The USFG should make the MMR vaccine mandatory

Looking forward to debating this topic with you, Pilot.
Before I get into my case, I will aim to clarify the burdens in this debate, as well as the criteria that judges should use to assess it. Starting with the latter, I think it goes without saying that any policy decision comes with the criteria of net benefits. Debates on policy are a comparison of two worlds, and it’s up to each of us to justify the worlds each of us is defending.
This is the criteria on which the burdens for each side in this debate are based. While I carry the burden of proof, that only means that I must show that my case is net beneficial over whatever alternative Con provides, whether that's the status quo or a counter plan. Con can either show that my case is not net beneficial or seek outweigh my case with whatever alternative he presents. Con is welcome to challenge my policy position in any way he wishes.

With that out of the way, let's kick this thing off with the case.

The U.S. Federal Government will require that all individuals before attending school receive the MMR vaccination. All individuals who are beyond schooling age and under the age of 65 would have to get the vaccine within 5 years. These will be subsidized on an as-needed basis, ensuring that it is broadly affordable. Vaccination will be verified in much the same way as it has been verified for schools – a signed and authenticated notice from one’s doctor. Failure to comply would incur a tax that scales with income; as such, this program would largely be run by the IRS in conjunction with the CDC. Exclusions based on allergies, pregnancies, and those individuals who are immunocompromised would be allowed.

Before I transition into some contentions, I'll start with some general overview of this issue.

This debate is fundamentally a comparison between individual choice and public good. I will aim to establish that vaccines are efficacious and that their efficacy leads to substantial benefits to the public good, whereas Con is welcome to counter these claims or introduce negative elements that overwhelm the benefits. Again, this is a net benefits debate, ergo Con will have to argue that the harms of mandating this specific vaccination.

So, how do we balance freedom vs. health?

As a society, we do this quite often. Think about traffic laws. We require people to follow certain rules of the road because not doing so makes them a danger to both themselves and others. And this isn't the only instance where our government goes against basic beliefs in the general population. Despite widespread acrimony over drug tests, workplaces are still allowed to require them. We are taxed despite the protestations of individuals who don't like certain taxes. All of this is allowed not because the government is being overbearing, but because we've accepted an aspect of shared responsibility for our actions. We accept that individual rights do not always trump that responsibility, particularly when doing so could cause harm to others.

So, when is it justified to subvert individual choice to the public good?

That requires that two conditions to be met. Whatever is being regulated or mandated must be safe and effective, and the risk of not participating in said behavior must outweigh any risk from the behavior itself. I would argue that vaccines meet these criteria. Vaccines are both safe and effective, and they have a track record of reducing illness and death from the diseases they prevent. 

All this puts Con in a difficult position. He's going to try and argue that vaccines are markedly different from other issues that encounter the liberty vs. public good question, and he will have to show that the personal freedoms lost outweigh the widely evidenced good that vaccines provide. To do that, he will have to counter life and quality of life lost, which comes with numerical weight, with a vaguer conception of impact, as personal freedom isn't clearly quantifiable.

With that, onto my contentions.

1. Disease Spread

We must recognize that vaccination is not a choice that solely affects the individual being vaccinated. The decision to get the MMR vaccine affects everyone around you. Measles, mumps and rubella are all transmitted through droplets that are sprayed into the air, making them airborne pathogens with a high likelihood of transmission to those around the infected.[1, 2, 3] The mere fact that others are put at risk by people who refuse to take these vaccines creates a substantial societal harm in the status quo, as many are allowed to refuse to get the vaccine.

We're living this harm today, seeing a resurgence in these entirely preventable diseases in the U.S. and abroad.[4] This resurgence is most marked with measles, a disease that the U.S. had eliminated by the year 2000, but which returned in 17 outbreaks among 222 people just in 2011.[5] Mumps has had 4 reported outbreaks this year alone, and has had several small and two large outbreaks in the last 5 years, encompassing thousands of people.[6] Rubella has also returned from a long absence, appearing in three cases in the U.S. in 2012 after being eliminated back in 2004.[7] This change resulted mainly from a false public perception that vaccines have been linked to autism.[8]

In order to understand why vaccinating a large portion of the population is necessary, we have to understand the term "herd immunity." This has been defined differently by different authors, but I will use the term in this fashion: "a particular threshold proportion of immune individuals that should lead to a decline in the incidence of infection."[9] What that means is that if someone becomes sick with a given disease, herd immunity would ensure that that person is so much more likely to run into someone vaccinated against that disease than someone who is vulnerable that they would be extremely unlikely to infect other people. We cannot possibly vaccinate everyone and achieve absolute immunity because of the necessity of the exclusions I listed in my case, but we can seek to achieve herd immunity.

