There’s a measles outbreak in Massachusetts, probably thanks to low vaccination rates.
It’s hard to believe, but we’re sliding backwards on two of the three public health achievements of the 20th century: vaccination, antibiotics, and clean water. Antibiotic resistance is a growing problem, one that we’re partly inflicting on ourselves by rampant overuse. And now vaccine resistance is spreading among parents who want to free ride on the herd immunity of others. If these diseases were widespread, they’d be rushing to vaccinate their kids. But they can delay, or forgo the vaccines entirely, thanks to other parents who are willing to risk their kids in order to do the right thing. They’re already killing little babies who catch pertussis before they can be vaccinated, and now measles has killed six people in France just since the start of the year.
That is from Megan McArdle.
Well, at least someone mentioned ‘herd immunity’ in a sentence.
Libertarians such as McArdle and Cowen like to tut-tut people like Andrew Wakefield, even though he is doing nothing that upsets their dogmas. Bad, even deadly advice is one of the harms of free speech. This particular bad advice extends its effects even to those who haven’t taken it, because of contagion of disease.
In general, libertarianism has no solution to problems of contagion. Real solutions such as mandatory vaccination and isolation of infectious persons violate their ideas of liberties.
Requirements for vaccination to enter public schools are routinely denounced by libertarians. Generally, there are exceptions granted to those with deeply held religious beliefs (such as Christian Scientists) because herd immunity can still be attained if that minority is not vaccinated. Unfortunately, that requirement is now being bypassed by homeschoolers and others.
Public health REQUIRES government regulation of individuals. Libertarians have no ideological way of coping.
A healthy rule of thumb would seem to be that the government can step in if there isn’t an effective way to enforce contracts. In this instance, a person contracting measles generally doesn’t have a workable way to receive compensation against the person giving it to them, so it’s been assigned to the government to deal with.
A private entity may in theory be more efficient at vaccinating large numbers of people than the government, but for obvious reasons be prohibited from compelling people to receive one of their shots.
So the argument seems to be “government is necessary because it can force people as a group to do things”, which is fine, but it can’t seem to even do THAT, apparently, so the anti-libspeak is a red herring.
Well, that is certainly a stretch. A person’t right to act on their own beliefs ends where harm to others begins, doesn’t it? Refusing to vaccinate would seem to meet that dictum, therefore a good libertarian will gladly and dutifully vaccinate.
Libertarianism doesn’t recognize a right against passive harms. The fact that you find someone ugly doesn’t give you a right to rearrange their face, even though their hideousness is a clear harm to others. Likewise, if someone is a disease carrier, you have no right against them since they haven’t taken an action to harm you.
Once you strip ignorance of passive harms from libertarianism, you get unusual results like “it is the upstream owner’s failure to build a damn which caused the flood, they should pay for the damage.”
Isolation of infectious persons certainly seems well within the boundaries of libertarianism.
I do not have a problem with requiring mandatory vaccinations to attend school or adding to the requirements to get a passport or a even a driver licence, but I can not think of a way to enforce mandatory vaccination for home schooled children that I would not be a disaster.
Target them when they go to college. They might be home-schooled but probably not “home-colleged”…..
The increasing popularity and rigor of online degrees make this more likely than you might think.
Require immuniation for any child seeking to use healthcare, in any non-emergency situation (with the usual exceptions for religious objections and the rare health exceptions).
I find the “religious objections” excuse somewhat anachronistic in today’s world.. Firstly, often such excuses would be hard to evaluate and in some cases often an easy back-door. OTOH if objections on religious grounds are valid why wouldn’t it be at least as acceptable for someone to say he objects on “scientific”, “aesthetic” or “philosophical” grounds? For something so widely seen as essential is there really a need to carve out exceptions?
I seem to think this is a uniquely American phenomenon but maybe I am wrong; do other Western countries allow this as a valid excuse too?
