Doubling down on mandatory vaccinations
Earlier this week I tried to explain why, from a risk management and public health position, saying ““I believe that vaccinations are good, but shouldn’t be mandatory” will result in having a vulnerable populace:
Past all of the immediate threats, however, is the issue of risk management and culture.
People in the workplace have a tendency to gravitate toward the path of least resistance without strong signaling from both management and regulators. This is pretty much universally true with all organizations, and it is why a construction company with no safety meetings will average far, far more frequent and more severe worker injuries than companies with regular safety meetings. It isn’t that workers learn anything new at these meetings; in fact, they almost never do. It’s just that knowing that safety is important to the boss and OSHA leads to employees deciding that it’s important to them as well, and this leads to fewer accidents. The same would absolutely be true of the government telling restaurants that worker hygiene wasn’t a big enough public health issue for anyone to make washing their hands after wiping the butts mandatory.
Cultural signaling also applies to vaccinations. “I believe that vaccinations are good but shouldn’t be mandatory” communicates something far different than what needs to be communicated. Indeed, intentionally or not what it really communicates is this:
“Vaccinations are good, but not getting them is okay too.”
As it turns out, Oregon is a state that chooses to communicate such a message to its populace.
Oregon has a mandatory vaccination requirement to attend public school. And like all things mandated by the government — be it selective service, age of consent or filing taxes — the system is set up to make exceptions under certain circumstances. The way Oregon choose to communicate the “mandatory” part is definitely squishy, with far more of an emphasis put on the “exception” than the “mandatory.” Indeed, in an attempt to play the “I believe that vaccinations are good, but shouldn’t be mandatory” and placate all sides of the fence, Oregon law provides for a “personal belief” exclusion, where a parent is simply required to state (with signature) that they do not believe that immunization is the best choice for their child. The thought at the time, of course, was that you only needed 90-ish% of the population in order for immunization programs to be effective. If the state simply chose to lead with the message of “you don’t have to get one of you don’t want,” surely that 10% buffer would be enough to keep everyone safe, right?
Not so much.
Largely because of what the state chooses to signal when talking about the importance of immunization, Oregon has the highest vaccination exemption rate in the United States. The rate of non-vaccinated children in some Oregon schools is currently as high as — and I am not making this up — 70%. As a result, measles cases have been on the rise in Oregon over the past half decade.
There currently is a bill being proposed in Oregon that would tighten my state’s mandatory immunization requirements for public schools: Exceptions would continue to be made for medical and religious reasons, and there would be a requirement that children already in elementary school would need to be immunized prior to being allowed into junior high school.
Of course, even in such a system as the one proposed other exceptions will inevitably be made, and some other people will simply fall through the bureaucratic cracks. Again, this is the way of government mandates. But as less than 2% of Oregonians have medical conditions which would make vaccination too risky, it should be easy to stay within the 90+% requirement.
Oh, and by the way — if you’re wondering which religions actually forbid inoculations and vaccines, here is the comprehensive list:
Aaaaaand, that’s basically it.
[Picture: Oregon welcome sign, via Wikipedia]
I see a huge coming for the Dutch Reformers.Report
Mother Jones has a pretty good article on this whole subject:
http://www.motherjones.com/environment/2014/02/vaccine-exemptions-states-pertussis-map
It is very interesting on how this whole thing maps out, I would be very interested in seeing this on a county by county basis. I think that would help identify the best methods of the education needed to help end this problem. Do you have one for Oregon?Report
Not that I’ve found, and even if you did it would be potentially dubious: It appears that for some reason only about half the schools in the state have reported the numbers. (You can find the listing here.)
From a cursory glance, however, it looks to me like the schools/areas that have high percentages of non-immunized kids skew upper-middle class, well educated, and liberal. Which, I would think, potentially makes the issue of education tricky. (My personal anecdotal experience tells me that it’s easier to get adults who haven’t been to college to agree that maybe they don’t know everything than it is adults who have been to college.)Report
i think part of the issue – and this is more of a nit mr. kelly than anything else – is that for years many parts of the population with media access have been using “educate” or “education” when they mean “persuasion”. people inside that loop understand that it means “convincing”, but taken as it’s #1 dictionary definition how would you educate the educated? (generally speaking orgs “educate downward”, so this is a double hitch)
that make any sense? it’s a minor peeve of mine.
you don’t educate this population; you convince them. and you do so by using stories that illustrate loss, destruction, widespread communal harm, deprivation of prosperity and station. if you can do so without turning it into “you are a bad person!” and focus instead on the choice…well, it’s tricky, but it would likely be most effective. or we just wait until wee dylan and wee brooklyn start being seriously injured within these enclaves, at which point it will start self correcting again. (which means terrible harm to many folk outside of the park slope schmuck demographic)
or you do so with force of law, of course.Report
Sadly, educated still != scientifically literate. Even MDs, who arguably SHOULD be scientifically literate, have among their numbers the likes of Dr. Wolfson, who just will not be swayed no matter the evidence.Report
@dhex
how would you educate the educated?
