Measles as Metaphor

Whatever one’s views of the anti-vaccination “movement” (full disclosure–mine run from incredulous to angry), its growth, and the current epidemic of measles that has resulted, offers a vivid metaphor for the basic tension that underlies liberal democratic governance.

Our system, as I tell my students, restrains and limits government, especially when laws threaten to infringe on fundamental human rights–religious or political beliefs, free speech and the like. Government is absolutely prohibited from interfering with an individual’s beliefs, and must demonstrate a compelling purpose before interfering with conduct based upon those beliefs.

One of the enduring debates in a liberal democracy concerns where we draw that line–under what circumstances do we allow government to require or prohibit behavior that is based upon an individual’s deeply held belief?

Another way of asking that is: how much danger must the behavior pose to others before government interference is permissible?

With respect to vaccination, many states have historically accommodated religious objections because relatively few people have harbored those objections, allowing the rest of us to develop what doctors refer to as “herd immunity.” A few non-immunized people in a population that is 95% vaccinated pose little threat to the rest of us, and it thus costs us little or nothing to accommodate their beliefs.

Legal scholars have suggested a similar calculus was at play when the Supreme Court, in Yoder, exempted the Amish from laws requiring that children attend school until age 16; whatever one’s opinion of that decision, it affected very few people. Had the impact been wider, the decision would probably have been different.

The current effort to exempt “bible-believing Christians” from compliance with otherwise applicable civil rights laws raises the same issue. Religious folks have absolute liberty to believe whatever they want about gay people or black people or Jewish people or whoever. But do those beliefs entitle them to engage in discriminatory behavior that is contrary to America’s cultural and legal commitment to civic equality? Can they claim a religious privilege to behave in ways that we collectively deem destructive to our social health?

If my “sincere” beliefs required me to blow up your headquarters building, or sacrifice my newborn, few people would argue that I should be allowed to act upon those beliefs.

If your religious (or just uninformed) decision to forego vaccinating your child is shared by enough people to pose a health risk to other children in a classroom, shouldn’t government be able to exclude your child from that classroom?

If your demand for “religious liberty” includes your right to breach the social contract and refuse to do business with certain of your fellow-citizens, shouldn’t government be able to rule such behavior out of order?

It’s all about where we draw the line.

24 thoughts on “Measles as Metaphor

  1. Having said this before, I will say it again…I almost lost my 11 month old son to chicken pox which became chicken pox encephalitis years before the vaccines were available, I strongly support required immunization. My cousin’s 9 year old daughter lost all hearing in her right ear due to measles. It is the protection of many vs. the “right” of the few to endanger lives. Having researched the anti-vaxxer’s belief that the innoculations cause autism; I stand with the Institute of Medicine, World Health Organization, Food and Drug Administration and the CDC who reject the role of vaccines in autism. The “questionable” ingredient, Thimerosal, was phased out in 1999 due to the controversy. It was used in the larger vials of vaccines as a preservative to prevent potentially life-threatening contamination with harmful microbes. The larger vials were cheaper to market than single dose size. Thimerosal is a mercury-containing compound which is used is some flu vaccines; the FDA is working to reduce or remove it. Thimerosal was produced in 1927; it was marketed by Eli Lilly under the name Merthiolate.

    There are those anti-vaxxers who who believe it is the triple vaccine, measles, mumps, chicken pox) MMC that is the problem. Possibly they do not understand or are are not aware that the preservative Thimerosal has been removed from these vaccines. For decades DPT innoculations have been used successfully by millions.

    My daughter-in-law was prescribed Terbutaline to prevent premature contractions during her 2nd pregnancy. Her son was misdiagnosed as being autistic; a later diagnosis of a similar disability has been found to be due to the Terbutaline taken during pregnancy…I haven’t seen this factor mentioned in all of this anti-vaxxer argument. I am aware I am repeating myself here but believe it is a serious enough situation/argument to be repeated. I remember when childhood diseases were required to be reported to doctors who reported to Board of Health who came to our homes and nailed large yellow Quarantine signs on the front. We were not allowed to leave home and other than those who lived in the home were not allowed in.

  2. To me, EXACTLY the same argument applies to the question of whether
    undocumented immigrants in this country should be given free or
    subsidized health care.

