Should vaccinations be mandatory?

March 10th, 2015

No “Mickey Mouse” matter

The self-proclaimed “Happiest Place on Earth” recently became the epicenter of a major measles outbreak. By mid-January, 51 measles cases had been confirmed in California; and all but nine could be directly connected to Disneyland in Anaheim, where, apparently, a tourist from overseas fell ill with the disease in December. As of February 13, 141 cases of measles had been reported in 17 states and the District of Columbia — the highest number of American cases since 2000, when the disease was declared eliminated in the United States.

Since 1963, “getting your shots” has become a routine part of childhood for most Americans. Widespread vaccination against measles is a major reason measles became less of a threat over the years. Some people, however, choose against the protection the vaccine offers. That choice has consequences not only for them but also for society.

Opting out of “the herd”

The majority of victims in the current measles outbreak (as in 2014 and 2013 outbreaks) were unvaccinated. While no medicine is 100 percent effective, most childhood vaccines do produce immunity most of the time (about 90 to 100 percent) and remain one of society’s best defenses against infectious disease. According to a 2011 article published by the Oxford University Press, widespread vaccination creates “herd immunity,” meaning “the risk of infection among susceptible individuals in a population is reduced by the presence and proximity of immune individuals.” Herd immunity protects people who cannot receive vaccines and contributes to the eradication of infectious diseases. “If you think about the way disease spreads,” explains Professor Stephen Eubank of Virginia Tech, “somebody is sick and infects others who infect others … If on average, each person who is sick infects less than one other person, the disease will die out.”

Most Americans vaccinate. All 50 states require that children entering public schools receive certain vaccinations. In the 2013–14 school year, the Centers for Disease Control and Prevention (CDC) reported the median vaccination coverage among kindergartners for the measles, mumps and rubella (MMR) vaccine was 94.7 percent. Some medical reasons for forgoing vaccinations exist, such as severe allergic reactions to their ingredients or a weakened immune system. All states except Mississippi and West Virginia also allow for nonmedical exemptions.

These states’ laws accommodate religious objections, but no major world religion — including most Christian denominations, the three main branches of Judaism, Sunni and Shia Islam, Hinduism, Buddhism and the Mormon Church — opposes vaccines. In fact, according to John Grabenstein, Ph.D., of Merck Vaccines, “multiple religious doctrines or imperatives … call for preservation of life, caring for others, and duty to community,” all aims that vaccines can further.

Where religion does discourage or forbid vaccination, infectious disease can run rampant. From 1990 to 1991, for instance, 486 cases and six measles-associated deaths occurred among members of two churches in Philadelphia, Pennsylvania, that refused vaccination. “If I go to God and ask him to heal my body,” one member said, “I can’t go to a doctor for medicine. You either trust God or you trust man.” Such theology doesn’t allow for the possibility that God works through human doctors to bring healing.

In some cases, America’s history of racial prejudice and discrimination may inform decisions against vaccines. The College of Physicians of Pennsylvania notes that some suspicion of vaccines “is best understood in a social and historical context of inequality and mistrust,” citing the infamous Tuskegee Syphilis Study — during which proper medical treatment was withheld, for decades, from hundreds of black men — as emblematic of the shadow racism can cast over public health interventions. “African-Americans have a well-earned skepticism towards the medical community,” says Dr. Carlton Haywood Jr. of Johns Hopkins. “Anytime somebody in a white coat and a mask comes around telling me what to do I’m going to be suspicious, based on our history and interactions.”

Most objections, however, are motivated by parental concerns about the safety of vaccines. “At their core,” writes risk consultant David Ropeik (who himself does not oppose vaccines), “parents who don’t vaccinate their kids or who vaccinate less than health officials recommend, are only doing what good parents are supposed to do: keep their kids healthy and safe.” They are also often well-educated individuals who, says Dr. Paul Offit of the Children’s Hospital of Pennsylvania, “believe that they can know anything and know as much as their doctor — if not more — by simply studying it [and] reading about it.”

Certainly, parents should protect their children and should educate themselves about their children’s health. There is, however, no longer any legitimate scientific debate about vaccines. Dr. Steven Novella of Yale University allows that “vaccines are not without risk (no medical intervention is),” but he stresses that “the benefits far outweigh those risks.” Vaccinations are one of the most proven ways to protect children. “Not only is a vaccine protecting your kids against disease,” says Dr. Barry Bloom of Harvard, it’s “protecting every other kid, some of whom have conditions you’re not aware of. Why don’t people — if they’re on the borderline [about vaccines] — find it more acceptable to say, ‘I have reservations, but I don’t want anyone to die because my kid comes near them’?”

Vaccines and autism

In recent decades, worries that vaccines cause or increase the risk of autism in children have attracted attention. Actress Jenny McCarthy, whose son is autistic, is the best known of several celebrities voicing concern that vaccinations can “trigger” autism. “I don’t know what number it’s going to take,” she has said, “for people to wake up and start really listening to what these parents are saying, which is, ‘We vaccinated our baby and something happened.’ ”

In 1998, British surgeon Andrew Wakefield published a study in the prestigious, peer-reviewed medical journal The Lancet claiming a causal link between the MMR vaccine and autism. As word of Wakefield’s study spread in the United Kingdom, so did the measles; immunization rates sank from over 90 percent to 54 percent, and people got sick. Subsequent investigation, however, has discredited Wakefield’s methodology and conclusions. In 2010, The Lancet fully retracted Wakefield’s paper, and Britain’s General Medical Council stripped him of his license.

According to the nonprofit Autism Science Foundation, “Multiple studies have been completed which investigated the measles, mumps and rubella vaccination in relation to autism. Researchers have also studied thimerosal, a mercury-based preservative, to see if it had any relation to autism. The results of studies are very clear; the data show no relationship between vaccines and autism.”

Nevertheless, the anti-vaccination movement remains influential in the United States. Celebrity champions account for some of that influence. The abundance of easily accessible, inaccurate health information online is another factor. And, ironically, the proven track record of vaccines can bolster anti-vaccination sentiment. “We are a victim of our own success,” says the CDC’s Dr. Kristine Sheedy. “We’ve made these diseases disappear for the average person so … parents don’t necessarily feel … urgency to get [their children] vaccinated.”

Personal choice and public interest

Vaccinations in the United States are not mandatory, but a recent Pew Research Center survey shows a majority of Americans believe they should be. A sizeable minority of young adults (41 percent), however, think parents should have the right to decide whether their child is vaccinated. Only 20 percent of adults 65 or older agree, possibly because they recall when now easily preventable infectious diseases were common.

Given the documented effectiveness of vaccines, some observers and public officials have suggested moving toward mandatory vaccinations. In the wake of the Disneyland outbreak, for example, Governor Jerry Brown, previously an advocate for parental choice, stated that any bill repealing California’s personal exemption laws “will be closely considered” since “vaccinations are profoundly important and a major public health benefit.”

Personal choice does not always supersede compelling public interest. Journalist and noted science fiction author Cory Doctorow made this point in a recent satirical blog post, “Having the brakes removed from your car is a personal decision,” which lampoons arguments often used by people who refuse vaccines: “Scientists may say that brakes save lives, but virtually every car-wreck co-occurs with panicked braking — did you know that in the old days, cars didn’t have brakes? … Do your research and make your own decision.”

David Ropeik, however, suggests a solution other than compulsory vaccinations: “Evidence suggests that making it harder to opt out discourages all but the most adamant from doing so.” Making exemptions possible but much harder to obtain is, he argues, a sensible way to ensure both public health and civil liberties.

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