Why “I believe vaccinations are good but shouldn’t be mandatory” isn’t as neutral as it sounds

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Tod Kelly

Tod is a writer from the Pacific Northwest. He is also serves as Executive Producer and host of both the 7 Deadly Sins Show at Portland's historic Mission Theatre and 7DS: Pants On Fire! at the White Eagle Hotel & Saloon. He is  a regular inactive for Marie Claire International and the Daily Beast, and is currently writing a book on the sudden rise of exorcisms in the United States. Follow him on Twitter.

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247 Responses

  1. The first thing I will say is that I very much believe that saying “Vaccines are good but shouldn’t be mandatory” is quite neutral. I think what Chris Christie said was even more neutral. The problem is that neutrality is not appropriate and trying to be friendly to both the pro and anti side of the vaccination debate is a bad neutrality.

    That being said, I don’t think it’s worthwhile to say “Unless you support passing a law to make it mandatory, you are objectively anti-vaccine.”

    The part I lament is not that people won’t be able to make mealie-mouthed let’s be supportive of everyone’s decision sort of way. It’s that we should base policy preferences – ones with real consequences – on the basis of bad signal reception.

    I don’t personally consider myself very friendly to the anti-vaccination side. It’s only a(n exemption-free) mandate that actually pushes me to a place where I actually need to defend their interests.Report

    • Avatar Michael Drew in reply to Will Truman says:

      It’s neutral as to what? It’s not neutral as to whether people should get vaccinated (or whether vaccines are “good”), and it’s not neutral as to whether they should be mandatory. And those are things the statement addresses.Report

    • I don’t consider it a very strong pro or anti-vax stance. Relatively neutral between those sides.Report

      • Avatar Michael Drew in reply to Will Truman says:

        I guess my point is that I don’t think I understand what neutrality would mean on this topic in general. You can be neutral on various questions. Whether vaccines cause autism. Whether vaccines should be mandatory. Etc. But I don’t know what it would be to be neutral on the whole topic, as an amalgam of most of the most salient questions.Report

      • On the topic in general I think it means not being strongly on one side or the other on the larger debate. Agreeing a little bit with this side here and that side there, none very forcefully.Report

      • I think that buys too much into whatever the sides might be saying. Agree with one side here, agree with another there, you can end up actually thinking some pretty non-neutral things substantively, supporting major positions of one side or the other. Un-affiliation isn’t necessarily neutrality.

        And I think this is good. As you say, I don’t think we want politicians to be attracted by a false nectar of neutrality. Saying “you should get your kids vaccinated; they’re not going to harm them” isn’t neutral, and it shouldn’t be understood to be just because one then says, “but I don’t want them to be mandated.” A politician saying the former should be clearly understood to be be making a non-neutral, pro-vaccination statement.

        In reality, mandates aren’t really on the table yet. A strong statement saying that parents should vaccinate their kids followed by opposition to mandates that aren’t being proposed isn’t neutral. It’s pro-vaccination.

        The problem with Chrstie’s original statement is that is was evasive, not that it was neutral. Neutrality would be saying that his actual view is that it doesn’t matter whether parents vaccinate their kids. What he initially said was, “It’s more important what you think as a parent than what you think as a public official. I also understand that parents need to have some measure of choice in things as well. So that’s the balance that the government has to decide.” He just doesn’t want to say something that will alienate some significant number of anti-vaxxers there; he’s not expressing neutrality on the actual question. Then he says there should be “some degree” of choice, which is really not a position with any content at all. People can home-school, etc., do what they need to do to avoid the corralling toward vaccination that is in place.

        Why is it so important (“I very much believe”) to you to make the point that this or that statement is, in fact, neutral, when neutrality is not even what we want here? Neutrality is just not having a substantive view on a given specific question. Why is pinpointing a neutrality on the topic in general important? Is your point just that that statement (or one of Christie’s) is not clearly anti-vaccination?Report

      • Avatar dragonfrog in reply to Will Truman says:

        The only neutral position is “I have no opinion.” ‘Not the most extreme possible opinion on the spectrum of opinions available’ is not neutral, it’s nuanced.

        Is “Heroin and cocaine are terribly dangerous drugs and you shouldn’t consume them, but we need to end the war on drugs that’s killing tens of thousands of people a year,” a safe, neutral statement? I think not – if it were, politicians wouldn’t be so very terrified of acting on it. It’s precisely the nuance they’re afraid of.

        Oversimplified snarky version: If you take a position with any nuance to it, those who hold the most extreme positions on either side of the relevant issue will start off by expressing opposition to your stated position, but if you let them go on unchecked for a few sentences, they’ll stop addressing your position, and address a straw-man of what they think everyone who disagrees with them says.

        That’s why politicians are so afraid of taking an nuanced stance on the drug war – by putting themselves at an extreme of the spectrum of opinions, they only have to defend against arguments from one side of the spectrum. By standing anywhere in the middle, they then have to defend against arguments from both sides, likely making statements in trying to reason with people on one side that will be used against them by those on the other.

        So here: If you say “vaccines are good and effective and you should get them, but there are sufficient arguments against using the force of state coercion to force people to get them. We need patients to be willing to go to their doctors with any concern they have. If state coercion reaches to the point of forcing people’s medical decisions, how are patients supposed to trust their doctors to respect their bodily autonomy? That would lead to people withholding healthy information from the people they most need to be able to express it to, and worsen health impacts overall.” – then:

        – extreme anti-vaxxers will start addressing their arguments to the “vaccines are good and effective” part, but soon go off on you as if you were trying to force everyone to get vaccinated
        – extreme pro-vaxxers will start addressing their arguments to the “but making them mandatory would do more harm than good” part, but soon go off on you as if you were saying they aren’t a good idea.Report

      • Avatar Patrick in reply to Will Truman says:

        That’s why politicians are so afraid of taking an nuanced stance on the drug war – by putting themselves at an extreme of the spectrum of opinions, they only have to defend against arguments from one side of the spectrum. By standing anywhere in the middle, they then have to defend against arguments from both sides, likely making statements in trying to reason with people on one side that will be used against them by those on the other.

        My best posts at the blog are those where everybody is yelling at me.Report

  2. Avatar Saul Degraw says:

    Great post Tod!

    Why do you think the 18-29 year old crowd is so different from the other age demographics? Is it because they are not likely to be parents and can be more hazy with the answers?

    I am in the 30-44 year old demo as are most of my friends. Many of my friends have small children and most of these children are under 8 years old. All of my friends are very pro-vaccination.* The TPM article reveals that once you enter 30-44 as an age range, pro-vaccination sentiment shoots up to 50 percent. This is still low. I imagine that a lot of the anti-vaccination crowd are also in this category. Marin is a local hotbed of anti-vaccination sentiment in Northern California. Marin is not known for young parents. Rather it is known as being a place of people who manage to be wealthy but kind of crunchy at the same time. Marin is one of the richest places in the United States. The median income for a family in Marin is close to 89,000 USD. A town like Mill Valley has a median family income of 119,000 dollars.

    I’ve heard anti-vaccination as a theory tends to swing wealthy and it seems that it is the kind of wealth with a decent grad education that allows people to assume that being experts in one fields allows them to be experts in all fields.Report

    • Avatar greginak in reply to Saul Degraw says:

      I think young folks expect everything to be exactly customized to their own needs and desires now. We see it mostly in tech stuff or anything that can be computerized where things are be tweaked or adjusted exactly how you want it. Under 29’s have lived a life where their cells phones will always be customized in one of dozen ways.

      The discussion about Marin is a bit of outlier. Its not like many other places in the country and anti vax sentiment seems equal in liberal and conservative types. Rich and educated people always seem to think they are experts in everything and it being Cali they probably have a lot of the “purity” and more natural than thou thing going on.Report

      • Avatar Saul Degraw in reply to greginak says:

        @greginak

        I picked Marin because other wealthy parts of the Bay Area are still vaccination strongholds. Silicon Valley is extremely wealthy and very pro-vaccination. So is the city and county of San Francisco. Alameda and Contra Costa county are also still highly vaccinated. The anti-vaccination sections of the Bay Area are in Marin and Sonoma which tend to be kind of crunchy-wealthy instead of science/tech and wealthy. Mike Schilling can probably talk more about what makes Marin Marin.Report

    • Avatar dragonfrog in reply to Saul Degraw says:

      What’s “pro-vaccination”? Pro-getting vaccinated, pro-imprisoning people who refuse vaccination, or something in between?Report

      • Avatar Saul Degraw in reply to dragonfrog says:

        @dragonfrog

        I am pro getting vaccinated and banning children from public school if they are not vaccinated unless the parents can prove a legitimate medical reason not to vaccinate their children. None of this “personal belief” stuff. They have to objectively prove that their child has some medical condition which makes vaccination not an option.Report

    • Avatar Montaigne in reply to Saul Degraw says:

      “Only 43% of millennials think vaccinations should be non-voluntary, compared with 73% of those over 65”

      And to answer your question, Saul, I suspect one reason that millennials are more casual about vaccinination is that they are too young to remember the iron lung horrors of the polio epidemics of the ’40s and ’50s. Or rubella (German measles), which was more or less innocuous in children, but caused multiple, severe, congenital defects in the fetuses of mothers 20 weeks pregnant or less.Report

      • Avatar Saul Degraw in reply to Montaigne says:

        This would probably be the case. They grew up with all the benefits of vaccinations and none of the pain of the diseases or the horror stories of summer polio epidemics.Report

      • Avatar Tod Kelly in reply to Montaigne says:

        @saul-degraw, “Why do you think the 18-29 year old crowd is so different from the other age demographics? Is it because they are not likely to be parents and can be more hazy with the answers?”

        I don’t know that it has much to do with not being parents. IN my own life experience, the biggest anti-vax experiences I had was as a young parent in new parent groups.

        @montaigne is spot on here, I think. But as I did in Will’s threads, I would also add this…

        As has oft been noted around here, millennials seem to be bending generally toward an opinion over objectivity mindset. Certainly most of the millennial journalists I read believe this. And as you know, I believe that this is partially caused by greatly fueled by the democratization of knowledge that the internet brings.

        I think the shift toward being anti-vax friendly by the young is not unrelated. When I was growing up, our doctors said we should vaccinate (and had facts to back it up) and that was pretty much the end of the story. Today I can find slick, professional websites with non-pear reviewed case studies and doctor testimonials that look just as professional as anything the AMA or CDC can put up. Why should I choose to believe the latter in a world where academia or government provided data is seen as just one opinion?Report

      • Avatar Don Zeko in reply to Montaigne says:

        Today I can find slick, professional websites with non-pear reviewed case studies and doctor testimonials that look just as professional as anything the AMA or CDC can put up.

        Have the fruit become self-aware, or are you calling some doctors pear-shaped?Report

      • Avatar Tod Kelly in reply to Montaigne says:

        Let’s just say it’s not for me to judge the attractiveness of the medical community and leave it at that.Report

  3. Avatar Jack says:

    When we are talking about a vaccine that is 100% effective, then maybe talk about personal freedoms is warranted, if everyone has reasonable access to vaccinations; after all, your non-vaccination only puts those at risk who refused the vaccination. But many, maybe even most, vaccines are not 100% effective, and not everyone has adequate access to health-care. The fact is that you can be vaccinated and still be at risk, so the less exposure the better.Report

    • Avatar Gabriel Conroy in reply to Jack says:

      There’s also the possibility that some cannot for a medical reason get the vaccine. If there’s not enough herd immunity from those who can get the vaccine, those who can’t get it are in more danger.Report

    • Avatar dragonfrog in reply to Jack says:

      All vaccines are less than 100% effective, and all vaccines have some portion of the population who can’t safely get them for medical reasons (mostly due to being too young to benefit from vaccination).Report

      • Avatar TrexPushups in reply to dragonfrog says:

        Exactly my 6 month old won’t get immunity from the vaccine which is why I have to wait 6 more months to protect him from measles.

        I think politicians who just want to get away from the question without generating heat should say.

        “Vaccines are very effective and the have been demonstrated to be safe. Vaccinate your children for their safety and the communities safety. ”

        Invoking mandates in your response undermines the important part of the message.

        Although I completely support the mandates myself.Report

      • Avatar Tod Kelly in reply to dragonfrog says:

        @trexpushups Yeah, this sounds pretty perfect, actually.Report

  4. Avatar Saul Degraw says:

    http://www.scientificamerican.com/article/why-do-people-believe-in-conspiracy-theories/

    According to this, conspiracy thinking might be a state of mind with people having left-wing and right-wing conspiracy theories.Report

  5. Avatar Don Zeko says:

    Oh, Thom Tillis. He’s only been in office a couple months, and he’s already making us proud.Report

  6. Avatar Saul Degraw says:

    http://www.slate.com/articles/life/family/2015/02/anti_vaxxers_and_the_measles_outbreak_understanding_why_parents_don_t_vaccinate.html

    Slate has been running a series of narrative articles on the anti-vaccination movement. Here is what I’ve learned

    1. It has been around since the 1970s and 80s.

    2. It has a deep crunchy origin. The woman who wrote this article vaccinated her children but was exposed to the anti-vaccination movement from a “group of older, wiser women in hemp blouses and Birkenstocks. They had sweet-smelling homes full of herbs and tinctures; most of them were on kid four or five, their husbands at the university getting postdocs in marine biology or comparative religion. These women took me in, they schooled me in attachment parenting and the family bed, and they warned me about vaccines”

    3. These groups existed in living in a “liberal little flower burst of a university town.” Semi-aside: What is it about college towns that allowed hippiedom to live longer than anywhere else? Places like Eugene, Berkeley, Ithaca, Burlington, Amherst, etc seem stuck in the 1960s or large parts of areas seem stuck in the 1960s. Most of the hippie types are not exactly gown.

