Recent news (such as this sample) concerns a controversy about the current rising number of cases of measles that previously was considered eradicated from the country as a result of widespread acceptance of childhood vaccinations. The measles vaccine protects most people who take it and this limits the prevalence of the disease to prevent transmission to the population who can not take the vaccine (such as infants) or people with compromised immune systems (such as some treatments for cancer). Health and government officials as well as news organizations appear to be mostly blaming the anti-vaccination movement for creating a larger vulnerable population to allow the disease to spread and increase chances for exposure to those who can not be vaccinated.
Although there are exceptions, the general explanation for the outbreak is that unvaccinated people are catching measles from others who have it because they too were unvaccinated. Many of both groups declined to accept vaccinations available to them they were eligible for vaccines and the vaccine would have been effective.
I think one of the reasons that this is getting so much attention is that it wasn’t long ago that we considered the disease eradicated from the country due to near complete vaccination of the population sometime in the late 1960s or early 1970s. The protest is that we have allowed a previously conquered disease to return because many people are declining to get their children vaccinated.
The recent avoidance of the vaccine is the result of now debunked studies about a decade ago that showed that vaccinations correlated with increased incidents of certain health conditions such as autism. At that time, these results received a lot of attention, including prominent coverage in major news sources. The coverage gave the impression that the vaccines were not risk-free although the exact mechanisms were unclear. This news gave permission for people to decline vaccination out of a sense of caution.
Many blame today’s outbreak of measles on the large number of people who made an informed decision to not vaccinate their children. This criticism has more strength today because of the debunking of the earlier studies showing a cause for concern. From what I can tell, the current evidence proves the vaccine to be very safe and effective.
On the other hand, the anti-vaccination groups make some good arguments against the urgency for vaccination and the need to preserve the liberty of people to make their own choices, for example this quote from Sen. Rand Paul:
“I’m not arguing vaccines are a bad idea. I think they’re a good thing, but I think the parents should have some input,” he added. “The state doesn’t own your children. Parents own the children and it is an issue of freedom.”
For this post, I am not taking a position on the debate. Instead what impresses me is the resemblance of the timeline with what I would expect from a dedomenocracy that makes frequent short-lived decisions based entirely on the most most recently available information.
Unlike the current US democracy that is generous toward individual liberty, my vision of a dedomenocracy is one that coerces the population to follow the rules with the understanding that the rules will be short-lived and soon replaced by rules focusing on more urgent issues. In effect, a dedomenocracy has a short attention span but this can have lasting impact on society by conditioning the public to continue the good practices without further coercion.
Excluding the political controversy, the large scale sequence would probably be the same for a dedomenocracy as we experienced in our democracy:
- Based on evidence of a highly infectious disease and the newly available safe and effective vaccine, the government made MMR (measles, mumps, rubella) nearly compulsory for school attendance.
- After a while, the government was more relaxed about granting waivers to the vaccination or allowing voluntary participation. In a dedomenocracy, it is a feature that rules are always short-lived to last long enough to affect a cultural change. The same relaxation of the rule would occur.
- The majority of people voluntarily continue to vaccinate their children.
- New evidence appears that suggests that the high vaccination load on children may be harmful, with a particular concern raised on the MMR vaccine. In our experience, a cultural movement started to discourage people from taking the vaccine. A similar result may very well happen in a dedomenocracy that would observe the same data and make a rule to exclude or excuse certain populations from taking the vaccine.
- The evidence of harm is later discredited but there is no urgency to change the attitudes for vaccination because the disease remains rare.
- Eventually an outbreak appears and spreads rapidly among the large population of unvaccinated at an alarming rate compared to recent history of nearly zero cases. This new evidence elevates the urgency to reemphasize the need for mandatory vaccinations. In our experience, this is our present political/cultural debates of incrimination and protestation. In a dedomenocracy, the same data can justify a new rule that everyone must follow.
The difference between a dedomenocracy and our current debate is what will happen next. Currently, there is a growing demand for a permanent law to require everyone to be vaccinated. It will take months or years of debate to make or change such laws. In contrast, a dedomenocracy might immediately make a rule to mandate vaccination but only for a short duration. Eventually the rule will expire and continued cooperation will depend on the population having a lasting appreciation for the value of the vaccine.
Alternatively, a dedomenocracy may decline to make any rule at all because either the evidence is not that strong that a vaccination campaign will be effective or that the measles epidemic does not rise to the level of priority needing attention. I suspect this result of no automated rule will be more likely and it is the better option. First of all, as we are seeing now the population is responding voluntarily to seek vaccinations that they previously declined. This a significant fraction of those who previously declined the vaccines and they may be enough to stop the outbreak. Second of all, the recent outbreak could qualify as distraction from more important issues that better deserve the government’s attention. The outbreak may be a tolerable nuisance.
