How to Solve the Vaccination Problem: Two Politically Feasible Proposals

Posted on by Bill Herman

My last post, “Is It Constitutional and Desirable to Require Vaccinations?“, asked serious questions about what at this rate is still probably not necessary. Here, I make two proposals that would be good policy right now, and would also be politically palatable.

After all, roughly 92% of American children are getting their MMR vaccine. How do we deal with the other 8%? This matters to everyone because vaccines are not 100% effective, and infants and some other folks can’t get vaccines for health reasons.

1. Eliminate, or at least harden, non-medical exemptions for school students

There are already two states, Mississippi and West Virginia, that only accept medical exemptions for public schools — not even religious exemptions. Little wonder, then, that Mississippi has a 99.7% MMR vaccination rate among kindergartners. It has been more than 20 years since either state had a case of measles.

This is good policy, and it should be adopted by the other 48 states. If your personal or religious beliefs are so strong that you insist on ignoring the advice of the collective, virtually unanimous opinion of medicine writ large, fine. You have to find another way to educate your children, at your own expense.

There is a bill in the California state legislature to do exactly this.

It’s getting some pushback from vaccine fear mongers, of course, but also from libertarian types. Here’s the thing, though: You don’t get to take advantage of a public service,  provided at public expense, and then tell the body politic that some very reasonable conditions placed on that service are a violation of your individual liberty.

It’s against policy to smoke anywhere on a K-12 campus in most if not all states — including in North Carolina, for G-d’s sake — and this infringement of liberty has come about with broad if grudging acceptance even among the gravelly-voiced crowd.

If you believe in this extreme of a version of personal liberty, you’re probably a follower (at least indirectly) of Ayn Rand. So take that reasoning to its conclusion. Rand didn’t even think public schools should exist. Until we abolish public schools and live in an objectivist utopia, then, there are just some times — from vaccines to seat belts to food safety inspections — that your liberty to do things “your way” might be curtailed.

Again: It’s constitutional to require vaccines, period, on penalty of a sizable fine. Requiring vaccines as a condition of using a public service? Sorry, not a violation of your basic rights.

But, you might say: What about private schools? Won’t all these well-off anti-vax families just pony up to send their kids elsewhere? A number surely will. The state should therefore also make private schools publicize their vaccination policies, exemption rates, and number of confirmed cases of vaccine-preventable diseases per year for the last five years. They should have to share this, in writing, with all current students’ parents and with any potential new students’ families.

A number of softer-hearted souls have proposed merely hardening the rules on personal exemptions — making it harder for parents to get the forms, making them resubmit every year, making them complete online learning modules, and so on. This has been partially effective, but it does not go far enough in my view.

“Resisting vaccination isn’t a matter of laziness; it’s actually time-consuming and expensive,” writes Whet Moser. Which means the same kind of parent who clings to anti-vax believes is also the kind of parent who will do “anything” for their kid. (Except, you know, make the single easiest decision a parent can make.) Instead of daring these folks to jump through more hoops, just keep the kids out of public schools, period.

If you want to compromise on the religious exemption, that is more reasonable — or, at least, less subject to the whims of changing opinions. I would, however, add a mechanism for sniffing out sham churches set up for this purpose.

I don’t feel particularly compelled to give on even this point, however. We have all sorts of rules in public schools that might conflict with a sincerely held religious belief, from mixed-gender classrooms to not letting kids get out of biology class because they don’t believe in evolution. If parents want something different on these counts, they have to find a school that meets their beliefs, and putting vaccinations on this list is perfectly reasonable.

2. Medical Isolation

Many people are talking about school policy changes, but I’m also concerned about infection at the doctor’s office — where you’ll find a disproportionately large share of infants and immunity-compromised children.

Thus, I propose that all medical offices have to post their vaccination policies prominently, and those caught not sticking to theirs are subject to a serious fine.

Imagine walking into the office and seeing this:

Statement of Office Policy on Vaccinations

XThis office only accepts patients that are up to date on their vaccinations (barring medical exemptions), and we verify.
This office only accepts patients that are up to date on their vaccinations (barring medical exemptions), but we do not verify.
X(If either of the above is checked) This office has after-hours "catch up" vaccinations.
This office accepts patients regardless of their vaccination status.

In today’s climate, that would be very reassuring to see. And if I make an appointment, show up, and instead it’s Box 4 that’s checked? My kid and I are going elsewhere.