    4. Despite the long-history of anti-vaccination, the issue was not a big one until recently because let’s face it, there are not that many super-crunchy types out there and if they stick to the Eugene and Ithacas of the world, they can’t do much damage. But somehow it spread to wealthier quarters that are semi-crunchy or wear the wealth allows people to question experts and now the real damage is happening.Report

    • Avatar Michael Drew in reply to Saul Degraw says:

      Madison is a college town with a big holdover hippie community from the Sixties, as well as progeny thereof who try to maintain the counterculture.

      However, I’ve lived there most of my life, and I haven’t known most of those hippies to be against vaccinating their kids. Maybe I’ve haven’t been quite close enough to enough of them, or known them at the right times of their lives (when they had their kids). But this whole narrative of anti-vaxxing being a big thing amongst hippies is foreign to me, and I’ve known some hippies.Report

    • I find it humiliating that the consequences of the anti-vax movement have manifested so clearly in my state and yet so many Californians persist in insisting on free riding.Report

    • Avatar Damon in reply to Saul Degraw says:

      @saul-degraw
      Don’t forget about Tacoma Park MD. 🙂Report

    • Avatar LeeEsq in reply to Saul Degraw says:

      Hippiedom coudl thrive longer in college towns than other places for the same reason that ideologies that don’t work in regular political environments like anarcho-syndicalism or the more radical Evangelical politics do very well in universities. Universities and college towns create a sort of cloister that creates a protective environment as long as some type of employment could be gained.Report

  7. Avatar Jaybird says:

    What if Eric Garner was refusing to be vaccinated?Report

    • Avatar Saul Degraw in reply to Jaybird says:

      Of course this is what you bring up.Report

    • Avatar Michael Drew in reply to Jaybird says:

      Uh, he still shouldn’t have been arrested with as much force as he was? But maybe he still should have been arrested if there were a law saying he has to get his kids vaccinated (and he was refusing to pay the fine)?Report

      • Avatar Jaybird in reply to Michael Drew says:

        If we’re going into this with our eyes open that “mandatory” means that, hey, some cops are probably going to over-react here or there, then I guess that my main concerns have been met.

        After all, on a purely utilitarian basis, fewer people will die with mandatory vaccines under threat of arrest even with exceptionally enthusiastic police officers than will die if we let folks decide to run with herd immunity.Report

      • Avatar greginak in reply to Michael Drew says:

        If only there were places where vaccinations were mandatory or least with limited or rarely used exemptions. If such places existed we might have an idea how it worked out.Report

      • Avatar Michael Drew in reply to Michael Drew says:

        Unsatisfactory police tactics are not a function of vaccine laws. Our feelings about unsatisfactory police tactics can’t tell us what laws to pass or not.Report

      • Avatar Jaybird in reply to Michael Drew says:

        Our feelings about unsatisfactory police tactics can’t tell us what laws to pass or not.

        Only if we’re Deontologists.

        If we’re Utilitarians, we get to make estimates about what will be worse: what happens if we don’t pass this law vs. what happens if we do.

        We don’t get to pull the “well, I didn’t know that police would enforce this law with much more vigor in the inner city than in the Whole Foods part of town!” defense at this point in the game.Report

      • Avatar North in reply to Michael Drew says:

        Well except that the anti-vaxx demography appears to be primarily focused around whole foods. Poverty doesn’t seem to be a particularily salient indicator of vaccination trends. So cops who’re terrorizing inner city people over vaccination requirements would otherwise be terrorizing them over drug laws or other laws. The solution there is to sort out the police, not cower away from preventing people from destroying the herd immunity commons.Report

      • Avatar Jaybird in reply to Michael Drew says:

        Well except that the anti-vaxx demography appears to be primarily focused around whole foods.

        And what do you think the weed numbers look like?

        The solution there is to sort out the police

        Just like we did last time?Report

      • Avatar Chris in reply to Michael Drew says:

        Well except that the anti-vaxx demography appears to be primarily focused around whole Foods.

        This is not true. There are a whole lot of non-Whole Foods anti-vaxxers. For example, the Alex Jones crowd seems to be centered less around whole foods than around lower middle/working class. Same, I think, with much of the rest of the, for lack of a better adjective, “right” anti-vaccine crowd. On the “left” the Whole Foods crowd may make up the bulk of the anti-vaxxers, but that’s not true generally.Report

      • Avatar North in reply to Michael Drew says:

        So since we haven’t and didn’t sort out the police we should instead shy away from necessary requirement around vaccines? Sounds nonsensical to me.

        I think I’m missing the weed point, everyone uses it and the police use it to terrorize poor minorities? The common thread I’m seeing here is the policy use whatever excuse they have at hand to terrorize poor minorities. This is a bad thing and should be addressed. I am getting a slight vibe of “this will give them more excuses” but is your assertion that the police would like to beat on poor minorities more but can’t because they are lacking fig leaf excuses? That seems like a stretch to me. It also seems to have no relevance to vaccine requirements, as the vaccine requirements currently being suggested don’t involve police at all; they mostly involve either eliminating the “sign a piece of paper no questions asked” loopholes or requiring that one’s prescious bundle of joy be immunized before you can stick him or her in daycare (school) with thirty of his or her peers.Report

      • Avatar North in reply to Michael Drew says:

        Chris, that is true. I suppose we could have a plague of police terrorizing the Amish and other right wing religious non-vaxers though as the stuff we’re talking about imposing re vaccines currently is not police related at all I remain skeptical.Report

      • Avatar Jaybird in reply to Michael Drew says:

        So since we haven’t and didn’t sort out the police we should instead shy away from necessary requirement around vaccines?

        No, not at all. My point was and remains: If we’re going into this with our eyes open that “mandatory” means that, hey, some cops are probably going to over-react here or there, then I guess that my main concerns have been met.

        After all, on a purely utilitarian basis, fewer people will die with mandatory vaccines under threat of arrest even with exceptionally enthusiastic police officers than will die if we let folks decide to run with herd immunity.Report

      • Avatar North in reply to Michael Drew says:

        I still question your assertion that vaccine regulations would add a new weapon to an abusive police officers holster; I think there’s some causitive links missing from that chain of reasoning.

        That said, if I granted your assertion, I would still say, eyes wide open, that it’d be worth it. Hell yes.Report

      • Avatar Jim Heffman in reply to Michael Drew says:

        “I still question your assertion that vaccine regulations would add a new weapon to an abusive police officers holster”

        It’s not the weapons, it’s the excuses to use them. The point is that if someone is Breaking The Law by Refusing To Comply with Lawful Instructions, then the police have not only the right but the duty to use Appropriate Force. And there are huge thick books of precedent declaring that “appropriate” is entirely up to the officer.

        You’re acting like saying “the police would never shoot someone for refusing to vaccinate their child!” What about when the city child-care services representative shows up after the fourth written warning, escorted by police, and the screaming parent waves their arms around and accidentally bumps a police officer’s gun? Bang, dead, she was going for his gun right? Oh shit, they have a dog too, bang bang.Report

      • @jaybird

        Right, but that’s an assumption we have to make about any law – that’s what you’re saying isn’t it? So the issue is, what laws do we want in place more? The unfairness of enforcement doesn’t tell us anything about that.Report

      • Avatar Jaybird in reply to Michael Drew says:

        The unfairness of enforcement doesn’t tell us anything about that.

        It depends on our definition of “us”, doesn’t it? If we don’t have to worry about getting choked to death standing in the middle of the street for verbally disagreeing with a police officer, we might come to an entirely different conclusion about the legality of loosies than people who do have to worry about that.Report

      • Avatar greginak in reply to Michael Drew says:

        Okay, do we have evidence for unfair implementation of laws about vaccines????? We have fairly strong laws about vaccination now with some exemptions. What are the penalties for breaking the current rules we have and how have they been misused.

        Will the evil cops/gov will do bad things to poor people is a good question but not the end of the discussion. What is the history in this context? What are the proposed penalties? If we are going to have some laws, and we all agree we will, there will always be the risk of differential enforcement. That isn’t an argument that can defeat any particular law since it doesn’t deal with the specific context or the need for the law.Report

      • Avatar Patrick in reply to Michael Drew says:

        No, not at all. My point was and remains: If we’re going into this with our eyes open that “mandatory” means that, hey, some cops are probably going to over-react here or there, then I guess that my main concerns have been met.

        Megh. I get your point, but I think you’re dipping into it a bit too shallowly.

        If some cops are going to over-react here or there, they’re going to over-react not about any one given law, they’re going to over-react in their interaction with whoever they’re over-reacting to.

        That interaction is the cause of the over-reaction, not any one specific law. Giving them one more law to use as a bludgeon when they over-react (or taking one away) isn’t solving that problem or making it worse.Report

      • Avatar Jaybird in reply to Michael Drew says:

        The argument “Oh, this law won’t be like those other laws” is less convincing for libertarian types than you probably think it is, Greg.Report

      • I agree with @patrick 100% here.

        (This is also why I believe ending the WOD is not going to have the results so many people believe it will.)Report

      • Avatar Jaybird in reply to Michael Drew says:

        Wait, so the problem with my tentative acceptance of making vaccines mandatory isn’t that I think that the cost of the occasional shooting isn’t too high, but that I think that there might be an occasional shooting?Report

      • @jaybird “The argument “Oh, this law won’t be like those other laws” is less convincing for libertarian types than you probably think it is, Greg.”

        Yeah, but that goes both ways, doesn’t it?

        Washing your hands is mandatory if you work in a restaurant, and yet I can tell you from experience that many people don’t follow this rule. (In fact, I have heard all kinds of arguments over the years from people who got caught not washing for why they believed not washing was actually safer.) You will probably notice you haven’t seen too many SWAT teams storming restaurants and tasing people for this, even though it’s mandatory and people don’t do it.Report

      • Avatar greginak in reply to Michael Drew says:

        Jay, i understand the appeal of generic arguments. That doesn’t make them any stronger though. The more you try to avoid addressing any specific context in any situation the more vague, gauzy and unfocused arguments become. That doesn’t mean a generic idea might not lead to specific thoughts about a specific situation. But still generic is generic, it does well to show tribal membership, general principles and makes people feel good but don’t really address any one situation.Report

      • If we don’t have to worry about getting choked to death standing in the middle of the street for verbally disagreeing with a police officer, we might come to an entirely different conclusion about the legality of loosies

        …as well as of everything else, is the point. What does having to worry about that (or not) tell us about how much we want loosies to be legal compared to how much we want to be able to not vaccinate our kids compared to how much we want to be able to walk out of stores without paying for stuff? Nada.Report

      • Avatar Jaybird in reply to Michael Drew says:

        Well, it seems that your calculations are Deontological rather than Utilitarian.

        That’s okay.Report

      • Avatar trizzlor in reply to Michael Drew says:

        Bang, dead, she was going for his gun right? Oh shit, they have a dog too, bang bang.

        Alternatively, if we *loosen* vaccine restrictions, an angry pro-vaxxer could storm into his town hall, slip on a banana peel, bump into the security guard, and – bang dead. Is that how moral responsibility works, now? I guess that’s why some people look at the Mike Brown shooting and think – if we only got rid of those damn jaywalking laws, this whole thing could’ve been avoided.Report

      • Avatar Jaybird in reply to Michael Drew says:

        For the record, I probably hang out in crazier corners than most and I’ve never heard that particular argument with regards to Mike Brown. Not saying that it’s never been made… just that I hang around crazy people who, you’d think, if anyone would be making that argument, they would.

        I *HAVE* heard that argument with regards to Eric Garner/Broken Windows Policing, however.Report

      • I don’t think so, not entirely. I agree that we want to consider whether a given law is worth subjecting a part of the population to an unequally violent enforcement regime in its name. I agree that we generally want to consider the outcomes of laws from a utilitarian perspective, though I imagine we agree that we want deontological considerations to enter into our evaluations of at least some laws as well. I’m just saying that it’s not clear to me how the insight that an unfair enforcement apparatus will be used to enforce all laws help up determine from a utilitarian perspective which laws are more and less worth the justic costs of the unfairness of the enforcement apparatus. That insight tells us that there is a bar of X degree of inherent injustice in the way we enforce any law we might pass. It doesn’t help us figure out which laws clear the bar and which don’t. Presumably a mix of utilitarian and deonotological considerations will do that. But the point is that, though it’s necessary to get a fix on the size of the bar of injustice in order to figure out what laws are worth bringing that to bear on, getting that fix won’t help us figure out the countervailing value of whatever laws we might consider – whether they clear the bar.Report

      • Avatar trizzlor in reply to Michael Drew says:

        Is it possible that you hear people making the “regulations are to blame” argument for Garner but not for Brown because being against tax-regulations cleanly lines up with their tribal affiliations and being against jaywalking laws doesn’t?Report

      • Avatar Jaybird in reply to Michael Drew says:

        Is it possible that you hear people making the “regulations are to blame” argument for Garner but not for Brown because being against tax-regulations cleanly lines up with their tribal affiliations and being against jaywalking laws doesn’t?

