Vaccinations and the State (Part II)

In a previous post I tried to show that two of the key arguments against requiring vaccinations miss the mark.  The inflamed rhetoric of "freedom" verses vaccination is an abstract debate that has little applicability in the real world. In the real world, we constraint freedom of action all the time in order to enhance people's freedom. We don't allow people to beat up others to get what they want, we require parents to look after their children, and we have rules that prevent you from lying publicly about other people (defamation). What this means is that once we move the issue of vaccinations out of the realm of a first year debating club and consider how requirements actually function in our society, this becomes much less of a yes/no issue. 

Not only that, while we compel people do all manner of things in our society (not drive until a certain age and passing a test, properly store fire arms, drive below a certain speed on the road), we do these things in the name of freedom.  A quick example: I start a business because I know people cannot lie about my product. Imagine the reverse situation. I start a restaurant and people (say, my competitors) are allowed to say I poison my customers ... I'd likely not start my restaurant. The law against libel and defamation enhances my ability to make meaningful choices.  Likewise, preventing people from beating others up to get their way expands freedom allowing us to do the things we want without fear that someone will come by and beat us up and, say, rob us. 

I also tried to show that the slippery slope argument is problematic. It is not a trump card (we don't know what will happen next so ....), but an argument and that argument can, in that case, be subject to reasonable proofs. It is a question of evidence; not of speculation and necessarily needs to be. If speculation was our policy and legal standard, we would be in pretty bad shape. Why? Because speculation is, necessarily, speculative. It is a hypothetical situation that might or might not happen and different people's speculations can lead in different directions. What one person sees as a reasonable speculative probability; another does not.  Because there is little way to determine which speculation is correct we cannot, without recourse to some kind of evidence, make it the basis for policy decisions. Thus, I see little evidence that a vaccine requirement (something we already have had for a range of vaccines and for certain professions) will cause an erosion of democracy. 

Finally, there are other grounds on which we can and do compel behaviour. We compel behaviour because it is fair. The example I've used before is paying taxes. We have people pay taxes because they derive benefits from public policy. I periodically hear people say things like "I should not have to pay tax X if I don't want." This comment is often made, however, from a perspective of ignorance. For instance, some people might not want to pay the percentage of their taxes that go to fire protection because, they might say, they don't intend to use the fire department. This argument sounds reasonable except when you consider the fact that these people have already benefitted from having fire protection.  Having fire protection makes everyone safer whether you use it or not. It stops fires from getting out of control, increases property values, etc. Same thing with public works (water, roads, bridges). Consider this example. Someone might say "I don't drive, why should I pay a gas tax?" Well, you don't. That is levied at the gas station but you do benefit from roads. Do you buy groceries or clothes or heating oil? Did someone hook up your wifi or did you need to use the hospital? Roads are essential for all of our well being, Hence, we have to pay for them because they don't build or maintain themselves. Hence, paying something for the benefit (even while not as much as the person who drives) through indirect costs is fair. If you did not pay, you would be in a situation where others were paying your share and you were benefitting. You were, in effect, off loading costs onto me. 

Vaccinations can be like that. When you have a large population where most people are vaccinated, it is possible that non-vaccinated people can off-load the cost. Because a large enough people are vaccinated a population immunity of sorts is created and you (or, say, your child) can derive a benefit (not getting ill) without paying the cost (getting vaccinated) because others have paid it for you. Sometimes there is serious confusion about this. I have heard people say "well, my kid is not vaccinated against measles and they didn't get sick." There is a real faulty logic here that we won't get into but you can see what has actually happened. The anti-vax parent has, in effect, offloaded their child's safety onto parents who vaccinate their kids. 

The real problem, of course, is that the anti-vax parent has mistaken safety caused by population immunity for safety in general.  The irony is that it is the very efficacy of the vaccine that makes people safe and allows people to think that they don't need to vaccinate. And, yet, you can see what happens when we are unable to get to population immunity. The situation becomes more grave. It starts to strain resources (say, in the health care system), threatens the economy (there is a further irony here that we don't have time to address), and threatens people who have been vaccinated via breakthrough infections. The key thing about these points is that they are not speculative. They are empirically demonstrable. Thus, we can point to hospitals with increased numbers, for instance, in American states well into their next wave. 