So then they’ll wait until (fill in whatever condition) is in fact an emergency before seeking care. Smooth! Anyway, I can’t speak to affairs everywhere in the US, but what you’re describing is close to the existing state of affairs here in Pennsylvania, in that no GP will deal with your kids unless you are vaccinated *or* have a properly filled out religious/philosophical exemption. Even then, you’ll definitely be hunting for one of the more ‘alternative’ doctors, since the majority of them take the view: vaccinate or GTFO.
I’m pretty sure our pediatricians have that policy–I don’t think they’ll even see someone whose parents refuse the normal schedule of vaccinations for nonmedical reasons.
“Public health REQUIRES government regulation of individuals. Libertarians have no ideological way of coping.”
Bullshit. There is simply no medical intervention without side-effects. McArdle, a (l)ibertarian, is the first person to mention herd immunity on Cowen’s (l)ibertarian blog.
The (a) libertarian solution is: You pay them.
You create some kind of on-line option auction. The only reason you need the internet is to reduce transaction costs. Have a box for “mail a friend who might not have internet.” This is cheaper than a doctor visit.
I could work out the details of this type solution in an afternoon, and I’m not that smart. I just know to look and not give up because I mistake ‘inconvenient’ for ‘impossible’.
Aren’t the measles killing free riders?
And also those who are too young to receive the vaccine yet.
There are also people who can’t be vaccinated because of other medical conditions and people for whom the vaccine wasn’t effective.
There have been 20 cases (last I heard, there may be more by now) in Minnesota this year, mostly in the Somali immigrant community.
To a first approximation, they aren’t killing anyone in first-world countries any more. And the people they are killing (in India and Africa, by the millions) obviously aren’t free riding.
Your first approximation is wrong. Unless you think that dozens of people isn’t “anyone”, in which case your moral compass is seriously broken.
“Libertarians such as McArdle and Cowen like to tut-tut people like Andrew Wakefield, even though he is doing nothing that upsets their dogmas. Bad, even deadly advice is one of the harms of free speech. This particular bad advice extends its effects even to those who haven’t taken it, because of contagion of disease.”
“Public health REQUIRES government regulation of individuals. Libertarians have no ideological way of coping.” – Mike Huben
Lets check the implicit and explicit debate points. The ultra minimal state vs. authoritarianism. -Or- the protective society vs. utopia. Hence the Mike Huben
dystopia [authoritarian utopia] requires government regulation of the individual. Therefore the omnipresent Huben dystopia, with its omnipresent disease of the state directed individual, is superior to random contagion disease.
Further, the dogma of authoritarian utopia is notionally presented as better than the ultra minimal state. No empirical evidence is forth coming, rather the notional is put forth as fact.
Huben merely sets forth a notional proposition as fact, takes the giant leap into the-way-things-ought-to-be, adds verbal virtuosity, and ends by painting the world in his own self image.
Very nice Mike!
Your wild fantasies don’t characterize my actual position. Nor are such ridiculous false dichotomies “debate points” except from the Procrustean ideal of forcing people to take extreme positions they really don’t espouse.
“Your wild fantasies don’t characterize my actual position”. Followed up with some Huben vilification. Very nice!
Then comes “extreme positions”. Right. Uh huh. The extreme position is in fact your position of “Public health REQUIRES government regulation of individuals. Libertarians have no ideological way of coping”. Hence your extreme position is now somehow transposed? Think not oh Dystopian one.
This comment must have the highest recorded text density of the word “notional”
Anon:
‘…text density of the word “notional”’. The density of notional is a function of Huben dystopia notional positions.
17 cases is an “outbreak”?
im sorry, i know there are potential longer term effects, but every kid in my school, and probably 80% of my generation, had measles when we were kids, (chicken pox & mumps too), and for the most part we’ve survived..
Are you talking the real measles, or the so-called German measles? The latter was still common when I was a child. Its a very mild, and short-term illness (hence its other name, “Three day measles”), though it’s very dangerous for pregnant women, or rather their fetuses.
