A measles outbreak linked to California’s Disneyland has once again thrust concerns about the spread of preventable illnesses into the spotlight, causing policymakers and public health officials to re-examine how and why families are allowed to opt their children out of vaccines required for school attendance.
As the illness spread this month, leaders in some states, including California, proposed limiting or eliminating so-called philosophical or belief-based exemptions—, that allow families to avoid vaccination.
“We knew this could happen. It’s not a surprise,” Catherine Martin, director of the California Immunization Coalition, said of the spread of measles in her state. The organization has supported efforts to eliminate nonmedical exemptions from the state’s vaccine policies.
“We’re trying to really use it as a teachable moment,” she said.
At the national level, U.S. Sen. Chris Murphy, D-Conn., said he plannedthat would offer incentives for states to require parents to be informed by a doctor about the risks before refusing vaccinations for their children for nonmedical reasons.
Between Jan. 1 and Feb. 6, there were 121 reported cases of measles in the United States, according to the Centers for Disease Control and Prevention. Many of those cases were linked to visits to Disneyland in Anaheim, Calif., in December. While a majority of those affected are California residents, the outbreak has spread to 17 states, the CDC reported.
Most of those who contracted measles weren’t vaccinated, the agency said. But, because vaccines aren’t always 100 percent effective, it’s possible that some vaccinated people also may have been affected, public health officials said.
Schools in California felt the effect of the outbreak as, under state law, large numbers of unvaccinated students had to remain isolated at home after they discovered their classmates may have been exposed to measles. States across the country have similar laws that drive up absences during outbreaks of vaccine-preventable illnesses.
Broad Exemption Policies
State vaccine mandates have been credited with helping to largely wipe out illnesses like measles, mumps, and pertussis. But broad exemption policies have led to concentrations of unvaccinated or under-vaccinated children in some communities, federal data show. In some areas, vaccination rates are below the 90 percent threshold public health officials say is generally necessary to prevent the spread of illnesses and protect immune-compromised people and infants who cannot be vaccinated.
“If you live in a school district where 1 in 4 or 1 in 5 kids aren’t vaccinated, the state exemption rate or the national exemption rate doesn’t matter to you,” Daniel Salmon, the deputy director of the Institute for Vaccine Safety at Johns Hopkins University, said at a forum in Baltimore last week.
As a result, some states have considered requiring schools to track and report exemption rates to parents.And some school nurses have worked to coordinate with health organizations to provide vaccines and education to reluctant families.
In the debate over exemption policies, public health officials and supporters of vaccines face off against some politicians, who say requiring vaccines violates personal freedom, and opposition groups, whose concerns include immunization frequency, the way the inoculations are produced, and discredited claims that vaccines are linked to autism.
As the number of reported measles cases continued to climb, the advocacy organization Autism Speaks took its most direct position to date on the issue last week by releasing a statement.
“Over the last two decades, extensive research has asked whether there is any link between childhood vaccinations and autism,” chief science officer Rob Ring wrote. “The results of this research are clear: Vaccines do not cause autism.”
Just two states, West Virginia and Mississippi, only allow exemptions from vaccine mandates for medical reasons. Those two states, along with New York and Montana, are among those considering bills that would create new medical or philosophical exemptions.
A pair of California Democrats, including state Sen. Richard Pan, a Sacramento pediatrician, said this month they would like to add their state to the list of those that only allow medical exemptions. They will push to eliminate the state’s personal-belief exemption policy, which families also use to opt out for religious reasons. Dr. Pan supported a 2013 state law that requires medical counseling before families can opt out.
Battle Lines Drawn
North of San Francisco in affluent Marin County, where about 6.5 percent of kindergarteners are not fully vaccinated, the board of the Reed Union school district voted to support Dr. Pan’s proposal last week. The vote followed a speech by 7-year-old leukemia survivor Rhett Krawitt, who just became healthy enough to be immunized.
“At most school board meetings we talk about math and science, but what we don’t talk about is ensuring the safety of our students,” said board president Dana Linker Steele, according to the Marin Independent Journal. “So to me, eliminating the personal belief exemption, ensuring the children and the members of our staff are safe, is important.”
But even the bill’s supporters say it faces an uphill battle in the state’s legislature.
“The battle lines are clearly drawn,” wrote Barbara Loe Fisher, president of the National Vaccine Information Center, which opposes vaccine mandates, on the organization’s website. “Now Americans have a choice to make: will we stand up and fight to protect our human right to make voluntary decisions about which vaccines we buy and use, or will we permit liability-free drug companies and government health officials to take that freedom from us?”
In considering the measure, California joins state legislatures around the country that have introduced bills that would strengthen or, in some cases, loosen immunization requirements. In Minnesota, for example, a bill would require parents to submit proof that a doctor has discussed the risks of forgoing vaccines with them before pursuing the state’s philosophical exemption.
Proposed shifts in state vaccine policies are a perennial issue, as are outbreaks of vaccine-preventable illnesses. But public health advocates hope the unusual epicenter of the California measles crisis—a highly visible environment associated with fun and innocence—will help influence parents and policymakers to pursue higher immunization rates.
Ms. Martin, of the California Immunization Coalition, said she recently got a call from a mother of a 3-month-old child who said, “I can’t believe that I might have to deal with measles in this day and age.”
Parents who are concerned about the re-emergence of preventable illnesses “are just as fearful as the parents who are afraid of getting vaccines,” Ms. Martin said.
A version of this article appeared in the February 18, 2015 edition of Education Week as Measles Outbreak Cues Action on Vaccine Rules