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A Bill to Require Immunization

A Bill to Require Immunization

Background

This bill eliminates religious exemptions for vaccinations in order to increase the number of vaccinations and reduce the spread of disease. This has become controversial lately, as there is some evidence of diseases spreading as a result of lower vaccination rates.

Pro arguments

Increasing vaccination rates reduce the spread of disease.

Con arguments

Vaccination requirements threaten freedom.

Vaccines are useless and produce by profit hungry capitalists.

Updates

New York Ends its Religious Exemptions for Vaccines (2019). New York is requiring all schoolchildren to be vaccinated, even if parents have religious objections. Gov. Andrew Cuomo signed legislation Thursday that removes nonmedical exemptions from school vaccination requirements. The law goes into effect immediately, his office said.

California bill amended to allow more exemptions (2019)

General

Annual Review of Public Health Personal Belief Exemptions From School Vaccination Requirements (2014)

Despite the impact vaccination has had on the control and prevention of many infectious diseases, some parents choose not to vaccinate their children. Although there is no federal law requiring vaccination of children in the United States, all states require evidence of vaccination against at least some diseases as a condition of school entry. Which vaccines are required; how many doses are required; whether entry requirements apply to child care, kindergarten, or middle school; and whether exemptions from vaccine requirements will be allowed all differ by state. All but two states allow some kind of personal belief exemption from school vaccination requirements. This article reviews the history of school vaccination requirements and exemptions, the legal status of state vaccination laws and exemptions, the impact of school vaccination requirements and personal belief exemptions on vaccination rates and disease incidence, and strategies for maintaining adequate vaccination rates in states that allow personal belief exemptions.

Advisory Board. The states with most (and least) strict vaccine policies (2015)

In the 2013-2014 school year, 94.7% of kindergartens received both doses of the measles, mumps, and rubella (MMR) vaccine, according to CDC data. But at the community level, where herd immunity really matters, vaccination rates vary significantly.

Altogether, 17 states have MMR vaccination rates below 90% among preschoolers. The five states with the lowest vaccination rates are:

  • West Virginia (86%);
  • Ohio (86%);
  • Colorado (86%);
  • Montana (87%); and
  • Louisiana (88%).

All five states—and more than a dozen others—fall well below the vaccination rate that CDC says is needed to maintain herd immunity against measles, about 92% and 95%.

Moreover, rates can vary within a state, with specific communities reporting significantly lower rates. A USA Today analysis of vaccine data from 13 states found that nearly one in seven schools have MMR immunization rates below 90%. At some schools, the rate falls below 50%. “Really, what should concern parents is the microclimate of their child’s school or day care center,” says Sunari Kraft, who helped pass a bill last year requiring Colorado schools to provide vaccination data on request.

Pro

John Lantos. Why we should eliminate personal belief exemptions to vaccine mandates. (2012)

We argue that personal belief exemptions to the mandate for childhood immunizations should not be allowed. Parents who choose not to immunize their children put both their own children and other children at risk. Other children are at risk because unimmunized children go to school or day care when they are contagious but asymptomatic, exposing many more children to potentially dangerous infections. The risks to children from disease are much higher than the risks of vaccines. There are, of course, some bona fide reasons why children should not be immunized. Some children have known allergies or other medical contraindications to certain immunizations. Immunization refusals based on parental beliefs, however, do not fall into this category. In those cases, children are denied the protection of immunizations without any medical or scientific justification. By eliminating personal belief exemptions to those childhood vaccines associated with contagious diseases that have high rates of childhood mortality, we would better protect children and would more fairly spread the burdens of this important public health program.

The Right To Refuse Vaccination: Revisiting Vaccination Exemptions and the ‘Best Interests of the Child Standard’ (2016)

Part I of this paper highlights the origins of vaccination and its widespread success in the medical community. Part II discusses the anti-vaccination movement across the country, the resulting infectious disease outbreaks that have occurred and factors that have lead to antivaccination sentiment. Part III details the authority of the federal and state governments to mandate childhood vaccination. Part IV purports how exemptions to mandatory childhood vaccination should be reformed, namely that states should be banned from offering non-medical exemptions and that courts should heighten the “best interests of the child standard” used in parental healthcare decision-making. Part IV also discusses policy reasons for why this is a better approach and the concerns that may arise from it

Philadelphia Bar Association. Who Should Call the Shots? Proposing Federal Oversight of Mandatory Childhood Vaccinations (2016)

