      Posted March 28, 2014 at 8:27 am | Permalink

      Rule 10 comes to mind.

      • Richard Olson
        Posted March 28, 2014 at 9:32 am | Permalink

        Seven separate and distinct Rule 10 hits appeared on page one of my Google search. I have no idea which, if any, of those might apply here.


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