Vaccinations: Personal Exemption vs. Public Health?

The recent outbreak of measles in California has ignited a national debate between the safety of public health and those exercising their personal and religious choices, so-called "anti-vaxxers", who opt out through state offered exemptions. Can there be middle ground in this debate without restricting religious and personal ideologies?

VACCINATIONS

Personal Exemption vs. Public Health

Due to the recent measles outbreak, linked to the two Disney theme parks in California, the debate over childhood vaccinations has itself gone viral.  This latest outbreak infected 125 people, of those 110 were California residents and 45% were known to be unvaccinated. 

Measles spread like any other contagious disease does, to 6 other states and both of our border countries. This outbreak in conjunction with the additional 534 reported measles cases in2014, affected a total of 18 states and ignited tensions between parents who vaccinate their children and a growing group of parents, dubbed “anti-vaxxers,” who have taken advantage of state-offered exemptions that allow them to opt out of the recommended vaccinations for their children.

 Media and popular public opinion have held anti-vaxxers as the culprit in this outbreak, but are they solely to blame? Or has our own nation’s quest to protect individual liberties left the safety of public health at risk? After all, anti-vaxxers have not broken any laws; they have only held true to their personal belief of what is right for themselves and their children. There is no national mandate requiring parents to vaccinate their children; vaccination regulations have been left in the hands of individual state legislation. 

Currently, in the United States vaccinations requirements vary state to state and are only necessary if you plan on enrolling your child into the public school system. Only 2 states, North Carolina and Virginia, require vaccination for homeschooled children. While all 50 states allow for medical exemptions, depending on the state in which you live, you may still be eligible to opt out based on your religion or personal ideologies. There are 2 states that do not allow any exception other than medical, West Virginia and Mississippi.  47 states allow religious exemptions and of those 18 states include personal ideology exemptions.

 

It’s important to note that, while a total of 668 measles cases may seem small in comparison to the United States population, as recently as 2000, measles had been declaredeliminated within the United States; meaning that for 12 months there was not one reported case. I feel the steady increase in measles cases over the past 14 years foreshadows a larger future epidemic. While offering religious and personal exemptions are a well-meaning gesture in respecting individual ideologies, they do not take precedence over the safety of public health and can be revoked by the state to eliminate potential risk to residence, as West Virginia and Mississippi have done. I do not feel as though we have reached the point of no return in regards to the need to revoke exemption; however, if the anti-vaxxers movement continues to gain support our country many have no choice but to protect public health over individual liberties.

Presently, 83% of our population view vaccinations as safe. They see vaccination as a way to boost their immune system to protect not just themselves, but the population as a whole from diseases. Vaccinations are beneficial not only to the individual that receives them, but also to those individuals within our population who by no choice of their own cannot. This includes, but is not limited to, infants too young to start vaccinations and individuals with immune system deficiencies or allergies to vaccines. These individuals are eligible for medical exemptions and ultimately depend on the rest of the population to get immunized in order to protect their own health. They are reliant on what is called herd immunity.

Here is a quick overview of herd immunity: When the vast majority of the population receives vaccinations, those with medical exemptions are protected by the “herd” of vaccinated individuals. The herd’s immunity helps to break the chain of infection when a disease is introduced into the population. When people who can but choose not to get vaccinated, the “herd” thins out and outbreaks become more common. So depending on how contagious a disease is determines how thick the herd must be to avoid an outbreak.

Needless to say, children who are opted out of vaccinations also rely on herd immunity to stay healthy. It’s easy to conclude, if more parents join this movement then more children will not receive vaccination and herd immunity will become obsolete in protecting them and the population. There are steps now that we can take to not only ensure the safety of our public’s health and the option to obtain exemptions.

Parents who do vaccinate their children, and especially those who live in California and saw the firsthand effects of the measles outbreak, have understandably made this personal. It would be hard not to when children are the victims. However, in order to proceed they should first stop denouncing those dubbed “anti-vaxxers” for their own personal ideologies. We are a nation built on diverse beliefs. We should not place judgment on those individuals whose beliefs differ from our own. In the case of Dr. Eric Ball, a California pediatrician, parents should not have issued him an ultimatum that if he continued to treat patients that did not vaccinate their children they would find an alternative doctor. With what he felt was no choice he decided patients who did not vaccinate could either get vaccinated or go elsewhere. As stated above, exemptions are permitted by the state’s government, so for parents who feel action is what they need to take to do their part, starting at the source would be a more productive option. Another, more beneficial way to affect change would be to address anti-vaxxers’ concerns without attacking their dignity.

Currently, 7% of our population does not know if vaccinations aresafe while another 9% do not think they are safe at all. These individuals need to be our main focus if we hope to decrease the number applying for exemptions.

 Some parents have let their worries and fears interfere with what seems like an obvious choice to the majority of our population, to vaccinate. But, that’s what fears do; they distort our prospection of reality and prohibit rational thinking. These parents are troubled by the mixed information available on the internet. They are pressured by friends and family, while never researching immunization themselves. They are afraid of the side effects listed on the doctor’s vaccination handout sheets. They worry that their infant will be the 1 in 14,000 that will have a seizure or the 1 in 16,000 who will spike a fever of 105 degrees, because at the age of two months how would one know if their infant may be allergic? They are afraid of taking the minimal risk in fear of the shot being a life changing mistake they made for their child. This is the group where we could implement the most affective change.

                                                                           

Research hasindicated that trying to persuade parents who are fearful of vaccines with its health benefits and safety information is ineffective in changing their minds. Their preexisting disbelief causes them to become even more wary when confronted. The report suggest the best way to address these parents is to not single them out with shaming or to dismiss their fears as inauthentic, but to address their underlying apprehensions with compassion and understanding in order to further a more productive conversation on vaccinations. Ideally this conversation should be with their trusted health care provider and take place prior to any recommended vaccination for their child to allow them time to make the right decision for their family. To help foster change, a conversation like this should be required by all states before any exemption would be granted.

The last thing I would like to see is a national mandate that restricts religious or personal exemptions. However, the safety of our public’s health must come first. My hope is that anti-vaxxer will take into consideration what long term effects their individual choices may ultimately have on our country as a whole.