The USFG should make the MMR vaccine mandatory
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Full Topic: The United States Federal Government should mandate that individuals without a valid medical excuse receive the Measles, Mumps and Rubella (MMR) vaccine.
Vaccinations: A biological preparation that improves immunity to a particular disease. A vaccine typically contains an agent that resembles a disease-causing microorganism, and is often made from weakened or killed forms of the microbe, its toxins or one of its surface proteins. The agent stimulates the body's immune system to recognize the agent as foreign, destroy it, and "remember" it, so that the immune system can more easily recognize and destroy any of these microorganisms that it later encounters.
Measles, mumps and rubella are all viral diseases that cause a wide range of symptoms and are highly transmissible. The symptoms derived from these viruses are pretty broad, so I'll just provide a link with specifics about them:
Mandatory: required by law or rules; compulsory.
Some light ground rules:
1. Citations must be provided in the text of the debate
2. No new arguments may be presented in the final round for either side
3. All definitions provided must be agreed to by both sides prior to accepting the debate
4. 12,000 characters maximum
For structure, debaters are allowed to initiate rebuttal in any round. New arguments are restricted only in the final round.
With that out of the way, let's kick this thing off with the case.
The U.S. Federal Government will require that all individuals before attending school receive the MMR vaccination. All individuals who are beyond schooling age and under the age of 65 would have to get the vaccine within 5 years. These will be subsidized on an as-needed basis, ensuring that it is broadly affordable. Vaccination will be verified in much the same way as it has been verified for schools – a signed and authenticated notice from one’s doctor. Failure to comply would incur a tax that scales with income; as such, this program would largely be run by the IRS in conjunction with the CDC. Exclusions based on allergies, pregnancies, and those individuals who are immunocompromised would be allowed.
Before I transition into some contentions, I'll start with some general overview of this issue.
This debate is fundamentally a comparison between individual choice and public good. I will aim to establish that vaccines are efficacious and that their efficacy leads to substantial benefits to the public good, whereas Con is welcome to counter these claims or introduce negative elements that overwhelm the benefits. Again, this is a net benefits debate, ergo Con will have to argue that the harms of mandating this specific vaccination.
So, how do we balance freedom vs. health?
As a society, we do this quite often. Think about traffic laws. We require people to follow certain rules of the road because not doing so makes them a danger to both themselves and others. And this isn't the only instance where our government goes against basic beliefs in the general population. Despite widespread acrimony over drug tests, workplaces are still allowed to require them. We are taxed despite the protestations of individuals who don't like certain taxes. All of this is allowed not because the government is being overbearing, but because we've accepted an aspect of shared responsibility for our actions. We accept that individual rights do not always trump that responsibility, particularly when doing so could cause harm to others.
So, when is it justified to subvert individual choice to the public good?
That requires that two conditions to be met. Whatever is being regulated or mandated must be safe and effective, and the risk of not participating in said behavior must outweigh any risk from the behavior itself. I would argue that vaccines meet these criteria. Vaccines are both safe and effective, and they have a track record of reducing illness and death from the diseases they prevent.
All this puts Con in a difficult position. He's going to try and argue that vaccines are markedly different from other issues that encounter the liberty vs. public good question, and he will have to show that the personal freedoms lost outweigh the widely evidenced good that vaccines provide. To do that, he will have to counter life and quality of life lost, which comes with numerical weight, with a vaguer conception of impact, as personal freedom isn't clearly quantifiable.
With that, onto my contentions.
1. Disease Spread
We must recognize that vaccination is not a choice that solely affects the individual being vaccinated. The decision to get the MMR vaccine affects everyone around you. Measles, mumps and rubella are all transmitted through droplets that are sprayed into the air, making them airborne pathogens with a high likelihood of transmission to those around the infected.[1, 2, 3] The mere fact that others are put at risk by people who refuse to take these vaccines creates a substantial societal harm in the status quo, as many are allowed to refuse to get the vaccine.
We're living this harm today, seeing a resurgence in these entirely preventable diseases in the U.S. and abroad. This resurgence is most marked with measles, a disease that the U.S. had eliminated by the year 2000, but which returned in 17 outbreaks among 222 people just in 2011. Mumps has had 4 reported outbreaks this year alone, and has had several small and two large outbreaks in the last 5 years, encompassing thousands of people. Rubella has also returned from a long absence, appearing in three cases in the U.S. in 2012 after being eliminated back in 2004. This change resulted mainly from a false public perception that vaccines have been linked to autism.
