When Florida’s surgeon general, Joseph Ladapo, announced his plan last month to get rid of all vaccine mandates in his state, he referenced “medical freedom” and letting people do whatever they want with their bodies. Nevertheless, vaccine mandates are integral to current and past United States legal immigration policy. Under U.S. immigration laws, a foreigner who applies for an immigrant visa or seeks to adjust status to that of a lawful permanent resident while in the U.S., must provide proof of vaccination to prevent mumps, measles, rubella, polio, tetanus, diphtheria, pertussis (whooping cough), haemophilus influenzae type B and hepatitis B. Otherwise, they are deemed “inadmissible” by U.S. immigration authorities.
Meeting these and other health-related requirements is non-negotiable, though two possible exemptions exist. A waiver can be granted if there is a medical contraindication that is “likely to result in a life-threatening problem if the vaccine is given.” And, under a strict set of conditions, applicants can apply for a waiver based on “religious or moral convictions.”
Ladapo immigrated with his family to the U.S. in the early 1980s. Virtually the same vaccine mandates applied then as do now.
The purpose of longstanding federal policy established by the Immigration and Nationality Act in 1952—and amended several times since then to include increasing numbers of mandated vaccinations—is to “protect the public health of the nation” and prevent the transmission of communicable diseases. These requirements focus on “diseases that have the potential to cause outbreaks” or are in the process of being eliminated in the U.S.
For similar reasons, currently all 50 states and the District of Columbia include at least some form of state-mandated vaccinations for young children who are entering school (including all public and most private institutions). The usual diseases targeted include mumps, measles, rubella, polio, diphtheria, tetanus, pertussis and varicella (chickenpox). Typically, parents can only opt out after demonstrating a philosophical or religious objection. It’s notable that one of Ladapo’s employers, the University of Florida, has an immunization requirement, which presumably he met.
Empirically, there’s a strong argument in favor of mandatory vaccinations in federal and state law. A study published in the New England Journal of Medicine concluded that vaccinations in the past 100 years have prevented 103 million cases of polio, measles, rubella, mumps, hepatitis A, diphtheria and pertussis. They have played a substantial role in greatly reducing death and hospitalization rates.
But Ladapo doesn’t appear to want to examine data on vaccine-preventable outbreaks. It’s a principled thing with him, as was shown in an exchange on CNN when the host asked whether the Florida department of health ran any projections before making its plan known to gut vaccine mandates while hepatitis A, whooping cough and chickenpox are surging in the state. Ladapo responded, “Absolutely not. It’s about right and wrong.”
Ladapo likened vaccine mandates to slavery. He added, “Your body is a gift from God.” This statement echoes the founder of libertarianism, the philosopher John Locke, who argued in favor of the freedom to what he called “self‐ownership” with God as the ultimate owner of selves.
Furthermore, Ladapo has said that mandates go against informed consent, which is a principle in the code of medical ethics. Healthcare providers must fully explain to patients all of their options before they agree to a treatment plan. This ensures transparency between patients and their doctors and allows shared decision-making.
However, as a public health intervention, vaccination typically has herd-protective effects, certainly for the diseases included in federal immigration law and state regulations. In instances like these, the provision of public goods cannot be conditioned on individual informed consent since public goods cannot be tailored to individual choice.
In the case of routine childhood vaccine, if a parent or guardian decides not to vaccinate their child, not only are they putting their child’s health at risk, but others, too. Here, a person’s choice may lead to the otherwise preventable infection of another individual. This defies a libertarian principle established by the philosopher John Stuart Mill, who argued that “the only purpose for which power can be rightfully exercised over any member of a civilized community, against his will, is to prevent harm to others.”
Reason magazine featured an in-depth discussion on the topic ten years ago. Here, ideas of self‐ownership and the priority of bodily autonomy featured prominently. But as several discussants argued, if not getting a certain vaccine puts other people in danger, then one may be obliged, possibly even on libertarian grounds, to receive that treatment. This is because knowingly omitting to make oneself less infectious may count as a violation of another person’s self-ownership. And so, giving the government the power to override parental decisions can in certain instances be justified.