Vaccination and Circumcision

As a followup to my earlier post on the proposed circumcision ban in San Francisco (and Santa Monica), one argument I’ve seen made in response is that I shouldn’t be so vehemently pro-vaccination if I want to preserve choices about circumcision on the grounds that the medical evidence is mixed. Three quick responses to this argument:

1. The medical evidence in favor of vaccinating children is far more powerful than the evidence about health benefits or risks on either side of the circumcision battle. For this reason alone, we shouldn’t demand that the two cases be treated in parallel.

2. I advocate mandatory vaccination, but not mandatory circumcision. I don’t think there’s even remotely near enough evidence of health benefits from circumcision that the state should mandate the procedure. My position is simply that there’s enough evidence for me personally to think it’s a good idea for my own child, but even then it was a close and difficult call. When the state is going to mandate something, as opposed to leaving it an open choice, the standards of evidence have to be very high.

3. Failure to circumcise could have small and indirect effects on the health of others: for example, female partners of circumcised males would lose the apparent benefit of being somewhat less likely to contract an STD. However, several other and better preventative measures exist. Failure to vaccinate, by contrast, has major and direct effects on the health of others. Diseases that should be eradicated or incredibly rare are making comebacks because of the spreading anti-vaccination sentiment. Vulnerable populations who cannot receive a vaccine or who remain susceptible even with vaccination are dependent on the “herd immunity” that is threatened when more people choose not to vaccinate. Because of the direct and life-threatening consequences for others, this case needs to be treated differently from the circumcision case.

I had doubts about giving my oldest child the chicken pox / varicella vaccine back when it first became available to her. My father had only a mild case of chicken pox as a child, and developed insufficient immunity so that he caught the illness again when I had it. As a child, I suffered from a few days of uncomfortable itching; as an adult with the disease, my dad became gravely ill, was hospitalized, and could have died or suffered severe complications. I was worried that if children didn’t develop sufficient immunity from the vaccine–since there was talk that immunity might wear off over time, or that more shots would be required later–they would be more vulnerable to the kind of serious case my dad suffered. However, it turns out that the best way of preventing those cases is simply to reduce the number of kids who have chicken pox, thereby reducing exposure for adults or other vulnerable patients. Needing a booster shot later isn’t a problem if most children in the community aren’t contracting the illness in the first place. If people don’t choose to vaccinate, though, we won’t achieve this kind of group effect, and more people will suffer from an easily preventable problem.

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