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“How To Handle The Vaccine Skeptics”: Parents Should Face A Higher Burden Before Removing Their Children From The Immunized herd

The alarming number of measles cases — a record 644 last year, and 102 last month, the most since the disease was declared eliminated in the United States in 2000 — has focused scrutiny on parents who refuse vaccinations for their children. There are some who want state and local governments to sue, or even criminally charge, such parents. A bill in California would end all nonmedical exemptions to immunization requirements.

For epidemiologists like me, eliminating exemptions may seem satisfying, but it is not the wisest policy for protecting kids. Instead, we should borrow a concept from behavioral economics, and use administrative rules and procedures to “nudge” parents to immunize their kids, rather than trying to castigate or penalize these parents.

Currently, all states allow medical exemptions, since some children — for example, those getting chemotherapy or who have certain types of immune disorders — cannot safely receive vaccines. All but two states (Mississippi and West Virginia) allow exemptions for religious reasons. Nineteen states allow exemptions based on personal (or “philosophical”) beliefs. Such beliefs are increasingly cited by parents whose misplaced skepticism is not really principled but premised, rather, on false notions like that of a link between autism and the measles vaccine.

So shouldn’t all states follow the example of Mississippi and West Virginia, and ban all nonmedical exemptions? The courts have generally upheld such bans, but the political backlash is great, as history shows. After the smallpox vaccine was made compulsory in England and Wales in 1853, there were years of protests, until a commission exempted those with conscientious objections.

Partly because of intemperate comments by politicians, some Americans continue to view vaccines as an intrusion on their personal liberty rather than as a matter of public health. Between 2009 and 2012, 31 bills aimed at making it easier to obtain exemptions were introduced in various states (including 11 in Mississippi and West Virginia). Vaccination advocates who want to make exemptions harder to obtain will have an uphill fight.

But even states like Arizona and Colorado that allow fairly broad exemptions can tweak their rules to make sure parents are as informed as possible — and to make the exemption process difficult.

They can require parents to write a letter elaborating on the reason their child should be exempt. They can require that the letter be notarized. They can insist that parents read and sign a form that discusses the risks of nonvaccination. Better yet, they should mandate in-person counseling so that the decision not to vaccinate is truly informed.

States can also require that parents obtain an exemption form by specifically requesting one from the state or local health department, rather than downloading it online. They can insist that these parents acknowledge that they will be responsible for keeping the children away from school during outbreaks. Moreover, they should have procedures to review each request for exemption rather than automatically approving them, as many states do now. And they should require parents with exemptions to apply annually for renewal.

States with easy procedures for obtaining exemptions have higher rates of nonmedical exemptions — and, more important, higher rates of vaccine-preventable diseases. In a 2006 study published in The Journal of the American Medical Association, for example, we documented that states with easy procedures for granting nonmedical exemptions had approximately 50 percent higher rates of whooping cough.

In a 2012 study, which my colleagues and I published in The New England Journal of Medicine, nonmedical exemption rates were 2.3 times higher in states with easy administrative policies for granting exemptions (like Connecticut, Missouri and Wisconsin) than in states with difficult policies (like Florida, Minnesota and Texas). Moreover, the annual rate of increase in nonmedical exemptions was about 60 percent higher in states with easy exemption policies compared with states with difficult policies.

These practices will cost taxpayers money. But they will be more effective, in the long run, than condemning vaccine skeptics as ignorant and irresponsible. The goal should be to make the number of parents who decide to seek exemptions — and follow through with it — as small as possible. Given the high costs of controlling disease outbreaks, including the current rise in measles, it might be reasonable to tax parents who seek exemptions to recover some of the cost.

All democratic societies must try to balance the rights and views of a variety of constituencies. Parents of children who are too ill for vaccination should of course be granted an exemption. Everyone else — no matter their belief — should face a high burden before being allowed to remove their children from the immunized herd.

 

By: Saad B. Omer, Associate Professor of Global Health, Epidemiology and Pediatrics at Emory University; Op-Ed Contributor, The New York Times, February 6, 2015

February 7, 2015 Posted by | Measles Outbreak, Public Health, Vaccinations | , , , , , , | Leave a comment

“I Am A Scientist, Man, But A Conservative One”: Vaccine Skepticism Isn’t A Conservative Problem, But It’s A Problem For Conservatives

Because New Jersey Governor Chris Christie recently quarantined a nurse in a large tent when he thought she might have had Ebola, you might have assumed that he of all people would seize upon a measles outbreak—attributable to a movement of anti-vaccine reactionaries—to lecture parents for putting children at risk. But when pressed to take a position on the view that parents should vaccinate their children, Christie hedged. “It’s more important what you think as a parent than what you think as a public official,” he said. “I also understand that parents need to have some measure of choice in things as well. So that’s the balance that the government has to decide.”

