SB277 Opposition: The Smokescreen of Parental Choice

Humans love to have choices. From early on in our childhood, we like to be able to choose what we want to do. Play with this toy or that one. Eat this food or that. And we don't like having limitations placed on our choices, especially if it involves doing something we don't want to do. Our parents try to teach us that while we are able to choose, sometimes our choices have strings attached. "You need to finish your vegetables if you want dessert." We're given the power to choose what to do: eat the veggies so we can have dessert, or choose not to eat the veggies and miss out on dessert. We might not like the options, we might wish we could choose the dessert without any other limits on our choice, but we have to deal with the reality. Depending on our maturity, we may throw a tantrum when we don't get what we want, when there is even the most minor constraint on our choices.

By the time most people are adults, they're mature enough to realize that every choice we make has some sort of consequences. They may occur prior to getting what we want, or they might follow it; they may be good consequences, or they may be bad. Then there are those who never seem to reach that maturity. They're stuck in the childish dream of wanting their choices to be free from any limitations, unable to accept that their choices may have consequences or that there may be some manner of prerequisite before they can have their choice fulfilled.

We can see this in action in the anti-vaccine movement, in particular as they fight against a bill in California (SB277).

Introduced by Senators Richard Pan and Benjamin Allen, SB277 would eliminate all non-medical exemptions to school vaccination requirements for students enrolling in a public or private school. Any parent who wishes to skip a vaccine for non-medical reasons would have to enroll their child in a home-based private school or arrange for an independent study program outside of classroom-based instruction. The bill went through three committees in the state Senate (Health, Education, and Judiciary) before being passed by the full Senate. Then it went to the state Assembly, where it passed the Health Committee and is currently in the full Assembly for a vote. If it passes and is signed into law, which is looking likely, California would join West Virginia and Mississippi as the only states that value children's health enough to allow only medical exemptions to school immunizations.

No hyperbole here. Move along.

So what arguments have opponents been using to fight this bill? There's the usual rhetoric: calling anyone who supports it a Big Pharma shill, comparing Sen. Pan to Hitler, claiming that our public vaccination programs are like the Holocaust, and so on. But the central argument around which they have rallied and allied themselves to Libertarians, far-right Republicans, the Nation of Islam, and Scientologists is "freedom of choice". They argue that SB277 removes their parental choice about which medical treatments and interventions to give their children.

Removing parental choice

The biggest flaw with their argument is that SB277 does not remove their choice to vaccinate or not vaccinate their children. What it does do, however, is force them to accept responsibility for their decision. Parents are free to choose not to vaccinate their children, leaving them susceptible to infectious diseases, but that choice comes with the consequence of having to home-school their child. Vaccination is like a serving of spinach that must be eaten before getting dessert (public/private school). Like the spinach, the vaccines improve a child's health by decreasing their risk of becoming infected with a bacterial or viral disease. There are some risks associated with spinach (choking, contamination with listeria or salmonella), but the benefits outweigh the risks. Likewise, vaccines carry risks such as severe allergic reactions or other very rare serious reactions, but on balance, the benefits outweigh the risks.

I posed the following question to several anti-SB277 folks on Twitter: if I, as a parent, want to strap a bomb to my child, should my child be allowed entry into the school? It's an extreme and unlikely example, but it highlights that parental choice is not 100% free. [Edited to Add (6/23/15): Just to clarify, I'm not equating vaccinated or unvaccinated children to bombs or terrorists. I chose this scenario because it is extreme and people will more readily have a very clear "yes" or "no" answer to it. The bomb in this scenario is simply a bomb, not an analogy or metaphor for vaccination status.] Only one individual actually answered my question, saying that no, my child should not be allowed in. When I argued that not allowing my child in violated my parental rights, they admitted that in situations where others would be put at risk of harm or that would create false fears, parental choice should not be honored. In my scenario, I could choose to follow through on my choice to strap a bomb to my child, but I'd have to find some other way to ensure their education.

When I pressed further, asking if it was the school's decision to not allow medical exemptions, my interlocutor said that was fine. For them, when it really came down to it, it really wasn't about choice. That was just a smokescreen. It was really about the government taking an action to protect its citizens from infectious diseases. Had all of the schools, public and private, in California initiated this on their own, then, if this person is to be believed, there would be no protest. Yet they also complained about physicians choosing, on their own, to exclude non-vaccinating families from their practices, so their claimed acceptance of private measures being enacted rings hollow.

Where there's risk, there must be choice

Anti-SB277 activists (many of whom oppose the bill despite being from outside of California) have come up with the slogan, "Where there's risk, there must be choice". Part of this argument, as we've seen, is based on a false premise: namely that parental choice is being removed. They also argue, however, that because vaccines do carry risks, they should have the option to choose whether or not to vaccinated their children and still be allowed to enroll them in a public or private school.

