The example, while hypothetical, raises a question surprisingly absent from public discussion about vaccine mandates: To what extent am I responsible for my neighbors' health?
"In the United States, personal medicine has dominated public health," said University of Pennsylvania bioethicist Arthur Caplan. "Pediatricians don't think about 'public' health. They think about Joey."
In fact, lots of research shows that vaccination for the sake of others "is not a message that parents generally find motivating," said Kristine Sheedy, who oversees immunization media campaigns at the U.S. Centers for Disease Control and Prevention.
With one interesting exception: influenza. "The flu is out there, you hear about it, you see it," said Sheedy, as opposed to measles, whooping cough, diphtheria, and other diseases most living Americans have never experienced - thanks to vaccines.
Vaccination differs from other issues in law and medicine. First, it is entirely preventive. Unlike the balancing of, say, a cancer drug's risks and benefits, the upside of immunization is largely invisible and off in the future.
Mandates differ, too. Children's vaccines are needed to enter school, although medical and religious exemptions exist in Pennsylvania and New Jersey. Most U.S. mandates - insuring your car, shoveling your walk, not polluting the air - do not involve personal medical procedures.
Perhaps the biggest difference is how individual and group behavior combine to provide the benefit. Immunizing an individual usually creates an incomplete yet significant barrier against disease; the degree varies depending on the illness and the person. Immunizing a high percentage - this also varies - of the community removes most sources of transmission.
Such "herd immunity" helps protect those who cannot be vaccinated because they are too young or are allergic or their bodies don't respond. For public health workers, protecting the unprotected is paramount.
