Vaccines and other collective action problems

February 5, 2015

It’s pretty clear that vaccination views don’t break down on partisan lines. Elizabeth Stoker Breunig is no doubt right that good old American individualism motivates many people’s refusal to take major risks to other people as seriously as minor risks to themselves. But not all of them. (It’s hard to generalize about anti-vaxxers.) And individualism itself of course exists across much of the political spectrum.

Nor is support for specifically mandatory vaccines found mostly just among us liberals, with our comparative comfort with statism. And some of the best things I’ve read on this have been by right-leaning commentators.

One is Ross Douthat, who among other things raises this important fact: vaccine refusal isn’t actually on the rise. It’s geographical clusters of unvaccinated people, not the overall number, that are causing a problem. The issue is not so much fierce individualist types—herd immunity can absorb a few lone wolves, after all—but places where anti-vax sentiment has worn the herd down.

A subsidiarity-minded conservative like Douthat might then conclude that community-level problems have community-level solutions. Unvaccinated kids are a risk first and foremost to their own neighbors, not some faraway other. So getting vaccinated represents a social solidarity that is local and concrete—a solidarity the feds can’t mandate and shouldn’t try to.

On the other hand, some community-level problems may be uniquely resistant to community-level solutions; that’s how social pressure works. So the issue of tightly knit clusters of dangerous germ factories might be precisely an argument for top-down coercion, for tighter federal mandates.

Douthat allows that coercion may be the answer, but he’s not convinced. I am. Still, I appreciate his thinking and priorities here: it’s important that the vast majority of people in a given place be vaccinated. So let’s think seriously about the best way to do that.

Then there’s this by Megan McArdle. A libertarian, her focus is rights: specifically, the right of people to enter a public space without being infected with dangerous, preventable diseases. It’s a right she says trumps other people’s right to refuse vaccines, even if the latter right also exists—outside public spaces.

McArdle raises a favorite topic of mine: collective action problems, when doing something only benefits you if everyone else does it, too. Government intervention, she says, is an answer here: require vaccination so that no one can ride free on the herd of immunity.

In short, both Douthat and McArdle take government coercion seriously as a viable means to a desirable end, even if they’re not ideologically inclined toward coercion. Now, these are heterodox conservative thinkers, hardly spokespeople for the GOP faithful. Still, it seems like their arguments on vaccination make sense to much of the right.

I just wish more people applied such thinking to other collective action problems, too. Because vaccines aside, Breunig’s not wrong about the outsized role individualism plays in American politics. 

McArdle highlights the example of people who hypocritically support public schools but only for other people’s kids. What she doesn’t say but I will: if everyone had to go to public school, over time it would benefit the entire community, not just the kids who had no choice but to go there anyway.

Or take paid sick days, which benefit workers, public health, and even businesses—as long as there’s a level playing field. Offering them voluntarily can create a competitive disadvantage unless and until everyone else does it, too. Enter the feds—if only supporters had the votes.

More generally, social spending is (in part) a question of collective action, too. For instance, imagine if we began by agreeing that

  • people shouldn’t be hungry,
  • a community without hunger is a better community for everyone who lives there, and
  • relying on voluntary giving puts too much pressure on the most generous few.

Then taxes to pay for food stamps become a question of simply sharing the burden for a mutual goal. Needless to say, this is not the sort of conversation about social spending we have in this country.

The most obvious objection here is that most social ills are not contagious in the immediate, literal way measles is. Yet that doesn’t mean they don’t affect other people throughout the community. They do—and so does an individual’s choice to do their part to solve the problem. Whatever else they are, top-down social programs are an answer to a collective action problem.

But in this country, we can’t even agree about the problem itself, much less the solution, except when it’s a highly contagious virus that might infect our kids. If only we saw social solidarity as less of an ideology and more of a general fact: like it or not, we are in this together. Then we might recognize that a community thrives on the well-being of all its members.



What we lack is memory of what childhood diseases can do to kids. I graduated from medical school in 1970 then spent 37 years in pediatrics and pediatric neurology. I have seen polio, pertussis encephalopathy, and a variety of neurologic complication of measles, the worse being a rare but devastating disease called subacute sclerosing pan encephalitis (SSPE) which ends in death.

Many of the worse childhood neurologic diseases emerge over the first and second years of life. They may not at first be recognized for what they are. We give our vaccines during that same period. When parents and some doctors see the time association between the two, they erroneously see the relationship as causal. The risks of vaccination to children is minimal if any.

If parents don't want to vaccinate and the state has no mandate (we should mandate), they would be wise to keep their kids home. They would be helping themselves and the population that cannot be vaccinated due to other medical conditions.

Finally, let us turn off the politicians (Dr. Rand Paul, for example) who pass along anectdotal information as though it was science.

Bill Holmes M.D., M.Div.
Louisville, KY