The outbreak of measles has many concerned about the resurgence of a deadly disease. But what if it is actually the symptom of something much larger?
A January outbreak that originated in Disneyland and has spread to over a dozen states has brought the vaccine debate back to the national spotlight. Many people are pushing against parents who refuse to vaccinate their children. Physicians, parents and public officials point out the benefits of “herd immunity”—that a vaccine not only protects the child who is vaccinated, but safeguards those who are not vaccinated by slowing the disease’s spread. Herd immunity is particularly important for infants too young to be vaccinated and children who are immunocompromised, such as those battling cancer. Parents who refuse vaccination are accused of putting other people’s children at unnecessary risk for deadly diseases.
Parents who oppose vaccines push back, claiming that it is their right as parents to decide whether to vaccinate their children. Some state a desire for a “toxin free” life for their children. Others believe big pharmaceutical companies push vaccine benefits in order to make a profit. And many, shockingly, continue to believe a widely discredited link between vaccines and autism.
Rahm Emanuel, current mayor of Chicago, famously said, “Never let a serious crisis go to waste.” Many public health officials believe that the most recent measles outbreak is just such a crisis and see it as their opportunity to increase low vaccination rates in certain parts of the country. The Centers for Disease Control and Prevention have said that they are “very concerned” about a widespread measles outbreak and are once again pushing vaccination campaigns. White House Press Secretary Josh Earnest said, “People should evaluate this for themselves with a bias toward good science and toward the advice of our public health professionals.” With all due respect to my public health colleagues and public officials, I think they are missing the point.
I am unequivocally on the side of vaccination. Yet I believe that this crisis cannot not be easily characterized as the fault of the parents who refuse to vaccinate. Some of the blame must also rest on the scientific community that has too often refused to acknowledge that our values and morals play a sometimes decisive role in our decision-making. We cannot know if these parents are violating a social expectation until we have an honest conversation about what our social expectations are.
We will never get to the heart of this issue if we keep pretending that it is a crisis of simply not understanding. It is a crisis of not discussing what we mean by the common good. A crisis of not having an honest debate about balancing rights and responsibilities. A crisis of not talking about what we owe to our neighbors.
Imagine that, instead of getting vaccinated on national television, politicians actually engaged us in a conversation about the role of the common good. We could then talk about the true social consequences of an extreme libertarian philosophy. And we could entertain the notion that our individual opinions cannot, in fact, be absolutized. This moment is too serious to waste it on the tired vaccine-autism debate. Let’s talk about something that matters.
Personal 'Belief' Exemptions
Try as they might, encouraging “a bias toward good science” won’t solve the debate over vaccines. Over a decade ago, a prestigious medical journal and a Playboy Playmate of the Year made strange bedfellows in laying the foundation for the anti-vaccine movement. The article in The Lancet has been retracted, and Jenny McCarthy is contradicted by piles of data; yet hopes that science will ultimately win the day do not seem to be coming true. Experts must be exhausted from constantly reiterating that the link between vaccines and autism has been discredited. The physician who published the 1998 Lancet article has been barred from practicing medicine. There is not much more the public health community or public officials can do to marshal scientific evidence in defense of vaccines. So what is next?
I hate to say it, but in some ways leaders in the science community have contributed to the problem. Since the scientific revolution, it has made concerted efforts to discredit other domains of knowledge and convince us that science is the one true font from which to draw. In truth, science has reason to present itself as the most powerful explanatory model for our lives. Many parts of the world were once explained by magic and mystery. These mysteries are now very well understood thanks to generations of scientists and their sacrifices. But some scientific leaders pushed a belief in the scientific method with a slash-and-burn strategy designed to discredit other ways of knowing. And now it is forced to dwell in the world it created. So when scientific arguments do not seem to work, what is left? In practice the solution of my colleagues is to keep throwing more science at the problem or to dismiss those who dare challenge it as foolish.