It’s tempting to attribute his sudden fondness for “balance” to lessons he over-learned during the Ebola panic he helped nurture. But it’s also mistaken.

Vaccine skeptics don’t mirror climate change deniers, who are overwhelmingly conservative and amplified by vast wealth. But the anti-vaxx movement nevertheless presents a greater political problem for Republicans than Democrats, who, like President Obama, are unafraid to make explicit declarations about the importance of vaccinating children. By and large, Republican politicians don’t tout their own ignorance of vaccine science or use it to shield themselves from substantive questions about immunology, public health, or child rearing. Vaccine skepticism and climate change denial are, again, more different as reactionary movements than they are alike.

But two facts about vaccine skeptics and the risks they pose make it difficult for Chris Christie and perhaps other Republicans to treat anti-vaxxers as brusquely as he’s happy to treat unionized teachers in Newark.

It’s not that Republicans must pretend to believe that vaccines cause autism. But a large, motivated population of vaccine skeptics begs for interventions Republicans can’t easily get behind. The two most straightforward ways to increase vaccination rates or otherwise reduce the risk of losing herd immunity are: Imposing government mandates and stigmatizing the white, affluent people who comprise the core of the anti-vaxx movement.

Hectoring white people and imposing mandates on their families doesn’t fit comfortably in the GOP wheelhouse these days, and Christie’s awkward walkback underscores the bind that places on conservatives exquisitely.

Christie’s office: “The governor believes vaccines are an important public health protection and with a disease like measles there is no question kids should be vaccinated. At the same time different states require different degrees of vaccination, which is why he was calling for balance in which ones government should mandate.”

Shorter Christie: I am a scientist, man. But a conservative one.

Conservatives and liberals are both overwhelmingly of the view that childhood vaccines carry important benefits; conservatives, however, are inherently skeptical of government interventions of any kind. Thus, Republican politicians who lean too heavily on the state action, even in the realm of something as essential to the common good as immunization, will run into problems.

A 2014 study by Dan Kahan for Yale Law School’s Cultural Cognition Project found that people with left-leaning political outlooks are likelier to support restricting non-medical exemptions for childhood vaccine requirements, likely reflecting “an ideological predisposition against government regulation independent of any ideological sensibility specific to childhood vaccination.”

This tendency might not hold if anti-vaxxers existed on the fringes of political life, or were overwhelmingly of foreign origin, or were monolithically liberal. Opposition to government intervention can be both reflexive and selective. But the available evidence suggests vaccine skeptics tend to be white, educated, affluent, and, per Kahan’s study, politically diverse.

It’s not that Republicans are in thrall to vaccine skeptics, but it can be difficult for them to confront vaccine skeptics in ways that don’t alarm conservatives for other reasons. And taken to an extreme, it becomes hard to tell the difference between the two.

 

By: Brian Beutler, The New Republic, February 2, 2014

February 6, 2015 Posted by | Chris Christie, Conservatives, Vaccinations | , , , , , , , | Leave a comment

“Parents Own The Children”: Libertarians Have A History Of Horrifying Views On Parenting

In a recent CNBC interview, Senator Rand Paul tempered some of his recent remarks about the alleged horrors of vaccination by claiming that he only opposes vaccine mandates because they infringe upon parents’ freedom. When confronted with the question of whether or not discouraging vaccination is a threat to children’s health, Paul launched into a meandering consideration of public health and liberty that concluded with the assertion that “the state doesn’t own your children, parents own the children.”

Paul’s bizarre rendering of the parent-child relationship as unilateral ownership is not the most unhinged thing a well-regarded libertarian has ever said about children. In fact, libertarians exhibit a historical inability to adequately explain how parents should relate to their children, why parents are obligated (if at all) to care for their children, and whether or not moral nations should require that parents feed, clothe, and shelter their children within a libertarian frame.

