Wednesday, January 07, 2009

Whose Risk is Important? Why?

Sitting around in my collection of unopened moving boxes is a copy of In Pursuit: of Happiness and Good Government, in which Charles Murray offers an invaluable insight into how social risk should be calculated. With regard to the link between speed limits and highway deaths, Murray argues that the proper quantity with which we should be concerned is the risk that a driver moving at a proposed speed limit (70 mph, in Murray's example) poses to those driving at the existing speed limit (55 mph, at the time of the book's publication). He wrote that the danger posed by the "fast" driver to himself and to other "fast" drivers is not properly a public concern in a free society. Only the true externality should be accounted, and weighed against the positive goods of the increased limit.

This strikes me as a powerful argument, and one that came immediately to mind when Megan, indicating support for mandatory vaccinations, issued the following obiter dictum.

[P]arents who don't vaccinate their children are able to do so only because most parents do vaccinate theirs.

This is almost certainly true, but it struck me as a poor argument for mandatory vaccinations. I'm not an immunologist, and I don't actually know what the risks actually are, but in the comments, I put forth that only the risk that unvaccinated people pose to vaccinated ones merits consideration. Commenter Rob Lyman enumerated such risks thusly:

Because [1] sometimes the vaccine doesn't "take," because [2] immunity wears off over time, because [3] populations of inccubators encourage mutations which might not have been included in vaccines, and because [4] some number of people can't be vaccinated, the failure of herd immunity cause by elective non-vaccination poses a threat to the non-elective ones.

I replied:

So it appears that between groups 1, 2, and 4, above, there remains a core of effectively un-vaccinated people posing a risk primarily to each other, but also some risk to the vaccinated population by incubating mutations. It is this last risk that should be quantified.

I would then ask: to what extent does the marginal electively unvaccinated person increase that risk. I would then ask how that risk compares to the risk of receiving the vaccine. I don't know what these risks actually are, but it seems reasonable to insist that the first risk outweigh the second before resorting to coercive measures.

Rob subsequently objected to my dismissal of the marginal risk posed by the electively unvaccinated to the non-electively unvaccinated on the grounds that, through either bad health or ignorance, the latter couldn't help their own vulnerability and externalized risk, while the former group could.

My first reaction is to rebel at this distinction. Those in group [4] clearly have not run the risk they would seek to impose on others, and perhaps in group [1] as well. People in group [2] presumably run the risk, but in both case [1] and [2], are there no other alternatives? Cannot anyone concerned about the effectiveness of their own vaccination be tested for the antibodies? My impulse is to look for alternatives before reflexively resorting to coercive vaccinations. But perhaps I am being myopic or hard-hearted.

Unfortunately, I can't end this essay without pulling back the curtain, so to speak, on my own suspicions. No small amount of the energy put into the calls for mandatory vaccinations is simple herd-think: we have accepted the risk of vaccinations for ourselves, and thereby produced some externalized good; you therefore must not be allowed to enjoy that benefit without accepting the same risk. This syllogism is powerfully seductive as a psychological matter, but it's not the same thing as risk management.

And at the risk of descending even further into tinfoil hat territory, I have difficulty in trusting the motivations of Megan's more zealous commenters. I suspect that the enthusiasm of many self-identified "progressives" for mandatory vaccinations is a function of their perception, not entirely unjustified, that resistance to vaccination programs is overrepresented among highly religious people, and that coercive measures is yet another front in their ongoing efforts at "conservative ethnic cleansing" about which I have written much.

UPDATE: After taking me to task for my tinfoil hattery, Trumwill brings up another class of unvaccinated persons that I had not considered: children too young to receive the vaccine but who are nonetheless vulnerable to the disease. I want to state that absolutely the risk to such children should be accounted when contemplating mandatory vaccination programs on the grounds that such risk is univeral -- although I would still insist that such programs result in positive-sum utility.

5 comments:

trumwill said...

I'm honestly not sure how to respond to the last two paragraphs. How do I prove what my motives are compared to what you think my motives are. Or, if you think that my motives are good but the motives of people that agree with me are not good, what am I to say when you respond to what I say with "People with bad motives also say that because they want to hide their bad motives?"

I can't prove that my views on vaccinations aren't based on hatred of religion any more than you can prove that your views on a whole host of issues aren't based on racial hatred.

The extent to which people are at risk even when they take the shot is in large part determined by by how many people don't take the shot. I don't see how you can divorce risk - even to the vaccinated and those that will be vaccinated at the earliest opportunity - from herd immunity. The threat to a baby too young to receive the vaccine (let's say measles, in this case) depends on how many people are carrying it. As long as the herd is immune, the risk to the vaccinated and will-be vaccinated is quite small. In cases where vaccination rates are low, the risk is much higher to those vaccinated and those that will be as soon as they are eligible.

If I could have my future kid safely vaccinated in utero, I would. And I would worry less about what other parents are doing. But I can't. And if the vaccination doesn't take, you can bet I will want to explore every other option. People aren't withholding alternatives just to stick it to religious people. That may be the motivation for a select group of smug, secular liberals, but fears simply cannot be reduced to that. Because secular liberals (among many, many others) support something does not make it wrong and does not make it about hating religious-types.

Also, you're greatly underestimating anti-vaccine sentiment on the left. More of the folks that I know that are against vaccinations are lefties concerned about the medical-industrial complex foisting unsafe products on us for bloody profit. Not to say that there isn't a contingent among religious conservatives that feel the same way, but this is an area of intense debate on the left. I would wager that most liberals who spend more time with people on the left than on the right probably know more liberals than conservatives against vaccinations. It's not like nativity scenes in that regard.

Burke said...

Trumwill: Please accept my apologies if you took the last two paragraphs personally. I did not intend to direct them at you or Megan, but only at that "select group of smug, secular liberals."

Let me add that both my children are vaccinated, and you and I do not disagree about the overall distribution of risk. My narrow technical point is only that a mandatory program ought to produce positive-sum utility.

Thanks, as always, for commenting.

Burke said...

Let me add that I hadn't really considered the case of children too young to be vaccinated. Since this is "disability" is presumably universal, then certainly the risk to such children should be taken into account. I will write a clarification.

trumwill said...

Just to let you know, I wrote a response to this a few days ago, but it never showed up. I thought it was in moderation but either Blogger ate it or I did something wrong.

The thing is that I can't remember what it said. I'm sure it was something genius.

Burke said...

I'm sure it was something genius.

I expect nothing less! But since I don't moderate comments, I guess blogger ate it. Let's see what happens to this one . . .