Opting out of measles vaccine could be a death sentence for others

Immunizations have been such a resounding public health success that most Americans have never seen a child with measles, mumps, diphtheria or many of the other diseases that once killed or maimed thousands every year. As a result, it has been too easy for misinformation about vaccines to take root and spread, because parents have the luxury of fearing the vaccines instead of the diseases. 

This year is on track for record numbers of measles cases, with numbers already exceeding the entire number reported for every year in the past decade, except one. An unvaccinated child in Oregon almost died of tetanus; he suffered terribly for almost two months, and his care cost close to $1 million. And now, state health officials are reporting that 95 percent of parents choosing to opt-out of required vaccinations are doing so by watching an online educational video and printing a do-it-yourself form. 


In too many places, parents are choosing not to vaccinate their children, or to vaccinate late or selectively, based on misinformation about lifesaving immunizations. In the case out of Oregon, the opt-out process is so simple that some state lawmakers worry it’s easy for kids to remain unvaccinated. On the other hand, New York City recently declared a public health emergency and ordered mandatory measles vaccinations amid a measles outbreak.

If you asked most U.S. parents today whether they are worried about their child contracting polio, you would likely get a puzzled look. Not so long ago, parents spent each summer dreading the possibility that their child might be stricken by that feared and deadly disease. Today, many parents aren’t even sure what polio is. 

The reason parents can be confident their children won’t contract polio is simple: The safe, effective polio vaccine developed by Jonas Salk with funding from March of Dimes. In the 1950s, millions of children lined up to get vaccinated against that childhood killer. Having diagnosed and treated numerous polio patients in my career, I helped launch India’s first Pulse Polio campaign in 1995.

During this campaign, we immunized 75 million children aged less than 3 years in a single day, ultimately leading to its eradication from a nation of 1.3 billion. Today, cases due to polio have decreased by over 99 percent since 1988, from an estimated 350,000 cases then, to 33 reported cases in 2018 due entirely to the global vaccination efforts.

In order to protect both individuals and communities, all children must be vaccinated fully and on time, unless there is a medical reason not to do so. So-called “herd immunity” requires high immunization rates in order to protect everyone, including those who cannot be vaccinated such as children with cancer or immune deficiency. If all children are immunized on time, the transmission of disease is broken, and infection cannot be passed along.

States with high immunization rates for MMR, DTaP, and varicella vaccines among children enrolled in kindergarten, such as Mississippi and West Virginia, have shown us the path to success and we would be wise to emulate them. Communities can best be protected if all states have in place three key policies.

First, all children should be vaccinated on schedule, on time, as recommended by the Centers for Disease Control and Prevention. Alternative schedules should not be used — they simply leave children vulnerable to infection longer. 

Second, states should have in place requirements that all children be up-to-date on their vaccinations at appropriate entry points to child care, elementary school (whether public, private or parochial) and high school. Schools are veritable petri dishes, and children must be immunized to prevent disease outbreaks. 

Third, non-medical exemptions should be eliminated. It comes as no surprise that Oregon, which allows philosophical exemptions, has the highest rate of kindergarten vaccine exemptions at 7.6 in the 2017-2018 school year. A physician uninvolved with the child’s routine care should review all requests for medical exemptions and coordinate with the pediatrician supported with due process for reviews and appeals.


With these three strategies, states can protect entire communities. Herd immunity also protects those who cannot be immunized who can then attend school with some reassurance that they will not needlessly face a vaccine-preventable disease. 

Protecting our children from vaccine-preventable diseases is a collective responsibility. If some people choose not to participate, the entire enterprise can fail, with potentially deadly results. But if we all come together in support of immunization, we can eradicate many more diseases like polio. Our children deserve no less.

Dr. Rahul Gupta is senior vice president and chief medical and health officer at March of Dimes. Follow him on Twitter @DrGuptaMD and @MarchofDimes.