At least for this crisis, the scientific community must seek help from an area it discarded as irrelevant long ago. The solution for the low vaccination rates, and many other crises, is admitting that values and beliefs shape people’s lives in major ways. They are domains of knowledge—although not empirically testable like gravity and germ theory—that must be debated as openly and clearly as we debate scientific theory.
Many of the parents who refuse to vaccinate their children take advantage of “personal belief exemption” laws that allow them to send their unvaccinated children to school. In Colorado, the state with the lowest vaccination rate, nearly 20 percent of children are not fully immunized. An early childhood center in Santa Monica, Calif., is reported to have a personal belief exemption rate of over 65 percent. This means that there are some communities in the United States that have lower vaccination levels than countries suffering from civil war and famine.
These personal belief exemptions are different than religious exemptions, although the worlds are often difficult to distinguish. What we do know is that there is something motivating parents to refuse vaccinations even when their physicians give them clear evidence of the their importance. Talking about more science isn’t working. So why aren’t we talking about the personal beliefs or values that these parents are invoking? And if we think the social expectations are settled and that these parents are violating them, then shouldn’t state laws make exemption more difficult?
Worthy Debates
If the scientific community could admit that values and morals are worthy of debate alongside science, it might find more allies than it expects.
There is scientific consensus on climate change. Yet there is little action. So what can another report from the Intergovernmental Panel on Climate Change actually do? But Pope Francis and his long-awaited encyclical on the environment may move hearts as well as minds. I do not expect climatologists to invoke “our moral responsibility for creation,” but they would be wise to recognize that at this point our faith leaders may be able to change more minds than they can.
Those who favor gun control continue to marshal more scientific evidence to support their positions. But, again, these public health experts and social scientists fail to recognize their opponents will not be swayed by more science. Opponents of gun control evoke values to support their position. Therefore, gun control advocates might be better served by debating which position best fosters a culture of life. Or they might engage in a debate on what we mean by liberty—whether it is liberty from government or liberty for human flourishing. But that will require admitting morals and values can stand alongside science in the public square.
I am not claiming that if we just talked about values we would all suddenly find we agree with each other. We will disagree on fundamental notions of how we want to construct society. But at least we won’t be talking past each other.
The Republican presidential contenders have faced an interesting dilemma during this most recent measles outbreak. Many of them are trying to thread the needle of recognizing the good vaccines do for society while evoking the political dog whistle of “freedom.” The reason it has been so difficult for them is because they are trying to hold mutually exclusive positions. You can either give parents unrestricted freedom to vaccinate or not, or you can use the government’s coercive power to limit exemptions so that the community reaches herd immunity. But this contradiction in positions will only be exposed if we include values alongside science in our public discourse.
A recent Pew Research survey revealed some noteworthy divisions in this debate. The expected division was based on political philosophy—a slight partisan divide with Republicans less likely than Democrats to believe that parents should be required to vaccinate their children. The unexpected one was based on an age—younger adults are less likely to believe that parents should be required to vaccinate their children. Only 59 percent of adults age 18 to 29 said parents should be required to vaccinate, compared to 79 percent of adults age 65 and older. This may be attributable to the fact that older adults actually lived through the ravages of many infectious diseases, which younger adults have never seen. But what if it is because younger adults are less likely to claim responsibility for the "other"? Then it is not a matter of science better explaining how deadly these diseases are, but a matter of the values that underpin our society.
We are faced with several crises that will not be simply resolved by appealing again to science. As a Jesuit priest working in the field of public health, both of my worlds are interested in the human person fully alive. It took the church far too long to admit that science had many important things to say about the workings of our world. The church was wrong. I hope science is a quicker study in admitting its mistake. We will ultimately stop this measles outbreak, but we should not be fooled into thinking that doing so solves the crisis. The real crisis runs much deeper and it is far too serious to let go to waste.
Update, Feb. 6, 2014: Here are a few online resources recommended by the author for Catholics wondering about the specific moral question regarding vaccines:
