Vaccination Public Health and Health Autonomy

Jeff Golden

Vaccination Controversy 

It isn't about whether vaccinations are good. It is about whether we can make someone else have one.

Oregon State Senator Jeff Golden made news this week, by opposing the bill to tighten the requirements that Oregon schoolchildren be vaccinated against measles and other traditional "childhood diseases" in order to attend school.

By odd coincidence a Harvard classmate of Jeff's made news this week as well, Rob Restuccia, M.D. just died, and left a significant legacy of public health advocacy. He was Executive Director of Health Care for All Massachusetts, and of Community Catalyst, groups which spearheaded movements of health care advocacy, which went national from a Massachusetts base and helped pass the 2010 Affordable Care Act. His basis for public health access started with the notion of patient empowerment and autonomy.

Progressive Health Care Advocacy Group

Bodily autonomy and self direction was the policy intersection between the two men.

Restuccia believed that we have the fundamental human right to be empowered health consumers. The patient is the principal, the decision maker, in health care. Physicians and the health care system is their agent. The system serves the patient, not the other way around. 

Vaccinations. Golden ran into opposition from the community--including his Democratic progressive friends--for recognizing that notion of personal autonomy and empowerment when it comes to mandatory vaccinations. Political observer, technology entrepreneur, and Golden supporter, Charles McHenry, raised the question of why in the world Golden would back the anti-science opponents of vaccinations.

Nearly half of young students in Ashland schools have not been vaccinated, a public health risk, he noted. McHenry describes those risks and potential outcomes, observed from his personal experience as an RN dealing with Congenital Rubella Syndrome and other catastrophic outcomes from these diseases.

This isn't a matter of "personal choice," McHenry observes. The diseases are highly communicable, and some people in any community cannot protect themselves from infection by carriers and spreaders of the disease, including infants too young to be inoculated and people with certain immune deficiencies. Unvaccinated children spread disease and create innocent victims, including the children themselves when parents don't vaccinate them.

McHenry's commentary is published in full in Medium, where he asks "Is Oregon State Senator Jeff Golden Standing with the Anti-Vaxxers? :  Click: McHenry

Golden said he agrees with most vaccinations and indeed his own two children were vaccinated, but the issue isn't the value of vaccination. It is health autonomy. Whose body is it, anyway? It is simultaneously a civil liberties issue and a public health one.

From a civil liberty viewpoint there is the right to forego medical care and accept death with dignity; the right for a woman to choose what contraception to use and whether and when to bear children; the right of people not to endure sexual assault; and the right of people to keep private their own health information and DNA profile; the right of people to use alternative rather than "conventional" medicine.

Progressive politicians like those positions. They favor consumer empowerment and personal health and sexual privacy. They have also been associated with science and expert opinion, pushed in that direction by Trump's anti-intellectual right-populist attacks on "fake:" fake media, fake science, fake experts.

The issue gets muddled when it comes to vaccination.

There is a public health issue because these diseases are highly communicable, and when the innocent and helpless are at risk, the government routinely gets involved. We have an interest in whether the restaurant server carries typhoid, and whether a neighbor's septic tank works. We also take an interest in whether parents put infants in car seats. A drug abusing parent who is discovered to leave needles around the house can lose parental rights. A parent who doesn't vaccinate her children puts them at risk. 

The politics are all over the place on this issue, and they have reversed polarity, depending on the specific issue. 

In the early 20th century progressives demanded sterilization of the "unfit." Now they consider this an outrageous assault. They are the chief advocates for privacy for people carrying HIV or Hep C, yet they are also more likely the pro-vaccination group. It was Donald Trump who said vaccinations cause autism.

Meanwhile, we have not yet heard from the plaintiff bar. Sometime, someone in Ashland will carry a baby with a profound disability from one of these diseases, infected by someone who chose to risk getting measles, got it, and spread it.  It may be an assault, and a tort. Millions of dollars may be at stake.

This controversy isn't over.