Health officials in Washington state have declared a state of emergency as they struggle to contain a measles outbreak, with one new case diagnosed each day. Forty-eight new cases of measles have been found this year in Washington alone. In addition to this, measles cases have been reported in Hawaii, Oregon, New York, Pennsylvania, Connecticut, Colorado, California, and Georgia.
While there is some evidence that outbreaks stem from travel to or immigration from countries with lower levels of vaccine coverage, the fact that vaccination rates are lower in some communities across the country is significantly affecting the spread of dangerous diseases. A disease can’t spread among people immune to it, after all. In Washington, 41 of the 48 people who have come down with measles were not vaccinated.
Despite the demonstrated safety and efficacy of the measles vaccine, which is 93 percent effective with one dose and 97 percent effective with two doses, some parents are choosing not to immunize their children. By avoiding vaccination, they are not only endangering the health of their children, but also the health of their communities.
Time and time again, we are seeing that reduced vaccination rates are a driving force behind vaccine-preventable outbreaks. Last year, the Asheville Waldorf School in North Carolina experienced a widespread chickenpox outbreak, because 110 of the 152 students had not received a a chickenpox vaccine. According to a recent study, the number of non-medical exemptions (made for moral, personal, or other reasons) is increasing in many states that allow such exemptions, driving a reduction in vaccination rates.
Over recent years, the movement against vaccinations has become increasingly vocal. The so-called “anti-vaxxers” support their rejection of vaccines for a variety of reasons, such as religious or philosophical objections, the alleged risk of side-effects, supposed links to autism, questions regarding the efficacy of vaccines, and other debunked theories. The aggressive and deceptive movement actively targets new parents by weaponizing the stress parents feel when trying to make basic child-care decisions.
When deciding to refuse all vaccinations for non-medical reasons, whether for single or multiple immunizations, parents often state that their choice is a matter of personal liberty. On the face of it, this seems like a reasonable argument, as this logic applies to other child-care decisions, such as whether to breastfeed or bottle-feed, what type of diapers to use, or whether to homeschool. These are all clearly the parents’ decision. What is the difference between these examples and vaccinations for contagious diseases?
The answer is the idea of externalities—when your actions affect others who are not involved in the decision. The strength of vaccinations relies on herd immunity. When the majority of the population is vaccinated against a disease, the minority who are medically unable to be vaccinated remain protected, since the disease is unable to spread due to an insufficient number of hosts. However, if enough of the population are needlessly unvaccinated, the disease is able to spread, putting the lives of those who cannot be vaccinated at risk.
This is the reason vaccinations are not simply a matter of personal liberty, because they directly threaten and endanger the personal liberty of those who cannot be vaccinated. Supreme Court Justice Oliver Wendell Holmes Jr. famously stated that “The right to swing my fist ends where the other man’s nose begins.” In this case, refusal to vaccinate is the swinging fist, and the risk posed to others is the nose.
If the decision not to vaccinate was made on a deserted island, then there would be no externalities, and therefore no violation of others’ liberty. However, most parents make the decision not to vaccinate while their children remain part of mainstream society. In effect, they are making a choice that affects other people while requiring other people to bear the consequences of their decisions. This is a direct attack on the personal liberty of those put at risk as a consequence of their choices.
A simple analogy that describes this scenario involves fireworks. If you light fireworks while alone in the wilderness, then no one is endangered against his will. However, if you light fireworks in the middle of a crowded street, then your actions directly affect the personal liberty of anyone who is endangered. This shows that the level of risk posed to others has a direct correlation with the validity of the action.
Parents’ right to refuse vaccinations for their children should not include the right to impose the non-consensual consequences of non-vaccination upon others. If anti-vaccination advocates choose to cite personal liberty as their reason for not vaccinating a child, then they need to equally respect the personal liberty and health of those in their communities they endanger.