Why “I believe vaccinations are good but shouldn’t be mandatory” isn’t as neutral as it sounds
“As an aside, I do think we’re headed to the point where “I believe that vaccinations are good, but shouldn’t be mandatory” will be increasingly responded to and treated as though you said “Vaccines shouldn’t be mandatory (and are no good).”
Will and I agree that this is a likely outcome in our fragmented social-media-ized world. Where (I think?) Will and I part ways is whether we anticipate this possible social stigma with dread or hope.
By definition, the question of mandatory vs. voluntary vaccinations for children is a political one. When seen through this lens, saying “vaccines are good but shouldn’t be mandatory” seems relatively innocuous. Politically speaking, it’s similar to declaring that you believe gay marriage is good but that a church should not be required to perform one — or, for that matter, that gay marriage is wrong but you don’t believe the government should forbid it. To say that you believe that X is good but shouldn’t necessarily be mandatory is, in the world of politics, one of the most neutral, moderate and basically nice positions one can have on almost anything.
The issue of vaccinations, however, is also one of public health. And from my perspective as a risk manager, this distinction is extremely important. And not just with vaccines.
Which brings me to Thom Tillis.
Tillis is the junior Senator from North Carolina. Yesterday while speaking about over-regulation to the Bipartisan Policy Center, Tillis said he would support the cutting down of government regulations by allowing the companies — including those in the food service industry — to “opt out” of requiring employees to wash their hands after using the restrooms:
The senator said he’d be fine with it, so long as businesses made this clear in “advertising” and “employment literature.”
“I said: ‘I don’t have any problem with Starbucks if they choose to opt out of this policy as long as they post a sign that says “We don’t require our employees to wash their hands after leaving the restroom,” Tillis said.
“The market will take care of that,” he added, to laughter from the audience.
Skipping over the degree to which this all confirms what I always say about government regulations as a political issue, Tillis’s off-the-top-of-his-head thoughts betray a fundamental lack of understanding about managing public health. For one thing, telling food-service employers that it’s fine to “opt out” of hygiene assumes that the variety of diseases that can be transmitted in an Applebees all stop at the restaurant’s front door. They do not; such a decision would not simply endanger Applebee’s customers and leave everyone else unharmed. There is too the issue of food warnings and recall for things such as e. coli or salmonella, something that the government is actually astoundingly good at tracking down and in very short order after an outbreak. “Voluntary” hygiene throughout the food pipelines would make it significantly more difficult to trace disease sources. (Not to mention that there would be substantially more of them.)
Past all of the immediate threats, however, is the issue of risk management and culture.
People in the workplace have a tendency to gravitate toward the path of least resistance without strong signaling from both management and regulators. This is pretty much universally true with all organizations, and it is why a construction company with no safety meetings will average far, far more frequent and more severe worker injuries than companies with regular safety meetings. It isn’t that workers learn anything new at these meetings; in fact, they almost never do. It’s just that knowing that safety is important to the boss and OSHA leads to employees deciding that it’s important to them as well, and this leads to fewer accidents. The same would absolutely be true of the government telling restaurants that worker hygiene wasn’t a big enough public health issue for anyone to make washing their hands after wiping the butts mandatory.
Cultural signaling also applies to vaccinations. “I believe that vaccinations are good but shouldn’t be mandatory” communicates something far different than what needs to be communicated. Indeed, intentionally or not what it really communicates is this:
“Vaccinations are good, but not getting them is okay too.”
And the higher you go up the food chain of cultural and political power, the more dangerous that message becomes. A congressman who tries to walk the voter tightrope by giving the press soundbites that communicates this message needs to be corrected harshly, loudly, and publicly. This applies doubly to presidential candidates. Anything short of this communicates to the country that vaccines are but a medical cultural marker and a lifestyle choice, somewhere in between taking a daily multivitamin and eating only raw food.
What’s more, communicating what we should about vaccines is a more urgent thing today than it was before. As is often noted these days, in order for vaccinations to work for society in general they need to be given to over 90% of the population. And that’s going to be harder and harder to do at the rate we’re going, because as jaw-drooping as it sounds we might actually be losing this battle.
As Josh Marshall noted over at TPM, the up-and-coming generations are less likely to push for vaccinations than the ones who have come before. Only 43% of millennials think vaccinations should be non-voluntary, compared with 73% of those over 65. These numbers aren’t static, of course, and just because a millennial thinks vaccines should be voluntary doesn’t mean that they won’t volunteer to have their own children inoculated. Still, 43% is pretty fishing low, and if attitudes don’t change it’s not too hard to see us fall below that magic 90+% within the next ten years. (And in places like California and, errr, California, much, much sooner.)
And if the “good-but-not mandatory” viewpoint just seems too moderate to oppose with any kind of vigor, consider what you would say if you heard a Presidential candidate make any of these statements:
“I agree that it would be good if the young men who have been diagnosed with smallpox were quarantined. But it’s not our business to insist that they are.”
“Should the man we now know has asymptomatic typhoid refrain from working in a soup kitchen? Yeah, that would be good. But it’s not our place to force him from doing so.”
“I believe that burning only unleaded gas is good, but that’s my choice. We shouldn’t be telling someone that wants to sell manufacture leaded gas they aren’t aloud to sell it here.”
The question of vaccines is no different than these examples above, even if vaccines’ overwhelming success means that you can’t really see it with your eyes.
The temptation over these coming years to agree that “vaccination is good, but we’re not twisting anyone’s arm” will be strong. We should not give in to this temptation.
 Okay, so maybe I can’t just skip over it:
The obvious flaw in the notion that you can help get rid of government regulations by Tillis’s example is that you aren’t getting rid of government regulations. You’re simply replacing one regulation (everyone should wash their hands) with different regulations (mandatory new signage, mandatory new statement in advertisements, mandatory new pages for employee handbooks).
It’s like I have been saying since I got here: Only a very small percentage of people who claim they are anti-government regulation are in fact anti-government regulation. And this goes double for elected officials. Saying you’re anti-government regulation — or that the government has “too much regulation” — has just become a knee-jerk signaling device people use to identify which team they play for.
[Picture: Typhoid inoculation, via Wikipedia]