I didn’t think the “hard” measles had been at all common in this country since before WWII.
Yes, the fatality rate for measles dropped dramatically even before vaccination reduced the incidence. A hundred years ago maybe one person in three who got the measles would die (rates in Africa can still get close to that). In the UK and Wales, the annual deaths from measles (but not the number of cases) dropped from ~10,000 per year to about a hundred, before the vaccine was introduced.
“…and for the most part we’ve survived.”
So, are you trying to claim we must pay for our liberty by letting a few people die from preventable diseases in childhood, a few more become scarred, more go deaf and blind, some become crippled and dependent???
You need to work a lot harder to extol the virtues of the past, or what I as a boomer who got the first of a polio vaccine and others considered very unpleasant childhood diseases. I saw my peer’s kids grow up without suffering those diseases I did, and didn’t think they were harmed for being denied my experience.
Most libertarians are okay with “public health” when it encompasses, y’know, actual public health. It’s just that a lot of what passes for healthcare debate in this country doesn’t have anything whatsoever to do with communicable diseases.
It’s also important to remember that general knowledge of how disease works is very recent. Had the founders had a conceptualization of it, it would no doubt have found its way into the enumerated powers. (In turn, “post offices and post roads” wouldn’t have been included in a 2011 Constitution.)
The Founders were well aware that diseases could be passed from person to person: that knowledge is ancient if not prehistoric. Though to be sure the mechanism of infection was not understood until late in the 19th
century.
The Founders however were not, and did not see themselves as, omniscent gods able to foresee every possible future situation. The Constitution is a very general document and we should not pretend that it covers all contingencies that may ever arise. that’s why we have a Congress (and state legislatures), to pass pecific legislation on specific issues.
The Founders wrote a document completely constrained by the political economy of the time. It is ridiculous to appeal to their “vision,” because their only “vision” was to try to hammer together something that worked better than the Articles of Confederation that most of the states would sign.
The antibiotics issue is huge. As someone who contracted MRSA in a hospital, I can speak to how much of a pain it is to have an infection that “may or may not” be cured by antibiotic A, and then we’ll try B, and if not B, then we’ll try C. These microbes evolve around antibiotics very quickly. Between people demanding antibiotics from their doctors even when they have a cold virus (against which antibiotics have no effect) and the fact that for the sake of cheap beef and pork we proactively pump our meats full of antibiotics, we’re throwing away our most powerful public health tools under the banner of the free market.
As for the water, I worry about what we are going to allow in the Marcellus Shale. As a resident of NYC, if fracking disrupts the reservoirs upstate, the city will be doomed. Natural gas is am important resource, but after recent events I do not trust the safety track records of our oil companies and regulators.
So NYC is doomed. Is there a downside?
Presumably there are some (minor) risks from vaccination, and a vaccination program is effective even if fewer than 100% of people are vaccinated. Therefore, a certain number of people ought to be exempted from vaccination. Ideally, those at greatest risk from the vaccination would be exempted, but as a practical matter a central administrator may be unable to target just these people. So the exemptees might better be self-chosen: people could be paid a bounty, out of tax revenues, to undergo the risks (and inconvenience) of vaccination. The amount of the bounty would be set so as to achieve the desired percentage of vaccinations; those who chose to exempt themselves would forgo the bounty.
Right I’m surprised not to see this mentioned until so far down on an economics blog.
Although I would rig it in reverse, auction off a limited number of permits which allow you to go to school (and college, and to get a driver’s licence, and to get on a plane) without being vaccinated. The first few permits go to those with medical necessity, the remainder are sold at auction.
One problem with these ingenious schemes is that we are assuming that the “desired percentage of vaccinations” is a known and calculable quantity.
