Measles outbreaks across the nation are prompting state lawmakers to consider eliminating vaccination exemptions for religious and personal beliefs that have been claimed by the parents of some children.
Public health experts and officials blame the exemptions as one reason why states are seeing an increased number of cases of measles.
“What you see as religious choice could possibly cause negative health outcomes for other members of your community and society,” said Pat Burke, a Democratic state lawmaker in New York who is pushing to eliminate the state’s religious exemption.
Laws allowing parents to opt out of vaccinations were created by states trying to strike a delicate balance between religious freedom, personal choice and public health.
But the most recent measles outbreaks, which have infected 159 mostly unvaccinated people in 10 states, is leading some states to reconsider.
“That goes beyond religious freedom,” said Burke.
Every state requires that students be vaccinated to enroll in school, and all states allow exemptions for children who are too sick to receive vaccines or who have a weakened immune system.
Most states also allow exemptions for religious reasons, and 17 states, including Washington and Texas, allow exemptions for both religious and personal or philosophical beliefs, according to the National Conference of State Legislatures. Both Washington and Texas have seen measles outbreaks this year.
Lawmakers in Iowa, New Jersey and Vermont, which already ban personal or philosophical exemptions, are now debating proposals to eliminate religious exemptions.
Proposals in Maine and Oregon would eliminate both exemptions, while measures in Minnesota, Colorado, and Washington state, where there are 66 confirmed measles cases this year, would only eliminate personal exemptions and leave religious exemptions in place.
All of the major medical and health organizations oppose religious and personal exemptions and have for years urged state lawmakers to eliminate them.
“Protecting our communities’ health requires that individuals not be permitted to opt out of immunization solely as a matter of convenience or misinformation,” American Medical Association President Dr. Barbara McAneny said in a statement to The Hill.
“That’s why we urge policymakers to eliminate non-medical exemptions from immunization and urge all children and adults to be immunized unless medically inadvisable.”
In states with broader vaccine laws, nonmedical exemptions have soared in popularity over the years as misinformation about vaccine risks spreads online, said Dr. John Cullen, president of the American Academy of Family Physicians, which opposes religious and personal or philosophical vaccine exemptions.
“In communities where vaccination rates are low, that’s a set-up for a measles outbreak,” Cullen said.
“We lose sight of how bad these epidemics are because we have generations now that have never experienced it.”
Proponents of vaccine exemptions argue that parents should be able to make their own decisions regarding their children's health.
“We believe that stripping vaccine laws of personal belief exemptions is a violation of human rights, including freedom of thought, conscience and religious belief,” said Barbara Loe Fisher, co-founder and president of the National Vaccine Information Center.
The Centers for Disease Control and Prevention (CDC) considers the MMR vaccine, which protects against measles, mumps and rubella, to be “very safe” and effective, and it’s recommended by every major medical association.
“This is an area where it is important to have peer-reviewed, scientific evidence. That does not exist for the anti-vax movement,” he said.
According to CDC data, the median exemption rate for kindergarteners in the 2017-2018 school year was 2.2 percent, marking the third consecutive school year it observed a slight increase.
The CDC says it's hard to know why, but suggested it could be tied to how easy it can be to obtain exemptions, and parental hesitancy about vaccines.
But it could be difficult for state lawmakers to take action on such a politically contentious, and sensitive, issue.
There were 17 measles outbreaks in the U.S. in 2018, according to the CDC, with a total of 372 confirmed cases.
But that wasn’t enough to spur change in state legislatures: no states were able to pass measures eliminating or restricting exemptions, according to the National Vaccine Information Center, which opposes such proposals.
Some states have actually proposed legislation this year expanding exemptions: Arizona, Iowa, Hawaii, Mississippi, Rhode Island and West Virginia.
So far in 2019, there have been six outbreaks in four states: New York, Illinois, Texas and Washington, according to the CDC. The CDC defines as outbreak as three or more cases in one state.
The CDC says the outbreaks are mostly linked to unvaccinated travelers bringing measles back into the U.S. from other countries, like Israel and Ukraine, where large outbreaks are ongoing.
Outbreaks can occur in communities where there is not a high enough percentage of people who are vaccinated.
Described as “herd immunity” by public health experts, at least 94 percent of a community must be vaccinated against measles to prevent the disease from spreading.
Herd immunity protects those with weakened immune systems, babies who can’t be vaccinated or those who are too sick to receive vaccinations.
But as more and more parents claim vaccine exemptions, experts say, the disease is more likely to spread.
And federal officials have indicated the government might step in if state legislatures don’t.
“Some states are engaging in such wide exemptions that they're creating the opportunity for outbreaks on a scale that is going to have national implications,” Food and Drug Administration Commissioner Scott Gottlieb told CNN last week.
If “certain states continue down the path that they're on, I think they're going to force the hand of the federal health agencies.”
Health committees in the House and Senate are set to hold hearings on the measles outbreaks this month.