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A Not So Innocuous Crisis

MMR (measles, mumps, rubella) vaccine.  97% effective with 2 doses.  Source:
The MMR (measles, mumps, rubella) vaccine, which is 97% effective with 2 doses. Source:

The horrific nationwide outbreak in measles has caused a renewed interest and discussion regarding vaccinations of such diseases. While in 2013 there were just under 200 reported cases in the United States, there were around 650 cases in 2014, and in the first two months of the 2015 calendar year, there have already been 173 cases across 17 different states. Many of these cases could have been prevented, but the recent anti-vaccination movement has prioritized misinformed agency over public health. And children are needlessly suffering and dying as a result. Because irresponsible parents are ignoring important warnings at the peril of many children, the federal and state governments need to pass more stringent regulations mandating vaccines, most importantly abolishing the personal belief exemption. We are at a crossroads for public health in the United States; all states must take action immediately before this health crisis evolves into an epidemic.

Currently, all states have laws that require children attending public school to be vaccinated. However, only Mississippi and West Virginia consider medical exemptions as the only acceptable reason to avoid vaccinations. The other 48 states all have some type of loophole that allows non-medical exemptions, such as for religious or philosophical reasons. In addition, the public school vaccine law is essentially a joke in California and 19 other states; these states allow “personal belief exemptions,” which means that parents can use any personal, philosophical, or religious belief to be exempt from this law and send their unvaccinated children to public schools. In some states, parents can just check a box to apply the personal belief exemption while other states simply require a signature from a health care practitioner to demonstrate they understand the risks of not vaccinating their children. Forms are typically just one page long, showing how easy it is to obtain this exemption. Thus, it is no surprise that states which allow the most number of exemptions have the lowest vaccination rates.

We are faced with these outbreaks because there are not enough vaccinated children to prevent transmission of such diseases in crowded and disease-prone places such as schools and amusement parks. In California during the 2013-2014 school year, 14,304 pre-schoolers and 16,811 kindergarteners were unvaccinated due to personal belief exemptions alone. This is a relatively large group of children especially considering only 1,411 pre-schoolers and 1,013 kindergarteners had medical exemptions. By removing the personal belief exemption, 93% of currently unvaccinated children would be vaccinated against these preventable diseases, including measles. It doesn’t take an expert to realize that this will greatly improve the effectiveness of herd immunity and drastically reduce the chance of an outbreak.

Note: 92 of the 173 cases in California.  Source: CDC
Note: 92 of the 173 cases in California. Source: CDC

However, there is a fine line to walk regarding mandatory vaccinations because when a government can regulate what to put into the bodies of its citizens, the government may have exceeded its powers. The federal government could incentivize vaccination by only giving tax credits for vaccinated children, but there does not seem to be a constitutional basis for the federal government to mandate its citizens to get vaccines. Thus, it is more important for state governments to minimize the risk of epidemics by putting pressure on parents to vaccinate their children. State governments can follow the lead of Mississippi and West Virginia and remove non-medical exemptions, especially the broad and self-defeating personal belief exemption. And while some parents may claim that not vaccinating their children is a constitutionally protected religious freedom, there are many precedents for removing non-medical exemptions as various state courts have already determined that religious exemptions are not protected by the Constitution.

But personal belief exemptions can go beyond religious reasons. Some people say that any suggestion for mandatory vaccines is infringing upon one’s individual rights as it places the government, not the parent, as the ultimate authority over children’s bodies. However, in some instances social responsibility trumps our right to do whatever we like or else, as Thomas Hobbes says, life would be “nasty, brutish, and short.” Barring legitimate medical exemptions, mandatory vaccines should be one of those responsibilities. The CDC likens school immunization laws to traffic laws; we sometimes don’t want to obey speed limits and stop signs, but these laws are in place not only to protect ourselves, but others as well. In this sense, parents adamant upon using non-medical vaccines on their children are like drunk drivers, disregarding the safety of both their loved ones and the general public. It is quite tragic that certain members of our society will not take their social responsibility seriously and insist upon working against public health.

It is even more distressing that is takes such a public health fiasco for state governments to begin realizing just how ridiculous the personal belief exemption is. Nonetheless, progress should be lauded.  On February 20th, two California legislators introduced a bill that would allow only medical exemptions as legitimate reasons to dodge vaccines. Passing this bill would certainly be a step in the right direction for California. Now, it is up to the other 47 states to make their move and better ensure the wellness and safety of its residents.