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Positive change not only requires a valid argument, it requires political will. My colleagues and I have been pointing out for years that vaccines are safe and effective, and the anti-vaccine movement, which is built largely on misinformation, threatens the public health by eroding herd immunity. These arguments are no more valid today than they were five or ten years ago (except that new scientific evidence continues to support our conclusion).

We also predicted that it will likely take the significant return of vaccine-preventable diseases to muster the political will to effectively push back against the anti-vaccine movement. Parents need to be more afraid of infectious disease than the false fearmongering surrounding vaccines. We, of course, did not want this to happen, we just thought this was a likely scenario.

I did not think, however, that it would be so sudden and dramatic. The Disneyland measles outbreak created an undeniable media and popular backlash against the anti-vaccine movement. Recent evidence for this is the Jimmy Kimmel segment in which he blasted anti-vaxxers and showed a fake PSA in which real doctors express their frustration over vaccine refusers. Anti-vaxxers replied with their usual shrill nonsense, comparing Kimmel’s statements to hate speech and falsely accusing him of attacking autistic children. Kimmel responded with still more ridicule, making a mockery of anti-vaxxer tweets attacking him. Being the butt of late night comedian jokes is a reasonable sign of popular backlash.

Popular opinion, which is turning against vaccine refusers for threatening the public health, translates into political will. In the case of vaccines there is a specific focus for this political will – state laws allowing exemptions from the requirement for children to be up to date on their vaccines in order to attend public school.

All 50 states require vaccines to enter public school, and all 50 states allow for medical exemptions. Medical exemptions are not controversial; some children have medical conditions that do not allow them to be vaccinated. Their numbers are small enough that they can be protected by the herd if a sufficient number of the rest of the population are vaccinated. In fact, these sick children depend upon herd immunity.

Every state except Mississippi and West Virginia allow for religious exemptions. In the 1944 Prince v. Massachusetts case, the Supreme Court ruled:

The right to practice religion freely does not include liberty to expose the community or the child to communicable disease or the latter to ill health or death.

Ideally there would be no non-medical exemptions to vaccines. There is no legal requirement for such exemptions, and I think there is a solid case that such exemptions are not ethically defensible. Politically, however, religious exemptions specifically will be difficult to eradicate.

Twenty states allow for exemptions from vaccines based on personal belief (called philosophical or personal belief exemptions). These laws create a very low bar for parents to obtain an exemption. Often they simply have to check a box stating they don’t want to vaccinate their children, and that is sufficient. States with philosophical exemptions have 2.5 times the vaccine refusal rate as states with religious exemptions only. Essentially, the easier it is to obtain a vaccine exemption, the lower the vaccination rate. We have 50 data points showing this correlation. The state with the highest vaccination rate is Mississippi, which is close to 100% and allows for no vaccine exemptions beyond medical exemptions.

It would therefore aid vaccine compliance and herd immunity to make obtaining a vaccine refusal as difficult as possible, or simply impossible by removing them altogether. We seem to have reached a critical level of public understanding of this issue, and state lawmakers are responding by introducing bills that will reduce or eliminate non-medical vaccine exemptions. This would be a concrete step that would directly protect the public health.

Here is a list of 14 states that have recently introduced bills that would reduce or eliminate vaccine exemptions (the list may not be exhaustive). Among them is the home state of Disneyland – California. State Senator Richard Pan, who is a medical doctor, introduced the bill, which now has 26 sponsors, which apparently means it is likely to pass. As the law is currently written it would eliminate all non-medical exemptions. This may change, however, before the bill is passed.

Anti-vaxxers, of course, are firing back. The tide is turning heavily against them so they are turning up their shrillness generators to maximum. Fortunately I think this is serving only to marginalize them even further, as the Jimmy Kimmel episode demonstrates. One of their strategies is to characterize vaccine requirements as “forced vaccinations.” They want to conjure images of officers pounding down your door, holding down your child, and vaccinating them by force. This, of course, is absurd. Vaccinations are only required to attend public school. Parents can still avoid vaccination by homeschooling their children or sending them to private school (although some states require vaccinations for homeschooling as well).

Arguments based on parental rights are losing steam as the public realizes that children with medical exemptions from vaccines and their parents also have rights. Parents are saying, “your right to think that you know better than the medical community does not trump my right to protect my child from communicable diseases.” Again, humor is a good barometer of public opinion. The satirical paper, The Onion, captured this feeling perfectly with an article titled “I Don’t Vaccinate My Child Because It’s My Right To Decide What Eliminated Diseases Come Roaring Back.”

Even worse, anti-vaccine “paleo” doctor, Jack Wolfson displayed the callous face of the anti-vaccine movement when he had his 15 minutes of fame. In an interview he stated:

I’m not going to sacrifice the well-being of my child. My child is pure. It’s not my responsibility to be protecting their child.

If asked if he would feel bad if a sick child with a medical exemption caught measles from his child and died, he replied:

I could live with myself easily. It’s an unfortunate thing that people die, but people die. And I’m not going to put my child at risk to save another child.

His words did a better job of exposing the anti-vaccine movement for what it is than any commentary or criticism from the medical community.

Now is therefore the time to increase our efforts. Public opinion and the political will are there to reduce vaccine exemptions, increase vaccination rates, and protect the public health. Public and political will, however, is a fickle thing.



Posted by Steven Novella