Things You Are Unlikely To Make Me Understand, No. 492

Let me get this straight. Republican Presidential front-runner Rick Perry is catching heat for mandating that girls get vaccinated against the human papilloma virus — not because he awarded the contract to a crony political ally, but rather because it encourages premarital sex? And faced with that kind of heat, he’s backpedalling?

HPV causes cervical cancer, and those girls were going to have sex, or not, regardless of whether they got the vaccination. The only possible objection to the vaccination I can think of would be the cost, and the cost of vaccinations today is dramatically less than the cost of cancer treatments tomorrow. Vaccinations are good public policy and even for the most libertarian amongst us, this has to be at least eligible for consideration under the “E.D. Kain’s campfire category” of situations when government activity makes sense:

… campfire bans may seem like a terrible affront to personal liberty, but in a bad drought with high winds, lighting a campfire that soon turns into a wildfire that burns homes and cattle and wilderness lands strikes me as much worse.

As for the cronyism, at the time that the contract was awarded, the company to whom the contract was awarded had the only approved vaccine. Maybe there was competition coming down the pipe* soon; the question, though, is whether it’s a good idea or not to immunize your children from a disease. The answer to that question is so blindingly obvious it ought not to warrant sober consideration.

Of all the things that Rick Perry could be criticized for, this is one of the most insane yet.

* That’s for you, Tim.

Burt Likko

Pseudonymous Portlander. Homebrewer. Atheist. Recovering litigator. Recovering Republican. Recovering Catholic. Recovering divorcé. Recovering Former Editor-in-Chief of Ordinary Times. House Likko's Words: Scite Verum. Colite Iusticia. Vivere Con Gaudium.


  1. The size and ferocity of anti-vaccine champions was one of the things that I was truly caught off guard by as new parent 15 years ago. I think until this election cycle I had thought that this nuttiness was a predominantly liberal thing.

    Is that just because of where I live, or has the right fringe started adopting from the left fringe?

    • This nuttiness is a predominantly liberal thing. But I think that’s a correlation right now, not a causal thing.

      • I believe it’s quite causal. There’s a hippie element to opposition to Big Pharma and the Medical Establishment. There are elements of the right that are also skeptical, but (outside of policies mandating it) it’s more left than right and I think at least some of it is attributable to worldview.

        • … yes, but the f*ckers running the anti-genetic engineering stuff tell their tamed wolves to back teh fuck off things like “yellow rice.” There’s rational dislike for things, and then there’s “we’re going to break everything just cause”

        • > There’s a hippie element to opposition to
          > Big Pharma and the Medical Establishment.

          Sure, but there’s also a red-state element in opposition to Big Brother and the CDC.

          Hippies are hippies, granted, and lots of ex-hippies vote Blue. But lots of things about hippies that make them a fringe element of Blue are tied to their antivaxx nonsense.

          I mean, scientists are generally liberal, and very few scientists are into The Woo. So the antivaxx thing can’t be directly tied to liberalism, as it’s clearly orthogonal to another largely-liberal leaning subgroup of liberals.

          • If your argument is that anti-vax is not inherent in liberalism, I agree. But it’s related beyond mere correlation, is my main point. The anti-vax views don’t merely correlate, but are part of the same worldview that leads them to be liberal in the first place.

            Maybe “causality” isn’t the right word, but there is an… interrelatedness. Stronger with liberalism itself than with the Democratic Party, which smartly distances itself from this nonsense.

          • Oh, sure, I think we’re on board with each other, really. Just clarifying.

    • More like the right is using a handy club for a bigger argument against mandatory vaccinations that relate to teenagers having sex. The fact that the timing coincided with the insurance mandate also makes it more topical.

  2. Perry isn’t really “backpedaling”. What he said was “maybe I shouldn’t have overstepped the authority of my office, and should instead have gotten the legislature to do this, because it’s really their job instead of mine.” It’s not like he’s saying “oh wait, I guess nobody should get the vaccine after all”.

