How would vaccine choice work?

Chris Christie (R), governor of New Jersey and likely presidential aspirant, recently announced that parents should have choice over obtaining vaccinations. Though he has since stated this choice should not be applied to the measles vaccine, Sen. Rand Paul (R-Ky.), another presidential aspirant, has taken up the call for vaccine choice. Such statements raise an important question: Is it possible to have true vaccine choice without endangering the most vulnerable members of the population, so that everyone’s rights are protected? This is no idle question, given recent outbreaks of the potentially deadly measles virus.

A comparison with the evolution of public smoking laws provides an avenue to see how vaccine choice might work. It used to be the case that one could smoke anywhere. Then it gradually became apparent to the public that smoking had negative health effects, not only for the smoker, but also for some of the people in the vicinity of the smoker. At first, this led to a patchwork of public and private rules banning smoking in tightly enclosed areas such as airplanes and restaurants and workplaces. Over time these rules were extended to places in which smoke could more indirectly impinge on others, such as dorm rooms and hotel rooms and doorways.

{mosads}This kind of rule-making tends to infuriate the libertarian-leaning, but it shouldn’t; it is entirely consistent with accommodating free-market forces. Let’s assume we all had personal property rights over the air in our immediate vicinities. That’s just economics-speak for the statement that we all have a right to do what we want with the air immediately around us, including filling it with smoke or keeping it smoke-free. The problem is that air moves. This makes it likely that your smoky air will come over and get into my non-smoky air if we stand too close together, and not in a fun “you got your chocolate in my peanut butter” sort of way.

One way to avoid having this happen is to separate us physically. If we collectively agree to stay apart while you are smoking, then we can each enforce rights over (that is, do what we want with) our own air. Yes, you don’t get to smoke exactly where you want, but there was no universally agreed-upon right to do that enshrined anywhere, anyway. Separation ensures that we each have more important local rights over our own choices.

Vaccine choice is closely analogous to this, and might be enacted similarly. The pro-vaccine crowd — the overwhelming majority of the country — wants neither themselves nor their children to be exposed to preventable diseases such as measles. Vaccines are a proven way to accomplish this for many diseases, including measles. Members of the anti-vaccine crowd worry about the perceived risks of vaccines, and to avoid them, they are willing for their children to be exposed to diseases such as measles. Politicians such as Christie argue that people should have the right to make this choice.

As with smoking, you have two groups who both want their own personal rights — in this case, over their own and their own children’s bodies. Also as with smoking, these two personal rights come into conflict in close proximity. If unvaccinated Bob comes into close contact with Mary or her children, then exposure to a preventable disease may violate Mary’s personal rights. If she or her children were too young or too ill to vaccinate (or the vaccine had a failure, rare for the measles), this violation could be deadly.

One way out, once more as with smoking, is physical separation. If Bob (and his children) and Mary (and her children) stay very far apart, the risks of transmission are comparatively low. Bob can choose not to vaccinate himself and his children, while at the same time securing Mary’s right for her and her children not to be exposed to preventable diseases.

Extended to populations, this means that those who choose not to vaccinate could be allowed to do so, as long as they never came into contact with those who chose, or would choose if not for health issues, to vaccinate. Children would be so restricted as well until they hit 18 and could choose for themselves to vaccinate or not. Everyone would keep local rights over his or her own choice to vaccinate or not, at the cost of reduced freedom of movement. We’d just need vaccinated and non-vaccinated doctors’ offices and hospitals and schools and restaurants and airplanes and workplaces and …

Effectively, we’d need entirely separate nations to allow vaccine choice while protecting everyone’s personal rights. This is, of course, untenable. Vaccine choice cannot work.

Siegel is an associate professor of political science at Duke University.