This seems a bit perverse; part of being ‘educated’ is understanding that there’s always more to learn, to educate yourself about; not that once you got through college it’s a done deal.Report
@zic
“This seems a bit perverse; part of being ‘educated’ is understanding that there’s always more to learn, to educate yourself about; not that once you got through college it’s a done deal.”
it only seems perverse because it’s being used (and understood) interchangeably with different concepts and by different audiences:
[1] educated meaning formally trained in school, likely to a certain level (college probably for most speakers).
[2] educated meaning acculturated to a certain class and manners related to it, etc. a megachurch preacher with a divinity doctorate isn’t “educated” as understood under this definition, because they’re a megachurch preacher.
[3] educated in the public health sense – persuaded, convinced, cajoled, etc, into a certain set of behaviors.
[4] educated in the idealized sense you indicate, meaning intellectual humility and curiosity.
so restated, my statement reads “how would you [3] a [2]?”Report
I think dhex has the right of it here, with the added proviso that much of (2) feels that (3) has been used against them over the last few years and that (1) pretty much seems to feel that as they are (1) they already know what is going on. See:
http://matt.might.net/articles/phd-school-in-pictures/Report
@dhex
That’s a pet peeve of mine, too, though perhaps for a slightly different reason (depending on if I read you aright in what you’re getting at). To me it seems to signify that you (the generic you, not you you) are enlightened, and the only reason people could ever see things differently is that they’re unenlightened and ignorant.Report
Excellent comment dhex.
Reminds me of this: One of the things I learned when I was learning to teach was that no one teaches anyone anything. What a good teacher does is present stuff so’s to inspire other folks to put in the effort to learn it. Or slightly less than that, present things clearly enough that folks already so inspired will better understand the map of what a certain territory looks like. I mean, learning is an internal process, yeah? If so, then there is no teaching. Just better ways to help people learn. But some people don’t wanna learn. Others who may want to learn one type of “education” are pretty durn uninterested in learning another type. That’s just the way it is, it seems to me.Report
To me it seems to signify that you (the generic you, not you you) are enlightened
Don’t disagree even tho I’m not sure I’d go with the word “enlightened”. I think it’s more a form of splainin or something. A presumption that anyone who disagrees with you does so because they’re too stupid to think properly. A good friend of mine likes to tell a story about how she used to (doesn’t anymore!) think that she could resolve disagreements with people merely by clearly and carefully explaining to them where she was coming from on an issue. She laughs about it now, but at the time it was horrible.Report
Yah, that’s the way to do it…
Persuasion. Getting all preachy is nothing but a major turn off. Hell, I’d oppose or resist anything presented in that method, if only out of spite. Sadly there’s a very large population of folks who advocate for his “education” that consider you a rube who needs to be told what to do and how to live by their betters because you clearly wouldn’t make any other choice if you were smart enough.Report
I thought Christian Scientists also banned vaccines? And JehovahsReport
Here is a link to a Mercury News article on vaccines and religions: http://www.mercurynews.com/science/ci_27437392/why-religions-dont-oppose-vaccines The article points out that the church of christ science does not oppose vaccines just some members, likewise Jehovah’s Witnesses. In these an a number of cases it appears that parents may take the churches doctrines and stretch them a bit further than the church body itself does. In any case the 1905 case on vaccines essentially said that public health trumps religion, in the case of easily communicable disease (in that case smallpox).
In one sense that is a basic result of the my freedom stops at the end of your nose idea, i.e. you can do what you wish as long as it does not harm me, and me or my kids getting measles is harming me.Report
Re: religions forbidding vaccination. Doesn’t matter what the official doctrine of a particular organized faith is. A subjective, individualized belief is what counts for the religious exception. For instance, in the Holt v. Hobbs case, we learned that it doesn’t matter if ten out of ten imams say shaving your beard is cool with Islam, as long as you personally think the Koran says a man ought not to shave. So I might not be Dutch Reformed, maybe I’m a Jehovah’s Witness and I think — even if ten out of ten of my ministers say I’m wrong — that the Biblical injunction to abstain from blood (Genesis 9:4, Leviticus 17:10, Deuteronomy 12:23 and Acts 15:28-29) means I can’t taint my blood in any way, then it does and I have a religious objection to a vaccination. State must come up with a compelling reason to require me to do so and must also demonstrate that no less intrusive means are available to effect that objective.Report
@burt-likko Yeah, I know. I just thought after hearing so much about it that it was interesting to see how many actual official doctrines actually backed up the belief.
In fact, I’m wracking my brain on this right now: Can you think of any other semi-widespread religious belief that does not come from doctrine from anyone (except something as obscure as Dutch reformed)? The only one I can think of off the top of my head is “SSM for that brief two-month period between beginning to be somewhat accepted and being officially sanctioned by the Anglican/Episcopal churches.”
