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Vaccine Hesitancy as Free-Riding

photograph of masked passengers on subway

As the pandemic rages on, attention is beginning to turn to the moral status of those who refuse the COVID-19 vaccine. Some of these individuals have succumbed to outlandish conspiracy theories concerning microchips and magnetic implants. But for most, vaccine hesitancy is instead the expression of a genuine concern regarding the safety of the vaccine. It was, after all, developed using a novel mRNA approach to vaccines, and approved in what seemed like an exceedingly short period of time. For these individuals, their hesitancy to receive the vaccine is not based on bad-faith conspiracies, but in a sincere — if scientifically unfounded — fear of the unknown.

There are many arguments we might make regarding those who are hesitant to take the vaccine. Some of these focus on the risk the unvaccinated pose to others who, for whatever medical reason, are unable to be vaccinated. Most of us agree that it is morally wrong of us to unnecessarily put others in harm’s way — particularly when that harm is as serious as hospitalization and death. Given this — and given the importance of ‘herd immunity’ to protecting the vulnerable — we might argue that it is morally wrong for those who can receive the vaccine to refrain.

But the argument I wish to consider here is different. It’s not based on the moral wrongness of failing to protect others, but instead on the unfairness of being a free-rider. What’s a free-rider? Put simply, it’s someone who affords themself a special privilege that they don’t allow for others. More specifically, free-riding occurs when someone receives a benefit without contributing towards the cost of its production. Suppose that my town runs a phenomenal public transport system. Suppose, further, that I frequently make use of this system — commuting to work via bus, and utilizing public transport to run all other kinds of errands. Because I’m particularly stingy, however, I refuse to ever pay a fare — instead sneaking onto buses and expertly avoiding those who would check my ticket. What I’m doing, it seems, is unfair on those who do pay their fare. Why? Because I’m carving out a special exception for myself; an exception that I don’t extend to others. I clearly value the public transport system, and therefore value the contributions of those who pay their fare (since, without those contributions, the system would cease to exist). At the same time, however, I refuse to make any contribution myself. This is deeply inconsistent. If I were asked why I can ride for free when others cannot, I would struggle to provide a good answer.

We might argue that the same is true of vaccine hesitancy. Mass vaccination is directed towards a clear public good — that is, the attainment of herd immunity. As such, we each must be willing to contribute towards the cost of its production. And that cost is receiving the vaccine.

But there’s one potential problem with this argument. As we’ve seen, someone is only a free-rider if they refuse to contribute to the cost of something from which they will benefit. In the case of mass vaccination, the benefit is the protection of those who are unvaccinated. But there’s the problem. As soon as someone contributes to this project by receiving the vaccine, they are no longer eligible to receive the benefit. Herd immunity doesn’t help those who are already vaccinated.

But this is to take an unnecessarily narrow view of the benefits of mass vaccination. Even if I am vaccinated, herd immunity might benefit me by protecting those who I care about — such as loved ones who are unable to receive the vaccine. Further, mass vaccination limits the opportunities for the virus to mutate into newer, more virulent strains (such as the Delta variant that has seen renewed breakouts around the world). And the benefits of mass vaccination extend even further than this. As a result of the pandemic, many of us have been — and continue to be — unable to work, unable to attend classes, unable to travel, and unable to reunite with loved ones. Our ability to do these things will continue to be limited to varying degrees until we find a way to end this pandemic.

All of  us can agree that the world returning to normal is an unequivocal good, and the scientific data suggests that mass vaccination (around 80-90% of the population) is the most effective way of doing this. Of course, more conspiratorially-minded individuals will disagree with this assertion. But this argument isn’t for those people. It’s for those who recognize that vaccination is required, but who — contrary to the evidence — still harbor concerns about its safety.

Essentially, it boils down to this: If a vaccine hesitant individual both (1) wants the world returned to normal, and (2) accepts that mass vaccination is the most effective way of doing this, then they must be willing to contribute to the cost of its production — namely, by receiving the vaccine. If not, then they need to provide a convincing reason as to why they get to be among the 10-20% of individuals who needn’t pay the cost of getting vaccinated. Some — like those who cannot receive the vaccine for medical reasons — will have good reason. But those who are merely hesitant will not. Many of us would love to “wait and see” what happens with the vaccine rollout, or avoid the inherent unpleasantness of an injection altogether. But we don’t have that luxury. The vulnerable must be protected, and the world must return to normal. By failing to contribute to this project, we are free-riding, and — like the fare-dodging bus passenger — treating those around us in a way that’s grossly unfair.

