There is a growing movement in the United States to opt out of vaccines for children and instead let them build their own natural immune system and utilize natural medicines to maintain health. This attitude of maintaining autonomy by enforcing it through limiting which substances can and cannot enter an individuals body is detrimental to the integrity of public health and, although it doesn't seem like an urgent issue because the United States is already almost entirely vaccinated, the small but steadily increasing number of people that are refusing to comply are generating problems now. Five days ago there was a measles outbreak at a Yuba Charter School in California, where a large number of unvaccinated students attend[11]. While only one student was identified with having the disease, the probability that another student contracted it is very high, and if another student has been infected, he or she has not been identified and can continue to spread measles throughout the student body. The school itself, naturally, is downplaying the significance of the event is allowing those that do not have immunization records on file to return to school on April 8. This event and the schools response is exemplary of the current attitudes towards vaccination in the United States, and is a signifier that the integrity of public health is beginning to backslide. This paper will examine the arguments made by anti-vaccination proponents, understand their significance, and then dismantle them to explain how a vaccine mandatory United States needs to be created in order to achieve the maximum amount of compliance without leaving the decision up to those with an inherently flawed idealogy.

The objective of the Anti-Vaccination movement is to maintain autonomy and control where, when, and how different substances enter their body. It is not a battle to keep "natural" or flawed medicinal practices in modern procedures like many assume, but rather it is a battle of free will. To understand and dismantle the arguments of these Anti-vaccination proponents, this (free will) must be the fundamental narrative that is addressed. In the United States, a nation founded on the principle of free will and the practice self governing, it is difficult to undermine those arguments, and is the reason that these retired medical methods are still in use today. It is difficult because they are entirely correct. To mandate vaccinations is to hinder the capstone of personal liberty. In a vaccine mandatory United States the government would dictate what enters your body, the government would fundamentally change the nature of an individuals immune system, and the government would possess the ability to impose penalties and restrictions to those who refuse to comply. The government, for the first time, would be able to forcibly manipulate health, well being, and immune system integrity in order to achieve a larger objective. Medical liberty would be completely destroyed. A measure that, although to some reminiscent of dystopia, is entirely necessary. That is, in fact, because the larger objective is simply that. Larger and more important than maintaining medical free will. 

Protecting medical free will means imposing on others the potential for those that cannot receive vaccinations due to medical reasons the risk of contracting life altering  --  yet still vaccine preventable  --  disease. In a sense, protecting the free will of anti-vaccination proponents inflicts upon the free will of those that do not have a choice in the matter. This is because of the most powerful tool in the battle against vaccine preventable diseases: herd immunity. The concept behind herd immunity is simple: the more people that receive vaccinations for a particular disease, the less chance there is of that disease spreading throughout a population. The disease, although it is not destroyed, loses its most valuable asset, the ability to spread. In a vaccine mandatory United States, rather than having population clusters that lack proper vaccinations (and thus the ability of a disease to spread returned), there would only be a few people in a community that lack the vaccination due to medical reasons, and because their peers are not able to contract and spread the virus, they in turn will not contract it either. Immunization without the need to immunize. By arguing that the government mandating vaccines imposes on free will to maintain a "gate keeper" status on what enters their body, those that do not have a choice in whether they receive a vaccine are put in a situation where they cannot control which vaccine preventable diseases can and cannot enter their body. Their free will is equally imposed upon, and rather than having what enters their body be an aid to their immune system, something life threatening could enter their body instead. The question of whether or not vaccinations should be forced then becomes rather simple: Is preventing the risk of potential loss of life for one individual worth less than keeping a needle out of another individuals body if only for a few seconds? 

To understand the declining rates of vaccinations for children in the United States it is imperative to recognize and understand the decision making process of parents when they decide to opt out. The decision making process itself is just as important to understand as the reason for why the decision was made. It might seem that parents who choose not to vaccinate their children embody poor decision making skills, but in reality it is the initial notion that vaccines are an parental decision in the first place rather than a necessity for public health (not a choice) that spawns non compliance[8,10]. Attempting to convince before the child is born to vaccinate the child actually makes them less likely to comply, because instead of vaccines being presented as a necessity it is being presented as a choice [8]. Parents question the need to be convinced and conduct their own research, and perceived risk increases. Parents who think about and research vaccines before the child is born are eight times more likely to opt out [7,8] due to a cognitive bias known as omission bias [10]. In this case the newly perceived risk of vaccination overrides the genuine risk of not vaccinating because the parent fears that choosing to vaccinate will put liability on themselves if something wrong does occur, but opting out doesn't seem like an active decision so if something wrong occurs they are not liable because being vaccine free is the default. Accepting nature as being as being both a default status and a solution to ailments is a growing trend throughout the Anti-vaccination community, and although most modern medicines are extracted from natural sources, those natural sources are not nearly as powerful as their modern medical counterparts[9].