People here are smarter than I am; what other ones are out there?Report
It partially depends on how you count “official” doctrine. Some religions, like the Catholic Church, have a fairly well-defined and worked-out way to establish what is “official” and not. Others don’t, or have a less well-defined definition.Report
I believe avoiding the spread of a communicable disease is a compelling reason, since at least a few may die from it is a compelling reason. The case cited did not present a risk to others. It is a question of rights my right to not get sick have a family member get sick versus your rights. In any case do to the folks involved refuse to eat hamburger, because it does contain some blood.Report
I think Burt’s point had more to do with how “religious belief” enters the picture (must it be “official” or can it be “non-official” doctrine?). It has less to do with what counts as compelling (and I think he’d agree with you on that, judging from his other comments.)Report
I’d appoint you. But I’d have to get a majority of the electoral college to vote for me first.Report
I though in the HL decision, Justice clearly said this was a limited decision; it did not apply to other things, most specifically vaccination, no?Report
Justice Alito went out of his way to indicate that the RFRA didn’t apply to things like antidiscrimination lawsuits under Title VII. But he didn’t really offer an explanation for why that would be the case, other than SCOTUS’ say-so, and the logic of his interpretation of the RFRA to the contraception mandate in PPACA and its regulatory progeny was such that absent such an unprincipled exception-by-judicial-fiat, RFRA pretty clearly would apply to antidiscrimination laws.
I don’t recall any mention of vaccination.
FWIW, I think that @lyle is well within the boundaries of reason to suggest that a compulsory vaccination law might survive that level of analysis — I’m inclined to agree that vaccination is the least intrusive way imaginable to prevent outbreaks of these potentially disastrous diseases. But if I’m so smart, why am I not sitting on SCOTUS instead of Samuel Alito?Report
Wasn’t vaccination one of the issues explicitly brought up by the dissent (I think by Sotomayor at oral and RBG in the dissent, or maybe RBG in both) as one of the kinds of cases that would come ‘out of the woodwork’ as a result of HL?Report
@burt-likko is this on a nondiscrimination (i.e. possibly non-Establishment) principle, or on a free-exercise principle? I.e., if you’re going to have a religious exemption it can’t discriminate between beliefs in that way, or free exercise means that an exemption like this has to exist?
I assume the former, because MS & WV don’t have any religious exemptions to their vaccination requirements at all. But perhaps those laws are unconstitutional/not RFRA-compliant but simply not yet challenged as such.
Also, is there any limit to the policy contexts to which this principle clearly applies, based on the precedent from which it springs? Doesn’t it seem that restricting exemptions to longstanding institutional religious doctrine rather than personal religious findings might be justified by a compelling government interest in maintaining herd immunity levels of vaccination in school, and that no less restrictive means than requiring vaccination for enrollment are apparent for achieving this purpose? Such a restriction, after all, would itself be a less restrictive means than simply allowing no religious exemption to vaccination requirements of any kind at all.Report
This tracks the history of Constitutional interpretation of the Free Exercise Clause, and Congressional response to SCOTUS’ rulings, culminating in the Religious Freedom Restoration Act (RFRA), a legal trend that reached full flower in last year’s Burwell v. Hobby Lobby Stores, Inc. decision.Report
If it’s on free exercise grounds, are Miss.’ and WV’s policies then on less than solid ground?Report
This made me do a double-take. I was raised in a Christian Reformed Church, which is sorta kinda like a North American variant of Dutch Reformed, although it’s more complicated than that too. Anyway, I had all my shots growing up and I had never heard of anything like this.Report
It appears from Wikipedia that a few churchs splintered off from the Reformed Chuch in America. Note that there is no longer a Dutch Reformed Church in the Netherlands it is now the Protestant Church in the Netherlands merging with the Lutherans and the Reformed Churches in the Netherlands in 2004.
So it appear to be a splinter.Report
Right. That’s why I said it was more complicated than just “CRC as the DRC in North America.” As you noted, there actually isn’t a denomination by that name in Holland anymore. In other countries you can find churches called “Dutch Reformed Church in [country]” but in North America the moniker is Reformed Church in America which doesn’t say anything about being Dutch. In my hometown we have two churches: one CRC and the other RCA. They’re so close socially and doctrinally that they share a pastor. I remember talk when I was a lad about the denominations merging which apparently has yet to occur.
Anyway the vaccination prohibition must have been specific to the Netherlands (and possibly other countries) because it’s the first I’ve heard of it. BTW, there is no overarching international structure to the governance or administration of the denomination. They may (or may not!) be doctrinally identical but the DRCs in [wherever] are just “associated” separate organizations.Report
Looked around a bit and found this link explaining the issue:
http://www.biomedcentral.com/content/pdf/1471-2458-11-102.pd
It appears that it is the orthodox protestants in the Netherlands. ” The orthodox Protestants form a closed community within Dutch Society, They have their own churches, their own schools, then own newspaper and their own political party. The orthodox protestant opposition to vaccination dates back to the 19th century.” The article states that the opposition to vaccination started with bad reactions to smallpox vaccinations in the 19th century. More modern objects sound a lot like Christian Science in the US in that they believe god will take care of things and man should not interfere with God.
Now of course if you are talking about vaccinations to enter school, then just like the amish in the US it becomes a non issue in one sense as school is where the vaccination rules are enforced.Report
I’m pretty sure the Dutch Reformed Church doesn’t forbid vaccinations, because the Christian school I went to from grades 6-12 was associated with the Dutch Reformed Church (and many of the students went to Dutch Reformed churches) and we still got vaccinations at school.Report