    • Give him time. The anti-vaxxers are a measurable constituency.

      Many/most of ’em are independents and Democrats, too.

      • … if only because autistics tend to crop up with uppermiddleclass professional parents. People are still idiots, even if they’re democrats.

        • > autistics tend to crop up with upper- middle-
          > class professional parents.

          No, Autistics tend to be diagnosed when their parents are upper- and middle-class. There’s a subtle difference there.

          There is some evidence that autism is causally linked to socioeconomic status, but it doesn’t outweigh the current evidence that it’s just a correlation (at least, in my opinion).

          Gillberg C, Schaumann H (1982) Social class and infantile autism. J Autism Dev Disord 12: 223–228.

          Steffenburg S, Gillberg C (1986) Autism and autistic-like conditions in Swedish rural and urban areas: a population study. Br J Psychiatry 149: 81–87.

          Newschaffer CJ, Croen LA, Daniels J, Giarelli E, Grether JK, et al. (2007) The epidemiology of autism spectrum disorders. Annu Rev Public Health 28: 235–258.

          Fombonne E (2003) Epidemiological surveys of autism and other pervasive developmental disorders: an update. J Autism Dev Disord 33(4): 365–382.

          • Isn’t there some evidence of a link between parental age and autism? If so, it does seem likely that it would affect the well-heeled with greater frequency, since they tend to wait longer to have children.

      • I’d like to see an actual argument beyond “Republicans are fucking bastards”, please.

        • Why? Looking over the past thirty years, politics has been easy to explain. Republicans are bastards, Democrats are pussies.

        • I’d like to see an actual argument beyond “Republicans are fucking bastards”, please.

          OK, how about, “Republicans have long been fucking bastards, but over the past 15 years they have become insane fucking bastards”?

          • I think you need to check your balloon; the juice is leaking out of it.

          • No, jokes and wise-ass remarks are encouraged here. Well, at least they are when they’re funny.

            The wise commenter uses humor judiciously, though, because it is often mistaken for more sober sorts of commentary. When you get to be an advanced-level online humor-user like Jaybird you’ll have mastered the rules and everyone will instantly know when you’re being funny (or at least trying to be) and when you’re being serious.

            Until then, it frequently pays to be cautious.

  3. I don’t think I’ve ever heard a Teenager utter “Well now that I’m vaccinated against one of a few dozen STD’s, most of which will lead to scaring, blindness, impotence, complications, never mind the latent risk of pregnancy should my birth control fail… well based on that vaccine to ONE of them I think I’ll go have sex.”

    To a degree I will give Anti-Vaxxers some leeway for being “nervous” about giving their kids cocktails of weakened viruses so that their immune systems can bulk up for the real thing. I mean even in Military War games, people get injured; no reason to think that doesn’t happen in our bodies.

    However. To say “no” because it “encourages pre-marital sex”? Really?


    Speaking of.. don’t we all know that the only kind of sex ~IS~ premarital? Or am the only married man here?

    • Speaking of.. don’t we all know that the only kind of sex ~IS~ premarital? Or am the only married man here?

      Sorry to make you feel even worse, but fortunately your experience is not universal.

  4. “Speaking of.. don’t we all know that the only kind of sex ~IS~ premarital? Or am the only married man here?”

    This reminds me of a quote from a friend of mine over beers, who told me “When we were dating I used to have to say ‘I love you, come on baby, please’ before sex. Now I have to say ‘OK, but we need to hurry, halftime’s almost over.'”

    • I have never understood why people who disapprove of gay sex also oppose gay marriage.

  5. Burt,

    I oppose the mandatory HPV vaccination because I generally oppose the nanny-state. I don’t think this falls in the “campfire” category.

    But a person can hold that contrary view and still support an extensive government-funded educational campaign and citizen-led public shaming of parents who don’t vaccinate their kids.

    So it’s not necessarily an “either government does it or it doesn’t get done” situation.

    • But the thing is that mandatory vaccinations aren’t a nanny state thing, they’re a common good thing.

