On Vaccinations and the Social Contract: Why Autism is No Philosophical Justification for Avoiding Vaccination.

Great,  another pro-vaccination article. 

Yes, but with a twist. 

One of the more confounding phenomena of contemporary Western society is the way in which we have increasingly turned away from relying on reason and science as a basis for discussion on public policies and government action.

(Don’t worry, this essay will not address this phenomenon. However, it is worth noting that others, such Niall Ferguson, have written extensively on this process of emotional rather than rationally derived opinion).

Tangents of ‘unreason’ aside, nowhere has this rejection of science and reason been more apparent than in the Anti-Vaccination Movement. Although opposition to vaccination has existed since the invention of the Smallpox vaccine, the movement gained its legitimacy in a Lancet medical journal article which purported to connect the MMR vaccine with higher incidences of autism in children. The link was thoroughly debunked and the article discredited, but nevertheless there has remained a strong belief that certain vaccines cause illnesses and disorders in children, and parents have increasingly elected to not vaccinate their children.

 

For a change, I want to look at the vaccination question from a philosophical as opposed to scientific basis – what if we hypothetically accept that vaccines do have health risks for children? What if they can cause autism? Is there more than one way to skin the proverbial cat? Can risking your child’s health by vaccinating them be a morally binding command from the State?

The premise of this article focuses on this decision by parents to not vaccinate their children, and whether or not they have the moral right to do so, as they claim. Inherent in this is the underlying question of whether or not a society should have the moral authority to compel vaccination. Subsequently, this essay will largely avoid any discussion of the science behind anti-vaccination and instead accept their premise that vaccinations do cause illnesses to examine the philosophical justifications for mandatory vaccination.

Vaccination and a Parent’s Right to Choose

Anecdotally, what a significant number of parents who sympathise with the Anti-Vaccination Movement position express is that, as parents, they have the right to decide whether or not to vaccinate their children. It must be admitted that, although emotionally based, such a position has a strong resonance of authority – where and how should the State be permitted to interfere in the private decisions of the family? Indeed, if we accept that vaccinations can cause autism or other illnesses, then mandatory vaccinations must be based on some form of higher reasoning that is capable of supplanting or transcending the rights of the individual and their autonomy to make their own decisions with the interests of the State. We are, after all, considering the proposition of compelling parents to put their children at risk for the benefit of the State.

Admittedly, western philosophy is grounded in liberty, and is reluctant to give moral authority to the public intrusion of individual autonomy. However, it is reluctant; not diametrically opposed. It recognises that some limitation and control of citizens is necessary for the function and survival of the State; it is this balance of individual rights and State needs that concerns the philosophical enquiry of the social contract, and it is the social contract in which we attempt to examine the moral authority of the State to mandate vaccination.

What the fuck is the Social Contract?

In its essence, the Social Contract is the idea that humankind once existed in nature, and has progressed and organised itself into societies. By leaving nature and entering society, humans inherently acquiesce to a ‘contract’ between itself and the apparatuses of said society with the mutual benefits of social stability and personal protection. Generally, the social contract can be envisaged as the forgoing of certain liberties for the protection of society. This can be most poignantly illustrated through revenge – upon entering society, we give up our right to exact vengeance on others in most circumstances. Where we have been wronged, we rely on the absolute and irresistible authority of the State to punish others on our behalf. In doing this, we are protected from continued vengeance as well as mistaken vengeance, because the liberty of vengeance in nature is controlled only by the person taking the action, whereas in society it is controlled by the State, and determined by the delegated authority of the judicial system.

Subsequently, the social contract does recognise that certain liberties are restricted as an inherent consideration for the protection of society, and there is no restriction in principle restraining the State from mandating vaccination.

Social Contract and the State of Nature

Understanding the premise that society compels humans to give up certain liberties, the question is what is ‘nature’ and why did we form societies? This is important because comprehending this gives us an insight into the sort of protections we might be seeking, which allows an enquiry into whether or not this applies to vaccinating.

The notion of what the state of nature ‘is’ or ‘was’ has been firmly contested since the Enlightenment. Fundamentally, it is a question of what human existence would have been like preceding organised and civilised societies; intrinsically, a question of how society and government evolved, and the morality that underpinned this process.

In Leviathan, Hobbes argued that, in the absence of a common power to keep humans ‘in awe’, humans fought for their perceived rights. Essential to this was that every person had the liberty to do whatever they needed to preserve their own life, irrespective of the liberty of others to do the same. It was not a right as, in Hohfeldian terms, there was no corresponding duty on others to recognise a persons’ liberty. Subsequently, Hobbes held nature to be anarchy, eloquently asserting that life in nature was ‘solitary, poor, nasty, brutish and short’.

