Vaccine exemptions create problems for states

Vaccine exemptions create problems for states
© Getty Images

The Center for Disease Control and Prevention has confirmed six measles outbreaks so far in New York State, New York City, Washington, Texas, Illinois and California. The outbreak has prompted some states, like Maine and Vermont, to consider further restricting vaccine exemptions and a federal judge has turned down a request to allow unvaccinated children to return to school in suburban New York during the measles outbreak there.

However, some states like Arizona and Texas are considering broadening vaccine, non-medical exemptions, making it easier to obtain a philosophical or religious exemption from required childhood vaccinations.

What do we know about states with policies that make it easier to obtain non-medical vaccine exemptions?


It’s no surprise, the data shows they are more likely to have increased exemption rates and also are to experience a vaccine-preventable disease outbreak. For example, in Clark County, Washington only 76.5 percent of kindergarteners completed all their immunizations in the 2017-2018 school year — they now have 73 confirmed cases.

The CDC reported 372 cases of measles in 2018 and 268 cases in 15 states to-date in 2019 — 75 percent of these recent cases are in small communities.

These numbers may seem small, but they represent nearly a three-fold increase in cases in the U.S. since 2016. From 2000 to 2016, the CDC reported 20.4 million lives saved globally thanks to vaccination — yet, measles remains a leading cause of vaccine-preventable infant death. The consequences of measles are highlighted in Madagascar, a country off the eastern coast of Africa, where 80,000 cases of measles and 900 measles-related deaths have been reported since September.

The re-emergence of measles in the U.S. is due to falling rates of vaccination, partly resulting from increased skepticism in science, government and the pharmaceutical industry, and the fact that measles is highly contagious.

The measles virus spreads through coughing and sneezing and can linger in the air and on surfaces for up to two hours after an infected person has left the room. Those infected can spread the disease to others before they even know they’ve been infected.

Current anti-science trends in public policy threatens public health. We need to make fact-based decisions to protect ourselves, our families and our communities from contagious diseases that are preventable. Where we obtain our facts and how we interpret them matters.

Like any medical treatment or intervention, vaccines come with a risk. These risks are typically non-life threatening allergic or inflammatory responses that can result in flu-like symptoms. Clinical trials have shown these risks are far outweighed by those associated with the infectious disease.  

Rigorous studies demonstrate that vaccines are not only effective, but safe. In addition, the FDA, CDC and other federal agencies continue to monitor vaccine safety through various national vaccine monitoring systems. These include the Vaccine Safety Datalink, which is used to rapidly assess whether particular side-effects are linked to a vaccine.

According to the Health Resources and Services Administration, From 2006-2017, of 3.45 billion vaccinations were given in the U.S. — 6,430 (or 0.00018 percent) resulted in confirmed injuries. By contrast, measles has killed 1.3 percent of the people infected in Madagascar.

Anti-vaccination trends surged in 1998 when a single study linked vaccination to severe consequences, such as autism. This study was debunked in 2010, after the findings were proven to be fraudulent. Nevertheless, the study continues to fuel anti-vaccine sentiment despite numerous subsequently scientifically rigorous studies having shown no increased risk for autism.

Prior to vaccines and antibiotics in the early 1900s, the average life expectancy in the U.S. was 47 years. The leading cause of death was infectious disease. Vaccination has been a driver in the increase in average life span to 78.8 years. Further, we have seen a 99 percent decrease in vaccine-preventable disease incidence for the nine universally recommended childhood vaccines, along with similar declines in disease-related complications and death.

Vaccines protect not only the vaccinated individual, but also others who cannot be vaccinated, including babies, the aged and immunocompromised. While only smallpox has been completely eradicated, other communicable diseases persist around the world and we must remain vigilant. With the widespread and rapid movement of people between countries and continents, infectious diseases can cross continents in a day.

The measles outbreak has states grappling with balancing public health policy and personal choice in considering whether to allow philosophical and religious exemptions to vaccination, in addition to medical exemptions. Currently Mississippi, West Virginia and California allow only medical exemptions to vaccination.

Our major defense to the re-emergence of diseases still prevalent in other parts of the world is the protective shield of immunity that high vaccination rates provide — and we must ensure that information about vaccines is fact-based and tailored for specific groups, especially those who may be vaccine-hesitant.

Dr. Heidi L. Pottinger is a public health researcher at the University of Arizona. She has studied vaccinology, vaccine exemption, and topics related to children with special health-care needs for 16 years. Dr. Felicia Goodrum Sterling is a professor and scientist at the University of Arizona. She has studied viruses for 27 years. Both are fellows of The OpEd Project.