        Dunno. Was “we need to stop putting so much emphasis on Jaywalking” a big meme in the weird corners on the left?Report

      • Avatar trizzlor in reply to Michael Drew says:

        I think the memes on the left were mostly about the racial angle, mixed with some calls for minarchy or violent retaliation.

        Personally, I don’t see a difference between saying “loosie regulations are responsible for Garner’s death” and saying “jaywalking laws are responsible for Brown’s death”. Do you see a difference? Do you think there’s a reason why the former became a meme while the latter did not?Report

      • @trizzlor I suspect the difference is baked into the need for people to justify these types of deaths. In Brown’s case, there was an allegation of violent behavior; this was all that was needed to provide the justification. Jaywalking never became a part of the conversation on any side.

        In Garner’s case there was irrefutable evidence that there was no threat of violence, and so the justification became the fact that he had been caught — multiple times! — selling loosies. Subsequently, lot’s of other conversations branched off of this thread — including the libertarian-ish one about how the real villain was a law against selling looses.Report

      • Avatar Jaybird in reply to Michael Drew says:

        Well, if I only look at it from the viewpoint of “the people who say such things are merely signaling their tribal affiliation”, I absolutely cannot figure out why the two cases are being treated differently by members of that tribe.Report

      • Avatar trizzlor in reply to Michael Drew says:

        Maybe there is a tribe where “the government should stop taxing stuff” is a more potent signal than “the government should stop hassling young punks for walking in the street”? You raised the concern that we need to think about loosie laws as the culprit for Garner, so why the distinction on Brown and walking in the street?Report

      • Avatar Jaybird in reply to Michael Drew says:

        I guess I’m one of those shallow people who suspects that maybe they are doing as much to signal what they think about such things as Jaywalking and loosie-selling as trying to figure out what their tribe thinks of such things and making sure that they parrot those things.Report

      • Avatar Kazzy in reply to Michael Drew says:

        @tod-kelly

        There was definitely some conversation about Brown walking in the street and cultural norms around the practice. Not a lot, but it did take place.Report

    • Avatar North in reply to Jaybird says:

      Herd immunity is, technically, a commons is it not?Report

    • Avatar LeeEsq in reply to Jaybird says:

      There is no evidnece that people of color get vaccinated at lesser rates than wealthy, white people. Evidence suggests quite the contrary.Report

    • Avatar KatherineMW in reply to Jaybird says:

      I really don’t understand you. Cops would not be involved in requiring vaccination of children.

      There’s no circumstance I can think of in which there’s any possibility cops would be involved in forcing people to vaccinate their kids. Require vaccines for public school attendance. Make it difficult to opt-out of having your kids vaccinated (lots of time and paperwork). The most severe measure (which I don’t support) would be removing children from the custody of parents who refused to vaccinate, which would be done by social service workers rather than armed cops.

      Saying “the government should do [x]” does not mean “the government should shoot people in order to do [x]”. Amazingly, the vast majority of everything government does uses methods other than men with guns.Report

      • Avatar LWA in reply to KatherineMW says:

        “Saying “the government should do [x]” does not mean “the government should shoot people in order to do [x]“. ”

        Are you new here?Report

      • Avatar Jaybird in reply to KatherineMW says:

        Saying “the government should do [x]” does not mean “the government should shoot people in order to do [x]“. Amazingly, the vast majority of everything government does uses methods other than men with guns.

        When we’re discussing “mandatory” but we’re deliberately excluding enforcement, then we’re not using a definition of “mandatory” with which I am familiar.Report

      • Avatar Jim Heffman in reply to KatherineMW says:

        Jaybird: It seemed to work for ACA supporters, though. (Remember how we were absolutely assured that the no-insurance penalty wouldn’t actually be applied?)Report

      • Avatar dragonfrog in reply to KatherineMW says:

        How are you going to keep the unvaccinated out of schools? Ultimately if they show up anyway, they’re trespassing and someone authorized to use force to remove them and effect the arrest for the crime needs to show up.

        How are you going to deal with people who don’t get the vaccinations, and also don’t do the paperwork? Ultimately someone has to make them to one or the other.

        How are you going to remove children from their parents’ custody when they (quite justifiably) use force to fight off the social worker trying to bodily seize their child?

        The vast majority of everything the government does can be achieved without the involvement of men with guns because everyone knows that ultimately, if they don’t cooperate now at the annoying paperwork stage, the chain of events ends with men with guns getting involved.Report

      • Avatar Saul Degraw in reply to KatherineMW says:

        @dragonfrog

        Make the parents provide proof of vaccination before school starts.Report

      • Avatar Patrick in reply to KatherineMW says:

        When we’re discussing “mandatory” but we’re deliberately excluding enforcement, then we’re not using a definition of “mandatory” with which I am familiar.

        Most enforcement comes with “pay a fine” or “deal with red tape” for these sorts of things, not “have cops arrest you”.

        Now, granted, there are folks who will take “pay a fine” all the way down to “get killed in an altercation with the police”, but (a) they represent a small minority of the overall folks involved and (b) they’re not lacking for paying fine offenses to take all the way down to martyrdom.

        The fact is, just making a red tape requirement encourages a lot of people to do something rather than deal with the red tape. They’ll file their driver’s license extension because they don’t want to take the exam, stand in line, etc. If they forget they’ll pay their fine to get on with things. For the ones that don’t pay immediately, most of them will walk down and rant at some poor window clerk about how they’ve been driving for years and a supervisor will come over to them and tell them that the law’s the law and they’ll pull out their card and pay the vig even while they mumble about the injustice of it all.Report

      • Avatar Jim Heffman in reply to KatherineMW says:

        “Most enforcement comes with “pay a fine” or “deal with red tape” for these sorts of things, not “have cops arrest you”.”

        Sort of like “selling cigarettes loose out of the pack”.

        er. One would think, at least.Report

      • Avatar Patrick in reply to KatherineMW says:

        I don’t know if you’re missing the point on purpose or not.

        If you have a bad actor in the police department, they have a book full of things to accuse you of doing. Adding one more thing or removing one of the things is not going to change the fact that there’s still a book full of things that the bad actor in the police department can use to leverage their authority over you.

        The way to tackle that problem is to cut down on the number of bad actors in the police department (I think I’ve established my bona fides that I think this is a good idea, for the record)

        Unless there is no book of things, I don’t even think this is a particularly interesting observation unless one of the particular rules in the book is much more easily leveraged against a historical underclass, in which case we may want to take a second look.

        I don’t think upper-middle-class woo believing white folks are a historical underclass. I really doubt the helicopter parent in the park is going to be singled out by a bad actor police officer for the sake of abusing authority and they’ll reach straight for “do you have a license to allow your child in this park showing that they have their vaccinations?”

        Granted, folks close down tiny little libraries because there’s always an anonymous complainer around somewhere, so it’s not an absolute zero possibility. But I **really** doubt some bad actor cop is going to gun down the soccer mom under the “there will be no indictment” idea, here.

        All that said, I can think of all sorts of persuasive enforcement techniques here – including Jaybird’s simple signage idea, for that matter – that are plausible mechanisms for encouraging vaccination and discouraging opting-out without getting anywhere near “if you don’t vaccinate your children, guys with guns will bust down your door, shoot your dog, and put your children into foster care”.Report

      • Avatar Chris in reply to KatherineMW says:

        As far as I can tell, there’s only one law we actually need: resisting arrest.

        Killed someone? Resisting arrest.
        Stole someone’s car? Resisting arrest.
        Say something a cop doesn’t like? Resisting arrest.Report

      • Avatar LWA in reply to KatherineMW says:

        I remember when the cops brutalized the Occupy folks with pepper spray for the infractions of loitering and trespassing.

        What I don’t remember is the argument put forward that “if only we had no laws against trespassing on private property…”

        Come to think of it, of all the gummint laws and regulations that people want to get rid of, that one never comes up.Report

      • Avatar Kimmi in reply to KatherineMW says:

        LWA,
        Just as a note: plenty of places don’t see the need for trespassing laws:
        http://en.wikipedia.org/wiki/Freedom_to_roam

        (as always, cultural assumptions prevail. Can’t go into houses, can’t light fires, can’t trample gardens is the Finnish way)Report

      • Avatar Citizen in reply to KatherineMW says:

        “the law’s the law and they’ll pull out their card and pay the vig even while they mumble about the injustice of it all.”

        Peoples ability to tolerate this at every turn is not infinite. Institutions may become less favorable than what comes out the backside of dogs.Report

      • Avatar Jim Heffman in reply to KatherineMW says:

        “If you have a bad actor in the police department, they have a book full of things to accuse you of doing. ”

        But what about the ones who are Good Germans instead of bad actors? I really doubt that the cops woke up that morning and said “let’s choke us a black guy”, even though that’s what happened. You’re saying “fine, they were obviously bad and we can tell by what happened, get rid of ’em” but what does that say to les autres? That if they make a judgement call then they’re toast? This is how you get Zero Tolerance policies. It’s how you get a dozen firefighters watch a man drown because they’re not the beach patrol.Report

      • Avatar Kimmi in reply to KatherineMW says:

        Jim,
        ahh… the banality of evil.Report

      • Avatar Glyph in reply to KatherineMW says:

        Fairly recently I saw footage of a cop threatening to arrest a PD for…resisting arrest; which struck me as absurdly recursive.Report

  8. Avatar Burt Likko says:

    I don’t think the position I staked out in response to Will’s post is neutral. If you’ll recall, I suggested “you don’t have to get your kids vaccinated, but if you don’t, you can’t send them to public school.” The idea is to provide substantial disincentives and costs for opting out of vaccination, or other desirable behavior.

    Furthermore, I’m very cool with the idea of the government picking up 100% of the cost of the vaccine and the cost of administering it. If we were to achieve very high rates of vaccination, the long term public health savings would be much greater than the cost of implementing free-to-the-consumer vaccination.

    Making something free to do but expensive not to do is not adopting a neutral stance.Report

    • Avatar Road Scholar in reply to Burt Likko says:

      The school thing has the advantage of being practical as well, thus adding a layer of justification. If an unvaccinated kid is going to spread a plague the school is where it’s most likely to happen.

      I’m not in favor of fines or the like, but I agree that making being an anti-vaxxer expensive and a big hassle, plus a measure of social opprobrium, is the way to go. Kid sports leagues could be another pressure point. Perhaps even some churches.Report

      • Avatar Kimmi in reply to Road Scholar says:

        Really? not the bus, where there’s substantially less space between people? not on the playground? Not in an airplane?

        I’d be more okay with this if the anti-vaxxers were told to stay the fuck away from large population centers.Report

      • Avatar morat20 in reply to Road Scholar says:

        Nope. Kids are in close proximity, daily, for hours at a time.

        Buses don’t have ANYTHING on schools when it comes to spreading disease. Passengers get on and off the bus, the population changes.Not as much ‘time in contact’ with the ill. But a sick kid? he’s around the same 30 kids all freaking day. Every day.

        Offices aren’t as bad simply because adults practice better hygiene. Covering their mouths when coughing or sneezing, or at least turning their heads. Washing their hands more often, etc. You can see how time spent with the same people helps with pinkeye, though. It spreads through offices the way most infections spread through schools, because adult hygiene standards aren’t up to it, since you reinfect your hands — and everything you touch after — every time you rub your eye.

        Kids are still working on covering their mouths when they sneeze and washing their hands.

        In short: Kids are dirty, drippy, don’t clean their hands, sneeze and/or cough in other kids faces, rub snot on stuff, and spend 5 days a week around the same kids, multiplying the changes of spreading it. Bugs spread through schools like wildfire, which makes the rather ridiculously stringent sick leave policy most schools have pretty stupid. (Kids aren’t supposed to come at ALL if they’re running a temperature, vomited in the last 24 hours, etc. Teachers aren’t either, but most have limited sick pay. And tend to get hassled by administration for using it. Fun incentives there).Report

    • Avatar zic in reply to Burt Likko says:

      Many of the people I know who don’t vaccinate also don’t want to send their children to government schools; so I don’t know that the public-school denial is going to get very far. I expect it would be welcomed in some corners with the most resistance to vaccination; an excuse to not educated, but indoctrinate further.Report

      • Avatar Saul Degraw in reply to zic says:

        @zic

        http://www.huffingtonpost.com/jack-jennings/proportion-of-us-students_b_2950948.html

        According to this article, 90 percent of American students attend public school. This has to include a lot of the anti-vaccination crowd. It certainly does in California.Report

      • Avatar zic in reply to zic says:

        @saul-degraw from what I can tell, the choice not to vaccinate is generally pockets of people, often holding some common culture; and despite the fact that huge numbers of organic-eating, yoga-paint-clad, pot-smoking hippie moms in CA might not opt to vaccinate while sending their children to school, there are other pockets, and the ones I’m familiar would welcome excuses to make not going to gummint schools an easier choice/easier to do. We’re generally talking groups of people with something akin to cult-like beliefs, and those beliefs will vary. It’s just that for the folks I see, the right to attend school would not be an incentive to vaccinate, it would be the final incentive to fully buck the system.

