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Exemptions for Anti-Vaccination Activists Are Incompatible with Liberty: A Response to Robert P. Murphy – Article by G. Stolyarov II

Exemptions for Anti-Vaccination Activists Are Incompatible with Liberty: A Response to Robert P. Murphy – Article by G. Stolyarov II

The New Renaissance HatG. Stolyarov II
July 12, 2015
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The anti-vaccination movement today constitutes one of the most astounding rejections of scientific progress. Taking many steps beyond an aversion to emerging medical breakthroughs, this movement turns its back on modern medicine established as long ago as Edward Jenner’s famous experiments with vaccination in the 1790s. Largely fearing the completely discredited and fraudulent “connection” between vaccines and autism, opponents of vaccinations have no qualms about exposing masses of people to the infectious diseases that shortened typical lifespans by factors of two or three in the eras before vaccination was prevalent. The anti-vaccination movement’s scare tactics have already led to a resurgence of measles in the United States, bringing about the first death from the disease in 12 years within American borders. If vaccination rates continue to drop, we can expect more ancient killers to be resurrected, particularly endangering the lives and well-being of those who are unable to be vaccinated for legitimate medical reasons.

Vaccination has been among the most successful medical techniques in history. We have it to thank for the eradication of smallpox and impressive reductions of the rates of polio, tetanus, typhoid, cholera, and many other maladies that routinely reached epidemic proportions in the premodern world. The evidence is overwhelming that opponents of vaccination are not just mistaken, but dangerously so. Their pseudo-scientific rhetoric does not merely affect personal lifestyle choices, but also exposes innocent individuals to harm. Yet the question has arisen as to how libertarians, who reject the initiation of aggression as a matter of principle, ought to respond to the anti-vaccination movement. Even if one considers the refusal to vaccinate to be misguided and scientifically unfounded, should it remain a legitimate personal choice from the standpoint of the law or of private institutions within a hypothetical libertarian-leaning society? Recently, the Foundation for Economic Education (FEE) hosted a debate between Robert P. Murphy, who argued that mandatory vaccinations are incompatible with liberty, and Randal John Meyer, who presented a case for the legitimacy of mandatory vaccination (in some circumstances) from the standpoint of the non-aggression principle.

As greatly as I respect Dr. Murphy’s work as an economist and a libertarian political theorist (despite some notable differences between us in the latter area), the strength of Dr. Meyer’s articulate arguments, as well as a recognition that opponents of vaccination do not only endanger themselves, lead me to wholly disagree with Dr. Murphy’s position in this debate. Dr. Murphy seems to agree with the medical science supporting the use of vaccines, but, out of libertarian considerations, writes that “Mandatory vaccinations are a gross violation of liberty.” Here I will argue that providing exemptions to mandatory vaccination on the mere basis of “philosophical” opposition to vaccination is the true violation of liberty.

Like Dr. Meyer, I base my argument on the non-aggression principle and the recognition that people do not have the right to involuntarily expose others to deadly diseases that, with continued vaccination, could become eradicated or remain at minimal levels. Unlike anti-vaccination activists, somebody who decides to take recreational drugs or consistently overeat or reject the scientific evidence about evolution harms only himself – physically or intellectually or both. While counterarguments might be made regarding indirect harms of such behaviors to others, those indirect harms are not proximate and can be prevented by the individual himself or by the choices of those who refuse to be affected. Therefore, such mistaken choices of lifestyle or belief should only meet with voluntary persuasion and education. A libertarian respects the right of others to be wrong, as long as their wrong inflicts no involuntary harm upon others. But to infect unwitting others because one is “philosophically” opposed to vaccination is not a valid exercise of personal freedom and not a behavior that harms oneself only; it is, rather, a negligent infliction of harm in violation of others’ rights.

To be clear, my position does not recommend mandatory vaccination for everyone – since there can be legitimate medical reasons not to vaccinate some people who might be at greater risk of usually rare side effects or who might be too vulnerable for the vaccine to work properly (e.g., pregnant women, infants, or the elderly in the case of certain vaccines). But precisely because not everyone can be safely vaccinated, anyone who can be, should be – in order to prevent the spread of disease to those who cannot directly protect themselves. As my central position on this issue, I strongly support abolishing all “religious” or “philosophical” exemptions to vaccination, as well as any exemption based on the purportedly medical advice of a doctor who is a “vaccine skeptic”. Only medical doctors who recognize the benefits and efficacy of vaccination in the majority of instances, but consider the risk of adverse side effects to be too great for a particular patient, should be able to provide exemptions to vaccination. Furthermore, medical doctors who fabricate reasons for vaccine exemptions or who deny the efficacy of vaccines in fighting disease, where such denial affects their areas of practice, should be stripped of their licenses by the credentialing organizations that oversee them.

