Quite a few of my blog posts – all tagged I think ‘Reclaim the State’ – have

been based around the idea of personal choice and self-ownership and the
degree to which these ideas should be pre-eminent. Some claim I know – and
not just individualist anarchists - that individual rights do indeed trump all
others. Where conflict arises between individuals this argument seems to me
to rely on the principle that defence of those rights by all means necessary is
legitimate – ultimately therefore on armed force. I’ll perhaps come back to that
another time.
Most however, me included, accept that some limitations on individual actions
are essential, while continuing to disagree on what those limitations might be
and their extent. For example, if someone has a highly contagious and
potentially fatal disease like smallpox, most would think it a very severe view
of liberty not to accept that the infected person should be isolated from society
to prevent that disease spreading. The loss of liberty for this person is surely
essential for the avoidance of a much greater evil, namely the spread of that
disease to many others and does them no lasting harm.
Even so, this is still a complex issue. While isolation is a fairly neutral term, it
still means imprisonment; moreover imprisonment for reasons beyond the
control of the infected person. While there is precedent, this must always be a
difficult decision. It raises serious questions about the balance between the
collective rights of people in society against those of individuals. In the case of
Mary Mallon – otherwise known as ‘Typhoid Mary’, she knowingly placed
others at risk, even though she had been repeatedly been told of the threat
she posed to others. She was kept in a hospital away from society for three
years until she promised not to work with food. She broke that promise and
was confined again, this time until her death. It is known that she was
responsible for the deaths of at least 3 people, possibly as many as 50.
In Mary’s case, transmission of the disease did not occur except through poor
hygiene in the handling of food. It is possible to imagine however much more
virulent diseases where an asymptomatic carrier is at large. As a thought
experiment, imagine a highly virulent, perhaps genetically engineered disease
which somehow turns 1% of those infected into symptom less carriers. These
people show no symptoms but if allowed to wander around would infect the
rest of the population and spread the disease further. Assuming some test is
available to identify them, should they be confined? Perhaps more to the point
how do we administer the tests required? Blood tests for example are invasive
and in themselves require consent. Is it legitimate therefore to require
everyone to submit to a blood test in order to identify the 1% who are
carriers?
What happens if the percentage is not 1% but 10%, 20%, 30% or 40%? Is
there a threshold point at which the risk to society at large, perhaps to
humanity itself makes such an intrusion acceptable? What happens if these
people choose not to be tested or confined? Can the state use deadly force to
protect others? Some of the implications of this are dealt with in a science
fiction context in Greg Bear’s book ‘Darwin’s Radio’, or in the films ‘28 Days
Later’ and ‘28 Weeks Later’ but the potential threat posed by Bird Flu reminds
us that there are real dangers.
Immunisation takes us into even more difficult territory. Unlike confinement,
immunisation depends on an ‘invasion’ of the person. It also depends on ‘herd
immunity' to be fully effective. In other words when the proportion of
vaccinated people in a population exceeds a given percentage, the spread of
the disease is effectively stopped - to the benefit of the unvaccinated as much
as the vaccinated. This percentage depends on the disease and the vaccine,
but 90% is not uncommon. Failure to take up immunisation thus places at risk
not just that individual, but also every other un-immunised person – including
people who may be allergic, too young or too old.
The classic recent example of this was the debate over MMR, where because
of fears about a relationship between the vaccination and autism, vaccination
levels in some areas of the country have fallen well below the herd immunity
level, with consequent increase in infection rates.
Even with high vaccination levels those affected by measles are not evenly
distributed.
Where vaccination is widely practiced, as in the United States since
1962, measles has continued to occur in poorly immunized subgroups
that are characterized by low educational level and economic status,
very young age, or religious beliefs forbidding acceptance of vaccine.
Ultimate success of a systematic immunization program requires
knowledge of distribution of susceptibles by age and subgroup and
maximal effort to reduce the concentration of susceptibles throughout
the community rather than aiming to reach any specific proportion of
the overall population.
The vulnerable sub-groups described above presumably do not choose to be
vulnerable and the low take up of MMR vaccine in these groups is not in
general related to concerns about side effects. By contrast parents who do
choose not to immunise their children are doing so because of specific fears
about the MMR vaccine. In doing so they are effectively deciding that the risk
of adverse effects to their child from the combined injection outweighs the risk
of contracting Measles, Mumps or Rubella including the increase in that risk
as a result of the decline in herd immunity.
If these fears are unfounded, as is almost certainly the case, then these
calculations are erroneous and are increasing the general risk of infection for
all children. Setting those particular concerns aside for the moment however,
it must be recognised that there will still be some cases of an adverse
reaction. In those circumstances would it be legitimate to make vaccination
compulsory?
It seems to me that for low levels of adverse reaction the case can be made
but it is by no means clear-cut. The number of children aged 10 and under in
the UK in 2001 was slightly over 8m. Assuming for the moment an adverse
reaction rate of 1 in 100,000 children, this would mean 80 children would
suffer across the country as a result of the MMR injection if every one of the
8m were given the vaccine. An outbreak of measles triggered by the
vaccination rate falling below the herd immunity level would almost certainly
lead to many more than that suffering serious illness including blindness.
While I don’t think the science of herd immunity is disputed, I suspect that
parents withholding their children from MMR are underestimating the risk of
contracting the diseases against which it protects, are probably not factoring
in at all the increased risk due to loss of herd immunity, and are almost
certainly overestimating the risk of adverse reaction to the vaccine. It is easy
to say they are acting irrationally, but the essence of this sort of decision is not
just about risk, but also about where that risk falls. If they overestimate the
risk of an adverse reaction it is a risk nevertheless that affects their child,
while the risk of contracting the disease is a risk spread across all children.
The choice of perspective on the decision affects the decision itself.
I’m not sure where this leaves my original questions. We appear to have a
situation where individuals acting as rationally as possible in situations of
imperfect knowledge nevertheless produce outcomes that are not optimal for
them or for society as a whole. Is this of itself enough justification for
compulsion?