    Like the Amish — only FAR more so — these people live and work among us, their
    children sit next to our children in school, so why would I NOT want their kids
    (and those kids’ families) to be as healthy as possible,
    and minimize the chances of disease spreading?

    Similarly, re driver’s licenses — why would I NOT want every single driver on the
    road to have had to pass a test to prove his or her knowledge of the rules
    of the road? Why leave it to chance?

  3. A little over 100 years ago there was person named Mary Mallon who was identified as a Typhoid Carrier. Her life became so notorious for spreading Typhoid Fever she became known as Typhoid Mary. At least from what I have read about her she seemed totally unconcerned about all the sickness and death she spread. Good scientific evidence identified her as a carrier of Typhoid Fever. However, she was totally uncooperative.

    The Anti-Vaxers seem to have roots in the certain “Science” is bad movement and the Government is the enemy. Certainly science and technology have produced some very destructive inventions, such as A and H Bombs, Agent Orange etc. The Government has lied to us think of the hyping of Gulf of Tonkin Incident and WMD’s in Iraq. Some drugs have been pulled from the Market because of their adverse effects. So I do understand some of the reticence to believe Science and the Government is always good.

    I do find it rather odd the Reactionary Right will defend a “Parent’s Choice” to decide if their child will not be vaccinated and expose the un-vaccinated child to possible death and expose others as a result of their decision. The Reactionary Right will fight tooth and nail against a Woman’s Right to have an abortion or take birth control pills.

  4. Earl; if you mean J.D., my young friend in Woodruff Place, I lost touch long ago. Otherwise, who is J.D.?

  5. Amen Sheila Kennedy. At what point do we allow people the freedom of their stupidity to negatively affect the masses.

  6. “One of the enduring debates in a liberal democracy concerns where we draw that line–under what circumstances do we allow government to require or prohibit behavior that is based upon an individual’s deeply held belief?”

    A profound statement IMO of the question causing so much political angst in American culture today.

    One side: limited government so the profit motive is not restrained. The other: strong democratic government so that the greater good restrains the profit motive.

    There is however a hard stop coming that will decide for us which worldview grows and which declines. Anthropogenic Global Warming.

    Science has determined that it is unequivocally an existential problem. Perhaps the first in human history.

    The profit motive, which is fundamentally built on growth, not only can’t solve it but can only make it worse.

    So the question is, when will the consequences of AGW become so undeniable that the common greater good overwhelms the reliance on profit to make fundamental societal decisions? Also, how will that point manifest in human behavior?

    One possibility is the violent collapse of society. The return to where we came from during our brief 200,000 journey to dominant species.

    The other end of the spectrum is to me unimaginable. The voluntary ordered planned building of a new world. One in which what got us here is restructured suited for the future that we created. Perhaps my imagination is too limited and our species will rise to the occasion but I see no evidence of today of progress in that direction and we are pretty much out of time.

    I’m sure that I will die not knowing our decision to this most fundamental question in the history of life. That’s a real bummer.

    However I’d love to live long enough to see some evidence of a direction for our joint answer to those questions.

    Please?

  7. Pete; I have believed for years that semantics plays a big part in these current debates. Everyone seemed to understand the term “destroying the environment” when it was used a few years ago. Global Warming and Climate Change may be too technical for people to bother trying to understand or realize the terms are not interchangeable. It is like “sex education” not being welcome in schools because people thought the schools were going to teach their little darlings HOW to have sex. The importance of this being part of education was best expressed between Gloria and her mother, Edith Bunker on “All In The Family” when Edith began going through the change – that is menopause in the technical term. Edith responded, “When I was a young girl I didn’t know everything every young girl should know. Now I’m an old lady and don’t know everything every old lady should know.” There is a great lack of understanding on both issues due to a lack of basic education.

    Many states have ruled innoculations and boosters are required for children to attend school. Many states – Indiana is NOT among them – have limited pollution from big business to save/improve the environment. Many people consider either or both to be an invasion of their private lives and rights without understanding the inevitable outcome. Semantics! Just sayin’

  8. JoAnn, I appreciate your thoughts. It’s a huge challenge to guess the full impacts of preaching down to the lowest common denominator compared to educating up to relieve the limitations of ignorance. I think the choice is really what separates politics from education.