        We are talking the margins here, of how to get from 90% to something closer to 95%.Report

      • Avatar Michael Cain in reply to zic says:

        Many of the people I know who don’t vaccinate also don’t want to send their children to government schools; so I don’t know that the public-school denial is going to get very far.

        Just over a decade ago, when I applied at the University of Denver (private school), my initial acceptance by the school said it was conditional on providing a history showing that all of my childhood immunizations had been done. At the bottom of the page was a number I could call to get a waiver because I was born before 1957. The only other waiver I remember seeing was “compromised immune system”; it didn’t appear that religious or other personal grounds were accepted.

        I had visions of high school seniors telling their parents “Thanks so much for skipping my childhood vaccinations, so that I can have them and the possible adult side effects now.”Report

    • Avatar Lyle in reply to Burt Likko says:

      In addition I would suggest allowing (and encouraging) pre schools to require the immunizations for attendance. Further colleges could catch some folks by requiring the same. (I know back in 1972 I had to get a smallpox vaccination in order to go to grad school).Report

  9. Avatar Emile says:

    I believe vaccines are an unmitigated good, have 2 kids who have both gotten their full course of vaccinations, and *absolutely* think that talk of “mandatory” vaccination is counter productive and wrong. Why? Because us technocrats need to have a little fishing humility and reflect on our history.

    Thalidomide. Radium toothpaste. Forced sterilization of “mental defectives.” The ice-pick lobotomy fad. Tuskegee.

    It is absolutely not crazy for people to have reduced trust in the “better living through chemistry” cheerleading squad. The way to win this fight is stop calling people idiots, let them know that their questions about vaccine safety have been taken seriously, and to patiently and repeatedly explain exactly how the research has been done to show that there is no evidence of a link between autism and vaccination.

    Yes, it’s frustrating to have the same conversation over and over. No, you won’t convince all the diehards. But it will make a difference, while legislating it will just feed the paranoid. (And would be, you know, *wrong*.)Report

    • Avatar Susara in reply to Emile says:

      I’m a lurker at OG, but for once I feel the need to post something in support of a comment. This is a really sensible post.Report

    • Avatar Michael Drew in reply to Emile says:

      Where’s this talk? I feel like talk of making vaccinations more mandatory than they are is mostly a figment of anti-vax people who need something to actually oppose, since they know opposing schools’ requirements for vaccinations isn’t a tenable position.

      Who’s actually talking about more onerous, comprehensive legal vaccination requirements than we have right now?Report

      • Avatar Kimmi in reply to Michael Drew says:

        I am, for the record. But I am not a politician.Report

      • Avatar Kazzy in reply to Michael Drew says:

        Um… Tod? In the OP? A few scrolls north of here?Report

      • Avatar Kazzy in reply to Michael Drew says:

        @michael-drew

        How mandatory are vaccinations?

        A number of people on this very blog have said they should be MORE mandatory. @burt-likko has discussed removing religious exemptions. Others discussed denying non-vaccinated children access to public schools. Others discussed denying parents who don’t vaccinate their kids access to government services. All of that took place on this very blog. Making vaccines more mandatory is absolutely being discussed. As it should be.Report

      • “Removing” religious exemptions overstates my position. “Weakening” is probably a rough simplification.

        The actual position I advocate is “critically rather than uncritically evaluating claims for religious exemption, and not demanding unattainable standards of countervailing interests from the government.” As it stands now, I think the test is overbalanced in favor of religion and fails to properly weigh communal interests.

        The thing I link the better-balanced religious exemption analysis to is precisely the denial of public benefits.Report

      • I didn’t see it in the OP. You’re moving your aim around now.

        I would still ask Emile what talk he was referring to. If it’s limited to a couple of commenters in the comments section of this blog post, it seems we hav the problem pretty well contained, and there’s not much to be concerned about.

        But I mean… you’re the teacher. I think we do restrict public school attendance to kids who have been vaccinated… don’t we? In a hell of a lot of states, I thought. That’s my point: from a certain perspective, it’s pretty damn mandatory already. But then you don’t have to send your kid to public school. So it’s not mandatory. Exemptions to that policy would be exemptions to a policy that doesn’t make it truly mandatory for anyone.

        When Emile talks about calls to make vaccination mandatory, I take him to be talking about calls made in more important venues than our comments sections, that’s one. And two, I take him to be talking about calls to make it actually mandatory, since if we’re defining “required to attend public school,” then “calls” for that are beside the point; that’s already a widespread reality. So until I read otherwise, my assumption is that anyone expressing real concern over “talk of “mandatory” vaccination,” they are talking about talk that 1) calls for vaccinations to be made truly legally mandatory (with or without exceptions), 2) by people in more consequential positions than “contributor or regular commenter at Ordinary Times.” Or at least, that’s what I’m asking about when I’m asking what talk it is we’re talking about there.

        Because obviously people all over the place will say the damnedest things; if they’re not important I think we’re playing to unfounded concerns of anti-vaxxers by crediting such calls. And if the calls are not for actual mandates, then what are we talking about, since it is already widely the case that you can’t send a kids who’s not been vaccinated to a public school? What’s the middle “more mandatory than that, but not mandatory” ground we’re contesting? Calls for a few religious exemptions to conditioning school attendance on vaccination? That’s not “talk of mandatory vaccinations”; that’s just the reality of mandatory vaccinations (with a few exceptions), if we’re defining “mandatory” as “to send your kids to public school you’ve gotta get the vaccines.” It’s not mere talk in that case.

        But IMO that’s not the case – that’s not a real mandate. So my question is, who (that matters) is calling for mandatory vaccination?Report

      • Avatar Jim Heffman in reply to Michael Drew says:

        “So my question is, who (that matters) is calling for mandatory vaccination?”

        Here ya go!Report

      • Read me out the proposal for a mandate in there , JIm.Report

      • Avatar Stillwater in reply to Michael Drew says:

        Jim, unless I missed something all the proposed solutions revolved around education and access.Report

      • Avatar Kazzy in reply to Michael Drew says:

        @michael-drew

        You also have Obama saying that everyone should be vaccinated. Is that calling for a mandate? No. But is it understandable that it may be interpreted as such? Sure.

        As for schools, I work in a private school and we require vaccinations but the state allows various exemptions that we cannot overrule (as I understand it). I even posted a copy of the form parents had to fill out in requesting an exemption and was alarmed at how easy it was to get one.

        If you don’t think there is a growing tide — as evidenced by people in this very community! — that believes the vaccinations should be mandated through greater/different enforcement mechanisms, than you’re not paying attention.

        And, again, I largely agree with the idea of getting as many people as vaccinated as possible. For me, it is a question of “how” not “if” or “why”. To say that the idea of mandating vaccinations (more than we already do) is a bogeyman made up by anti-vaxxers is simply not true.Report

      • @kazzy

        You’re trying to have it both ways. For example, in saying what he said, Obama hasn’t said anything more than you did right there.

        I don’t know exactly what tide might be coming in, but I do think that if it’s only evidenced in what a few commenters on this website are saying, then it really doesn’t matter at all; and it’s not a tide, it’s a ripple.

        And if the tide toward a belief that “vaccinations should be mandated through greater/different enforcement mechanisms” and those different enforcement mechanisms just are “a few fewer exemptions to the requirements for kids to get vaccinations in order to go to public schools, which itself isn’t a mandate,” then I would say you’re using a conceptual conflation to advance an false argument – that there is a tide toward vaccinations being mandated in a way they currently aren’t.

        If the requirements that kids get vaccinated in order to attend school count as a mandate, then there isn’t a tide toward a mandate that really matters – there is already a broad mandate. Many, many people who might not want to do it are “required” in that way to do it. But if it isn’t a mandate – and it’s not – then a tide toward a few fewer exemptions to the policy about sending your kids to school without their shots is not a tide toward a mandate.Report

      • Avatar Kazzy in reply to Michael Drew says:

        @michael-drew

        Christie was attacked for distancing himself from the President by saying parents should have choice in the matter.

        What is the conclusion we draw from that? How can it be anything other than Christie’s critics think there should be no choice; there should be a mandate?Report

      • @kazzy “Um… Tod? In the OP? A few scrolls north of here?”

        No, not really. We already *do* have a fairly comprehensive system of mandatory vaccinations, as you will discover when your kids get old enough to go to school — when you will discover that they are by law required to go to school and by law required to be vaccinated before they do.

        Are there ways to not get vaccinations in this system? Of course. You can home school and plan on your kids never going to college and having their career courses somewhat limited. You can live off the grid. You can, under certain very specific circumstances, show religious considerations. This is the way of all “mandatory” things government imposes in our society, from selective service to filing taxes to not trading with certain countries. We still refer to these policies as mandatory, mostly because of what we are trying to communicate.

        Our country is full of mandatory requirements for for people and businesses where exceptions are made, and almost none of them result in police rolling up in tanks putting chokeholds on people and shooting them. That this is the assumptive conclusion many here draw from a mandatory vaccination system says more about those of us who hang out here and the subject matter we like talking about than it does about reality, IMHO.Report

      • Avatar Jim Heffman in reply to Michael Drew says:

        That was just the first link I found from a quick Google search. Maybe you’d prefer this one.

        And sure, you can roll around in stinky technicalities, but the point is that “nobody would ever make vaccinations mandatory for all children” is demonstrably not a true statement.Report

      • I’m not entirely clear what Christie was attacked for.

        But its possible to attack the statement that parents should have choice, not for being wrong, but for having the wrong emphasis. Christie in his initial statement declined to strongly say that parents should not choose not to vaccinate their kids. He walked back his gaffe not by withdrawing his assertion that parents should “have some degree of choice,” but by affirming that parents should not use that choice to do anything other than get the MMR vaccine.

        That seemed to significantly quiet the uproar (i.e., the criticism then turned to what a big political gaffe it was to ever have to issue that clarification, not to maintain that that was not enough, that he had to come out for a mandate). So I’m not sure the uproar implies that those reacting to the statement think there should be no choice. The nature of the uproar to me suggests that people strongly feel that public officials should tell parents in no uncertain terms to use the choice they are given to choose to vaccinate.Report

      • The Texas law would not have been a pure mandate either, as Perry noted in Monday night’s debate. As in Virginia, parents would not have been required to have their daughters vaccinated. The law would have just made the vaccine available and affordable to all girls, insured and uninsured, through the state vaccination program.

        It sounds to me like they were going to inoculate kids at school whose parents wanted it to happen – with less veneer of requirement than even the more standard vaccines that are required for school attendance (to which there are exemptions).

        “Stinky technicalities”? If you want to say something is a mandate, it needs to be a mandate. That’s neither stinky (by which I take you to mean insignificant), nor a technicality.

        And I’m not saying and haven’t said anything about what will never, ever happen. People certainly might call for real vaccination mandates. It’s possible. I’m asking about who has called for what we’re talking about here, to date.Report

      • Avatar Kimmi in reply to Michael Drew says:

        Mike,
        according to reports from NJ, Christie’s admin has been responsible for a TRIPLING of the number of non-vaccinated kids.Report

      • @kazzy

        Let me offer up this. My impression is that there are pretty tough requirements for kids to get vaccinated in order to attend public school in a lot of states right now. I.e., you already have to have some pretty good reason to be able to opt out – a sincere religious objection, obviously an inability to be inoculated with live virus, etc.

        If that is mistaken because in fact by and large these are not real requirements at all, but instead all that is required is a mere request not to be subject to the requirement, then I can see where a tightening of those “exemptions” to something more rigorous would introduce a situation where the policy was maerially more like a real mandate than it was before.

        I would say that that continues not to really be “talk of a mandate.” These school requirements just aren’t mandates. It’s an important distinction. And do we really feel that, if exemptions to vaccination requirements are really just general passes making the policy a de facto recommendation or request, tightening these exemptions up will have the kind of effects that Emile is talking about? Should we credit that reaction if it does? The schools already claimed it was their policy to “require” vaccinations; they just didn’t in fact do so (in this hypothetical). Is “talk” of actually instituting something like the policy they always said they had in place really “counterproductive and wrong”? Not at all. It’s clarifying and probably wise.Report

      • Avatar Kazzy in reply to Michael Drew says:

        @michael-drew

        http://www.p12.nysed.gov/sss/schoolhealth/schoolhealthservices/modelreligiousexemptionformmarch10.pdf

        That is the letter parents must submit. Exactly how determinations are made, I can’t speak to. A website that landed me there (which was blatantly anti-vax) noted NY as one of the most difficult states for “parents to assert their rights”. If they are correct in this regard — and NY simply requires a letter be submitted — it makes me think that these requirements are not robust.

        I will also say that when I worked at a daycare in Boston, one of my jobs was entering child information into a database. This included noting whether they were up-to-date on vaccinations. If they were not, all I was supposed to do was tell the director. This wasn’t stressed, mind you. It was simply, “Enter the data. If anything is missing or not up to date, let me know.” Now, this was about a decade ago. But it similarly indicates that enforcement of requirements is not particularly strong.Report

      • If […] NY simply requires a letter be submitted

        If.

