Arguments for Compulsory Vaccination
By Pierre Lemieux
The Connecticut legislature wants to abolish the last non-medical exception for the compulsory vaccination of children, following in the steps of five other state governments (“Connecticut Lawmakers Brace for Public Hearings on Vaccination Bills,” Wall Street Journal, February 15, 2010). Two serious economic arguments can be made in favor of this measure. (It wouldn’t protect against the coronavirus, for which there is yet no vaccine, but this epidemic is certainly a motivation or an excuse for strengthening compulsory vaccination.)
The first argument is a public good argument, which can be summarized as follows. Everybody potentially benefits from other individuals being vaccinated, the main beneficiary being those whose age or state of health precludes vaccination. Immunization through vaccination is thus a public good, to the production of which everybody must contribute. A large part of this contribution consists in having oneself vaccinated. In order to prevent potential free riders from skirting vaccination while benefiting from that of others—benefiting from the so-called “herd immunity”—compulsory vaccination is justified. Richard Epstein’s article “Let the Shoemaker Stick to His Last” (Perspectives in Biology and Medicine 46:3, 2003) can be interpreted this way.
The second argument for “compulsory” vaccination relates to the fact that, nowadays, it is, thus far, advocated only for children as a condition for admission in public schools (or perhaps private schools too). A child, the argument goes, is, by definition, too young to know where his own interest lies, especially in probabilistic choices such as between the risk and consequences of catching the disease on one side, and the inconvenience and risk of vaccination on the other side. The child’s parents must make the choice. However, as was famously said in a slightly different context:
A priori, parents would ideally always be willing and able to protect children from tobacco themselves. If this happened, there would be little need for governments to duplicate such efforts. Perfect parents, however, are rare.
This statement is due to Prabhat Jha et al., “The Economic Rationale for Intervention in the Tobacco Market,” in Prabhat Jha and Frank J. Chaloupka, Eds., Tobacco Control in Developing Countries (World Bank and Oxford University Press, 2000), p. 164. Note that the title of the book is a misnomer, for it is concerned as much with rich countries as developing ones.
The validity the two arguments for compulsory vaccination, even for children, is not obvious.
The first argument is analogous to the one that Thomas Hobbes, in his 1651 book Leviathan, made for the state in general. Since the security provided by the state is in everybody’s interest—since it is, in today’s terms, a public good—it is also in everybody’s interest not only that everybody contribute to financing the state, but also that the state be the only judge of everybody’s contribution. Otherwise, free riders will ride. Or so claimed Hobbes.
One problem with the Hobbesian argument, as well as with the public-health argument for compulsory vaccination, is that it justifies absolute power. Although Hobbes took the argument very seriously, some would dismiss the fear of tyranny as a slippery-slope argument. As if slippery slopes did not exist. Consider how, in the early 20th century, compulsory vaccination was used to legalize forced sterilization. The famous 1927 Supreme Court decision in Buck v. Bell (274 U.S. 200) said it clearly:
The principle that sustains compulsory vaccination is broad enough to cover cutting the Fallopian tubes.
It was not an abstract matter. The decision legalized previous and future forced sterilizations against individuals deemed to be “imbecile,” “feebleminded,” “defective,” or “socially inadequate.” It is estimated that more than 65,000 Americans were forcibly sterilized up to the 1980s. The last sterilization statute, in Mississippi, was only repealed in 2008. (On this topic, see Paul A. Lombardo, Three Generations, No Imbeciles: Eugenics, the Supreme Court, and Buck v. Bell [John Hopkins University Press,2008].)
Another problem with the public-good argument is that, technically, it only applies to goods or services unanimously desired. If basic security against aggression can be assumed to be a public good, the assumption becomes less valid as it is extended to other goods or services. Indeed, from what we can observe in the anti-vaxxer movements, many people do not want vaccination because they think that its cost is higher than its benefits for them or their children. From the point of view of a philosopher-king, this may be true or not, but it is not correct to think that there is no “objective” risk. For example, philosopher Mark Navin (who believes that compulsory vaccination is morally justified) cites the Centers for Disease Control and Prevention according to whom the DTaP vaccine (against diphtheria, tetanus, and whooping cough) causes long-term seizures or brain damage in “only” one out 1,000,000 children (Values and Vaccine Refusal: Hard Questions in Ethics [Routledge, 2016]).
Furthermore, there is a good economic argument against government pretending to determine the “optimal” vaccination coverage. University of Chicago economist Tomas Philipson brilliantly argued that the fewer the number of people who get vaccinated, the higher the risk factor for the unvaccinated, and the higher the latter’s incentives to get vaccinated (or to use other prevention measures). (See notably his “Economic Epidemiology and Infectious Diseases,” in A.J. Culyer and J.P. Newhouse, Eds., Handbook of Health Economics, Vol. 1 [Elsevier Science B.V., 2000].)
As for the argument that imperfect parents cannot be trusted to make decisions in the best interest of their children, the basic counterargument is quite simple: have you seen many perfect politicians and perfect bureaucrats? Despite a few extreme and troubling cases, parents have been genetically hard-wired to look out for their children’s interests. There is no such hard-wiring for the state.
To be clear—and to this extent that this may seem relevant—I am not arguing that the anti-vaxxers are right. In fact, I don’t agree with their evaluation of costs, but I don’t claim that their children belong to me either.
In this short post, I have only scratched the surface of the issue. It may get especially pressing if an epidemic scare grips the public. It will be interesting to see if populists affirm the primacy of individual choices or, at least, the presumption of individual liberty or, instead, just follow a frightened and irrational mob.