Consider Lew Rockwell, former congressional chief of staff for Rand’s father, Ron. Rockwell, who may or may not have had a hand in composing the now infamously racist and homophobic slew of newsletters sent out to Ron Paul fans between the late ’70s and early ’90s, is a professed fan of child labor. Complaining of laws that prevent, among other things, second-graders from operating forklifts, Rockwell opines that “we are still saddled with anti-work laws that stunt young people’s lives.” Like Rand Paul on vaccine mandates, Rockwell sees child labor laws as government overreach. “In a free and decent society, decisions about these matters are for parents, not bureaucrats,” Rockwell writes, referring to whether or not schoolchildren should be breadwinners. The type of society Rockwell envisions here hardly seems “decent,” but it would certainly be “free” in the way Paul imagines, and in that sense it is perfectly libertarian.

Rockwell’s mentor, Murray Rothbard, one of the twentieth century’s more famous libertarians, was similarly fond of kids in the workplace. Rothbard imagined that laws against child labor were passed in order to artificially inflate the wages of adults, who viewed children as competition capable of underbidding them. “Supposedly ‘humanitarian’ child labor laws,” Rothbard remarks in his book The Ethics of Liberty, “have systematically forcibly prevented children from entering the labor force, thereby privileging their adult competitors.” While the real impetus behind child labor laws was child welfare, it is telling that Rothbard tended to look upon kids with a suspicious eye, and his ethics bear out this cold approach. Later in The Ethics of Liberty, Rothbard, in keeping with the libertarian exaltation of personal freedom, argues that “no man can therefore have a ‘right’ to compel someone to do a positive act”—that is, because all people are free, by his account, your rights cannot impose positive actions on others. This means, Rothbard goes on, that a parent “may not murder or mutilate his child, and the law properly outlaws a parent from doing so. But the parent should have the legal right not to feed the child, i.e., to allow it to die.” He concludes that “the law, therefore, may not properly compel the parent to feed a child or to keep it alive.” To do so, for Rothbard, would be pure government overreach.

Such dark fantasies are not restricted to the weird world of libertarian academia. Williamson “Bill” Evers, formerly a libertarian candidate for congress and advisor to the McCain 2008 campaign, also argues that there should be no laws preventing a parent from, say, starving an infant to death. In an article published in the Journal of Libertarian Studies, Evers concludes, “We have considered the hypothesis that there should be an enforced legal duty of parents to support their minor children. Having found the various reasons advanced in support of this duty inadequate, we can only conclude that no such duty exists … one has to regard the notion of a legal duty of parents to support their children as without merit.” Evers allows that parents might be morally obligated to do something for their children, but also that morals should not be legally enforced. Therefore, vaccination, labor, and finally whether or not to give one’s children the necessities of life ultimately comes down, for these classic libertarian thinkers, to the free will of the parents.

Libertarianism rests on the whimsical notion that all people are isolated, entirely free agents with no claims on others except those that they can negotiate through consensual contracts. The very existence of children flatly disproves this; any moral intuition indicates that children come into the world with claims on their parents at the very least, and their entire societies considered broadly. To avoid a hellish death spiral of infectious disease and neglect, we would all do well to reject Paul and his cohort on the subject of child rearing.

 

By: Elizabeth Stoker Bruenig, The New Republic, February 4, 2015

February 6, 2015 Posted by | Libertarians, Public Health, Rand Paul | , , , , , , , , | Leave a comment

“Suffering Is The Whole Point”: This Is Going To Hurt You More Than It Hurts Me

We’re now having a national debate on the merits of corporal punishment, an issue that has many facets and brings up all kinds all kinds of complications involving religion, culture, gender, authority, and tradition. I’m not going to begin to address even a small portion of them, but I do want to talk about one thing that gets me a little perturbed about this discussion.

If you actually look at what corporal punishment advocates (and yes, there are people who do that on a semi-professional basis) say, there’s a constant effort to characterize “good” corporal punishment as something that isn’t really all that unpleasant for the child. They say it should never be done in anger (and if more than one out of 20 actual spanking incidents in the real world isn’t done in anger, I’d be shocked), but only in a controlled, limited way that is over quickly, causes no injury, produces only temporary discomfort, and carries the ultimate message, “I love you.”

