Self-identified Libertarians and Mandatory Vaccines (take 2)

[Estellea]

That may be true, but only for so long as the unvaccinated remain a tiny percentage of the population. Currently, the main driver toward vaccination is public school policy. If you want your child to get an education, get vaccinated or go through a hellish process of getting an exemption.

I'm pretty happy with this. It seems to be working well enough. The only thing you could toughen up is the religious exemption and that raises serious problems of its own.

True it's a hurdle but it can be done as there are already two states in the U.S. which do not allow religious exemptions, only medical. There is no constitutional protection for religious refusal of vaccination.

No, not really. However, I think the requiring vaccination of others is asking a great deal more than is asking you to tolerate others being unvaccinated. IOW, the cost to society due to the loss of individual freedom and autonomy is higher than the cost to society to allowing people to decline vaccinations.

No. My point is that the actual religious objectors are a small enough group (< 5%) such that if they were the only refusers, it would not endanger herd immunity. Likewise with the medical exemption. It's the people who are refusing because they don't think the vaccines are the best choice for their kids that are messing that up.

This is where an understanding of epi comes in handy. Herd immunity assumes equal distribution of susceptibles i.e. non-immune. But there is clustering of like-minded individuals who are creating gaps in herd immunity sufficient to sustain outbreaks. Add to that one of the most infectious diseases, measles and why the U.S. is experiencing the largest outbreak in over ten years. You also believe that people who sign a religious waiver are doing so for religious reasons and that is false. Twenty-one states have a philosophical waiver in addition to religious so that leaves 22 states with just religious. There are no organised religions which prohibit the use of vaccines and no scripture which precludes the refusal of vaccines. In essence, people are using religion to refuse vaccines simply because they don't want to vaccinate.

Okay. I agree there's no conspiracy as you are thinking of one. IMO, we can't trust the pharmaceutical companies for unbiased results. That's not a conspiracy theory though, just a general cynicism about how business works in the modern world.

Who said anything about solely trusting pharma results; vaccine safety and efficacy data extend far beyond pharma's grasp and don't forget there are many countries surveilling vaccine safety and efficacy.

That's not an unexpected outcome. On the other hand, such outbreaks are leading to more people deciding to vaccinate against those diseases. It is a self-correcting problem in that regard.

It should be but isn't, we keep seeing larger outbreaks of VPDs because people are stupid and selfish. They convince themselves that the victim did something wrong ergo they are doing everything right so will not suffer complications from disease.

I have a reasonable familiarity with epidemiology. It is the study of the spread of disease, with 'disease' being able to be defined quite loosely. I don't see how my understanding or lack of understanding of epidemiology has any bearing on this though. Why do you think that epidemiology is a argument that trumps allowing individuals to make their own choices about vaccines? It's not because of the risk to others, which is what my examples were about. So what is the reason?

You need more than a passing familiarity of the definition to arm yourself with the requisite knowledge to do a proper risk assessment. I read a blog post of a particularly arrogant anti-vaxx person who prided himself and his wife for having very high I.Q.s so could do his own risk assessment of both risk of infection as well as complications. His maths were so laughable and crude that I hurt myself face-palming. He didn't take into account such basic (for an epidemiologist) factors as the infectivity rate of a disease and population at risk. I think he was representative of the average anti-vaxxer who ignorantly believes they possess as much or sufficiently enough knowledge to make such decisions.

Este

 

[Beth]

Why do you think that epidemiology is a argument that trumps allowing individuals to make their own choices about vaccines? It's not because of the risk to others, which is what my examples were about. So what is the reason?

You need more than a passing familiarity of the definition to arm yourself with the requisite knowledge to do a proper risk assessment. I read a blog post of a particularly arrogant anti-vaxx person who prided himself and his wife for having very high I.Q.s so could do his own risk assessment of both risk of infection as well as complications. His maths were so laughable and crude that I hurt myself face-palming. He didn't take into account such basic (for an epidemiologist) factors as the infectivity rate of a disease and population at risk. I think he was representative of the average anti-vaxxer who ignorantly believes they possess as much or sufficiently enough knowledge to make such decisions.

Este

This doesn't answer the question I posed. Why do you think that epidemiology is a argument that trumps allowing individuals to make their own choices about vaccines?