The theory of herd immunity is pretty well developed and I believe that the CDC does have such desired percentages as targets. However, I think that the proposed solution would probably be a lot more expensive than the current one. Psychologically, once you start telling people ‘hey, we’ll *pay* you to take this vaccine’, they’ll be much more likely to view it in a negative way, and want a significant sum to undertake what they would previously have considered a benefit that they would pay to receive. In short, you’re assuming rational consumers.
Your hypothetical “irrational consumers” get to be immunized AND receive a large payout.
Just what is supposed to be irrational in this behaviour?
I am against the death penalty. I wouldn’t even favor it for Andrew Wakefield.
Megan McArdle wins the prize for the most gratuitous mention of the “death penalty”. Where did that come from?! Could this be a emerging corollary to Godwin’s Law?
You think pollution is bad now wait til the government takes over oil production. You should read up on the environmental disasters in the USSR. At least in a democratic society, pressure groups push for safety measures. But when the government controls everything, public dissent is quashed.
Remember, Obama and Durbin cut a deal with BP so it could continue to pollute Lake Michigan.
http://www.thefreemanonline.org/columns/why-socialism-causes-pollution/
Simple solution: pay parents to vaccinate their children from the Medicaid budget. It’s a positive externality.
I don’t think the vaccination issue is a problem for the consistent libertarian. I don’t buy the vaccine-autism link after what I’ve read on the subject, but think about what would be happening if there was a link between vaccines and autism – the state would be forcing autism on schoolchildren. Pretty horrifying. Or what would be happening if the anti-vaccine folks were in charge of the machinery of the state – the vaccines would be banned and many more children would be dying of measles. Sure, the state may be on the side of science this time (it often isn’t – banning the teaching of evolution in Kansas, Soviet Lysenkoism, Copernicus, Socrates, there are a lot of examples) but its clumsy, coercive approach to these issues is nearly always worse than a simple policy of laissez-faire. People already have the proper incentives to seek vaccines – mandates and central public health planning smack of the tradeoff-ignoring monomania characteristic of well-intentioned totalitarians.
“but think about what would be happening if there was a link between vaccines and autism – the state would be forcing autism on schoolchildren”
I’ve read that someone in USSR’s health care system had a bright idea to obligate doctors to treat streptococcal infections in babies with antibiotics (mix of streptomycin and penicillin) . Allegedly treatment failed to achieve it’s goals, but it’s side effects caused deafness in huge number of children.
If this story is true (and I do know that there were lots of “deaf-mute associations” before the fall of the Soviet Union) then it shows how well bad ideas mix with mandatory implementation.
The pertussis aka Whooping Epidemic is almost exclusively related to immigrants from Mexico and other third world nations, legal and illegal both. Ditto for measles. Ditto for bedbugs. Ditto for TB and on and on.
I don’t think paying people would work out too well. Currently the idea is to convince people that the vaccine is a benefit they should be happy to receive. If you start paying them, they will perceive the vaccine as a negative thing, and then you’ll find you have to pay them quite a lot in order for them to do it.
I think it’s mostly irrational autism fears that make parents choose against vaccination, not cost of the vaccines and not free-riding.
Because more kids are drinking bottled water and drinks made without tap water, the lack of fluoridation is causing an epidemic of tooth decay. The irrational fears of mercury poisoning are also causing dental problems. I had metal fillings for 20 years, with no problems. My dentist replaced them with composite fillings and within a year I had a cavity in one of those molars. The composite fillings disintegrated twice in two years, and of course my dentist charged my dental insurance for both sets of replacements. There was nothing wrong with my metal fillings which would have lasted the remainder of my life.
Diseases are also spreading more because of increased exposure to foreigners. I’m not saying we should stop that, but we must be aware of the fact that people coming here are introducing pathogens we’re not accustomed to. All sorts of nasty critters are coming from China and Mexico.
“I had metal fillings for 20 years, with no problems. My dentist replaced them with composite fillings and within a year I had a cavity in one of those molars.”