But it really isn't about the risk itself. There are far greater risks that they take every day when sending their child to school, which they probably don't even think about. For example, in the state of California, 1 in 3 children are victims of bullying. Bullying not only affects the victim's performance in school, but can have significant health effects, some of which can last into adulthood. Effects can be psychological or physical, sometimes even fatal. Although treating the effects of bullying after the fact is an option, it is often impossible to prevent, other than by avoidance.

Then there is getting to school. If the child walks, they risk injury by tripping or slipping or being struck by a vehicle. There's a risk of abduction or targeting by drug dealers. If they take the bus, there's a risk of getting into an accident. Likewise with cars, which brings up another government mandate that carries risk: seat belts.

A seat belt is intended to reduce the risk of injury in an accident. And it does. But it also carries a risk of injury caused by the seat belt itself. This can include minor effects, like bruising, to more serious effects, like laceration or damage to internal organs. And even though a seat belt may operate exactly as properly designed, such injuries can be potentially fatal. And yet the government mandates seat belt use in passenger vehicles, and no one protests. That is because, despite the risks posed by the seat belt operating precisely as designed, it reduces overall risk of serious or fatal injury to both the user and other passengers. People can choose to wear or not wear a seat belt (or choose to vaccinate or not), but they risk being fined if caught (or not being allowed into a school), not to mention the increased risk of injury if in an accident (or exposed to a disease).

Not choice, but fear and selfishness

The opposition to SB277, then, isn't driven by valid questions around choice. Parents can choose whatever they wish to do, but their choice drives the available options. Choice is just a tool around which to frame the issue. It gives people something to latch onto in the name of "freedom" or "fairness". But the real basis of the opposition is about fear and selfishness.

The core contingent of anti-SB277 activists fear vaccines, thinking that they cause autism, among other alleged maladies. That risk, to them, is greater than what they see as minimal risks from "benign" childhood illnesses that they view as completely harmless. They go so far as to encourage pox parties and measles teas (or, as Prof. R. Tanner Hewlett and Dr. Austin Threlfall Nankivell put it in 1921, an "orgy of death") rather than getting immunized, forgetting lessons from history of what happens when immunization rates drop.

That fear drives them to compare vaccination to the Holocaust, themselves the equivalent of persecuted Jews. To them, autism is the same as being rounded up in concentration camps and exterminated. It is a disgusting comparison that demeans survivors of the Holocaust and their families, as well as autistics themselves.

Yet just as with the "parental choice" argument, their fear is based on a false premise. There is no evidence that vaccines cause autism, and even if they did in some tiny percentage of individuals, a living autistic child is better than a dead child. But to them, it is reversed; autism is worse than death. Perhaps that is why so many bend over backwards to excuse the murder of autistics. In the world of the anti-vaccine movement, autism is so feared that they whitewash brutal murders, blaming everyone but the murderer for the death.

There is also an egotism associated with their opposition. What matters is their choice. They know better than all of the doctors and researchers who have dedicated their lives to improving children's health. They are smart enough to see the conspiracy that us sheeple are apparently too blind to see. They attempt to justify it by arguing that, if vaccines work, why does it matter what they do? This is nothing more than the Nirvana fallacy in action. It ignores the fact that for a small percentage of individuals, some vaccines will not produce immunity. Worse, and where the selfishness really shines through, is that their argument ignores those who, for medical reasons, cannot be immunized.

Vaccination has a very low level of risk for real injuries, but autism is not one of them. The real risks, though, are vastly outweighed by the benefits conveyed. Vaccines reduce the risk of infection from multiple diseases, and consequently the much greater risks of complications from illness. There is even evidence that immunization may protect against more than just the disease vaccinated against. When the facts and science are accounted for, there is no sound reason to skip vaccination. Time after time, we see how forgoing vaccines leads to outbreaks that affect far more than just the unvaccinated individual. And we have seen how, left to their own devices, the fearful few put the greater community around them at risk.

SB277 aims to protect the citizens of California by increasing vaccine uptake among schoolchildren, the ones most prone to infection and the ones most likely to spread the disease in an outbreak. Those who oppose it are putting not only their own children at increased risk, but their communities, as well, not to mention visitors to their state, as evidence by the measles outbreak at Disneyland that spread to several other states and countries. They couch their opposition in terms of freedom of choice, but it's a false and dishonest argument. Even they must admit that parental or personal choice is not sacred and inviolate. There are reasonable limits placed on them. They can choose to drink and drive, but they face consequences. They can choose to beat their children, but they face consequences. They can choose to not vaccinate their child, but they face consequences.

For the people of California, I sincerely hope that SB277 passes, and they become one of the top three states with the lowest rates of preventable diseases. Don't let fear, masquerading as choice, put children at risk.