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Scarce Goods and Rationalization

photograph of crowded waiting room

A friend of mine recently posted on Facebook asking for insight into “the ethics of (1) getting vaccinated as quickly as possible for the common good and (2) not using privilege to be vaccinated ahead of vulnerable people.”

Many responded with arguments along the lines of, “by getting a vaccine you are contributing to herd immunity, so it is a good thing to do.” Others linked to this New York Times ethics column in which Dr. Appiah argues that the advantage of easy management means that people should get vaccines when they can get them (and not worry too much about whether others might need them more), and further that by getting the vaccine “you are contributing not just to your own well-being but to the health of the community.”

Another friend recently mentioned in a group chat how she was able to get a vaccine that, technically, she did not yet legally qualify for (since Florida is only officially vaccinating K-12 educators, and not college instructors). I demurred, saying it’s important as healthy youngish people to wait our turn, and a third friend argued that even if you are not the ideal person to get the vaccine, you should still get it if you can since more vaccines are better than fewer and you can help protect others by getting vaccinated.

Assessing the Arguments

The Herd Immunity Argument — The thing that unites all these replies is the thought that by getting the vaccine you are helping to protect others. But in these cases, that is probably wrong. I want to be clear. I am not denying that more people being vaccinated contributes to herd immunity. What I am denying is that my friends getting a vaccine contributes to more people being vaccinated.

Right now the vaccines are a scarce good. If I do not get a vaccine, someone else will get that particular injection. As such, in getting a vaccine I have not actually done anything to increase the percentage of the population that is vaccinated, I have simply made sure that I, rather than someone else, am part of that vaccinated percentage.

The Waste Rejoinder — Some commenters on Facebook mentioned that some vaccines go to waste. But for the most part the vaccine distribution process has sorted itself out. While a good number of vaccines were being wasted in January, we are now in mid-March and the number wasted is utterly tiny in comparison to the number used. The odds that if you do not get a vaccine that the vaccine will end up in the trash is extraordinarily small.

So sure, if you happen to be in a situation where the alternative to not getting a vaccine is throwing it away, then get the vaccine. But unless you know that to be the alternative, you should not think that in getting the vaccine you are heroically contributing to solving the problem.

Speed of Distribution — While no one in the threads mentioned this argument, there is something that could be said for skipping the line. Even if someone else would have gotten that same vaccine, it’s possible it would have taken longer for the vaccine to get in someone’s arm. Now, it’s true that at this point the states are not sitting on nearly as large a vaccine stockpile as they were originally. But it is still the case that some vaccines, while they are not being wasted, are taking longer than ideal to end up in someone’ arm. Indeed, this seems to be happening where I am in Tallahassee.

But the problem is, this was not the situation either of my friends were in. Sure, this situation might be more common than the wasted vaccine situation. But it will still be rare (and indeed, markets are such that this waste usually does not last very long; soon after that article about Tallahassee was published demand at the site increased).

The Lesson

Now, I don’t want to argue that it is wrong to get the vaccine if you have the chance to do so. Probably sometimes it’s right and sometimes it’s wrong. As is often the case, it all depends on the details.

Instead, I want to suggest that we need to be careful to not convince ourselves that our selfish acts serve an altruistic motive. I think it’s probably ok to be somewhat selfish. It’s reasonable to care more about saving your own life than  the lives of a stranger (even Aquinas agreed as much). But I think when you are prioritizing your own good over the good of others, it’s important to recognize that that is what you are doing.

So if I get the vaccine perhaps that is ok. But I should recognize that if I get the vaccine someone else will not. I should also recognize that since I am young and healthy, that other person probably would have gotten more value from the protection than I did. The question, as far as altruism goes, is how do I compare to the average person getting a vaccine these days? Am I younger than the average person who would get the vaccine instead of me? Then probably it is better that the other person gets it. Am I healthier than the average person who would get the vaccine instead of me? Then probably it is better that the other person gets it.

