Understanding Vaccine Refusers

Michael Specter explores resistance to vaccination, through the lens of smallpox vaccination in the United States.

Specter re-caps several of the key concepts in Michael Willrich’s Pox: An American History, including the tension between public health and the rights of an individual:

The logic used by the increasingly powerful federal government was straightforward: the good of the community had to outweigh objections raised by a minority. After all, what could be worse than a smallpox epidemic? Willrich offers an answer: curtailing basic civil liberties.

The article touches on another key challenge in vaccination: the danger of “herd immunity” – in which an individual who refuses vaccination still benefits from the fact that other people have been vaccinated against a disease:

After all, what makes it easy to be a vaccine dissenter these days is the fact that most people aren’t. Because of routine vaccination, measles—which kills at least a hundred and fifty thousand people in the developing world each year—long ago ceased to be a significant threat in the United States. This creates a paradox. Public-health officials must struggle constantly with the consequences of their own success: the dangers of complacency are real. Vaccine-preventable illnesses have made a strong resurgence in the past decade in the United States, fuelled almost wholly by fear. There is currently a measles outbreak in Minnesota; last year, pertussis (whooping cough) cases, and deaths, reached a record high in California.

And an eloquent final paragraph that mirrors some key design principles:

A public-health establishment that regards vaccination as merely a technical matter has failed to register the genuine clash of values—not least between social welfare and individual liberty—that Willrich describes. Making the case for vaccination means taking its opponents seriously; it means taking the time to understand the reasons for resistance, and it means figuring out how to prevent and allay mistrust. Modern vaccination is a triumph of medicine; its decline would be a failure of politics.

New Yorker – Resistant

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