My mom came for a visit last week.  She brought in hand a pamphlet from UCLA Medical Center stating that a Federal Court had concluded, there is no evidence that vaccines cause autism.  The pamphlet states, it is proven that vaccines are safe.

The pamphlet angered me in how disingenuous it was.  It is true that there is not any overwhelming evidence to support the idea that the MMR vaccine causes autism.  But there is also no evidence to support the conclusion that the current vaccine schedule is safe.  Indeed, it is very difficult to know what the risks are.

This month Mothering magazine has a well written article addressing the issues of vaccine rejecters and public health.  It asks how much of a health risk non-vaccinated children create for their well conforming vaccinated playmates.

First, a disclosure.  Tara and I are not vaccinating exactly according to CDC recommendations, and on a modified schedule.  There are vaccines like Hep-B that seem inappropriate and protect against diseases that represent no risk to Theory.  And we are spreading out shots to reduce aluminum spikes.  We, like everyone, are trying to make informed decision with imperfect information.

OK.  Back to the article.  It raises a fundamental question.  As a parent, who’s interest are you primarily responsible for?  Those of your child, or the public’s health?  If you believe your child’s interests and health comes first, it creates a “prisoner’s dilemma.”  In game-theory terms, each parent is better off defecting from the common good of vaccination and free-riding on the benefits of a vaccinated population.  If the population is vaccinated, it reduces the number of hosts for a disease and reduces the possibility of contracting the illness.

Now each person pursuing their common self-interest would over time reduce the proportion of the population that was vaccinated, thus increasing the risk of contracting a disease.  Eventually the population would come to a Nash equilibrium point, where the benefits of vaccinating were the same as the benefits of not vaccinating.

This is why people describe vaccinations as a “moral obligation”.  This is quite accurate as morals are a means for establishing cooperation through what is called “moralistic retribution.”  Defectors must be punished if cooperation is to be maintained.

This is partly why it is the educated, more advantaged portion of the population that frequently refuses vaccinations, setting aside the folks who do it for religious ideological reasons.

Now, cooperation should not be of concern for the vaccinated population if indeed the vaccines were truly effective.  They would be immune from any risk.  So why does it anger them so?  Perhaps it is because they feel that they have absorbed a cost to themselves for the public good.  But if vaccines were so effective this would not be the case.  Maybe it is a rejection of their world view that is so threatening - that maybe they have done something horribly detrimental to their children.  Your guess is as good as mine.

What is odd, is that many states force families to make an all or none choice with vaccines.  Either you claim a religious exemption based on the belief that vaccines are an affront to God, or you do the entire schedule.  This policy is based on the notion that, unless you ascribe to religious beliefs that are non-rational,  the association of physicians is in the best position to make health choices for your child.  It assumes that context is unimportant and that public health always over-rides the individual’s interests.

At the same time, States choose individual rights over public health when cigarettes are concerned. Gee.  I wonder why.    According to the California EPA, second-hand smoke causes more than 50,000 deaths a year*.   And some 430 SIDS cases are attributed a year to second-hand smoke. So, the chances of your child dying from second-hand smoke are many times higher than of dying from measles, mumps, rubella, chickenpox, etc., combined.

So the logic escapes me.  How many parents who argue that unvaccinated kids are a threat, also smoke, or would support smoker’s rights?  Which is a greater threat to the health of their own children?

The bottom line, is that for most people, to vaccinate or not to vaccinate is indeed, a philosophical choice.  If one is rational, the question is: which vaccine to use and when?

*      California Environmental Protection Agency. Identification of Environmental Tobacco Smoke as a Toxic Air Contaminant. Executive Summary. June 2005.