Parsing the Measles Outbreak

I don’t ordinarily venture beyond food allergies on this blog. However, the debate about how the current measles outbreak in California began and who is responsible for it has really caught my attention. I see debates about caretaking, responsibility, blame, and morality at play in the coverage of this outbreak – concepts which I’ve studied at length in the course of my research.

I’m not taking sides. I’m not trying to compare measles prevention and treatment to food allergies. I’m going out on a limb here because I believe the perspective I’ve developed as a result of my PhD research offers another lens on the measles issue. This debate is shaped by some of the underlying tensions that Americans grapple with in choosing and using health care.
Everyone more or less agrees that the measles outbreak has been made possible by a combination of falling rates of immunization and bad luck. From there, it becomes a proxy fight over who has the authority to decide whether or not individual children receive vaccinations. I see two divisions emerging: how risky measles is perceived to be, and who parents who have the final say over vaccination are responsible for protecting.

Division 1

The first division concerning the riskiness of measles is being couched by one side as a problem of public health and public education, and by the other as a cost-benefit issue. For people in favor of vaccination, diagrams showing the historical impact of measles and appeals to civic-minded Americans to protect their neighbors are the currency of the day. The intention is to “educate” the public about why they should vaccinate their children for measles. Vaccinating protects not only the individual, but also their vulnerable friends, neighbors, colleagues, and classmates through building up “herd immunity.” Vaccinating reduces the risk of illness and complications for all.

On the other side are those who claim there is a link between vaccination (often specifically the measles, mumps, and rubella vaccine) and autism. For these folks, the question is one of balancing risks. Is measles – once a common childhood disease – really so dangerous that it’s worth risking autism to be vaccinated against it?

(Often lost in this back and forth is a key set of voices: those with autism who assert that life with the condition is really fine and no cause for panic.)

Division 2

The second division about who parents are responsible for protecting is often cast as a struggle between well-informed, moderate-to-liberal citizens who look out for their neighbors and right-wing, science-deniers who put their individual well-being above that of everyone else. As this outbreak has revealed, it’s actually much more complicated than that. Vaccination decisions don’t map neatly onto political beliefs, as suggested by the fact that politically liberal regions of the western US like California and well-educated north shore Chicago have some of the lowest vaccination rates – and have become epicenters of the epidemic.

What I see at issue with this dimension of the debate is this: Who has the authority to decide whether and how to vaccinate young children? One view is that medical professionals have this power because of their deep and extensive knowledge of human biology and the effects of disease. Their knowledge gives them the ability to accurately assess and compare the risks posed by the disease and the risks posed by the vaccine. An intermediate view is that doctors know a lot, but parents have the right to make the final decision. In making this decision, they will gather as much information as possible, from both orthodox and unorthodox sources of authority. Ultimately, they will probably side with the physician but might change the timing or order of shots.

A third view consists of people who are, for one reason or another, skeptical of medical authority. There are all kinds of reasons to be skeptical of medical authority: a commitment to the idea that individuals ought to have absolute autonomy when it comes to deciding how to care for their health and body, a preference for religious or cultural authority over scientific authority, a wariness toward the medical profession rooted in its complicity with the historically racist social and reprehensible military policies of the United States. No matter the cause, this final perspective presumes that medical knowledge is untrustworthy and ought to be considered just one more (possibly the least) among many sources of information. Vaccination, in this view, is entirely the choice of the individual getting vaccinated and their caretakers.

Take-aways from a social science perspective

So that’s my take. Two dimensions: one dimension which questions which is a bigger risk, measles or the measles vaccine, and one dimension the represents a spectrum of ideas about the balance between medical authority and personal autonomy. These are distinctly American preoccupations with the world that meet in a specific, modern way. We are used to making decisions based on cost-benefit or risk-reward analyses. These ways of thinking demand that we balance danger with reward, present comfort and future benefit. We’re taught this from a young age – from the first moment we’re taught to save up our coins today in order to get a bigger reward tomorrow.

We’re also taught to think about social conflicts through a lens of rights. Having inalienable rights, we’re taught, is the feature of American life that sets us apart from everyone else. Yet most of us are also socialized to give up those rights in limited circumstances to support the greater social order and greater good. We learn not to speak over others and not to swear in public despite having a “right” to free speech. We make decisions about our physical well-being and our financial futures based on the input of professionals, despite having an extensive legal right to do as we please with that first and last piece of property we will own, our bodies.

Vaccines are a key battleground for both of these issues today. They require us to think beyond an individual framework of risk to think about the risk we pose to our communities, and that our communities pose to us. They reveal to us the fact that medical professionals are duty-bound to act as agents of the state when they inform us what we must do to our bodies to participate in civic institutions like public schooling. These things are uncomfortable sometimes, and people find ways to opt out of a system which can be experienced as coercive while providing little immediate, tangible benefit at an individual level.

There’s more to say – there always is for an academic – but I’ll leave you with that.

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