Monday, April 28, 2014

Do Proponents of Mandatory Vaccinations Have a Point?

Between the fact that it's World Immunization Week and the Center for Disease Control and Prevention's (CDC) recently published a statement on the benefits of immunizations, I started to think about vaccines and their benefits. The truth of the matter is that vaccines work. Vaccines have averted 2-3 million deaths per annum; they also have completely eradicated smallpox and rinderpest. As the infograph from UNICEF below shows, vaccines have greatly reduced the incident rate of many diseases, including polio, measles, tetanus, malaria, and whooping cough. The World Health Organization, the American Academy of Pediatrics, the National Institutes of Health, and the CDC all agree that vaccinating children is a good idea. I'm sure that there are naysayers out there, and my response is this: much like any other health-based procedure (e.g., circumcision), there are always risks, but the risks of vaccines are few and far in between (also see here), and are certainly much, much smaller than the benefits derived from vaccines.      

If vaccines are so great, then it would make sense for everyone to voluntarily get vaccinated. However, there are still a sizable amount of people who refuse to do so. The question I would like to ask here is not about the efficacy of vaccines, but rather about whether the government should mandate that citizens get vaccinated.  

In the United States, we currently have de facto opt-out system. What this means is that children who enter public schools are required to get vaccinated. However, if the parents finds that vaccination violates their [religious] beliefs or there is a legitimate medical issue, they can file for an exemption. 48 states allow for religious exemptions, and 19 allow for exemptions based on philosophical grounds. For most states, parents are not so much coerced to vaccinate their children as they are coaxed in doing so.

The premise behind the opt-out system is to prevent the negative externality of the spreading of communicable diseases while showing some respect for one's personal liberties. The question here is whether the negative externality argument is legitimate enough to warrant the government mandating that everyone get vaccinated.

We cannot make a blanket statement about vaccinations because it partially depends on the disease for which one is being vaccinated. There are diseases such as the chicken pox, influenza or rotavirus for which the threat of death is minute, which is to say that the immune system can fight off those sorts of diseases just fine. Measles, meningitis, or polio...that's a different story. It also depends on the extent of the outbreak of the disease, which, if bad enough, might justify government-mandated vaccinations. But short of a pandemic of epic proportions, it's hard to justify such paternalistic impulses.

If you want to ignore the fact that vaccines have been a medical innovation that have saved millions of lives, that should be your prerogative. Unlike with the negative externality of pollution, the individual is not in control of the disease; there is no way to determine with certainty whether the individual will actually pass on the disease. Plus, if the only ones who get ill are the non-vaccinated, the only ones who would contract the disease are other non-vaccinated individuals. Those who want to be immune from a certain disease will get vaccinated, and those who are neglectful in that will pay the price for making that choice. It's no different from telling someone to stop smoking, drinking heavily, or eating a voluminous amount of unhealthy food. In a free society, you are allowed to make whatever intelligent or idiotic health-related decisions you want regarding your body as long as you are not harming others. In spite of what criticisms I have of the British health care system, at least the British government allows for voluntary vaccination, and it works.

If we are to keep the system we have, the government should allow for a way to opt out of vaccinations, regardless of religion or philosophical persuasion. Informing individuals of the benefits of vaccinations would also help. Conversely, I don't see any pronounced negative externalities that would require an opt-out system, so why don't we give a system based on voluntary vaccinations a shot?

2-5-2015 Addendum: With all of the hullabaloo I have seen on Facebook regarding vaccines lately, I thought that I would slightly modify my position on the issue. At the end, I thought that an opt-out system was unnecessary. In order for there to be a legitimate case for requiring an opt-out system, two things need to be the case: 1) vaccines actually work, and 2) herd immunity is ineffective because not enough individuals are vaccinated. I don't have a problem with the first bit; vaccines do work. If you don't think they do, well, that's a problem, to put it lightly. As for the second part, it's trickier, partially because herd immunity is different for each disease. However, if there are a sizable amount of people not getting vaccinated, like we currently experience, then an opt-out system is required to protect public health. In this case, diseases and viruses are a negative externality, and people are unable to control them. For many diseases, a vaccine is the best approach. If you have an exigent medical condition, then you should receive an exemption. Religious exemptions are trickier, but on the whole, they should not be considered because their freedom to not get vaccinated affects others around them. On the whole, vaccinating children should be the default because we should not put ourselves in a situation in which we infringe on other peoples' lives, intentionally or otherwise.


  1. Very logical, and I do like your conclusion.

    I think you missed one important fact: vaccines have more severe adverse effects than originally believed. Some vaccines have more adverse effects than others, and the cumulative number of vaccines received seems to play a role. Adverse effects not originally anticipated include autoimmune and seizure disorders, neither of which are fully understood.

    A lot of people are delaying or even turning down vaccines because they know someone who had a reaction. With some vaccines (like flu shot, MMR, and hepatitis B)having overhyped safety and efficacy, and some diseases (like flu and measles) having overhyped dangers, shouldn't we worry when states mandate a vaccination schedule, particularly one that does not prioritize safety?

    Why are there no protocols for screening patients for risk of vaccine reaction? Some of those risks are actually known.

  2. Approved vaccines are not only safe and effective for individuals, but cost-effective for the larger community. And, when taken non-orally, are kosher, too. Encouraging opt-out, except for specific personal health reasons like an immune deficiency, is subordinating good health to political dogma. For more, see