In order to understand why vaccinating a large portion of the population is necessary, we have to understand the term "herd immunity." This has been defined differently by different authors, but I will use the term in this fashion: "a particular threshold proportion of immune individuals that should lead to a decline in the incidence of infection." What that means is that if someone becomes sick with a given disease, herd immunity would ensure that that person is so much more likely to run into someone vaccinated against that disease than someone who is vulnerable that they would be extremely unlikely to infect other people. We cannot possibly vaccinate everyone and achieve absolute immunity because of the necessity of the exclusions I listed in my case, but we can seek to achieve herd immunity.
What does that threshold look like for these diseases? For measles, this is 95%. For mumps, it's at least 88%, though it "may need to be higher" than this previously established threshold. For rubella, it sits at 90%. Only through mandatory vaccination could we ever hope to reach those numbers.
2. Disease Impact
My first contention established a threshold for harm in status quo, but I will now show that that threshold has a tremendous impact on society. In order to understand that, we have to know what the impact of these three diseases is.
"Prior to the vaccine, 3-4 million people were infected in the U.S. each year, resulting in 48,000 hospitalizations, 400-500 deaths and approximately 1,000 who developed chronic disabilities.
Even with modern medical care, the disease can lead to serious complications, including blindness, pneumonia, otitis media and severe diarrhea. Despite the availability of a vaccine it remains a leading cause of death among young children worldwide, with deaths mainly attributable to the complications of the disease...
More than 90 percent of susceptible people, usually unvaccinated, develop the disease after being exposed. There is no treatment except to make the patient as comfortable as possible by keeping them hydrated and trying to control the fever. Unvaccinated young children and pregnant women are at the highest risk for measles and its complications, including death."
"Mumps is not normally a fatal disease, and up to 30% of mumps infections are asymptomatic. There can be serious complications, however, including aseptic meningitis, orchitis, oophoritis, mastitis, pancreatitis, and deafness. Meningitis occurs in up to 10% of mumps cases; it is usually subclinical and self-limiting. Symptoms of mumps-related meningitis include fever, headache, vomiting, and neck stiffness, which peak for a period of 48 hours before resolution and might appear up to 1 week before parotid swelling. More serious neurologic symptoms are rare and are due to encephalitis. Hearing loss following mumps infections is rare (1 in 2000 to 30,000 cases) and usually results in mild to moderate hearing loss.
Orchitis [swelling of the testicles] occurs 4 to 8 days after the onset of parotitis and is a common complication, affecting 20% of men who develop mumps after puberty. Of those cases, 40% will develop testicular atrophy and 30% will have lasting changes in sperm count, sperm motility, and sperm morphology."
While the disease usually only results in a light fever and small rash, this disease is mainly problematic for pregnant women. "In 1964-65, America had a major rubella epidemic, with more than 12 million cases and 20,000 babies born with congenital rubella; of these, 13,000 were deaf, 3,500 were blinded by congenital cataracts, and 1,800 more suffered severe cognitive impairment." Since pregnant mothers are among the few who cannot get the vaccine, every single person who decides not to get the vaccine is putting these mothers at risk.
Taken together, this means these three viruses present as enduring, broad threats to public health that are made dramatically worse in the absence of herd immunity. As we have clearly not reached a level of herd immunity in the absence of a mandate to vaccinate with the MMR vaccine, my plan solves for this harm.
With that, I await Con's argument.
1. The Solvency Press
I feel I need to address a through-line point Con is making before I get into the rest. A lot of this involves Con employing stating that my case is invalid because it has never been done before.
Con’s approach treats direct evidence of effectiveness on every plank of a given policy as absolutely necessary to establish net benefits. In doing so, Con effectively invalidates every policy that has any unique elements. By Con’s logic, these policies have no benefits, bar none. If Con is correct, we cannot establish solvency of such plans logically, we cannot establish it by comparison to similar policies, we cannot compare the effectiveness of different approaches to a similar problem. None of these are meaningful to Con, and Con would automatically invalidate every approach that includes novel elements.