Creating and propagating bias is the most effective model anti-vaccine proponents have. In their battle against modern science and massive amounts of data to counter their claims, they find strength in numbers and use each other for explanation and validation. The internet, although useful for spreading those massive amounts of data to everyone that could hold these beliefs actually works in the opposite direction of spreading awareness. The formation of online communities for anti-vaccination proponents has allowed the movement to gain traction. These communities widely appeal to the emotion of parents, as an example one post from a German website reads "My four year-old daughter received the five-in-one combination vaccine at nine months, she then had a fever for two weeks, was apathetic and had screaming fits, since then she has suffered from atopic dermatitis and many allergies. My son is now four months old and I don't know if I should get him vaccinated or not" [9]. The trend with all of the posts follows a similar pattern: a parent discovers something abnormal with their child, the parent quickly searches for an unnatural (and thus not normal) answer as to why the abnormality is occurring, they then turn to the dozens of needles that their child has been injected with, and then also turn to the internet to find other parents who share similar experiences. Parents have a preference for personal experience over big data, relating more to the stories of other parents rather than blatantly accepting statistics as an answer to their fears[9,10]. This fear, although understandable, generates an unhealthy amount of confirmation bias in these online communities. Parents, after being exposed to this mass documentation of personal claims stating that vaccines are hurting their children, very quickly become a part of the community themselves and become proponents. The community tells them what they already suspect, and thus confirms it. A viscous cycle that is keeping the anti-vaccination movement alive, creating massive amounts of their own data to combat the rest.

So where does the mistrust in vaccines lie? The holes that proponents poke into counter arguments to validate their own? Their beliefs reside with the fact that companies are pushing for an over abundance of vaccinations, and their profits are being used to fund the research that tells them that vaccines are good for them[1,3]. For them this is enough, large corporations have been repeat offenders of abusing their customers to make a profit, so it is very possible that the same companies that are producing our medicine are doing the same. Except the large pharmaceutical companies, rather than being based purely on profit, are also based on advanced medical practices, and the continuation of the development of new and improved vaccines allows the medical community to advance into a new era of well being and increased life expectancy. Michael Spectre, a New Yorker journalist focusing on science and technology, addresses this mentality in his TED talk "The dangers of science denial" stating that the attitude towards the "hidden" motives of pharmaceutical companies "has nothing to do with science. It's law, It's morality, it's patent stuff. You know science isn't a company. It's not a country. It's not even an idea; it's a process. Sometimes it works sometimes it doesn't but the idea that we should not allow science to do it's job because were afraid is really very deadening. And it's preventing millions of people from prospering"[. Instead of opting in to vaccinations for their children, what many "anti-vaxxers" do is try to embrace natural and holistic medicines which have little to no proven medical value. Although many modern medicines are derived from natural sources, the science behind extracting those components makes the medicinal value magnitudes larger. Spectre comments on this mentality behind the disbelief of technological and medical advancements stating that "When you start down the road where belief and magic replace evidence and science you end up in a place you don't want to be. You end up with Thabo Mbeki in South Africa. He killed 400,000 of his people by insisting that beetroot, garlic and lemon oil were much more effective than the antiretroviral drugs we know can slow the course of AIDS". It is crucial to understand that difference between keeping an ideology alive through practice and keeping a population alive through research acceptance. Those that inflict their views on others by opting out of modern medical practices are solely responsible for any and all illnesses and deaths that occur as a result, and although ignorance is a common trend throughout the anti-vaccination community, it will be impossible to ignore the science once the diseases begin arriving and death begins to take its toll. 

The necessity to mandate vaccines is becoming increasingly apparent, with declining rates of measles vaccines and an overall "it won't impact me" attitude coming in to light in the United States the future of modern medicine and the embrace of new and powerful technology will be questioned and might ultimately fail if the public begins to backslide in their practices. The threat of widespread disease seems to be almost invisible in the United States due to the distribution of vaccines to the vast majority of the public, and while that is fantastic in terms of public health, it is generating a care free attitude because of the lack of knowledge that the public has about these diseases because they haven't existed in most people's lives. However, with the very recent outbreak of measles at the Yuba Charter School in California it is easy to identify a trend that can and will damage the integrity of public health. By eliminating the choice from parents to opt out of vaccines like in Uganda [12] and in our own country West Virginia and Mississippi the overall integrity and compliance rates would reach unprecedented levels and the eradication of vaccine preventable diseases in the United States would create a new era in medical progress and acceptance.