Nor does the elimination of belief-based vaccine exemptions imply the necessity of overwhelming enforcement of vaccination mandates. There should be enough enforcement, combined with education and social pressure, to bring herd immunity back to levels where a disease is kept at bay even if a few individuals slip through the cracks of the vaccination system for whatever reasons. The key is to avoid systematic allowances that lead to vaccination rates dropping below crucial thresholds.

Dr. Murphy writes that “Mandatory vaccinations involve a supreme violation of liberty, where agents of the state inject substances into someone’s body against his or her will.” However, nothing in my position requires the government to forcibly inject any person against that person’s will. Rather, the institutional mechanisms that have sufficed to maintain herd immunity prior to the rise of the anti-vaccination movement should simply be allowed to work without a belief-based exemption to get in their way. For instance, one can debate the legitimacy of public schools – but so long as they exist and remain a part of the lives of many families, they can justifiably be governed by rules designed to preserve the health of their students. Parents who refuse to vaccinate children (without a legitimate medical exemption) should simply be disallowed from sending those children to public schools, where they could serve as carriers of deadly diseases to other innocent children. Private schools could also choose to adopt similar criteria, requiring evidence of vaccination as a prerequisite for admitting a student (and, I hypothesize, in a libertarian society where legitimate science is able to triumph on a free market of ideas, almost all private schools would adopt such criteria). As a libertarian, I would consider the use of physical force against people’s bodies to achieve vaccination to be too disproportionate a remedy – but refusal of access to government facilities and services, along with a healthy dose of education, cultural pressure, and ostracism of the unvaccinated would be perfectly legitimate as ways to prevent the dangerous misconceptions of the anti-vaccination activists from resurrecting age-old killers. Anti-vaccination activists should face not a stick, but the removal of the carrots that almost everybody else would receive.

The remainder of this essay will cite each of Dr. Murphy’s main arguments, followed by my response.

Dr. Murphy writes: First, among those who hew strictly to a nonaggression principle and a stateless society, mandatory vaccinations are, of course, a nonstarter. Whether they identify themselves as ‘strict libertarians,’ ‘voluntaryists,’ or ‘anarchocapitalists,’ this group would obviously never condone the state’s forcing someone to be vaccinated, because most believe the state is illegitimate.”

I respond: While I am not an anarcho-capitalist and consider some government functions to be legitimate as long as they respect individual liberty, it is possible to be anarcho-capitalist and also support widespread vaccination with no belief-based exemptions. Virtually every anarcho-capitalist will support some form of private law, since the case for anarcho-capitalism relies on the possibility of social order without a central authority. Furthermore, this private law, to be legitimate, would need to be based on the theoretical foundations of libertarianism – which might be natural law or might be utilitarian or consequentialist considerations, or some combination thereof, depending on the philosophical persuasion of a given libertarian who would advocate for such a system. A private law based on natural law would recognize scientific truth, since scientific truth is part of natural law – and the efficacy of vaccination in protecting against disease, as well as the consequences of a widespread lack of vaccination, constitute some of the best-established scientific truths. A private law based on consequentialist considerations (for instance, minimizing the harm that people are able to inflict upon others) would also recognize that allowing anti-vaccination activists to run rampant while carrying highly contagious infections would not be in the interest of maximizing human well-being or ensuring that people are protected against unwanted harm. Therefore, it is entirely conceivable that a hypothetical anarcho-capitalist society, through networks of private courts or arbiters, would develop a theory of negligence that encompasses those who, in their refusal to vaccinate themselves or their children, recklessly and needlessly endanger the health and lives of others.

Dr. Murphy writes: Second, for minarchists, the proper role for the state is that of a ‘night watchman,’ a minimal government that only protects the individual from domestic criminals and foreign threats. In a minarchist framework, it is only legitimate for the state to take action against someone who is violating (or threatening to violate) the rights of another. A person’s failure to become vaccinated is hardly by itself a violation of someone else’s rights. Flipping it around, it would sound odd to say you have the right to live in a society where everyone else has had measles shots.”

I respond: An important implication of the non-aggression principle is that it is illegitimate to expose others to involuntary violation of their lives, liberty, or property. This principle applies even when the aggressor does not realize that he or she is engaging in aggression. (For instance, a thief who steals another’s property and genuinely believes himself to be doing good, because he intends to redistribute that property to the poor, is still a thief who is violating his victim’s rights.)

