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January 10, 2017

Why Vaccinations Need to be Mandatory

There are multiple news reports (see here and here, for example) that Robert Kennedy Jr. says that Donald Trump appointed him to head a presidential panel to review vaccine safety and science. As of this moment, there’s no direct confirmation from the Trump team and no explanation of how the findings of this commission are supposed to be used. I’m hoping the story is as inaccurate as the testimony I heard Kennedy give here in Vermont against mandatory vaccination. But it’s a good time to review why many vaccinations (which are obviously intrusive) still MUST to be mandatory.

We used to have periodic epidemics of polio, smallpox, rubella and other diseases. Huge numbers of people were either killed outright or left badly damaged. When I went to grammar school a long time ago, there was almost always at least one classmate in permanent braces as a result of polio. Not true anymore. Because of vaccines, smallpox has been eradicated and we no longer have to vaccinate against it and polio is almost there.

So why can’t people just decide for themselves whether their children should be vaccinated? Two obvious reasons are that parents don’t have an inherent right to risk the life and health of their children and that, especially in a society where many health costs are socialized, everyone else will have to pay for the disease that could have been prevented. But let’s put those two arguments aside.

There are always some people who cannot be given a particular vaccine either because of a general medical condition or because they’re allergic to the ingredients of the vaccine. So long as everyone who can get vaccinated does, the risks to those who can’t get vaccinated is very low

According to Vaccination greatly reduces disease, disability, death and inequity worldwide from the World Health Organization (which is also the well-documented source for other assertions in this post):

“’Herd protection’ of the unvaccinated occurs when a sufficient proportion of the group is immune. The decline of disease incidence is greater than the proportion of individuals immunized because vaccination reduces the spread of an infectious agent by reducing the amount and/or duration of pathogen shedding by vaccinees, retarding transmission.” [footnotes deleted but available via the link]

Those who can’t be vaccinated need herd protection. Those who diminish the herd effect by refusing vaccination for themselves and their children are putting those who can’t be vaccinated at deadly risk.

Most vaccines are not 100% effective, even if they are always administered properly which, of course, can’t be the case. However, so long as there is sufficient herd protection, there is very little risk for those few whose shots didn’t take for one reason or another. However, if there are a large enough group who just don’t get vaccinated, then those individuals for who the vaccine didn’t work are at great risk.

California used to have very liberal laws on refusing vaccination. NOT vaccinating became a fad among the nominally well-educated health-food-eating citizens in affluent Marin County. In 2015, only 84% of that County’s students entering kindergarten were fully vaccinated according to the San Francisco Chronicle in a story about the ensuing measles outbreak. “Last year there were 61 measles cases in California — the highest since the disease was declared eliminated in the United States in 2000. The state beat that number in the first month of this year.” California, seeing that there could easily be epidemics of more deadly diseases, has sensibly made it more difficult to avoid vaccination except for those who have a specific medical condition which would make a particular vaccination unsafe.

Part of the anti-vaccination hysteria come from a study claiming a link between autism and measles vaccine originally published in the Lancet; it was reasonable to take that seriously. However, this study was not only wrong; it was fraudulent (see story here). The principal author was funded by lawyers representing parents in suits against vaccine companies. The article was retracted by Lancet and the falsification of data revealed. Because of the scare the article engendered, huge followup studies were done. That was easy because there is lots of vaccination. Absolutely no statistical or causal link has been found between any vaccination and autism. None the less, the myth lives on and both Trump and especially Kennedy have cited this non-existent link (see news stories linked to in the first paragraph). That’s scary.

The truth is that every vaccination does have some small risk. If it’s by injection, there’s a tiny chance of infection. There’s a very small chance that the vaccine, like anything else, can be contaminated. There’s an equally tiny risk that the recipient will have an undiagnosed allergy to the infection. Obviously new vaccines like the one for Zika have to be thoroughly tested and procedures can always be improved. We always have to be aware of the possibility that new data can surface.

Ironically, as long as almost everyone else gets vaccinated, those who opt their families out of the very small risk of a tested vaccine get to free ride on the very herd protection they are compromising. Society can’t afford to let that happen. We can’t leave those who can’t get vaccinated or whose vaccine doesn’t work at risk. We can’t give preventable epidemics room to blossom. Some vaccinations must be mandatory. This is an example of a case where the needs of the society come before the needs of the individual and state compulsion is justified.

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