What does that threshold look like for these diseases? For measles, this is 95%.[10] For mumps, it's at least 88%, though it "may need to be higher" than this previously established threshold.[11] For rubella, it sits at 90%.[12] Only through mandatory vaccination could we ever hope to reach those numbers.

2. Disease Impact

My first contention established a threshold for harm in status quo, but I will now show that that threshold has a tremendous impact on society. In order to understand that, we have to know what the impact of these three diseases is.

Measles:

"Prior to the vaccine, 3-4 million people were infected in the U.S. each year, resulting in 48,000 hospitalizations, 400-500 deaths and approximately 1,000 who developed chronic disabilities.

Even with modern medical care, the disease can lead to serious complications, including blindness, pneumonia, otitis media and severe diarrhea. Despite the availability of a vaccine it remains a leading cause of death among young children worldwide, with deaths mainly attributable to the complications of the disease...

More than 90 percent of susceptible people, usually unvaccinated, develop the disease after being exposed. There is no treatment except to make the patient as comfortable as possible by keeping them hydrated and trying to control the fever. Unvaccinated young children and pregnant women are at the highest risk for measles and its complications, including death."[13]

Mumps:

"Mumps is not normally a fatal disease, and up to 30% of mumps infections are asymptomatic. There can be serious complications, however, including aseptic meningitis, orchitis, oophoritis, mastitis, pancreatitis, and deafness. Meningitis occurs in up to 10% of mumps cases; it is usually subclinical and self-limiting. Symptoms of mumps-related meningitis include fever, headache, vomiting, and neck stiffness, which peak for a period of 48 hours before resolution and might appear up to 1 week before parotid swelling. More serious neurologic symptoms are rare and are due to encephalitis. Hearing loss following mumps infections is rare (1 in 2000 to 30,000 cases) and usually results in mild to moderate hearing loss.

Orchitis [swelling of the testicles] occurs 4 to 8 days after the onset of parotitis and is a common complication, affecting 20% of men who develop mumps after puberty. Of those cases, 40% will develop testicular atrophy and 30% will have lasting changes in sperm count, sperm motility, and sperm morphology."[14]

Rubella:

While the disease usually only results in a light fever and small rash, this disease is mainly problematic for pregnant women. "In 1964-65, America had a major rubella epidemic, with more than 12 million cases and 20,000 babies born with congenital rubella; of these, 13,000 were deaf, 3,500 were blinded by congenital cataracts, and 1,800 more suffered severe cognitive impairment."[7] Since pregnant mothers are among the few who cannot get the vaccine, every single person who decides not to get the vaccine is putting these mothers at risk.

Taken together, this means these three viruses present as enduring, broad threats to public health that are made dramatically worse in the absence of herd immunity. As we have clearly not reached a level of herd immunity in the absence of a mandate to vaccinate with the MMR vaccine, my plan solves for this harm.

With that, I await Con's argument.

1. http://www.cdc.gov/measles/about/transmission.html
2. http://www.cdc.gov/mumps/about/transmission.html
3. http://www.cdc.gov/rubella/about/index.htm
4. http://www.npr.org/blogs/health/2014/01/25/265750719/how-vaccine-fears-fueled-the-resurgence-of-preventable-diseases
5. http://www.cdc.gov/mmwr/preview/mmwrhtml/mm6115a1.htm
6. http://www.cdc.gov/mumps/outbreaks.html
7. http://www.thedailybeast.com/articles/2013/03/30/why-rubella-s-scary-comeback-should-convince-vaccine-deniers.html
8. http://online.wsj.com/news/articles/SB10001424127887323300004578555453881252798
9. http://cid.oxfordjournals.org/content/52/7/911.full
10. http://www.theguardian.com/society/2013/apr/25/measles-mmr-the-essential-guide
11. http://jid.oxfordjournals.org/content/202/5/655.full
12. http://www.ncbi.nlm.nih.gov/pubmed/23099870
13. http://guardianlv.com/2014/07/measles-resurgence-in-u-s-after-development-of-vaccine-in-1966/
14. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3135444/

Thank You Whiteflame. 