The intentional transmission of disease to others clearly impinges on those others’ lives and liberty. One might be killed by the disease, or one might be incapacitated or inconvenienced to the point of being unable to pursue opportunities one might otherwise have had. Technically, transmitting any disease to any unwilling person would constitute an act of negligence in a society guided by libertarian principles, and would require proportionate compensation. However, in many cases, it is practically difficult to determine who transmitted a disease to whom and how. Furthermore, medical science has not yet discovered consistently reliable ways to prevent the transmission of certain infections, such as the common cold. Therefore, while it is still infeasible to prevent the spread of all infectious diseases, a libertarian who supports the non-aggression principle ought to support the prevention of disease transmission where it is currently technically feasible. Vaccination is one of the major tools in the current arsenal for preventing disease transmission. Those who are vaccinated against a given disease gain the benefit of a greater likelihood of their own protection from the disease, but – more importantly from a libertarian perspective – they reduce their likelihood of becoming unwitting initiators of aggression against others. I agree fully with Dr. Meyer that, where it is cheap and practical to vaccinate, while the costs of not doing so can include a devastating, deadly epidemic, the decision to require vaccination as a condition of participation in public life is justified.

Dr. Murphy writes: Third, and most interesting, let’s consider a broader notion of liberty, which balances a presumption of individual autonomy against the public welfare. In this approach, there’s not a blanket prohibition on the state restricting the liberties of individuals — even when they haven’t yet hurt anybody else — so long as such restrictions impose little harm on the recipients and possibly prevent a vast amount of damage. This is the only conception of the state for which the mandatory vaccination debate is possible.”

I respond: I will interject here only to reiterate that this is not the only view of the three described by Dr. Murphy which could justify mandatory vaccination. As I discuss above, any libertarian school of thought can consistently embrace vaccination requirements, if the implications of the non-aggression principle are fully applied to the transmission of infectious disease.

Dr. Murphy writes: Let’s be charitable and assume this more expansive definition, under which, for example, even self-described libertarians might not object to stiff penalties for drunk driving or prohibitions on citizens building atomic bombs in their basements. How does mandatory vaccination fare in this framework, where we’re not arguing in terms of qualitative principles but instead performing a quantitative cost-benefit test? Even here, the case for mandatory vaccinations is weak. First of all, the only realistic scenario where the issue would even be relevant is where the vast majority of the public thinks it would be a good idea if everyone got vaccinated, but (for whatever reason) a small minority strongly disagreed. This is obvious: if the medical case for a vaccine were so dubious that, say, half the public didn’t think it made sense to administer it, then there would hardly be an issue of the government clamoring to inject half the population against their will.”

I respond: Scientific truth is true no matter what proportion of the population believes it to be. If, in a hypothetical society, 1% of the population was enlightened and recognized the role of vaccination in preventing epidemics, while the other 99% believed that only bleeding and magic rituals could cure disease, it would still be justified to require vaccination – since the objective mechanisms of disease transmission are not affected by the prevailing beliefs in a society. I bring up this point not merely for hypothetical purposes, but to highlight the dangers of the anti-vaccination activists’ pseudo-scientific and anti-scientific propaganda. Like many Neo-Luddite and “back to nature” movements, the anti-vaccination movement is dangerous precisely because it does have the potential to persuade a critical mass of people who lack the training to distinguish between scientific truth and deception, and who find the siren song of a romanticized primordial Eden alluring. Anti-vaccination activists exploit widespread primal fears of the technological, the modern, the “artificial”, and exhort people to return to a mythical age of bliss that never was. In fact, if enough people embrace anti-vaccination propaganda, we will indeed revert to an earlier paradigm – the Hobbesian primitive world in which life was nasty, brutish, and short. Anybody who supports reason and science and endorses technological progress as a pathway toward individual flourishing should recognize anti-vaccination activists to be great foes of human well-being and civilization.

Dr. Murphy writes: We’re dealing with a scenario in which the vast majority of the public thinks it would be a good idea for all of the public to become vaccinated. In that environment, if vaccines are voluntary, then we can be confident that just about all of these enthusiasts would go ahead and become vaccinated. In other words, any ‘free riding’ would only take place at the margin, if most of the population had gotten the vaccine and thus an outbreak of the relevant disease was unlikely.”

