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Dr. Singer worries that medical authoritarians would bend the arguments for vaccination to justify intrusions on liberty in the name of public health. Sadly, he is quite right. Already, nanny-state busybodies have ginned up "epidemics" of obesity and high blood pressure. Unlike people afflicted with contagious diseases, a fat person or a consumer of excessive amounts of salt cannot give someone else excess pounds or a heart attack. The arguments for vaccination apply only to situations in which innocent bystanders are at risk of being harmed by contagious microbes. Sticking to that limiting principle would prevent a fall down a slippery slope toward public-health totalitarianism.
Now let me directly address the issue of coercion. Dr. Singer—and many other readers—have been somewhat misled by the subhead on my article, “A pragmatic argument for coercive vaccination.” I did not see that subtitle until after the article was published. My original article was supposed to make a more modest argument that vaccine refusal puts others at risk and that people should be responsible for their own microbes. My intent was to leave open the question of how to hold the intentionally unvaccinated liable for the damage they cause others, hoping to provoke readers to think about the issue and debate it among themselves. I stand behind what I wrote, but the subtitle has evidently somewhat diverted that discussion.
Education and the incentives of the market have encouraged lots of Americans to get themselves and their children vaccinated. Surely those avenues of persuasion have not been exhausted and should be used more. Perhaps schools and daycare centers could attract clients by advertising that they protect their charges by refusing to admit unvaccinated students. Or social pressure might be exercised by parents who insist on assurances from other parents that their children are vaccinated before agreeing to playdates. But it would be naïve not to note that state requirements that public school children be vaccinated against many highly contagious diseases have more than merely nudged most parents into getting their children vaccinated.
In the case of vaccination, the non-aggression principle, the harm principle, and proper respect for the autonomy of others combine to point to the libertarian conclusion that the intentionally unvaccinated do not have a right to “swing” their microbes at other people.