1. Untried, untested, and unproven.

A vaccination mandate has never been tried before, not only in the United States, but anywhere, so that leaves my opponent without any reliable statistics to argue his case. Whatever scientific data that my opponent would hope to have to prove that a mandate is "net beneficial", simply does not exist. If my opponent can prove any net beneficial nature to anything, it will be in the MMR vaccination itself, and not the mandate. I will ask the judges of this debate to please keep in mind that my opponent has not, and will not be able to produce any statistical evidence that proves that there is any benefit at all to a vaccination mandate. It is my hope to demolish any theoretical bridge that he tries to use to link the benefits of the MMR series, to a mandate. Basically, I will make it my duty to uncover whatever "slight of hand" argumentation he will certainly use to try and make a convincing argument. Please remember, he will be able to present a lot of evidence about the benefits of the MMR vaccine, but that is not what this debate is about. We are arguing about the "net benefit" of a vaccination mandate, and nothing more. For the most part, I won't be challenging him on the "net benefit" of MMR, so any literature he is able to throw at you regarding vaccinations will be a waste of his and your time. I'm only really going to challenge the mandate itself!!!!!

It can be argued that a vaccine mandate was attempted in the USSR to address a diphtheria outbreak, but the stats on this are spotty and totally unreliable, so it can't really be verified whether it actually happened. However, there is reliable data that links high vaccination rates to government programs that offset the cost and help with the availability of vaccinations. On the flip side of this, there is no evidence which shows that even the most aggressive vaccine policies are able to drastically increase vaccination rates in a population. Australia can be considered a case study of that point. Australia employs programs that offsets the cost of compulsory vaccinations that are required for children and adults to attend school. The vaccines that are covered by the program have high rates of vaccination coverage, while others that are not covered have very low rates of coverage. Saudi Arabia achieved "full coverage" in 1990 without the need of a mandate. It has been shown that because most of the people in Saudi Arabia have no trouble affording vaccinations, they have been able to have (arguably)the highest rates of vaccination coverage in the world. Saudi Arabia also employs a comprehensive public awareness program that helps to convince their society of the benefits of vaccinations. A study has shown that only about 1% of people in Saudi Arabia have doubts about the safety and effectiveness of vaccinations.

It can be argued that Slovenia has one of the most aggressive compulsory vaccine policies in the world. Even medical exemptions must be brought before a medical committee who needs to sign off on the verification of said exemption. Yet, there is no evidence that suggests that Slovenia has ever been able to achieve drastically higher vaccination rates than any of their neighbors with comparitably lax vaccination policies. Overall, Europe is considered to have high vaccination rates despite of an active antivaxxer community there. On the flip side of that, Africa is considered to have one of the lowest vaccination rates in the world. The evidence is undeniable, low vaccination rates are tied to the cost and availability of vaccinations, and lack of dynamic public awareness initiatives, not the antivaxxer community, and not a lack of a mandate. 

My opponent will have no statistical evidence that shows a mandate will cause people to reject vaccinations because they'll view it to be a violation of their civil liberty. He will need to prove to us that a mandate will certainly not cause many in the public to become skeptical or even fearful of the medical community, because they may see it as an overbearing government policy that invades their freedom of choice. We are talking about forcing a medicine upon people who are fearful of it. We are talking about not even attempting to persuade them, but forcing it on them, and my opponent will be totally unable to prove that a mandate will produce the opposite effect of what we want, which is herd immunization. It will not be proven that a mandate is "net beneficial" for society!!! 

2. There are already effective laws in place in the United States, they're just not being enforced.

There are reliable studies that show the benefits to compulsory vaccinations for children and adults who attend school. But in the past two decades, there has been a backlash to rules that were considered to be a violation of peoples civil liberties. Currently, there are only three states that don't allow for any vaccination exemptions aside from medical exemptions. All other states allow for exemptions on religious grounds, and the rest allow exemptions of religious and philosophical grounds. A study of school children in California has shown that when compulsory vaccinations are enforced properly, vaccination rates for people attending school do indeed rise, sometimes dramatically. Compulsory vaccination laws should not be misconstrued with a mandate. They're simply laws put in place to protect people who assemble in large groups for several hours a day. These laws aren't a mandate, you aren't required by law to be vaccinated. The only requirement is for those who will be attending school. You can choose homeschooling. I will argue that it is not a lack of a mandate that puts the public at risk, but the lack of enforcement of compulsory rules, and the ease of claiming an exemption, that puts the public at risk. It's worth noting that there's no guarantee every state will properly enforce a mandate. With this kind of public backlash against vaccinations, perhaps the choice of action would be public outreach programs aimed at educating the public about the safety and effectiveness of vaccinations. A mandate seems ineffective when it comes to educating the public. There is currently no public programs aimed at teaching adults of the threat of disease, and the benefit of vaccinations. A mandate will be impotent when it comes to addressing the problem of public attitudes toward vaccines.

