Comment by sergiosgc | Hacker News Reader

Comment by sergiosgc | Hacker News Reader

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There are situations where you should convince people, there are situations where you must mandate a decision. Whenever personal freedom produces large negative externalities, the law must mandate behaviours.

These mandated behaviours should be such that freedom is restricted by the minimum needed amount. As an unrelated example: smoking is not prohibited; Smoking in closed public spaces is.

For vaccination, I believe the sweet spot of mandated behaviour is to mandate vaccination of children participating in large public groups. Children that go to public schools must get vaccines. Children playing team sports must be vaccinated.

Parents then maintain the freedom of not vaccinating their kids, but must abide by the rules that prevent those kids from being a menace to the rest of the population.

Note that this is only needed because vaccines rely on "herd protection". If vaccination coverage drops, vaccine efficacy drops precipitously. The effect is very pronounced. 90% coverage is much less effective than 99% coverage. Not vaccinating a child poses a risk for the child, but also poses a risk to all other children he/she is in regular contact with.

P.S. A lot of other discussions may arise: Government prohibitions tend to be slippery slopes; Children should be somewhat protected from their own parents; Should groups be allowed to skip vaccination altogether?. These are secondary issues, irrelevant to the main decision that is: Mandate vaccination for children that are members of larger groups, so that the group maintains disease protection.

We should handle this the same way we handle other negative externalities. With taxes. You certainly have the right not to vaccinate, but you should bear the full cost of that decision and not simply be allowed to free ride on the herd immunity of other people who did accept the small (mostly perceived) risk of vaccination.

I'm betting once there is even a small tax on skipping out, most of this nonsense will vanish like smoke.

Taxing people who don't vaccinate their children has got to be the easiest way to pour gasoline on the libertarian fire.

I don't see why; if we can quantify the average economic cost to others of you not vaccinating your children, then by charging that to people who don't vaccinate, we are merely increasing the efficiency of the free market by removing an externality. That's about as Libertarian as you can get.

I think one problem would be how much can we legally restrict from society someone who isn't vaccinated? Can work places restrict this (especially ones like hospitals and the like)? What about government jobs? What about health insurance companies? Life insurance companies? Public transportation? Flying? What about the government-subsidized/provided health care? Can they mandate vaccines?

They're free to roam about our society as they please (within reason).

Here, it helps that the problem is more acute in children groups. It is acceptable for schools to require proof of vaccination on admission. It is also acceptable for sports clubs to do so on admission. Mixed adult/children environments are not as problematic, because adults resist better to these diseases and so the infection rate gets a lot lower.

A lot of text to say that this is a Pareto rule scenario. Cover the 20% of places where kids spend 80% of their social time and you get most of the needed protection.

I think you're missing the point. The question is not whether it's effective for a business to exclude the unvaccinated. The question is whether it's legal, or perhaps whether it's morally acceptable. AFAIK yes it is, and it should stay that way for the exact same "get the government off everyone's back" reason that people use to resist a vaccination mandate. Businesses of all types should have that freedom, and IMO they should use it.

"Can work places restrict this"

Absolutely. Voluntary disease carriers are not a protected class under any law. If there is a scientifically and legally provable threat to others' health and safety, I'd say a business has a responsibility to reduce that threat. The main way these outbreaks start, quite likely including the one at Disneyland, is unvaccinated people coming back from places where measles are still endemic. Those people are walking bioweapons. If they're not going to be quarantined at the border, then it's up to businesses to contain the damage as best they can.

What about the ones that do it for religious reasons? I have to imagine that these are a non-trivial number of people.

Religion is protected, of course, but the majority of refusals to vaccinate are based on "personal belief" or "philosophical" rather than true religious grounds.

https://www.americanprogress.org/issues/healthcare/report/20...

Unfortunately, once you allow for religious exemptions it becomes hard to distinguish sincere people of faith from the more common agnostic (sometimes even actively atheistic) bioterrorists. Thus, it might be impractical for businesses and their proprietors to exercise their rights in this area.

There are people who claim religious exemptions, but aside from fringe sects of Christianity (some Amish, and a handful of <20k member denominations), no major religion or religious denomination practiced in the US forbids vaccinations.

There are around 100K Christian Scientists in USA, they only must be vaccinated if required by law, and there are religious exemptions most places.

More people claim religious exemptions than are a part of religions that actually forbid vaccination, and Christian Science doesn't have a problem with vaccinations when they are required legally. If your religion doesn't have a problem with something if it is required legally, then it's not a religious problem: it's a policy problem.

A good lawyer could argue that non-vaccinated people are not taking sufficient precautions in preventing themselves from being an accidental bioweapon, and are through voluntary and explicit negligence committing a treasonous act.

Most hospitals(1) require all their employees to get yearly flu vaccinations with threat of termination if you refuse.

(1) I only have direct experience with two hospitals in the area, but based on other employees reactions, this is standard procedure.

Pardon my ignorance, but I am curious. If one child in classroom full of children is not vaccinated, what risk is posed to the vaccinated children?

Vaccines aren't 100% effective.

... on a single person, but in a close to 100 % vaccinated population, they are close to 100 % effective.

The issue is not just risk to vaccinated children, but risk to the legitimately unvaccinated - too young, immunocompromised, any other condition that's scientifically known to make vaccination unsafe. Those people can't rely on vaccination, so they must rely on herd immunity. When herd immunity weakens beyond a certain point, those people are completely vulnerable for reasons that have nothing to do with their own choices. When we talk about the freedom of some people to forego vaccination, we're talking about taking away these other people's freedom to participate normally in society without significant risk of contracting an often crippling or even fatal disease.

Not all children are able to be vaccinated for medical reasons (allergies, weak immune systems/cancer). They could also potentially carry the disease to children who aren't old enough to be vaccinated yet.

In the recent Disneyland/California measles outbreak, 5 of the infected were considered vaccinated against measles.

http://www.cdph.ca.gov/Pages/NR15-008.aspx

Here is a concrete example. MMR is two dose regiment. The current anre recently updated CDC recommendation is that if a child experiences thrombocytopenia within six weeks after the first dose to not give the second dose. Thrombocytopenia is usually not serious - nose bleeds, easy bruising, bleeding of the gums - but since the risk is higher for those that experienced that side effect after the first dose, that is why it has become the recommendation.

One dose of MMR puts their effective immunity to measles at something like 85% during childhood. It varies with how strong the immune system is when the first dose is given, most children get it at six to nine months. At nine months one dose is 85% effective and at 12 months 95% for most infants. It is presumed that the effect is smaller in those vaccinated at six months and those that experience thrombocytopenia and the recommendation is relying on 95% immunization rate for herd immunity. Something like one in 25K children are in this category. There are other categories of people not immunized as well.

Other scenarios have already been given, but one risk to be considered is younger siblings of classmates who are not yet vaccinated.

Not far from where I live, a 3-month-old baby died of whooping cough. The DTaP vaccination against pertussis is given at age of 3 months, so the baby had no immunity yet; some scolded the baby's parents for being anti-vaxxers but that was cruel - they were simply following the standard vaccination schedule. The legitimately not-yet-immunized baby was killed by being exposed to someone who most likely had refused vaccination. This is difficult to prove, of course, and case details are not public.

Vaccines increase individual resistance to infection, but they do not increase it to 100%. However, when a group is all vaccinated, the effect is that transmission rate drops below what is needed for a disease outbreak, and thus the group gets near 100% protection.

A cluster of unvaccinated children in a group create a living habitat for small outbreaks, lengthen exposure time of vaccinated kids, and thus create the conditions for the extra vaccine protection to get pierced.

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