If I discover this, I should leave, and I shouldn’t be forced to pay a cancellation fee. Such an office should also have to get written assent to this choice from all patients before they can bill for dollar one.

Box 2 would probably work well enough as long as patients/parents have to sign a statement, under penalty of perjury. Which brings up another important point: Verification would work best if states require that all immunizations be submitted to the state database. Vaccinating doctors are not required to submit this information in some states, such as (I’m very sorry to see) California, so it would be a good bit of extra work to be a Box 1 office.

I would probably be comfortable taking my child to a Box 2 medical office, but he’s 10, vaccinated, and healthy. If I had an infant or other especially vulnerable child, though, I’d really try to find a verified-immunization office.

It would be hard to find a doctor who’s willing to advertise to their patients that the unvaccinated are explicitly welcome in their office. Sure, even the occasional anti-vax quacks can be found, but it’s becoming hard to find doctors who will even see anti-vax parents. (Even without a mandate, if I were a doctor, I’d post a prominent “must be vaccinated” notice in my office, and I suspect we’ll start to see this soon in any case.)

So that’s my proposal: No public school without vaccinations or a valid medical excuse, and mandatory notice about medical office policies.

If you’re not vaccinating your children, you’re free-riding on herd immunity (to say nothing of harming your own child!), and the herd should try to limit the damage that your adorable little disease vector can do to the rest of us.

 

 

 

 

 

 

 

Posted in Politics, Uncategorized

Is It Constitutional and Desirable to Require Vaccinations?

Posted on by Bill Herman

(This is the first of two posts, in which I ask if it’s desirable and constitutional to require vaccinations as a matter of law. My more pragmatic policy proposals are in part two.)

As with many others, I’ve been on an anti-anti-vax rampage on social media.

(I should perhaps rethink my strategy, but it’s not clear that there is a good strategy for dealing with someone once they’re in that camp. It’s not the first such example, either. How do you argue with a Scientologist? How do you convince congressional Republicans that we won’t eliminate the deficit without either raising taxes or seriously harming the economy? There aren’t a lot of good solutions here.)

Thus, one of my more libertarian friends (who gets all her kids’ shots, thank G-d, but who thinks you should use an alternative vaccination schedule that delays vaccinations) posted on my wall to ask if I would really support an infringement on individual liberty in the form of forcing folks to get vaccinated.

To which I say: Hell yes! I would support it, and it would even be constitutional. Which is not the same thing as supporting such a policy as politically pragmatic — but I have an answer for that, too.

As for my personal preference for whether we should force people to get vaccines against airborne pathogens — when they have been proven safe and effective, winning near-universal support among medical experts: Yes, I do want to live in that world.

I suppose I’d allow an exemption for truly anti-modern-culture isolationists who agree to keep away from broader society. (The Amish seem not to qualify on either count, by the way, with the majority getting vaccinated AND their willingness to participate in commerce with outsiders. Zippers no, shots mostly yes. Who knew?))

But in the general population — among those healthy enough to be vaccinated, of course — yes, I would support forcing folks to get their shots. If you’re not willing, I would gladly levy a stiff fine. (I mean, I’m not proposing that we lock unvaccinated families in a tent inside a hospital in Newark where they have to poop in a bucket or anything. That would be inhumane.) This would be especially effective if it had a high ceiling and explicit instructions to judges that it should be proportional to income — since, you know, being an anti-vaxxer seems primarily to be a disease of privilege.

The Supremes ruled on this over a century ago, by the way, in Jacobson v. Massachusetts. In 1905, the court ruled that Massachusetts was within its power to fine Jacobson five dollars (equivalent to roughly $130 today) for failing to get vaccinated, at zero cost to himself, against smallpox.

