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It so happened that I was preparing an introduction to an anthology of the writings of Edmund Burke when I read an article in a recent edition of the New England Journal of Medicine with the title “Social Distancing and the Unvaccinated.” One of Burke’s main contentions, at least according to me, is that politics are, or ought to be, more than the application of abstract first principles to practical affairs: and, as if to prove him right, along came this article.
The question was this: if it is permissible for parents to refuse to have their children immunized against preventable childhood diseases, does the state have the right, through one or other of its agencies, to exclude those children temporarily from school or other social institutions if there is an epidemic developing?
This question can be answered neither by a single abstract principle alone nor by appeal to scientific fact. The matter is complex, and on this occasion arose in the context of an outbreak of measles in California that soon spread and was in part occasioned by a reduction in the rate of immunization against the disease consequent upon the fraudulent activities of Dr Andrew Wakefield, a British doctor who claimed falsely to have discovered a link between the measles, mumps and rubella vaccine and the development of childhood autism.
In addition, two sets of parents in New York legally challenged the exclusion of their children from school because they were unimmunized against chickenpox after an infected child was found in the school. The article did not make clear whether the exclusion was primarily to protect the unimmunized children themselves or others in the school, or both (no immunization conferring 100 per cent immunity, and the more cases encountered the greater the likelihood of spread).
Scientific considerations are relevant to, but not probative of, any answer. The article, strangely, made no mention of the fact that parents’ rights, which we all accept within quite wide limits, nevertheless may impinge on those of their children, for example that to life itself: in which case parents’ rights have to be, or at any rate are, overridden.
If the parents’ decision not to immunize were one of life or death, either for their or other children, most (but perhaps not all) people would agree that their say in the matter should not count. But in fact it is rarely one of life and death, but rather one of transient illness with very occasional severe complications. Just how great is the risk of the latter is dependent on factors other than the parents’ decision not to immunize: measles is much less serious a disease in rich than in poor countries, for example. Moreover, some questions, for example, how long it is necessary to socially distance (Orwellian phrase) children in order to abrogate the risk of spreading may not be completely answerable in the current state of knowledge.
How many days off school for one child equal the risk of contraction of a mild illness by another? There is no way of answering this question except by the exercise of judgment in particular circumstances. This is precisely what Burke would have predicted: what we decide cannot be determined by appealing to conflicting rights alone, the more fundamental of them prevailing. Sometimes one will prevail, sometimes another; there is no way of making politics a matter of such accurate calculation that no faculty of judgment, with its permanent possibility of error, will ever have to be exercised.
The article focuses on religious objectors to immunization, but they are probably outnumbered by Californian-style cranks, paranoiacs and believers in all you read on the internet.
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