Legally Mandated Vaccinations

The recent measles outbreak that started at Disneyland and quickly spread to different parts of the country, with 107 cases in 14 states, has reignited debate over requiring laws that require parents to vaccinate their children.

Currently, 48 states allow parents to forego vaccinating their children for religious reasons, while 19 states allow exemptions for personal or philosophical reasons.  Only two states — Mississippi and West Virginia — ban all nonmedical exemptions.  While there is room for debate as to whether any parent should be able to deny their children the basic benefits of modern medicine, the more pressing question raised by the recent measles outbreak is whether parents should be allowed to opt out of vaccinations even when it puts other people’s children at risk.

This was not always the problem it has become.  Although the exemption for personal and philosophical reasons has been available since the 1960s, the number of parents seeking to opt their children out of vaccinations has increased significantly in the past ten years; in California, over half of all children have an exemption.  As fewer and fewer children are vaccinated, the chances of an outbreak continue to grow; in fact, the latest measles outbreak spread more quickly in those communities with higher exemption rates.

This poses a particular problem for children that cannot get vaccinated for medical reasons.  Children whose immune systems are too weak to fight off infections, and therefore cannot be safely vaccinated, are at the mercy of their peers, or perhaps more accurately, the parents of their peers, absent stricter vaccination requirements.  These children depend on herd immunity — the general inoculation of the community — to minimize the chances of infection.  While a handful of exemptions may not undermine herd immunity, the growing number of parents seeking exemptions may ultimately change the moral equation; at a certain point, the rate of exemptions poses a distinct threat to herd immunity, and we as a society will be forced to make the choice between protecting the autonomy of parents to raise their children according to their beliefs, and the right of children to go to school without risking their lives.

Instead of acknowledging that there is this inherent conflict, that a choice needs to be made, those politicians that have supported the anti-vaccine movement — or at least shied away from the opportunity to openly criticize it  — have obfuscated the issue by muddling the science, often through anecdotal evidence of the medical dangers posed by vaccinations.  Sadly, polls suggest an increasingly politicized debate, with Democratic support for vaccines increasing from 71% to 76% from 2009–2014 and Republican support for vaccination dropping from 71% to 65% over the same time period.

While the science seems clear, there is considerable debate as to whether an outright ban on nonmedical exemptions or a policy designed to incentivize vaccination while preserving parental choice is likely to be more effective.  While an outright ban on nonmedical exemptions seems more effective on its face, some are concerned that it could provoke a backlash among anti-vaccination parents, who may simply try to circumvent the new law through fraudulent doctor’s notes; worse, some parents may try to undo the effects of the vaccine through methods such as chelation, which has been linked to several deaths.

Policies that make it easier to vaccinate than to not vaccinate one’s children can produce higher rates of compliance without this kind of backlash.  California passed  a law in 2013 that required parents seeking an exemption to discuss the potential risks with a licensed health care provider, and in 2014 the number of children seeking a personal belief exemption decreased by 20%.  However, as the recent outbreak in Disneyland, located in Southern California, makes clear, that might not be enough.  As other states consider mandatory vaccinations, the main focus of the argument is not the merits of vaccinations, but the ethics of requiring parents by law to vaccinate their children.



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