From a rights perspective, the issue is this: where does your right begin and my right end?  This is the old "fire in a crowded building" argument. The standard argument is that your right ends when it infringes on my right and vice versa. I don't have any easy answer to this but rephrased the question might be this: do you have a right to engage in behaviour that we know endangers my life?  In terms of speeding on the highway of driving drunk or misusing a fire arm, the answer is no. 

This is not a lock sync argument. It is, however, a way of saying that compelling vaccinations is an argument that is on a continuum. People who believe that they can easily assert their right against it as if calling something an individual right made it immune to any argument is inaccurate. 

In my view, then, the state is within its bounds to require vaccination for certain jobs, particularly but not exclusively those that deal with high risk populations (say, those living in long-term care facilities or those with health problems). In my view, private institutions (say, universities) are also right in so doing -- although for slightly different reasons that I won't get into. Finally, requirements are also legitimate in those instances where there is a risk of passing on infections that can create dangerous situations for third parties (say, people who work in the public schools) or creating situations for widespread infection. 

Does this mean that we say "my way of the highway" to those who oppose vaccination? I don't think so. I think that we can, depending on the circumstance, do our best to accommodate people.  Such accommodations might range from transfers to other departments, working or studying from home, providing timelines, or perhaps other measures.  Said differently, where possible, we should do what can reasonably be done to accommodate differing perspectives on vaccination. But this would not be a relationship of equals, as it were. The anti-vax position would be accommodated where it could be. I don't imagine, for instance, that students would be forced to learn from home because their teacher refuses a vaccination. I do imagine that it might be possible to transfer that teacher into a different job (say, curricular development) that does not involve interaction with unvaccinated minor populations.  In short, I am not looking for a balance of a half-way point but something that can work for most people while underscoring the legitimacy of requiring vaccination. 

Vaccination and the State (Part I)

Can the state compel vaccinations? There is more than one answer to this question, but I will confess that my own thinking is not 100% settled.  The first and most obvious answer is "of course it can." Pass a law, institute penalties and vaccination passports, and presto.  But, this is not really the question people ask when they ask this question. The question is not about the ability the state to force people to be vaccinated, but the ethics of so doing. Is the state "right" in compelling vaccination or is this an example of "overreach?" Do people have a right to determine what goes in their body and, if so, might not any law -- say, one requiring vaccinations for long-term care workers, teachers, those who seek to attend hockey games -- be subject to a judicial (Charter) challenge, whereby the complainants will look to the courts to throw out laws that mandate vaccination. This is a more complicated question.  It is made more complicated by the fact that anti-vaxxers have adopted a feminist "my body, my choice" language. (There is something odd about this language but I'll address that in a separate post.) 

One serious problem in answering this question lies in the fact that public discourse on this subject has reduced the argument to slogans (potentially, as I'll suggest in the future, misappropriated).  In part, this is a political and rhetorical strategy. By creating a simplified discourse, the opponents of vaccination seek to make their case that requiring vaccinations is wrong. The discourse is polarized and, I think, intentionally so to admit only a limited consideration of the issue. It is often framed as "the government can't tell us what to do with our bodies" or reframed as a question "do you think the government should be able to tell you what to do with your body?" Framed in this way, the obvious answer is "no." It seems to provide a license to allow the state to do all kind of things -- to compel people to do all matters of things against their will -- and so seems to be a clear and present threat to democracy. 

Without giving my view yet (because I want to work through an argument), my sense is that this discussion needs to be moved out of the realm of rhetoric and into a real world situation for it to be meaningful. I've tried to make this point about other matters before and I do recognize that politics is politics, but I still think it bears asking what might a real world perspective on this issue tell us? 

First, I am not certain that the issue is one of individual freedom verse tyranny.  As a society, we compel our members to do many things. We are compelled to respect speed limits, pay taxes, feed, care and educate our children, among a host of other things. We are compelled not to walk across the street and strike our neighbour because we don't like the new tree they have planted. In other words, there are many things we are compelled to do. We are compelled to do things because they maintain the safety of others (speed limits), we are compelled to do things because we have a duty of care (look after children or report crimes), we are compelled do things because we derive benefit from them (pay taxes) and it would be unfair for us to derive benefit from something and stick others with the bill. We can be compelled to things because of emergency situations (war or pandemics) or because natural disasters create unusual pressing circumstances in which action needs to be taken. We are compelled to do things to promote the smooth operation of public facilities (I can't go on the ice until my team is playing. I can't just jump on in the middle of someone else's game.)  

