A couple of days ago, I wound up in a Twitter discussion (or whatever it should be called) about an article suggesting people who refuse to vaccinate should be sued. There was some back and forth, but ultimately I’m convinced–and apparently I’m not the only one.

The argument against this strategy was that it might make martyrs out of the anti-vaxxers (martyrs is not my word). But I think that’s looking at it the wrong way–this is the Kumbaya Fallacy applied to public health (boldface mine):

During the 80s and 90s, there was a popular revisionist version of the history of the Civil Rights movement that claimed that we all one day just realized that denying black people the vote and lynching was bad and that it needed to stop (i.e., we just held each others hands ’round the campfire and began singing Kumbaya).

Not exactly. The Civil Rights movement shamed enough people into forcing the end of segregation–often at the point of a federalized guardsman’s bayonet. If the Civil Rights movement had waited to convince the overwhelming majority of Americans of the justness of its cause, black people still wouldn’t be able to vote. There will always be those who don’t want to face reality, whether it be cynical self-interest, fear, or slavish devotion to a worldview. No mystical or mythical incantation of the right, focus-group tested, perfect phrase will alter this. The effort would be far better spent politically organizing.

In states where getting vaccination exemptions has been made more difficult, the number of exemptions requested has dropped dramatically. To a considerable extent, I think this is a relatively broad, but shallow, movement. The realization they could be legally liable would help push the undecideds to the vaccination camp.

As for the bitter dead-enders (to use a phrase), they’re not coming out of their spiderholes. For instance:

According to NPR, the father of a little boy with cancer is pushing for law changes to keep unvaccinated kids out of school, even if there were no confirmed cases of measles or other infectious diseases.

In several prior articles, we’ve discussed the potential link between childhood vaccinations and cancer. Would this little boy have cancer if he hadn’t been vaccinated? Will the father ever learn of this link? It’s sad and ridiculous to think the unvaccinated are a threat when vaccines have the potential to cause such life-altering diseases.

An oncologist there, Dr. Robert Goldsby, admits hundreds of kids are going through chemo in the San Francisco Bay area. We can bet most of them, if not all of them, are vaccinated. Manufacturers avoid doing cancer causation studies so when your kid gets cancer, they can say they didn’t know, so they cannot be blamed. All package inserts state they are not tested for causing cancer.

This father needs to learn that although vaccines aren’t the Only cause of cancer, they are a known cause, and that chemo is very dangerous and most oncologists wouldn’t undergo chemo if they found out they had cancer.

I don’t think there’s a lot of common ground here. They dwell in their own ideological, ethical, and most importantly, factual universe. No well written journal article, no witty blogpost will change their minds. So if we need to get higher vaccination rates, I really don’t care if someone gets vaccinated grudgingly due to legal fears–we need herd immunity. So as the two posts suggest, the unvaccinated need to be held liable for their actions (though one suggestion that I can’t dig up suggested jailing people, which probably would generate a backlash).

There is also a second policy that should be enacted: quarantining the unvaccinated when they return from abroad. Most of our measles outbreaks, when we can trace back the source, originate from an unvaccinated person returning from another country.

Unlike, let’s say, I dunno, Ebola, we really can’t tell if someone has the measles (a person can be contagious for up to a week with no symptoms). And you really can get it just by being in the same room as someone who has it. Quarantines would be appropriate here.

I don’t make these suggestions lightly–certain kinds of coercion don’t work for public health (much of the War on Some People Who Use Certain Drugs). But we don’t have to get everyone vaccinated–just more people vaccinated. Legal liability just might accomplish that.