45 Enemies of Freedom" list (August/September 2013). That selection brought forth a deluge of mail, such as this succinct riposte from reader Christopher Kent: "Freedom doesn't get much more personal than the right of individuals to choose what is put into their bodies, and to accept or reject medical procedures."Few issues divide libertarians so emphatically as government-mandated vaccinations against communicable diseases, as reason discovered after including anti-vaccine activist Jenny McCarthy in our "
But what happens when one person's individual choice leads to the otherwise preventable infection of another person who chooses differently? How do you assign property rights and responsibilities to an airborne virus? And how far can or should the state intrude into family decisions that affect the safety and health of children? The issue seems almost tailor-made to produce philosophical conflict among those who otherwise share a heightened skepticism of government power.
This is no mere debate-society chum. Over the last 15 years, spurred on by McCarthy and other high-profile advocates who claim that vaccinations may cause such damaging side effects as autism, more parents are opting out of vaccinations for highly contagious diseases for their children. A 2011 survey by the Associated Press reported that exemption levels in eight states now exceed 5 percent.
At the same time, incidence and morbidity of diseases such as whooping cough are back on the rise. reason Science Correspondent Ronald Bailey, who contributes to our forum below, has argued forcefully that the popularization of junk anti-vaccine science, and the resulting increase in opt-outs, has led to scores of needless deaths, thousands of hospitalizations, and tens of thousands of cases of preventable illnesses.
Yet neither vaccines nor the diseases they combat are 100 percent predictable or controllable. Pathogens adapt, hosts develop resistance, unforeseen consequences arise. As Jeffrey Singer, a general surgeon and longtime libertarian activist, points out below, "Not everyone who is vaccinated against a microbe develops immunity to that microbe. Conversely, some unvaccinated people never become infected."
That uncertainty does not stay the government's hand. Currently, all 50 states and the District of Columbia include at least some form of state-mandated vaccinations for young children who are entering school (including all public and most private institutions). The usual diseases targeted include the mumps, measles, rubella, polio, diphtheria, tetanus, pertussis, and varicella (chickenpox). Typically, parents can only opt out after demonstrating a philosophical or religious objection. One of the last official acts of the famously paternalistic former New York City Mayor Michael Bloomberg (who also made our "45 Enemies of Freedom" list) was to make flu shots mandatory for all children under 5 who are enrolled in city-licensed schools or daycare facilities. As clinical physician Sandy Reider makes clear below, government keeps expanding the list of mandatory vaccines. It now often includes diseases, such as hepatitis B, that rarely affect children.
So what is the proper role for government, and the citizenry, in the vaccination of children? The lines are hard to draw; all the more reason to have a reason debate. Below, Bailey, Singer, and Reider take the scalpel to each others' arguments, in the hope of bringing more practical and philosophical clarity to a divisive topic.
Refusing Vaccination Puts Others at
Millions of Americans believe it is perfectly all right to put other people at risk of death and misery. These people are your friends, neighbors, and fellow citizens who refuse to have themselves or their children vaccinated against preventable infectious diseases.
Aside from the issue of child neglect, there would be no argument against allowing people to refuse government-required vaccination if they and their families were the only ones who suffered the consequences of their foolhardiness. But that is not the case in the real world. Let's first take a look at how vaccines have improved health, then consider the role of the state in promoting immunization.
Vaccines are among the most effective health care innovations ever devised. A November 2013 New England Journal of Medicine article, drawing on the University of Pittsburgh's Project Tycho database of infectious disease statistics since 1888, concluded that vaccinations since 1924 have prevented 103 million cases of polio, measles, rubella, mumps, hepatitis A, diphtheria, and pertussis. They have played a substantial role in greatly reducing death and hospitalization rates, as well as the sheer unpleasantness of being hobbled by disease.
A 2007 article in the Journal of the American Medical Association compared the annual average number of cases and resulting deaths of various diseases before the advent of vaccines to those occurring in 2006. Before an effective diphtheria vaccine was developed in the 1930s, for example, the disease infected about 21,000 people in the United States each year, killing 1,800. By 2006 both numbers were zero. Polio, too, went from deadly (16,000 cases, 1,900 deaths) to non-existent after vaccines were rolled out in the 1950s and 1960s. Chickenpox used to infect 4 million kids a year, hospitalize 11,000, and kill 105; within a decade of a vaccine being rolled out in the mid-1990s, infections had dropped to 600,000, resulting in 1,276 hospitalizations and 19 deaths. Similar dramatic results can be found with whooping cough, measles, rubella, and more.
And deaths don't tell the whole story. In the case of rubella, which went from infecting 48,000 people and killing 17 per year, to infecting just 17 and killing zero, there were damaging pass-on effects that no longer exist. Some 2,160 infants born to mothers infected by others were afflicted with congenital rubella syndrome-causing deafness, cloudy corneas, damaged hearts, and stunted intellects-as late as 1965. In 2006 that number was one.
It is certainly true that much of the decline in infectious disease mortality has occurred as a result of improved sanitation and water chlorination. A 2004 study by the Harvard University economist David Cutler and the National Bureau of Economic Research economist Grant Miller estimated that the provision of clean water "was responsible for nearly half of the total mortality reduction in major cities, three-quarters of the infant mortality reduction, and nearly two-thirds of the child mortality reduction." Providing clean water and pasteurized milk resulted in a steep decline in deadly waterborne infectious diseases. Improved nutrition also reduced mortality rates, enabling infants, children, and adults to fight off diseases that would have more likely killed their malnourished ancestors. But it is a simple fact that vaccines are the most effective tool yet devised for preventing contagious airborne diseases.