First there’s the "Medically Exempt Refuser,” the person told by a physician that her child has a medical condition that makes vaccination inadvisable. Children like this depend on herd immunity, because immunization would put them at excessive risk.

A second sort we might call “Doing vs. Allowing Refusers.” These people think harms are not all alike. It’s worse when doing something to a child harms him, and different (not as bad) when something merely happens to a child. Giving a shot is active, so to be held to a higher standard. Better to be harmed by a disease, this thinking goes, than harmed by a doctor doing something to prevent a disease. If you take this attitude to the logical extreme, refusers of this sort will exempt their children from all vaccines, and from many other medical interventions as well. But in a more attenuated instance, the attitude is neither bizarre nor foreign to most of us. Suppose a vaccine called “Killsave” had this track record: it prevents a disease that’s been killing 3 percent of the population but it kills one out of a hundred people inoculated. Though ultralogical to use Killsave, most of us would not. We’d rather allow three deaths than actively cause one. This preference for allowing fizzles out when the risks of causing harm are very, very low, and what we are trying to prevent is both far more common and far more severe.

A third group we might call the “Critical Refusers.” Unlike those in the first three groups, these parents are critical of the science behind current vaccine mandates. For example, some Critical Refusers today believe that the MMR vaccine causes autism (despite overwhelming evidence to the contrary); others think that certain vaccine ingredients have very serious side effects (despite reassurance from medical experts). They have no objection to vaccines, in principle, but see the risks of using them as greater than the benefits—in sharp contrast to all mainstream medical organizations. It’s certainly not always benighted to be a Critical Refuser. Sometimes vaccine science is flawed or in the early days, and critics are right to be skeptical. For example, in the early days of the polio vaccine, there had been insufficient testing, and parents would have been on solid ground to say no.

Fourth, there are “Conscientious Refusers,” a type of refuser I’m naming by analogy with wartime conscientious objectors. People old enough to remember the draft in the era of the Vietnam War will remember Quaker pacifists being exempted from military duty. These were people who would not go to war under any circumstances, no matter how seemingly justifiable. They didn’t object to the Vietnam War per se and wouldn’t have been any more willing to fight in another war. They wouldn’t have fought for the United States against Hitler or with Darfurians against the genocidal Janjaweed— they don’t fight, period. The analogous refuser in the context of vaccination might be a member of the Church of Christ, Scientist, a church that frowns on all modern medicine, out of the belief that disease is always a mental problem, curable through faith healing. The church doesn’t require nonvaccination as a condition for membership, but a particularly ardent member might see her religious duties that way. This sort of conscientious objector didn’t vaccinate their children against smallpox in the 1940s, or against polio in the 1950s, or against tetanus in the 1960s. Today, this sort of refuser would reject all vaccines, but also all other preventative and curative medicine.

And fifth, there is the " 'Why Me?’ Refuser.” This refuser is happy to see other parents vaccinate their children—in fact, she wants as many children as possible to be vaccinated. Given how many do vaccinate, this refuser thinks there’s no need for her own children to be vaccinated. By simply living in a society with very high vaccination rates, this parent procures all the protection for her child she deems necessary. She’s all for herd immunity but refuses to immunize her own little calf.

Clearly the first group—the medically motivated refusers—have legitimate grounds for opting out. And just as clearly, the reasoning of the next two groups is dubious. You would have to have a highly inflated aversion to risks of doing, compared to risks of allowing, to think we mustn’t "do” vaccines, despite their low, low risks. In some time periods, a philosophical parent might justifiably have been a Critical Refuser, but not today. There is no good science backing the various media-driven worries about vaccines—no vaccine-autism link, for example.

That leaves the Conscientious and "Why Me?” Refusers. True Conscientious Refusers are extremely rare and prone to behavior much more worrisome than not vaccinating; they also don’t give their children antibiotics or allow operations and blood transfusions, and their children sometimes die as a result. If their freedom to dictate their children’s medical care should be restricted (and surely it should), it would take us very far afield to spell out the details, so I’m going to focus just on the "Why Me?” Refusers. They deserve most of our attention because they are far more numerous, and also because behind the facade of refusal for other reasons, often there lies a "Why Me?” Refuser. It’s far easier to scoff at science and mainstream medicine if you know that almost everyone else is complying with science and mainstream medicine, creating a community with a very low risk of vaccine-preventable diseases. It’s far easier to creatively concoct the other rationales for not vaccinating, knowing your kind of creativity is quite rare. If we get a grip on "Why Me?” Refusing, we may actually be tackling at least a large part of the thinking of all the refusers.

So what should we say to the "Why Me?” Refuser? If I can protect my child enough by relying on herd immunity, why should I subject my child to the small risks associated with all those shots? Do I have to contribute to a society-wide immunization program, just because I can’t help but receive its benefits?

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