I respond: The flaw with this argument is that effective herd immunity often requires not just a majority or even a substantial majority of people to be vaccinated – but rather an overwhelming majority. For some diseases, such as measles and pertussis, herd-immunity thresholds are significantly above 90%. Because vaccines are not always 100% effective on those who do get vaccinated, this means that the entire population is at risk of the disease if the anti-vaccination activists persuade even 5 to 10 percent of the public to refuse to get vaccinated out of fear. To minimize our individual chances of becoming victims of a preventable disease, we need as many people to be vaccinated as is safely possible. While it is true that effective herd immunity can coexist with tiny pockets of the unvaccinated, the danger of the anti-vaccination movement is that it will not confine itself to such tiny pockets of the most zealous believers, but rather seeks to spread its damaging influence to as many people as possible. The real danger arises when this pseudo-scientific movement ceases to be the purview of lone cranks and becomes a trend in upscale areas such as Orange County, California, now known for miserably low vaccination rates.

Dr. Murphy writes: When a person gets vaccinated, the primary beneficiary is himself. And this benefit is all the greater the lower the rate of vaccination in the population at large. In other words, among a population of people who all believe that a vaccine is effective, the individual cost-benefit analysis of taking the vaccine will only yield a temptation of ‘free riding’ once a sufficient fraction of the population has become vaccinated, thus ensuring ‘herd immunity.’”

I respond: While I agree that individuals are indeed often beneficiaries of their own vaccinations, the primary benefit from a libertarian standpoint is the reduction in the probability of their unintentional aggression toward others. From a libertarian political standpoint, the case for mandatory vaccination rests precisely on the fact that lack of vaccination poses negative external harms. Additionally, in the case of parents who refuse to vaccinate their children (which is the type of situation to which most of the controversies regarding vaccination pertain), the case can be made that those parents are negligently exposing their children to harm, in situations where the children do not have sufficient information or autonomy to override their parents’ fear-based judgments.

Furthermore, I disagree regarding herd immunity being a necessary precondition for the “free riding” of the anti-vaccination movement to arise. Such a state of affairs would presuppose that the “free riders” actually agree with the scientific case for vaccination, but consider it too inconvenient or burdensome to be personally vaccinated. If only this were the case with the opponents of vaccination today! The very reason why the anti-vaccination movement is so dangerous is because it is, like all “back to nature” movements, rooted in an anti-technological, Neo-Luddite ideology of fear. The anti-vaccination activists refuse to get vaccinated not because of a pragmatic (if sloppy) cost-benefit analysis, but rather because of a burning hatred of vaccination due largely to the mantra that “vaccines cause autism!” No amount of evidence or demonstration of the fraud involved in the alleged vaccine-autism connection suffices to dissuade those for whom this view has become an article of faith. No matter how low the vaccination rates are driven, or how many people are felled by the resurgent epidemics, the anti-vaccination activists will continue to hew to their irrational dogmas. For this reason, it is the task of the remainder of Western civilization to protect itself against the harms the anti-vaccination activists perpetrate.

Dr. Murphy writes: Unlike other examples of huge (alleged) trade-offs between individual and public benefits, with vaccinations there is no threat of a mass outbreak in a free society. With vaccines, we have the happy outcome that when someone chooses to vaccinate him or herself, so long as the vaccine is effective, then that person is largely shielded from the consequences of others’ decisions regarding vaccination.

I respond: The key phrase in the above argument is “so long as the vaccine is effective”. It turns out that most vaccines are quite effective, but not always 100% effective. The U. S. Department of Health and Human Services states that “most childhood vaccines produce immunity about 90 – 100% of the time” but some vaccines, such as the seasonal flu vaccine, achieve effectiveness rates in the ranges of 40% to 60% during good years. This is still nothing to scoff at, but it reinforces the point that some people might remain vulnerable to the diseases they got vaccinated against, in spite of their best intentions. This is another reason why maintaining herd immunity is crucial; it protects those individuals whose specific vaccinations failed to work. This also implies that getting individually vaccinated is not a guarantee of protection against the depredation of the anti-vaccination activists. In the short run, mandatory vaccination as a precondition for participation in governmentally run institutions can provide some added protection. In the longer run, the anti-vaccination movement needs to be relegated to the dustbin of history through persuasion, education, and social ostracism.

Dr. Murphy writes: Notice the irony and how weak the mandatory vaccination case has become. We are no longer being told that vaccines are ‘safe,’ and that anyone who fears medical complications is a conspiracy theorist trusting Jenny McCarthy over guys in white lab coats. On the contrary, the CDC warns certain groups not to take popular vaccines because of the health risks. This is no longer a matter of principle — of the people on the side of science being pro-vaccine, while the tinfoil-hatters are anti-vaccine. Instead it’s a disagreement over which people should be taking the vaccine and which people should not take it because the dangers are too great.