        Then, see the rest of my argument. Nevertheless, they claim to require the vaxs, right? So “talk” of “mandating” it in this non-mandate way of conditioning school attendance on it – but actually starting to do that – really shouldn’t be that big a deal. The state has already made a big deal about talking about such a mandate. They already claim to require it.

        I just can’t see where talk about enforcing a requirement that’s already on the books can be seen to be so counterproductive and wrong. If it was not enforced, it was because there seemed to be so little resistance to vaccination that effective herd immunity was not at all in doubt. Certainly the requirement exists so that no one wonders whether the authority is there to enforce it if the slightest doubt crops up.

        But still, you’re not providing much evidence of talk of making things more mandatory. If it was as easy as submitting a letter in NY, why would they be saying it was particularly hard to vindicate their rights there? And where’s the quote from a NYS public official talking about maybe starting to restrict whatever the exemption policy had been heretofore?

        Hey, maybe it exists. That’s all I’ve been asking for from the start.Report

      • …And this is not “just” a letter. It requires the parent aver that they have “sincere and genuine religious beliefs which prohibit the immunization of their child in which case the principal or person in charge may require supporting documents.”

        So, parents can’t just think that the vaccines might cause autism, or have a preference their kids not be vaccinated. They need to have a real religious belief that prohibits it – or be willing to lie about that. That’s why they complain – because many of them do not. This is a tough standard, and does not at all effectively render the requirement a request. It looks to me, with the reference to supporting materials, like not only does the averral of religious belief have to happen, where I imagine that falsely providing it is not without penalty, but that some investigatory process actually takes place to confirm its truth.

        Outside of this religious exemption, it sounds like New York’s law conditioning attendance on vaccination is pretty hard and fast: “Philosophical, political, scientific, or sociological objections to immunization do not justify an exemption under Department of Health regulation 10 NYCRR, Section 66-1.3 (d).”Report

      • Avatar Kimmi in reply to Michael Drew says:

        Michael,
        20 states give philosophical objections to immunization as a way of evading the law.Report

      • Thanks, Kim.

        It would be interesting to find out how much “talk” about narrowing those exemptions is occurring in those states. It would be nice to see some examples, too.

        Also, as I’ve said, my main question is whether that is the kind of ‘talk of “mandatory” vaccination’ Emile is talking about. (I still have a hard time with characterizing such talk of narrowing exemptions as “talk of mandatory vaccination” when there is no talk of changing the fundamental requirement, and it’s such a longstanding thing for states to require vaccinations for school attendance. They aren’t just talking of requiring it – they already do – at least they claim to. That’s more than just “talk” of mandatory vaccination, if requiring vaccination for attendance is “mandatory vaccination.”). But anyway, yeah, I’d like to know if this is what Emile was referring to.

        And then it would be good to know whether Kazzy and others agree that such talk is counterproductive and wrong.Report

      • Avatar Kimmi in reply to Michael Drew says:

        Michael,
        I actually think that “philosophical” is an orthogonal vector to “narrowing exemptions”. Christie’s admin has loosened exemptions by simply not requiring people to prove that they have a religious exemption. (if you say loosened means tripling the number of non-vaccinated kids).Report

      • The exemptions are where the battle is. Whether there is a religious or philosophical exemption available and how to get it.

        Saying “there is already a mandate” doesn’t reveal much because the mandates in Vermont and Mississippi are very different.

        Nobody is talking about tanks, but expanding or retracting the ability to evade it are live issues. And there are more than a few people who want to retract.

        I’ve never seen so much praise of Mississippi and West Virginia in my life, as I’ve seen this week.Report

      • Talk of wanting to retract exemptions to existing requirements simply cannot be “talk of ‘mandatory’ vaccination” that is counterproductive and wrong. For talk of mandatory vaccination to be so clearly counterproductive and wrong, it would have to be talk of the introduction of a policy that is new and threatening in kind, not mere movement along a continuum of strictness and leniency in enforcement of a policy of conditionality of shcool attendance on vaccination that is well-known, widespread and generally expected to be heeded.Report

      • Avatar Jim Heffman in reply to Michael Drew says:

        So what you’re saying is that when Rick Perry said “all girls must have the HPV vaccine before entering the sixth grade”, that wasn’t a mandate.

        You seem to need that to be true very badly.Report

      • I’m saying he never said that.Report

      • Avatar Chris in reply to Michael Drew says:

        Perry’s 2007 executive order, which was quickly overturned by the state legislature, would have required all sixth grade girls in the state to receive the vaccine unless their parents opted out.

        Jim, by you leaving out that sentence, you make it quite clear who really needs to believe something here.Report

      • …And my emotional commitments on this issue are very limited indeed.Report

      • Most policy movement is along a spectrum.

        I wouldn’t characterize it the way that you object to it being characterized (obviously counterproductive and wrong or whatever), though I think it takes the notion of mandate out of being some sort of invented issue. If exemptions are tightened, people who previously didn’t have to vaccinate their child will have to or face significant consequences (like having your kid not be able to go to school). If you’re someone who doesn’t want to vaccinate your child, that’s pretty significant. It’s a real issue and a live issue that “But that’s already the law in some other state” doesn’t undo.Report

      • Most policy movement is along a spectrum, but we don’t usually seek to characterize talk of most policy movement along a spectrum as talk of the creation of a mandate where none existed before, hence counterproductive and wrong. We characterize it as adjustment to this or that specific of this or that existing requirement, with these costs and these benefits.Report

      • Some of this is terminology. When I say that I don’t favor a mandate, it’s partially because I don’t believe that someone that includes both a religious and philosophical exemption truly qualifies as a mandate (or a requirement, if that’s a word you prefer). So to my mind, only roughly 30 states have a mandate. Going from “Philosophical or religious objection” to simply “religious exception” changes the dynamics, for me, almost completely. For other people, that line is going to be between the existence of a religious exemption or no exemption at all.Report

      • …I mean, if a state is considering adjusting its exemption regime so that one more person will not be given an exemption, is that really “talk of mandatory ______,” whether we think that is counterproductive and wrong? When there was already a rule nominally requiring everyone to do it? The (mere) talk of mandatory ______ was back when they were considering the rule, whatever the exemptions would be. Then they decided there in fact would be mandatory _______, with these exemptions. The time when talk of mandatory _______ would have been novel enough to clearly on its own be counterproductive and wrong is long past. A few more people subject to mandatory ________ than before is not talk of mandatory _________ where there was none before.Report

      • To me, it’s only really a mandate or a requirement when you can’t freely opt out of it. That’s where my line is. The number of people isn’t the important part.Report

      • At least, that’s one axis. The other axis is the extent to which the penalty for not following the mandate strikes me as punitive or a significant hardship. Which not being allowed to attend public school – especially when education in compulsory – meets that standard.Report

      • I don’t believe that someone that includes both a religious and philosophical exemption truly qualifies as a mandate (or a requirement, if that’s a word you prefer). So to my mind, only roughly 30 states have a mandate.

        Well, I’m glad we got that figured out, because there would have been no way for me to know that prima facie. I wonder if that is what Emile has in mind by “talk of mandatory vaccination” – talk of eliminating philosophical exemptions in the minority of states where they exist.

        Going from “Philosophical or religious objection” to simply “religious exception” changes the dynamics, for me, almost completely. For other people, that line is going to be between the existence of a religious exemption or no exemption at all.

        And for others, between formally having the requirement or not. I can’t say for sure I’m there, but I can say that that is enough to vitiate for me any sense in which “talk of mandatory vaccination” can be seen as at all problematic. The sense of “mandatory” we mean is conditioning school attendance on it, whatever exemptions to that requirement there might be. Once a state has taken steps to at least nominally act to impose that condition on attendance (even if with broad exemptions), it has gone way past mere “talk of mandatory vaccination”; it has taken concrete action (including however many exemptions) to that effect. If that is long-established status quo in something like 50 states, there can be no way that “talk of mandatory vaccination” can be a meaningfully counterproductive and wrong step anymore. Mere talk has been eclipsed by policy. Is anyone objecting to the actual action that’s been taken in pursuit of same long ago in basically all states?Report

      • What brief characterization (trying for a label, or a name, here) would you give to the nature of the policy in states claiming to require vaccinations for kids attending school, but which allow philosophical exemptions? What would you call their policy?Report

      • That depends on the actual action, doesn’t it?

        I’m not sure I agree with Emile’s comment (kinda depends on the actual action). I do think that this:

        I feel like talk of making vaccinations more mandatory than they are is mostly a figment of anti-vax people

        … is wrong, because whether you accept my threshold of mandatory or not, going from religiousphilosophical exemptions to just religious exemptions does, to my mind, make something “more mandatory.” Or at least believing so is something other than a search for something to oppose.Report

      • “Opt-out requirement” (as in you have to actively opt-out of doing it).

        My wife (who hates the policy) calls it a “theoretical requirement”Report

      • Yes, I sort of bought it by using “more,” I understand. When I said that, up until now, I simply didn’t believe that the closing of some exemptions on the same basic requirement amounts to making it “more mandatory.” I thought Emile was proffering proposals to introduce a requirement new in kind from conditioning school attendance on vaccination. Something short of a jailable offense; something along the lines of a tax penalty (in addition ot the school requirements), but with limited enforcement a-la the ACA mandate, where for those who can contrive to not pay that part of their tax bill, there will be no pursuit with the usual tax enforcement means. Something like that.

        But even by your/Kazzy’s definition, it depends on how much such talk is actually happening versus how much anti-vaxxers are fixating on maybe one stray example or some such. (“[M]ostly.”) Which is the real substance of what I’ve been getting at here. So far, zero examples of significant talk from important people about doing this have been provided.

        Nor much clarity on whether anyone thinks such talk would be “counterproductive and wrong.” If it turned out that Emile, like you, wouldn’t consider talk of going from phil+relig to just religious exemptions (i.e. of some of 20 states becomeing like the 30) counterproductive and wrong, then it turns out I’m right about what he had in mind with “talk of mandatory vaccination,” aren’t I? Something more different in kind than just closing a few exemptions on the same school-based policy.Report

      • She hates the philosophical exemption?Report

      • About as much as she hates the religious exemption. My standards for what qualifies as a “mandate” have likely been influenced by her, in a way. I’m not sure she would consider anything short of MS-WV as qualifying. But she was particularly incensed when we lived in a state with both. In states with religious-only, I think she was more frustrated with the people rather than the state.Report

      • Let me put my position this way: if you want to say that an actual mandate (requirement; condition of school attendance) would be counterproductive and wrong, then it is certainly reasonable to say that what’s on he books, even though it calls itself a requirement, is not a requirement, so that that’s not a claim that long-established policy is counterproductive and wrong.

        But if you want to say that even just talk of a mandate (requirement; condition of school attendance) would be counterproductive and wrong, then you have to allow that of talk of a mandate (requirement; condition of school attendance) would be counterproductive and wrong. And a law on the books purporting to be a mandate (requirement; condition of school attendance) would have to be recognized as at least talk of a mandate (requirement; condition of school attendance), even if exemptions riddled it with holes and made it in fact not a mandate (requirement; condition of school attendance). The purporting is itself clearly very loud talk of mandatory vaccination, even despite the exemptions. And presumably much more talk of the same preceded the enactment of that (non-)requirement. This is all clearly at least talkof a mandate, even if what’s actually in place is not that due to exemptions. And all that is water that’s way, way under the bridge historically.

        Talk of a vaccination mandate (understood as a requirement/condition of school attendance) is simply a fait accompli. We have to understand talk of mandatory vaccination as something different in kind, not just incrementally different in reach, from the long-established reality of school attendance being conditioned on vaccination (with exemptions) for talk of mandatory vaccination to be sensibly thought to be counterproductive and wrong.Report

      • Avatar Jim Heffman in reply to Michael Drew says:

        “Jim, by you leaving out that sentence, you make it quite clear who really needs to believe something here.”

        Boy, I remember the good old days of about five years ago when it wasn’t mandatory to buy health insurance, and the people who said “the government solution to healthcare costs will be to make insurance mandatory” were laughed off as crazy cranks.Report

      • Avatar Chris in reply to Michael Drew says:

        Jim, a simple “I was wrong” would have sufficed.Report

      • Avatar Patrick in reply to Michael Drew says:

        Not to mention the fact that people have been talking about making insurance mandatory for all sorts of under-insurance problems for years, so I don’t know where this crazy crank talk comes from.

        Is there a state in the Union without a mandatory car insurance law? Is there a state in the Union without a mandatory minimum insurance amount for a laundry list of professions as long as my arm?Report

    • Avatar Gabriel Conroy in reply to Emile says:

      I agree with Susara. This is an excellent comment.Report

    • Avatar North in reply to Emile says:

      I disagree. Vaccinations have historically often had a rather heavy hand applied behind them and have always had a serious amount of public pushback. We’re not talking about something that the masses have loved. Back when polio crippled and killed with abandon at least reality backed up the vaccination pressure adequately but I do not wish to have to surrender the luxury of not having polio crippled limping around to remind people that vaccinations are really fishing important.