    I’m much closer to being an educator than a politician and that is a limitation on my approach so I try to move cautiously towards more marketing and less techno!ogy. Tough for me.

    Part of figuring out this balance is experience. From that I know that referring to greenhouse gasses as pollution or environmental toxins is inaccurate and therefore subject to a priori rejection because life is possible on earth only because they have always existed in our atmosphere. Without them our climate would be like the moon. Boiling hot in the sun, freezing cold in the dark with an average of near zero degrees F instead of the nearly 60 degrees F that we’ve always had. Which was necessary for the formation of life here.

    Our problem is not that they exist but only that we are changing their atmospheric concentrations, and therefore our climate, from what we built civilization accommodated to to something different. If we were uncivilized and far fewer we’d just move from where we were to where the environment was more friendly. But now we have to move our farms and cities with us and there are no more places to move to.

    If we weren’t so darned civilized we’d just let death fix overpopulation and allow the wilyest of us start over again.

    That’s why one possible reaction by humanity to these self inflicted changes is to become uncivilized again.

  9. The media could do a better job of educating everyone to the significant dangers of measles which many of us have forgotten and many more have never heard. Measles is much more than an uncomfortable childhood rash. According to the Centers for Disease Control (and others), measles inflames the respiratory and intestinal tracts. Its complications can include pneumonia, encephalitis, appendicitis, severe retardation, motor impairment, deafness, conjunctivitis, blindness and even death.

    Doctors can help parents separate fact from fiction on the diseases and vaccines. They can also separate the multiple vaccines given in single injections (some parents think this ‘overload’ causes autism in some children) and give vaccines instead in single injections at different times.

    Children can’t take the measles vaccine until they pass their first birthday, making them particularly vulnerable to measles. Pregnant mothers and fetuses are also vulnerable if the mothers have not been vaccinated.

    PUBLIC health is very much at risk when some of us don’t act responsibly to stamp out preventable, dangerous diseases.

  10. Nancy; can you please post this on Facebook – probably list your source so the nutcases don’t accuse you, as they have me, of believing the “skewed data from CDC to cover the facts”. Thanks; this is important information to share.

  11. I don’t think any parent wants their child to either get sick or cause another child to get sick. I think, as others have written, that many people don’t trust government or big pharma, and for very valid reasons. I also think that there are many stories of children who seemed to be fine, then receive vaccinations, and then are diagnosed with autism a short time later. This happened to the son of a friend of mine, who is an attorney, and who, ironically, works for big pharma. His son, who had been developmentally advanced, was diagnosed with autism about 2 weeks after receiving vaccinations. You will never convince him there isn’t a connection. Maybe a small percentage of kids are more vulnerable to developing autism after receiving vaccinations than others, for reasons that are not understood at this point, and therefore, this problem can’t be predicted or prevented at this point. I also think that we haven’t lived in a time when people were dying or getting seriously sick from things like diphtheria, measles, mumps, rubella, pertussis (whooping cough), tetanus and other illnesses that vaccines prevent. At the end of the day, I think some parents fear autism, which they perceive as a more clear and present threat, more than the risk of diseases that are prevented by vaccines.

  12. Because vaccinations are given mostly in the same age range as autism typically manifests it’s tempting to believe that correlation suggests causation. As far as I know no science supports that conclusion though.

  13. Pete: in response, I would say that the answer might be that certain kids are vulnerable to developing post-vaccination autism for reasons that aren’t understood at this point. This might explain why studies don’t establish a firm cause-and-effect– because there aren’t enough susceptible children to establish a firm statistical correlation. On the other hand, autism rates keep going up and up–why? The answer might be some genetic or other individual variable that makes the developing brains of certain children more susceptible to the effect of exposure to things like vaccines, environmental toxins or pollutants, food additives, chemicals or other un-natural things introduced into their bodies. One thing I do believe is that some parents have thought long and hard about this problem and have decided that the risk of illness is preferable to the disability of autism.

