By: Katherine Lewis

Editor’s note: This article is the conclusion of a 3-part series on measles and vaccines. You can read part one here and part two here.

This debate over who can decide if a child is vaccinated—the government, the parents, or the child him/herself—is back in the news as the mayor of New York City, Bill de Blasio, called for mandatory vaccinations of all citizens in the Brooklyn outbreak area. The area, covering four zip codes, has had 285 cases since October, some resulting in hospitalization. The order only allows medically-based exclusions and incurs a fine for non-vaccination, though there are still questions on enforcement procedures.

Image of the seal of the United States Senate. It is a blue circle with a yellow boarder. Inside the circle is a rectangular shape with E Pluribus Unum set on a background of the stars and stripes of the US flag.
Seal of the United States Senate

This announcement occurred in the wake of a recent Senate committee hearing called, “Vaccines Save Lives: What is Driving Preventable Disease Outbreaks?” Witnesses included representatives from the Washington State Department of Health, the University of Tennessee Health Science Center, and the Immune Deficiency Foundation. Also present were Dr. Saad Omer, Professor of Global Health and Epidemiology at Emory University and Ethan Lindenberger, an 18 year-old student at Norwalk High School in Ohio who recently chose to become vaccinated despite his parents’ objections.

In his testimony, Lindenberger, who had never been vaccinated—even for highly dangerous diseases such as measles, chicken pox, and polio—stated: “My mother is an anti-vaccine advocate that believes vaccines cause autism, brain damage, and do not benefit the health and safety of society despite the fact such opinions have been debunked numerous times by the scientific community.” He went on to discuss his own research into the safety of vaccines and the disagreements he had with his mother concerning the risks. Lindenberger emphasized this disagreement was respectful and stressed that, “anti-vaccine individuals do not root their opinions in malice, but rather a true concern for themselves and other people. Although it may not seem to be true because of the serious implications of choosing not to vaccinate, the entire anti-vaccine movement has gained so much traction because of this fear and concern that vaccines are dangerous.” Lindenberger, who began catching up on his missed immunizations in December of 2018, emphasized that the real enemies are the sources of misinformation about vaccine safety, not anti-vaccine individuals themselves.

In this way, they seem to be choosing risk of death over risk of disability. This choice epitomizes ableism and the stigma of disability in modern society.

The fears that Lindenberger’s mother expressed are deeply rooted in misinformation as well as a culture of ableism, which is defined by the Center for Disability Rights as “a set of beliefs or practices that devalue and discriminate against people with physical, intellectual, or psychiatric disabilities and often rests on the assumption that disabled people need to be ‘fixed’ in one form or the other.” Like Lindenberger’s mother, parents who chose not to vaccinate their children because they believe that vaccines cause autism choose to put their children at risk for these potentially lethal diseases over running the “risk” that their children will become disabled. In this way, they seem to be choosing risk of death over risk of disability. This choice epitomizes ableism and the stigma of disability in modern society.

In addition to Lindenberger’s personal insight, Dr. Omer also emphasized the importance of increased vaccine coverage in his testimony, which was largely based on his previous writings and research on measles outbreaks and prevention strategies. Omer commented that “the rate of protection against measles [in the US] is hovering dangerously close to the ‘herd immunity threshold’, computed as the proportion of people who need to be immune to prevent outbreaks.” Falling below this threshold could have drastic implications for public heath in the United States, as demonstrated by the current measles outbreak in Madagascar, where vaccine coverage is dangerously low.

Dr. Omer is a professor at Emory University Medical School (pictured above) and Emory University School of Public Health
Image by Countzander

In his testimony, Omer discussed the benefits and drawbacks for vaccine mandates, which are currently being debated as a potential strategy to increase vaccine coverage. Laws regulating vaccine policy are regulated by the state governments, which has led to variations in the effectiveness of these programs. All children entering kindergarten in the US must be vaccinated or file for an exemption. Some states, however, allow religious and personal belief exemptions. Others only allow medical exemptions. According to Omer, “Ease of obtaining a nonmedical exemption has been shown to be associated with state vaccine exemption rates — and, more importantly, higher rates of vaccine-preventable diseases.” While Omer discussed the possibility of eliminating all nonmedical exemptions, he also stated that “the evidence on the impact of this option is nuanced and evolving.”

In the face of uncertain evidence about the effectiveness of state policies regarding vaccine mandates, Omer believes that the federal government has “a substantial role to play in increasing vaccine acceptance.” Omer discussed various policy strategies which could be implemented at the national level to help increase vaccine coverage and control outbreaks. These approaches include investment in and prioritization of vaccine acceptance and safety research, implementation of the recommendations of the National Vaccine Advisory Committee (which focus on “evidence-based strategies for increasing confidence in vaccines”), and support of the CDC’s efforts to control measles outbreaks. Additionally, Omer emphasized the possibility of making vaccine counseling reimbursable, since “healthcare providers, particularly physicians, are the most trusted source of vaccine information- even among those who refuse vaccines”, as well as the importance of maintaining bipartisan support for vaccines.

As the outbreak continues, efforts like those in New York may be replicated and will become part of the national conversation around government responsibility and personal autonomy regarding vaccinations as well as the role of science and science denialism in public health. These are critical conversations and ones that should be guided by experts and those most deeply impacted by the anti-vaccination campaign.

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