America. The land of freedom and now, the incubator of an epidemic. With 704 cases (and counting) of measles in the United States this year alone, epidemiologists and citizens alike are in a mass panic. Controversy abounds as legislators and activists debate over vaccination policies. Epithets, obscenities, and good old-fashioned righteous conviction pervade online forums and conversations between expectant mothers at prenatal yoga classes.  How did we get here? The answer is more complicated than you may think.

Compulsory vaccination wouldn’t eradicate measles in America. Infectious diseases thrive in the disadvantaged and underserved communities prevalent in third-world countries. The vector for measles is humans, and the measles’ virus is spread by an infected coughing or sneezing. With a respectable sit-and-wait capability, the virus can even survive in the air where an infected person coughed or sneezed for two hours. So, the cramped and crowded conditions of poverty provide the perfect conditions for measles. Even if measles was eradicated in the United States, some of the international travelers going to visit relatives, conduct a religious mission, or participate in eco-tourism would inevitably bring back the virus. However, measles couldn’t even be internally eradicated from America. The same issue that plagues third-world countries –poverty – also affects the United States. Historically marginalized groups often lack access to healthcare. If we made vaccination enforceable by law, we would be penalizing the populations that are unable to obtain vaccines and therefore, enforcing the cyclic nature of wealth disparity.

The fact that measles is unlikely to be eradicated doesn’t mean that all hope is lost and that we should passively accept the oncoming epidemic. Vaccination has the capacity to render measles an endemic, that is, present in the population at constant, low levels. This is a marked improvement from an epidemic and something we should strive for. In addition, herd immunity only necessitates that a certain proportion of the population be vaccinated for both the vaccinated and unvaccinated population to enjoy the benefits. Think of it like this. Let’s say your best friend, John, has an immunocompromising disease that prevents him from getting vaccinated. John’s immune system, unlike a healthy person’s, is unable to fight off the attenuated form of the measles virus that the vaccine contains. If most of the people John comes into contact with are vaccinated, it is less likely he will become infected. And even if he does, you and all your friends are vaccinated and so John cannot infect enough other people to begin the exponential, chain-reaction process of infection that constitutes an epidemic.

So, why get vaccinated? If other people are doing the work for you (by getting vaccinated), why should you have to? You may not want to vaccinate your child for various reasons – such as concerns about adverse effects – but the ultimate denominator is base, human nature. The childhood taunt of “You can’t make me!” is applicable to adults. However, just because this sentiment is shared among children and adults alike doesn’t make it necessarily wrong. The founders of America desired a place where they could be free to make choices for themselves and their family (though their inability to apply this principle to America’s indigenous communities is certainly a blight on our history).  America was founded on the idea of freedom and this is reflected in our democracy and the structure of our government. So, if both historical values and sociological concerns about marginalized populations prevent us from legalizing mandatory vaccination, what should we do?

Just because something is legal, doesn’t mean it is necessarily the ethically correct action. The law is the bar – anything below it is illegal and anything above it is legal. However, legality doesn’t necessarily equate with acceptability. Let’s say my (former) friend tells me (wrongfully) that I’m an intolerable, conceited, pile of sludge of a human being. I am unlikely to be successful in pursuing a tort against this person (on the basis of slander), unless perhaps they decide to publish this information in the local newspaper. However, just because that person’s action is legal doesn’t make it the right one. This premise can be applied to the issue of vaccination. Just because you aren’t being legally forced to comply doesn’t mean that you shouldn’t. By living in America, you are participating in democracy and in effect, signing a social contract. You are not one person in a vacuum. You owe a responsibility to others. Vaccinate your children.