I respond: The above argument regarding the implications of the non-universal safety of vaccines is far too simplistic. The key element missed by this argument is the existence of objective, scientific truth regarding which segments of population vaccines are safe for, and which segments of the population are vulnerable. The scientific truth is that individual vaccination remains safe for the vast majority of the population, whereas the anti-vaccination activists assert that vaccines are unsafe for everybody. There is an insurmountable qualitative gulf between a risk-based scientific assessment regarding vaccine safety by population segments and a reflexive, ideologically motivated condemnation of all vaccination efforts just because adverse side effects might occur somewhere for somebody. The disagreement is still one of principle – whether objective, scientific evidence should guide the administration of vaccinations, or whether the fears of the “back to nature” types should be allowed to override the health and safety of everyone else.

Dr. Murphy writes: Regarding children, social conflict can be resolved through the fuller application of private property rights. If all schools, hospitals, and daycare centers were privately operated and had the legal right to exclude whichever clients they wished, then the owners could decide on vaccination policies. Any parents who were horrified at the idea of little Jimmy playing with an unvaccinated kid could choose Jimmy’s school accordingly.”

I respond: I concur that, if all of the institutions described by Dr. Murphy were privately operated, their owners could set vaccination policies. I would suggest that most such owners – if acting in their genuine, long-term, rational self-interest – would recognize the scientific evidence and require some evidence or vaccination or at least refuse access to overt anti-vaccination activists. I expect that Dr. Murphy would agree with me that this would be consistent with libertarianism and the non-aggression principle.

The disagreement arises in a world where governmentally run institutions do exist and are not going away anytime soon. The vast majority of people attend and use these institutions because the incentives of the current “mixed economy” leave them with no better options. Given that these institutions exist, it is still desirable for them to operate in such a manner that maximizes genuine individual liberty and reduces the involuntary infliction of harm upon others. Therefore, rules for the operation of governmental institutions, designed to prevent those institutions from being hotbeds of disease transmission, are entirely reasonable and justifiable within the imperfect world which we inhabit. Just like the administrators of a public school airport can legitimately implement prohibitions on littering or visitors who carry the Ebola virus, so can they legitimately require evidence of vaccination as a prerequisite for admission. Ideally, of course, we should strive toward a society where such presentation of positive evidence would not be necessary, because everybody who is medically eligible would get vaccinated out of a recognition of vaccination’s overwhelming benefits. However, as long as the anti-vaccination movement remains a prominent force in public discourse, one cannot fault administrators for taking precautions to protect those who use their facilities.

Dr. Murphy writes: We have seen that even assuming the best of government officials, it is difficult to state an argument in favor of mandatory vaccinations. Yet, the debate tilts even more when we recall that throughout history, government officials have made horrible decisions in the name of public welfare, either through incompetence or ulterior motives. It should be obvious that no fan of liberty can support injecting substances into an innocent person’s body against his or her will.”

I respond: This may be a valid concern to raise in response to a forced-injection program, but not in response to a mere denial of positive benefits (like access to certain government services) for those who refuse to be vaccinated. Furthermore, I am not arguing for any extraordinary level of coercion – just a return to the system of vaccination requirements that existed before religious or “philosophical” exemptions to vaccination came into vogue. The empirical evidence suggests that those requirements did not result in any horrible abuses of power – perhaps because those requirements were compatible with the non-aggression principles and the legitimate functions of law (be it public or private law) in the first place.

Conclusion

Ultimately, the best of all worlds would be one in which everybody who could safely be vaccinated, would be, without the need for any mandates – just because people would be sufficiently enlightened to recognize vaccination’s scientifically established benefits and reject the fear-mongering of those who would return us to the age of blood-letting, witch-fearing, and “medicine” based on the “four humours”. It is likely that Dr. Murphy would agree with me that universal, voluntary vaccination would be the most desirable outcome. Where we differ, however, is in our assessment of how much involuntary harm the anti-vaccination movement is able to inflict upon the rest of us. By weakening herd immunity in the Western world, the anti-vaccination movement is perhaps the most dangerous of the “back to nature” strains. It is a cultural infection to which we should develop an immunity using as many tools as we can effectively deploy.

This essay may be freely reproduced using the Creative Commons Attribution Share-Alike International 4.0 License, which requires that credit be given to the author, G. Stolyarov II. Find out about Mr. Stolyarov here.