By PAUL LEVY

David Ropeik, about whose excellent work on risk perception I have written before, recently offered some additional perspectives on the issue of vaccinations — making us think about the cost of personal liberties to public harm. He wrote this Op-Ed, entitled, “Public health: Not vaccinated? Not acceptable,” in theLos Angeles Times. The subheading is: “What should we do about people who decline vaccination for themselves or their children and put the public at risk by fueling the resurgence of nearly eradicated diseases?”

Here are some excerpts:

What does society do when one person’s behavior puts the greater community at risk? We make them stop. We pass laws, or impose economic rules or find some other way to discourage individual behaviors that threaten the greater common good. You don’t get to drive drunk. You don’t get to smoke in public places. You don’t even get to leave your house if you catch some particularly infectious disease.

Then what should we do about people who decline vaccinationfor themselves or their children and put the public at risk by fueling the resurgence of nearly eradicated diseases? Isn’t this the same thing: one person’s perception of risk producing behaviors that put others at risk? Of course it is. Isn’t it time for society to say we need to regulate the risk created by the fear of vaccines? Yes, it is.

David keys in on examples of the growing threat to public health caused by people worried that vaccines will cause autism and other harms, despite overwhelming evidence to the contrary.

In many places, particularly in affluent, liberal, educated communities . . . unvaccinated people are catching diseases that vaccines can prevent, like measles, whooping cough andmeningitis. In 2010, as California suffered its worst whooping cough outbreak in more than 60 years (more than 9,000 cases, 10 infant deaths), Marin County had one of the lowest rates of vaccination statewide and the second-highest rate of whoppingcough. A 2008 study in Michigan found that areas with “exemption clusters” of parents who didn’t vaccinate their kids were three times more likely to have outbreaks of whooping cough than areas where vaccination rates matched the state average.

He offers the follow ideas for our consideration, “each fraught with pros and cons and details that require careful thought and open democratic discussion:”

• Perhaps it should be harder to opt out of vaccination. (Twenty-one states allow parents to decline vaccination of their children simply for “philosophical” reasons; 48 allow a religious exemption, but few demand documentation from parents to support claims that their faith precludes vaccination.)

• Perhaps there should be higher healthcare and insurance costs for unvaccinated people, or “healthy behavior” discounts for people who do get vaccinated, paid for from what society saves by avoiding the spread of disease.

• There could be restrictions on the community and social activities in which unvaccinated people can participate, like lengthy school trips for kids, etc.

David expands on these thoughts on his blog and in Psychology Today and provides a full context in his most recent book: How Risky Is It, Really?: Why Our Fears Don’t Always Match the Facts.

Paul Levy is the former President and CEO of Beth Israel Deconess Medical Center in Boston. For the past five years he blogged about his experiences in an online journal, Running a Hospital. He now writes as an advocate for patient-centered care, eliminating preventable harm, transparency of clinical outcomes, and front-line driven process improvement at Not Running a Hospital.

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