The purpose of my research is to prove that the public’s health should come before the right of the individual on issues dealing with vaccinations in public schools. The 2014 measles outbreak that carried over to 2015 called attention to the steadily decreasing percentage of vaccination rates among children. Parents can opt out of vaccinations by obtaining an exemption from their child’s school. Each state allows different types of exemptions, and a comparison of states with stricter policies versus states with more lenient exemption policies demonstrates that those with stricter policies have been less affected by the outbreak as a whole. Schools help spread disease because of the close contact between students. Students then pass disease on to their families at home. Parents feel that their individual rights entitle them to choose not to vaccinate. Leaving vaccine exemptions as they currently stand threatens public health, which overrules the right of the individual. By creating stricter vaccination requirements, the rate of exemptions will decrease, helping America reach a state of herd immunity and a safe environment for public health.
“Parents need to know that not vaccinating their babies can also have scary and dangerous consequences,” Shelley Johnson Carey (2015, para. 19) warned vaccine refusers. In 1990, Carey’s own eighteen-month-old daughter, Gillian, taught her this lesson when she contracted the measles. Gillian was just a few months behind schedule for vaccines, which did not concern Carey because she could not even recall the last time she had heard of a measles case. As an outbreak of measles unfolded in front of our eyes on the news, many people had the same thoughts as Carey: there are still cases of the measles in the United States? The answer to the question is yes, but the more important question is: why? The National Public Radio (NPR) reported that from 2008 to 2009, the vaccination rates for the measles, mumps, and rubella (MMR) vaccine fell from 93.5% to 90.6% (Galewitz, 2010, para. 3). These rate drops are linked to vaccine refusers, in particular, parents who decline to vaccinate their children based on religious or philosophical beliefs. Rates continue to fall each year as parents are misguided by false information about vaccine safety. The World Health Organization (WHO) estimates that the measles vaccine prevented 15.6 million deaths during 2000-2013 (World Health Organization, 2015, para.1). By allowing parents to exempt their children from vaccine requirements, public health is at stake. My research will argue that the good of the public’s health should come before the right of the individual on issues dealing with required vaccinations in public schools.
Historically, the issue of vaccination requirements has been prevalent in federal court cases. In 1922, Rosalyn Zucht refused vaccination and challenged the law that required students in public and private schools to receive the smallpox vaccination. The U.S. Supreme Court case, Zucht v. King, addressed the issue with direction from the 1905 Supreme Court decision, Jacobson v. Massachusetts. This case also addressed the topic of vaccination refusals when Henning Jacobson refused to get the smallpox vaccination in Cambridge, Massachusetts, after the city required all adults to obtain the vaccination. The federal government upheld the state’s decision and deemed it lawful for states to enact quarantine laws and health laws to protect public health (Mariner, Annas & Glantz, 2005). The Supreme Court decision in Zucht v. King also upheld the city ordinance and established that, when health regulations are in question, states have the authority to enforce policies. Federal and state vaccination policies still operate as decided in Zucht v. King (Justia Law, 2015). There are federal vaccination recommendations provided by the Centers for Disease Control (CDC), but vaccination laws are decided by and enforced by the state (National Vaccine Information Center, 2015). The present-day policies set by past court cases explain the development of vaccination requirements and allow us to utilize precedents and establish more effective policies from them.
As a result of Supreme Court decisions, vaccination policies for schools vary greatly from state to state. States choose which vaccines are required from the CDC’s recommendations and then enforce them as they see fit. The state decides whether vaccination regulations only apply to public schools or are equally enforced among private school, preschool, and even home-school students. The state also decides what types of vaccination exemptions exist and how these exemptions must be obtained. Exemptions include medical, religious, and philosophical reasons for refusing vaccines. All fifty states allow medical exemptions, while forty-seven allow religious, and eighteen allow philosophical. The District of Columbia allows all three (Sandstorm, 2015, para.1). A medical doctor gives medical exemptions to students if a vaccination will harm their health. Religious exemptions may be available to students whose religious or spiritual beliefs oppose vaccinations, but the stipulations to obtain a religious exemption differ in each state. Philosophical exemptions are for students and parents whose personal beliefs influence them to refuse vaccines. The contrasting policies in each state allow comparisons of the effectiveness of different policies. When comparing state policies in relation to the recent measles outbreak, as of February 4, 2015, there were ninety reported cases in California, a state allowing religious and philosophical exemptions, which far surpassed the zero reported cases in Mississippi, a state that only allows medical exemptions. As evidenced, there is an explicit contrast between the outbreak results of states with different school vaccination policies. Creating stricter vaccination laws would help prevent the spread of disease, as proven by Mississippi (Cohen & Yan, 2015).
