Vaccines, science and the limits of freedom
Alarm over the current measles outbreak that began mid-December at Disneyland in California — more than 100 cases in 14 states reported in January — has renewed debate about laws in all 50 states and the District of Columbia mandating that students be vaccinated for certain diseases before entering school.
At issue are the religious and personal belief exemptions granted to parents who choose not to vaccinate their children.
While all 50 states allow medical exemptions, 48 states offer religious exemptions — reflecting our nation's historic commitment to liberty of conscience as guaranteed under the First Amendment.
Twenty of the 48 also provide a broader opt-out based on "personal beliefs." Only two states, Mississippi and West Virginia, limit exemptions to medical reasons.
Although no one has died (yet), reports of babies at risk and children being kept home from school have focused media attention on the growing anti-vaccine movement in the United States — and the relative ease with which objecting parents can now invoke religious and personal belief exemptions to opt out of vaccinating their kids in many states.
What's at stake is maintaining herd immunity — the public health principle that when at least 92-94 percent of people are vaccinated, their immunity prevents contagious diseases like measles from spreading.
According to a 2013 study published in Scientific American, "many states are dropping below safety thresholds" because "parents are opting out of state vaccination requirements for kids entering public school despite a dearth of evidence that vaccines are harmful or unnecessary."
Despite a looming public health crisis of significant proportions, scientists and public health officials are having a difficult time convincing the swelling ranks of naysayers.
No matter how clear and compelling the scientific evidence about the safety of vaccines, many parents still refuse to vaccinate their children out of fear, religious conviction, anti-government animus, commitment to a "natural" lifestyle, distrust of pharmaceutical companies — or some combination of the above.
Some anti-vaccine advocates reinforce the fears and distrust by promoting bogus science, including a 1998 study that claimed to have found a link between vaccinations and autism — a study that was soon debunked and retracted.
Education helps, but it isn't enough. States need to revisit their laws and find ways to make opting out of vaccinating children more difficult for parents.
Right now, religious and personal belief exemptions are far too easy to get in most states, requiring little more that filling out a form stating a personal objection to vaccination. Personal belief exemptions are the most common — and they are on the rise.
The measles outbreak should be a wake-up call. The time has come to eliminate broad "personal belief exemptions" entirely and tighten guidelines for religious and philosophical exemptions.
Also this week, a committee of the Mississippi House of Representatives turned back an effort to amend the law to add personal belief objections and voted instead to retain the state's policy allowing only medical exemptions.
Unless states act soon, high-risk people — including babies who cannot be vaccinated in their first year and children who cannot be vaccinated for medical reasons — will contract measles with potentially fatal results. Medical experts tell us that for every thousand children who get measles, one to two of them will die.
Ending all nonmedical exemptions — a remedy suggested by some public health advocates — would be both politically difficult and counter to our religious freedom tradition of accommodating, when possible, claims of conscience based on deep religious or philosophical convictions.
Instead, states should continue to grant a limited number of exemptions to those who articulate clear religious or philosophical grounds for their refusal to vaccinate their children. States should also thoroughly inform all parents about the scientific evidence supporting the benefits of vaccination — and the health risks to the community of refusing vaccination.
Eliminating personal belief exemptions and tightening guidelines for religious exemptions should lower the number of parents opting out. If that works, we can restore and maintain herd immunity while still providing exemptions for genuine conscientious objectors.
However, if narrowing the grounds for exemption doesn't work — and parental opt-outs continue to rise — then states will have little choice but to follow the example of Mississippi and West Virginia by limiting exemptions to those with legitimate medical reasons.
Protecting individual rights is a core American value. But when the lives of children are at risk, public health and safety must necessarily trump even the most sincere claim of conscience.
Charles C. Haynes is senior scholar at the First Amendment Center. His email address is email@example.com.