March 29, 2019

With cases of measles spreading across the country and an increasing number of parents not wanting to vaccinate their children due to religious or philosophical beliefs, more states are expected to debate legislation on whether or not parents should be required by law to vaccinate their kids.

At least 314 individual cases of measles have been confirmed in 15 states since January, according to the Centers for Disease Control and Prevention. The CDC also reports that the majority of people who contracted measles were unvaccinated. More than 150 cases of the mumps were also reported to the CDC in January and February. In Greater Philadelphia alone, over 100 cases of the mumps have recently been reported and that number continues to grow.

According to a recent Politico story, such outbreaks have turned 2019 into one of the most active years for vaccine policy, with several states trying to toughen their vaccination mandates while some legislators are advocating giving parents more control over whether their children need to be vaccinated. The story reported that legislators have filed more than 130 vaccine-related bills in over 30 states.

Neal D. Goldstein, PhD, assistant research professor in Drexel University’s Dornsife School of Public Health, led a study published in the American Journal of Public Health in 2018 that found that despite an uptick in anti-vaccine legislation proposed by state lawmakers in recent years, pro-vaccine bills were more likely to be enacted into law. Goldstein weighed in on the current outbreaks as they relate to legislation.

Can the uptick in vaccine-related legislation be attributed to the recent outbreaks of diseases like the measles and mumps? 

This is such an important question to answer. In a democracy, we hope that legislators are bringing forth bills that address the needs — and health — of their constituents. But reasons for introducing and supporting bills are varied and there are lots of interested parties. Consequently, we see bills being introduced for a variety of reasons, some good and some bad. As our study in the AJPH demonstrated, these bills are not always reflective of the public good.

While I would like to believe that legislators act in the best interest and health of their constituents, this may not always be the case. Perhaps one silver lining to these disease outbreaks is the widespread attention they are garnering in the media, and legislators may be responding by clamping down on the ability to exempt from vaccination in their states. The evidence clearly shows that states with more restrictive vaccination exemption laws, such as West Virginia and Mississippi, have higher vaccination rates, and less disease.

Currently only three states don’t allow vaccine nonmedical exemptions, with the current outbreaks can we expect more states to follow?

I believe so. Several states have pending legislation that would eliminate nonmedical exemptions, whether religious or philosophical or both. These types of bills have been tough to enact in otherwise typical legislative years, but as was demonstrated in California with the Disneyland measles outbreak several years back, the state legislature was able to respond by eliminating nonmedical exemptions in that state. We may see the same effect in other states with the most recent outbreaks. This is really an opportune time to advocate for public health legislation.

Is there a chance we could see more states loosening legislation on vaccines this year?

I would be surprised if we saw a state pass legislation that relaxed exemption requirements this current year. But that does not mean that public health advocates should be complacent. The AJPH study really demonstrated how vaccine advocates needs to remain vigilant. After the current outbreaks subside — which hopefully they will soon — then this issue may no longer resonate with lawmakers.

Several years from now we may then see bills being introduced or re-introduced that attempt to relax exemptions requirements, or even add nonmedical exemptions. Unfortunately, if this happens, and they become law, then we may find ourselves right back in the same position of increasing frequency of disease outbreaks. The bottom line really is: More people need to get themselves and their children vaccinated against these otherwise preventable diseases.

When are vaccine exemptions necessary?

Vaccine exemptions exist for a reason. Not all individuals can receive vaccinations. For example, some people have compromised immune systems or allergies and they cannot be immunized. These individuals rely upon their community for protection. High levels of vaccination in the community means protection from disease for those not immune. If vaccination exemptions were used as intended, we would not be in the present situation.

Author: Niki Gianakaris