Whooping cough (pertussis) and civil rights

I’ve written before about whooping cough, or pertussis, and its vaccine. It’s a potentially deadly illness for infants. There’s been quite a large epidemic of whooping cough over the past few months in California. In fact, it’s shaping up to be the largest epidemic in fifty years. Five infants have died as a result.

We have a vaccine for it, although it’s not an ideal one. For one thing, it can’t be given to the youngest of infants, those at most risk of dying from the disease. For another, the protection the vaccine gives wanes with age, requiring booster shots. The upshot is that those receiving the vaccine are getting it as much (or more) to protect others than to protect themselves. That raises the key question of to what extent it is our civic duty to get the vaccine, and give it to our children, to protect those very small, vulnerable infants who can’t get it yet. Freedom of choice collides with the public welfare.

Dr. Bill Schaffner, a distinguished infectious disease expert at Vanderbilt University, recently weighed on on the question of compulsory vaccination in this context. He writes:

“But here’s a reason [for refusing vaccine] that really makes me cringe — our society puts more value on personal choice than on protecting our fellow citizens. “Mandates” has become a dirty word. We don’t like mandating anything in this country. No, we’re not going to mandate and take away personal choice. But what choice did those five infants have? Does our thirst for individual freedom absolve us of our responsibility to protect them?”

There is precedent from the past for compelling people to do things for public health reasons. Old quarantine laws are one example. Of course making a sick person stay at home does not force them to get a particular treatment, such as a vaccination. There is a parallel, however, with tuberculosis treatment. There have been instances when courts have confined a person with active TB and forced them to receive treatment for it. Although this treated the person, the reason for the compulsory treatment was that it protected the community.

As a trained infectious disease specialist myself, I have do doubt that the vaccine, although not ideal, works. You will find people who disagree with that statement. What interests me the most on the issue is the question of civil rights: to what extent does the state have the right to compel its citizens to do something to protect the health of others? The answer, I think, is — it depends.