The Oingo Boingo fan immediately responds, “NO SPILL BLOOD!”
That’s not what I’m going to talk about today, though. I’m going to be talking about some other laws.
First, The Law of The Instrument. In the book, “The Psychology of Science”, written back in 1962, Abraham Maslow famously said, “When the only tool you have is a hammer, it is tempting to treat everything as if it were a nail.”
Second, The Law of Unintended Consequences. Often times in complex systems, an action has unforseen reactions, due to the layering of dependent variables.
If you ever run across one of those silly internet tests that attempts to tell you what your political affiliation is, you may be surprised with the results. I’m still looking for a good one, because whenever I take those tests it invariably tells me that I’m a Liberal, and yet I find myself arguing with Liberals at least as often as I find myself arguing with Conservatives. This recent discussion over at Phil’s blog is a perfect example of the sort of proposition that is usually supported by liberals with which I disagree.
The question at hand, for those who don’t want to read the entire screed is, “Should vaccinations be mandatory?”
(I’m really verbose on that particular thread, which is one reason why I haven’t been blogging recently on my own blog)
Now of course, you’re getting the standard votes of “no” for the standard reasons. The Slippery Slope (“Nanny State!”) The Religious Freedom argument, and so on. Of course, you’re also getting the standard “yes” votes, for the standard reasons. Nobody’s actually interested in the *first* question anyone should be asking, which is, “is this practical?”
From a philosophical standpoint, the question of individual freedom vs responsibility to the community is a question that is never going to go away. It’s certainly well advised to have these discussions, I’ll grant you . [edited to add] For the record, I agree with Janet; people who don’t get vaccinated are rightly categorized as free riders. [/edit]. However, if we’re going to be discussing one of the central, weighty issues concerning human societal structure, perhaps we ought to start with those questions that actually have a reasonable chance of being worthwhile.
As I argue over at Phil’s place (and also at Janet’s and at Jimmy’s), a government-enforced mandatory vaccination program is going to be expensive. More importantly, most of that money goes directly to overhead.
See, audit is by its very nature very inefficient. What you are attempting to do, in any audit process, is verify that something has happened. This has several design considerations. For starters, you need to recognize that if you’re auditing a process that is infrequently bypassed, *most* of the time you’re pouring money down a hole. For the parents out there, here’s a humorous example: when you’re potty training, your toddler is somewhat likely to have accidents. Therefore, when you take off the diaper and go with underpants, you’re going to spend a certain amount of time checking with your toddler fairly frequently. “Did you go to the bathroom?” “Do you need to go to the bathroom?” “I think you need to go to the bathroom.” “Honey, before we leave, I want you to try and go potty.” In frustration alone (if you have a headstrong child), this can be a taxing process… your payback comes because you avoid cleaning up a mess in public.
However, once the child gets the gist, you don’t bother auditing them anymore. They voluntarily go potty on their own. You might have an occasional accident, but the occasional accident happens so infrequently that it’s simply no longer worth your while to constantly badger your toddler to go to the bathroom (unless of course you’re a control freak, but then you’re going to have slightly messed up children, and that’s a topic for another post altogether).
Enforcing government mandated vaccinations is a very costly proposal. Some of the questions you need to consider (dragged from my commentary over at Phil’s) include:
- What behavior are we trying to enforce?
* A full vaccination schedule? Partial?
- Who decides what’s on the list?
* The CDC? How often to they revisit the list?
- Who are we covering?
* Just school-age children? Infants? Adults?
- How many of them are already doing what we want anyway?
* In which coverage windows?
- How do you propose that they prove their compliance?
* Required to… enter public school? What about private schools? Daycare? Drive a car? Register to vote? What are your avenues for authorization?
- How do you propose that we trust the authorization mechanism?
* Who can sign off? Doctors? EMTs? Nickel clinic workers? How do the people who *check* the authorization actually check it? Do they check a doctor’s signature against an authoritative database? Is there a physician ID number? Who has access to this information? How do you secure it? How do you ensure that FERPA, HIPAA, and other privacy regulations (in the case of the U.S.) are followed and enforced?
- How do you have a reasonable audit?
* You must assume that in the above there are going to be people who attempt to circumvent the process. Your audit design must therefore incorporate every weak part in the chain to a suitable degree, and in the above there are thousands of venues. How do you make sure that doctors are legitimately signing the forms? How do you make sure that school clerks who don’t believe in vaccination aren’t just rubber-stamping forms out of a sense of political freedom? How do you prevent fraud? How do you prevent forgery?
- How do you enforce the audit?
* What is your penalty system when people circumvent the process? Do doctors lose their license? Do you expel children, so they’re now uneducated and unvaccinated? Do you revoke driver’s licenses, so drivers now can’t get insurance? Revoke licenses for professionals?
Now keep in mind that most people vaccinate already (of course, there are communities of non-vaxxers, but we’re talking about universal policy here, not fixing the outliers)… so all of the above checking, auditing, authorizing, with all of the attendant red tape, paperwork, and frustration is being borne by all those people who vaccinate voluntarily to no benefit. We’re not even considering legal costs, legislative costs, etc. involved with getting such an initiative on a ballot and past the inevitable court challenges.
Whatever you believe that is going to cost per capita (and keep in mind, there’s 80 million children under the age of 19 in the U.S. – thanks to Jimmy for checking my numbers there – and 306 million people), that’s going to wind up being a pretty big chunk of change. The NIH funds cancer research at the National Cancer Institute to the sum of $660 million dollars (in 2007). Cancer kills a half a million people every year. If you’re going to convince me that this audit process is going to be worthwhile, you’re going to have to convince me that spending all that money is a better idea than just taking the lump sum and transferring it wholesale to the NCI.
Or better yet, give the money to the NIH or the CDC and ask *them* how they think it ought to be spent. I bet dollars to donuts anyone who works at the CDC would recommend spending that red tape money on buying vaccinations for those that can’t afford ’em before funding red tape.
Dr. Paul Offit, director, Vaccine Education Center, and chief, Division of Infectious Diseases, Children’s Hospital of Philadelphia (CHOP) penned an editorial in 2007 in the WSJ that indicates that it’s likely he’d disagree with my last paragraph. Then again, perhaps not; I don’t know that anyone has ever offered him a few hundred million dollars and asked him to choose between research or enforcement. It would be an interesting data point in the argument, though. The existing mandatory vaccination laws in the U.S. (for public school or daycare entry) do have a demonstrated reinforcement value, which is not considered above (that is, many people might otherwise vaccinate but forget or are lazy or what have you… and the existence of these laws reminds them that they need to get their vaccinations) – thanks to Jimmy for those links.
Now, that may or may not indicate that the existing laws are an effective mechanism, but I’ll grant that point – the reinforcement value alone appears to be pretty significant. I’m not suggesting we change the status quo. I don’t think this is necessarily compelling evidence that major changes to the existing laws (covering home schoolers, or extending mandatory vaccination requirements to adults) are going to be effective, however. The low hanging fruit aspect means that every additional person you want to compel is going to require that much more in the way of audit and enforcement, so the existing mechanisms are not likely to scale in a linear fashion.
The law is a good venue for fixing a lot of societal problems. It is generally, however, very bad at efficiently auditing any behavior… if you can find a good counterexample feel free to leave it in the comments, but on the whole government audit processes of public behavior tend to spend lots of money and not substantially alter citizen behavior… the “War on Drugs” is the poster child for this.
Don’t think the law is your only tool. Then your only response to behaviors you don’t like is to criminalize it. This usually doesn’t fix your problem.