To be clear, while I agree that support for a given policy is a lot stronger when you can cite the effects of a policy that is identical to that policy in every way, I disagree that any alteration from existing policies automatically invalidates any and all comparisons to similar policies. We can compare elements that are identical or similar. Specifically, we can reasonably compare the effectiveness of different mandates, so long as we establish that each mandate is effective in driving people to take a given action. This is how policies evolve and change in the real world, and this is how they should be treated in debate as well.
Now that these problems have been established, let’s go through Con’s arguments.
He concedes that compulsory vaccination via exclusion from public schools is a mandate, just stating that it’s a different kind of mandate. This is crucial. By conceding that these are both mandates, he invites comparison between those mandates. So, let’s compare them.
The school mandate requires that anyone attending public school be vaccinated. By doing so, there is a clear opt-out condition: you may simply choose not to attend. That reduces the effectiveness of the mandate; it applies to a smaller number of people as a result, as it excludes those who are home schooled and those who attend more lenient private schools. All states also have the medical opt-out, but some also include ideological means of opting out. Nonetheless, I will point out that, contrary to my opponent’s assertion, this is an economic penalty. Many families cannot afford home or private schooling, and as such, this is a major blow to the potential income of their family over time.
The tax mandate (my mandate) requires that every American who pays federal taxes vaccinate themselves and their families. This also has a clear opt-out condition: medical need. As such, this applies to a greater proportion of the general population, as it includes all individuals paying federal taxes.
So, when Con argues that I must convince you of the benefits of my policy mandate, I think it’s absolutely clear: ensuring that a larger swath of the population is induced to action by said mandate. People like money. They don’t like losing money. Losing a larger portion of their income through federal taxes is a clear net negative for everyone who pays those taxes, whereas the loss of public schooling is less effective in driving action for some people. Con has never argued that the tax would be ineffective, instead choosing to argue that, solely by virtue of its differences from existing policies, it is unproven. That isn’t enough. He must attack the tax directly, otherwise he fails to challenge the solvency of my case. I suppose this isn’t surprising, though, as it’s been clearly shown that taxes can and do often alter behaviors, particularly when applied to a given product. This is clear evidence of the solvency inherent to tax policies aimed at altering consumer behaviors, which include mine.
However, when Con argues that I must “prove that a federal mandatory vaccination law is the same as a State policy of compulsory vaccination,” he is absolutely wrong. If the two were completely identical, there would be absolutely no point in implementing said policy. Policies that are status quo change nothing, hence debaters tend to present alternatives to the status quo, as I have done. This mandate functionally expands on the efficacy of state-based mandates, and those mandates stand as exemplars of the effectiveness of a mandate in expanding vaccination coverage. The two need not be identical to see how one resembles the other and infer related effects.
Con also grants or drops three essential points on my solvency.
He grants that all I need to do to achieve solvency is induce any increase in the number of vaccinated individuals. Given that that reduction automatically softens the blow of (or entirely prevents) future measles, mumps and rubella outbreaks, this is a huge concession because it ensures that I need only have minimal solvency in order to see the effects.
He drops the subsidy. This alone is enough to grant me some solvency, as I provide a greater ease of access to vaccination via federal funds, thus ensuring that those who lack the economic resources to vaccinate can do so.
Lastly, he drops the country examples Con himself presented. In doing so, Con concedes that Saudi Arabia and Slovenia present viable examples of federally-imposed vaccination mandates. Saudi Arabia imposes mandates for those visiting during the Hajj, reducing a great deal of the disease burden borne by these pilgrims. Slovenia mandates numerous vaccinations within the first 3 and 18 months of life, as well as prior to the start of school. “Failure to comply results in a fine,” hence this is a similar federal mandate enforced by a fine instead of a tax. These examples both show that a federally-imposed mandate, enforced either by exclusion from a religious ceremony or via a fine, that leaves fewer opt-out opportunities, has worked in the two countries in which it has been tried. These systems are the most akin to mine abroad and showcase the effectiveness of similar mandates.
Again, let’s recognize that this is Con’s only piece of offense on this debate. He must win this to stand any chance of winning.
He splits this up between state response and individual response.
