Tuesday, February 03, 2015

The current brouhaha over vaccination presents a fascinating case study illustrating three frequent conflicts in American politics:  between democracy and individual liberty, between science and public policy, and between individual and collective goods.  While it should go without saying that vaccination is a vital and powerfully effective disease-fighting tool, the issue of how a democracy should deal with anti-vaccine fanatics isn't quite so cut-and-dried, and has exposed some of the idiosyncrasies of American political debate:
  •  Libertarianism and distrust of democracy:   Most of the arguments I've seen so far amount to hysterical rants about the evil and stupidity of "anti-vaxxers", coupled with nasty partisan accusations of the "other side's" pronounced anti-vaccine tendencies.  (In fact, there are loud anti-vaccine fringes on both the left and the right, to which mainstream politicians on both sides have occasionally pandered.)  Sprinkled in amongst these diatribes are indignant anti-vaccine pronouncements steeped in libertarian self-righteousness, larded with references to alleged scientific proof of the dire consequences of vaccination,  and finished off with apoplectic accusations of "poisoning children".  This acrimony is typical of debates--such as abortion--where both sides deeply distrust the democratic process to provide the "right" answer, and prefer instead to gin up enormous volumes of rhetorical fury in order to provide preparatory justification for whatever possibly extra-democratic tactics might be necessary to win the day for their own side.
  • Science as authority, citizen pursuit or villain:  Some of the most embarrassing arguments are the ones in which the participants attempt to invoke science on behalf of their claims.  The anti-vaccine efforts are laughable, of course, citing vaguely-referenced studies alleging all manner of terrible harms, while simultaneously denouncing the medical establishment for covering up the awful truth.  but the pro-vaccine ones are rarely better--they either cite a scientific consensus whose strength and validity the speakers are completely unqualified to assess, or else recite potted versions of the actual science that they don't really understand.  The truth is that neither side is really competent to discuss, much less judge, the science behind this issue.  And it's a good bet that on one or more other issues--second-hand smoke, say, or genetically modified organisms, or global climate change, or evolution--any given pair of disputants would find themselves adopting each other's previous approach to the relevant scientific evidence. 
  • Allergy to collective burdens:   Vaccination, like virtually all public policy options, imposes risks on some people, and benefits for others.  It therefore produces "winners" and "losers" either way--the losers, in this case, being those who suffer from either a vaccine reaction or the disease itself.  As it turns out, there's a "free-riding" opportunity here:  if only a very few people refuse vaccinations, then they are effectively protected by "herd immunity", while avoiding the risk of an adverse reaction to the vaccine.  This risk is very low, and is also insured by a strict tort liability system incorporated into the funding of vaccine production.  But Americans are generally very reluctant to enter into this sort of collective assumption of even very small individual risks.  That's why the vehicle for the insurance system is tort law, rather than normal insurance--it gives individuals the sense that they are autonomously receiving compensation for a wrong, rather than passively accepting societal care following a misfortune.  And that's why enough Americans still choose to free-ride that the herd immunity on which the free-riders depend is in some cases quite possibly on the verge of collapsing.
In an earlier time, when circumstances were dire (thousands of children dying of infectious diseases), these problems were overcome of necessity.  And one certainly hopes that they will be overcome once again, before any preventable diseases rage completely out of control.  But in the meantime, it sure would be nice if more Americans discussed the issue as if they hoped to persuade their fellow voting citizens, rather than bulldoze them; admitted that they don't really understand science and are simply using their common sense as best they can; and spoke more of their concern for each other's well-being than of their rights and entitlements to do as they please and still have others look out for them.

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