The Wikipedia article is mostly accurate — relative to my skim of the case (IANAL, as always) — but read some of what the Supremes have to say on the matter. Pretty convincing, and definitive, stuff:

… the liberty secured by the Constitution of the United States to every person within its jurisdiction does not import an absolute right in each person to be, at all times and in all circumstances, wholly freed from restraint. There are manifold restraints to which every person is necessarily subject for the common good. On any other basis organized society could not exist with safety to its members. Society based on the rule that each one is a law unto himself would soon be confronted with disorder and anarchy. Real liberty for all could not exist under the operation of a principle which recognizes the right of each individual person to use his own, whether in respect of his person or his property, regardless of the injury that may be done to others.1)Court footnote 7

Not a lot of wiggle room left there. Watch them apply it to this specific question:

Upon the principle of self-defense, of paramount necessity, a community has the right to protect itself against an epidemic of disease which threatens the safety of its members. It is to be observed that when the regulation in question was adopted smallpox, according to the recitals in the regulation adopted by the board of health, was prevalent to some extent in the city of Cambridge, and the disease was increasing. If such was the situation,—and nothing is asserted or appears in the record to the contrary,—if we are to attach, any value whatever to the knowledge which, it is safe to affirm, in common to all civilized peoples touching smallpox and the methods most usually employed to eradicate that disease, it cannot be adjudged that the present regulation of the board of health was not necessary in order to protect the public health and secure the public safety. …

 

If the mode adopted by the commonwealth of Massachusetts for the protection of its local communities against smallpox proved to be distressing, inconvenient, or objectionable to some,—if nothing more could be reasonably affirmed of the statute in question,—the answer is that it was the duty of the constituted authorities primarily to keep in view the welfare, comfort, and safety of the many, and not permit the interests of the many to be subordinated to the wishes or convenience of the few.2)Court footnote 8

The court goes on, at length, in a way that might make the Ayn Rand followers of the world a bit uncomfortable. I feel no obligation to assuage their feelings, however. If what you’re doing might harm or kill me, the state has a right to stop you from doing it — even if it’s something as banal as forcing restaurant employees to wash their hands. Ditto foolish self-harm, such as with seat belt and helmet laws.

The decision is also a fantastic read for some historical context on exactly how far back the consensus on vaccines really reaches. For instance:

[Jacobson’s arguments] in the main seem to have had no purpose except to state the general theory of those of the medical profession who attach little or no value to vaccination as a means of preventing the spread of smallpox, or who think that vaccination causes other diseases of the body. What everybody knows the court must know, and therefore the state court judicially knew, as this court knows, that an opposite theory accords with the common belief, and is maintained by high medical authority.3)Court footnote 10

It is therefore the law of the land that, when confronted with a deadly infectious disease that is reliably and safely vaccinated against, a state or municipality may affirmatively compel the populace to be immunized.

This has been the definitive law of the land for 110 years, and the medical consensus behind — and safety of — vaccines has only increased.

This decision is many times more remarkable because it is from an era (the start of the Lochner era — Jacobson was published just two months before Lochner v New York) where the Court had a much, much more restricted view of what the state is allowed to do under the Constitution. This is the same session when the court held it unconstitutional for a state to tell employers how many hours a worker could work, and yet it held mandatory inoculation against deadly disease to be fully constitutional and consistent with American values.

I agree on both counts — constitutionality and consistency with our values. This is doubly so when it comes to children. They’re not your property. If you starve them or assault them or psychologically torment them, the state can and should intervene.

On the affirmative side, you have to send them to school or educate them in some comparable way, period; the value of education is not up for debate. When parents won’t do what’s demonstrably in a child’s best interests, the state can intervene and — when the risk is serious — should seriously consider doing so.

Thankfully, there are less invasive policy choices that would likely lead to the same desirable outcome of a return to near-100% childhood vaccination. That is the subject of my next post.

Footnotes   [ + ]

1. Court footnote 7
2. Court footnote 8
3. Court footnote 10
Posted in Politics

On DeflateGate, Statistics, and Reasonable Inferences

Posted on by Bill Herman

[I’m not a sports analyst, and this is not a sports blog. We’re scholars, especially of political communication, politics, and media policy. But I do crunch numbers, and I thought I could help add something to this debate.]

[Also, corrections and updates at the bottom, appended Jan 28, 2pm-ish.]

We’ve all spent the last week hearing a lot about Tom Brady’s balls. Patriots fans and Pats haters are fighting online with a viciousness that’s hard to overstate. A good number of you have also seen the use of statistics to try to sort out whether the Pats have a measurable advantage in something that would be directly related to the inflated pressure of footballs — namely, fumble rates. Statistical analysis is only good, however, if the data are correct, if we are testing what we think we are testing, and if we are using the right statistical tools for the job. In this case as in so many, we need more good analysis that asks the right questions and uses the correct data.