Whilst other philosophers disagreed or differed in their characterisation of nature, what is important that each indentified reasons which drove humanity towards forming societies. Whether by mutual contracts formed to protect self interest (Hobbes), reason under the Laws of Nature (Locke) or fear (Montesquieu), humans came to exit nature and enter society; trading in liberties for the protections and benefits offered by the State.

The question remains, however, what liberties, and for what protections?

Social Contract and Vaccination

Short summary of its historical development aside, how does the philosophical notion of the Social Contract help us in approaching the vaccination problem?

The Social Contract is primarily concerned with the fundamentally difficult conundrum of balancing the rights and liberties of the individual with the needs or prerogatives of the State; it helps us determine the parameters of the State’s moral authority to compel or prohibit citizens’ behaviour. Mandating vaccination is, at is essence, a question of what an individual can be morally compelled to do by their government, even in circumstances risking detriment. Fundamentally, by framing the vaccination conundrum as a question about the application of the social contract, we are positing a challenge about whether State laws have the moral authority to compel vaccination over the objection of the individual.

Can it be justified by the social contract?

Generally, it is accepted that the social contract allows society to create laws that protect the survival of society and its citizens. Indeed, this is the moral underpinning that gives the State its legitimacy. Therefore, the protection of life and property, creation of rules conducive to social living, and the protection against outside threats form the basis of the State’s power under the social contract. Whilst there have been later discussions about other powers/obligations such as the question of environmental protection or social safety nets, these are largely semantic arguments inherently derived from the ones listed above.

It is not difficult to assert that vaccinations fall within the parameters of the social contract – it purports to protect society from outside threats. Threats need not necessarily be other State actors; in the case of humans, our historical coexistence and cohabitation with domesticated animals has exposed us to a variety of viruses and diseases which have mutated from animal hosts to be transmitted through human to human contact. As social creatures, this makes us inherently vulnerable to outbreaks and epidemics because the risk of transmission is significantly increased by our everyday interactions and social functions.

The manner in which we exist in contemporary society – largely urbanised in medium to high density housing, and entirely interdependent on one another for sustenance and the provision of goods and services, makes society inherently susceptible to disease. In a sense, we are strapped to society by the division and specialisation of labour so that individual subsistence is almost impossible. As such, vulnerability to diseases and viruses at an individual level posit risks to the existence of society as a whole. Consequently, society has the moral authority to compel vaccination even if they cause illnesses, because the overall risk to society is lower than allowing the proliferation of viruses such as polio, measles and mumps.

The Herd Immunity 

The validity of this argument is further strengthened by the social nature of immunisation – the Herd Immunity principle. There are a multitude of reasons why not everyone can be effectively immunised, including because they are too young, or simply the vaccination does not elicit the specific antigen reaction in some people. As long as a high enough proportion of people are immunised, these unprotected people are nevertheless covered by the herd immunity because the rate of incidence within the society is so low that they cannot be exposed in the first place. Once the proportion of people vaccinated falls below a certain percentage, however, this herd immunity begins to fail, and people who are involuntarily unprotected are at risk of contracting the illness.

What must be accepted is that certain humans cannot be immunised, and hence herd-immunity is not a carte blanche liberty for parents of otherwise healthy vaccination candidates to opt out based on their own beliefs or proclivities. Instead, it is this herd rate that must be protected, and this creates an obligation on members of society to contribute to the upholding of it.

In this sense, the moral authority of vaccination is not incomparable with taxation. Whilst it might be disagreeable, the government has the inherent authority to require citizens to pay for the upkeep of society for the greater social benefit. Those who lack the capacity to contribute are proportionally excused, whilst those who have the capacity are progressively compelled. Individuals may not agree with taxation, or how their tax is spent, but that does not reverse the inherent moral authority of the State to compel payment. It is difficult to comprehend how the same justification does not apply to vaccination.

Holy shit, isn’t this just an excuse for totalitarianism? Thomas Jefferson would be rolling in his grave! 

The above argument does have flaws. Merely relying on the Social Contract to justify the forced medical treatment of children, without safety nets, is a pretty outrageous assault on individual liberty. Such an argument is dangerously similar to the supposition that the ‘greatest good for the greatest number’ is the applicable standard for deciding on human rights. The intellectual outrage is palpable – such crude Bentham-esque utilitarianism is surely not appropriate justification for stripping the rights of individuals? We are not discussing weighing up two different building plans and determining which one is of the greatest benefit to society, we are talking about intruding upon individual autonomy and exposing them to risk for social benefit. When the opinion of the majority is used to quash the rights and liberties of a minority, freedom itself is at risk – history stands testament to this so-called tyranny of the majority. From the death of Socrates to the writings of de Tocqueville, Burke, Mill and Nietzsche, philosophy has long noted the fact that majority opinion is not sufficient to deny individuals their rights and liberties; indeed, it is diametrically opposed to freedom.