For state response, Con says that states may try to invalidate the mandate via the judiciary on the basis that it is their right “to make policy choices on vaccination”, though he doesn’t specify where that right comes from, nor why the courts would be likely to uphold it. There is absolutely no reason why the courts would find the levying of a contingent tax, aimed at altering the behaviors of its citizens (as so many do), by the federal government to be unconstitutional. This kind of tax is extremely common, often used to dissuade or encourage the usage of a given product by increasing or decreasing its price directly. Since my policy effectively makes it more expensive not to vaccinate with the MMR vaccine, I am using a similar dynamic that is not markedly different from any other taxes (such as those on cigarettes or alcohol) aimed at altering consumer behavior. If states can do this through school mandates, there is nothing unconstitutional about doing the same federally via taxation. Con’s argument also assumes that states lose all power to choose to mandate any vaccination, though all other vaccinations would still be in their purview, and they would still be able to choose to exclude those who choose to pay the tax from public schools. But even if he’s right that the mandate would be invalidated, the subsidy would continue to exist, meaning at least some of the benefit would persist.
For individual response, Con introduces uncertainty, saying that this policy could do harm to various aspects of patient-doctor relationships. He doesn’t justify any of these, simply asserting that they could happen. I can do the same. This policy could engender a greater connection between doctors and patients, allaying unfounded fears and uncertainties by showing patients that these vaccines are safe. It could show much of the public that the government cares about their health and takes the recommendations of medical professionals seriously, increasing trust in the government and its role in the lives of citizens. Whatever “could” be is largely irrelevant because possibilities exist on both sides: we are discussing what is most likely and why. Terrorism may be possible, but Con doesn’t spell out why it’s likely, merely comparing to Planned Parenthood. Even if it is likely to happen, Con is suggesting that these violent groups should be allowed to dictate policy. Violence from a subset of the population mentally disturbed enough to commit such acts (and likely willing to do so under the slightest provocation) seems an especially absurd basis for failing to implement a given policy, and if we’re using Con’s analogy, it would be akin to shutting down Planned Parenthood because it is a target of such threats. Most importantly, Con has failed to provide any quantitative impact to this backlash, leaving all these impacts as nothing vague possibilities. Remember what these vague threats are pitted against: any and all reductions in massive and dangerous epidemics spreading across the United States, which are a certainty with my plan.
3. Alternative b.: educate more
Once again, Con has failed to provide any specificity to his alternative, including, but not limited to: how it will run, who will run it, how long it will run, and what it would include. He points to examples of successful public awareness programs, but never tells us what, if anything, he has learned from them. This means Con is solely asserting his solvency without reasoning or evidence, as they are both only possible if he has a clear plan of action to assess.
Realize that neither of the examples Con cites discuss outcomes like what he is proposing. Neither the World AIDS Day nor Autism Speaks drove people to so substantially shift their attitudes that they willingly pursued treatment for against previously-established views.
These are big problems for this alternative. Con drops my point that not all such programs (particularly those aimed at substantially altering behaviors) are successful, as many of them are not successful and some are even harmful. Here are two examples:
The Drug Abuse Resistance Education (DARE) program, a widespread anti-drug program for youths: “20-year-olds who’d had DARE classes were no less likely to have smoked marijuana or cigarettes, drunk alcohol, used "illicit" drugs like cocaine or heroin, or caved in to peer pressure than kids who’d never been exposed to DARE. But that wasn’t all. "Surprisingly," the article states, "DARE status in the sixth grade was negatively related to self-esteem at age 20, indicating that individuals who were exposed to DARE in the sixth grade had lower levels of self-esteem 10 years later." Another study, performed at the University of Illinois, suggests some high school seniors who’d been in DARE classes were more likely to use drugs than their non-DARE peers.”[32, 33]Suicide prevention efforts via media campaigns have practically all failed to address the problem: “Such public education and awareness campaigns, largely about depression, have no detectable effect on primary outcomes of decreasing suicidal acts or on intermediate measures, such as more treatment seeking or increased antidepressant use… A systematic review of studies published from 1980-1995 found that knowledge about suicide improved but there were both beneficial and harmful effects in terms of help-seeking, attitudes, and peer support.”
4. The Remainder
Con drops his second alternative, as well as his effort to mitigate my solvency on mumps.