      We have, in the anti-vaxx movement, a very odd phenomena where some latent woo free riding metastasized with a massively crooked researcher seeking to perpetuate massive fraud to infect some people with active rather than passive resistance to vaccination. Demographically this seems to be manifesting mainly in upper income areas. I don’t like increasing the shove behind necessary public health interests but we’re fighting the resurgence of some of humanity’s oldest scourges here God(ess?)damnit! Since people are so far ignoring simple facts and the contagion seems to be spreading it seems unhappily necessary to start incenting them with a bit of nudging. CA is closing loopholes in its opt out system and that seems like a good first step; other states should follow suit. If that doesn’t work the nudging should get more insistent, perhaps by banning the darling plague bombs from public schools, maybe more.Report

      • Avatar LeeEsq in reply to North says:

        I’m with North. The early vaccinations and innocculations against small pox involved a lot of governmetn coercision and mandates to get people to accept it. Massachusettes had a compulsory small pox vaccination law that was affirmed by the Courts. The arguments of the anti-vaxxers in the early 19th century were very similar to the ones using today.

        There is always going to be an element of coercision with all public health measures from vaccinations to simply making sure living spaces remain clean for a variety of reasons.Report

      • Avatar LeeEsq in reply to North says:

        Its also important to point out that polio was considered such deliberatng, terrible disease that the sigh of relief when Dr. Salk released his vaccine for it. The “Thank you Dr. Salk” signs were completely sincere and without irony.Report

      • Avatar TrexPushups in reply to North says:

        Mississippi pretty much does that. Without vaccinations you can’t send a kid to public or private schools.

        Medical exceptions are allowed. Nothing else.Report

    • Avatar North in reply to Emile says:

      ll that being said- it really is an excellent comment.Report

    • Avatar Kimmi in reply to Emile says:

      Are you, personally, willing to pay for hospitalization for people who can’t get vaccinated? Because it’s one thing to stand on principle.
      But put your money where your fucking mouth is, and go visit the graves of the dead.Report

    • Avatar Chris in reply to Emile says:

      I agree with this by and large. I’d add this, though:

      Much of what we believe, and by “we” I mean every single one of us, is determined not by facts, but by which experts or authorities we choose to trust. That trust is often deeply wrapped up in our sense of self and our social identity: attacking the ideas, and in some cases attacking the authorities from whom we get the ideas, can therefore be seen as a direct attack on us personally. Such attacks, then, will often make us ignore information that would, in a perfect world, cause us to change our minds, and it may even make our beliefs in the attacked ideas even stronger.

      So, when we want to change people’s minds about facts that most of us could never verify, and which therefore requires trust in the source, we have to walk the very thin line between undermining the ideas, and the authorities, and insulting them and the people who believe (in) them.

      Jenny McCarthy is a perfect example: a lot of people trust her, for whatever reason, perhaps because she is a mother who has gone through something that they understand. It’s tempting to just tear her down, a temptation I admit succumbing to more than once, and we should not simply give her a pass, because she is responsible for the deaths of children. However, if we want to change the minds of the people who trust her, simply tearing her down is not enough. We have to undermine her without undermining their identity, and just as importantly, we have to give them someone else to trust.Report

      • Avatar Kazzy in reply to Chris says:

        @chris

        The moment people start talking about bleached blonde hair or breast implants vis-a-vis McCarthy, they’ve essentially conceded the argument. And, the thing is, I think many of them are okay with this. Far too often debates become about destroying the opponent rather than actually pursuing truth.Report

      • Avatar Dave in reply to Chris says:

        @kazzy

        And, the thing is, I think many of them are okay with this. Far too often debates become about destroying the opponent rather than actually pursuing truth.

        Having dealt with a few McCarthy apologists, and ripping them up one side and down the other (one of them so badly she suggested I see a counselor) I see nothing wrong with being ok with an approach far less diplomatic than the one Chris suggests.

        For those of us without the luxury of looking at this from a more sanitized, rational perspective, emotions come into play, and there’s little that can be done to avoid it. It’s why I feel terrible for the people that came to believe that the autism of a loved one was vaccine-related, only to then find out that the study was bullshit.

        Worse, the people still selling that shit today are indirectly blaming the decisions of parents for causing harm to a child when we have no idea whether or not this is the case. The emotional toll of raising an autistic child is difficult enough and not knowing what caused this eats at me all the time, but for pompous assholes to throw on a whole other level of hurt based on something that can’t be substantiated?

        They don’t deserve diplomacy nor do they deserve my respect. End of story.Report

      • Avatar Kazzy in reply to Chris says:

        @dave

        I’m not saying they deserve diplomacy or respect necessarily. My point is that when the debate devolves to the point of personal attacks that are wholly unrelated to the matter at hand, any hope of actually educating people goes out the window.

        There exist REAMS of facts that can thoroughly and comprehensively debunk all that McCarthy has to say on the matter. And if you want to drop them with a hammer, by all means, do so. But when people reduce their argument to, “You’re going to listen to some former centerfold with fake boobs,” what exactly does that accomplish? That isn’t going to convince anyone. So why engage in that? I think it is because some people (note: not you) are just looking for an excuse to be nasty. McCarthy’s breasts or hair or modeling career carry zero weight in this debate so let’s leave all that out and focus on what does carry weight: the mountains of evidence that prove her demonstrably wrong.Report

      • Avatar Dave in reply to Chris says:

        @kazzy

        I should probably be a little more clear. When I’ve ran into problems, it’s been with people that I thought were not only beyond hope but also borderline belligerent. I think there’s a difference between people that have been influenced by her views and opinions and those that are her most vocal supporters. I prefer the velvet glove approach with the first group and a mighty big hammer with the second group.

        The worst fight I got into was with a high school guidance counselor that decide her flashing her two Master’s degrees in Psych or whatever was sufficient grounds for an autistic father to defer to her professional opinion. Not wise. It got very ugly, and while I thank you for excluding me from this:

        I think it is because some people (note: not you) are just looking for an excuse to be nasty.

        I’ll be the first to tell you that while I won’t look for an excuse to be nasty, if I get into a certain situation (like the one above), the amount of guilt I’ll feel about treating someone poorly is next to nonexistent. It’s not something to be proud of since I wasn’t raised to treat people that way, but it’s a consequence of my circumstances, I suppose.

        There exist REAMS of facts that can thoroughly and comprehensively debunk all that McCarthy has to say on the matter. And if you want to drop them with a hammer, by all means, do so. But when people reduce their argument to, “You’re going to listen to some former centerfold with fake boobs,” what exactly does that accomplish? That isn’t going to convince anyone. So why engage in that? I think it is because some people (note: not you) are just looking for an excuse to be nasty. McCarthy’s breasts or hair or modeling career carry zero weight in this debate so let’s leave all that out and focus on what does carry weight: the mountains of evidence that prove her demonstrably wrong.

        I think her previous background is fair game because it shows that she lacks a scientific background, and when you add on top of that the fact she peddles theories that have been debunked, it questions her credibility for sure. Would I attack her using the examples you mentioned? Probably not, but I could incorporate that somehow.

        A challenge that you may have educating people is that a lot of people feel connected to her as autism parents (I don’t personally). If there’s an emotional tie, all the reams of research in the world may still not convince people. The vaccine issue aside, people may still think she’s a net good and want to give her the benefit of the doubt.

        In case I didn’t make this clear before, I don’t want to tear an autism parent a new asshole when that person has a good faith reason to believe in something I don’t agree with.Report

      • Avatar Kazzy in reply to Chris says:

        @dave

        Saying that McCarthy lacks even the most basic professional credentials to be taken seriously on the matter is fair game.

        But I’ve heard people say, “McCarthy? You mean the big titted whore from MTV? Maybe all that silicone went to her head.” Those comments aren’t about actually addressing the situation. They’re about taking potshots. If you are at the end of your rope and dealing with a situation that impacts you personally on a deep, emotional level, I’d give you a hell of a lot of deference in terms of how ‘civil’ I’d expect you to be. But, again, that really isn’t what I’m talking about.

        I’m talking about people being nasty for nasty’s sake. I’m talking about people who still want to lead off every discussion of Christie’s politics with a crack about his weight. I’m talking about people who want to discuss the color of Obama’s suits. Or the size of Michelle’s arms. The petty, personal bullshit that people all-too-willingly engage in because it is about signaling to their own side just how “down” they are instead of actually constructively promoting their cause.

        McCarthy is dead wrong and should be taken to task for advocating a dangerous course of action. But her hair color or breast size are immaterial to any of that and anyone who starts their argument with reference to those points immediately identifies themselves as non-serious participants in the conversation, as far as I’m concerned.Report

      • Avatar Chris in reply to Chris says:

        I think there’s a difference between people that have been influenced by her views and opinions and those that are her most vocal supporters.

        This is definitely true. I think that, in laying out an approach to an issue like anti-vaccination, we have to separate the followers from the leaders, and among the followers, those who are most strident. That said, we do have to be careful with the leaders and the most strident followers, because even if they are lost causes, the rank and file may not be (and, in fact, cannot be, if there’s any point in having this conversation at all), and they are watching the leaders and most vocal followers closely, because it’s from them that they take their cues. So when we’re talking to a McCarthy or our neighborhood anti-vaccination zealot, there’s a good chance we’re not just talking to them. Dealing with such people is then a lot like performing surgery: you have to make the right slices in the right places, and be careful not to cut too deep or too far outside of the issue at hand.Report

    • Avatar Jaybird in reply to Emile says:

      Emile: hang out more. Comment more.Report

    • Avatar Saul Degraw in reply to Emile says:

      @emile

      Do you think we should separate the government actions (forced sterilization) and stories of drugs which were released onto the market without fully studying potential adverse events or with adverse events that only manifested later?

      I fully believe in a robust FDA but the solution to drugs with adverse events is tort law, not wide-spread suspicion. I am a product liability lawyer. I work on cases with medicines that produce adverse events, I am still going to take medication that a doctor prescribes if I get sick because it is more likely to be effective than homeopathy or alternative medicine.

      Western science and medicine, by and large, works and works wonders. Suspicions about this science often seem to come from places of woo and wanting something to be more “pure” or “spiritual”Report

      • Avatar Kazzy in reply to Saul Degraw says:

        @saul-degraw

        “I fully believe in a robust FDA but the solution to drugs with adverse events is tort law, not wide-spread suspicion.”

        Says you. Suspicion seems like a reasonable response in many cases. Tort law is only available after adverse events have occurred. If you are (wrongly) fearful that your child may acquire autism through vaccines, being told you’ll have the option to sue after-the-fact offers little solace. You want assurances beforehand. And, as @chris discusses, trust in authorities is essential to feeling assured.Report

      • Avatar Saul Degraw in reply to Saul Degraw says:

        @kazzy

        No doubt. There is research that shows one of the reasons that poor people stay poor is distrust in the authorities and potentially with good reason. I might be critical of banks and financial institutions but I still have enough trust in them and in the FDIC to keep my money in banks and invested as an example. I am not even a credit union kind of guy.Report

      • Avatar Kimmi in reply to Saul Degraw says:

        Saul,
        It’s not paranoia if they’re really out to get you.

        Big Banks like the ones you patronize make a living off the stupid and the people without assets (“poor” if you will). You’re probably a net loss to them.Report

    • Avatar zic in reply to Emile says:

      The current version of this, though it doesn’t involved things forced on individuals, is antibiotic resistance. We live in a world where the meat we eat is force-fed antibiotics, where the practices of factory farms are legally shielded from public view, and there’s growing antibiotic resistance to hospital-acquired infection.

      The conflict there — defending the farming practice even as people develop untreatable disease that used to be treatable — discredits the government’s advice in other areas of public health.Report

    • Avatar Michael Drew in reply to Emile says:

      Despite my question above, I agree that I like the cut of @emile’s commenting jib. Though I imagine it’s a little weird to post one comment and suddenly have an entire community begging him to please comment more. Makes us sound a little… needy.

      But despite that, I have further disagreement with Emile. I’m not so sure the best way to persuade is to be willing to repeatedly and patiently say, “Your concerns have been taken seriously… and duly liquidated by SCIENCE!” To me that sounds a little head-patty and patronizing. Plus… it’s a bit dishonest. The reality is that they were never taken all that seriously, but they became a big folk belief, so they were taken just seriously enough to debunk. And the reality is that no one who is informed is particularly patient with these beliefs.

      I’m not sure that the way to persuade people isn’t to just level with them about where they stand in the estimation of informed people if they persist in these beliefs despite the evidence. And I’m not sure that a lot of them won’t mistake people being nice about informing them of the science with people being a bit wishy-washy about what the science is. Sometimes bluntness is necessary to achieve the degree of clarity that is called for in a given situation. There was a professor who used to hang around here who I think took that philosophy a bit too far too often. But sometimes it’s appropriate. You don’t have to be mean about it or call them stupid. But you can be real about it.

      Now, perhaps Emile is right about what the right approach is. But I’m not at all sure he is. It doesn’t follow from anyone’s assertion that it is one or the other, or one and not the other in all situations.Report

      • Avatar Jim Heffman in reply to Michael Drew says:

        “I’m not so sure the best way to persuade is to be willing to repeatedly and patiently say, “Your concerns have been taken seriously… and duly liquidated by SCIENCE!””