      Take something highly communicable like Small Pox. You have four classes of people:
      a) those that chose to be vaccinated
      b) those who get vaccinated but the vaccine who does not work on
      c) those who cannot be vaccinated due to likely complications
      d) those who willfully chose not to be vaccinated.

      Now suppose I’m in group b. I did what I was supposed to do, yet I’m at risk if I’m exposed to the vaccine. This is ~not~ my choice. If I get ill I become a burden on society in some way either through my insurance or through some other program to get me treatment. Likewise I’m not working and I’m not producing and I’m not contributing.

      Now, suppose you are in group a. That means that I cannot get Small Pox from you. You’re vaccinated. You can’t have it.

      Because I’m in group b (or group c), I’m forced to bank that the people around me are in group a to keep me from getting exposed. If Bob, way over there, has small pox, then I’m, literally, putting my life in the hands of those around me to be vaccinated. And this is more pressing with small children who are in group c and simply can ~not~ be vaccinated due to their age.

      But if you’re in group d, and you shake hands with Bob, and then shake hands with me, then we’ve got 3 people with Small Pox rather than just 1. And more importantly I didn’t do ~any~thing wrong. I did my duty! I got vaccinated. The failing was on ~you~ for not.

      I agree that there should be more invested in education but if my son is in group c, why should I risk him encountering a kid of a parent who simply doesn’t care about the shame factor and instead is happy to expose my child to a deadly disease because of their own misguided sense of self-righteousness?

    • Just to add to A Teacher’s point, herd immunity is a useful tool in efforts to eradicate communicable diseases. Without mandates, a small percentage of the population could stop efforts to eradicate measles for instance. When the aim is to eliminate an infectious disease, why should that minority have such disproportionate power over the majority?

    • Analogy fail. Smallpox and HPV aren’t transferred in the same way. If you have smallpox and I am not inoculated against it, I can get it from you simply from face-to-face contact or even by inadvertently coming into contact with items you have infected–I don’t even ever have to have actual contact with the carrier. So it’s very easy to get unwittingly.

      HPV, on the other hand, requires a much more serious commitment to close contact with an infected person, so it’s quite easy to protect oneself.

      But I also notice this, particularly in Creon Critic’s reply; that the first instinct is to coerce people into getting the innoculation, rather than to offer them remuneration for it. That’s one of the offensive things about liberalism–not that it makes use of the government for ends that are good in themselves, but that it consistently insists upon doing so in the more morally dubious fashion. In that behavior liberalism really isn’t very distinguishable from conservatism; only the ends themselves differ, while the means are the same.

      • Two points. The mode of transmission is the key factor for you? So while not for HPV, for measles a vaccination mandate would be ok?

        Second, government should pay citizens to be vaccinated? I understand providing the vaccination itself for free, but authorities should pay the individual to protect public health? Did I misunderstand what you meant by “offer them remuneration for it”?

        I suspect any discussion of so-called first instincts won’t go anywhere productive, so I’ll leave that alone.

        • Creon,

          Absolutely the mode of transmission is a factor for me. The more easily spread a disease is, the more justification there is for more invasive measures. A disease that spreads more easily is less easily avoided by the innocent bystander, whereas a disease that spreads much less easily is much less likely to harm an innocent bystander. Potential for harm to the innocent is one of the classic justifications for government action. The disparity in ease of transmission of smallpox vs. HPV is substantial and significant.

          Where we draw the line on such things is endlessly arguable, of course, and I can’t really object if you draw it in a different place than I do, since we’re both making fairly subjective claims about where it should be drawn. But I don’t think you can honestly say that the difference in transmission doesn’t matter. To take an extreme example, kuru is a degenerative brain disorder caused by cannibalism. If we had a vaccine for kuru, would you recommend mandatory inoculations? If you say, “no, that’s crazy,” then you’ve admitted my basic point about transmission mode mattering, and we’re just arguing about where to draw the line, which is a perfectly legitimate debate.