Stricter vaccination laws for public school students are not the only actions that could be taken to prevent the spread of disease, but they are the most efficient. Younger children are the most susceptible to diseases because they have not been exposed to a disease long enough to have their immune system fight it. Young children are also unaware of good hygiene and they often do not understand how diseases spread. They do not always comprehend that they must cover their mouth and nose while sneezing or coughing. The risks children face of contracting a disease can be minimized or eliminated by vaccinating them. Additionally, stricter vaccination laws in public schools are necessary because of how rapidly the spread of diseases occurs within a school and then almost immediately circulates into the community. Schools are common sources of outbreaks. Students are enclosed in the confined area of a school for at least six hours, five days a week, using the same utilities and supplies. In addition to the school day, students also participate in after-school activities and sports. Throughout these activities, students come in close contact with each other multiple times during the day. Scientists from Stanford University conducted a research study tracking high school students’ and staff members’ movements during a school day. Everyone wore a device that tracked the number of encounters between one person’s device and another’s within ten feet. In just one day, 762,868 encounters were recorded.(Discovery News, 2015). After students’ encounters at school, they go home to their parents, siblings, and other family. Then their family encounters other people in their lives, and the cycle continues. "A school connects an entire community," Marcel Salathe said (Discovery News, 2015, para. 10). After considering all of these encounters, imagine that each person encountered was infected with a disease. This disease would travel through a community rapidly if people were not vaccinated. If we start by making sure students are vaccinated, then a huge percentage of disease transferrals are eliminated.
With the information provided, one may wonder why stricter vaccinations are not already enforced for public school students. According to Mariano Castillo (2015, para. 1), “The scientific and medical consensus is clear: Vaccinations are safe, and they work.” So why do parents continue to refuse vaccination for their children and fight for exemptions? One evident reason is religion. “Researchers and journalists have struggled to identify a single major U.S. religious group that currently advocates against vaccination for children” (Sandstorm, 2015), but some interpret that their religion does not permit vaccinations. A few among these groups are the Christian Science Church, Jews, Muslims, and Catholics. The Christian Science Church follows the belief of healing only through the power of prayer. Jewish and Muslim groups do not consume by-products of swine, which causes a conflict because pig gelatin is used to create some vaccines. Others have been developed using the tissue cells of aborted fetuses, which is why the Catholic Church has encouraged its members not to receive certain vaccines (Sandstorm, 2015). While the reasoning behind religious exemptions is very broad, and usually only used by religious extremists, it stems from these kinds of beliefs. That being said, it is the philosophical exemption that is applied more often and has a greater impact on public health.
The CDC (Cohen & Yan, 2015) found “during the last school year, 3.3% of California kindergartners—about 18,200—were allowed to skip vaccinations. The vast majority of exemptions were due to personal beliefs” (para. 12). These personal beliefs fall under the category of philosophical exemptions. Amy Graff of The San Francisco Chronicle (2015) collected the most common reasons that parents do not vaccinate. The top two reasons were that many parents feel that the diseases the vaccinations help prevent are rare or not serious diseases. The diseases may be rare in the United States, but this is only because of the direct impact of high vaccination rates. By not vaccinating, the herd immunity built by high vaccination rates decreases, making these “rare” diseases more common. Required vaccinations offer protection from diseases, such as polio and hepatitis B, which result in serious complications. Polio can lead to temporary or permanent muscle paralysis and disability (Mayo Clinic Staff, 2014a), while hepatitis B can result in liver cancer or failure (Mayo Clinic Staff, 2014b). Another common concern parents have is the idea that vaccinations are linked to autism. The CDC (2015) states, “Studies have shown that there is no link between receiving vaccines and developing ASD.” A 2013 CDC study examined antigens, which tell the immune system to make antibodies to fight diseases that enter the body. The number of antigens from vaccines were recorded in children, some with and some without autism, until the age of two. The study concluded that children with autism had the same amount of antigens from vaccines as the children without autism (Centers for Disease Control and Prevention, 2015a). Most vaccine refusers have been influenced by false information. The best way to address this issue is to continue educating parents on accurate vaccination research.
