Americans often pride themselves on the many freedoms granted to them by their government: the freedom of speech, the freedom of religion, the freedom of assembly, and the ability to enjoy many other freedoms that go beyond this short list. When are our freedoms limited in some way, it can be met with much backlash. But is there ever a time when limiting freedoms can do more good than harm? The limitation of the freedom for parents to opt out of vaccinations for their children is one possible example. Since the health of others is in question, is it acceptable for the U.S. government to mandate vaccination? Or, would this be a severe infringement upon the rights of American parents?
Similarly to many others, my early experiences with vaccinations were decidedly negative. As a child, I resented my annual doctor’s appointments, mostly due to my intense fear of getting shots. The dreaded pinch of the needle in my flesh was short-lived but still painful enough for me to be glad it was over. Year after year, I was terrified of getting yet another needle jabbed into my upper arm. However, as time went on, my focus shifted from the sharpness of the needle to the cloudy substance within the syringe. The idea that this liquid has the ability to protect me against a deadly disease was fascinating for me. Oftentimes, it is easy to take our health and wellbeing for granted.
Recent developments in vaccinations have virtually eliminated viruses that were once commonplace, which is an astonishing feat. With the statistics clearly suggesting that vaccines have been tremendously successful in their primary goal, why are many parents still so cautious in choosing whether or not to vaccinate their children? And are their fears justified, or are they posing a risk to the herd immunity of the larger society?
A QUICK HISTORY OF VACCINES IN AMERICA
Before we answer these questions, we must first look back into the archives of American history to see the impact vaccines have had on public health. In 1775, a smallpox epidemic infected half of the American troops in Canada, leading John Adams to call this outbreak “the cause of our precipitate retreat from Quebec” (“Timeline”). Two years later, George Washington’s choice to force the Continental Army to be inoculated against smallpox at Valley Forge prevented both a large number of infections and another defeat similar to the one that had occurred in Quebec (“Timeline”).
Like the rest of the world, the U.S. suffered from a number of deadly disease outbreaks until the mid-1900s, when many vaccinations in use today were first introduced on a mass scale. Since then, according to the Centers for Disease Control and Prevention, the annual number of cases for diseases such as smallpox, diphtheria, polio, measles, mumps, and rubella have all dropped by over 99% (“Comparison of 20th Century Annual Morbidity & Current Morbidity”). Many other diseases are expected to drop as the vaccine for that disease becomes more and more commonplace.
According to the World Health Organization, between two to three million deaths are prevented annually from vaccines (The Editorial Board). There is no doubt that vaccines have had an enormous positive impact on public health. However, the politics and side effects surrounding vaccinations are far more complicated.
ARE THERE ANY DANGERS?
Small groups skeptical about the safety of vaccinations are nothing new for the United States. According to the History of Vaccines, the Anti-Vaccination Society of America was founded over a century ago in 1879 (“Timeline”). Its members were adamantly against the compulsory smallpox vaccination, especially once Massachusetts became the first U.S. state to make vaccines mandatory for all healthy school children in 1855 (“Timeline”). Many believed that the state was infringing on the rights of a parent to decide what is best for their child. The anti-vaccine movement continued through the 19th and 20th centuries, culminating in 1998 with the publication of Andrew Wakefield’s infamous study that allegedly–and falsely– linked vaccines and autism. However, in 2010, his entire study was found to be conducted “dishonestly,” “irresponsibly,” and with data that was “bogus” (Gerson).
Despite this, according to the New York Times, one in four parents still believes that vaccines can cause autism (The Editorial Board). This is worrisome, given that absolutely no studies have been able to find any connections between the two since Wakefield’s study was declared to be a falsehood. In addition, just 23% of American parents have no fears of vaccines (Hardt).
There is nothing wrong with this belief; all vaccines come with some common minor side effects. One in four children experience a rash near the injection site, and one in twenty children experience a fever of up to 101 degrees (“Timeline”). But when looking into more serious side effects, such as eye infections, severe rashes, or death, the chances are one in one to two million (“Timeline”). As frightening as these statistics may be, it is actually more likely to contract a disease from not vaccinating than to get a serious side effect from a vaccination (Lillvis). Plus, by not vaccinating, people have the potential to harm not only themselves but also the immunity of their entire community.