The thing is, we have strong biases in favor of rationalizing our own selfish acts. Thus, we often look for reasons to think doing the thing we want is also good in general. This is a very dangerous tendency. People often accept really bad arguments, if those really bad arguments help them think well of their own selfish activity. This should scare us, and make us all a little more self-critical about our moral reasoning anytime we come up with plausible reasons for thinking the thing we want to do is also the best thing for the world as a whole. Remember, we all have a tendency to think that way, even when the act is merely selfish.

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Incentivizing the Vaccine-Hesitant

photograph of covid vaccination ampoules

Since the beginning of the COVID-19 pandemic, vaccine hesitancy has remained a constant concern. Given expectations that a vaccine would be found, experts always anticipated the problem of convincing those who distrust vaccines to actually get inoculated. A great many articles coming from the major news outlets have aimed at addressing the problem, discussing vaccine hesitancy and, in particular, trying to determine the most promising strategy for changing minds. In The Atlantic, Olga Khazan surveys some of the methods that have been proposed by experts. Attempts to straightforwardly correct misinformation seems to have proven ineffective as they can cause a backfire effect where individuals cling to their pre-existing beliefs even more strongly. Others instead suggest that a dialectical approach might be more successful. In The Guardian, Will Hanmer-Lloyd argues that we should refrain from blaming or name-calling vaccine-hesitant individuals or “post on social media about how ‘idiotic’ people who don’t take the vaccine are” because “it won’t help.” Similar to this “non-judgmental” approach that Hanmer-lloyd recommends, Erica Weintraub Austin, Professor and Director of the Edward R. Murrow Center for Media & Health Promotion Research at Washington State University, and Porismita Borah, Associate Professor at Washington State University, in The Conversation propose talking with vaccine-hesitant people and avoiding “scare-tactics.” Among the things that can help is providing “clear, consistent, relevant reasons” in favor of getting vaccinated while at the same time discussing what constitutes a trustworthy source of information in the first place.

In spite of all these good suggestions, to this day, Pew Research reports that only 60% of Americans would probably or definitely get a vaccine against COVID-19. Though confidence has been on the rise since September, this still leaves a concerning 40% unlikely to pursue vaccination. It is perhaps in light of these facts that a recent proposal is beginning to gain traction: incentivizing people by offering prizes. Ben Welsh of the LA Times reports that the rewards proposed include “Canary home security cameras, Google Nest entertainment systems, Aventon fixed-gear bicycles and gift cards for Airbnb and Lyft.”

But is it right to give out prizes to lure the initially unwilling to seek vaccination?

The answer depends on the moral system to which you subscribe. You might think that given the seriousness of the current circumstances it is especially crucial to get as many folks vaccinated as possible, and that the means of accomplishing this task are of secondary importance. This would be a consequentialist view according to which the moral worth of an action depends on the outcomes it produces. One might feel the force of this line of argument even more when considering that the consequences of vaccine hesitancy can carry dangers not only for the individuals refusing to get vaccinated but for the rest of us as well. Just recently, a Wisconsin pharmacist purposefully made unusable 57 vials of vaccine that could have been used to vaccinate up to 500 people because of a belief they were unsafe. So considering how significant the impact of vaccine-distrust can be, it is understandable that one might employ even unusual methods – such as prizes – to convince those who remain reluctant to join the queue.

On the other hand, if you do not feel the force of this outcome-based argument, you might think that there is something to say about the idea that changing people’s behavior does not necessarily change people’s beliefs. In this sense, offering a prize might not do much to alleviate the distrust they feel towards vaccination or the government. Consider another example. Suppose you do not believe that exercising is good. Yet your best friend, who instead does believe in the positive aspects of exercising, convinces you to go running with her because the view from the hill where she runs is stunning. In that sense, you may eventually elect to go running, but you will not do it because you are now a believer in exercising. You will go running just so that you can admire the view from the hill, without having changed your beliefs about exercise.