3. There is a disconnect between the medical community and the public.

Obviously a culture of discord exists between the medical community and the antivaxxer community. This is indicative of a culture wide phenom known as the "echoe chamber effect". We can point to the antivaxxer community and claim they're purposely ignoring evidence, but is the medical not guilty of ignoring evidence themselves? There is an attitude among healthcare providers that there are only two kinds of people when it comes to vaccinations. Those who are up to date with their vaccinations, and the antivaxxer community. But who are the people in between? A study in Ohio has shown that out of all the adults who were interviewed, around 35% of them did not realize that they need to keep up to date with their vaccinations because either a) they thought that adults immune systems were strong enough to keep them safe, or b) because they thought that since they received vaccinations when they were children, there was no need for them to keep up to date with their vaccinations. These people aren't necessarily antivaxxers, and this points to an urgent need for educating the public, but the medical community has opted out of the debate entirely and turned their focus to enforcement of a mandate. There's also a new trend among healthcare providers to not receive any patients who are not up to date with their vaccinations. This points to a disturbing trend that the medical community is either unable, or unwilling to teach the public, even when there's an obvious need for them to do so. They are just as guilty of living in an echoe chamber as the antivaxxers are!

4. No comprehensive public awareness initiatives exist to make adults aware.

There is an ebb and flow when it comes to public attitudes toward vaccines. There was a time when the public was begging for a cure to debilitating diseases. Our Grandparents will remember the fear around polio. Everyone knew someone who was effected, and anyone could be next. We are three or four generations removed from a time when the public had a fear of disease. Because of the effectiveness of past vaccination programs, our society has become complacent to dangers of disease, and even has begun wondering if there is truly a need for vaccinations. If a disease  no longer seems to be a threat to the public, then the public will obviously not be threatened by it, even though they should be. One would think that the medical community would be able to pick up on this trend, because the antivax community is nothing new and has been around virtually since the beginning of vaccinations or inoculation was in use. Yet, there is absolutely no public awareness initiatives that exists to educate adults on the need to keep up to date with their vaccinations. As I've pointed out before that high vaccination rates are tied to cost and availability, it's just as strongly tied to public awareness. There's an obvious need for this, but the medical community has nothing in the way of education. This point in juxtaposition with my last point, shows that there's a "perfect storm" scenario here, and the medical community is not going far enough when it comes to public outreach programs. We need public awareness initiatives, and we need it NOW!!!! My opponent will not be able to provide evidence which shows that a mandate will only prove to widen the disconnect between the medical community and the public.

5. The mumps vaccine may not be adequate to reach herd immunization.

In 2006, an outbreak of the mumps took place in several midwestern states. Studies have shown that this outbreak occurred in areas that had high vaccination rates against mumps. If my opponent is going to argue that to be "net beneficial" we have to reach herd immunity, then it's worth pointing out that herd immunity may not be conceivable as it is now with the mumps portion of the MMR series. It has also been shown that even when people get a second round of the mumps vaccine, it still has not bolstered their immunity to adequate levels, leaving them venerable to the mumps. There's an idea of trying a third round for this vaccine, but most people are unsure if that will work either. My opponent will not be able to prove that the mumps vaccine is "net beneficial".

Thank You again Whiteflame.

My opponent is now relying on convincing us that compulsory vaccination policies are vaccine mandates, but even he can't hide the difference by using coded terminology. Take note of the wording in his argument when he uses the term "unique". That was not a haphazard choice in phrasing, that was a concise choice of terminology used for the purpose of avoiding the word "different". It wouldn't be daft of me to claim that there's another word that could be used in place of "unique", and that word is "different". He's right, a vaccine mandate is "unique", because it has never been done. He argues that there are two things that make his proposed mandate different from compulsory vaccinations, which are, extending the law to include all adults whether they attend school or not, and making it a federal law. He leaves out a glaring difference between mandatory and compulsory which is the tax penalty. Compulsory vaccinations do not make it mandatory for anybody to be vaccinated, it only makes it mandatory to attend school, but it still gives you the choice not to vaccinate, because nobody is required by law to attend public school. The mandate differs from compulsory vaccinations because you will be in violation of the mandate whether you attend school or not. Making the mandate a federal law also differs from compulsory vaccinations because it takes away each States rights to make their own choices on vaccination policies. It worth noting that a mandate could likely be challenged by some States, and my opponent can't prove that the Supreme court wouldn't side with the States. The last difference between the mandate and compulsory vaccinations is the tax penalty. Compulsory vaccination policies in the United States were never enforced by a tax penalty. You're child could be removed from school if they didn't comply, but nobody was ever penalized economically. Much of the rest of my opponents argument rellies on keeping us convinced that compulsory vaccination policies are the same as a vaccine mandate.  