THE ISSUE WITH VACCINES TODAY
The idea behind herd immunity is that if enough people (usually about 95 percent) in a community are vaccinated against a certain disease, the spread of that virus will be limited and the entire community–even those who don’t vaccinate–will be protected (Sun). If the vaccinated population drops below this threshold, the effects can be devastating. When a community of Somali-Americans in Minnesota heard about these supposed risks in 2014, their immunization rate for measles dropped to a meager 42% (Sun). The effects of this were alarming; that year, according to The Washington Post, the number of measles cases in this one community over the span of two months was higher than number of cases in the entire U.S. in all of 2013 (Sun). Those who were infected were mostly infants, who were too young to receive the vaccine, but who were also the most vulnerable to acquiring the disease.
Ironically, vaccines have backfired on themselves; with most citizens of the United States having no memory of a time when disease was prevalent throughout society, they are more likely to believe that vaccinations are unnecessary and could do more harm than good. Therefore, it comes as no surprise that vaccination rates are dropping in the United States (The Editorial Board). According to the Pew Research Center, this is largely due to the skepticism that younger generations have of those in positions of power (Funk). 25% of those between 18-29 believe that most doctors think the MMR vaccine is not safe, compared to just 7% of adults 65+ (Funk). Therefore, as this younger generation ages, their children will be less likely to get a vaccination. The issue of parents choosing to opt their children out of vaccinations is more pertinent than ever, and the many deadly disease outbreaks throughout history display just how dangerous this problem could be.
HOW CAN WE SOLVE THIS?
When looking at vaccination in America, a problem that affects every infant and parent in the United States, it may be extremely difficult to formulate an effective solution. A good way to begin is for all fifty states to require children to be vaccinated, unless they have a medical complication that would put them in danger if vaccinated. Currently, all but three states (California, Mississippi, and West Virginia) allow religious exemptions from vaccinations, and nearly half allow parents to opt out for broadly defined “philosophical or personal belief” reasons.
Although some argue that mandating vaccines would be a severe violation of personal freedom, the Supreme Court ruled in Jacob v. Massachusetts (1905) that this is not the case, and that “the rights of the individual in respect of his liberty may at times … be subjected to such restraint, to be enforced by reasonable regulations, as the safety of the general public may demand”. In other words, our freedoms can be hindered when they reach a point of having the potential to harm those around us.
A CASE STUDY
Before 2015, California was a state marked by its lax vaccine requirements and, consequently, its low vaccination rates. A large portion of the population lived in an area with a vaccination rate below the 90% requirement for herd immunity to be achieved. Medical experts believe that this is one of the primary causes of a measles outbreak in Disneyland in December 2014. Rather than meeting Mickey Mouse and walking through the Sleeping Beauty Castle, 159 visitors were infected with measles, which is more than the usual number of yearly cases for the entire country (Oster).
In response, California passed Senate Bill 277, which eliminated religious and personal belief exceptions for vaccinations, only allowing parents to opt out if their child has a medical condition. In 2016, 99.7% of children were attending a school with a vaccination rate of over the herd immunity threshold of90%, compared to just 64% two years before. This both illustrates the significance of policy changes in vaccination rates and demonstrates that low vaccination rates are in fact a solvable problem.
WHAT COULD AN INDIVIDUAL DO?
Vaccination is an issue that affects every individual in the world. If you or your children are not yet vaccinated, please consider to choose otherwise. It would be a choice that would improve the safety of not only yourself and your family, but also your entire community.
If you wish to further get involved in this issue, there are a variety of ways to do so. Feel free to explore the following links detailing specific ways to make an impact!
Researchers are still working on developing new vaccines for HIV, AIDS, malaria, and cancer. Donating to the Emory Vaccine Center would greatly support the discovery of these groundbreaking innovations.
Support or become a member of Voices for Vaccines, a nonprofit organization that works to provide parents with science-based evidence about vaccines and the diseases that they prevent.
Do you want to spark political change within your community? Contact your local representative to voice your opinions or concerns surrounding vaccinations.
Are you interested in the role of vaccines outside of the United States, specifically in developing nations? Consider supporting the Bill and Melinda Gates Foundation, which contributes to the delivery of vaccines in the world’s poorest countries.