What is the problem of not changing people’s beliefs? You might be tempted to think that there is no problem, if you believe that the end result is all that matters. But even in that case, it is beliefs that drive our actions, and so as long as individuals still believe that vaccines are not to be trusted, giving out prizes will only be a marginal and temporary solution that fails to address the deeper, underlying issue. The worry is that someone who may opt to get vaccinated upon receiving a gift card is not deciding to get vaccinated for the right kind of reason. This argument picks out a distinction famously known in philosophy between right versus wrong kinds of reasons. The philosophical debate is complex, but, in general, when it comes to believing something, only epistemic, evidence-based reasons represent good reasons for actions. Should one, instead, come to act on the basis of reasons that have more to do with, say, wishes or desires, those would represent the proper kinds of reasons.

So what is the solution here? Well, there is no solution, as is often the case when it comes to philosophical positions that are fundamentally at odds with one another. But here is the good news: looking at the ways in which real life events connect with philosophical issues can help us figure out what we think. Examining issues in this way can prove useful in isolating the features that may help us understand our own particular commitments and convictions. Thinking through these tensions for ourselves is what allows us to decide whether we think the proposal to encourage vaccination efforts by offering prizes is a legitimate one.

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This for That: Trading Vaccinations for Stimulus Checks

photograph of gloved hand offering syringe and vaccine vial

Lawmakers are getting creative in breaking partisan deadlock over a long-overdue third coronavirus relief bill. After a months-long standoff, Congress remains at an impasse. While Democrats are advocating for a $900 billion starting point that includes state and local government funding, the Republican leadership has indicated they want something around $500 billion with a liability shield to insulate employers from coronavirus-related lawsuits that might be brought by employers over unsafe workplaces.

Part of this negotiation concerns whether to include another round of stimulus checks like those that went out in the spring. Despite popular appeal on both sides of the aisle, those opposed to direct payments stress the cost of such a policy and the need to limit government spending. They also argue that aid efforts should be more narrowly focused on providing relief for those who are most deserving (i.e., the unemployed who are actively seeking work).

In an attempt to appease these critics, former Maryland Representative John Delaney recently suggested providing $1,500 stimulus checks to individuals in exchange for them getting immunized. Its appeal to holdouts is fairly straightforward: rather than a cash giveaway with limited impact and so-so odds of success, this policy is more obviously goal-oriented. It’s a specific answer to a particular problem: only 60% of Americans say they would be willing to get vaccinated, but we need to at least 75% of the population to be immunized to start approaching herd immunity. In order to close that gap, “we have to create […] an incentive for people to really accelerate their thinking about taking the vaccine,” Delaney argues. By making stimulus payments contingent on showing proof of immunization, we can expect a great many more Americans to get a vaccine who might otherwise resist.

So is Delaney’s proposal just good policy or might it be objectionably coercive? Putting money in people’s pockets while stopping the spread of COVID-19 certainly has the potential to create a lot of good. And it does so without getting into sticky conversations about public health and bodily autonomy; we can leave all that anti-vaxx baggage at the door. As Delaney explains,

“If you’re still afraid of the vaccine and don’t want to take it, that’s your right. You won’t participate in this program. But guess what? You’re going to benefit anyhow, because we’ll get the country to herd immunity faster, which benefits you. So I think everyone wins.”

Delaney emphasizes that his plan would not force anyone to get vaccinated, it simply encourages socially responsible behavior by providing financial incentive. And “It’s not like we don’t pull levers to get people vaccinated,” Delaney argues. “We do that now.” There are already similar measures in the U.S. to encourage vaccinations like MMR immunization for children attending public school.

But school vaccinations look a bit different than withholding financial aid in a pandemic in order to effect compliance. For one, there is a distinct difference in exit options. Parents can avoid vaccinating their children by pursuing medical, religious, or philosophical exemptions relatively easily (as Kenneth Boyd has previously discussed here). But Delaney’s proposal doesn’t intend to make similar space. Clearly, one could choose to forgo government assistance, but the situation has the most vulnerable among us over a barrel: barter your beliefs or risk (more) financial insolvency. (And given the mild to moderate side effects from the Pfizer-BioNTech COVID-19 vaccine recently reported in the severely allergic, at least some (albeit few) of those beliefs surely qualify as legitimate.) This policy, then, threatens to severely undermine individual autonomy. With unemployment insurance benefits set to run out and the federal moratorium on eviction expiring, a $1,500 stimulus check might not save the day, but it’s not the sort of thing many could afford to turn down either.