 Just as I said in my first argument, my opponent uses the benefits of the MMR vaccine as if they are the same benefits of the mandate. When it comes to the backlash that could occur because of a mandate, I was never arguing that there are no "benefits of more vaccinated people." This is the "slight of hand" kind of argument that I said my opponent must use to try and tie the benefits of the MMR vaccine to the mandate. I assert that it is my opponent who must convince us of the benefits of a mandate, and to do so, he is now arguing that the mandate is merely just an extension and widening of compulsory vaccinations. If my opponent cannot prove that a federal mandatory vaccination law is the same as a State policy of compulsory vaccination, his argument will unravel. If he can't make those two things identical, he can't argue that a mandate will be "net bennificial", because he will be arguing for a policy that's never been done. The backlash that will likely occur will be when individual States question the constitutionality of the mandate, and they will argue that it violates States rights to make policy choices on vaccination policies. As far as the backlash from individuals, it could widen the dissconect between the medical community and the public. It could validate the fears of many who believe that the medical community is an agent of the Government. Although it's not a nice thing to have to talk about, the possibility of rogue militant vigilantes could find reason to commit acts of terrorism, and they may target people in the medical community. The medical community is sometimes a target of these egregious acts already. Acts of violence against planned parenthood is unfortunately a reality in the United States. Since there is no data on mandatory vaccinations, I have no evidence to prove this will happen, but my opponent will have none to prove that it won't happen.

The reason I haven't provided any evidence of the effectiveness of a public awareness program for educating adults on vaccines, is because there has never been such a program, but there certainty has been other effective programs. There was an HIV and AIDS initiative. There's a child abuse awareness program. There's one for smoking, drugs and alcohol, racism, sexism, an awareness program for the LGTBQ community. There was a better awareness program for listening to your headphones to loud because of hearing loss, than there ever was for educating adults on vaccines. I can't prove that a public awareness program for vaccinations by using hard evidence, because there has never been one. However, there have been several other programs that have been effective. This topic warrants such a measure, and my opponent has done nothing to prove that it would be innefective. Here's some convincing testimony from a couple of groups whose stated goal is to raise awareness.

"During the week of the most recent World AIDS Day, December 1, 2014, AIDS.gov got the most engagement and new followers of the entire year, Miguel Gomez, the director of AIDS."

Liz Feld, president of the nonprofit advocacy organization Autism Speaks, says she has seen results from World Autism Awareness Day, which was April 2, and Autism Awareness Month, which goes on for all of April. The organization has raised more than $10 million so far in April, more than 50,000 people registered on Autism Speaks’ website, and more than 18,000 buildings around the world illuminated with blue lights on April 2 as part of the “Light it Up Blue” campaign. A spokesperson also told me that “Light it Up Blue” was a trending topic on Facebook and Twitter on April 2.

Thanks to Con, onto the third round!
 
1. The Solvency Press

I feel I need to address a through-line point Con is making before I get into the rest. A lot of this involves Con employing stating that my case is invalid because it has never been done before.

Con’s approach treats direct evidence of effectiveness on every plank of a given policy as absolutely necessary to establish net benefits. In doing so, Con effectively invalidates every policy that has any unique elements. By Con’s logic, these policies have no benefits, bar none. If Con is correct, we cannot establish solvency of such plans logically, we cannot establish it by comparison to similar policies, we cannot compare the effectiveness of different approaches to a similar problem. None of these are meaningful to Con, and Con would automatically invalidate every approach that includes novel elements.

To be clear, while I agree that support for a given policy is a lot stronger when you can cite the effects of a policy that is identical to that policy in every way, I disagree that any alteration from existing policies automatically invalidates any and all comparisons to similar policies. We can compare elements that are identical or similar. Specifically, we can reasonably compare the effectiveness of different mandates, so long as we establish that each mandate is effective in driving people to take a given action. This is how policies evolve and change in the real world, and this is how they should be treated in debate as well.

Now that these problems have been established, let’s go through Con’s arguments.

He concedes that compulsory vaccination via exclusion from public schools is a mandate, just stating that it’s a different kind of mandate. This is crucial. By conceding that these are both mandates, he invites comparison between those mandates. So, let’s compare them.

The school mandate requires that anyone attending public school be vaccinated. By doing so, there is a clear opt-out condition: you may simply choose not to attend. That reduces the effectiveness of the mandate; it applies to a smaller number of people as a result, as it excludes those who are home schooled and those who attend more lenient private schools. All states also have the medical opt-out, but some also include ideological means of opting out. Nonetheless, I will point out that, contrary to my opponent’s assertion, this is an economic penalty. Many families cannot afford home or private schooling, and as such, this is a major blow to the potential income of their family over time.

The tax mandate (my mandate) requires that every American who pays federal taxes vaccinate themselves and their families. This also has a clear opt-out condition: medical need. As such, this applies to a greater proportion of the general population, as it includes all individuals paying federal taxes.

