Vaccinations - Balancing Community and Individual Liberties and Rights

The measles outbreak has brought the United States face-to-face with a critically important question that spills over into many other areas and is in many ways at the heart of our political debate: How do we balance the protection of individual liberty with the liberties and rights of the community we all live in?

Vaccines are one of the true miracles of modern medicine. We have wiped out smallpox worldwide, are closing in on polio and have nearly eradicated measles, mumps, chickenpox in this country. That is, until recently, when we began to see a resurgence of measles, mumps and whooping cough in the United States. This is attributable to less-than-desirable vaccination rates nation-wide, but mostly in clustered areas around the country. The current measles outbreak is the most recent consequence of the purposeful inaction of too many of our fellow citizens.

This brings us to the issue of individual liberty versus community liberty.

Our country is based on a balance between the rights of the individual and the rights of the community as enshrined in our Constitution and Bill of Rights. The failure of our original founding document - the Articles of Confederation and its loose government structure - led our Founders to draft the Constitution, which created a strong federal government. However, in order to secure passage of the Constitution, our greatest compromise was struck - the creation of and inclusion in the Constitution of our Bill of Rights, which gave individuals specific rights and freedoms from the government.

But as our legal history has shown, these individual rights have boundaries because they are granted to each of us, which means as we exercise them we can and do come into friction with other citizens. Hence the prohibition of yelling "Fire!" in a crowded theater if there is no fire, and the prohibition against citizens owning and/or possessing military weapons, such as grenade launchers. One of the ways we deal with this friction is by paying the consequences for those choices that infringe on the rights of others (i.e., our legal system). If you run a red light after you choose to drink and then hurt or kill someone, you are subject to a legal consequence, even including a loss of liberty.

Vaccination falls into a similar category. There is no doubt vaccinations have and continue to provide a huge community benefit. Millions of our children and adults no longer become ill because of vaccines, and hundreds of thousands are spared medical trauma that can last a lifetime (i.e., surviving polio). In the end, thousands of lives are saved because many of these diseases can and did kill our fellow citizens. Our problem is that we have done such a good job of nearly eradicating these illnesses that most people are completely unfamiliar with the health impact of contracting them. Who actually knows someone, for example, who suffered through polio, or even know that as recently as the late 70s children died from the measles in this country?

Yet just as freedom requires constant vigilance, so, too, does our country's health -- because all of these diseases still circulate around the world. And given the fluidity of travel they can come to our doorstep more quickly and without notice. This is what happened with the current measles outbreak that started in California. Our vigilance has historically taken place through mandatory vaccination of children with few exceptions (physician-identified medical exemptions being the primary and legitimate reason), but over the years, more and more exceptions have crept into our policies, and our vaccination rates have decreased to the point we are now seeing the return of disease once thought dead and buried. With this comes more illness, and if we do nothing we will see increased numbers of cases and more people dying.

I am not going to take the time to go into why we are seeing decreasing vaccination rates, a question that has and is being covered by others, except to say the science is clear, vaccinations are effective and safe. Like everything in this world there is risk, but it is minimal and rare. You're safer getting a vaccine than crossing the street.

But there are some, mostly recently New Jersey Governor Chris Christie and Kentucky Senator Rand Paul, who suggest that parents should have the right to say no to vaccines for their children. Senator Paul went so far as to say many vaccines should be voluntary. So what if we agree as a society to allow this based on the principal of individual liberty? How do we address those circumstances where an individual parent makes a choice to not vaccinate their child and that child goes on to get the preventable disease and infect others, including a child with a compromised immune system and that child gets sick and dies? What should we do? If the parent had made a different decision the child would not have died, and my guess is that if the parent could have seen into the future and saw that their decision not to vaccinate their child would lead to the death of another, they would vaccinate. Who wants to see a child die?

But we can't see into the future. Or can we? Vaccinations are as good a tool to see into the future when it comes to disease prevention as any high-tech gadget we have. We know that if we get our overall vaccination rates high enough we can protect the children who cannot get vaccinated.

We know we can wipe out disease, but only if we all cooperate and give a little bit on the individual-liberty score. Otherwise, individual decisions made by parents to not vaccinate their children will lead to illness and death in others, and like the consequence paid for negligent driving, perhaps the answer is to make the offending parents suffer legal ramifications.

Maybe, on a lessor note, you should only be held legally liable if you chose for non-medical reasons not to vaccinate your child and that led to illness or death in others. Or perhaps if you chose to not vaccinate your child, he or she should be kept out of school until vaccinated (but the parent would still be required to meet the education requirements). There are some schools where it is forbidden to bring peanuts into the building because of some children's allergies. Doesn't this policy somewhat abut others' individual liberty to give peanuts to their children? I see little difference.

When it comes to vaccinations that have immense benefits to our public health, we should move forward with policies that preserve the community's rights to a healthy environment free of eliminable health hazards.

William Pierce has worked on health care issues, including vaccine policy, for over 20 years. His ideas, thoughts and words are his own.