A correspondent tells me I wasn’t clear in my previous post on vaccine denial, so let me clarify.
Suppose there are 2 preschools, each with 100 kids. In the first, 80 kids are vaccinated. In the second, 97 kids are vaccinated. In the school with the high vaccination rate, a non-vaccinating parent who changed her mind would protect her child—but her contribution to protecting everyone else is almost zero: herd immunity in a school where 97/100 kids are vaccinated has already kicked in.
In the low-vaccination school things are different. The 81st parent to vaccinate her child protects both her own child and, through herd immunity, other people’s children as well.
Because the impact is different, the ethics are different as well. We can justify coercing parents when doing so protects other children. Justifying coercion when only the parent’s own child is affected is much harder.
Mandated vaccines will increase vaccination rates among those with tepid anti-vaccination beliefs, but some people have very strong beliefs, and will not be persuaded despite the evidence. These non-vaccinating parents might use a different scientific method than Jonas Salk, but they have thought about the issue carefully by their own lights, and they clearly want what’s best for their children. They are not child-abusers. What do we do with them?
Some would say that even if 97 out of 100 kids are vaccinated, we should coerce the remaining 3 parents to vaccinate their children. This is the position of California’s new law, and it’s the position I called harsh.
The risk of their vaccine denial is small, at least where herd immunity exists. In 2015 to date, there have been 189 cases of measles in the United States, and over the past 10 years there has been an average of 1 death a year nationwide.
Set against this risk are the less tangible—but still very real—risks of the sanctions for non-vaccination. Under the new California law, children who are not vaccinated may not attend school. No doubt under the right conditions home-schooling can be good, but forced home schooling runs the risk of limiting a child’s cognitive, physical, social, and emotional development. Whatever the risks of vaccine refusal, compounding those with school denial does not put the child’s interests first.
Hence my proposal for a cap-and-trade system in vaccine denial. In a school of 100 kids, 7 vaccine-denial slots would be auctioned off to the highest bidder, where bids are defined as a percent of income. This proposal would expand the choices for vaccine skeptics: instead of having to choose between compliance or home schooling, they would have two additional choices: pay or move to a school with fewer vaccine deniers. Because the bids would be evaluated as a percent of income, all parents could equally afford the privilege of following their own science on vaccines.
Public health has been called the science of social justice. We should extend our justice even to those with whom we disagree, and we should more carefully design policies to maximize opportunities for healthy development.