Lastly, I welcome your constructive feedback and helpful thoughts on how we can address dropping vaccination rates in the United States. Comment below to reflect, pose questions, and upload photos.
Beltz, Laura. “Where does the government’s right to require vaccinations come from?” National Constitution Center. National Constitution Center, 27 Feb. 2015. Web. 11 Mar. 2018, https://constitutioncenter.org/blog/where-does-the-governments-right-to-require-vaccinations-come-from.
“Comparison of 20th Century Annual Morbidity & Current Morbidity.” Centers for Disease Control and Prevention. Center for Disease Control and Prevention, Apr. 2015. Web. 21 Jan. 2018, https://www.cdc.gov/vaccines/ed/surv/downloads/VPD-morbidity-slide1-mmwr-508.pdf.
Funk, Cary. “Vast Majority of Americans Say Benefits of Vaccines Outweigh Risks.” Pew Research Center. Pew Research Center, 2 Feb. 2017, http://www.pewinternet.org/2017/02/02/vast-majority-of-americans-say-benefits-of-childhood-vaccines-outweigh-risks.
Funk, Cary. “Younger Generations Are More Skeptical of Medical Scientists and Their Research on Childhood Vaccines.” Pew Research Center. Pew Research Center, 2 Feb. 2017. Web. 15 Jan. 2018, http://www.pewinternet.org/2017/02/02/vast-majority-of-americans-say-benefits-of-childhood-vaccines-outweigh-risks.
Gerson, William T. “Wakefield Study Linking MMR Vaccine, Autism Uncovered as Complete Fraud.” Healio. Infectious Diseases in Children, Feb. 2011. Web. 7 Feb. 2018, https://www.healio.com/pediatrics/vaccine-preventable-diseases/news/print/infectious-diseases-in-children/%7B24b5933b-b212-4b86-b170-d8097c205a64%7D/wakefield-study-linking-mmr-vaccine-autism-uncovered-as-complete-fraud.
Hardt, Karin, et al. “Sustaining Vaccine Confidence in the 21st Century.” Vaccines, vol. 1, no. 3, 2013, pp. 204-224, Research Library Prep, http://www.mdpi.com/2076-393X/1/3/204.
Lillvis, Denise F., et al. “Power and Persuasion in the Vaccine Debates: An Analysis of Political Efforts and Outcomes in the United States, 1998-2012.” The Milbank Quarterly, vol. 92, no. 3, 2014, pp. 475–508. JSTOR, JSTOR, https://www.ncbi.nlm.nih.gov/pubmed/25199897.
Oster, Emily. “After a Debacle, How California Became a Role Model on Measles.” The New York Times. The New York Times Company, 16 Jan. 2018. Web. 24 Mar. 2018, https://www.nytimes.com/2018/01/16/upshot/measles-vaccination-california-students.html.
Oster, Emily. Chart of Californian Vaccination Rates. The New York Times. The New York Times Company, 16 Jan. 2018, https://www.nytimes.com/2018/01/16/upshot/measles-vaccination-california-students.html.
Sun, Lena H. “Anti-Vaccine Activists Spark a State’s Worst Measles Outbreak in Decades.” The Washington Post. The Washington Post, 5 May 2017. Web. 15 Jan. 2018, https://www.washingtonpost.com/national/health-science/anti-vaccine-activists-spark-a-states-worst-measles-outbreak-in-decades/2017/05/04/a1fac952-2f39-11e7-9dec-764dc781686f_story.html.
Sun, Lena H. Charts of Somali Vaccination Rates. The Washington Post. The Washington Post, 5 May 2017, https://www.washingtonpost.com/national/health-science/anti-vaccine-activists-spark-a-states-worst-measles-outbreak-in-decades/2017/05/04/a1fac952-2f39-11e7-9dec-764dc781686f_story.html.
The Editorial Board. “Populism, Politics and Measles.” The New York Times. The New York Times Company, 2 May 2017. Web. 20 Jan. 2018, https://www.nytimes.com/2017/05/02/opinion/vaccination-populism-politics-and-measles.html.
“Timeline.” History of Vaccines. The College of Physicians of Philadelphia, 2018. Web. 19 Jan. 2018, https://www.historyofvaccines.org/timeline.