Apart from these worries, though, there is concern that Delaney’s proposal fails to account for the reasons supporting relief in the first place. Political justifications for government’s obligation in this regard come in various flavors, but the two featuring most prominently at the moment involve causation — as lockdown orders have interfered with citizens’ ability to pursue their livelihoods they are due some financial consideration — or economic preservation — to lessen the economic downturn we will all experience (to greater and lesser extents), it behooves us to ensure that bills can be paid, goods can be bought, money moves through the economy and isn’t hid under mattresses, and that the workforce can be maintained and summoned back at a moment’s notice. At bottom, both these accounts rest on an understanding that the government is duty-bound to provide assistance to citizens, vaccinated or not, because our fortunes are inextricably linked. And while these two justifications might not necessitate that all citizens be treated alike, they also can’t justify differential treatment according to immunization status.

In the end, these two projects are simply too far apart. As Howard Gleckman, senior fellow at the Urban-Brookings Tax Policy Center, sums up, “It’s always nice to be able to kill two birds with one stone, but in this case I think the two birds are flying off in different directions.” Those most in need of direct payments are the same people most likely to abstain from vaccination, and those more likely to get vaccinated are the same ones less likely to put that stimulus check back into the economy. We’re trying to solve two collective action problems — herd immunity and economic recovery — by tying them together, but they may be less connected than they might first appear.

But let me not overstate the case. This is not an argument against the use of financial incentives or psychological nudges in general. It isn’t even an argument against incentivizing people to get vaccinated. I’ve merely tried to offer an explanation for why Delaney’s particular proposal can’t be considered a solution to Congress’s current problem. There are reasons regarding fairness, justice, and autonomy that speak against holding direct relief payments contingent upon vaccination and for keeping the issues of economic stimulus and immunization separate.

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Vaccination Abstention and the Principle of Autonomy

image of 1960's polio vaccine poster with Wellbee Cartoon

The suppression or eradication of many serious diseases in vaccinated populations has been one of the great public health successes of the twentieth century. There have always been those who resist or refuse vaccination for a variety of religious, political, or health reasons. Though there can be some risk of negative reactions to vaccines in certain individuals, vaccination is very safe for the general population.  Continue reading “Vaccination Abstention and the Principle of Autonomy”

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The Ethics of Philosophical Exemptions

photograph of syringe and bottle of antiobiotics

While every state in America has legislation requiring vaccinations for children, every state also allows exemptions. For instance, every state allows a parent to exempt their child from vaccinations for legitimate medical reasons: some children with compromised immune systems, for example, are not required to be vaccinated, since doing so could be potentially harmful. However, many states also allow for exemptions for two other reasons: religious reasons and philosophical reasons. While religious exemptions are standardly granted if one sincerely declares that vaccinations are contrary to their religious beliefs, what a “philosophical reason” might consist in varies depending on the state. For example, Ohio law states that parents can refuse to have their children immunized for “reasons of conscience”; in Maine a general “opposition to the immunization for philosophical reasons” constitutes sufficient ground for exemption; and in Pennsylvania “[c]hildren need not be immunized if the parent, guardian or emancipated child objects in writing to the immunization…on the basis of a strong moral or ethical conviction similar to a religious belief” (a complete list of states and the wordings of the relevant laws can be found on the National Conference of State Legislatures website).

Of course, not all states grant exemptions on the basis of any reason beyond the medical: California, Mississippi, and West Virginia all deny exemptions on the basis of either religious or philosophical reasons. And there seem to be plenty of good reasons to deny exemption except only in the most dire of circumstances, since vaccinations are proven to be overwhelmingly beneficial both to individuals, as well as to the community at large by contributing toward crucial herd immunity for those who are unable to be vaccinated due to medical reasons.

