This story originally appeared on xoJane.com.

By now, you’re probably familiar with the fact that some people in the US refuse to vaccinate their children. You are probably also familiar with the raging debate over vaccine refusal and whether parents should suck it up and vaccinate their kids for the sake of herd immunity, the common good, and society.

But a recent piece in the Hollywood Reporter by Gary Baum really cuts to the heart of the vaccine refusal issue: It’s a class and privilege problem. The people refusing to vaccinate are primarily wealthy, coming from backgrounds of privilege, following in the footsteps of their wealthy and misguided peers — and they don’t care that their actions are harming society as a whole, which is another function of privilege. When the world revolves around you and your needs, your actions don’t have real-world consequences, and what happens to other people because of what you’ve done is irrelevant.

The numbers on vaccine refusal and its consequences are rather stark. In some states, including Michigan and Oregon, the number of parents seeking vaccine exemptions is in excess of 6%. In an evaluation of the relationship between the difficulty of getting an exemption and the exemption rate, researchers from Emory University noted that: “Our results show that nonmedical exemptions have continued to increase, and the rate of increase has accelerated.”

Six percent probably doesn’t sound like a big deal. However, to achieve true herd immunity in the case of, say, pertussis, a vaccine-preventable disease that’s on the rise, 93-95% of the population overall needs to be vaccinated. Given that some children really do have a genuine medical need to stagger vaccines or not receive them at all, the growing exemption list endangers those children, who are relying on herd immunity to limit their exposure to infectious disease. As the current population of unvaccinated children ages into unvaccinated adults (unless those individuals seek out vaccines later in life), the percentage of vaccination in the overall population will drop, which is bad news.

As a result of poor vaccination coverage, the number of vaccine-preventable outbreaks in the US has been increasing. It’s worth taking a close look at the map developed by the Council for Foreign Relations linked above, and following the patterns it reveals. Unsurprisingly, in Africa, where poor access to healthcare services, including vaccines, is an ongoing problem, vaccine-preventable outbreaks are a widespread issue. A similar phenomenon is present in India, where health care workers struggle to reach rural populations with vaccines.

But what gives with the ballooning outbreaks in Europe, the United States, Australia, and New Zealand? These are nations with ample access to vaccines, including the manufacturers to produce them, companies to handle packaging and shipping, and the facilities to store them, whether at doctors’ offices or elsewhere. Issues like poor refrigeration and lack of needles are not a problem in these regions, which means something is interrupting the chain between vaccine production and patient.

One issue is that pediatricians, the primary point of contact for vaccination, are having trouble with vaccine financing. Offering vaccines is a costly part of their practices, even with insurance coverage and government funding programs — but ultimately, most pediatricians still want to ensure that children get the vaccinations they need to be safe from infection. This is actually one thing Obamacare is supposed to fix: Under ACA, routine vaccinations will be covered.

If vaccines are available, why aren’t kids getting them? Because parents are refusing them — which brings us back around to the issue of which parents are refusing them. For relatively privileged parents, refusing vaccines is seen as an action with little consequences, and one that will benefit their children (while those parents are relying on terrible science and making terrible choices, it would be beyond unreasonable to suggest they aren’t trying to act in the best interests of their children). In the West, the incidence of vaccine-preventable diseases became so low at the end of the 20th century that many people hadn’t seen such illnesses first hand.

Meanwhile, in the Global South, parents of all social classes had ample incentive to vaccinate their children, because they knew what outbreaks looked like and they wanted to take steps to prevent them. Barriers to full vaccination primarily revolved around supply issues — making vaccines, making them affordable, transporting them, storing them, and getting health care providers where they need to go — not ideological ones. In the West, where vaccine refusal has become a growing issue, it’s primarily privileged classes of people who are sticking to the idea that refusing vaccines is scientifically and ideologically sound.

Why, in the face of science and the good of the commons, are people still refusing to vaccinate their children? Many people, of course, don’t want to admit that they’re wrong — and the vaccine refusal juggernaut has become so large that it’s difficult to go against it. Others have absorbed bad science as gospel, relying on information fed to them by the media they self-select to reinforce their beliefs on vaccination. And all of them rely on the idea that their personal choices have no effect on the world around them, which is setting the West up for a dangerous snowball effect.

This attitude isn’t necessarily innate to human nature, though some might think that it is. It’s a specific belief that’s born of privilege — when people spend their lives being taught that they don’t need to consider the needs, interests, and concerns of others, they internalize that belief. That’s manifesting in the current spate of vaccine denial, where people refuse to consider anything beyond their own children.

Consequently, 2012 marked the most pertussis deaths since 1955. But hey, it’s just someone else’s kids, right?

S.E. Smith is a writer, agitator and commentator based in Northern California.

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