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JAMA Forum

On the Public Harms of Personal Health Care Choices

In February, some parents’ decisions not to vaccinate their children caused great hubbub in the United States, fueled by measles outbreaks and a few politicians’ expressions of respect for this choice by “anti-vaxxers.” A natural concern is that lack of vaccination by some degrades herd immunity and makes spread of disease more likely.

Because choosing not to vaccinate harms others—something we economists call a “negative externality”—it justifies government action to encourage vaccination. But in other cases in which a negative externality arises, government action is much less widely accepted as justified. Why the difference?

In a piece titled “Your Right to Skip Shots Ends Where My Kid Begins,” journalist Megan McArdle made the externality-based argument for government action against the anti-vaxxers. “This is the purest case for public health laws: preventing people from putting others at risk,” she wrote. For those who fail to vaccinate their children, with few exceptions, McArdle recommends denial of many benefits, including tax deductions, student loans, entry to airplanes, or access to public schools, colleges, team sports, or municipal activities.

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