Eudoxa

To extend my reasoning about the distrust of vaccines: The original fears about vaccination were partially about safety, but also included ethical opposition on the ground that the process was inherently immoral, mixed species and changed the structure of creation. In many ways they mirror current fears of xenotransplantation, where the safety concerns are fuelled by deeper, less often expressed "philosophical unease" (or gut reactions) about the implications.

This is a common pattern in the slow transformation of biotechnology from perversion to practice. We see it in the current debate about biotechnology, where the discussions abour safety, equity and ethics in the narrow sense are fuelled by a deeper and broader conflict about differing views of nature, humanity and what they should become.

Later opposition was more about the rights of an individual to choose to be vaccinated or not to, with a debate concerning the ethics of public health. Here the debate seems to have ended in a fairly broad consensus that the collective benefits of vaccination outweigh the individual's right to bodily self-determination. Here most collectivist, utilitarian or duty-based moral systems were in agreement. But even from a liberal point of view it is not trivial to determine whether the expected harm to others due to not vaccinating oneself outweighs the small risks/costs/compulsion to oneself due to vaccination.

Being myself of the opinion that an act of omission of help to others is not necessarily immoral and that the right to one's body ranks very high in the hierarchy of rights, I think it would not be immoral to abstain from vaccination. After all, we do not forcibly confine people carrying colds to stay at home, despite the fact that they do infect others and the infections contribute to overall mortality. It might still be morally commendable and the rational thing to do out of self-interest. It is also potentially something that could be seen as part of a social contract: just as we relinquish certain rights to a government even in the minarchist case (i.e. the legal use of violence) in order to gain a useful social order, we could have a disease control clause in the social contract. But this presupposes (morally) explicit contracts that can be chosen or not, not the current coercive form.

Leaving people to decide whether to vaccinate can clearly lead to under- or un-vaccination. This can occur even in the completely rational and fully informed case; see Chris T. Bauch, Alison P. Galvani & David J. D. Earn, Group interest versus self-interest in smallpox vaccination policy, PNAS, September 2, 2003, 100(18), 10564-10567 for a game-theoretic analysis of voluntary vaccination that reaches the conclusion that it would not reach the optimal level.

But I find the trend of ignoring vaccinations due to vaccine scepticism more worrying. Rational non-vaccination can be handled through rational discussion, the construction of suitable institutions or incentives (what about insurance companies? One could find the cost of the non-vaccination risk and use them to have defectors pay for it, while using insurance to compensate for the vaccine risks). Lack of information and misunderstandings can be handled through education. But resistance due to risk complacency brought about by a safe environment, risk aversiveness towards mediagenic risks, selective information gathering and powered by traces of an anti-technological, romantic perspective cannot be handled this way.

It would be a tragedy if the only way to reverse the trend would be a widely publicized epidemic killing children. But it would likely work; for once a scare story could be based on something real. I think the only way of really getting anywhere with this is to re-establish a sense of "scientific belonging": to get people to really know how the vaccines works, their real pro's and con's, how their efficacy and safety are tested, how the current controversies are handled and especially show how we belong in the scientific universe.

Helping establish at least some scientific literacy is a good start to get people engaged in making actual risk assessments (e.g. "even if the sceptics are right and MMW vaccine increases the risk of autism, is that risk increase worse than the risk increase to my child and others of measles, mumps and rubella?").

The answers seems to be:

1) we need to create flexible, free institutions that help us sustain the benefits of our civilisation without dangerous or immoral concentrations of power

2) we need to become more aware of how the world around us works.