 

[Diogenes]

This doesn't answer the question I posed. Why do you think that epidemiology is a argument that trumps allowing individuals to make their own choices about vaccines?

Yes, yes it does, for the reasons Estellea already enumerated. If you don't understand how disease moves through a population then you can't accurately model the risk you impose on yourself and others.

Current data on outbreaks are not resulting in an increase in vaccination rates. If anything the number of Personal Belief Exemptions in California are still rising.

Your "freedom" to not vaccinate can directly impact the health of people around you...not even just "around you" but can ripple out though many Kevin Bacons.

People given more "freedom" to avoid vaccinations are harming other people that either can't be vaccinated (by virtue of age or allergy or being immunocompromised) right now. This isn't a hypothetical this is real right now.

 

[Beth]

Yes, yes it does, for the reasons Estellea already enumerated. If you don't understand how disease moves through a population then you can't accurately model the risk you impose on yourself and others.

And if you don't understand how carbon dioxide in the atmosphere adds to global warming, you can't accurately model the risk you impose on yourself and others. If you don't know the probability of accidents, you can't compute the risk to others when you drive. So? Does the inability to do so imply that we shouldn't be allowed to decide when an extra car trip to the store is worth the additional harm to others?

Current data on outbreaks are not resulting in an increase in vaccination rates. If anything the number of Personal Belief Exemptions in California are still rising.

It's difficult to say since PBE's are required to skip or delay even one vaccine in California.
But here's an example of where it changed to more vaccinations rather than less:

http://www.healthline.com/health-news/children-texas-megachurch-measles-vaccination-082613

Your "freedom" to not vaccinate can directly impact the health of people around you...not even just "around you" but can ripple out though many Kevin Bacons.

Yes, it does. That alone is not sufficient to justify vaccinating.
From my previous post:

As far accepting preventable deaths for the sake of "personal freedom" we do that all the time. We could prevent thousands of deaths due to motor vehicle accidents by simply reducing the maximum speed limit to 20 mph everywhere. We could prevent thousands of deaths due to lung cancer, emphysema, etc. by making the possession of any tobacco products illegal. Is it then intrinsically less ethical to support speed limits above 20 mph or the legality of smoking?

People given more "freedom" to avoid vaccinations are harming other people that either can't be vaccinated (by virtue of age or allergy or being immunocompromised) right now. This isn't a hypothetical this is real right now.

Yes, I agree that can be harmful to other people. I don't agree that the harm is sufficient to justify insisting on vaccinations for others. To some extent, this is a problem of different values. Can you quantify the risk to others for one or more vaccines and compare it with other situations like driving, smoking, etc.?

In general, because unwanted injections are a big violation of bodily integrity and most vaccines are given that way, I tend to be opposed to mandating it over an individuals objections more than I would be opposed to regulating how much driving an individual is allowed or making tobacco products illegal because I see those restrictions as considerably less of an affront to individual freedom.

 

[Estellea]

This doesn't answer the question I posed. Why do you think that epidemiology is a argument that trumps allowing individuals to make their own choices about vaccines?

Diogenes already answered and so did I. There isn't a single anti-vaxxer who can formulate a risk assessment that isn't based upon magical-thinking that's why. And that goes for those with the requisite biomedical education and experience too who have chosen to reject their training. The same goes for the average parent who has conjured up a myriad of horrible diseases and disorders they attribute to vaccines. If they had a sound education in epidemiology then they wouldn't succumb to such urban myths.

Este

 

[Beth]

Diogenes already answered and so did I. There isn't a single anti-vaxxer who can formulate a risk assessment that isn't based upon magical-thinking that's why. And that goes for those with the requisite biomedical education and experience too who have chosen to reject their training. The same goes for the average parent who has conjured up a myriad of horrible diseases and disorders they attribute to vaccines. If they had a sound education in epidemiology then they wouldn't succumb to such urban myths.

Este

It seems to me that epidemiology argument assumes that the benefits of mandating vaccinations are sufficient to justify overriding the bodily integrity and freedom to make personal health choices for oneself. I don't agree and I haven't seen any responses that acknowledge the harm of such mandates and weighs it against the benefits of herd immunity. There is simply an assertion that because it may cause harm to others not to vaccinate, it should be required. That it can cause harm to others is NOT sufficient justification without the details of exactly what those risks are and why they justify mandating vaccinations for those who don't want them.

 

[Diogenes]

...There is simply an assertion that because it may cause harm to others not to vaccinate, it should be required. That it can cause harm to others is NOT sufficient justification without the details of exactly what those risks are and why they justify mandating vaccinations for those who don't want them.

What you're continually choosing to overlook is that this is not hypothetical. There's no "may cause harm" there's "more disease, some of those infected die".

Breaks in immunization coverage results in outbreaks. Some people infected die. This is not hypothetical.

It DOES cause harm to others. That's supported by the science, pretty sure I linked some of that on the first page. Is knowing that it DOES cause harm sufficient justification?

Pathogens don't care about idealism.

 

[Beth]

What you're continually choosing to overlook is that this is not hypothetical. There's no "may cause harm" there's "more disease, some of those infected die".

Breaks in immunization coverage results in outbreaks. Some people infected die. This is not hypothetical.

It DOES cause harm to others. That's supported by the science, pretty sure I linked some of that on the first page. Is knowing that it DOES cause harm sufficient justification?

Pathogens don't care about idealism.

I'm not overlooking or disputing the harm it may cause. I'm asking you to quantify the harm and compare it to other harms we allow people to choose for themselves (like smoking or driving) in order to justify your contention that the harm of people deciding not to vaccinate is sufficient to justify mandating that they do. So far, your argument seems to consist of 'it's harmful if people don't vaccinate therefore we must force them to even if they don't want it'. That isn't sufficient.

If you want to change our current policies and beef up the penalties for not vaccinating, you need to show that the change is sufficiently beneficial to justify the costs - i.e. the loss of freedom of individual choice on the matter, the costs of implementing such a change and punishing violators. I suggest you try it with just one vaccine - say measles or whooping cough, both of which are experiencing outbreaks.

 

[Diogenes]

...

It's difficult to say since PBE's are required to skip or delay even one vaccine in California.
But here's an example of where it changed to more vaccinations rather than less:

http://www.healthline.com/health-news/children-texas-megachurch-measles-vaccination-082613

...

The megachurch is in Texas (and is old news), that hardly refutes the increases in refusal in California. Your point about PBEs is accurate but I'll submit it more likely they're avoiding vaccinations.

 

[Diogenes]

I'm not overlooking or disputing the harm it may cause. I'm asking you to quantify the harm and compare it to other harms we allow people to choose for themselves (like smoking or driving) in order to justify your contention that the harm of people deciding not to vaccinate is sufficient to justify mandating that they do. So far, your argument seems to consist of 'it's harmful if people don't vaccinate therefore we must force them to even if they don't want it'. That isn't sufficient.

If you want to change our current policies and beef up the penalties for not vaccinating, you need to show that the change is sufficiently beneficial to justify the costs - i.e. the loss of freedom of individual choice on the matter, the costs of implementing such a change and punishing violators. I suggest you try it with just one vaccine - say measles or whooping cough, both of which are experiencing outbreaks.

This is where you're trying to trump science with your ideology. You appear to be claiming that the cost to your "freedom" is too high despite the deaths associated with pertussis, primarily amongst children that are too young to be vaccinated...which is a good example as booster rates in our population are low.

You're still trying to compare it to smoking and driving.

You can't kill a newborn from 3 states away and through a series of 4 other drivers but you can kill a newborn by not vaccinating and having the pathogen spread through a series of 4 other non-vaccinating people. It would be next to impossible to prove that you were in that transmission chain so the "sue them" libertarian idea would obviously fail to reinforce the need for staying up-to-date.

 

[Beth]

The megachurch is in Texas (and is old news), that hardly refutes the increases in refusal in California. Your point about PBEs is accurate but I'll submit it more likely they're avoiding vaccinations.

I've no doubt they are avoiding some vaccinations. But what I've read indicates that relatively few are avoiding any and all vaccinations. When discussing the harm to others (justification for mandates) it's a very different matter if they are avoiding the Gardasil vaccine versus MMR.

 

[Estellea]

It seems to me that epidemiology argument assumes that the benefits of mandating vaccinations are sufficient to justify overriding the bodily integrity and freedom to make personal health choices for oneself. I don't agree and I haven't seen any responses that acknowledge the harm of such mandates and weighs it against the benefits of herd immunity. There is simply an assertion that because it may cause harm to others not to vaccinate, it should be required. That it can cause harm to others is NOT sufficient justification without the details of exactly what those risks are and why they justify mandating vaccinations for those who don't want them.

First let me say that I believe in limited mandates for vaccines by removing philosophical and religious exemptions for public schools so parents can choose private schools or homeschool. This is the cost for being in a society. I also would argue that teachers, daycare workers and healthcare workers have to be current on their vaccinations. That said, the epidemiology of diseases is sufficient to "override bodily integrity". Sorry but that is a poor argument and is irrational. What harm from such a mandate do you predict? Until you can provide one then merely arguing from assertion is insufficient. It does cause harm to others by not vaccinating. How many examples do you need to understand this? Pertussis prevalence is higher than it has been since pre-vaccine and measles was declared eliminated from the U.S. in the early 2000's but we now have 600 cases with numerous hospitalisations. How much do you know about SSPE? Some parents will get to wonder now if their child will get that a few years from now.

Yes vaccines aren't risk free but the risk of harm from a vaccine is orders of magnitude lower than from the wild-type diseases and these risks are well-known; the fact that you don't seem to know them but making the argument you are is worrying. Although it does strengthen the assertion that the average parent doesn't really know enough to make a valid informed decision if they reject vaccines.

Este

 

[Beth]

This is where you're trying to trump science with your ideology. You appear to be claiming that the cost to your "freedom" is too high despite the deaths associated with pertussis, primarily amongst children that are too young to be vaccinated...which is a good example as booster rates in our population are low.

Er, I not trying to 'trump' science with ideology. I'm saying that we have to make a value judgment about the risks and benefits of both courses of action. Ideology is part of setting the value of various costs such as freedom of choice and risk of harm. That doesn't so much 'trump' science as require it. Science is what we use to quantify the harms and benefits.

You're still trying to compare it to smoking and driving.

Yes. You can compare it to some other situation where people are allowed to make choices that have inherent risks to others if you like. They were simply the first that came to my mind. What do you think it should be compared to?

You can't kill a newborn from 3 states away and through a series of 4 other drivers but you can kill a newborn by not vaccinating and having the pathogen spread through a series of 4 other non-vaccinating people. It would be next to impossible to prove that you were in that transmission chain so the "sue them" libertarian idea would obviously fail to reinforce the need for staying up-to-date.

Where did the idea of "sue them" come from? I asked for a quantification of the harm that can be expected from allowing people the choice to vaccinate without more serious penalties than exist right now (it's required for public school attendance).

 

[Diogenes]

...Although it does strengthen the assertion that the average parent doesn't really know enough to make a valid informed decision if they reject vaccines.

Este

As we can see with the tragic cases of vitamin K deficiency based on "informed" refusals of that shot.

I have no idea how we fix this lack of information.

 

[Diogenes]

....They were simply the first that came to my mind. What do you think it should be compared to?


Where did the idea of "sue them" come from? I asked for a quantification of the harm that can be expected from allowing people the choice to vaccinate without more serious penalties than exist right now (it's required for public school attendance).

Eh, that's generally where the libertarian-oriented go as a remedy for low vaccination rates, feel free to disregard.

I think we should stick to actual data rather than trying to make-up an analogy. If you insist on an analogy then maybe compared to injecting random things into bottles of aspirin at a distribution center as you can't kill someone at even 2 degrees of separation by either driving or smoking.

 

[ehcks]

I'm not overlooking or disputing the harm it may cause.

No, it is not "may cause" it is "does cause."

If it were not for anti-vaccinators, measles would not exist in this country, and polio would be globally extinct.

Because of anti-vaccinators, those and other diseases do harm and do kill people. That is not "may cause harm."

 

[Beth]

First let me say that I believe in limited mandates for vaccines by removing philosophical and religious exemptions for public schools so parents can choose private schools or homeschool.

I don't because private schools and homeschooling is not a viable option for all families.

This is the cost for being in a society. I also would argue that teachers, daycare workers and healthcare workers have to be current on their vaccinations.

I won't argue this point. Vaccination requirements for certain jobs are reasonable and appropriate and people can change jobs if they want.

