Freedom, Citizenship and the Fear of Domination


This is a photo from 1978, but I live with the ghost of pre-immunization all around me here in Vietnam.

I can pinpoint the moment in my life when I began to have a deep understanding of the concept of citizenship. Oddly enough, it came while sitting stark naked in a huge, domed Turkish bath in Istanbul.  The public baths in that part of the world were introduced by the Ancient Greeks who noticed that outbreaks of disease dropped when populations had easy access to bathing facilities. Building public baths became an act of civic responsibility. Using them regularly was seen an act of good citizenship – a personal act that lead to a healthier community.

Before anything else, I’d like to identify my position: born in Canada, I have lived under the authoritarian, right-wing dictatorship of Franco in Spain in the 60s and 70s, in liberal democracies, and, for the past 16 years, in the ‘Socialist Republic of Vietnam’. I’ve experienced differing levels of government intervention in the lives of the people with whom I’ve lived. It would be fair to say my politics lean to the left, but I hold some radically un-socialist views on subjects such as censorship.

The recent outbreak of measles in the US, stemming from the Disneyland outbreak, has brought the discussion of vaccination to the fore once again. I’ve had a number of interesting discussions on twitter about it. Given the surplus of research data that correlates levels of immunization to drops in childhood mortality rates, charted since the introduction of vaccines such as  polio, pertussis, yellow fever, tetanus, MMR, etc., I’ve been surprised at how little this type of information matters to people who have already decided not to immunize their children. They will opt for anecdotal stories over robust, well-supported research every time. Inevitably, the conversation always devolves to personal anecdotes, and specifically to their choice as an individual, never do they base their argument on peer-reviewed well-grounded scientific data. And not once could I get them to  address the impact on the welfare of the community as a whole.

Over and over, discussions with Americans on the pros and cons of immunization seemed to devolve into: I won’t let the government tell me what to do. I have the freedom to decide what is best for my child. And indeed they do have that right under the law and, as far as I know, there is no credible evidence that the UK or US governments are proposing to force people to vaccinate their children. There are, however, some schools that have asked the parents of non-vaccinated children to keep their kids at home during an measles outbreak. There is a hair-trigger propensity to extrapolate this to the emergence of a vaccination police state. I’m interested in why people have conflated a preponderance of historic quantitative data – from diverse, global sources, with governmental overreach.

Disease Prevalence and Immunization, from the UC Atlas of Global Inequality

Disease Prevalence and Immunization, from the UC Atlas of Global Inequality

Vietnam has a 98% vaccination rate as of this year and immunization is mandatory for attendance at public schools – from pre-school creches to university.  The government has decided that the benefits of immunization outweigh the loss of personal freedom. It was a similar case when mandatory helmet laws were imposed. In both cases, these edicts had two effects: it made getting immunized free and purchasing a helmet very cheap – basically leveling the economic barrier to adherence. It has also saved hundreds of thousands of lives, as well as lowering the number of people living with long-term medical problems stemming from infection and head injuries.  However, It would be a mistake to believe that ‘socialist’ countries have ultimate control over their populations –  they don’t. Many government mandates don’t receive the same kind of approbation. In Vietnam, individual ambivalence takes the form of quiet, casual non-adherence, so unpopular edicts don’t survive long. They die an implicit, quiet death. But what is clear is that, on the whole, people do concern themselves with what is beneficial to the community as a whole, not just their own individual interests. Culturally, people here have a sense that living in a healthy community requires some sacrifice of personal freedom. This is the case in many Asian cultures.

It would be easy to argue then that this rise in the stance against vaccination in the US and the UK are simply symptoms of cultures who value individual freedom more greatly. But this doesn’t explain why the US went from having a measles immunization rate of 98% in 1983 to its present rate of 91% today. Understandably, after the widespread media coverage of a Lancet article on a possible correlation between autism and the MMR vaccine in 1998, vaccination levels dropped. But although the paper was retracted by the Lancet and an an enormous number of subsequent studies proved the paper was based on very poor, verging on fraudulent research, the number of people who declined to vaccinate their children kept growing in the US and UK. After the ‘thimerosal – vaccines contain mercury’ uproar, when it was revealed that the form of mercury in vaccines was not the kind that caused damage or build-up in tissue, similarly, there was no upsurge in vaccination. In both these cases, poor science unsupported by the vast majority of evidence in the field precipitated a deep and enduring mistrust of vaccines in a small percentage of people. The media – in its bid to engender controversy with which to sell airtime and newspapers – has played a pivotal role in downplaying positive data on the effectiveness and relative safety of vaccines, while granting a great deal of airtime and column space to discredited evidence of danger.

But curiously, what I encounter most of all when I talk to people who refuse to vaccinate their children or themselves is a underlying belief that the government wants to inject them with something that will be harmful, and is on the verge of doing so by force.  When I ask them why and how would it benefit their government to do that, they respond that ‘Big Pharma’ is running their government and enriching itself and doesn’t care if it hurts people.