At the same time, one might be concerned that, in general, the law needs to respect the sincere convictions of an individual as much as possible. This is evidenced by the fact that many states provide religious exemptions, not only for vaccinations, but in many other different areas of the law. Of course, while some of these exemptions may seem reasonable, others have become the target of significant controversy. Perhaps most controversial are so called “right to discriminate” conditions that, for example, have been appealed to in order to justify unequal treatment of members of the LGBT community.

While there is much to say about religious exemptions in general, and religious exemptions to vaccinations in particular, here I want to focus on the philosophical exemptions. What are they, and should they be allowed?

As we saw above, the basis for granting philosophical exemptions to vaccinations seems to simply be one’s sincere opposition (how well-informed this opposition is, however, is not part of any exemption criteria). In practical terms, expressing philosophical opposition typically requires the signing of an affidavit confirming said opposition, although in some cases there is the additional requirement that one discuss vaccinations with one’s doctor beforehand (Washington, for example, includes this requirement). In general, though, it is safe to say that it is not difficult to acquire a philosophical exemption.

Should such exemptions exist? We might think that there is at least one reason why they should: if sincere religious conviction is a sufficient basis for exemption (something that is agreed upon by 47 states) then it seems that sincere moral or philosophical conviction should constitute just as good of a basis for exemption. After all, in both cases we are dealing with sincere beliefs in principles that one deems to be contrary to the use of vaccinations, and so it does not seem that one should have to be religious in order for one’s convictions to be taken seriously.

The problem with allowing such exemptions, of course, is the aforementioned serious repercussions of failing to vaccinate one’s children. Indeed, as reported by the PEW research center, there is a significant correlation between those states that present the most opportunity to be exempted – those states that allow both religious and philosophical grounds for exemption – and those that have seen the greatest number of incidents of the outbreak of measles. Here, then, is one reason why we might think that there should be no such philosophical exemptions (and, perhaps, no exemptions at all): allowing such exemptions results in the significant and widespread harm.

The tension between respecting one’s right to act in a way that coincides with one’s convictions and trying to make sure that people act in ways that have the best consequences for themselves and those around them is well-explored in discussions of ethics. The former kinds of concerns are often spelled out in terms of concerns for personal integrity: it seems that whether an action is in line with one’s goals, projects, and general plan for one’s life should be a relevant factor in deciding what ought to be done (for example, it often seems like we shouldn’t force someone to do something they really don’t want to do for the benefit of others). When taking personal integrity into account, then, we can see why we might want there to be room for philosophical exemptions in the law.

On the other hand, when deciding what to do we also have to take into account will have the best overall consequences for everyone affected. When taking this aspect into consideration, it would then seem to be the case that there almost certainly should be only the bare minimum of possibility for exemptions to vaccinations. While it often seems that respecting personal and integrity and trying to ensure the best overall consequences are both relevant moral factors, it is less clear what to do when these factors conflict. To ensure the best consequences when it comes to vaccinations, for example, would require violating the integrity of some, as they would be forced to do something that they think is wrong. On the other hand, taking individual convictions too seriously can result in significantly worse overall consequences, as what an individual takes to be best for themselves might have negative consequences for those around them.

However, there is certainly a limit on how much we can reasonably respect personal integrity when doing so comes at the cost of the well-being of others. I cannot get away with doing whatever I want just because I sincerely believe that I should be able to, regardless of the consequences. And there are also clearly cases in which I should be expected to make a sacrifice if doing so means that a lot of people will be better off. How we can precisely balance the need to respect integrity and the need to try to ensure the best overall consequences is a problem I won’t attempt to solve here. What we can say, though, is that while allowing philosophical exemptions for vaccinations appears to be an attempt at respecting personal integrity, it is one that has produced significant negative consequences for many people. This is one of those cases, then, in which personal conviction needs to take a backseat to the overall well-being of others, and so philosophical reasons should not count qualify as a relevant factor in determining exemptions for vaccinations.