That said, the epidemiology of diseases is sufficient to "override bodily integrity". Sorry but that is a poor argument and is irrational. What harm from such a mandate do you predict?

The harm of establishing that the government is entitled to make personal health care decisions for individuals. The harm of forcing injections on citizens or their children against their will. I consider both of these to be significant harms. I can understand if you don't share these values, but I don't consider the potential harm of allowing people to decide against the current vaccines to be sufficient to justify those harms. As I said earlier, outbreaks of the diseases tend to result in people reconsidering their personal cost/benefit of the vaccine and deciding that they are worthwhile.

Until you can provide one then merely arguing from assertion is insufficient.

See above.

It does cause harm to others by not vaccinating. How many examples do you need to understand this?

I do understand this. I'm not disputing it. I've asked you to quantify it and compare it to other harms that people are allowed to inflict on others in our society.

Yes vaccines aren't risk free but the risk of harm from a vaccine is orders of magnitude lower than from the wild-type diseases and these risks are well-known; the fact that you don't seem to know them but making the argument you are is worrying. Although it does strengthen the assertion that the average parent doesn't really know enough to make a valid informed decision if they reject vaccines.

Este

I'm generally in favor of vaccinations. I agree that the risk to an individual from vaccinating is far lower than the risk of their getting the disease. That's irrelevant to the argument of whether or not the harm of allowing them to choose not to vaccinate is sufficient to justify overriding their ability to make such choices for themselves.

 

[Beth]

Eh, that's generally where the libertarian-oriented go as a remedy for low vaccination rates, feel free to disregard.

Okay.

I think we should stick to actual data rather than trying to make-up an analogy. If you insist on an analogy then maybe compared to injecting random things into bottles of aspirin at a distribution center as you can't kill someone at even 2 degrees of separation by either driving or smoking.

I don't think that injecting random things into bottles of aspirin is currently an accepted risk to others that people are legally allowed to make as smoking and driving are - i.e. it's a legally acceptable choice that inflicts some harm on others and we accept some restrictions on those choices for the overall benefit of society.

We already have some restrictions on people who choose not to vaccinate. You think we need more because so many people are choosing not to vaccinate. I think the fact that so many people are choosing not to vaccinate should be considered a symptom of problem with our health care system. Restricting people's ability to make that choice is treating the symptom (people choosing not to vaccinate) rather than the cause (lack of confidence official health care recommendations).

 

[Estellea]

I'm not overlooking or disputing the harm it may cause. I'm asking you to quantify the harm and compare it to other harms we allow people to choose for themselves (like smoking or driving) in order to justify your contention that the harm of people deciding not to vaccinate is sufficient to justify mandating that they do. So far, your argument seems to consist of 'it's harmful if people don't vaccinate therefore we must force them to even if they don't want it'. That isn't sufficient.

If you want to change our current policies and beef up the penalties for not vaccinating, you need to show that the change is sufficiently beneficial to justify the costs - i.e. the loss of freedom of individual choice on the matter, the costs of implementing such a change and punishing violators. I suggest you try it with just one vaccine - say measles or whooping cough, both of which are experiencing outbreaks.

You're claiming that parents, including yourself can accurately develop risk assessments but you're asking this? I would suggest starting here: http://www.cdc.gov/vaccines/pubs/pinkbook/index.html and I'm sorry but equating vaccine mandates with a loss of freedom is just hysterical. I don't think that "penalties should be beefed up" that's just a strawman.

Este

 

[Beth]

You're claiming that parents, including yourself can accurately develop risk assessments but you're asking this? I would suggest starting here: http://www.cdc.gov/vaccines/pubs/pinkbook/index.html and I'm sorry but equating vaccine mandates with a loss of freedom is just hysterical. I don't think that "penalties should be beefed up" that's just a strawman.

Este

I'm not claiming that all parents can and should develop risk assessments in order to make that decision for themselves. I'm saying if you want to change the current system, you need to be able to quantify the harm of the current system and the costs and benefits of the change. A risk assessment is necessary to that argument.

If you don't think that 'penalties should be beefed up', that's fine. But that's not what previous posters on this thread have suggested.

ETA: You might consider defining what you mean by 'mandate'. I don't consider current laws to mandate vaccinations by making them the default for public school enrollment. It doesn't sound like we have all that much disagreement in that regard.