But this directly contradicts the fact that big pharmaceutical companies are abandoning the development and manufacture of vaccines in droves. The economic reality is that it is much more in ‘Big Pharma’s’ interest to not vaccinate people. They make far more money selling people drugs to treat ongoing illness. In fact, they’d earn much more from people who have to live with the long-term consequences of polio, measles, mumps, rubella, whooping cough, etc., than they’d make from selling them an occasional vaccination.

Meanwhile, it seems that opposition to vaccination is not about a lack of information. Recent cognitive studies on parents who were ambivalent about immunizing their kids found that exposure to greater levels of information on the effectiveness of vaccines only made them less likely to get their children immunized. Many opponents say they do not trust the mountains of research. They say that for-profit medicine cannot be trusted to provide unbiased data. But when I asked them why research coming from countries with universal socialized (not for profit) medical systems comes out with the same positive research data, they dismiss it. Research data form non-American sources is also untrustworthy because it’s not American. There is an eerie sense that not only is no evidence trustworthy, but they don’t want any evidence to be trustworthy. There is a sense of righteousness in rejecting all evidence, whether it comes from countries with for-profit medical systems or not. Underlying it, I suspect a strenuous rejection for the authority of science, period. Ironically, these same people seem perfectly happy to trust the opinions of the for-profit doctors who belong to the anti-vaccination camp and make a profitable living from taking this stance.

Nor did an explanation of how ‘herd immunity‘ functions have any effect. In fact, quite the opposite. Many immunization skeptics had no ethical problem with leaving their own children unvaccinated while relying on herd immunity to keep their kids safe. They were happy to let other parents take what they consider to be ‘unacceptable immunization risks’ so they don’t have to.

I don’t think the growing number of parents who refuse to immunize their kids is a simple matter of differences between cultures. For many, many years, in both the US and the UK, the majority of people felt that some civic activities were important to maintaining a livable society and that sharing a responsibility to maintain a healthy country was not a negation of individual rights. Something has changed.

One of the greatest changes, I feel, has come in the form of the valorization of influential and economically successful individuals who view their own self-interest as paramount. Since the 1990s, it has become morally acceptable – even admirable – to act in self-serving ways, regardless of the harm it does to others. It began as a form of economic Darwinism, the drama of a dog-eat-dog environment in finance, but it is an ethos that has spread to many other aspects of our society. It is not hard to see the progression from “I’m going to make money any way I like and screw the social consequences” to “I’m not going to vaccinate my kids and to hell with how that affects everyone else’s children.”

The second change has been the legal empowerment of corporate entities. Legally, it affords corporations the rights of individuals without exposure to the biological, social, economic or emotional consequences of bad personal choices. Sure corporations can be sued, but for a company the economic impact of losing a suit is no where near as dire as it is if you are an individual. Mistreating employees doesn’t have the dire consequences of beating your wife or your children. Corporate behavior that is hazardous to health doesn’t incur the visceral risks of personally suffering illnesses for the individual. Corporate risk-taking doesn’t compare with personal risk-taking. The establishment of corporate entities as ‘persons’ has, I feel, made individuals feel like there is no level, legal playing field. It contributes to making individuals feel powerless, because, in comparison with the economic and political power of corporations, they are.

The third change has really come about since 9/11. Under the auspices of ‘keeping us safe’  governments in the US and the UK have progressively eroded many rights and freedoms once considered inviolable. In truth, individuals have little or no right to privacy in their daily lives. We are surveilled walking down streets, our private communications can’t be considered truly private anymore, we constantly are told to graciously submit to thousands of intrusive acts for the sake of ‘security’. There is a dominant narrative that seems all but unchallengeable that since we have demanded the government ensure our safety, we no longer have any say in how that is done or what measures are taken to do it. A recent Ohio State University study finds that the vast majority of people who refuse to vaccinate are deeply mistrustful of their government.

What is very interesting is that the opposition to vaccination is not characterized by any particular political pole. It seems to be embraced with equal strength by those on the far left and the far right. And no amount of calm, rational presentation of information that shows the overwhelming benefits to individuals and society holds any water.

I don’t believe the people who hold these views are all idiots or ignorant, or mentally unstable. This is not a rational debate because it’s not actually a debate about a rise in the incidence of measles; it’s about a fundamental lack of trust that corporations and governments have our best interests at heart. It’s a big issue masquerading as a smaller one. It’s a consequence of people who feel so abused and embattled over the larger issue of their ability as citizens to effect any change in what they see as an untrustworthy power structure, that they cling like grim death to the places where they still have some vestige of control.

I agree that there no reason to believe that our governments and the corporations that dominate the economic landscapes have our best interests at heart. They care about power, profits and their own success.  There are serious battles to be fought to claw back individual rights, to demand transparency and goodwill from our politicians, and deny economic entities the privileges we afford to living human beings.

But it is self-destructive and ineffective to play out that battle over immunization. We imperil our children and we win no significant territory by leaving them vulnerable to the diseases which killed and maimed so many in the past.

Please have the courage, the ethics and the sense of community to choose the bigger battle and to ensure that your children and the children of others grow up to fight it.