Bishop: Hitchhikers Guide to Vaccine Mandates

Thursday, September 03, 2015

Brian Bishop, GoLocalProv Guest MINDSETTER™

 

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PROSSER: “But Mr Dent. The plans have been available in the local planning office for the last nine months. . . .

DENT: . . . On display? I eventually had to go down to the cellar to find them.

PROSSER: That’s the display department.

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DENT: With a torch.

PROSSER: The lights had probably gone out.

DENT: So had the stairs.

PROSSER: But look, you found the notice didn’t you?

DENT: Yes, yes I did. It was on display at the bottom of a locked filing cabinet stuck in a disused lavatory with a sign on the door saying beware of the leopard.

Douglas Adams, The Hitchhikers Guide to the Galaxy

You would think in these days of the internet, that simple information about proposed government action wouldn’t be essentially covert, and Adam’s tongue in cheek treatment of bureaucratic process would be more notable for its hyperbole. The latest episode of bureaucratic misstep with the Human Papilloma Virus, HPV, vaccine mandate leads rather to the conclusion that the faceless unresponsive bureaucracy that wished to bulldoze Arthur Dent’s house (and its metaphorical alien equivalent that bulldozed earth out of existence) in the cult novel is alive and well.

Facebook outstrips “public notice”

If government really believes in the power of information and transparency, it is difficult to understand how the Rhode Island Department of Health could notify “interested parties” of their intended mandates and had 3 people show up to testify while a facebook group recently formed to oppose their mandate quickly gained 2400 members. Did it occur to anyone to ask that schools send home notice of pending regulations to parents? Or did it rather seem that such outreach was only likely to stir up a hornets nest around action the Department had already decided to take; and had no intention whatsoever of altering course regardless of any constructive criticism at the hearing.

The Politifact franchise in Rhode Island had the gall to characterize this sham hearing with 3 participants as public debate. If this proposal really received public debate, did the 2400 people who joined the facebook group opposing this mandate just move to Rhode Island? Or perhaps they all changed their mind since the “public hearing”. 

Science is not policy

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The Department of Health does not appear to be wrong on some central contentions about the disease and the vaccine: that there is an epidemic spread of  HPV (32% of women showing exposure, 12% of men who are less easily infected) ;  that it is implicated as the cause of the vast majority of cervical cancer and 5% of All cancers; that the vaccine is safe in the near term (no more adverse reactions than other common vaccines although long term studies are not available for this relatively new vaccine); that the vaccine is effective, aimed at strains of the virus associated with cancers, and its widespread administration correlated with a reduction in HPV prevalence (although its long term effectiveness is unknown and the possibility that HPV strains not targeted may ultimately exhibit carcinogenic character remains open).

But unless you are a tin-eared technocrat or a tin-pot dictator, such knowledge is not justification for mandating that the vaccine be administered to children. That is an exercise of the state’s police power – one from which it is retreating in this case – allowing public characterizations of the mandate as ‘more of a suggestion’ to stand. 

Mandate or Suggestion?

This is, of course, absurd. If there are safe and effective vaccines for contagious diseases that can be easily spread in the close contact of a school environment, mandating them for school attendance is rational. This does not mean that sincere issues of conscience and rare medical contraindications may not constrain a few individuals from vaccinating their children for measles or chicken pox. But to deliberately espouse a public policy of treating such exemptions as free for the taking undermines any real police power prerogative for mandating in the first place. Not to mention that some parents may feel wrong claiming a “religious” exemption when what they have is a philosophical disagreement with the regulation.

This mixed message is clearly being sent by RIDOH to defend their missteps on HPV. This is a silly bureaucratic habit of CYA -- instead of admitting they were wrong to conflate epidemic prevention in the school setting with an important discussion parents currently have with their children’s doctors. The American College of Pediatricians recommends its members offer the HPV vaccine to children beginning at 12, but does not believe it should be mandated. 

School exclusions necessary?

RIDOH wants it both ways on whether school immunization requirements should focus on preventing outbreaks in schools or serve larger public health goals. Lately they hide behind the notion that this mandate for vaccinating against a disease seldom ever transmitted in school is nothing new. RIDOH maintains it has always used the school exclusion cudgel to force parents and doctors along certain lines, for instance requiring a Tetanus vaccination – another disease not spread in schools, although it could theoretically be contracted from an injury suffered in the school environment.

But, in responding to the ACLUs objections from the January 16, 2014 hearing, the Department insists otherwise: 

“Excluding children from school is always a last resort. Rhode Island has programs in place that allow any unvaccinated child to be vaccinated at no cost. However, there are instances in which the exclusion of a child from school is necessary to protect that child, his or her classmates, and school faculty and staff. And while an exclusion may negatively impact one student academically, a disease outbreak can disrupt the learning of entire school communities.”

This is completely unresponsive to the ACLU criticism it proposes to answer, that excluding a child from school for failure to be vaccinated against a disease not prone to transmission at school is arbitrary.

Not only were these responses inadequate, but the regulations themselves aver that RIDOH couldn’t think of any alternatives. Really. With a voluntary private relationship between doctors and parents, Rhode Island has the highest youth HPV vaccination rate in the country, about 50%. 

One might suggest that, despite this success, it illustrates that only a mandate will get us the rest of way if that is as far as the ‘most enlightened’ state can go. Not only is there no evidence in the record for such a claim, but it forgets that mandates are not the only way to increase vaccinations. While free vaccines are available, that doesn’t mean they are offered in a way that is convenient, reassuring or gets buy in from parents. And, for that matter, higher vaccination rates are not the only alternative to preventing transmission of the disease.

Did anyone win the Sexual Revolution? 

Perhaps were the sexual revolution a little more bashful of its accomplishments we might recall that abstinence is an alternative -- indeed a medically preferable one because the vaccine does not prevent all strains of HPV and all associated cancers. But RIDOH didn‘t find that teaching abstinence wouldn’t be effective enough. Rather it found “no known alternative”.

This is the kind of sloppy process that creates an opening for the fervent anti-vaccination crowds to capitalize on a requirement that is unnecessarily intrusive into the family. Somehow, we have so conceded defeat in the arena of human sexuality that the government wants to take that option of self control off the table. 

Certainly it is reasonable to understand, whether as a matter of Christian doctrine or simply human nature, we are often fallen beings with regard to such aspirations. But should we so readily discard them? The very history of human consciousness has been to overcome immediate instincts for longer term outcomes and satisfaction, if haltingly and imperfectly.

Parent’s decision

These are certainly values that some still wish to embrace. They are not mutually exclusive with vaccination but where parents see a mixed message and potentially a failed teaching in taking both courses at once, they should not be forced to claim a religious exemption. They are making a difficult parenting decision as free people. Paternalism can be appropriate in the family setting but not the government one.

The obvious questions here are ones of meaningful process. The height of meaningless process was reached when Holmes writing for the Supreme Court in the case of Buck v. Bell approved eugenic procedures, because a hearing had been held, with the dismissive retort “Three generations of imbeciles are enough”. 

Any responsive, transparent agency would cease to cling to such poorly executed formalities as the January 2014 hearing that has lead us to this point, scrap this HPV mandate and start over.  

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Brian Bishop is on the board of OSTPA and has spent 20 years of activism protecting property rights, fighting overregulation and perverse incentives in tax policy. 

 

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