The first report came this year on January 7: seven confirmed cases of measles in Disneyland. Slowly the numbers rose. Then, there were twenty-six cases, twenty-two of which were linked to the original outbreak in Disneyland. By the beginning of February, 121 individuals across seventeen states had come down with the vaccine-preventable disease.
This is just one of over twenty outbreaks since the beginning of 2014. Those protected by herd immunity were finding that the walls of that barrier were crumbling. The frustration over these measles outbreaks is warranted: measles was eradicated in the U.S. years ago, and there are no native reservoirs of the disease. Yet, six hundred and forty-four cases were confirmed last year. To understand why people choose not to vaccinate, it is important to consider their reasons and how they fall within public policy.
Exemptions from vaccines can be either medical or non-medical. Children may be medically exempt if they are immunocompromised by a disease or after an
organ transplant. Furthermore, some parents either cannot afford or access vaccines, or they don’t have information about which ones their children need. These are relatively small populations, but they are in dire need of herd immunity.
On the other hand, two percent of Americans cite non-medical reasons, i.e. religious and personal beliefs that justify exemption. However, even religious groups are reconsidering their stance after a measles outbreak last year in Ohio’s Amish communities resulted in 341 cases. Those who refuse vaccines for personal or philosophical beliefs, however, cite “evidence” of correlation between behavioral disorders and vaccines (no such relationship has been found) or are repelled by unnatural ingredients. Although there has always been a small population exempt from vaccination for non-medical reasons, the proportion of the total population has increased dramatically from 0.99% to 2.54% between 1991 and 2004. Since opponents often live in close proximity, within tight-knit communities and counties, there are pockets of low herd immunity. In states like California, the overall vaccination rate of 90.7% is low, but exemptions are disproportionately concentrated in cities like San Francisco and Los Angeles. Thus, public health policies targeted at the regional level are one way to get vaccine coverage back on track.
Requiring vaccinations for school is another promising policy that may increase vaccine coverage from a young age. Ever since the 1905 landmark case Jacobson v. Massachusetts established states’ right to mandate vaccine laws, state
governments have taken on an increasingly important role. By the early 1980s, all fifty states had established vaccine requirements for school-aged children. However, some laws are stricter about approving exemptions than others, which translates into mixed vaccine coverage. Studies show an inverse relation between the ease with which exemption can be sought and overall vaccine coverage. Forms that encourage parents to cite more specifically the philosophical beliefs that dissuade them from vaccination, or to prove that they are sincerely against it, can help regulate the process of seeking non-medical exemption.
Another problem is that states target vaccination rules at school-aged children, leaving younger children between two and five uncovered. Thus, requiring vaccinations before kindergarten is an effective way of ensuring earlier immunity in case of later exposure. In addition to tweaking the actual exemption process, states can work to provide parents with more information about vaccines. Arkansas recommends that parents seeking non-medical exemption for their children receive counseling on the risks of not vaccinating. Such counseling sessions are effective at debunking myths about vaccines that continue to deter parents from immunizing their children, ensuring that they have all the information needed for informed decisions.
Although further studies are required to find more effective ways of reducing non-medical exemptions, measures like earlier vaccinations, targeting pockets of low immunity, increasing the stringency of the exemption process, and encouraging earlier vaccinations can help prevent the alarming rise of measles and other preventable diseases seen each and every year.