I prefer the dedomenocracy results over the likely democracy result.
It appears the current democracy process will result in a long drawn out debate that already has transformed into a partisan issue. So for both sides are blaming the other for being more in favor of the anti-vaxxers. Passing a mandatory vaccination law would provide liability immunity to vaccination vendors while there remains some concern about the safety. Alternatively, as in the above statement by Sen Rand Paul, such a law results in a debatable loss of liberty. The most likely outcome will be a lasting bitter partisan debate with no meaningful legislation at all. As ugly as that is, it may be preferable to a quick consensus to pass a compulsory vaccination law that will establish a new precedence of establishing authoritarian government for issues related to healthcare.
In contrast, the dedomenocracy response avoids the political discord. If the issue is urgent, then dedomenocracy will make a short-term rule to impose a mandatory policy of immunization with an anticipation that the population will learn its lesson for the long term. If the issue is not urgent (or there are many other more urgent issues), then there is no rule at all. As we are seeing with the current response of voluntary vaccination by people previously opting out, there is a good reason to expect that no rule is necessary.
By this evidence, a new rule may not be needed at all, but almost certainly the democracy approach will drag out a lengthy debate that may indeed result in permanent laws about mandating vaccines. In this context, the dedomenocracy approach appears superior to the democracy approach.
However, vaccination policy presents a serious challenge to the legitimacy of dedomenocracy. My formulation of dedomenocracy involves short-term rules that are strictly authoritarian while they are in effect but they will necessarily soon expire. In contrast, in order to work work properly, vaccination requires perpetual participation. For controlling a disease like measles, we need to maintain herd immunity. Herd immunity is important because there will be some in the population who can not be immunized because they are too young or suffering from immune-suppression conditions. Herd immunity provides an effective barrier to prevent the disease from reaching the vulnerable. For diseases like measles where immunity is not inherited, herd immunity requires continuous application of vaccines to each new generation. A democracy can create permanent laws to assure this result, while a dedomenocracy will ignore the issue until an outbreak provides the data that there is a problem.
My formulation of a dedomenocracy is one that makes only short-term rules based on data that is biased heavily on most recent observations. Such a government cannot sustain a preventive rule like vaccinations. Once the vaccinations become effective, the incidence of the disease disappears and it is no longer a priority to renew the rule. Worse, new evidence of a hint of vaccination risks may impose a new rule to avoid immunization thus causing an rapid decline of herd immunity. If we had a dedomenocracy for the past two decades, it is possible that the vulnerable population would be even larger than it is now, and the outbreak much worse.
The measles example provides a vivid illustration of what can happen with a government that is almost entirely focused on the short term, reacting only to the most recent urgent issues using rules using the most current data that may include preliminary results that are later discredited. This example is an analogy for similar scenarios for other policy areas and with even larger hazards.
Although dedomenocracy uses the latest data, it also has historic data. Based on the history of the disease, the algorithms for rule-making may come to the same conclusion as the theory of herd immunity. Based on historic data, dedomenocracy could perpetually renew short term rules for mandatory immunization. The automatic expiration of the rules leave open the opportunity to withdraw the rule if new evidence appears to identify serious risks of the vaccinations, or evidence shows that the disease no longer poses a risk to humans. In practice, the rule would be renewed indefinitely. An perpetually renewed rule is the same as a permanent law.
The measles example is an easy one to justify the need for permanent laws determined by the data. I suspect there are a large number of other policy areas that have equal justification for permanent laws. The problem for dedomenocracy is that the imposition of permanent rules is not democratic. Dedomenocracy is an authoritarian form of government. A dedomenocracy has no democratic participation in decision-making to earn or to maintain the population’s super-majority consent to be governed. Eventually, there will be protests and rebellions.
I assert that the population may cede their liberties to this form of government if they anticipate that the rules will quickly expire and there will be a high frequency of new rules (using the latest data) to take the place of the old rules. An accumulation of permanent rules will undermine this voluntary participation.
I continue to expect that a dedomenocracy must restrain its rules to be short in duration and introduce perhaps unrelated or even contradictory rules based on more recent data. Dedomenocracy can achieve lasting benefits such as herd immunity by using short-lived rules to train the population to change their cultural practices so that they will voluntarily continue a sound practice without having an perpetually renewed authoritarian rule to enforce that behavior. Such training of the population may be possible, but it may take a couple reminders such as we are experiencing today.
Even with that expectation, the example of the current measles outbreaks exposes an inherent vulnerability of dedomenocracy by allowing past defenses to degrade because there are not current evidence for their upkeep. When the danger eventually reappear, it can have a more devastating impact because there will be insufficient defenses and insufficient time to rebuild those defenses.