So, when Con argues that I must convince you of the benefits of my policy mandate, I think it’s absolutely clear: ensuring that a larger swath of the population is induced to action by said mandate. People like money. They don’t like losing money. Losing a larger portion of their income through federal taxes is a clear net negative for everyone who pays those taxes, whereas the loss of public schooling is less effective in driving action for some people. Con has never argued that the tax would be ineffective, instead choosing to argue that, solely by virtue of its differences from existing policies, it is unproven. That isn’t enough. He must attack the tax directly, otherwise he fails to challenge the solvency of my case. I suppose this isn’t surprising, though, as it’s been clearly shown that taxes can and do often alter behaviors, particularly when applied to a given product.[31] This is clear evidence of the solvency inherent to tax policies aimed at altering consumer behaviors, which include mine.

However, when Con argues that I must “prove that a federal mandatory vaccination law is the same as a State policy of compulsory vaccination,” he is absolutely wrong. If the two were completely identical, there would be absolutely no point in implementing said policy. Policies that are status quo change nothing, hence debaters tend to present alternatives to the status quo, as I have done. This mandate functionally expands on the efficacy of state-based mandates, and those mandates stand as exemplars of the effectiveness of a mandate in expanding vaccination coverage. The two need not be identical to see how one resembles the other and infer related effects.

Con also grants or drops three essential points on my solvency.

He grants that all I need to do to achieve solvency is induce any increase in the number of vaccinated individuals. Given that that reduction automatically softens the blow of (or entirely prevents) future measles, mumps and rubella outbreaks, this is a huge concession because it ensures that I need only have minimal solvency in order to see the effects.

He drops the subsidy. This alone is enough to grant me some solvency, as I provide a greater ease of access to vaccination via federal funds, thus ensuring that those who lack the economic resources to vaccinate can do so.

Lastly, he drops the country examples Con himself presented. In doing so, Con concedes that Saudi Arabia and Slovenia present viable examples of federally-imposed vaccination mandates. Saudi Arabia imposes mandates for those visiting during the Hajj, reducing a great deal of the disease burden borne by these pilgrims. Slovenia mandates numerous vaccinations within the first 3 and 18 months of life, as well as prior to the start of school. “Failure to comply results in a fine,” hence this is a similar federal mandate enforced by a fine instead of a tax. These examples both show that a federally-imposed mandate, enforced either by exclusion from a religious ceremony or via a fine, that leaves fewer opt-out opportunities, has worked in the two countries in which it has been tried. These systems are the most akin to mine abroad and showcase the effectiveness of similar mandates.

2. Backlash

Again, let’s recognize that this is Con’s only piece of offense on this debate. He must win this to stand any chance of winning.

He splits this up between state response and individual response.

For state response, Con says that states may try to invalidate the mandate via the judiciary on the basis that it is their right “to make policy choices on vaccination”, though he doesn’t specify where that right comes from, nor why the courts would be likely to uphold it. There is absolutely no reason why the courts would find the levying of a contingent tax, aimed at altering the behaviors of its citizens (as so many do), by the federal government to be unconstitutional. This kind of tax is extremely common, often used to dissuade or encourage the usage of a given product by increasing or decreasing its price directly.[31] Since my policy effectively makes it more expensive not to vaccinate with the MMR vaccine, I am using a similar dynamic that is not markedly different from any other taxes (such as those on cigarettes or alcohol) aimed at altering consumer behavior. If states can do this through school mandates, there is nothing unconstitutional about doing the same federally via taxation. Con’s argument also assumes that states lose all power to choose to mandate any vaccination, though all other vaccinations would still be in their purview, and they would still be able to choose to exclude those who choose to pay the tax from public schools. But even if he’s right that the mandate would be invalidated, the subsidy would continue to exist, meaning at least some of the benefit would persist.

For individual response, Con introduces uncertainty, saying that this policy could do harm to various aspects of patient-doctor relationships. He doesn’t justify any of these, simply asserting that they could happen. I can do the same. This policy could engender a greater connection between doctors and patients, allaying unfounded fears and uncertainties by showing patients that these vaccines are safe. It could show much of the public that the government cares about their health and takes the recommendations of medical professionals seriously, increasing trust in the government and its role in the lives of citizens. Whatever “could” be is largely irrelevant because possibilities exist on both sides: we are discussing what is most likely and why. Terrorism may be possible, but Con doesn’t spell out why it’s likely, merely comparing to Planned Parenthood. Even if it is likely to happen, Con is suggesting that these violent groups should be allowed to dictate policy. Violence from a subset of the population mentally disturbed enough to commit such acts (and likely willing to do so under the slightest provocation) seems an especially absurd basis for failing to implement a given policy, and if we’re using Con’s analogy, it would be akin to shutting down Planned Parenthood because it is a target of such threats. Most importantly, Con has failed to provide any quantitative impact to this backlash, leaving all these impacts as nothing vague possibilities. Remember what these vague threats are pitted against: any and all reductions in massive and dangerous epidemics spreading across the United States, which are a certainty with my plan.

