If "Why Me?”-ism is any part of someone’s decision not to vaccinate, it shouldn’t be. But in Texas and many other states, it can be. Parents in Texas can exempt their kids from vaccination for any reason. They get to call themselves "conscientious exempters” if they belong to an antivaccine church, but also if they have benighted ideas about immunology, and even if they’re ready to fool themselves about doing vs. allowing—doing whatever they can with antiviral drugs after a child becomes ill, but doing nothing with vaccines beforehand. Most bizarrely, they get to be called "conscientious exempters” when they are really just "Why Me?” exempters, stowaways on the immunization ferry. Essentially, you are exempt for reasons of conscience if you say you are exempt for reasons of conscience!

Exemption from school mandates started, in the 1950s, with exemptions for people religiously opposed to vaccination, and not opposed for any of the other reasons. The idea was much the same as allowing conscientious objectors to avoid military service. If you think people shouldn’t have to go into battle and kill others against the dictates of their own conscience, you might agree that they shouldn’t have to hand over their child for an injection, against the dictates of conscience—at least not in circumstances where the child is healthy and not imminently at risk of life-threatening disease. State insistence on being part of a military or biological defense force, no matter what a person’s objections, is worrisomely intrusive.

But exemption shouldn’t be easy for everyone, no matter the basis for their reluctance. The "Why Me?” Refuser has no principled objection to vaccination; rather, he just wants someone else to shoulder the burden. This sort of parent is much more like the draft dodger of the 1960s, not the conscientious objector. The Critical Refuser is also on shaky grounds. These people are often critical out of sheer stubbornness, ideological rigidity, failure to read research, inability to understand technical matters, or poor critical thinking skills. Sometimes it becomes a matter of identity to be a member of the antivaccination movement, making it difficult for refusers to yield to overwhelming evidence. Critical Refusers don’t have ethical principles that stand in the way of vaccination, like Conscientious Refusers do. And although Doing/Allowing Refusers do refuse as a matter of ethics, they have an ethical theory they are not always committed to: they know we can’t just stand idly by while germs kill our children, on the grounds that anything we actively do to them must be perfectly safe.

So, should there be exemptions only for bona fide Conscientious Refusers, or not even for them? Ending all exemptions would not totally take control from parents, because they do have a way out: if they refuse to vaccinate, they can keep their children out of schools. They are in the same position we are all in with respect to airport security. We all have to go through it, if we want to fly. We can’t be exempted because we favor prayer as the sole method of terrorism prevention. It wouldn’t be politically impossible, either, to eliminate all nonmedical exemptions. After all, in Mississippi and West Virginia there are none, and there seems to be no insurrection on the horizon in those states. Religious citizens seem to tolerate the situation, and can always rest assured that an all-good, all-fair god would not hold them responsible for vaccinations they have to accept, so their kids can go to school.

Ending all nonmedical exemptions would make a lot of sense, but this would be an uphill battle. In 2015, forty-eight states allowed religious exemptions, and twenty also allowed nonr eli- gious "personal belief” exemptions. In these latter states, there are 2.5 times more exempted children, according to a study by the Pew Charitable Trusts. And most of the growth in exemptions over the last ten years seems to be due to personal belief exemptions. For example, in California nonreligious personal belief exemptions doubled between 2007 and 2015. But there is hope for change: as of 2016, California became the third state in the nation with neither religious nor personal belief exemptions, and Vermont eliminated its personal belief exemption.

If most refusers are blameworthy free riders—essentially, cheaters—we could make some headway by saying so openly. I am not saying refusers should be forced to wear a scarlet "R”; but we do need to make it part of our understanding of civic virtue that disease prevention is a collective responsibility, not for some to take care of while others merely reap the benefits.

Contributing to public projects we implicitly support is not especially onerous, when it’s a matter of staying to the end of the talent show, or paying bills for unrequested but appreciated services. The obligation to vaccinate our kids falls into the same general category as the obligation to do these other things, but it’s one that’s much harder to fulfill. It’s hard to take a perfectly healthy, much-loved little child to the doctor and watch her scream as she’s injected with a vial of viral or bacterial proteins. Of course we want to get all the disease protection we can from others’ efforts, and lower our own child’s risks as much as we possibly can while sparing her pain. But here as elsewhere, taking advantage of other people is unethical. It doesn’t make it right that in this instance we want to do so out of the special love we have for our own children. It just makes it more understandable.

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