Back in 1998, a British doctor named Andrew Wakefield published a study linking the measles, mumps and rubella (MMR) vaccine to autism in young children. Though quickly discredited and repeatedly refuted, the study had lasting effects on health in the UK by decreasing vaccination rates below the threshold required for effective herd immunity. As a result, outbreaks of measles have reappeared in the UK. The same thing is currently playing out here in the US: Though Jenny McCarthy has tried to backtrack on her anti-vaccination stances, the effects of her movement against vaccines helped create the environment that allowed the Disneyland measles outbreak.
Perhaps the easiest way to counteract the force of fraudulent science and self-proclaimed experts when it comes to vaccinations would be to universalize the mandate that every child receive the MMR, DTaP and other vaccines. Every state currently has some sort of mandate for childhood vaccinations, and every state likewise has some collection of exemptions that they allow. Though all states have exemptions for children who cannot get vaccines due to valid medical reasons, all states except for Mississippi and West Virginia also allow exemptions for religious or philosophical reasons. That latter category, also known as “personal belief” exemptions or PBEs, is the one most often exploited and abused by the self-righteous disciples of Wakefield and McCarthy, to the detriment of people around them.
But though an exceptionless mandate for vaccinations (like that of Mississippi or West Virginia) might be the easiest way to get people vaccinated, it is by no means the most ethical. Instead, where education and reason fail, legislators around the country should restrict or remove only the oft-abused PBEs that have spurred recent outbreaks — all while protecting religious exemptions to vaccines.
Ethical justifications for removing both religious and personal belief exemptions would have to rest on one of the most important ideas in ethics: the Harm to Others Principle, as described by John Stuart Mill. In essence, the principle holds that a person’s rights and freedoms can only be curtailed through coercion if doing so would be reasonably necessary to prevent that person from harming another (or create an undue amount of risk of harm to another). Coercion, in the context of this ethical precept, includes legal mandates and only becomes justifiable when no other option would work.
By the logic of those supporting a stricter vaccination mandate, allowing people to opt their children out of vaccines in today’s social environment creates a huge risk of harm. The sheer number of people who have opted out makes this the case: Here in California alone, the vaccination rate has fallen to just over 90 percent (with herd immunity from vaccines requiring about 92 to 94 percent). Combining that with the fact that many people who have received their vaccines are still susceptible to infection, the utter foolishness of anti-vaxxers warrants an undue risk of harm to millions of people in California alone. The target of any action to restrict vaccine exemptions should focus on counteracting this temporary societal foolishness.
Religions that oppose vaccination, however, do not fit into that larger plague of scientific folly. While the Jenny McCarthys of the world misunderstand the terror of preventable diseases and the science of vaccines, adherents of the handful of fringe sects that benefit from the religious exemptions do not. Instead, those groups lack faith in modern biomedicine because they believe in the healing power of faith. Also unlike the Jenny McCarthys of the world, these groups cannot convert people by the thousands to oppose vaccines. After all, vaccines are hardly their main focus, and some (like Christian Scientists) can barely seem to convert anyone anymore.
So in the grand scheme of things, small groups of faith-healing fundamentalists do not pose a threat to public health. Trying to coerce those groups to violate their religious beliefs, therefore, cannot be reasonably necessary to curb the re-emergence of vaccine-preventable disease. The opposite holds true, though, for anti-vaxxers who abuse philosophical vaccine exemptions. Not only do they pose a substantial threat to public health, but we have seen that coercion of some form has, in fact, become necessary to negate that threat.
Back in 2012, California Governor Jerry Brown approved Assembly Bill 2109, which took effect at the beginning of 2014. The bill required that anyone seeking a PBE from vaccines for their children first consult with a physician about those vaccines, then have that physician sign the PBE form. Requiring this informed non-consent to vaccines certainly helped matters somewhat here in California, but even still, we still have vaccination rates lower than where they need to be. And in addition to the Disneyland measles outbreak, which began nearly a full year after AB 2109 came into effect, many elementary schools around the state still have abysmal rates of vaccination for the disease.
Going after religious groups at the fringes of their faiths makes little sense in the context of vaccine exemptions; we as a society can afford to leave them well enough alone. The consequences of doing the same with anti-vaxxers claiming PBEs, conversely, would simply become too costly.
Contact Johnathan Bowes at jbowes ‘at’ stanford.edu.