Interactive Vaccine-Preventable Outbreak World Map (This may take a minute or two to load.)
How Many People Aren’t Vaccinating Their Kids in Your State? Maps are as of 2/17/2014
Some Outbreaks of Vaccine-Preventable Disease in Groups with Religious or Philosophical Exemptions
Vaccine Education Center, Children’s Hospital of Philadelphia
Public Health Resource on Vaccine Awareness
The Case for Vaccines: An Open Letter to State Legislators
The trouble with the world is not that people know too little, it’s that they know so many things that just aren’t so.
— Mark Twain
Vaccines are one of the most cost-effective benefits in the history of medical science. Vaccines have reduced the incidence of mortality and morbidity for several diseases by 99%. The scientific evidence is clear: Vaccines work.
But in recent years there has been a concerted push in several states to make it easier for parents to opt out of otherwise mandatory immunizations for their children. Why? Because those behind the push simply believe that vaccines are dangerous. Sometimes this belief is rooted in religion and sometimes it is based on scary stories about alleged vaccine-related tragedies, even though the Centers for Disease Control states that serious adverse reactions are exceedingly rare. Some groups also believe that vaccines cause autism despite the nineteen studies the CDC cites as showing no cause-and-effect relationship between the two. (CDC Studies on Vaccine and Autism, 3/29/2013) Some just simply believe that the scientific method is not a valid way to understand how the physical world works or to devise strategies to deal with the threats it often poses. And still others just believe that the scientific evidence is either wrong or a conspiratorial lie, usually concocted by the pharmaceutical industry, the medical profession, and government agencies.
While these anti-vaccine advocates don’t express much concern for other people’s children, some do argue that vaccination rates of 90% are adequate because “herd immunity” will protect everyone. Though herd immunity does protect many unimmunized children, it is certainly not a perfect shield because unimmunized children are not randomly distributed throughout any given state nor are they always surrounded by vaccinated persons. Measles is such a highly contagious disease that the American Medical Association states that nearly 100% vaccination rates worldwide will be necessary to eliminate it. (For recent examples of this see the news stories on measles outbreaks in religious communities in both Texas and the Netherlands.)
An article in the Journal of the American Medical Association indicates that U.S. children with personal belief exemptions are 35 times more likely to contract measles than properly vaccinated children. (DA Salmon et al., “Health consequences of religious and philosophical exemptions from immunization laws,” 282 JAMA [July 7, 1999]:47-53.) Another JAMA article reported that Colorado children with belief exemptions were 5.9 times more likely to contract pertussis than their vaccinated peers. (DR Feikin et al., “Individual and community risks of measles and pertussis associated with personal exemptions to immunization,” 284 JAMA [Dec. 27, 2000]:3145-3150.)
Rephrasing for emphasis, these studies found that children with belief exemptions had a 3400% increased risk of contracting measles and a 490% increased risk of contracting pertussis.
Unvaccinated carriers lower the level of protection for everyone. They especially place at risk babies too young to be vaccinated and those who, for medical reasons, are not vaccinated. But they also pose a risk even to properly vaccinated persons whose immunity is compromised without their awareness of it. This was strongly illustrated by a 2008 outbreak of five cases of deadly HIB disease in Minnesota. Three of the children were unvaccinated because of their parents’ beliefs. A fourth baby was too young to have completed the HIB-vaccine series. The fifth child, Julieanna Metcalf, had completed the HIB-vaccine series, but, unbeknownst to her pediatrician and her parents, she had an immuno-compromising disorder making her vulnerable to the disease. Julieanna’s life was saved, but she endured pain from seizures and many invasive procedures and lost her motor skills, perhaps permanently. Please read her story. One of the five children died.
The risks to children such as Julieanna and to unvaccinated children are unacceptable in our view. Parents should not have the right to put a child at a 3400% increased risk of contracting measles, a disease which killed and caused brain damage to thousands of U.S. children in the pre-vaccine era and killed 139,300 people worldwide in 2010. Children such as Julieanna should have a right to a safe environment in their school or daycare.
In addition to the health risks posed by personal belief exemptions another good reason for states not to allow them is the tremendous expense of containing outbreaks of vaccine-preventable diseases. In this era of global travel, health departments sometimes have to track exposure over multiple continents. Last year Salt Lake County had a measles outbreak that cost the state well over $200,000 even though it was limited to 9 persons because of the high rate of immunization there (97% of county schoolchildren have had two doses of measles vaccine). County and state health departments incurred hundreds of thousands of dollars in costs containing the outbreak; the school district incurred thousands of dollars in extra costs to hire substitute teachers (teachers who had been exposed to the infected students with belief exemptions had to be quarantined) and many students had their academic and extracurricular activities disrupted. (Salt Lake City Tribune, April 14 and 17, 2011) Dr. David Blodgett, a public health physician in St. George, Utah, estimates that every person with a personal belief exemption costs the state $3,000 to $4,000. (Phone call to Rita Swan, April 27, 2012.)
In 2008 Arizona had a measles outbreak that incurred over $800,000 in direct hospitalization costs plus thousands of dollars more for Public Health to trace transmission among the 8,321 persons exposed. (SY Chen, et al., “Health care–associated measles outbreak in the United States after an importation: challenges and economic impact.” [Journal of Infectious Diseases, 2011 Jun 1; 203(11):1517-1525.] In 2007 just two cases of measles among religious objectors cost Oregon, Lane County, and a hospital $170,000 including the cost of tracking down exposure and transmission. (The Oregonian, Aug. 27, 2008.)
Many courts have ruled that the state has a compelling interest and a constitutional right to require immunizations without exception for religious or personal beliefs. West Virginia’s immunization laws, for example, were recently upheld in Workman v. Mingo County Board of Education et al., No. 09-2352 (Fourth Circuit, U.S. Court of Appeals, March 22, 2011), and the U.S. Supreme Court declined to review it.
Clearly, mandating immunizations without exception for personal beliefs is in the best interest of children and the community. All states allow medical exemptions because some persons do have medical conditions that make vaccines not in their best interest, but surely a parent’s philosophical beliefs do not obviate the value of immunization to his or her child.
State legislators: Please work to emulate the admirable immunization laws of a state like West Virginia, which allows only medical exemptions from its immunization requirements. It is well past time for legislatures to enact health laws in accordance with the best available scientific evidence instead of with the fears and beliefs of those who choose to ignore it. We should not backtrack on the valuable lessons learned by the development and deployment of vaccines. There are too many other important health issues demanding attention.
Rita Swan, President of CHILD