3. Alternative b.: educate more

Once again, Con has failed to provide any specificity to his alternative, including, but not limited to: how it will run, who will run it, how long it will run, and what it would include. He points to examples of successful public awareness programs, but never tells us what, if anything, he has learned from them. This means Con is solely asserting his solvency without reasoning or evidence, as they are both only possible if he has a clear plan of action to assess.

Realize that neither of the examples Con cites discuss outcomes like what he is proposing. Neither the World AIDS Day nor Autism Speaks drove people to so substantially shift their attitudes that they willingly pursued treatment for against previously-established views.

These are big problems for this alternative. Con drops my point that not all such programs (particularly those aimed at substantially altering behaviors) are successful, as many of them are not successful and some are even harmful. Here are two examples:

The Drug Abuse Resistance Education (DARE) program, a widespread anti-drug program for youths: “20-year-olds who’d had DARE classes were no less likely to have smoked marijuana or cigarettes, drunk alcohol, used "illicit" drugs like cocaine or heroin, or caved in to peer pressure than kids who’d never been exposed to DARE. But that wasn’t all. "Surprisingly," the article states, "DARE status in the sixth grade was negatively related to self-esteem at age 20, indicating that individuals who were exposed to DARE in the sixth grade had lower levels of self-esteem 10 years later." Another study, performed at the University of Illinois, suggests some high school seniors who’d been in DARE classes were more likely to use drugs than their non-DARE peers.”[32, 33]Suicide prevention efforts via media campaigns have practically all failed to address the problem: “Such public education and awareness campaigns, largely about depression, have no detectable effect on primary outcomes of decreasing suicidal acts or on intermediate measures, such as more treatment seeking or increased antidepressant use… A systematic review of studies published from 1980-1995 found that knowledge about suicide improved but there were both beneficial and harmful effects in terms of help-seeking, attitudes, and peer support.”[34]

4. The Remainder

Con drops his second alternative, as well as his effort to mitigate my solvency on mumps.

31. https://www.researchgate.net/publication/294736693_Taxes_and_Consumer_Behavior
32. http://content.time.com/time/nation/article/0,8599,99564,00.html
33. https://www.vox.com/2014/9/1/5998571/why-anti-drug-campaigns-like-dare-fail
34. https://www.centerforhealthjournalism.org/2014/09/09/preventing-suicide-all-wrong-ways

Thank You Whiteflame.

I've stated from the beginning that I will make it my duty to expose any arguments from my opponent that ties the scientifically verified net benefits of MMR to the unproven benefits of a mandate. My opponent is arguing that I am not allowing for any wiggle room when it comes to proving the effectiveness of anything untried. He's touched upon the very heart of this debate with that claim, but it is he who doesn't allow for any wiggle room when it comes to allowing for any viable skepticism toward the unused policy he's proposing. The fact is, no adult has ever been required by law to be vaccinated (in the US). The claim that a mandate is just an extension of coverage from compulsory vaccines is erroneous. The fact is, no child has ever been required by law to vaccinate. My opponent tries to side step that claim by arguing it is to economically burdensome for families to not let their children go to public schools, yet he provides no evidence which shows that families don't willfully take on that burden for the specific purpose of not vaccinating. Obviously that burden is not to much for some people to take on, because if it was, we wouldn't need to be having this discussion in the first place. My opponent is hoping to close the gap that allows families to choose not to vaccinate, but the purpose of my argument is to prove that mandatory vaccines aren't needed. I agree that "this is how policies evolve and change in the real world, and this is how they should be treated in debate as well." So that's why I'm here, to put up a solid retort to my opponents proposal. If my opponent wants to have a well rounded discussion about the benefits of a mandate, then he will need to concede that there must be a viable voice of scepticism to make viable retorts for this to be a well rounded discussion.

