Friday, February 6, 2015

A proposal from epidemiology for curing vaccination skeptics with epistemology

Here is a NY Times op-ed from an epidemiologist suggesting an epistemological fix for parents who opt out of immunization - thus negating "herd immunity" and hence imperiling the greater good.

Epistemology is defined as "the investigation of what distinguishes justified belief from opinion." So he proposes going after those beliefs by informing parents and tightening exemption rules.

... even states like Arizona and Colorado that allow fairly broad exemptions can tweak their rules to make sure parents are as informed as possible — and to make the exemption process difficult.

They can require parents to write a letter elaborating on the reason their child should be exempt. They can require that the letter be notarized. They can insist that parents read and sign a form that discusses the risks of nonvaccination. Better yet, they should mandate in-person counseling so that the decision not to vaccinate is truly informed.

Think about this one. If anti-abortion types want pre-abortion counseling, they should be on board with pre-exemption counseling, right?

The case for tightening exemption rules continues:

States with easy procedures for obtaining exemptions have higher rates of nonmedical exemptions — and, more important, higher rates of vaccine-preventable diseases. In a 2006 study published in The Journal of the American Medical Association, for example, we documented that states with easy procedures for granting nonmedical exemptions had approximately 50 percent higher rates of whooping cough.

In a 2012 study, which my colleagues and I published in The New England Journal of Medicine, nonmedical exemption rates were 2.3 times higher in states with easy administrative policies for granting exemptions (like Connecticut, Missouri and Wisconsin) than in states with difficult policies (like Florida, Minnesota and Texas). Moreover, the annual rate of increase in nonmedical exemptions was about 60 percent higher in states with easy exemption policies compared with states with difficult policies.

These practices will cost taxpayers money. But they will be more effective, in the long run, than condemning vaccine skeptics as ignorant and irresponsible. The goal should be to make the number of parents who decide to seek exemptions — and follow through with it — as small as possible. Given the high costs of controlling disease outbreaks, including the current rise in measles, it might be reasonable to tax parents who seek exemptions to recover some of the cost.

All democratic societies must try to balance the rights and views of a variety of constituencies. Parents of children who are too ill for vaccination should of course be granted an exemption. Everyone else — no matter their belief — should face a high burden before being allowed to remove their children from the immunized herd.

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