We can take comfort that modern science can handle infectious diseases. Questionable studies such as reports linking vaccinations to autism have been debunked. Despite the empirically demonstrable efficacy of vaccines, some people have decided to forego vaccinations for themselves or for children under their custody. Accordingly, libertarians have been forced to examine their own tenets to evaluate whether compulsory vaccinations are compatible with the principles of individual freedom.
I believe they are.
A major pitfall for libertarians examining this question is the consideration of whether mandatory vaccinations are too paternalistic. But because vaccinations prevent harm to others with incidental paternalistic effects, I argue that they are justified. Because certain deadly diseases are communicable from human-to-human contact, transmission can be prevented by using medically safe vaccines.
Vaccines do not always and in every case protect individuals who receive them. Bacteria and viruses can mutate, preventing vaccines from conquering them. And, over time, a particular vaccine can become less effective. But when given to a large enough population and updated periodically to counter mutations, vaccines act like a computer firewall, protecting the entire population. And if a significant enough portion of the population chooses not to be vaccinated, then the whole population becomes more susceptible to an outbreak. Immunization of a critical proportion of the population in this manner is called “herd immunity.” Though it may seem paradoxical, it becomes important to ensure that the vast majority of people get immunized to prevent harm.
Libertarian philosophy holds that it is justifiable to prevent unauthorized harm of one individual against another. Accordingly, even libertarians who have adopted principles such as the nonaggression axiom or the harm principle can see that vaccination is a means of preventing harm. Moreover, even libertarians who follow a strict Rothbardian nonaggression principle consider the prospect of aggression to be indistinguishable from actual aggression. And this is reasonable: preventing imminent harm is as good as stopping present harm.
University of Arizona professor Joel Feinberg has argued that “it is always a good reason in support of legislation that it would probably be effective in preventing (eliminating or reducing) harm to persons other than the actor and there is probably no other means that is equally effective at no greater cost to other values.”
John Stuart Mill famously notes in On Liberty that “the only purpose for which power can be rightfully exercised over any member of a civilized community, against his will, is to prevent harm to others.”
The questions of whether the nonimmunized members of a population pose a risk to others — as well as the effectiveness of vaccinations in preventing that harm — turn on facts. To address such questions, let’s take a look at the disease that has lead to most of this recent controversy: measles.
If one imagines a community with an immunity rate of 96–99 percent for measles due to vaccination (and most states fall below this rate), it is statistically unlikely that there will be an outbreak of measles in this population due to herd immunity. When only 95 percent of the population is vaccinated, an outbreak is possible. When the percentage vaccinated falls below 90 percent, the rate of infection per 10,000 children more than doubles. If the rate falls low enough, we can expect pandemics. “Before mass vaccination was introduced, measles used to follow a cyclic pattern, with [epidemics occurring each] period of about 2 years in Europe and North America,” according to research by V.A.A. Jansen and N. Stollenwerk.
From 1840 through 1990, measles killed nearly 200 million people globally. But from 2000 through 2012, measles deaths decreased by 78 percent after the UN sponsored immunization. During this period, 68 percent of the populations of member countries were immunized to herd immunity levels. In the United States, the vaccination rate among infants was 91 percent, considerably below the 96–99 percent needed for herd immunity to be maintained. In fact, in some enclaves, such as the Orange County school district, the immunization rate dropped to 50–60 percent among kindergarteners. This failure to vaccinate, at least in part due to the existence of the state philosophical exemption from vaccination, allowed the measles outbreak to occur in 2015 in more than a dozen states.
No individual has the right to expose other individuals to that risk.
Alternatively, there is parallel argument from the libertarian principles regarding common defense. According to David Boaz in his updated book, The Libertarian Mind, “most libertarians” believe that “governments should exist … [to provide] national defense against external threats.” The entire human race is at war with microbes, such as viruses, and has undergone massive assaults. Examples include the bubonic plague, smallpox, and polio. Each day, an individual’s immune system destroys numerous potential pathogens. Liberty-restraint principles allow for collectivization of defense efforts against equally deadly foes: our immune systems are not alone in this. Vaccines are instruments of that ongoing war.
People should not be compelled to be vaccinated for noncommunicable diseases, of course, but we don’t want any of these serious pathogens to reemerge. Measles, mumps, rubella, and pertussis cases are all on the rise in the United States. Polio has returned in more than 10 countries; the World Health Organization believes it constitutes a global health emergency. Childhood vaccines save nearly $40 billion in direct and indirect costs, in addition to numerous lives.
It is important to note, as well, that compulsory vaccination can accomplish herd immunity by means short of forced procedures. On one level, the civil law could be used to hold nonvaccinated adults and the parents of nonvaccinated children financially liable with punitive damages for their role in any public health emergency. Exclusion from various types of public space or activities could be justified, yet enforcement would be difficult, if not impossible, particularly in urban areas. On a more restrictive level, the state could use the criminal law to impose fines on parents or declare that such action constitutes child neglect. Regardless, more extreme measures for noncompliant adults would only be appropriate if more restrictive means could not achieve herd immunity thresholds.
Thus, it can be argued that vaccination policy approaching infringement on individual and parental choice does not pose an issue per se with mainstream libertarian thought, given the narrowness of the means of vaccination (how little it imposes on the recipient’s liberty) and the degree of relatively certain harm to others that is thereby prevented.
The harm of nonvaccination for serious communicable diseases poses a significant enough risk for others to become infected that it justifies such small impositions on personal liberty. A policy of voluntary vaccination, or the granting of philosophical exceptions to the general vaccination requirement, causes much more potential harm than requiring people to get a vaccination does.
Randal John Meyer is a Research Fellow at Brooklyn Law School. Randal was born in Rochester, New York. He has a J.D. from Brooklyn Law School, where he was an articles editor on the Brooklyn Law Review, and he has a B.A. in General Philosophy and in Philosophy, Politics, and Law from SUNY Binghamton. He has been cited for his published work on constitutional law, terrorism, and civil liberties, which has appeared in the Brooklyn Law Review, New York Journal of Law and Liberty Blog, and Brooklyn Law Review Practicum.
This article was published by The Foundation for Economic Education and may be freely distributed, subject to a Creative Commons Attribution 4.0 International License, which requires that credit be given to the author.