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The Ethics of Vaccination Exemptions

photograph of H1N1 vaccine bottles

On January 28, 2019, Washington Governor Jay Inslee declared a state of emergency in response to a spreading outbreak of measles in Clark County, WA. Measles is a highly contagious airborne infection caused by a virus in the paramyxovirus family. Before a vaccine was developed in 1963, the disease infected over 3 million people a year in the United States and resulted in 400 to 500 deaths annually. In 2000, thanks to a highly effective vaccination system in the U.S., the measles disease was declared eliminated by the Center for Disease Control. However, measle outbreaks have begun to emerge again in recent years due to a growing number of parents who refuse to vaccinate their children—often falsely claiming that vaccinations are either unsafe of unnecessary. Do parents against vaccinations, also called “anti-vaxxers,” have a legal right to refuse vaccinations for their children even if it means jeopardizing public health?

While the history of the anti-vaccination movement can be traced all the way back to the 1800’s, a study released in 1998 that claimed a false link between the measles vaccinations and autism has fueled much of the contemporary anti-vax fire. Author of the study, British doctor Andrew Wakefield, was found to have been paid by a law board to falsify evidence in support of a litigation case that claimed vaccines had harmed children. The study was formally retracted by its publisher in 2010 and Wakefield lost his licence to practice medicine in Great Britain. Since then, numerous studies (including one released on March 5th, 2019)  have failed to find any link between vaccines and autism.

There are legitimate medical reasons to delay or avoid vaccinations, but they are rare. While some doctors have decided to profit off the anti-vax craze by selling false medical exemptions to parents, most who refuse vaccinations for their children do so through non-medical, state-issued means. Most common is an exemption based on “religious beliefs.” Overall, no major world-religion has a theological objection to vaccinations. However, certain offshoots of ‘faith-healing’ denominations, such as Christian Science, reject modern medicine altogether. Some religious fundamentalists also claim that vaccines are unnecessary. Gloria Copeland, an Evangelical Christian minister who sat on the Trump campaign’s evangelical advisory board, claimed in a 2018 video on Facebook that Jesus was the best protection against the flu and people can avoid the disease by repeating “I’ll never have the flu.”

Many states also allow for “philosophical” or “personal” vaccine exemptions that do not require religious backing. Much of the motivation to acquire such exemptions stems from the spread of misinformation on social media sites like YouTube, Facebook, and Pinterest. Ethan Lindenberger, an Ohio teen who chose to get vaccinated against his parents wishes spoke of the necessity in addressing misinformation when he testified before congress on March 4th, 2019. Lindenberger said, “For my mother, her love, affection and care as a parent was used to push an agenda to create a false distress, and these sources which spread misinformation should be the primary concern of the American people.”

Non-medical vaccine exemptions (NMEs) endanger public health by reducing “herd immunity.” No vaccine is 100% effective, but when a population is highly vaccinated it prevents the spread of germs from one person to another—effectively protecting the population. The less vaccinated a population becomes the more susceptible both vaccinated and unvaccinated individuals are to diseases. This is why public schools require vaccinations for children who attend. In 2015, the Second Circuit U.S. Court of Appeals in Manhattan upheld a ruling that students who receive religious exemptions can be kept out of the classroom during a disease outbreak. The court stated, “The right to practice religion freely does not include liberty to expose the community or the child to communicable disease or to the latter to ill health or death.”

Proponents of NMEs believe public health should not take precedence over individual liberties and that mandated vaccinations are a threat to personal autonomy. However, in the case of public spaces, such as schools, vaccines are analogous to other government mandated safety measures. Exceeding the speed limit, running a red light, or breaking other rules of the road is illegal when driving because it threatens the safety of others. The famous ‘harm principle’ of British political theorist John Stuart Mill argues that infringing on personal liberties is justifiable when it protects others from harm. Under this principle, vaccination exemptions should be highly restricted since they pose a threat to public health.

Dr. Barbara McAneny, the American Medical Association’s president, argues, “Protecting our communities’ health requires that individuals not be permitted to opt out of immunization solely as a matter of convenience or misinformation.” A 2013 measles outbreak in Brooklyn, New York that infected 58 people was caused by a single unvaccinated child. Such an incident shows that, to keep a population best protected from disease, vaccination exemptions should only be allowed for legitimate medical reasons. While preventing the spread of misinformation is paramount to combating the rising rates of NMEs that are endangering both domestic and global health, the most effective means of reducing communicable disease is to do away with NMEs all together.