With these concerns about vaccinations, parents have asserted that it is their First Amendment right to have religious and philosophical exemptions for vaccines for their public school students. Parents think that it is not only unfair for them to have to vaccinate their kids, but even illegal. Parents feel that requiring them to vaccinate their children will infringe upon their civil liberties. However, multiple other individual constitutional rights have been tailored for applicable use in public schools such as the Second Amendment, the right to bear arms, and the Fourth Amendment, prohibiting search without a warrant. These deprivations of rights were all put in place because in each of these cases, the harm to the public overruled these rights in public school settings. Many also do not agree that it is the job of the government or public health officials to mandate whether or not their children should receive a vaccine. Bob Sears, a pediatrician, states, "Whether you are for vaccines, against them, or neutral, allow me to ask this question: Does the government have the right to force them on every American?" (Infobase Learning, 2015). According to a recent poll by CBS News, 34% of Americans share the same caution as Dr. Sears. On the other hand, 66% of Americans think it should be required for parents to have their children vaccinated (Dutton, De Pinto, Salvanto, & Backus, 2015). Health experts who agree with the implementation of nonmedical vaccine exemptions suspect that if these exemptions are taken away, it may cause a larger anti-vaccination movement. Parents see forced vaccinations as the government trying to control not only their health care, but also their daily lives. Those who oppose mandated vaccination are also skeptical of pharmaceutical companies’ involvement. They are concerned that with all public school children receiving vaccinations, pharmaceutical companies will manufacture unnecessary vaccines that the government will require just for their own profit (Infobase Learning, 2015). With a better understanding of why parents hesitate to vaccinate, we can attempt to create a solution that achieves the main goal of herd immunity and the safety of the public, as quickly and effectively as possible.
The first approach to creating stricter vaccine policies for public schools should not be to completely eliminate philosophical and religious exemptions. Only allowing medical exemptions would be ideal in regards to public health, but the reaction of the public would not support this policy. While the medical census supports completely eliminating exemptions, taking a stand this large to begin with will cause more complications and take more time to achieve than if handled step by step. The first step should be to make the process of receiving philosophical and religious exemptions more strict. In states like Florida, Texas, and Minnesota that have strict exemption policies, there are fewer non-medical exemptions than in states such as Connecticut, Wisconsin, and Missouri, with less strict policies. These states with lenient policies only require a note from parents to obtain a non-medical exemption. Those states with strict policies include some type of risk education before being granted exemption (Ropeik, 2015).
My research proves that the following ideas for stricter policies have great potential to increase vaccination rates, herd immunity, and the safety of the public. Educating parents on how they are putting public health, and specifically their children, at risk by refusing vaccines may sway their decision. My suggestion is that parents must consult with a family doctor about vaccination risks, as well as complete an educational course on vaccine safety before receiving a nonmedical vaccination exemption. The funds for the educational course will be entirely funded by the parents who seek exemptions. In addition to that, parents who receive a religious exemption must submit a notarized verification from a spiritual leader stating that their faith advocates an opposition to vaccines. As stated before, most religions do not have a clear stance on a vaccine policy, so receiving this verification will make it more difficult for parents to abuse the religious exemption policies. Parents unshakeable in their vaccination refusal stance are the only ones who will successfully obtain exemptions after the process becomes stricter. The state of Washington began requiring just a doctor’s note in 2011, validating a vaccine safety learning consultation for non-medical exemptions from parents (Cafazzo, 2015). Since 2011, the rate of non-medical exemptions has fallen 25% as a result of stricter exemption policies (Ropeik, 2015). By making the vaccine exemption process more difficult, fewer exemptions will be obtained. This will raise the vaccination rates to reach the percentage of herd immunity, which varies for each vaccine-preventable disease.