This post has a lot to say, so here’s a summary: Continue reading

Posted in Fun

Police Shootings and Creeping Fascism

Posted on by David Karpf

Trust the agents of the State.  Obey the agents of the State.  If agents of the State behave inappropriately, that will be determined later, by other agents of the State.  Your appropriate role is not to question.  Your appropriate role is to comply.

The words above are fiction.  They are a ham-handed attempt at depicting the language and ideology of a fascist state.  I’m not a fiction writer, and you can probably tell.  The language I come up with when I imagine a fascist ideologue is too brazen.  Real fascists would probably be more subtle.

So let’s try this instead:

How ’bout this? Listen to police officers’ commands, listen to what we tell you, and just stop. … I think the nation needs to realize that when we tell you to do something, you do it, and if you’re wrong, you’re wrong, and if you’re right the courts will figure it out.

That quote is nonfiction.  It comes from Jeffrey Follmer, the President of the Cleveland Police Patrolmen’s Association, at the end of an 8 minute MSNBC interview with Ari Melber .  Follmer was incensed that Cleveland Browns Wide Receiver Andrew Hawkins wore a shirt during warmups that read “Justice for Tamir Rice and John Crawford.”

For those who haven’t followed these cases, Tamir Rice is a 12-year-old African American boy who was gunned down by Cleveland Police Officers while holding a pellet gun.  The police account of the event did not match disturbing video of the event.  John Crawford was shot dead by the Cleveland Police while in a Walmart, holding an air rifle that was available for purchase in that Walmart.  A city prosecutor has cleared the officers involved in both cases.

And to Follmer, that should be the final word.  Any citizen voicing protest or concern is wrong, and should have to apologize for their wrong opinion.  At minute 7 of the interview, Follmer testily replies, “These two were cleared by a city prosecutor already. This shooting was justified, and […] it was a tragedy that it was a 12-year-old, but it was justified.”

This isn’t the first time we’ve heard this sort of language, either.  This past August, as the nation grappled with the Mike Brown shooting in Ferguson, MO, Sunil Dutta wrote an Op-Ed for the Washington Post titled “I’m a Cop. If You Don’t Want to Get Hurt, Don’t Challenge Me.”  Dutta is a 17-year veteran police officer with the LAPD.  Dutta writes:

Even though it might sound harsh and impolitic, here is the bottom line: if you don’t want to get shot, tased, pepper-sprayed, struck with a baton or thrown to the ground, just do what I tell you. Don’t argue with me, don’t call me names, don’t tell me that I can’t stop you, don’t say I’m a racist pig, don’t threaten that you’ll sue me and take away my badge. Don’t scream at me that you pay my salary, and don’t even think of aggressively walking towards me.

If you don’t want to get shot… don’t threaten to sue.

It’s good advice, of course.  Police Officers are agents of the state.  They have the capacity to use deadly force, and they are placed in trying situations every day.  As a rule for individual behavior, it is a good idea to be polite to police officers.

But Follmer and Dutta have stepped well past that rule for individual behavior.  In the cases of Mike Brown, Eric Garner, Tamir Rice, John Crawford, and far too many others, it is abundantly clear that police officers are not held responsible when they make a deadly mistake on the job.  Hell, they don’t even face a trial.

The American Public should be outraged.  And Police Officers should be as well.  The badge is not a license to kill without consequences.  As we’ve seen recently, the justice system is biased against enforcing, or even investigating, those consequences.  So we’re left with the weaker tools of public opinion and organized outrage.  The police ought to be standing alongside that public outrage, engaging in a dialogue and looking for ways to do better.

The current state of affairs is that Police Officers can be immediately absolved for shooting a 12-year-old boy within four seconds of arriving on the scene, but the officer will then be forced to endure celebrities and citizens wearing t-shirts that call it an injustice.  And officers like Jeffrey Follmer think the t-shirts are the problem.

Follmer’s ideology is too brazen for fiction and reality alike.  It’s fascism, cloaked in the language of police solidarity.  He’s telling us to trust the agents of the state, obey the agents of the state, and don’t dare raise questions when other agents of the state absolve them of wrongdoing.  And he wonders why all these protests are happening…

Posted in Uncategorized

On Brigade.com, Customers, and Products

Posted on by David Karpf

Last week, Techpresident.com published a fantastic interview between Alex Howard and James Windon, President of Brigade.com.  You should read it.  I’m going to riff on one point in a long, fascinating interview.  Please read the interview first, it’s better than anything I’m going to say.