It is not sufficient to say that it is in the interests of the majority to force people to vaccinate and put their children at risk. Indeed, if that is the moral standard to satisfy for the State to erode the rights of the individual citizen, then our notion of self and autonomy are nothing more than semantics balanced precariously on the rim of a furnace, awaiting inevitable destruction upon the bluster of public sentiment and outrage. No, if we accept that vaccinations cause illnesses then there must be a higher standard of utilitarianism than just the ‘greatest good for the greatest number’, a standard which respects that individual autonomy is precious. Remember, what we chose for determining the moral authority for mandatory vaccination is the precedent we then justify every other erosion of autonomy by. Ultimately, we need a standard which is more than a blank cheque of tyranny to future populist governments and despots.

The Social Contract Safety Net

John Stuart Mill gives us the answer:

“The only purpose for which power can be rightfully exercised over any member of a civilised community, against his will, is to prevent harm to others”

I have always enjoyed the way in which Mill characterised rights and the role of the State – whilst thinkers such as Nietzsche, Rand, Friedman and Hayek over-stress the importance of the individual, Mill’s construction of freedom seems far more grounded in the understanding that society is comprised of individuals, and the operation of individual freedoms is inherently conflicting. Whilst autonomy is important, the overemphasis on one individual’s rights can overlook the fact that a person’s full enjoyment of their rights can unfairly impede or preclude the rights of others. Subsequently, any characterisation of individual autonomy needs to be tempered by an understanding of how to protect the autonomy of everybody, not just the hypothetical individual we are examining. By restricting the moral authority of the State over the individual to preventing harm against others, Mill creates a far more balanced concept of freedom that is quite useful in ultimately settling the vaccination and social contract conundrum.

Indeed, the Mill principle above is the panacea to the dangers of applying the social contract and utilitarianism to the vaccination issue – the standard which must be satisfied becomes ‘is mandatory vaccination necessary to prevent harm to others, and allow individual citizens in society the best possible liberty and opportunity?’

It is difficult to deny this.

If only those whose parents chose to not vaccinate were at risk of infection, then the argument that parents, as individuals, have the autonomy to decide whether their child is vaccinated would be much stronger. Ignoring the rights and objective best interests of the child (it would be hypocritical to say parents have no right to impose their beliefs onto their children when religious indoctrination is exactly that), parents have the autonomy to, by and large, determine their child’s upbringing and values, insofar as it effects only that child. What they don’t have is the moral authority to risk the well-being of other children whilst being relying on the protection of a social effort to uphold herd immunity.

Many people in society have no choice but to rely on the herd immunity to protect themselves from what are quite devastating and life threatening illnesses that, in the absence of vaccination, occur at a much higher incidence than any of the side effects purported to come from vaccines. People who refuse to vaccinate otherwise healthy children are ‘freeloading’ on the risk the rest of society exposes itself to in order to protect themselves and others, and in the process risk seriously jeopardising the herd immunity. Quite simply, the risks of not vaccinating are not borne entirely by the individual, they risk the lives and well-being of others, and intruding on the rights of others is whereupon individual autonomy ends and the moral authority of the State begins.

Conclusion

If we accept that vaccinations can cause autism and other illnesses, then obviously mandating vaccinations against the will of the family poses serious questions about the balance of rights of individual and State, and how far a society’s moral authority can allow it to interfere with the private sphere. By looking at the social contract, we understand that individuals forego certain liberties upon entering society, and in return receive certain protections and benefits. Vaccinations fit within the parameters of the social contract precisely because they operate to protect all members of society from serious illness and disease, irrespective of whether or not they can be immunised. The fact that not everyone can be immunised, and the decision to not vaccinate is a decision with consequences beyond the individual, means that it is not an issue of individual autonomy. Subsequently, the State has the moral authority to compel a person to ‘pay’ their share in the same sense that they can compel a person to pay income tax. You may not like it, you may be philosophically opposed to it, but that does not weaken the moral authority of State to exact its required tithe.

Even if vaccinations cause autism, you as a parent are still compelled to put your child at risk because the risks of autism are far outweighed by the risks and social costs of the diseases that would proliferate in the absence of an effective herd immunity. So vaccinate your children – the autism question is irrelevant, what you are actually doing is endangering others and weakening the herd immunity because of your own beliefs. You enjoy the benefits of social living; you must sacrifice certain liberties to support this.

Or go live in nature.