The Herd

The Maine presidential primary, which I mentioned in an earlier post, will be held on March 3, Super Tuesday. There’s another issue on the statewide ballot for Maine voters that day, one that honestly matters a lot more than who will get a slightly larger percentage of the state’s small delegate count. I’m referring to Question 1, a referendum on whether to repeal a law removing religious and philosophical exemptions to vaccination requirements. A “Yes” vote is a vote to repeal the law, letting people decline vaccinations for what they claim are religious and philosophical reasons; a “No” vote leaves the law in place, denying people the right to claim such exemptions. I’m strongly in favor of “No.”

The first thing I want to say is that I regret that a law like this is even necessary. My instincts are libertarian; I think wherever feasible people should be able to make their choices and live with them. In a better world, it would be possible to allow religious and philosophical exemptions to the very small number of people who would actually want them. But that’s not what’s motivating the increasing numbers of people opting out. They’re driven not by religious or philosophical concerns but by pseudo-scientific ones. It’s not that vaccination is contradictory to their sincerely-held but inherently unverifiable beliefs about the nature of the universe. It’s that they think, incorrectly, that vaccination poses such a risk or offers so little reward that not vaccinating, or vaccinating in non-standard ways, might be a safer approach.

If you want an example of a genuine religious objection to a common medical practice, consider the refusal of Jehovah’s Witnesses to accept blood transfusions. Witnesses aren’t claiming that blood transfusions cause autism, or that they have unexplored dangers, or are a conspiracy by “big pharma.” They’re not trying to second-guess doctors on their own turf. They’re expressing a belief, based on a broadly credible but not falsifiable interpretation of established texts, about how God wants them to behave, whatever the consequences might be within the temporal world. You can certainly argue with them about their interpretation of scripture, but they’re not making a factual claim that’s open to easy dispute. When parents raise questions about vaccination, on the other hand, they’re not in the realm of the ineffable. They shouldn’t be able to decline simply because they have irrational fears, any more than a food service working should be able to get out of washing his hands because he says he’s not even sure germs are real.

I don’t want to seem unsympathetic to parents who are genuinely trying to do what’s right for their children. To paint vaccine skeptics as a gaggle of wacky conspiracy theorists would be as unfair as calling vaccine proponents tools of big pharma. Parents wouldn’t be doing their jobs if they didn’t worry about the risks the world poses to their kids. The trouble is that, as Alexander Pope put it in a misquoted and misunderstood poem, “A little learning is a dangerous thing.” The emphasis there is on little, not learning. Having some basic knowledge of a subject is often less valuable than knowing nothing about it at all. When you know nothing, you can admit you know nothing; when you have some facts at your disposal, there’s a temptation to try to use them. First year psychology students do this kind of thing when they go through the intro textbook and diagnose themselves and their friends with every disorder in the index. And in the 21st century, the Internet is everyone’s intro textbook to every subject on Earth.

Vaccination has emerged as a subject on which people are resistant to the general presumption that doctors know what they’re talking about. Those who would never second-guess their physician on what prescriptions to take or what surgical option to pursue feel free to treat vaccination schedules as optional or arbitrary. That’s probably because vaccination, when working as intended, is invisible in its effects: you only see it when it begins to break down.* That’s starting to happen, but (thankfully) not on such a scale that the link to vaccine skepticism is visible to people not predisposed to see it. But make no mistake: the decline in vaccination levels in Maine is reaching a point where it threatens herd immunity. Herd immunity is the ability to prevent disease outbreaks by vaccinating enough of the population that the disease can’t spread among the small group that has legitimate reason not to be vaccinated. It’s vital enough to public health that even as harsh a measure as this law is more than warranted.

The paradox of herd immunity is like the impulse to touch exhibits in museums. Everybody wants to do it, and everybody thinks, “What harm is one little set of fingerprints going to do?” But it doesn’t take very many people giving in to the impulse for permanent damage to occur. Herd immunity has largely protected the first wave of parents to decline vaccinations, but when their peers see the results and think, “It worked out OK for them, so why not me?”, they’re destroying the system that they hope to exploit. I understand that vaccination schedules often seem arbitrary, and that it feels reasonable to want the same freedom to do what you feel is best that you enjoy in most other aspects of child-rearing. But doctors aren’t petty bureaucrats: they don’t give detailed instructions about what to do and when to do it for the sheer thrill of having power over you. They do that because small changes can make a big difference to effectiveness.

Should there be room in Maine law for genuinely principled objections to vaccination? For people who believe, say, that God intended us to be susceptible to measles, or that the state has absolutely no right to take coercive action in the name of public health? In the long run, yes, I would like to be in a position for that to be possible. If the current anti-vaccination movement runs its course and the risk of outbreaks of preventable disease goes away, then I wouldn’t mind seeing the law changed to allow more freedom for those who demonstrate a sincere commitment to such ideas. But for right now, there’s too much risk that any exemption would become a loophole to be exploited. The safest option is to vote “No” on Question 1.

*It has this in common with democratic norms, the destruction of which by the contemporary Republican Party many Americans shrug at, because they take for granted the safety those norms provide and are under the dangerous impression that a decline into authoritarianism can’t happen here.

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