There has been a lot of discussion about vaccinations in the media because of the recent measles outbreak happening in the USA. Each side of the pro- or anti-vaccine camp hurls names at each other, crying that the other is being unfair or whatever. Full disclose: As a PhD Candidate in public health with an MSc in Global Health who did her undergrad in microbiology and spent a few years working in a research group that studied the human immune system, I am on the pro-vaccine side of things. In addition, informed decision making and respecting different perspectives is my bread and butter. I live and breathe those concepts, and they are the only way I know how to approach research, public health planning and healthcare. I’m not here to argue about which vaccine related evidence is good or bad (nor do I have the patience for it), or who is stupid or not. I recently quipped on a facebook post that I could probably spend my entire academic career studying why people argue so passionately about vaccine choices. Driving home on Saturday evening, I realized I ALREADY study this area*, if you look at it from a certain angle. What I’m interested in discussing is why I think vaccinators are angry at non-vaccinators, and why non-vaccinators should stop being so indignant about the backlash to their choices. And stop whining about the name calling.
I study knowledge commons, or more specifically and technically, I study a type of non-rivalrous non-excludable public good. Herd immunity is another similar public good. It’s non-rivalrous, because when I benefit from herd immunity, it does not take away from another person’s potential to also benefit. It’s non-excludable because you can’t really prevent people from using it. Public goods like this are vulnerable to social dilemmas like what is known as the “free-rider problem”. Free riders are people who benefit from a public good without ever contributing to it. So, if herd immunity is a public good, people who choose not to vaccinate are free-riders who benefit from the good without contributing to it. As you can imagine, free-riders tend to induce anger from non-free-riders.
But it gets worse, because free-riding non-vaccinators insist that’s not what they are doing.
People who choose to not vaccinate insist they are making that decision in an informed way because they’ve weighed all the evidence about risks and benefits and are making what they believe is the best decision for themselves and their family. The negative insinuation is, of course, that people who choose to vaccinate are not making an informed decision. The pleas I read for vaccinators to stop judging non-vaccinators and be open to new information takes the tone that if vaccinators only KNEW, they would also make the same decisions.
I’m going to go ahead and call bullshit.
If I’m to assume people who do not vaccinate make those decision in an informed way (which they are adamant about), then I also have to assume that all people who DO vaccinate also make THOSE decisions in an informed way. Everyone is making informed decisions. Congratulations everyone.
But, as the non-vaccinators are quick to use as their justification, vaccines are not benign. They do carry some risks, which is why vaccination has an informed consent process. If you didn’t know the risks before you went for your vaccine, you sure know before you get it. People who choose to get vaccinated are aware of those risks much like those who don’t vaccinate, and are making a decision to accept those risks and contribute to the public good (herd immunity). People who choose to not get vaccinated are rejecting vaccine risks, but still benefitting from the public good.
The only reason that non-vaccinators can weigh the risks and benefits and determine that the risk of disease is far less than the risk of a vaccine injury is because so many other people have made the opposite decision. Non-vaccinators make what they call the best and most informed decision because other people don’t make that decision. I’m told what they do is called “critical thinking”, but to me it seems more like elitist entitlement.
It’s entitlement because, whether you admit it to yourself or not, you rely on other people making a different decision that you would not want for yourself. Therefore, you feel entitled to what you think is the better option. If everyone can’t have something that you think is better and should be yours, that’s entitlement. It’s elitist because it takes a lot of time, education, access to information, and access to resources to make the decision to protect yourself from infectious diseases using means OTHER than getting vaccinated. Informed decisions not to vaccinate are more common in higher income groups for a reason.
I’ve also heard the argument that people would rather get the disease and develop an immune response naturally. I find that just as entitled and elitist as relying on others to get vaccinated. The argument goes that because vaccine-preventable diseases were around when healthcare wasn’t that great, we just couldn’t deal with them, and now there are things you can do to prevent severe disease outcomes. That’s entitled because apparently you feel entitled to mild diseases that only infect you. That’s not how infections work. YOU will not be the only one getting infected with vaccine-preventable diseases. Without herd immunity, lots of people will. And it’s the most vulnerable people in society you are sacrificing. It’s elitist because the hardest hit wouldn’t be the organic-lentil-feeding** naturopath-attending*** wealthy people (not that either of those things helps you when you have an infectious disease, for evidence I present to you the entirety of human history). Society thinks, overall, it’s shitty for individuals to make decisions for themselves that may harm other people, especially those who are vulnerable. It’s a break of the social contract.
When you break the rules of social contract, there are consequences. So far the worst consequence for non-vaccinators has been getting called an idiot on the internet, a similar fate as when one makes a spelling error on a comment board. That’s really not that bad now, is it?
*If somehow my supervisor happens reads this, I just want to point out that I wrote this rambling rant at 11pm after spending the whole day editing my thesis chapter. And then I waited until after I submitted my chapter to post the rant so I wouldn’t be distracted by replies. And technically, this counts as thesis-related writing because it’s about a commons.
**For the record: I love you, lentils. I’m sorry you had to get dragged into this.
***For the record: I do not love naturopathy. From a care perspective however, I have some understanding why people choose that approach, but overall, I am not a fan.