Further, statistics on the prominence of disease outbreaks among specific religious communities further bolsters the causal link between exemptions and epidemics. For example, members of Amish and Christian Science communities are generally given exemptions from mandatory vaccination statutes, and those groups have also experienced instances of vaccinepreventable diseases during nearly every major outbreak in the past twenty-five years.40 Finally, immunization exemptions directly increase health-care costs because preventing a disease through the use of vaccines is more cost-effective than treating a disease.41 More specifically, it costs approximately sixteen times more to treat an illness than to vaccinate against it. 42 Ultimately, vaccine exemptions result in thousands of Americans contracting preventable disease, which costs $10 billion to treat and results in 30,000 deaths each year.43

AAP News.  Eliminate nonmedical immunization exemptions for school entry, says AAP (2016)

The Academy supports medically indicated exemptions but says nonmedical exemptions are inappropriate for individual, public health and ethical reasons. To protect those who cannot be vaccinated, community or “herd” immunity requires at least 90% of the population to be immunized (95% for highly contagious diseases such as measles and pertussis).

Neurologica. Eliminating Personal Belief Exemptions for Vaccines (2017)

Overall the data is clear – if we want to optimally protect the public from outbreaks of vaccine-preventable diseases, and to eliminate and perhaps even eventually eradicate some of those diseases, we need to have strong mandatory vaccination laws. Personal belief exemptions all have to go. Religious exemptions should go too, but that will be more of a fight. In those states who allow for religious exemptions, it should be difficult to obtain them (like requiring parental education about the importance of vaccines). Further, medical exemptions should be evidence-based, and not overly permissive.

CNN Some states allow parents to get out of vaccinations. Then this happens (2019)

These states have particularly high levels — or “hot spots” — of unvaccinated children and are vulnerable to measles outbreaks, according to a study by Hotez and his colleagues that published last year.
One of the hot spots is the Pacific Northwest, specifically Seattle, Spokane and Portland.
On Friday, Washington Gov. Jay Inslee declared a state of emergency after 35 confirmed cases of measles and 11 suspected cases in his state. Since then, two more cases were confirmed in Washington and one case in Oregon. Hawaii also reported two cases in visitors from Washington who were infected before traveling to the islands.

For good reason, childhood vaccination programs top the Center for Disease Control’s list of “Ten Great Public Health Achievements” of the 20th century. Early in the 20th century there were almost 50,000 smallpox cases reported each year with a 30 percent mortality rate, but the United States reported none by 1949. Polio was eradicated in the Western Hemisphere by 1991, preventing more than 2,000 U.S. polio-related deaths every year; and the infant Haemophilus influenza vaccine has reduced by more than 99 percent the former leading cause of post-natal mental retardation. Unfortunately, despite these huge gains, anti-vaccine rhetoric and pervasive false claims now threaten to erode public trust in the safety and effectiveness of vaccine programs.

Compounding the effect of this distrust, dozens of U.S. states have enacted laws to permit non-medical, or “personal belief” exemptions to childhood vaccinations. These laws, while seeking to protect individual liberties, open the door to concentrated, like-minded communities of unvaccinated or under-vaccinated individuals. In turn, these communities become increasingly susceptible to disease outbreaks, and undermine what is called “herd immunity”. The loss of herd immunity places the general population at risk, and is especially devastating for infants, the elderly, and those with compromised immune systems who cannot be effectively vaccinated.

Health Affairs. Vaccine Exemptions And The Federal Government’s Role (2019)

A more cooperative congressional approach would leverage the “power of the purse” by conditioning the receipt of federal funds on states’ enactment of more restrictive immunization laws. Two federal funding streams would provide obvious vehicles—the PHSA Section 317 grants to states for immunization program infrastructure and vaccine purchase or the Vaccines for Children Program under Section 1928 of the Social Security Act (Medicaid). While Congress’ ability to condition funding to states in this manner has long been upheld (seeSouth Dakota v. Dole), a 2012 US Supreme Court decision that made the Affordable Care Act’s (ACA) Medicaid expansion optional essentially forbids Congress from attaching new conditions in exchange for existing federal funding (seeNational Federation of Independent Business v. Sibelius). In that decision, the court scolded Congress for crossing the line between “enticement” and “coercion” in their implementation of funding conditions.

Wall Street Journal. No Religious Exemptions From Vaccines (2019)

According to the National Conference of State Legislatures, all but three states—California, West Virginia and Mississippi—grant exemptions from school immunization requirements for religious reasons. And 16 states “allow philosophical exemptions for those who object to immunizations because of personal, moral or other beliefs.” The results speak for themselves. States with fewer exemptions tend to have fewer cases of vaccine-preventable diseases.

