Mandatory Vaccines and Libertarianism
In a recent Senate health committee hearing, Republican senator Rand Paul voiced his opposition to mandatory vaccination. Paul, frequently identified as a libertarian-leaning member of the senate, based his concerns on questions of liberty. Paul paraphrased Benjamin Franklin, stating ‘I still do not favor giving up on liberty for a false sense of security’. This was after stressing his belief that the benefits of vaccines outweigh the risks, and that he and his children have gotten vaccinated.
Paul isn’t the only person who feels this way. To give one example, a popular libertarian on Twitter stated that ‘i’m pro life and encourage vaccines but i don’t think they should be mandatory because i refuse to give the government the power to forcibly inject something into my body [sic]’.
So here’s the issue. While recognizing the value of vaccines, is the idea of government mandated vaccination compatible with a libertarian outlook? I’ll assume here that the value of vaccines is a given, but some don’t want them anyway.
This is difficult when considering mandating that fully independent adults receive vaccines. Many arguments here will hinge on balancing public safety against liberty, as a response to Paul published in the Washington Post did.
Libertarianism is normally skeptical of this approach, however. This balancing of goods and harms is similar to gun control, which libertarians tend to oppose. Even if a given measure makes society safer in general, ultimate responsibility still lies with the individual. It’s acceptable for free choices to increase the ‘background’ risk to others, provided they aren’t harming people directly. If lots of people purchasing guns makes you feel less safe, then you just have to take extra measures to ensure your own protection. Similarly, if people not getting immunized makes an outbreak more likely, you just better get your own vaccines to protect yourself.
But are there direct harms?
This response, however, must consider concerns such as herd immunity. Herd immunity is where contagious diseases like measles will be unable to spread among the population when a critical mass have been vaccinated. Crucially, this critical mass is below 100% but still rather high – up to 94% for some diseases. Some people can’t get vaccinated because of deficiencies in their immune system, so protecting them from contagious diseases requires that others are immunized . It may then follow that vaccination isn’t merely a matter of personal choice. Rather, refusing vaccines is more like actively placing others in danger, not just a ‘background’ risk similar to more armed people. Thus, mandatory vaccination is one of the few legitimate areas where the state may step in from a libertarian perspective.
I personally find the case above compelling. However, this might take the concept of placing others in danger too far. For one jealous of liberty, it could seem safer to lean more heavily on the side of avoiding state action where a dispute exists. The idea here would be that allowing the state to mandate vaccination would make other, abusive actions more likely. Rather than take that risk, we’ll play it safe and deny the state that power.
This also requires assuming that the critical mass needed for herd immunity won’t be reached without mandates. But enough people might voluntarily get vaccinated by a clever program of education, incentives and persuasion. This would then allow a small number of objectors to refuse vaccination without putting others in danger. So under some circumstances, refusing vaccination might not really be placing others in danger.
The case of children
The empirical case above might be correct under a particular scheme of persuasion. Even if this is the case, I argue that there is a situation where mandatory vaccination is entirely consistent with libertarianism – childhood vaccines.
We need to consider children differently here, as principles of liberty and individual responsibility apply to them very differently. Children are different from adults in that they are not really ‘at liberty’. They’re not independent and require others to see to their needs.
Milton Friedman recognized in his famous book Capitalism and Freedom, in the chapter entitled ‘Government in a Free Society’. Friedman notes that ‘the necessity of drawing a line between responsible individuals and others is inescapable’ – such as children. Importantly, Friedman also observes that while the ‘operative unit in our society is the family’, this is largely a matter of ‘expediency, not principle’.
This is a crucial point, as many parents who don’t want to vaccinate their children claim it’s their freedom not to. However this makes a critical error in understanding the role of parents. Society generally delegates paternalistic authority over children to parents – it’s in the name after all! This is because we normally trust parents to have their children’s best interests at heart. But that’s it – they’re not your children, they’re your children. As Friedman puts it, children aren’t ‘an extension of the freedom of the parents’, they’ve ‘a value in and of themselves’.
So we give parents the responsibility for their children because we trust they’ll do best at seeing to their well-being. But refusing children a vaccine is a clear violation of this responsibility. The above argument about herd immunity applies, but additionally the children themselves are put in harm’s way, needlessly vulnerable to a disease.
This tips the scales on state action in a crucial manner. The question isn’t about forcing a choice. Rather, it is one of which agent ought to make the choice for one unable to do so themselves. If parents are refusing to protect their children, I find it compelling that the state is justified in taking action. And as far as state actions go, a vaccine is one that’s not very intrusive.
The only way out of this from a libertarian perspective is one that rejects paternalistic authority over children in the first place. If that’s the case, then there’s a hell of a lot more wrong with society than questions surrounding vaccines – the family itself becomes an illegitimate institution. Not an argument that any reasonable person will make, in my view.
So, what to do?
I must stress that the above argument doesn’t necessarily find that mandatory vaccines are a good policy. An editorial in the esteemed scientific journal Nature was wary of the policy in France. Among the problems identified were the potential to ‘fuel further unfounded resistance to life-saving vaccines’. The editorial concludes that mandates ‘should be at most a stopgap’. Instead, we ought to put ‘efforts into making a strong case to the public about the benefits of vaccinations’.
My argument here isn’t one of which public policy approach is optimal. It is merely that libertarians have reasons to accept mandatory vaccines as legitimate, particularly in the case of children.