The Debate on Compulsory Vaccination: Give Me Liberty or Give Me Disease
In 1998, Andrew Wakefield and twelve co-authors published an article in the highly regarded scientific journal, The Lancet, associating the combined Measles, Mumps, and Rubella (MMR) vaccine with gastrointestinal issues that could, in turn cause a type of autism. The retrospective study focused on twelve English children post MMR vaccination that developed “severe mental regressions.” The study’s analysis suggested the correlation between the mental regression and the vaccination in eight cases “may have occurred together by chance, reflecting a selection bias in a self-referred group” because the twelve children were brought into the study at the behest of their parents or primary care physician. At a later press conference, however, Wakefield suggested that the MMR vaccine was to blame for an increased incidence of autism, and recommended that its administration be suspended and replaced with three separate vaccinations.
Wakefield’s study has since been discredited by dozens of subsequent studies and revelations of significant financial conflicts of interest. The Lancet has retracted the article, and all of the authors but Wakefield have distanced themselves from it. Wakefield’s license to practice medicine was revoked in the U.K. Despite all refutations, Wakefield’s legacy is a movement fueling fear of vaccines.
Despite credible and substantial evidence to the contrary, a significant portion of the U.S. population believes vaccinations to be harmful. Perhaps due to a surge in celebrity attention, the issue has gained traction in some communities. Individuals refusing vaccination cite a wide variety of concerns such as mercury in the vaccine, a link to autism, or a preference for more holistic preventative measures. This has proven deadly in some cases, as the U.S. experiences a resurgence in preventable disease outbreaks.
Vaccines have low levels of risk. Side effects are mild, and severe reactions are very rare. I attribute a large part of the anti-vaccination movement’s momentum to a mistrust of government vaccination recommendations and misunderstanding of scientific studies demonstrating the safety of vaccines. There is no sense of urgency in obtaining vaccination as the effects of the disease they prevent are a distant memory.
The well-reported resurgence of measles, whooping cough, mumps, and chicken pox are due, at least in part, to the anti-vaccination movement. Outbreaks of measles in New York City, Massachusetts, Illinois, and 13 other states, have all been attributed to people with inadequate immunization. Measles, classified as “eradicated” in 2000, infected 159 people from January to August in 2013. The CDC found 82% (131) of the cases were in unvaccinated people. Of those cases, 79% remained unvaccinated due to “philosophical objections.”
When approximately 95% of the population is vaccinated against a particular disease, “herd immunity” protects the community as a whole. Those who cannot be vaccinated due to age or medical contraindication are protected by herd immunity. While the concept of herd immunity reduces the risk of contracting a particular disease, the only method of eliminating the risk of outbreaks is total community participation in vaccination programs.
Is compulsory vaccination the answer? There is legal precedent supporting a government requirement of immunization. After a 1902 outbreak of smallpox in Massachusetts, the city of Cambridge ordered its citizenry, under penalty of a five dollar fine, to receive a smallpox vaccination. A citizen claimed this order, even though Massachusetts law allowed city boards of health to require vaccination during times of public health emergency, was “inconsistent with the liberty which the Constitution of the United States secures to every person against deprivation by the state.” The resulting Supreme Court case, Jacobson vs. Massachusetts, 197 U.S. 11 (1905), found that the State was within its Constitutional parameters to require vaccination during an outbreak.
In Maryland, and many other states, children are required to receive immunizations before attending public or private schools, but parents can seek an exemption based on legitimate medical contraindications or religious beliefs. The process to opt out of the State’s vaccination program is quite simple, merely requiring a signature under “Religious Objection” on the immunization certificate. Student exemptions other than medical contraindications, however, can be overridden during times of emergency or epidemic, as declared by the Secretary of the Department of Health and Mental Hygiene. Likewise, the Governor can require citizens to submit to vaccination, isolation, and quarantine measures if deemed medically necessary to reduce or prevent an epidemiological outbreak.
Recent outbreaks of preventable disease have reignited the compulsory vaccination debate. Supporters call to narrow the conditions by which exemptions are granted and others have proposed to eliminate religious exemptions, citing the outbreaks tied to church communities.
I believe, however, that compulsory vaccination campaigns should be only used during an emergency and as a last resort. Rather, as evidenced by the doubt and reasons parents are citing to not vaccinate their children, a massive educational campaign is needed. There is a lack of effective tools to communicate science to the public, during a time of serious suspicion of government control. Unfortunately, anecdotes and pseudoscience have proven more compelling than peer-reviewed and duplicated studies.
Working previously in a community health center nestled within a poor neighborhood in Providence, Rhode Island, I was struck by the amount of time each healthcare provider spent explaining treatments to their patients. Without any medical jargon, they simplified the risks, benefits, and processes of vaccinations – sometimes using illustrations or diagrams. Communicating health and science is a great skill that seems to be lacking in immunization campaigns.
Yet, despite these challenges, vaccination coverage in the US is high, although it varies by state. Nationally, our vaccinations rates are just short of the 95% required for herd immunity. There is a danger, however, that as more celebrities endorse the anti-vaccination movement these preventable outbreaks will increase in size and frequency. Public health departments should be doing more to combat the misinformation and alarm surrounding immunization programs. The current system of requiring vaccinations to enroll in school has been extremely effective, reducing morbidity and mortality from vaccine-preventable diseases by vast amounts, but more work is needed as the ebb of societal behaviors changes with the times.
CHHS Research Assistant Crystal Schroeder also contributed to this blog.