No, vaccination is not a “personal choice”

The dangerous myth behind HHS Secretary Kennedy’s claim that the decision to get vaccinated is a personal one.

Leaders at the Centers for Disease Control and Prevention (CDC) reportedly buried a report last week — produced by their own experts — warning that the risk of measles is higher in areas near outbreaks where vaccination rates are lower. It’s just the latest in a series of moves from federal health agencies that suggest major changes are underway now that an anti-vaccine activist is leading the nation’s health agenda.

Asked by ProPublica why the CDC withheld the new report, the agency replied in a written statement that there was nothing to learn from the report and that the agency still believes that vaccination is the best way to prevent measles. But the statement didn’t end there, nor did it offer a recommendation that everyone should get vaccinated.

“The decision to vaccinate is a personal one,” the statement said, echoing HHS Secretary Robert F. Kennedy Jr.’s own language about vaccination, which diverges sharply from how federal health agencies have historically talked about vaccination — as a public health issue, not a personal one.

An HHS communications director confirmed that this language reflects the position of the new leadership, saying that “Secretary Kennedy believes the decision to vaccinate is a personal one.”

But the truth is, when it comes to public health, there really isn’t such a thing as a “personal” or “individual” choice — because every choice we make as individuals has implications for the health of those around us. Framing vaccination as an issue of “personal choice” disregards the fact that choosing not to get vaccinated ultimately strips other people of their personal choice to stay healthy or to live a normal life.

It’s important to keep in mind that the people choosing not to get vaccinated — the ones depriving others of the choice to stay healthy and disease-free — are, for the most part, healthy adults, while those who are put at risk by these decisions are generally either very young (infants), very old, pregnant, or immunocompromised/immunosuppressed.

Take, for example, the story of a 9-month old baby girl whose choice to avoid preventable childhood illnesses was taken away from her by someone who made the choice to skip out on a routine vaccine. There’s a short, high-risk window of time between about 6-8 months through 12 months after birth when babies lose the immunity for chickenpox conferred by their mother in the womb but are still too young to receive the first shot in the vaccine series that prevents chickenpox. This window of time used to be much higher-risk before the chickenpox vaccine started eliminating the disease nationwide. Now, although it is still best to be cautious during that time period, the chances of running into someone with chickenpox are pretty low for the average American, and so most parents can breathe a sigh of relief, even with the knowledge that their infant hasn’t yet received the protection of the vaccine.

During this time, it’s generally advised to continue taking extra precautions like avoiding close contact with anyone who may not have immunity to chickenpox and shingles. In this case, the parents of the 9-month-old infant were already heeding that advice — and more — because at the time, the COVID pandemic was still raging. There were no play dates, showers, or mommy-and-me events; no babysitters or nannies coming into the home; no family gatherings where everyone passed the baby around to admire her. At the time this infant had her unfortunate encounter with a vaccine-preventable disease, she had spent the weeks prior in her home, with only her mother and father, who are both immune to the disease. The only exception was a trip to the grocery store down the street, and the time spent on the sidewalk in her stroller on the way there. While in the store, the parents avoided other shoppers and never brought their baby into the same aisle as another shopper, primarily because of their fears of COVID, not chickenpox.

Until this point in her life, the infant had not had so much as a cough or sniffly nose. That all ended one summer night when she came down with a fever, and — for the first time in her life — awoke in the middle of the night. (Yes — these were some lucky parents. Their child was a sound sleeper and had never woken up during the night before, which was why they immediately knew something wasn’t right when they heard her crying around midnight.) When they went to check on the baby and saw that she had a fever, that was all the confirmation they needed that something was wrong here. They decided to monitor her symptoms overnight, and seek medical care the next day.

By the time they could do that, their 9-month-old baby had already started to develop painful, red itchy spots all over her body. After consulting with her pediatrician and reviewing their activity over the past few weeks, they got a diagnosis: Chickenpox. The doctor said she most likely got it from someone who had either walked on the sidewalk prior to the baby being pushed down the sidewalk in the stroller or someone who had walked down a grocery store aisle and was gone by the time the baby and her parents went down that aisle. That’s how contagious viruses like chickenpox are: someone can cough on a sidewalk or in a grocery store aisle and then leave the area entirely, and you can come in 10 minutes later, and if you’re not vaccinated, you can contract chickenpox from breathing in the air where they coughed.