  14. I was in second grade when the first Salk vaccine for polio was launched using us school kids as the first to receive it; we were designated Polio Pioneers. The thought at the time (early 1950s) was the risk of the vaccine was acceptable compared to the relatively higher risk of contracting polio. My parents who were accustomed to living through outbreaks of polio were happy to have us vaccinated. The anti vaccinators never seem to consider the scale of the risks of not vaccinating.

  15. The vaccination / autism link was debunked several years ago as bogus, and the researcher Dr Wakefield, a medical doctor, in Great Britain had his license to practice medicine stripped for falsifying data. Despite that, there are anti-vaccination groups, both in the US and globally, including the homeopathic medical types, the Hollywood celebrity types, a very small number of religious organizations such as the Christian Scientists, the Amish, and now a growing number of university educated mothers, the helicopter moms, who inspect every morsel of a child’s food for killer additives, for each gram of sugar, and tend to live within a 5 miles radius of a Whole Foods store.

    My entire reference for autism is based upon the published research of Dr Leo Kanner, an Austrian by birth and a German educated child psychiatrist, who spent his professional life at Johns Hopkins University. Kanner autism has been expanded and expanded and expanded to the point where any child who’s not approaching the status of a social butterfly or whose grades are not worthy of the Honor Roll is now given a tidy label as ‘being on the spectrum’. Talk about being jaundiced.

    http://sfari.org/news-and-opinion/classic-paper-reviews/2007/leo-kanners-1943-paper-on-autism-commentary-by-gerald-fischbach

  16. Natasha, there are always limitations to what is known. My experience is that the best any of us can do is to use what is known to strive for the most favorable odds and accept that there are no guarantees.

    Whatever causes autism is apparently not known yet so there is nothing that can be done to change the odds. Someday that will change because science will have figured out the causes and how to mitigate them. Who knows when?

    In the meantime entering the lottery of guessing is to my way of thinking wishful thinking. But, I suppose, people do win the lottery. If it didn’t cost anything no sense in not giving it a shot.

    But not vaccinating children is far from zero cost from many angles.

  17. Pete, I’m in total agreement with the last sentence in your above post, “But not vaccinating children is far from zero cost from many angles.”

    There are rare occasions when I do not appreciate government interference in my personal life, but matters of public health are never included on that list. Fortunately in Indiana there are only two waivers/exemptions from the full array of vaccinations: 1) religious doctrine and 2) medical reasons as per documented by a licensed Medical Doctor. Other than the Amish, who live in small tightly defined communities and provide their own academic instruction, and the Christian Scientists, who evidently spend their time in the reading room, I cannot think of any major religious group with a doctrine that prohibits vaccinations. Of course, I’m sure there are a few people who would game the system and claim as their own whatever religious doctrine served their purposes.

    The second waiver/exemption, the medical waiver, does serve a group of school age children who have compromised immune systems because of chemotherapy and/or radiation treatment. I’ll give those kids a pass.

    On a broader note, I am sensing a push from the anti-vaccination groups to include the nebulous waiver/exemption, the philosophical reason that several States recognize. That would open Pandora’s box for the anti-vaccination crowd whereby we’d hear requests for waivers for such off-the-wall reasons as: 1) Zeus whispered “no vaccinations” in my ear while I was tending my organic garden, 2) the Socratic method does not endorse vaccinations, or 3) the sum of your life experiences cannot be determined by solving for ‘x’.

  18. Anti-vaccination folks who are endangering all of us, had better hope (I mean REALLY hope) that their own stubborn resistance will not cause their children to contract measles. It could happen, since the virus is so very contagious! It’s ugly and deadly, in case they haven’t noticed. They’re beginning to make up what they hope are legal-sounding reasons for no vaccine whether they believe those reasons or not. We all have seen those infection maps just explode in recent days–far beyond Disneyland. As Dr. Nancy Snyderman pointed out on NBC Nightly News, polio could be right around the corner again, what with so many people unvaccinated. Thanks again, Jenni McCarthy! Have we not learned anything?

  19. I was born in 1946 and certainly don’t consider myself an ancient relic anymore than would Bill Clinton, Cher, Dolly Parton, Steven Spielberg, Danny Glover, Susan Sarandon, Suzanne Sommers, Tommy Lee Jones, Diane Keaton, or Jimmy Buffett. In fact all these famous/celebrity name people and I began first grade in 1952 when the only vaccination available for us as young school children was the smallpox vaccination.