          As to paying people, yes, I mean that. When we turn to government for solution it seems our first instinct is always to reach for a stick instead of a carrot. If something is truly so tremendously beneficial (and I agree that eliminating or at least reducing HPV transmission is), it is worth paying for.

          We know that paying people to do things frequently works better than punishing them for not doing thing (read all the parenting literature on positive v. negative reinforcement), and yet when it comes to public policy, so often we get hung up on, “they should do it just because it’s the right thing to do, so let’s punish them if they don’t.” My preferred approach is to ask, “what is the most effective means of getting people to do X,” and “what is the means that actually does get people to do X that is least invasive of their personal autonomy.” The answers to those questions don’t always match, but sometimes they do.

          As to first instincts, this response is definitely not that for me. I came to a more libertarian approach via a fairly left-wing position (I’m both proud and faintly embarrassed to note that I’m a former Green Party voter). I also have three daughters, and am quite personally concerned about the potential for sexually-transmitted diseases, and the oldest of whom we had vaccinated for HPV as soon as was appropriate, and for the others we’ll do the same. It wasn’t necessarily an unfair suggestion, though, as long as you also consider whether it possibly applies to yourself. I can’t speak for you, obviously, but for many liberals I’ve known, group interest over individual interest is definitely a first instinct.

          • Well it is true, small pox is a much easier to transmit disease. I’m not sure I’d categorize it as “Analogy fail” because at the core of it, Herd Immunity is critical for any population. It’s also worth noting that the current infection rates of HPV are insanely high. Some websites (which I admit are not always accurate) suggest that 80% of women will be exposed/ by age 50 ( Those rates strongly suggest that while it’s not as transmitable as small pox, the likelihood of exposure is incredibly high.

            I question paying people to do something necessary for the common safety, when they also get a benefit as well. If the vaccine is offered free of charge then they are getting “paid”. They’re getting a vaccine against an STD that is directly linked to a deadly form of cancer. Seems like a benefit attached there.

            I just found out that my wife and I are having a girl. I would love for her to grow up in a world where HPV isn’t a factor for her to consider.

          • James, thanks for this thoughtful reply, I appreciate it.

            I take your point about approaching public health concerns with carrot-oriented solutions. But I think it avoids the hard cases, those who are steadfastly refusing vaccination in the face of advice from medical authorities (e.g. Jacobson v. Massachusetts). Perhaps I am too ready to brand these cases as akin to medical neglect and proceed with lofty public health goals. The goal of eliminating a disease seems so important that an individual’s poorly founded objections to vaccination do not resonate with me. I realize my scenario has the individual making an unfounded argument about vaccination and not expressing a scientifically worthy concern about actual harms; as far as I understand, vaccination skeptics’ objections to MMR are completely wrong. As much as I want to respect everyone’s autonomy, to me, disease eradication via vaccination swamps otherwise perfectly legitimate concerns about coercion.

            Lastly, with respect to the idea of a government-funded educational campaign, what about resource constraints? (Hat tip to Brandon Berg who brought up the resource constraints issue elsewhere on this site in a discussion of foreign aid, I wasn’t won over by it, but I wonder what you make of this resource constraints objection in this context.)

          • Teacher,

            “Analogy fail” may have been to strong a claim (perhaps I was feeling a tad dramatic at the moment), and I accept your points about why it may make sense to require HPV vaccination as valid arguments. That is, I’m not necessarily persuaded that it justifies mandatory vaccination (given that it’s so much easier to avoid getting HPV than it was to avoid getting smallpox), but essentially we are arguing on the same field, just disagreeing about where to draw the line, and that’s a fair argument.

            I disagree about paying people to do something they benefit from. Your very point about requiring HPV vaccination is that other people will benefit, too. So by definition the vaccinated person is not capturing the full benefit; there are positive externalities. Standard economic analysis tells us that when we have positive externalities we will get underproduction of what we desire, which is why you want a government policy. The only question then is what type of government policy. I say that A) because the person is not capturing the full value of the inoculation, it makes sense to give them additional compensation, and B) compensation (even if we call it bribery) is in general a more humane and preferable policy than coercion (which we can call extortion).

