A recent measles outbreak traced to Disneyland has put anti-vaccination advocates under the microscope once more. With upwards of 80 people now diagnosed with measles, it’s worth asking why this preventable disease has again been allowed to endanger public health.

According to The Los Angeles Times, only seven of the 39 patients whose vaccination status is known were fully vaccinated at the time of the outbreak. The numbers are not surprising. We know now that anti-vaccination parents tend to live in clusters, grouping in particular states and, in the case of California, particularly affluent parts of the Bay Area. This map from the Centers for Disease Control highlights states with higher vaccination exemption rates in darker shades of blue, and fewer vaccination exemption rates in lighter shades:

The clustering of anti-vaccination types around certain geographic pinpoints—especially the Pacific Northwest—may suggest that vaccine denial is tied up in subversive, countercultural sentiment. But compare research on Americans who resist vaccination and Swedes who willingly sign up for optional vaccines, and it seems as though anti-vaccination advocates are the most American of us all.

Consider sociologist Jennifer A. Reich’s 2014 article "Neoliberal Mothering and Vaccine Refusal: Imagined Gated Communities and the Privilege of Choice," published in the journal Gender & Society. Reich researched women who advocate against and refuse vaccines, and the techniques they use to obtain legal exemptions from them. Reich concludes that the well-off moms who skip out on vaccines do so...

…by mobilizing their privilege in the symbolic gated communities in which they live and parent. They utilize resources that facilitate their choices as informed consumers without feeling compelled to support the health or decision making of other families with fewer resources. They also refuse to acknowledge the role their children play in protecting or undermining systems of public health...

In other words, parents who opt out of vaccines come to their decisions by prioritizing the very virtues American culture readily recommends: freedom of choice, consumer primacy, individualism, self-determination, and a dim, almost cynical view of common goods like public health. If enclaves of anti-vaccination advocates are limited to the rarefied exurbs of California and Oregon, then the prevalence of this "neoliberal" frame makes all the more sense, as a certain laissez-faire attitude toward matters of mass coordination is associated with wealth and an attendant sense of personal control: Since money affords the wealthy a certain amount of control over their personal affairs, they both experience feelings of control (which may or may not correspond to reality) and feel less concerned with the welfare of others. After all, if one is convinced they can manage their own affairs, why shouldn't everyone else be able to?