Vaccination policy through Republican eyes

Vaccination policy through Republican eyes

The recent outbreak of measles in the USA has brought on an epidemic of Republican anti-science blathering, this time focused on vaccination. First we had Chris Christie saying measles vaccination should be optional, then Rand Paul putting his libertarian principles where his mouth is and declaring all Americans should be free to give each other smallpox; now the National Review Online has stepped into the fray with the rather contradictory policy advice that vaccination obviously works but should be voluntary (and thus, in the case of measles, almost certainly be rendered useless).

Vaccination policy is one of those areas that is ripe for Republican chaos. As the National Review observes, it involves “elites” (a perjorative deployed in this case to describe doctors) making decisions about what parents should do, and pushing for strong laws to ensure that everyone does what they’re supposed to. Like public education, it is only of value if the overwhelming majority of people do what the “elites” want. In this case, we can calculate mathematically what proportion of the population need to do what they’re told in order to prevent the spread of disease and, unfortunately for libertarians everywhere, the required proportion for measles and whooping cough is so high as to require even strict religious types and conspiracy theorists to obey if we want to prevent everyone getting the disease. This article from the Bulletin of the WHO makes the case for herd immunity, which in the case of measles requires greater than 95% of the population be vaccinated. Allowing parental opt-outs is going to rapidly get the proportion of children vaccinated below this threshold, especially in a society where many people can’t afford medical care. This is particularly likely for measles, mumps and rubella, since the Andrew Wakefield scandal has put the fear of God (well, autism) into parents in the UK and the USA, leading to precipitous falls in vaccination rates for these conditions. Indeed, the UK is now experiencing endemic measles after a long period of only having imported cases, and recent epidemics can almost certainly be traced to the cohort of children who were not vaccinated in the years after the Wakefield scandal. Elimination of these diseases requires strong pressure for all parents to vaccinate their children, and in rare cases these children will experience usually minor side effects. We all literally have to take one for the team, because those black-helicopter “elites” at the WHO tell us to. It’s a Republican’s nightmare.

But Republicans never used to be so fragile about science. This rash of equivocal statements from potential presidential contenders and their lackeys in the media is a new phenomenon. I have a feeling that the Republicans are lurching slowly towards a new orthodoxy of denialism, to add to their creationism and global warming denialism: anti-vaccination ideology. I hope I’m wrong, but I have a suspicion that this next denialist lurch is going to be inevitable given three potent forces driving modern Republican political ideology: populist anti-government rhetoric, potent sexual morals, and a virulent anti-science culture.

The modern Republicans are steeped in anti-science through their long association with the tobacco lobby, anti-environmentalism in the service of corporate interests, and their deep commitment to global warming denialism. US libertarian and right-wing politics is notable for its foolish fixation on DDT built on a foundation of false attacks on Rachel Carson, its hatred of the clean air act, its increasingly fantasist opposition to the science of global warming, and its strict libertarian stance on smoking. Indeed, the link between these ideological strands is hardly surprising given that big tobacco has funded the network of climate denial and anti-environmentalist organizations for years. But as this web of denialism expands, and newer activists grow up and learn their trade in a political environment that is suffused with not just the rhetoric of anti-science activism but also with a deep disrespect for scientists and the scientific process, it is hardly surprising that the Republican political world will become vulnerable to new forms of anti-scientific crusade. Many Republicans seem to be opposed to any form of scientific research, not just that which directly threatens business. How can we forget Senator McCain’s derision for a study of the DNA of bears? It’s easy to imagine that the post-tea party Republican party is easily fooled by anti-science rhetoric posing as scientific critique.

I think this toxic atmosphere turned its sights on vaccination science proper for the first time when the HPV vaccine was introduced, and vaccination got its full attention for the first time. This happened because the HPV vaccine is aimed at a sexually transmitted disease, that is only harmful to women, and in order to prevent this disease one needs to vaccinate girls before they become sexually active. Somewhat alarmingly for those in our community who want to pretend that their daughters are all good little girls, the policy therefore requires vaccination at a surprisingly young age, the implication being that good little American girls might be getting laid rather early. This immediately drew the ire of the sexually conservative wing of the Republican party and associated organizations like the Family Research Council. Initial objections were based on sexual morality, but it entered Republican politics during the primary season for the 2012 presidential election. By this time arguments against the HPV vaccine had become more nuanced, as for example in this National Review piece where the author tries to argue that HPV is different to measles because it is intentionally transmitted and rare (wrong!) and questions why only girls get it, as if this is some evidence of a sexual conspiracy by liberals (in fact this policy is followed because the science suggests it is sufficient to prevent cancer, and more cost-effective). However, in the modern world debates on health policy inevitably require some kind of scientific rhetoric, so by the time of this primary season Michele Bachman had found the spurious scientific objection that it causes mental retardation. In four years opposition to the vaccine had gone from a purely sexual-morality-based principle to a general scientific critique of the safety of the vaccine and the validity and necessity of the policy. All these “science”-based arguments are wrong, but how is a modern Republican to know? They have a kneejerk distrust of scientists and they are so negative about science that it’s hard to believe they would understand or accept any science they read. So of course people who want to object to the vaccine on principle but feel the need to cloak their opposition in scientific rhetoric are going to be willing to believe any rubbish they’re fed.

Finally, overlaid on this mixture of christian anti-sex moralizing and distrust of science we have the libertarian arguments about agency and control over one’s individual choices. For most moderns, health continues to be seen as an individual choice, and decisions about healthcare are things that we take for ourselves when we are sick. Vaccination policy is the exact opposite of this: it concerns actions taken with our bodies when we are well to protect others. It’s all too easy for libertarians to fall prey to conspiracy theories and bad science where vaccination policy is concerned because it just doesn’t sit comfortably with their ideology. So the trifecta is complete, and the entire ideological sweep of the Republican party is vulnerable to anti-vaccination claptrap.

If my theory is correct, then we should expect to see more of this kind of rhetoric as Republican primary season heats up, and we should also expect to see the typical Republican approach to undoing long-standing laws they don’t like: administrative procedures to make them too difficult to enforce, followed by court challenges rather than direct political debate. If we start to see that happen then I think we need to throw vaccination into the large and growing dustbin of sane and rational policies that have become too tough for the Republican machine to handle – along with gun control, universal health coverage, and global warming. Once they take the step to anti-vaccination denialism, what bridge connecting them to the science community is left to burn?

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