Seems you were a victim of bad qulity fillings. The main reason the metal ones are being replaced is that the ceramic ones should have an even longer lifespan. They are being replaced all over the world.
How big is the externality here, relative to other externalities we accept in normal life? My suspicion is that this is an issue that gets people upset because of a small number of horrible cases that are easy to see and be upset by, and because the antivax people are a pretty unsavory bunch. Those two elements make for a compelling story–here are the evil bad guys, and here are the sympathetic victims.
The problem here is that up to a certain number of people ding it, thre is lmost no externality. Then, if the number increases just slightly, the externalities become huge.
‘There was nothing wrong with my metal fillings which would have lasted the remainder of my life.’
Nope – decades of your life, definitely, and depending on how old you are, that may be enough. But metal fillings, even when done by a truly skilled dentist, are generally very unlikely to last 5 or 6 decades (depends on a number of factors, of course – where and how large is the filling, how and what one eats over decades, etc).
This is becoming more obvious over time, since people with routine and good dental care (and a healthy diet) don’t lose teeth as in the past.
So if you refuse to get your child inoculated and your child infects my child and my child subsequently dies from measles, I will charge you with murder.
and what if your inoculated child infects my non-vaccinated child and my child dies, do i get to charge you with murder? or do you think its still my fault? you cant have it both ways.
Beware the urge to see in every visible bad outcome in the world a morality story that requires the attention of a policeman and a judge.
The result in both cases is homicide; the actus reus in both cases is non-vaccination; the mens reus attached to the actus reus in both cases is recklessness (the result of someone getting infected and dying was foreseeable but not actively desired by the party committing the actus reus). The combination of recklessness and homicide is the crime of voluntary manslaughter on the part of the non-vaccinating party in both cases. Straightforward American criminal law as applied every single day by our courts.
We don’t normally charge people with criminal negligence for decisions whose probability of killing anyone are anything like as small as deciding not to get their kid vaccinated with the MMR. Though when we do, it is, like this, when there is an interesting morality tale into which we can fit the facts, and a human-perceptible tragedy. (Visible death of some other person via infection from your child is an example of a place where there is an easy story and an easily-perceptible tragedy. Existence of an outbreak as a result of your participation in non-vaccination of your kids, leading to a loss of herd immunity, is not–it’s hard to imagine how anyone would ever be charged with negligent homicide in that case.)
In case it’s not obvious from context, I think refusing to get your kids vaccinated is deeply stupid. But most stupid things people do, and most tragic outcomes from stupidity, aren’t actually very good places to apply the law.
The degree of mis-education among those *supporting* mandatory vaccination is astounding.
http://dulcefamily.blogspot.com/2011/02/10-things-i-wish-mainstream-media-would.html
A few posters have duly noted that pinning the resurgence of these diseases on soccer moms avoiding vaccinations is a red herring. This is caused by immigration, plain and simple. Besides TB, Whooping Cough, and Measles, Leprosy is also making a comeback. Leprosy, more-or-less eradicated by soap, water, and simple hygiene, is making a comeback.
{Citation needed}
Nice post there.Vaccine and medicine are becomes more common in human’s life. Our immune system is depends on the medicine or vaccine . Our Industrial Chemical Manufacturer and Bulk Supplier could help something as they provide certain necessary chemicals for treating the diseases by more researching. The need is to workout more physically and try to treat the disease more naturally then take the help of vaccinations.
Nice post and comments there. Ya its true that vaccination is become the need of life today’s. We need more and different vaccine and medicine to cure ourselves.There is a solution in Nanotechnology related various materials as single walled carbon nanotubes (swnt) and more could change the future of health industry. Scientist development nano equipments which could go inside the body and cure it effectively. The need is to find more natural methods to cure ourselves.
Good thing the third achievement (clean water) is easily the most important.
This shows which they last very much lengthier and thus saving you income which could otherwise are actually utilized to purchase new ones.gf
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