            I will admit that I am honestly perplexed at most people’s preferences for forcing people to things we want them to do instead of compensating them for doing those things. It’s the normal response, among both left and right, but I sincerely cannot comprehend it.

          • I am honestly perplexed at most people’s preferences for forcing people to things we want them to do instead of compensating them for doing those things.

            My offhand theory is that with incentives, the costs and the knowledge that there won’t be 100% participation is apparent up front. With coercion, it’s easy to forget that enforcing compliance is expensive and that there’s still no way to ensure 100% compliance.

          • Kuru! I haven’t seen mention of that disease since I gave a talk on spongiform encephalopathy in medical school. I appreciate both your point, and the obscure reference.

          • Heh, all thanks go to Jared Diamond, without whom I’d never have heard of it. To my limited knowledge it seems like the transmissible disease most easy to avoid. I’d be interested to hear about any possible competitors in that field, though, purely out of a sort of perverse curiousity.

  6. Creon Critic,
    But I think it avoids the hard cases, those who are steadfastly refusing vaccination in the face of advice from medical authorities

    Are those steadfast refuseniks a large enough number to compromise herd immunity or are they only harming themselves. If it’s just a tiny few, leave them to their own bad choices. I don’t think it’s government’s job to save individuals from themselves; only to save individuals from others who would harm them.

    If it’s a very large number, then we have a democratic problem anyway, and clearly the government has done a lousy job of persuading people of the value of getting vaccinated–in that case I think it’s best to work on that part of the problem first. Both because it’s more humane than doing something people object to (even if they’re wrong) and because, pragmatically, you risk a big backlash that causes further delay in achievement of the goal.

    with respect to the idea of a government-funded educational campaign, what about resource constraints?
    Resource constraints always exist, to be sure. But enforcement of command and control regulation takes resources, too. And the government’s engaged in a great number of educational campaigns over the years (“this is your brain on drugs!”), so while the concept of resource constraints is meaningful, I think it would be a stretch to say the reality is meaningful in this case.

    And I doubt I’ll find much disagreement here if I say that the costs of educating people about HPV–or even paying everyone to get the HPV vaccine–would be a better use of resources than our on-going wars. In fact you could pay 150 million females $1,000 each to get vaccinated, and it would only cost $150 billion, whereas the cost of the Iraq war is over $3 trillion, about 20 times as much. So resource constraints are real, but the more significant question is where we decide to apply our limited resources.

    • I talked about this over here, a while back.

      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.

      • Pat,

        Interesting thoughts, and thanks for providing further commentary on the cost of enforcement. As things stand right now, some of the cost of enforcement is simply placed on local schools, via the rules that you must be vaccinated in order to enroll. There’s certainly a logic to that rule, but it does serve to hide some of the enforcement costs by tucking it into the school’s administrative costs.

        • Well, a whole bunch of the costs are fuzzy opportunity costs. If a school nurse checks 500 vaccination certificates as part of her first day on the job, that really doesn’t matter all so much in most cases.

          A chunk of them are going to occur anyway: the CDC is going to put out a list of recommended vaccinations.

          The authorization mechanism is the one that presumably puts a load on somebody if it’s worth a damn (right now, it’s really not; you can forge an immunization record pretty easily, but the process works well enough given that it’s really just velvet glove encouragement to the general populace).

          Still the underlying point is important in public policy measures: auditing stuff adds a whole layer of expense you don’t have. The more in-depth you want the audit to be (drug testing for welfare recipients!) the more resources you need to expend securing that process.

          Generally, this is appropriate for large military expenditures that we need to audit anyway and other large contracts. Most other stuff, you’re just adding to the size of government.

          Which cracks me up, because the people calling for smaller government call for increased audit as often as the people who call for big government.

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