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March 29 2018

Don't mandate, but nudge parents hard to vaccinate their kids

via The Sacramento Bee
by Julie Gunlock

Deciding whether to vaccinate your child shouldn't be a tough decision.

The evidence that vaccines are safe is overwhelming. Yet, unfounded fears persist, leading many parents to forgo vaccines.

This raises an important public health question: Should vaccinating your child be mandatory? If so, how would the government enforce this mandate?

While many parents claim not to be anti-vaccine, they still employ a precautionary, or "better safe than sorry," policy toward vaccines – saying they'd rather not inoculate their children for fear that some of the rumors, no matter how many times they have been debunked, are true.

That lays bare the irony: It is often the parents who are the most concerned – one could even say obsessed – with their child's health and well-being that make the risky decision to render their child defenseless against diseases that cripple, maim and even kill.

There's a cost to this way of thinking.

In 2014, the CDC reported 667 cases of measles in 27 states – a record since 2000. Much of this is due to the reductions in vaccinations. According to a 2014 study in the American Journal of Public Health, between 2009 and 2013, nonmedical exemptions, personal objections or religious exemptions for school immunizations increased by 19 percent.

To stop this harmful trend, some in the medical and child welfare arena think vaccines should be mandatory. It's an understandable position to take considering those who fail to vaccinate not only endanger their own lives but the lives of their friends and neighbors too.

Yet, despite the clear moral imperative to vaccinate, many also believe that parents should be the ultimate arbiter of their children's medical care and feel uncomfortable with the idea of forcing a particular medical treatment on another person's child.

Enforcement is also an issue. Will children be taken away from their anti-vaccine parents? Will these children be placed in foster care, vaccinated and then returned? Will their parents face a large fine or even face jail for noncompliance?

If ultimately we're worried about the children, are these pro-child solutions?

A better strategy might be to deny anti-vaccine parents certain government services, like access to public schools. To do this, public schools might consider dropping the "personal objection" justification, which is an amorphous rule that makes all other school guidelines about the need to vaccinate meaningless.

Schools might also consider doing away with religious exemptions, which are too often abused by nonreligious, anti-vaccine parents looking to skirt the rules.

It's comforting to know that all major religions endorse vaccinations and encourage their members to vaccinate. Even Christian Scientists, who rely mainly – though not exclusively – on prayer for healing, have a nuanced position on the matter.

Instead of advising against vaccines, leaders advise their parishioners, if they vaccinate, to pray that no harm comes from the inoculation.

Federal and state governments might also consider attaching proof of vaccination to certain welfare programs. Most food assistance programs come with government guidance on how to stay healthy, which is why these programs shouldn't support unhealthy decisions like failing to vaccinate children.

And since these welfare programs often come with certain expectations of the recipients, all government welfare programs could be tied to proof of inoculation.

Agreeing to protect yourself and the greater community from dangerous diseases seems a fair tradeoff to receive government services.

In the 2008 book "Nudge: Improving Decisions About Health, Wealth, and Happiness," Richard Thaler and Cass Sunstein wrote about influencing behavior through choice architecture.

In other words, making life hard for those who make bad decisions. When it comes to encouraging people to give their children life-saving vaccinations, nudging people to make these good decisions will work better than punishing them for not.

Independent Women's Forum is an educational 501(c)(3) dedicated to developing and advancing policies that aren’t just well intended, but actually enhance people’s freedom, choices, and opportunities. IWF is the sister organization of the Independent Women’s Voice.​
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