“I’ll drive on the left side of the road if I want!”
Individual vs Community Rights
Dan Onion, MD, MPH
Mt. Vernon/Vienna Health Officer
Having dedicated my professional life to promoting and assuring community health, I am in despair about the debate we have had surrounding referendum question #1 because it seems to ignore the science! By the time you read this, we will know the result of that vote on requiring immunizations of school children. I realize forcing immunizations on any group of people generates understandable distress and feelings of loss of control. Two aspects of this recent debate particularly distress me.
First, many voters seem to be misunderstanding and/or distorting the science. In a KJ/Portland Press Herald story this last weekend, a mother described her young daughter’s having suffered disabling brain damage (encephalitic cerebellar ataxia) from a chickenpox immunization that took more than a year to recover from. That disease is more commonly seen in children who suffer from chicken pox itself. So, it might well have happened if she had contracted chickenpox. She now wants to be able to decline further vaccinations for this and her other children. The mother reports that she’s “been told” she must allow another chicken pox shot, which should not be necessary anyway, since that immunization is a one-time one and the reaction to it would medically preclude a repeat as well. Stopping all further vaccinations for this child and her younger sister makes no medical sense. And then there are the perennial fears of autism being caused by immunizations, for which there is no credible scientific evidence after years of searching. Population health is assessed by the health of the whole population; vaccine recommendations are based on helping the most individuals. So much of the argument seems to have been driven by anecdote and misinformation rather than the most good for the most people.
Secondly, this seems to be part of a wider national phenomenon of increasingly hostile conflicts between individual and community “rights”. The same issue comes up with even modest gun control restrictions to diminish the likelihood of mass murder. With motorcycle riders, studies show using helmets clearly and dramatically reduce permanent injury. When such injuries happen, the rest of us have to pay to care for such unfortunate crash victims’ medical care, often for the rest of their lives. I haven’t yet heard of anyone claiming the right to drive on the wrong side of the road if they want, but I worry that I may soon! I did note that a teacher cited in the KJ article used a similar analogy of driving at 120 mph if he wanted. Other individual rights, like those to vote or to health care, still make all kinds of sense.
Choices are easier when predominantly the individual suffers the consequences of his/her individual choice, like with helmets, and unlike the case of vaccinations or gun rights, where others may also experience adverse consequences from an individual’s choice. I wish we could devise some fair strategy to sort out where the community wants to come down on some of these hard choices. Maybe the voting booth is indeed the best way to them, but I wish we could stipulate a role for accurate and rigorous science to play a greater role in informing peoples’ votes. Anybody got a better method?