1. The difference between compulsory and mandatory!!!

 I've not conceded that compulsory vaccine policies are just short order mandates. My opponent pointed out that there is an opt out mechanism worked into compulsory vaccines, which he argues that when it comes to homeschooling, it's "an economic penalty"for families to choose not to vaccinate. Simply arguing that the economic burden everybody takes on when they have children is the same as a tax penalty is shortsighted. From the time a child is born, up to the time they attend school, there will need to be a trustworthy adult present to care for the child. In most cases, that would be a member of the family who will not be able to have a steady job (or they won't get much sleep). All of this takes place before any compulsory vaccines are required at all, and it represents an economic burden that all people who have children will face. That is not an economic penalty that is handed down by the government, that's just how it goes when you have children. If they can make ends meet for 5 or 6 years of having a child that doesn't attend school, they can do it for another 5 or 6 years, up until the child can be trusted to stay home alone and keep up with their studies. Homeschooling is simply a matter of having an internet connection. Furthermore, if there is an older child in the household who can be trusted, they can watch over the younger child, while the caregivers are out at work. Compulsory vaccines can be more burdensome for low income families, but they can receive government assistance to help with that burden. A mandate will levy a tax burden on families that choose homeschooling, regardless. That's an obvious difference, and my opponent hasn't properly addressed this.

My opponent concedes the other differences between compulsory and mandatory when he states "the tax mandate (my mandate) requires that every American who pays federal taxes vaccinate themselves and their families." He does nothing to address the obvious difference between the compulsory and mandatory. My opponent seems to be having trouble with convincing anybody of the benefits of a mandate, so instead he's opted to argue that a mandate is just an extension of coverage from compulsory vaccines. The fact that he pointed out that all taxpayers will be required by the mandate seems to be just an attempt to not drop those points rather than making a case for how the mandate is the same as a compulsory vaccine policy. But he has conceded those points, and they are 1) all adults will be required by law to vaccinate. 2) This policy will be enforced on the federal level. 3) The mandate will levy a tax penalty on those who don't comply. Those are obvious differences, and if my opponents argument hinges on compulsory being the same as a mandate, he should have done more to make his case.

2. Backlash 

Italy is struggling with a compulsory vaccine policy itself. Even with statistical proof that shows the compulsory vaccines were effective at raising vaccine coverage, in the summer of 2018, the law was scraped. Then later in 2018, the law was reinstated with more opt out options for those who are opposed. This shows that even if there are obvious benefits to vaccines, if the public rejects the policy, it won't be properly enforced. This is a crucial point that my opponent hasn't properly addressed. It seems that no policy regarding vaccines can be properly instated unless the public accepts its purpose. And in the case of a mandate, if the public ever were able to accept why we should have one, there would be no reason to have one in the first place. 

Public backlash is the most obvious point of contention on my side. It can't be proven that a vaccine mandate will even get passed, or be overturned if it is passed. It hinges on the publics perception of the policy, and if the public were to accept such a policy, there would be no need for a mandate in the first place because the public would understand why we need one. My opponent argues that there would be no reason for the courts to side with any states that have challenged a federal mandate, but he's provided no evidence that says the federal government does have the power to impose a mandate. He has nothing in the way of showing us that a state has no power to challenge a federal mandate, and he has nothing proving that the federal government can impose such a policy. Again, my opponents point here rellies on the publics acceptance of the policy at hand. The government has instated federal mandates, and in the case of prohibition, it was eventually repealed because of the publics rejection of the policy. If 90% of the US public rejected the need for a mandate, it's unlikely such a thing could be passed and implemented unabated for a long enough time to cause any beneficial effects. On the flip side of that point, if 90% of the public agreed with the reasoning behind the policy, they would obviously understand the benefits of the MMR vaccines, so there would be no need for a mandate. Implementation of a mandate can cause certain factors of the public to reject vaccine laws (as it has in Italy), and cause the rule to be unpopular. If the rule is unpopular, it will not be implemented, or it will be overturned. It seems the only effective policy is to convince the public, and my opponent has mishandled that point.

3. Public awareness programs.

My opponent has done little to prove that a public awareness program would not be able teach adults of the effectiveness of the MMR vaccines. He points to the mishandling of the DARE program, but in one of the links he posted, it clearly states that the "above the influence" program has produced results. He inadvertently contradicted his own argument. His argument on the suicide prevention program rellies on the testimony of a published article, not a study. This argument to attempt to discredit the effectiveness of public awareness programs totally ignores one public "awareness" program that my opponent would agree is effective. The antivaxxers have a totally effective public relations program and it's one of the underlying reasons for this debate. Furthermore, he's done nothing to persuade us of the ineffectiveness of all public awareness programs. The fact is, there's a public need for vaccine awareness and this policy should be tried before implementing a mandate. It seems my opponent has the same attitude toward public awareness, which goes something like, well they don't want to listen anyway, so just make it a law. In lew of the data from Italy (and other countries that I won't mention because they've been dropped), not only is it obvious that there's a need for public awareness programs, it seems that's the only effective way of doing this.