US Science: CREDIT: Stephanie Apple
By Evan Rose D’Arcy, US Science
In response to widespread vaccination hesitancy, many states have enacted laws mandating vaccination for certain vaccines. There are restrictions on the list, and these laws apply only to vaccines offered to children. As a result, implementation can vary greatly from state to state. What is clear is that the laws have the potential to reduce future public health problems.
“The major purpose of the legislation is to immunize children against preventable diseases,” writes University of Massachusetts Amherst Professor of Health Policy Dr Gregory Poland in an essay on his website. He explains that these laws seek to strengthen the protection of the public from the incidence of “condemned diseases,” which effectively include measles, mumps, rubella, whooping cough, and meningitis.
Poland says that current rates of unimmunized children are typically less than five percent, but that one in four children is currently unvaccinated. “The potential is to eliminate the transmission of these diseases that is spreading faster and faster through school-age children,” he says. If not all children are vaccinated, several hundred thousand are potentially exposed to the diseases each year, the result of which can be severe.
The motivation for enacting these laws, he says, is “that to have a greater level of security and safety for our children and society as a whole, we need to bring this epidemic under control by all means at our disposal.” In order to achieve that goal, Poland says, “we need to give up some of the freedom that we now take for granted.” In order to expand immunization, he contends, “we must be willing to sacrifice our personal rights and opinions on public health matters.”
But current vaccine laws, from Wisconsin to North Carolina, differ significantly in important ways. The Massachusetts law, for example, offers exemptions for religious or medical reasons, but only in instances where the parent or child can document objections, which are applied by schools. Parents often do not pursue the option of an exemption, either because they find it distasteful or because the costs are too great.
Meanwhile, the California law, which took effect in 2015, offers only “philosophical” reasons for vaccine refusal, without addressing medical conditions or personal beliefs. Though the law’s text allows for exemptions to be waived for medical reasons, actual discharges are rare. Even this law has a basis in equity: If a child with a serious health condition were to be suspended from school, his parents would lose all child-support payments.
State-by-state vaccination rates during 2017
On Wednesday, as Congress moved to strike down the Trump administration’s decision to end a measure allowing states to set their own rules on school vaccination, medical experts joined legislative leaders in expressing dismay over the White House decision. In a letter to the US Centers for Disease Control and Prevention, the group echoed the criticisms leveled by Poland, calling the move an assault on the efforts of vaccine-preventable disease preventors. “The emergency vaccination legislation … enhances the ability of communities to better protect all of its children by containing outbreaks,” they wrote.
“Well, the situation in North Carolina is very complicated,” says Pediatrician Michael Fratantoni, President of the American Academy of Pediatrics (AAP). Fratantoni says that many people have questioned the consistency and effectiveness of states’ ways of enforcing their mandates. “People are very concerned and have questions,” he says. North Carolina’s laws are based on Florida’s, and some critics argue that Florida law gives special treatment to public school students with special medical needs. Similarly, parents of school-age children in North Carolina recently filed a lawsuit challenging what they perceive as an unfair graduation requirement requiring children to be vaccinated before they can graduate. Another challenge against Maine’s law targets both alleged consumer fraud and misrepresentation.
Parents, school administrators, and medical leaders must use “an intelligent approach” to meet the challenges and disagreements that arise from this type of policymaking, says Fratantoni. He says that the solution lies in some combination of educating parents and school administrators about these new laws, connecting the dots between the laws and the individual goals of public health, and communicating to the public “what is at stake.”
Poland agrees. “We may be able to begin to overcome the