Caught up now? Good.  Okay, here goes.

I still don’t know what Brigade is going to be.  It’s been on the horizon for about 6 months.  I’ve kept my eye out. I still have no clue.  It sounds a bit like Change.org 1.0 — a social network for civic participation.  Change.org 1.0 didn’t work.  Neither did Change.org 2.0, 2.1, or 2.2 (variations on an issue blogging platform and a one-stop participatory shop).  Change.org didn’t succeed as a business until it stopped trying to be a civic social network and started trying to be a really, really good petition website.

Reading the interview hasn’t left me any clearer on what Brigade is going to be.  And I’m going to try to keep an open mind when it launches.  But two lines in the interview really stood out (bolded below) :

Q: I mean the fascination with ‘big data’ in the Obama campaign has subsumed the fact that both parties have a ground game. Both parties send people out with mobile apps. Both parties are trying to nudge people to use their social networks to target ads. So the campaigns are all about this. What’s the role of Brigade when the campaigns are all in that space?

 

A: I think it’s twofold. One, I think it’s about who’s your primary customer. And for Brigade, that primary customer is the citizen. The goal of this is to build a network that can connect citizens. And if we can do that, then we would invite and encourage candidates and elected officials to come on to that platform on the terms of the citizens who are there. So I think that’s one thing. We will ultimately interface with the existing structures of government, we hope. But there’s a difference between building tools for them from the get-go and then trying to plug the lists in, which is what this is really about, list management, versus building a social network.

 

You mentioned customers. Y’all are not a nonprofit.

 

A: We’re not a nonprofit.

 

Q: Where’s the money come from? Right now, it’s coming from funders, but down the road…?

 

A: I think that our best bet at how we will monetize is through advertising. That’s our best bet at the moment. We believe however that…

It’s become a bit of a cliche to say “if you aren’t paying for the service, then you are the customer, not the product.”  But it’s also a pretty damn important point.

Let’s think this through, using some other for-profits who operate in and around the non-profit advocacy arena as examples:

Change.org is a free service, used by millions of citizens.  But those citizens aren’t Change.org’s customers.  Advertisers (mostly non-profits and political campaigns) trying to cultivate new leads from among those active citizens are the customers.  Change.org provides a sleek user experience because more users = more business from their customers.

NationBuilder is not a free service.  It’s a CRM, used by thousands of campaigns and organizations, who in turn communicate with millions of supporters.  Those campaigns and organizations are customers.  The millions of supporters are not.  NationBuilder works to meet the needs of the campaigns and organizations that pay them.  If those campaigns want to send their supporters 50 emails per day, the supporters may hate it, but NationBuilder will make it possible.  That’s their job.

Upworthy is a free service for the millions of people who visit the site, or view their videos on the social web.  But those end-users are not Upworthy’s customers.  Allied organizations, who sponsor Upworthy curators in specific subject areas, are the customers.

That last example, Upworthy, is the most interesting one.  Upworthy doesn’t monetize through advertising.  And that has led them to track alternate metrics of success — “Attention Minutes,” instead of page views or unique visitors.  If Upworthy monetized through advertising, they would focus on maximizing page views and uniques.  That’s what pays the bills.  But Upworthy monetizes through convincing customers that visitors are deeply engaging, so they started tracking different things.

As Dan Ariely likes to say, “You Are What You Measure” (h/t Daniel Mintz).  And, as an obvious corrolary, your metrics are derived from your customer demands.

With all that said, I still don’t know what Brigade is going to be.  Right now, it has a big pile of VC money, and a lot of talented people on staff.  That’s a nice opening position.

But I find it troubling that the company’s President is referring to citizens as “primary customers.”  They aren’t the customers.  The advertisers are the customers.

Balancing the interests and needs of citizens and advertisers is one of the serious tensions that Brigade will need to navigate if it is going to succeed.  That’s hard to do.  And if Windon and company have a plan for it, they’re doing one hell of a job keeping it a secret.

 

Posted in Uncategorized

A Tale of Two Analytics Programs: It Really Matters What You Optimize For

Posted on by David Karpf

Steve Olson wrote a real barnburner at Medium last week, “DCCC, I’m ple