        Seems to be acceptable in the Global Warming discussion, though.Report

      • That’s the more solicitous option I’m considering there, Jim, so….

        I actually favor a bit more qualification on climate, because it’s hard to run double-blind trials on carbon’s effect on our atmosphere. Only a little bit more, though.

        Which is kind of ironic, because I think climate-change deniers are overall a tougher, less sensitive group, so that bluntness is probably more called for. But I just don’t think blunt assertion of fact is quite as well-founded on that question, simple as that. A bit more qualification is necessary just to be right.Report

      • Avatar Kimmi in reply to Michael Drew says:

        Jim,
        You can make actual, scientifically based arguments that maybe we really don’t understand what’s going on. Spoiler: Extrapolations are HARD!

        What you can’t do is say that Exxon (big oil in general) wasn’t, at one point, actively funding Every Single global warming denialist (who actually worked in the field). That they were doing that strains credibility. And, yes, the guy who did the research for ExxonSecrets was VERY thorough.

        You’d need an awful lot of new data to explain away a 300 year trendline though…

        But, hell, move to Miami. Put your money where your mouth is.Report

      • Avatar Jim Heffman in reply to Michael Drew says:

        It is true when you say that the people who are scared of vaccines aren’t coming to that feeling from having looked at the science.

        Despite being surrounded by technology, we live in a very superstitious age.

        Or maybe it’s because we’re surrounded by technology. Like the man said, a sufficiently-advanced technology is indistinguishable from magic. And maybe what that means is that these days there’s magic everywhere I look.Report

  10. I think issue isn’t whether the statement is “neutral” or not. I tend to think it’s not neutral and that very little that can be said about such controversial topics can ever truly be “neutral.” I also think that most of us are willing, in some cases, to make vaccines mandatory or apply a degree of coercion to push people to vaccinate. (And from reading @will-truman ‘s comments in the last thread, I think he falls into that camp.)

    For those people, the issue, to me,concerns two and a half questions.

    1. How do we balance sincere religious and philosophical/conscientious objections with the mandate?

    2 (and 1/2).What do we mean by mandatory and how far are we willing to go to make it mandatory?

    For 1, maybe it’s true, as @burt-likko said in the last thread, that we give too much deference to religious objections and that at least in cases where it concerns public health in a way that vaccines undoubtedly do, the public health concerns should presumptively outweigh the objections. But I just want to point out that should override such objections with due humility and meeting all the strict burdens we’ve set up for when it’s appropriate to do so. Or, to quote @emile above, “us technocrats need to have a little fishing humility and reflect on our history.”

    For 2, we really have to decide how far we’re willing to go and how effective what we choose to do will be. Should refusal to vaccinate result in a fine? a requirement to absent oneself from school/work in case of an outbreak? a prohibition to attend public school or do certain jobs? jail? community service? As Will said in the last thread–and Burt also said here–some people are conflict averse or cost averse, and those can probably be met by “push” regulations. But there will probably be diehards who will double down no matter how tough the regulation is, or at least unless the regulation becomes so draconian.Report

    • Avatar Kimmi in reply to Gabriel Conroy says:

      I want them out of major metropolitan areas.
      If you’re going to be a public health risk, both disclosure and minimization of the dangers to the maximal amount of people is appropriate.

      I don’t believe we need to quarantine these people, but having them live in major metros is just Dumb.Report

    • I tend to think it’s not neutral and that very little that can be said about such controversial topics can ever truly be “neutral.”

      Yes, this. Or at least, perhaps, neutral here actually would be a really extreme position that almost no one holds.Report

  11. 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.

    I think the analogy here supports what I’ve said above. The argument against “we shouldn’t quarantine” isn’t “it’s not our business to insist that they are.” It’s how are we defining “quarantine.” And it implicates the following questions. How are we punishing refusals to abide by it? At what point are we going to presume to insist on quarantine (when they’ve been exposed to smallpox or when it’s manifested itself, e.g.) and how are we going to balance that against each person’s liberty interest in not being quarantined? What about those who are harrassed and quarantined because they’re presumed to be “dirty” and likely to have the disease? (The last isn’t an idle concern. Tera Hunter, in “To ‘Joy My Freedom” includes a discussion of how public health officials in early 20th century Atlanta targeted, often unfairly, black laundry women, as unique carriers of tuberculosis. Read the h-net review here.)

    And for both the smallpox and typhoid examples, we presumably also have people who pose a more imminent and direct threat than one person’s refusal to protect the herd through vaccination. And when it comes to herd immunity, I suspect it’s not really that one person’s refusal, but, say, scores/hundreds/thousands (depending on the size of the herd) of likeminded refuseniks. And the danger they pose is less imminent, even if it is no less dangerous should an outbreak occur.

    And for leaded gas, my only objection to that example is that being denied the ability to sell something is at least one step removed from being required to submit to an invasive (if only in a minor way) procedure.Report

  12. Avatar Jonathan McLeod says:

    “When seen through this lens, saying “vaccines are good but shouldn’t be mandatory” seems relatively innocuous.”

    Well done.Report

  13. Avatar Kazzy says:

    I believe vaccines are one of, if not the single most, important scientific breakthroughs. Their benefits are undeniable and if I could wave a magic wand and make everyone vaccinated, I would with zero second thoughts.

    And yet… I am weary of a mandate unless and until we can identify enforcement mechanisms that do not risk doing more harm than non-vaccination presents. I do not want to see thousands of families broken up, the parents thrown in jail and kids becoming wards of the state because of non-vaccination. I believe that to be worse than the health risk presented by non-vaccination. Fortunately, I think there are other enforcement mechanisms that will appropriately ensure the immense good brought about by vaccination while presenting very little downside.

    If that makes me anti-vaccination… well, I don’t know what to say to you at that point.Report

    • Avatar North in reply to Kazzy says:

      I think it’d be a very uphill battle to prove that the majority of the pro-vaxxers think that non-vaccinating parents should be heaved in jail and have their children taken away. The more militant ones think they should be forced pay a fine or maybe be liable if their children become plague vectors maybe but the majority are hardly at that level.

      Also, considering that the harm caused by non-vaccination is that children and other people (many who are vaccinating or are unvaccinated because they can’t be vaccinated) die in agony; it would logically be possible to imprison non vaccinators and still be doing less harm than non-vaccination does (though, I’d re-emphasize, it’d not be a good idea to do so).Report

      • Avatar Kazzy in reply to North says:

        @north

        A fair point. Fully conceded that I have not seen anyone advance jailing all parents who refuse to vaccinate. I was using that as an extreme example of an enforcement mechanism that I think would be worse than that which it seeks to prevent.

        But what enforcement mechanism do you propose? Fines? That is far more palatable.

        I just worry that any enforcement mechanism we do come up with doubles-down on the harm done to the unvaccinated-by-parental-choice children. “Not only do you have a greater risk of dying a horrible death at the hands of a preventable disease, but you’ll do so at home because we won’t let you go to school! And you might have less food/books/toys than you otherwise would because we fined your parents or took away their government assistance.”

        If we were only talking about the parents, fuck yea, throw them in jail. But there are kids involved. Lots and lots and lots of kids who are victims themselves.Report

      • Avatar Kimmi in reply to North says:

        Kazzy,
        Just mandate some summer camps for the kids. Along with the homeschooling.
        [This is SUCH an evil bitch of a plan. And it sounds so Harmless too!]Report

      • Avatar North in reply to North says:

        I noted to Will in the other thread, Kazzy, that I am unenthusiastically accepting the current compromise of simply making opting out of vaccinations more onerous (though if it works then I will be delighted and would be content with going no further). If that fails to work then I’m for eliminating the opt out entirely except for some strictly monitored medical and religious reasons. If that fails to work I’m fine with fines, liability and banning from public areas, schools, and government assistance if necessary.

        I grant that this is doubling down on the unvaccinated tot who is blameless for their parents idiocy. This doesn’t move me enormously because the people who die come in several flavors: A) the unvaccinated tot, B) tots and people who can’t be vaccinated for legitimate reasons and C) tots and people who are vaccinated but it doesn’t take (a small minority of vaccinations simply don’t stick). Now all three groups, AB&C are blameless but while doubling down does indeed cause harm to group A (lost access to resources and public school) it significantly decreases the chances of agonizing death to groups B and C and also mildly reduces the chances of agonizing death to group A and strongly incents all but the strongest parental holdouts in group A to remove themselves from that group. That strikes me as a justifiable exchange in a situation where less punitive measures have failed and herd immunity is failing.Report

      • Avatar Kazzy in reply to North says:

        @north

        A compelling argument. And the type that may convince someone like me. This is how you engage with the folks like @will-truman and I. Not by taking an “You’re either with us or against us” approach, which is what I reckoned Tod to be doing here.Report

    • Avatar LeeEsq in reply to Kazzy says:

      Unless there are very good medical reasons not to vaccinate your child than refusing to vaccinate is a form of, at least, child neglect. This is one of the few instances where I think the needs of society outweigh ideas about freedom. We do not want to return to the world of epidemics, pandemics, and mass deliberating and marring diseases. Parents who refused to seek proper medical treatment for their children out of religious concerns have been prosecuted in the past and I don’t see why these laws should not appply to the ant-vaxxers.Report

    • Avatar TrexPushups in reply to Kazzy says:

      Let me put it this way in Mississippi they have mandatory vaccinations unless you have a medical reason to avoid.

      They also have a very high rate of vaccination and I am happy to read any thig you can point to that shows any down side.Report

  14. Avatar j r says:

    Most of this conversation has been about how we choose to signal our feelings on vaccinations. That’s not a bad thing; however, it often leads me wondering exactly what we are talking about.

    There has been some talk about the difference between requiring vaccinations for public schools and other public services vs. trying to enforce some universal legal vaccination regime. Both of those things can be described as mandatory vaccinations, but to me, there is a pretty big difference.

    Does anyone want to flesh out what they mean when they say mandatory?Report

    • Avatar KatherineMW in reply to j r says:

      My idea of “mandatory vaccination” is requiring that all children in the public school system must be vaccinated, and strong government advocacy and/or incentives that private schools should implement the same requirement. There may be methods beyond that which could be effective and which I’d support, but they don’t occur to me off the top of my head. Schools are obvious, because aside from the incentive factor, there’s a very strong public health reason for requiring it.

      Plus, all infant/childhood vaccinations, and all vaccinations that are important for the health of elderly or unwell people (e.g.: flu shots) should be free, and access to vaccination should be as convenient as safety allows. (For example, British Columbia has started allowing drug stores to offer flu shots, which is far more convenient than having to go to a specific location on a specific day or schedule a doctor’s appointment.) To me this seems like a no-brainer – you want as many people as possible to be vaccinated, so don’t deliberately create economic barriers to vaccination.

      I don’t support denying people income assistance or food stamps if they fail to vaccinate their children; it’s not relevant, it just singles out the poor, and the anti-vax movement seems stronger among the middle classes than among poor people. I don’t support taking children away from parents who won’t vaccinate them, because this has such a large negative effect on children’s lives and opportunities that it would have an even worse effect than non-vaccination has. I certainly don’t support imprisoning people over the issue. The goal isn’t to punish people, it’s to protect them from deadly diseases.Report

      • Avatar morat20 in reply to KatherineMW says:

        I note, just in passing: Kennels won’t take dogs unless their shots are up to date.

        For very solid, good reasons. People dislike it when their dogs come home with kennel cough. But we’re apparently getting okay with your kids coming back from Disney with measles.

        In any case, my ‘dream solution’ is simply to make the opt-out process more difficult, and require vaccinations for public schools. Possibly private schools over a certain size (I suspect almost all of them already DO require it). I’m iffy on things like summer camps, but again — I’d be surprised if many of them don’t already require vaccinations.Report

      • Avatar Kimmi in reply to KatherineMW says:

        morat,
        My nightmare solution is just making summer camps for homeschoolers mandatory for the anti-vaxx types. But I think that solution is more than a bit evil (hence nightmare), and WAY worse than simply taking the kids away.Report

    • Avatar Jaybird in reply to j r says:

      I do not consider myself a “mandatory” guy. I very much like my sign (“If You Have Not Been Vaccinated Then You Are Not Welcome Here”) idea and wouldn’t be opposed to seeing those plastered up all over town and, yes, on government buildings.

      I do think that it would have to be “mandatory” for the ADA, EEO, and, yes, the RFRA to ignore these signs and the attitudes behind these signs and not consider discrimination against the unvaccinated to be discrimination requiring intervention.

      I suppose that I could see how someone might say “well, that’s all *I* mean when *I* say ‘mandatory'” and, if we’re using that definition, then I guess I’m a mandatory guy too.

      But I don’t consider myself to be a “mandatory” guy.Report

    • Avatar TrexPushups in reply to j r says:

      http://msdh.ms.gov/msdhsite/_static/14,0,71,303.html

      What Mississippi does is what should be done. It works.

      I know I am shocked at Mississippi getting health policy right too!

      Signed
      An Ole Miss gradReport

  15. Avatar Brandon Berg says:

    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.

    There’s truth to this, but I’m not sure you appreciate the degree to which this is a) path-dependent, and b) an indication of how profoundly fished up our culture is.