The key to these situations is not that we are not compelled to do them. Nor are people "sheep" for blindly following government. Instead, most of us follow these rules because we agree with them. I don't disrupt others' hockey games because I want to play mine.  There is, for me, a benefit to the smooth functioning of a recreation facility and if that requires me to wait until my game starts, that is what it requires. If I naturalize the idea that anyone can jump on the ice any time they want, we no longer have a hockey game, do we? Likewise, while there is a lot of grumbling over taxes, most Canadians accept taxes and don't have problems paying them. The recognize the benefits they gain from public expenditures (better roads, health facilities, schools, lower crime, etc.), and recognize that if we want these benefits, we have to pay for them. Road crews, police officers, fire fighters, etc., don't work for free. And, I am not allowed to walk across the street and strike my neighbour to prevent them from walking across the street and striking me. 

None of this is perfect. People speed when they shouldn't. People neglect children when they shouldn't. People get into fights. But, what do we say when this happens? Why didn't someone stop this? How did the police (or school officials or coaches) not notice? In other words, in instances where required behaviour breaks down our answer is not to eliminate the requirement because we agreed with it in the first place. It is to ask why it was not enforced. 

In the real world, then, we have rules that we follow as part of our citizenship. It is a requirement of citizenship and is broadly accepted because these rules make sense (in a democratic society, there is the added consideration that rules are accepted because they can be changed, but that can also be the subject for another post).  In fact, they make so much sense that most of us don't bother to talk about them. I don't know about them because I have better things do with my time then spend it going through a list of things with which I agree. Instead, I tend to focus on my work, my family, things I like to do. 

This is important because it leads to this point: the difference between requiring vaccination and freedom is not the stark matter to which anti-vaxxers point. It is not white/black, you were free and then the government forced you to kind of thing.  The distinction, if there is one, is a far, far more a matter of degree than kind.  

Might this be a slippery slope? If we let the government require vaccinations, someone might ask, what next? I think this can be a fair argument but it is often misplaced.  Let me flip the question around and ask anti-vaxxers this question: "OK, fair enough, what do you think is next?" Because we have vaccinations, will the free press suddenly disappear? Will we be compelled to leave our jobs or barred from living in certain parts of the town? I might be exaggerating, but you can tell from the last point that I am asking historically based questions.  Rather than hinting darkly that a vaccination may lead to "slavery" or "totalitarianism" or the "loss of our freedom," can the opponents of vaccination name specific things  we will lose? 

This is not a rhetorical question and I am not trying to shift the burden of argument. It might be an important consideration. It might allow us to identify problems in advance -- perhaps even ironic or unforeseen problems that could follow from requiring vaccinations. But, I also think that we need to have this discussion to determine whether or not the concerns of anti-vaxxers are valid. After all, if one is going to argue for specific policy actions (not requiring vaccinations) that have implications for people's health, I think the least we can do is spell out the full implications of that argument. I am not the person to do this but my sense of the matter is that before we take actions that are potentially harmful to others, we likely should have compelling reasons. The demise of democracy can be one of those reasons. I won't go into all the details but I would accept that but before I do, I would like to know that democracy is really imperilled. 

Let's pause because I have not yet answered my question and I am on the verge of going on too long. Instead of answering the question "is it right to require vaccinations?" I've tried to shift the balance of the argument in a different direction. I've tried to contextualize the argument about requiring people to do things to a real world setting. Set in this context, the requirement is less a stark difference from public policy than a difference of degree. This difference of degree might be amenable to a slippery slope argument but we'd need to see the evidence of that. Rather than asserting that a vaccination constitutes a loss of freedom, what precisely is being lost and how does it affect your life? For instance, what can you *not* do after being vaccinated that you could do before. Do you lose your right to vote, the ability to publish a blog, due process of law? These are exaggerated examples but if we are going to talk about the loss of freedom ... then they might be appropriate. I've also tried to suggest requirements are part of living in a civil and democratic society. People follow rules, in other words, because those rules make sense to them.  There are further issues to address and I will pick them up in my next post.