To the indirectorate:

The issue of opposition to vaccinations is one that boggles the mind of most people. Vaccines are a proven means of erradicating disease through a means so simple, cheap and effective that we've already driven many diseases from global North continents, and throughout the world in the instance of smallpox, with more to follow. However, conspiracy fallacies about vaccinations have led to people not vaccinating their children, and diseases are markedly making their comeback. I say "conspiracy fallacy," because unlike a conspiracy theory that thrives on lack of evidence (potential accomplices to JFK's assassin, or UFOs, for example) this is a conspiracy that only thrives when blatantly factual information is ignored or denied. Take the theory that the moon landings were fake. Not only does this require the theorization of a vast quantity of evidence in the positive about the supposed fakery, it also requires the fallacy that the vast amount of evidence that the landings did occur is either itself all entirely fake or non-existent.

But I don't write this memo to argue the obvious about getting vaccinated. I'm curious about the idea of what we do about it.

There is a large amount of righteous frustration among people who do vaccinate, directed at those who don't. By refusing to participate, those who do not vaccinate do not just put themselves or their children at risk, but everyone, as well as the project of eradication. Frustration turns to anger, anger leads to hate. Or, not hate directly, but a middle step: ridicule.

It's very easy to ridicule an idea that is ridiculous, and smart people are doing so to the anti-vaccine position with vigor. And at first, the action seems reasonable. After all, if an idea is ridiculous, why should it not be presented as such? In an arena of fair debate, the ideas that are ridiculous and those that are reasonable will be presented as such, and through a (very reasonable) evolutionary process, eventually the ideas that sound ridiculous will be dropped, and those that are reasonable will remain.

Except that ideas don't work like this, and we know that. In fact, we live in a society that champions ridiculous ideas. Be a dreamer, an inventor, a disruptor. Think different. History will show that you were right, if you stick to your guns and reject those who want to pull you back into reasonable mediocrity. Haters gonna hate. These are some of the highest pillars of Western popular philosophy today, and ridiculing someone's idea pushes them right down that road.

That is not to say that simple, reasoned debate will work as an alternative. The anti-vaccination position is a fallacy, and those who hold it are not functioning according to reason. This is not to say that they are simply deluded. They are simply working with a different, fallacious, sense of logic. They have already decided their position, and only are able to see evidence to support it. They want to not vaccinate, therefore, any evidence against vaccination, no matter how specious, is accepted; while any evidence for vaccination, no matter how overwhelming, is rejected. You can't argue with these sorts of people, and it is worthless to try.

The reason that they are doing this is not simply because they are "stupid," as some might claim. It goes back to that popular philosophy of championing ridiculous ideas. Why be a dreamer? There is the eventual payoff from a just universe, sure, a chance to be as rich as Edison or Ford or Jobs. But there is the moral victory. To be a great artist that dies a pauper is considered a worthwhile aim, because it means being true to yourself. It means that you were more of an individual than anyone else. It really doesn't matter what your principle is, so long as you stick with it. It could be homeopathy, climate change denial, or belief in your ability to predict the apocalypse. You had the courage to stick with your convictions, and more than that: you had strong convictions. You were a person of faith, no matter what your faith might be. You were true to a cause, a leader, an example, and not a flip-flopper. This is a very strong sort of personality magic woven into the fabric of our culture. Look at those who pride themselves as being "skeptical of everything," and look at the way they imitate these magic ideas of faith and leadership. Their "logic," no matter how ridiculous, is part of who they think that they are. To try to tell them they are wrong, either via peacefully reasoned or forcefully mocking methods, is to try to negate their sense of self, a more powerful pillar than any system of logic. The negation of their selves is what they have been told their whole lives that society will try to do to them, and for which they have been preparing to defend themselves against, as a fate worse than death. Remember that Steve Jobs died of cancer, which he treated with alternative therapies at first, rather than traditional medicine. His de facto sainthood in our society, and what people worship him for, cannot be separated from that "iconoclastic" fatality. People have no trouble climbing into their own graves for an idea and an identity.

We risk turning this fallacy into a wedge issue of identity. Look at abortion—something not ever mentioned in the Bible, the fallacy of "life at conception" is now one of the most voiciferous convictions of the Christian identity. The same thing could be said for climate change and the free market anti-federalist ideologues. What will we call the identity of the anti-vaccination crowd in ten years time, when it has been able to cement itself into a voting block, that politicians will clamor to appease? Certain self-styled libertarian candidates are already toying with this audience, trying to equate it with a personal freedom issue. Attacking anti-vaccination proponents at the core of their identity will only help these efforts.