Con

Jeffrey Singer. Vaccination and Free Will (2014)

But free societies are sometimes messy. To live in a free society, one must be willing to tolerate people who make bad decisions and bad choices, as long as they don’t directly infringe on the rights of others.

A strong argument can be made that it is self-defense to quarantine people who are infected with a disease-producing organism and are objectively threatening the contamination of others. But in such a case, the use of force against the disease carrier is based upon evidence that the carrier is contagious and may infect others.

Any mass immunization program that uses compulsion rather than persuasion will, on balance, do more harm to the well being of a free people than any good it was intended to convey.

Wendy Parmett. Gottlieb’s threat of federal vaccine mandates: questionable legality, poor policy (2019)

With measles cases on the rise, it’s no surprise that health officials want to shortcut the often slow and frequently unpredictable democratic process and instead take swift action to reduce exemptions — and increase vaccination rates. Unfortunately, there is no vaccine against vaccine resistance, and constitutionally dubious actions by federal officials can’t do the trick. But by working to improve public education around vaccines, enhancing transparency, educating and paying health professionals to talk to parents about vaccines, and ensuring vaccine safety, federal officials can help bolster trust in vaccines. Those efforts, more than anything, may lead to fewer exemptions.

Liberty Voice. Vaccines and the Violation of Basic Human Rights (2015)

This is not Nazi Germany, but forcing individuals to receive vaccinations or any other procedure that is contrary to their personal wishes and beliefs as to what is good for them and their bodies is a violation of human rights. To maintain the liberty of The United States of America, people ought to think long and hard about agreeing to such a stance and choosing to take away the rights of their fellow humans with a vote toward making vaccination mandatory.

Saul Weiner Why Libertarians Should Vigorously Oppose the Vaccine Program (2015)

Parents are the ones who know their kids the best and care the most about them. They are the ones who should be making medical decisions on behalf of their minor children. Vaccine mandates undermine parental authority and in effect demonstrate that the state owns our children and can and should determine what is best for them. So it should come as no surprise that, in recent years, we have seen a spate of cases which have come to be referred to as “medical kidnapping”. Have a preference for some other type of cancer treatment over chemo for your kid? Sorry. Want to get a second opinion on the doctor’s recommendations for your kids? Not so fast. The bureaucrats and licensed health care workers know best and may take custody of your kids if you resist. While we might be horrified by these developments, we can also see that they are only a logical outgrowth of the vaccine program, whereby the state has asserted the authority to make medical decisions for our kids.

ABC News. Vaccine exemptions surge as docs do ‘Hail Mary’ around vaccine laws (2019)

The wording has led to a kind of gray market in which parents share names of “vaccine-friendly” doctors by word of mouth or in closed Facebook groups. And some of those doctors are granting children blanket exemptions — for all time and all vaccines — citing a range of conditions not supported by federal guidelines, such as a family history of eczema or arthritis.

Amid growing concerns about suspect exemptions, the California Department of Public Health recently launched a review of schools with “biologically unlikely” numbers of medical exemptions, said the agency’s director, Dr. Karen Smith. Doctors who have written questionable exemptions will be referred to the Medical Board of California for possible investigation.

ADDITIONAL

 

Personal Belief Exemptions From School Vaccination Requirements (2014)

The states with most (and least) strict vaccine policies (2015)

Pro

The Right To Refuse Vaccination: Revisiting Vaccination Exemptions and the ‘Best Interests of the Child Standard’ (2016)

Who Should Call the Shots? Proposing Federal Oversight of Mandatory Childhood Vaccinations (2016)

Vaccine Exemptions And The Federal Government’s Role (2019)

Why we should eliminate personal belief exemptions to vaccine mandates. (2012)

Eliminate nonmedical immunization exemptions for school entry, says AAP (2016)

Eliminating Personal Belief Exemptions for Vaccines (2017)

Some states allow parents to get out of vaccinations. Then this happens (2019)

WHY “PERSONAL BELIEF” VACCINE EXEMPTIONS PLACE MANY VULNERABLE AMERICANS AT RISK (2017)

Con

Vaccination and Free Will (2014)

Gottlieb’s threat of federal vaccine mandates: questionable legality, poor policy (2019)

Change in Medical Exemptions From Immunization in California After Elimination of Personal Belief Exemptions (2017)

Vaccines and the Violation of Basic Human Rights (2015)

Why Libertarians Should Vigorously Oppose the Vaccine Program (2015)

Responding to the Childhood Vaccination Crisis: Legal Frameworks and Tools in the Context of Parental Vaccine Refusal (2015)

Vaccine exemptions surge as docs do ‘Hail Mary’ around vaccine laws (2019)

No Religious Exemptions From Vaccines (2019)