Scott C. Ratzan is a senior fellow at the Harvard Kennedy School’s Mossavar-Rahmani Center for Business and Government. Barry R. Bloom is a professor of public health and former dean at the Harvard School of Public Health. Lawrence O. Gostin is the O’Neill professor of global health law at Georgetown University Law Center, where he directs the World Health Organization Collaborating Center on National and Global Health Law. Jonathan Fielding is a distinguished professor of health policy and management at the UCLA Fielding School of Public Health and a distinguished professor of pediatrics at the UCLA David Geffen School of Medicine.
In the year 2000, the United States essentially claimed victory against childhood diseases, eliminating measles and making the prevalence of other childhood diseases, such as mumps, extremely rare. Today, we are losing.
Eleven states have reported measles cases, and a checkerboard of communities across the United States lack the necessary vaccine coverage needed to maintain the threshold herd immunity of about 96 percent — when vaccination of a substantial portion of a population protects everyone. The costs in human and financial terms are enormous.
The rise in such cases is not due to more virulent strains or resistant viruses. Rather, society suffers from the success of anti-vaccine advocates who pushed “vaccine hesitancy and refusal” and issued unrelenting demonization, disinformation and demagoguery against immunizations. Social media is infected with viral messaging from bots and trolls that masquerade as legitimate information outlets but instead stoke illegitimate fear of vaccines.
The crisis has reached a tipping point, forcing Food and Drug Administration Commissioner Scott Gottlieb to warn recently that states are “going to force the hand of the federal health agencies.” As leaders in public health, we agree. It’s time for policymakers — especially those at the federal level — to respond decisively to this threat and protect the health of our children by eliminating broad nonmedical exemptions to vaccination mandates.
The medical and public-health community has overwhelming scientific evidence that demonstrates the safety and effectiveness of vaccines. Yet parents today can easily go to Google to find discredited anti-vaxxer pediatricians or find solace among anti-vaxxer “friends” in Facebook groups full of misinformation. Other culprits include mainstream websites and some pediatricians who publicly cast doubt on vaccine safety. The World Health Organization now lists “vaccine hesitancy” as a top-10 global health threat, joining others such as antimicrobial resistance, Ebola, air pollution and climate change.
The constitutional power to compel vaccination is beyond doubt. As early as 1905, the Supreme Court upheld a law in Massachusetts requiring the smallpox vaccination. The ruling, Jacobson v. Massachusetts, affirmed the constitutionality of state and local laws across the country requiring childhood vaccination as a condition of school entry. By 1922, the court found that school vaccination laws were squarely “within the police power of a state.”
Yet, federal law is virtually silent on childhood vaccinations. Although every state has school immunization requirements, cavernous gaps exist through generous exemptions. All states, appropriately, allow medical exemptions, but 47 states (excluding California, Mississippi and West Virginia) permit religious exemptions, and 17 states allow exemptions for philosophical or “conscience” reasons.
After experiencing a devastating measles outbreak that began in late 2014, California entirely eliminated nonmedical exemptions. Following the law’s passage, the state experienced a major increase in vaccination rates, with a precipitous drop in measles and other outbreaks.
But most states have failed to respond in a similar way, and it would be irresponsible to wait as outbreaks expanded with severe consequences for our children.
What would decisive action look like?
First, the federal government should immediately initiate a comprehensive communication “Safe Vaccinations for a Healthy America” campaign. Such an effort would improve our nation’s public health by delivering information about vaccine benefits and risks in plain language from sources we trust (not just health advocates but also athletes, celebrities, etc.).
Second, the federal government should work with states to eliminate all nonmedical exemptions, following the lead of California and the evidence-based health outcomes.
Third, for those states that fail to comply, the federal government should condition certain Medicaid or public-health funding on states eliminating nonmedical exemptions. The Constitution allows the federal government to use its spending power to entice states to comply with national public health norms, as long as there is no coercion.
Finally, the government should encourage major social network organizations to screen out false anti-vaccine messages that promote childhood disease, just as they do for sexually explicit, violent and threatening messages.
Anti-vaxxers will object to such a vigorous campaign and will likely argue that it interferes with parental rights. But they are wrong. Children are not able to make their own decisions, and no parent has the right to place their child, or other children, at risk of serious harm. Federal policymakers have a responsibility to protect those children who have been put at risk whenever a parent claims the “right” to refuse vaccination.