    Your argument here is basically that people have become so used to the government holding their hands that they’ll assume that the government failing to ban something is a tacit endorsement of it. You know where I’ve heard that before? Arguments against legalizing marijuana. You would think intelligent adults would understand the distinction, but this is the culture the nanny state has given us.

    If we had a different culture, one where people weren’t so used to the government micromanaging every little thing, then everyone would understand the distinction between the government merely tolerating something and endorsing it.

    Mandating that food-service workers wash their hands is not, in and of itself, a real problem. That they should wash their hands in not really in dispute, The problem is that a government that can do these things can also impose regulations of much more dubious utility—and will, every chance it gets.

    The problem is that democracy creates incentives for politicians to consider only the ostensible benefits of regulations and ignore the costs, which are ostensibly passed on to big business and fish those rich bastards anyway. “My opponent voted to allow fat-cat corporations to profit from poisoning our children” is a much more effective sound bite than, “According to our cost-benefit analysis, the proposed regulation will have a cost of roughly one million dollars per quality-adjusted-life-year, which will largely be passed on to consumers in the form of higher costs. By the way, it turns out you can put a price on life, and it’s $50,000 per QALY.” Politicians don’t exercise their discretion responsibly, because voters punish them for doing so.Report

    • Avatar kenB in reply to Brandon Berg says:

      Mandating that food-service workers wash their hands is not, in and of itself, a real problem. That they should wash their hands in not really in dispute, The problem is that a government that can do these things can also impose regulations of much more dubious utility—and will, every chance it gets.

      I think even this grants too much to the argument in the OP. A serious, non-ideological-signaling analysis of even the hand-washing case would have to consider all the various possible regulatory approaches, determine the likely marginal benefit of each and weigh that against the costs in enforcement and compliance. E.g., forcing companies to put up signs incurs costs for the companies (not just to make and post the signs but also to put processes in place to make sure it’s happening at all sites and is being maintained) and costs for the government (sending around inspectors to make sure companies are following the rule); so one question is, what’s the marginal increase in employee hand-washing over time based on the posting of these signs? It might be smaller than one would thing — as a bit of anecdata, we have signs posted in our office for various things, and I can tell you that they’re noticed for a few days and then just become part of the background, even when they’re there for our own benefit (e.g. the sign in bold letters reminding people not to leave the office without their security fob — it was very helpful for about a week. and then…).

      “It’s important and there are externalities so we should mandate it” is too simplistic even when there’s general agreement about the importance of the thing.Report

      • Avatar Jaybird in reply to kenB says:

        Re: Handwashing.

        One thing I’ve noticed is that fast foody places now have people wash their hands right in front of you when they move from the cash register to food prep. When they come out from the back, they wash their hands before they go to food prep. Wash hands, put on a pair of fresh gloves. Over and over and over again.

        (The “employees must wash hands before returning to work” signs in the bathrooms were always somewhat unsettling to me.)Report

      • Avatar KatherineMW in reply to kenB says:

        Jaybird – Good! I would guess that with a lot of different people using them, those cash registers would end up with a high bacterial/viral content. It’s well known that keyboards are disgusting; now think of a keyboard that’s used by dozens of people every day.Report

      • Avatar Gabriel Conroy in reply to kenB says:

        Not to mention money. Money is dirty.Report

  16. Avatar zic says:

    I had measles when I was four. The measles vaccine had been released publicly less than a year before, and wasn’t yet common (going to school seemed to be the thing that triggered kids getting it back then.) I remember it as a grand time, for two cousins and my little brother all had it with me, and we had days of playing together as we suffered through the measles at my house. Looking back, this seems odd; my mom wasn’t much of a touchy-feely mom; my aunt, on the other hand, was all that and more. Most of the incidence of common illness saw us at my cousins. Why were we at my house instead of my cousins?

    I spoke with my mom about this yesterday, and the answer was my little brother. He was about eight months old at the time. He’d only been home with us for for a few months; he spent the first four months of his life in Boston Children’s Hospital after undergoing major surgery to attach one side of his diaphragm, which wasn’t attached, and was crushing his heart and lungs and made it impossible for him to breath. There was serious concern that the measles would kill him, and my mom spent that time in total panic she’d lose him (If you don’t recall my family history from my writing her, she’d already lost two babies when they were infants).

    My parents lived in an age where knowing people who’d been crippled by polio was common; I’ve met exactly one person, one of the last cases of polio in the US after the vaccine had been introduced. It would be very easy to not view polio as a problem for me, and to have concerns that the vaccine might harm my child; but for my parents, getting us vaccinated for polio was a no-brainer. It wasn’t about trusting the government or pharma, it was a miracle that prevented horrid disease.

    But here’s the real problem, as I see it: the people I’ve talked to who don’t vaccinate (and I know a lot of those people, both religious and lifestyle purists) seem comfortable with the notion that diseases like polio, measles, etc. are nature/god’s way of culling the herd. They don’t feel a whole lot of remorse that someone else’s kid, someone like my little brother, might die because of their choices, and they have this powerful faith that god/nature/healthy-immune system will protect their own children. It’s really selfish thinking; and I’ve had people make the argument that my view is selfish, inflicting harm (autism! mental disorders!) on their children in the name of protecting weak children. They don’t see weak children as people like my brother or the patients my sister cared for. At an abstract level, they’re fine with these children dying of measles.Report

    • Avatar Kimmi in reply to zic says:

      Oh, the best part is the people who don’t mind if they die because of influenza.

      I want to say to the people who are soo skeered that their kid might have autism… There are solutions to that, permanent ones, even. But, you’d have to do the deed.

      These people may never know when or if they’ve killed someone. And that sickens me. You should at least need to look at the person’s grave. At the young child who will never grow up, or his grandma that won’t get to bake another batch of chocolate chip cookies.Report

      • Avatar dhex in reply to Kimmi says:

        the autism fear needs to be considered in the context of what would be most awful for the group that fears it. the delayers/avoiders we knew personally all had phd or were abd (in the humanities, but still) and were overwhelmingly white. all were women.

        for that group, having a child who didn’t speak well – who didn’t communicate “smartness” – was a kind of death. and this fear manages to overwhelm the actual risk of disease and death, not only for their own child, but for others.Report

  17. Avatar Brandon Berg says:

    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).

    That’s true, but giving firms the ability to choose the less costly of two options can help quite a bit. Let’s say, for example, there’s a bad regulation that raises cost
    s by 5% and provides benefits to customers equal to 2% of costs. That’s a net social loss of 3% of costs. But if the firm also has an option to publish information about whatever the regulation addresses at a cost of 1% of total costs. Customers, choosing between the firm that sells the unmodified product for 101% of the original cost and the improved product for 105% of the original cost, decide that the improvement isn’t worth the extra 4% cost and go with the original product at 101%, for a net social loss of 1% of total costs.

    The gains are even better, if, say, the benefits of the regulation are 6% of costs for half of customers and nothing for the other half. Then both version will be offered, and the customers who prefer the improved version can get that one and customers who prefer the original version can get that one. And if all customers prefer the improved version because they all get benefits equal to 6% of the original cost, then that one will dominate the market.

    So the notice option is as good as or better than having a nonnegotiable mandate.

    This doesn’t work with externalities, of course, because consumer choice doesn’t fully capture the costs and benefits. But externalities are better addressed by Pigovian taxes, for similar reasons. Of course, this runs up against the public choice and voter ignorance problems I described in my previous comment, but the Pigovian taxes can at least be presented as a fine, with the “make the bastards pay” spin. Plus they can offset income taxes, so even if they’re set too high, they reduce other distortions in the economy.Report

    • Avatar zic in reply to Brandon Berg says:

      What about insurance?

      Don’t want to vaccinate, okay. Purchase insurance that pays out to the pregnant women who get rubella; this is one area where group ratings might work well, force premiums up in conclaves of anti-vaxing.Report

      • Avatar Mad Rocket Scientist in reply to zic says:

        I think this is the path to take.

        Don’t want to vaccinate, then you need to have health insurance that will cover the cost of your kids getting sick. If you are using Medicare/Medicaid, your kids are getting vaccinated, end of story (the public should not be on the hook for your bad choices, see seatbelt laws, helmet laws, liability insurance laws, etc.). Also, grant health insurance companies the right to drop a family if they refuse to vaccinate absent a valid medical reason, or at least the right to jack up rates.

        I bet Tod can tell us how quickly health insurance companies would slip that requirement in, and how quickly any who didn’t would suffer financial meltdown during an outbreak.Report

      • Avatar zic in reply to zic says:

        @mad-rocket-scientist not just your kids, other people. Babies too young, people with impaired immune systems, pregnant women, even believers who don’t vaccinate for religious beliefs, long-held (the Amish).

        Your insurance needs is to cover others, because that’s the problem here. If you don’t care that your kid might contract measles, chances are your kid has an immune system strong enough to have measles be no-big-deal. Rubella won’t necessarily harm your child, but your friend who’s pregnant’s child.Report

      • Avatar Citizen in reply to zic says:

        I am greatly opposed to another insurance, and the poor would do without it as they are doing without auto insurance.Report

      • Avatar Jim Heffman in reply to zic says:

        ” If you are using Medicare/Medicaid, your kids are getting vaccinated, end of story ”

        Also you have to take drug tests.

        Because, y’know, public interest and all that.

        (I’m not suggesting that vaccination shouldn’t happen–I’m just pointing out that we’ve had a similar discussion before.)Report

      • Avatar Mad Rocket Scientist in reply to zic says:

        @zic

        That would, arguably, be part of the increased premiums a family pays (covering the general risk pool).

        @citizen

        This is not “another” insurance, just a change to existing insurance. Also, while the poor might forego insurance if there was a vaccination requirement, a number of studies I’ve seen have suggested that for many the true objection to vaccination is less ideological and more financial/time. In short, a poor parent makes a judgement call to not vaccinate because it requires at the very least the time needed for a trip to the doctor, plus a co-pay, and possibly more (although most insurers cover vaccinations, although poor people may not know this, so they assume it’ll be the co-pay + extra). When it comes time to enroll in school, they just check the objector box because it is free & takes all of 2 seconds, versus the hour or more for the trip plus a minimum of $20 to see a doctor.

        If we change the calculus – a refusal to vaccinate causes a monthly spike in a fixed cost, then the incentive shifts.

        @jim-heffman

        Noted. However, as was shown many times, the costs of the drug tests for welfare recipients far exceeded the realized savings in keeping drug users off the dole. A better criticism in EMTALA, in that an anti-vaxxer who refuses insurance and Medicare can still use Medicare by bringing their sick kid/self into the ED.Report

      • Avatar Citizen in reply to zic says:

        Which insurance are we assuming this gets added to?Report

      • Avatar Mad Rocket Scientist in reply to zic says:

        @citizen

        Medical insurance, obviously.Report

  18. Avatar morat20 says:

    As a related aside:

    My brother-in-law works safety. He’s responsible for numerous work sites, shows up for scheduled and unscheduled visits, and something like a 100+ workers whose every on-job injury gets sent to his desk (well, his phone since he’s generally driving site to site).

    He is CONSTANTLY complaining about his workers — he has to not only constantly remind them to wear protective gear, he’s had to dock pay and even have people fired for repeatedly removing protective parts from equipment (hand and finger guards, that sort of thing).

    People have lost fingers, hands, and even lives with this equipment and he still spends several hours a week making sure the guys doing the work don’t skimp on safety. And they would in a heartbeat.

    Because they’re horrible at assessing individual risk. Humans are horrible at it. These guys remove safety protections because it makes their immediate task easier or quicker, and think “I’ll be fine” (they probably will be). But when a 100 guys do that, the odds of someone NOT being fine shoot up. When 1 guy does that day in and day out, the odds of him not being fine shoot up.

    There’s a comedian who makes a joke about a monkey at his birthday party, and how it walked ‘like a little gentleman’ and commented that the only way to get a monkey to walk that way was with violence. You had to hit the monkey every time it walked a different way. My brother-in-law swears that keeping his workers with all their fingers attached feels like that — having to hit the monkey every time it tries to walk a different way.

    So your comment of “It has to come from the top” really resonates. He’s had to leave a family event because a guy lost a finger (safety guard removed). And if he wasn’t there, metaphorically hitting them daily about safety, there’d be a lot more lost fingers.Report

  19. Avatar LWA says:

    I’m trying to get my head around what the fear of “mandatory” vaccination is.
    I mean, vaccinations have been mandatory since before I was born in 1960.
    Its just that the enforcement was weak and passive- you couldn’t enroll in school for instance.

    I get the sense that there is an unspoken assumption that mandatory has one and only one meaning, which is SWAT teams and assault rifles.Report

  20. Avatar LWA says:

    I guess in order to achieve herd immunity, you have accept the idea that there is such a thing as a herd, instead of a bunch of individuals who freely associate, or not.

    Or rather- you have to accept that germs don’t respect such concepts.Report

  21. Avatar A Compromised Immune System says:

    There’s nothing to be said in this discussion that hasn’t been said by the parents of preteen children going through chemotherapy for leukemia.

    Or by the sons and daughters of adults in chemotherapy for other forms of cancer.

    Or by the relatives of people who have CVID or LAD.

    Vaccinating isn’t for you. It’s for everyone you come into contact with.Report

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