Furthermore, there is the point at which ridicule becomes bullying. Arguments for argument-sake, when logic is not part of the equation, quickly become trolling. One might disagree with the political policies of conservative religious people, but is ridiculing their religion really going to help you? And at what point does ridicule in the name of reason simply become mean, or violent?

Given the public health crisis that is resulting from refusals to vaccinate, many might argue that bullying is not a step too far. They point to anti-racism, anti-bigotry efforts against homophobia and transphobia, as evidence that incessant ridicule is a form of self-defense. But this equivalence does not hold up. Firstly, anti-racism and anti-bigotry is, precisely, an identity issue. Defending one's identity as black, gay, trans, or any other minority identity requires specifically rejecting the identity of "white," "straight," and "cis," that are not so much identities themselves as platforms of majoritarian persecution. Real identities of self are important, and worth defending, while majoritarian identities of self that are a tool for brutalizing and bigotry are worth erradicating.

But, "pro-vaccination" is not an identity that needs to be defended to counter that of "anti-vaccination," nor should it be. What someone who gets a vaccination gets from someone who does not vaccinate, is not in anyway analogous to what someone who is black, gay, or trans receives from those who consider themselves to be white, straight, and cis (let alone those who encompass multiples of these identities). Vaccination is a public health issue, and should be treated as such. While not vaccinating is doing real harm to people, we must keep in mind that the harm comes from the disease that we are attempting to fight, not the anti-vaccination crowd. The goal should always be getting as many people vaccinated as possible, according to the science of epidemiology. In service of that goal, we should work against making this an identity issue, that will cost valuable time and effort to fight once it becomes a political wedge issue in the high-priced circus of American politics. No public health crisis has ever been solved by bullying or ridicule. To even shroud coercision within epidemiology would be a diservice to that science. Look at the harm that the CIA did to erradication efforts by attempting to use vaccinations as a cover for its own ends.

Comparing anti-bigotry and anti-racism with vaccination efforts completely misunderstands the nature of racism and bigotry, as compared to that of disease. Anti-bigotry and anti-racism is, first and foremost, a self-defensive action. To stand one's ground when faced with bigotry is not "bullying back," as those who make the idiotic argument for "reverse-racism" will tell you. It is self-defense. To attempt to recover one's identity when for centuries it has been slandered, malligned, illegalized, brutalized, and forcibly cut from human bodies is not something as child-like as "ridicule," it is the basic right of any individual of our species. For hundreds of years, minorities have been the victims of the most terrible forms of violence the human species can divise, and this continues today. Racists and bigots do not simply "disagree" with minority identities, they want physically harm them, and evidence of this is written into every level of our society.

And since anti-racism was brought up in the same sentence as epidemiology, we might do well to consider the racist history of epidemiology by remembering the Tuskegee experiments, the Guatemala syphilis experiment, and many other such instances. Research on human subjects was performed without consent, people were deliberately infected, and treatment was withheld, resulting in the deaths of many patients. This was allowed because the populations used for the experiments were foreign to the US, prisoners, prostitutes, and minorities. Science can be a form of persecution. But it doesn't have to be. When discussing the best methods for disease control, we would be wise to remember the history of that science, the history of racism and bigotry, and the best method for fighting the latter while defending the former, going forward. These are separate efforts, because historically, they have been anti-thetical efforts. If it was 1972 today, and black Americans rejected getting vaccinations because of the relevations of Tuskegee, they would be right, and "objective science" would be wrong. This reminds us that epidemiology constantly need to re-assess itself against a society filled with various identity politics, and make the best choice both for its own ends, and the people it is purportedly working for.

This is, first and foremost, a public health issue. But the public health resides within society, which is a chaotic cloud of politics, identities, and the realm where logic does not often rule, which we call the diversity of human thought and emotion. We cannot erradicate the disease by killing or imprisoning people who refuse to vaccinate. That would be like attempting to erradicate terrorism by leveling all the villages in an area that could potentially house them. We must fight the actual vector, which we already know how to do. This will probably take new ideas in the practice of epidemiology, new strategies on every level from vaccination method, to public education. But we can do this, if we are smart. After all, we were smart enough, after hundreds of thousands of years of our species, to begin to fight disease on the level of the vector of where infection occurs, after trying magic, religion, vapors, miasma, and countless other false leads. Let us not follow another false lead down the path of an unwinnable culture battle, and remember who our patient is: the human species, with all that this entails.