In addition to stricter school exemption policies, the idea of fining refusers because they are not vaccinated is also an effective influence. Fines could be included in an insurance payment as a high-risk behavior, similar to the costs smokers and negligent drivers pay. High-risk fines are applied because individuals at a higher risk will cost the insurance companies more money than those who are not at risk. Not being vaccinated does open up a high-risk situation because it is more likely that a person will get sick and cost the insurance company more. Enforcing stricter exemption requirements and including high-risk fines will sway a large portion of vaccine refusers. These new policies are a step in the right direction to create herd immunity across America for each vaccine-preventable disease. Parents still have the right to choose what they want for their children, but this way forces parents to choose based on an informed decision, rather than a common myth, and ensures that they are not taking advantage of the exemption system. This approach will be potent in the attempt to avert disease outbreaks and death from preventable diseases. If herd immunity can be obtained through these policies, then it will reduce the danger to public health. However, if outbreaks continue to harm the public and children’s lives after these policies are put into action, the idea of eliminating non-medical exemptions must be re-visited.
Reflecting on 1990, when Carey (2015) found herself looking over her baby, Gillian, in a hospital bed with measles, she remembers thinking, “I couldn't believe how my lack of awareness had led to such a frightening situation.” At this time, the percentage of vaccine refusers may be small, but their effect is large, as there were 667 reported cases of measles in 2014 and 189 cases in 2015 (Centers for Disease Control and Prevention, 2015b). With complications of pneumonia, encephalitis—a brain infection—, or even death, we should be considering and enforcing any steps possible to prevent a widespread measles outbreak in the United States (Boston Children's Hospital, 2015). However, measles is not the only disease that should cause concern. Those who decide to refuse vaccines are also not protected from other highly infectious and serious diseases such as polio, hepatitis B, or pertussis (whooping cough). While banning vaccine exemptions right now may not be the most effective solution to the vaccine exemption problem, changes must soon be made that limit the rights of individuals regarding exemptions. It is not viable to permit a large percentage of unvaccinated individuals to threaten the population when it has been scientifically proven that vaccines are safe. How long do we continue on like Shelley Carey, lacking awareness, before we decide the good of the public health should come before the individual rights?
*Opening image is an oil painting by Richard Canals
Boston Children's Hospital. (n.d.). Measles in Children. Retrieved March 20, 2015.
Cafazzo, D. (2015, February 6). Parents could lose some vaccine exemptions under new proposed state law. Retrieved April 17, 2015.
Carey, S. (2015, February 24). Measles was no big deal -- until my daughter caught it. Retrieved March 2, 2015.
Castillo, M. (2015, February 2). Measles outbreak: How bad is it? Retrieved March 17, 2015.
Centers for Disease Control and Prevention. (2015a, March 17). Vaccines Do Not Cause Autism. Retrieved March 20, 2015.
Centers for Disease Control and Prevention. (2015b, February 9). Measles Cases and Outbreaks. Retrieved March 13, 2015.
Cohen, E., & Yan, H. (2015, February 4). Measles outbreak: Different states, different rules on vaccinations. Retrieved February 7, 2015.
Discovery News. (2013, February 11). Busy High School Model Shows How Diseases Spread. Retrieved March 26, 2015.
Dutton, De Pinto, Salvanto, & Backus. (2015, February 20). CBS News poll on vaccines and the measles outbreak. Retrieved April 18, 2015.
Galewitz, P. (2010, October 13). Fewer Kids Get Vaccinated As Parents Worry About Side Effects. Retrieved March 19, 2015.
Graff, A. (2015, February 11). Top 10 reasons parents don't vaccinate - debunked. Retrieved March 13, 2015.
Infobase Learning. (2015, April 7). Mandatory Vaccination. Retrieved April 19, 2015.
Justia Law. (n.d.). Zucht v. King 260 U.S. 174 (1922). Retrieved March 17, 2015.
Mariner, W. K., Annas, G. J., & Glantz, L. H. (2005). Jacobson v Massachusetts: It’s Not Your Great-Great-Grandfather’s Public Health Law. American
Journal of Public Health, 95(4), 581–590. doi:10.2105/AJPH.2004.055160
Mayo Clinic Staff. (2014a, March 11). Polio. Retrieved March 18, 2015.
Mayo Clinic Staff. (2014b, March 11). Hepatitis B. Retrieved March 18, 2015.
National Vaccine Information Center. (n.d.). Vaccine Law Information. Retrieved March 13, 2015.
Ropeik, D. (2015, February 9). Vaccine exemptions should be harder to get, but don't eliminate them. Retrieved April 19, 2015.
Sandstorm, A. (2015, February 25). Nearly all states allow religious exemptions for vaccinations. Retrieved March 7, 2015.
World Health Organization. (2015). Measles. Retrieved March 18, 2015.
About the Author(s)