“WHY ME?” REFUSERS

A popular book about vaccination, The Vaccine Book, by Robert Sears, MD, articulates and defends "Why Me?” refusing. Dr. Sears does so explicitly, but he also does so implicitly—by reporting the incidence of vaccine-preventable diseases in a certain way. When we consider the necessity of vaccinating, we have to think about the chances of our child being infected by a particular germ. We don’t vaccinate against diseases that are rare in the United States, just because they still occur in Africa or Australia. Sears reports the incidence of vaccine-preventable diseases based on what’s happening here and now, in the United States, where there are very high rates of vaccination. Thus, the incidence of polio becomes zero. Who would bother to vaccinate against a disease with an incidence of zero?

Tetanus is so rare, on his estimation, that only five people a year are hospitalized with it. Diphtheria is also nothing much to worry about: "This illness is so rare that I put the risk at close to 0 for all age groups.” Measles led to just five hospitalizations in one recent year. There is no benefit to vaccines, looking at the data this way; to Sears and his adherents, vaccines ward off nonexistent threats.

Looking at it without taking vaccination for granted, the picture would be very different. It’s hard to say how widespread polio would be today if nobody vaccinated, but there is no doubt that it would be far more prevalent than it is. Before vaccination started in the 1950s, children were being affected at a rate of 40,000 to 50,000 cases per year in the United States. In 1952, the peak year, there were over 57,000 cases; 21,000 children suffered some degree of permanent paralysis, and 3,000 died. In contrast, since 1979, no cases have originated in the United States, thanks to the inoculation of millions of children. But according to the Centers for Disease Control, polio would come back if people stopped vaccinating young children. In fact, there have been outbreaks in the United States in communities with low vaccination rates, including an Amish community. Fears about vaccination have resulted in polio resurgences in Pakistan, Afghanistan, Syria, and several countries in Africa.

Measles is now uncommon in the United States, but it has been making a comeback in communities with lower-than-average rates of vaccination. In the rest of the world, low rates of vaccination precede higher rates of the disease. The World Health Organization reported 158,000 deaths from measles worldwide in 2011, with deaths resulting from complications such as pneumonia. Likewise, diphtheria is uncommon to rare in places where people vaccinate, but on the resurgence where they resist vaccination drives. And the same goes for other vaccine-preventable diseases.

Suppose money is needed to repair a leaky roof at your child's elementary school. Must you contribute, so your child can learn without water dripping on her head? Sears’s way of representing the need would presume the contributions of all other parents, which might be sufficient to pay for the repairs, considering that there are some parents who like to be especially munificent. Oh good, you don’t have to contribute! But the more reasonable approach is to look at the bill for the repairs before anyone has contributed, and decide what’s your fair share. The more reasonable approach to disease threats, likewise, is to ask yourself what the threat would be today if nobody vaccinated, and then determine how many need to vaccinate, to reduce the threat to a tolerable level.

But suppose you do think about risks in Sears’s way. You know that 97 percent of kindergarteners in your child’s school (four hundred kids, let’s assume) will probably be vaccinated. That’s enough for herd immunity against all the diseases in question. "My child would be number 401,” you think, "so his being vaccinated is superfluous! Why take even the low risks associated with the shot?” Are you doing anything wrong to your own child if you don’t vaccinate him or her? Are you doing anything wrong to everyone else?

Taking the first question first, it’s not so clear. If the child’s entire environment were homogenously vaccinated at a rate of

97 percent, then the child would be safe. However, the school is just a part of the child’s environment. The child will be in doctors’ waiting rooms, where he can be infected by sick children. He may come into contact with home-schooled children, on whom the state doesn’t collect vaccination statistics. Immigrants from other countries can bring disease from other countries, as can travelers returning from abroad. So strictly for purposes of protecting one’s own child, there’s a case to be made for vaccinating. But maybe not a conclusive one.

The really interesting ethical question is the second one— whether the refuser does wrong to everyone else. Dr. Sears isn’t worried. We are all entitled to put our children first, he thinks, even knowing that disease levels would rise if everyone thought that way. We have a right to hope everyone else vaccinates first, so we can not vaccinate at all. But there is an ethical problem here. The "Why Me?” Refuser takes it for granted that 97 percent vaccinate, treating that as a background fact. Thus, the other vaccinators, to her, are environmental conditions, like the amount of tetanus bacteria in the soil, or the amount of flu virus circulating in the population. What she’s not thinking is that every other parent is in the exact same position that she is. If each thought of the other 97 percent as definitely vaccinating, each would have good reason not to do so either, and herd immunity would vanish. Her reason not to vaccinate cannot be spread around and made everyone’s. And so she is privileging herself in a troubling way.

Now, sometimes it’s alright to think in a way we wouldn’t want everyone to imitate. One person’s desire to have eight children cannot be spread around and made everyone’s. That’s okay. We don’t all have to have 2.0 children, just because that’s the only desire that can be safely generalized. You might say that, likewise, the refuseniks at an elementary school with high vaccination rates are just harmless stowaways on the ferry carrying everyone to safety; they want what very few people do.

I don’t find this line of defense plausible, because I think many people would like to be the stowaways. In fact, I found it frightening to vaccinate my children—probably an irrational reaction, but a genuine reaction nonetheless. I believe many people feel this way. Vaccinators pay their fare because they think it’s their obligation to do so, not because they want to. So fare-evaders really can’t comfort themselves that their preferences are idiosyncratic, so nonproblematically impossible for us all to share.

 
Source
< Prev   CONTENTS   Source   Next >