    If the above people’s medical history is anything like mine during elementary school, most of us had chickenpox, mumps, Rubella (called German measles or 3-day measles), and the old-fashioned measles occasionally termed red measles to separate it from Rubella, the 3-day German measles. Along with those diseases, many of us encountered scarlet fever (occasionally called scarlatina), a type A strep infection that today is controlled by antibiotics that were unavailable when we were in elementary school.

    Somewhere along the way in elementary school, I managed to contract what, at that time, was termed Infectious Hepatitis from unsafe food handling in a school cafeteria, actually now called Hepatitis A which kept me out of school for over 6 weeks and in retrospect took several months to recover fully. At present, food handlers in most States are mandated to have the series of Hepatitis A vaccination.

    Finally in 1955 with the availability and approval of the Salk vaccine, our mothers could stop worrying about our contracting polio and all the students lined up willingly when the county health nurse came to our schools to administer the vaccine. Most of us had known at least one person who’d spent time in what was called an iron lung, perhaps a few kids who’d recovered from polio and left with an unwanted souvenir, a pronounced limp, or one leg that did not grow at the same rate as the other.

    These anti-vaccination people are undoing every protection that my parents longed for, for their children.

  20. Barbara: Thanks! Your story is my story, except that mine began in 1942, my birth year. My birthdate would be President Clinton’s birthdate four years later, and Tipper Gore’s as well. As elementary school kids, we had those same childhood diseases and stood in line at the clinic (hardly any schools have clinics with nurses and inoculations anymore–pity!) for our series of shots. It was a rite of passage, thank goodness! I think we went from ‘polio shot’ to polio vaccine (pink) on a little sugar cube. Our parents never thought about who had or had not been vaccinated for MMR, DPT, polio, or any other illness–every kid had been vaccinated. No religious or philosophical mumbo-jumbo about why their kids won’t be getting vaccinated. Didn’t happen! Now look where we are.

    Just tonight at Walgreens, I was about to inquire about how safe I might be in today’s world. I did have mumps, chicken pox, and German measles. What about me and the red measles? I never had ’em. The pharmacist had closed that window for the night, so I will check tomorrow. This is big-time scary stuff! You can’t unring a bell, and once the anti-vaccine folks heard the word ‘autism,’ they shut completely down, no matter that the MD who started the nonsense has been booted out of the medical profession and his theory roundly debunked. You can’t unring that bell, and we’re stuck with what is happening now.

  21. Betty, I suspect, perhaps am even convinced, that your story and my story are basically the same as countless others’ stories of those who were born in the 1940’s and spent our primary/elementary school days during the 1950’s. As Sheila wrote in her topic, my thoughts about the anti-vaccination groups run the gamut from incredulous to angry, tending to settle on angry, flat out angry.

    I also don’t happen to ascribe to any belief the anti-vaccination groups are identifiable by demographics, as in tending toward the right-wing religious evangelical or fundamentalist types or the uneducated high school drop-outs. Frankly, I believe this small, growing movement is morphing into a cause du jour that transcends the usual partisan litmus tests. And, lord knows, we don’t need any more litmus tests, any more single-issue groups.

  22. As I wrote a hour or so ago, I am angry with the anti-vaccination crowd, and I suggest we focus a bit of our attention toward a group of quasi-medical professionals, those practicing chiropractic medicine, who likely have large lobbying groups representing their interests, as in a quick and easy way to hang out your shingle and call yourself a doctor. A large number of chiropractors are deep into natural holistic treatments which sounds benign on surface but think again.

    The chiropractic position on pediatric immunizations appears to range from virulently anti-vaccination to, at best, tepid support from a small group. Yet many within chiropractic view themselves as capable of acting as primary care physicians in general and pediatricians in particular. Their lack of education and training belies those beliefs, as does a look at their actual practices. And their lack of support for childhood immunization makes the proposition downright scary.

    http://www.sciencebasedmedicine.org/chiropractic-pediatrics-firmly-in-the-anti-vaccination-camp/

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