Over the next couple of days, the infant continued to experience progressively more severe symptoms, eventually getting red itchy, sores in her mouth, inside of her nostrils, and even inside of her eyelids and ears. She was clearly miserable and in pain, yet her parents couldn’t explain to her that things would get better soon and that she wouldn’t feel like this for long. In fact, even if she could understand language, her parents still couldn’t even explain to her how she had gotten sick because they didn’t even know for certain how it happened.

I can tell you from firsthand experience that watching your child suffer from a vaccine preventable childhood illness is something that no parent should ever have to go through, and thanks to the miracle of vaccines, no parent does have to go through that – that is, if everyone makes the responsible choice to get vaccinated. But if we continue talking about vaccination as an individual choice that only affects our own health, we will continue to allow the most vulnerable and helpless among us suffer from the selfish decisions of those who believe that vaccination is simply an individual choice.

The baby in this story, if you haven’t figured it out by now, was my own. Nearly four years later, she still has a couple of chickenpox scars and will now be at risk of shingles in later life due to her exposure to the virus, but all things considered, we were lucky that it didn’t turn out worse. Within a few years of her exposure to chickenpox as an infant, the rural county where we live experienced an unprecedented polio outbreak that resulted in my infant son needing to get his polio vaccine doses closer together than the schedule calls for because we were concerned about him being at risk of contracting a virus that can cause lifelong disability, including paralysis. Typically, children get the first two polio vaccine doses at ages two months and four months, and then go in for the third dose at 6 to 18 months of age, and then finally get their fourth and last dose between ages 4 and 6. My son — who wasn’t even two yet at the time — got his final two doses about three months apart. It wasn’t how I would have chosen to do things, but that choice was taken away from me by someone who didn’t get vaccinated at all, and who brought the virus to where we live and put my son at risk. That’s what happens when you tell people that vaccination is an individual choice. They don’t think about how their decision will impact the most vulnerable and helpless members of our society – the ones who can’t speak up and say how unfair it is that they have to suffer the consequences of someone else’s “individual choice“.

Babies and young children aren’t the only ones who suffer the consequences of people choosing not to get vaccinated. In order for vaccination to work effectively, there must be a healthy immune system to produce an immune response to the vaccine and confer the associated protection from disease. Elderly folks, people who have autoimmune diseases, and people who are undergoing certain types of cancer treatment or living with HIV can’t rely on their own immune systems to produce the response needed to protect them from disease. That’s why they have to rely on the rest of us to make responsible decisions about our own health as well as the health and well-being of those around us. One of the major ways we can protect people like this is by choosing to get vaccinated, knowing that we ourselves may not be at a heightened risk of becoming infected with a vaccine preventable disease or suffering from the severe consequences of one — but also knowing that we’ll never be able to know which of our friends, family, neighbors, or just those people we see every week at the grocery store, may be relying on us to protect them.

In the US, conservatives are most likely to view vaccination as a personal choice. And that makes sense, given that they tend to place a high value on individual liberty and having the freedom to make decisions without government or anyone else telling them what to do. But those same individuals also place a high value on things like personal responsibility and self-sufficiency — and that’s where their position on vaccinations starts to fall apart. If you view vaccination as an individual choice and believe that anyone should be able to opt out for any reason at any time, then what you’re saying is that it’s okay to decide not to uphold your end of the social contract; that it’s okay to free-ride off of everyone else who actually did go get vaccinated. Because to be clear, when you choose not to get vaccinated in a country like the US, what you are ultimately doing is free-riding on the backs of everyone else who did their part.

Sure, we all have the opportunity to decide whether or not to get vaccinated. But those who forgo vaccination are not making a personal choice — they’re making a costly decision to let the most vulnerable members of our society pay for their choice.