The decision by the Italian Parliament to drop mandatory vaccinations for children entering school has provoked numerous commentaries. From the “ignorance” of the anti-vaxxers, to their alignment with ever more vocal nationalists, to their general distrust of authority and expertise. The vaccinations, which include tetanus, polio, and measles, in the words of Italy’s Interior Minister “are useless and in many cases dangerous, if not harmful." And this statement is made knowing that Italy had approximately 5,000 cases of measles in the past year, a six-fold increase from previous years.
Rather than rehash those political or scientific arguments, I would like to introduce a different view. This Italian decision is reflective of another trend in our world, the tyranny of the minority.
Minority Rule
It is a simple concept; when faced by an intransigent minority, a compliant or at least, less resolute majority, will give in to their demands. Minority rule or perhaps over-rule. While one can uncover multiple cultural, behavioral, and even mathematical explanations, the control of the minority surrounding peanuts on planes, is illustrative and comes with the least cultural baggage.
In the case of peanuts, the intransigent minority are those with peanut allergies, who adamantly refuse peanuts and may “be put in harm’s way” in their presence. It is far easier for the general public, few of whom are rabid peanut eaters, to remove peanuts in all its forms from plane flights; after all, who really cares? It is also in the interests of the airlines because it means they need not carry varying inventories or be at risk and liability, for provoking an allergic response in an unsuspected peanut-allergic passenger. [1]
I hasten to add that this tyranny is agnostic to the underlying contested principle or belief, it requires primarily a vocal, intransigent minority confronting a less concerned majority. The minority need not be correct or wrong, simply resolute and vocal; the majority need only be complacent. If I am right in believing that the tyranny of the minority underlies many of our civic decisions, then how we approach anti-vaxxers and their allies need to change.
The beliefs of the anti-vaxxers have repeatedly been shown to be ill-informed and wrong. But it is for them a matter of faith, bolstered by whatever data they choose. Providing them with our scientific beliefs has no impact. They believe that they are entitled to their facts and science is a conspiracy in some form. We are never going to change their views.
Instead, to curb this particular version of minority tyranny we need to strengthen the majority’s will. Vaccinations are effective in protecting the herd, that is the majority of us when a sufficient portion of the population is vaccinated. The threshold necessary for conferring immunity to the general population is related to how contagious a disease is to others. Polio is more difficult to spread than measles; as a result, the threshold needed to protect us is lower for polio than measles. If 85% of the population, in the case of polio, or 95% of the people in the case of measles are inoculated, it protects the remaining unvaccinated members of the population. In an increasingly migratory world, we act more like one global herd, rather than many local communities. And in that context, the decision by the vocal minority of anti-vaxxers in Italy can have adverse consequences for the broader European Union. Infection doesn’t recognize borders, nor dissuaded by trade agreements or tariffs; isolation may be useful containment, but it is not an option when discussing geography the size of Italy.
Mandatory vaccinations come with the baggage of centralized regulation and government intrusion, so those mandates always contain an opt-out for those with particularly strong objections. In California, there were “personal belief” exemptions in addition to those exemptions based upon a medical contraindication. Those personal-belief objections were ended because of a rising rate of what was termed “vaccine-hesitant.” After a temporary improvement, immunization rates again began to fall as those with personal-belief objections found a medical exemption from willing physicians. Rules can be circumvented and while mandating vaccination plays a significant role it is, apparently, insufficient.
Alternatively, education is a worthwhile approach - for the complacent majority, not the disbelieving anti-vaxxers. The majority view, that anti-vaxxers are fringe distractions, with little or no real effect on our health, or that of our children facilitates complacency. It may be time to educate the majority more specifically, on how lower immunization rates affect us. A “mama bear,” concerned for the health and safety of her children, will be more vocal in resisting anti-vaxxers rhetoric. The campaign against tobacco is far more adamant than anything we have used to inform the herd, the general public, about the dangers of not vaccinating. It is time to flip the script. Enough of explaining why not being vaccinated is bad for you; it is time to explain why not vaccinating is bad for us.
[1] Let me be clear, restricting peanuts on a plane makes good sense given how severe these reactions can be and is not entirely analogous to vaccinations. Airlines have enough difficulties and concerns about transporting us and our luggage; they are not good at checking for peanut allergies.