As Focus on the Family founder James Dobson wrote in his book Dare to Discipline, which has sold millions of copies, a bit of “minor pain” is the way nature instructs us about things that are unwise to do. “God created this mechanism as a valuable vehicle for instruction,” he writes. Dobson also recommends using a “neutral object” of some sort, “because the hand should be seen as an object of love.” And if your child cries for more than five minutes after a spanking, you can shut that whole thing down “by offering him a little more of whatever caused the original tears.”

I will give Dobson credit for not shying away from the central philosophical underpinning of corporal punishment, which is that the infliction of pain and fear on your child is the whole point of the practice.

The assumption of corporal punishment is this: the child did something wrong, and in order to convince the child not to do it again, I will subject them to physical anguish. Thereafter, their fear of living through that anguish again will be so powerful that it will constrain their behavior. That this is the logic at work is utterly undeniable. If that wasn’t the logic, there would be no point. You can’t say the purpose of a pain-based physical punishment is to “get their attention,” because there are a hundred ways to get someone’s attention. The purpose is to hurt them and render them fearful of reliving that pain.

By that logic, Adrian Peterson’s actions only seem a tad overenthusiastic. His four-year-old son snatched a video game controller from another kid, and as a consequence got a vicious beating from a muscle-bound adult. You can bet he won’t be snatching any more game controllers from anyone! Mission accomplished.

Or maybe he will; there’s a raft of research showing that “short-term compliance” — i.e., stopping what the kid is doing right at that moment — is pretty much the only positive outcome from corporal punishment, while it’s associated with a range of negative long-term psychological and behavioral outcomes. But even if you think that it’s good for your kid (or somebody else’s), you should at least have the courage to acknowledge that making the child suffer is the whole point.

 

By: Paul Waldman, Contributing Editor, The American Prospect, September 18, 2014

September 19, 2014 Posted by | Child Abuse, Corporal Punishment | , , , , | Leave a comment

“Uzi Accident Sparks Debate About Children And Guns”: Why Would A Parent Or A State Allow A Child To Handle Automatic Weapons?

It was the kind of story that was hard to miss yesterday. A 9-year-old girl, on vacation with her family, was given an Uzi to fire at the Last Stop shooting range in White Hills, Ariz. When the child couldn’t control the submachine gun’s recoil, she accidentally killed her instructor, 39-year-old Charles Vacca.

It’s generating some overdue conversation.

In the aftermath of the tragic death of a gun-range instructor killed by a 9-year-old girl who wasn’t able to control an Uzi 9mm submachine gun, many are raising questions about whether it is safe – or even legal – for young children to handle powerful firearms.

Arizona, where the incident happened on Monday, is one of 21 states that has no laws restricting the access of guns to minors under 18, as long as there is adult supervision.

Twenty-nine states have child access prevention laws. Fourteen prohibit someone from “intentionally, knowingly, and/or recklessly providing some or all firearms to children,” according to the Law Center to Prevent Gun Violence.

The Arizona Republic’s E.J. Montini ran a compelling piece with a notable headline: “Why do we allow a child to handle an Uzi?”

The columnist wrote, “Arizona law allows a minor to possess a weapon if accompanied by a parent, guardian or an instructor. But this type of weapon? It’s time we asked ourselves: Why would a shooting range allow a kid to handle an automatic weapon? Why would a parent? And, most importantly, why would a state?”

A New York Times report added that these ranges have become popular tourist attractions. People can “fire the weapons of their dreams: automatic machine guns, sniper rifles, grenade launchers. A hamburger lunch is included; a helicopter tour of the nearby Grand Canyon is optional.”

And while the public comes to terms with the propriety of these activities, we might also want to ask a related question: who’s in charge of the NRA’s social-media operation?

Yesterday afternoon, with much of the country stunned by the images out of Arizona, an official NRA twitter feed published a link to “7 Ways Children Can Have Fun at the Shooting Range.” This isn’t a joke. In fact, I took a screen grab of the message.

NRA Women

 

It’s worth noting that the gun group eventually unpublished the tweet, but not before many wondered aloud what in the world the NRA could have been thinking.

MSNBC’s Nick Ramsey added yesterday, “ ‘Think before tweeting’ is advice everyone on social media can use, but particularly those behind the Twitter handle @NRAWomen.”

Truer words were never spoken.

 

By: Steve Benen, The Maddow Blog, August 28, 2014

August 29, 2014 Posted by | Gun Control, Gun Violence, Guns | , , , , , , , | Leave a comment

   

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