"Omissional Infanticide"

Who pays for the "right" to reject vaccines?

Last spring, when I was researching the chapter in A Pox on Fools on the centuries-long battle over vaccine mandates, I came across a quote that stopped me dead.

In 1857 Sir John Simon, then the Chief Medical Officer to Britain’s Privy Council, wrote that those objecting to the requirement to vaccinate their children against smallpox were, in effect, demanding the right to commit homicide on their own kids:

“The so-called ‘liberty’—thenceforth to be abridged—was that of exposing unconscious infants to become the prey of a fatal and mutilative disease. It was this liberty of omission infanticide which the law took courage to check. [emphasis in the original.]

There it is. “Omissional infanticide:” manslaughter (childslaughter?) by the choice not to act.

Simon was right then and he is so now. This kindermord is not a wretched curiosity confined to some barbarian past, long since abandoned in our enlightened age. An assault—not yet but potentially a killing—is happening as I type. It precisely matches Simon’s indictment, a century and a half ago:

Six weeks ago, Ethan was like most 7-year-olds — spending the weekend riding his new bike or playing Minecraft on his iPad on a rainy day.

Not anymore:

Since late January, the schoolboy has been confined to a hospital bed with measles encephalitis, a complication that causes swelling and inflammation in the brain. “He’s pretty much as if he was paralyzed,” his devastated father, 41, told The Independent in a phone interview from his son’s hospital bedside.

Ethan’s parents decided not to immunize him against measles as they did with his three brothers. Three out of four of them contracted measles. Still, despite Ethan’s ordeal, his mom stands by their decision. “We’re not blaming God for this,” said 35-year-old Kristina. “Yes, it hurts, of course, it hurts. But God has chosen Ethan for a reason. God is doing something, and we’re gonna glorify his name regardless.

“And we wouldn’t change it any other way,” the mom continued. “If I knew this could be the outcome, I still wouldn’t have given my son the vaccine.”

And why not?

“Our biggest reason why we didn’t do it is just with all the unnecessary stuff they add into it,” Kristina added, referring to her beliefs about the vaccine.

“With my own eyes, I have seen the damage it does to kids who are perfectly normal, and then once they get it, they’re not the same anymore,” she claimed.

To be absolutely clear: none of that is true. The measles vaccine, usually packaged as a triple shot against measles, mumps, and rubella (MMR) is not packed with “unnecessary stuff.” It is fantastically safe. From the CDC (before the Trump junta took power):

The most common adverse events following the MMR vaccine are pain where the vaccine is given, fever, a mild rash, and swollen glands in the cheeks or neck.

Studies have shown a small increased risk of febrile seizures occurs among children who are younger than 7 years old approximately 8-14 days after vaccination at a rate of one for every 3,000-4,000 children vaccinated with MMR vaccine. This is compared to children not vaccinated during the preceding 30 days.

Febrile seizures are scary, but are both common—associated with high fevers, as many as 5% of kids under five will experience one—and, as the pre-Trump/Kennedy CDC wrote, “febrile seizures do not cause any permanent harm and do not have any lasting effects.”

All of which is to say that Kristina is spouting nonsense. Whatever she saw in other kids, it wasn’t vaccine injuries. What she describes doesn’t happen—though it does echo the repeated claims of the foundational fraudster of modern anti-vaccine activism, Andrew Wakefield.

But we know that. As Paul Offit has written and said in a bunch of contexts, vaccines are the safest medical intervention humankind has ever invented. The false belief that the MMR vaccine is worse than the infections which it prevents is born of disinformation, an increasingly effective flooding of the mass- and social media ecosystem with zombie claims of harms the vaccines do not cause.

I know, I know. This is a tragically familiar story and repeating it won’t persuade those committed to the anti-vaccine stance. Ethan’s mother makes that very clear.

But the fact that some people will make foolish, dangerous choices is not what Dr. Simon raged against 150 years ago. Break down that phrase, “omissional infanticide.” The harm done by parents does not (directly) adhere to those adults. It strikes down those with no power, no voice, no means of escape: babies, toddlers, kids.

It was to shield those defenseless children that Simon wrote. He did so in support of a specific policy: a mandate, the requirement, passed by Parliament four years earlier, that every child born in England and Wales be vaccinated against smallpox before they were three months old (four months if the child was in an orphanage).

Vaccine requirements in the US are usually imposed as a condition of attending public school. They are most often justified by the need to achieve herd immunity. Herd immunity is a defense of others: by vaccinating a high enough fraction of a population so that a pathogen that makes its way into one body cannot find a new host to infect, it prevents single cases from turning into epidemics. If that level of immunization is high enough, those who genuinely can’t get a vaccine—those too young for their first shots, immunocompromised people, transplant recipients, an the like—can be protected. So, in good times, can anti-vaccine freeloaders like Ethan’s family.

These aren’t good times. The US is in the midst of its worst measles outbreak in years. But, as Simon reminds us, the fundamental reason that a seven year old boy is so sick is because he was his parents made it possible for the measles virus to find a welcoming home in him. He is now terribly ill, not through any fault or mishap of his own, but because his mother and father consciously left him in a virus’s crosshairs. He may endure permanent harm. He may die. If he does, he will have been a victim of omissional infanticide.

One more thing: I’ve blamed the parents, and their deeply-held commitment to an anti-vaccine stance is clearly the proximate reason for Ethan’s predicament. But there are accessories to this unfolding tragedy, chief among them the Health and Human Services Secretary, Robert F. Kennedy Jr. The very public, high profile and frequently repeated anti-vaccine catechism coming from the center of the federal public health apparatus is what fosters and reinforces faith in repeatedly debunked claims about vaccine harms.

And it is children who, to date, are paying the highest price for both the private folly of the adults supposed to nurture them, and for the sustained, often corrupt public attack on the idea of vaccination that lies behind each individual story of avoidable suffering.

Image: Gabriel Metsu, Sick child, between 1664 and 1666.