The Politics of Vaccination

Is the Key government pandering to people who oppose vaccination on principle?
by Gordon Campbell

To vaccinate or not to vaccinate? The issue bears a quite striking similarity to the anti-smacking debate, another controversy that got framed in political terms as a ‘parental choice’ issue, even though the prime concern was supposed to be what’s best for children. Now, as the vaccination controversy comes to the fore, conservative governments happen to be in power, on both sides of the Tasman. Yet for all the talk about Anzac unity…when it comes to vaccination, John Key and Tony Abbott are treating state compulsion and parental choice in very different ways.

Famously, Abbott has linked the receipt of state benefits to a requirement that beneficiaries must vaccinate their children. In Oz, the state is stepping into the parental role, but only with respect to the children of the poor. This policy is being reported worldwide.

Some definitional problems are now emerging, notably over the grounds on which an objection to vaccination can be exercised on religious grounds.

New Zealand has chosen to take a different tack, as Key explained at his post Cabinet press conference on Monday, April 13. When asked whether he planned to follow Abbott’s example, Key said :

In New Zealand, I don’t think it is necessary. 94% of children in New Zealand are vaccinated. The vast bulk of parents taken the important step to vaccinate their children, and I applaud them for that. But there should be an element of personal choice, because there is always a risk – its a very minute risk in my view [and] as a parent, a much greater risk if you actually don’t vaccinate your children. But if the state forced a child to be vaccinated and that child had a significant medical reaction and actually died as result – that would be a huge burden that the state would have put on those parents. So I think in New Zealand, we’re just lucky enough that the vast bulk of parents take the right steps, and the bulk of [children] are vaccinated.

What’s his message, a reporter asked, to parents who don’t vaccinate their children? Key’s reply was more of the same :

I’m not a medical expert, but the vast bulk of health evidence that I’ve seen strongly supports the view that you should vaccinate your children. And yes, while there is a minute risk that the child may have a reaction – potentially a serious reaction – there’s a far greater risk if you don’t immunize your child.

In passing, one would have to say that Key’s apparent re-assurance – ie, that 94% of New Zealanders do vaccinate their children – is actually not very re-assuring at all. Reason being, there are some infections – such as whooping cough, varicella and measles – that are so highly infectious that we reportedly need at least 95% of the population to be immune in order to prevent infections being passed on.

That is why there are still some outbreaks of whooping cough. If Key is right and only 94% are being immunised, we are already below that line overall – and since it is a national average, it means there will be pockets where non-vaccination is concentrated, and these will be falling significantly below that safety line.

Moreover, vaccination is not a failsafe procedure – in the sense that there will always be a certain percentage of those apparently immunized, for whom the vaccine simply doesn’t “take”. (This is an another reason for using the state’s powers and resources to press for full immunization.) Given the economic pressure to put toddlers – or babies – into daycare, the risk of infection and transmission are genuine, and are probably on the increase. At the risk of fuelling xenophobia, there is also a valid concern that migration from countries where vaccination programmes are (for obvious economic reasons) less widespread, will inevitably enhance the risk of transmission to those children who have not been effectively vaccinated.

For all these reasons, the medical argument for compulsory vaccination is quite strong. The political arguments are less straightforward. Interestingly, Abbott’s conservative coalition has opted for state compulsion of the poor. However, Key’s comments indicate that the health security of children (and of the community at large) weigh less heavily on his government than the personal freedom and conscience of the individual parent, even in the context of an admittedly minute risk from the vaccination procedure in question. This is an interesting contrast to Key’s stance on surveillance, where wider security threats to the community are held to justify an over-ride of individual freedom.

Key’s reasoning seems to be….however unlikely a serious negative outcome from vaccination is in practice, the mere possibility that a serious injury or death might occur must therefore trump any ‘greater good’ that can be shown to accrue from state compulsion. Readers can reach their own conclusions about the wisdom of that approach, at a time when social inequality is on the increase and the diseases of poverty are making a comeback. Also, a personal parental choice – I’m not going to vaccinate my kids – fails any moral test if (a) that decision exposes one’s own child to disease and (b) exposes other children to the risks of transmission.

Politically speaking, Key’s reluctance to embrace compulsion has two audiences – one poor, one wealthy. Currently, as Key pointed out at his April 13 press conference, beneficiaries retain the discretion to choose or reject vaccination for their children, without affecting their benefit entitlements. The segment of the wealthy audience that is opposed to vaccination is probably of more immediate interest to Key. Yet unlike Abbott, Key hasn’t laid himself open to the charge that he’s making only parents of the poor vaccinate their kids.

Why does this matter a lot ? Well, it matters because when it comes to vaccination it is rich, white people who pose the major health problem – to their own children, and to everyone else’s. Worldwide, the newest, staunchest opponents of vaccination tend to be wealthy white folk.

How come ? In brief, a libertarian philosophy opposed to state compulsion has become wedded to a suspicion of Big Pharma, and its vaccines.

A false and dangerous notion of “ purity” is being pursued. As Wired magazine found recently, the hostility to vaccination is disproportionately present among the disproportionately libertarian workers in Silicon Valley industries, and that’s evident in the daycare centres where they drop off their kids.

Here in New Zealand, it is much the same story. Recently, Werewolf reported on the relatively low take-up rate of the HPV vaccination programme (delivered through schools) for young girls. That’s despite the fact that the proven-safe Gardasil vaccine would drastically lower their risk as adults, of getting cervical cancer. Again, the studies done of this programme reveal a similar pattern of anti-vaccination prejudice among wealthier, white European parents whose children attend high decile schools:

Basically, the tables show that among low decile schools and among Maori and Pacific Island girls, the take-up rate of the HPV vaccine is very high, up around Australian levels. Conversely – and no doubt surprisingly to some – the vaccination programme has been less successful among white, higher income school communities, and it is the resistance from these groups that is dragging down the national average in New Zealand.

Politically, this is a group that Key does not wish to alienate, by introducing an element of state compulsion – no matter what the positive health outcomes for the parents and children involved may be, and even in a situation where as he readily concedes, the risks of non-immunisation vastly outweigh the risks associated with vaccination.

Why should this be the case? Here, we’re inevitably in the realm of speculation. Yet IMO, the evolution of the centre-right’s so-called “compassionate conservatism” has been fuelled by a cocktail of social liberalism and economic conservatism. Thankfully, the Neanderthal attitudes towards women and welfare recipients that used to be a hallmark of the National Party are simply no longer politically viable, nationwide. In New Zealand’s metropolitan electorates at least, almost everyone – Labour and National voters alike – is now a social liberal. Welfare ‘reform’ for example, is alleged to be a helping hand these days, and is not simply a cuff around the ears.

That may explain why on social issues to do with parental discretion, it is choice – and not compulsion – that holds all the trump cards. In Australia on the other hand, vaccination programmes tend to be dictated from above, and have been far more successful. The electorate in Australia has less truck with libertarian misgivings and as a consequence, both Labor and Liberal/Country Party governments have shown little hesitation in leading from the front on vaccination.

That’s not the case here. In this country, libertarian sensibilities have been well to the fore since the mid 1980s – and many New Zealand children have been paying the price in a variety of ways, ever since.