What do we learn when #SVUGoesViral? Quite a lot.

SVU

By Robyn Correll Carlyle, MPH

Full disclosure: I am not typically an SVU fan. But when I heard that the NBC drama was tackling measles, well, the vaccinerd in me just couldn’t resist.

So last Wednesday night I tuned in to watch, and I have to say, I was pleasantly surprised.

The plot started in standard SVU form. A group of prep school students partake in some scandalous activities, which results in inappropriate photos of underage teens being posted online. When detectives go to interview the kids, however, some of them are out sick with (you guessed it) measles.

While the detectives are attempting to trace the “viral” photos, they get wrapped up in investigating a parallel measles outbreak that spreads to dozens of people – including Sergeant Olivia Benson’s (Mariska Hargitay) immune-compromised foster son, who had only just received the MMR vaccine and didn’t have time to develop sufficient protection.

But how is that possible? These kids had to have been vaccinated?  asked Sgt. Benson incredulous.

It turns out, they hadn’t been vaccinated, despite medical records saying they had.

I won’t spoil it for you (if you missed the episode, you can watch it here on NBC’s website), but let’s just say a vaccine opponent nicknamed “Typhoid Trudy” has her day in court.

In the public health community, we grow to expect science portrayed in popular media to be sacrificed for the sake of plot. Statistics are exaggerated. Disease symptoms hyperbolized. But SVU touched on a wide range of topics throughout the course of the episode – signs and symptoms of measles, possible complications, the true risks and benefits of vaccination, who we vaccinate and when, etc. All of which was presented using scientifically accurate information. Because as it turns out, measles is dramatic enough. There’s no need to embellish.

There were a few mic drop moments – like when “Trudy,” whose son has been identified as the source of the measles outbreak, insists that as a mother, vaccination should be an individual decision. She exclaims passionately, “My child. My right. My decision.” The prosecutor then responds, “But you didn’t just make a decision for yourself, did you? You made a decision that endangered everyone else. What gives you the right to take away their choice?”

But what really impressed me were the more subtle moments. Like when Sgt. Benson finds out her son was exposed to measles, she makes a point of asking her colleague whether his kids were up-to-date. That little gesture, that simple act of just checking in with the people around her to make sure they are protected, is something that we don’t always see – in Hollywood or in real life. Yes, vaccination is something you do as an individual. But it’s an action that can protect not just yourself but your entire community.

When the measles outbreak made headlines in January, did you check in with your friends and family to make sure they were protected? Take a lesson from Sgt. Benson. It doesn’t have to be a big conversation. But it can make all the difference.

Click here for ideas on how you can talk about vaccines in every day conversations. 


Robyn is a project manager for educational programming at The Immunization Partnership

WHO: 10 Facts on Polio Eradication

In honor of the polio vaccine’s 60th anniversary this weekend, we wanted to share the World Health Organization’s 10 Facts on Polio Eradication. Thanks to the power of vaccination, we can #endpolio!

polio_11. Polio continues to paralyse children

While polio is a distant memory in most of the world, the disease still exists in some places and mainly affects children under 5. One in 200 infections leads to irreversible paralysis (usually in the legs). Among those paralysed, 5% to 10% die when their breathing muscles become immobilized.

polio_22. We are 99% of the way to eradicating polio globally

In 1988, when the Global Polio Eradication Initiative was formed, polio paralysed more than 350 000 people a year. Since that time, polio case numbers have decreased by more than 99% (with only 416 polio cases reported in 2013).

polio_33. There are just 3 countries which have never stopped transmission of polio

The 3 countries are Afghanistan, Nigeria and Pakistan. They face a range of challenges such as insecurity, weak health systems and poor sanitation. Polio can spread from these ‘endemic’ countries to infect children in other countries with less-than-adequate vaccination.

polio_44. Unlike most diseases, polio can be completely eradicated

There are 3 strains of wild poliovirus, none of which can survive for long periods outside of the human body. If the virus cannot find an unvaccinated person to infect, it will die out. Type 2 wild poliovirus was eradicated in 1999 and case numbers of type 3 wild poliovirus are down to the lowest-ever levels.

polio_55. Cheap and effective vaccines are available to prevent polio

There are 2 forms of vaccine available to ward off polio – oral polio vaccine (OPV) and inactivated polio vaccine (IPV). Because OPV is an oral vaccine, it can be administered by anyone, even volunteers. One dose of OPV can cost as little as 11 US cents.

polio_66. The global effort to eradicate polio is the largest public-private partnership for public health

In fact, it is the largest-ever internationally-coordinated public health effort in history. It is spearheaded by national governments, WHO, Rotary International, the US Centers for Disease Control and Prevention (CDC) and UNICEF, and is supported by key partners including the Bill and Melinda Gates Foundation. Underpinning the effort is a global network of more than 20 million volunteers worldwide who have collectively immunized nearly 3 billion children over the past 20 years.

polio_77. Large-scale vaccination rounds help rapidly boost immunity

The Global Polio Eradication Initiative assists countries in carrying out surveillance for polio and large-scale vaccination rounds. When India was still polio-endemic, there were 640 000 vaccination booths, 2.3 million vaccinators, 200 million doses of vaccine, 6.3 million ice packs, 191 million homes visited and 172 million children immunized: all this in just one round of the national immunization days.

polio_88. Every child must be vaccinated to eradicate polio

This includes those living in the most remote and underserved places on the planet. To get each vaccine safely to children everywhere, all manner of transport is used – from donkeys to motorbikes to helicopters – to reach those living in remote areas, in conflict zones or difficult terrain.

polio_99. Polio-funded staff, strategies and resources are also used to advance other health initiatives

Strategies to find and map every child can be applied to other public health initiatives. While a vaccination team is in a remote village, they can, for little additional cost, provide other health interventions while they are there. For example, vitamin A has been given alongside polio campaigns. Since vitamin A gives a general boost to immunity, it allows children to fend off a range of infections, this has averted more than 1.5 million deaths.

polio-1010. We can eradicate polio

In 2011, this little girl, Rukhsar Khatoon, was the last child to be paralysed by polio in India. The WHO South East Asia Region was declared polio-free in 2014, marking a significant leap forward in global eradication, with 80% of the world’s population now living in certified polio-free regions. The world can be freed of the threat of polio – with everyone’s commitment, from parent to government worker and political leader to the international community.

5 Ways you can support science-based immunization policy

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Every legislative session, there’s a flurry of activity. Hearings are held. Debates are had. And decisions set in motion changes that can have a profound impact on our communities, our families and even our own health. When it comes to immunization policy, it’s critical that those decisions be based on sound science and research.

Most Americans agree. The majority of us support vaccination requirements and understand the very real consequences of letting vaccination rates slip. Even still, policies regarding vaccination are rarely passed without heated discussions or commotion.

But amid the headlines and talking heads, there’s a voice missing in the conversation: yours.

We know you’re busy. You have a job, a family, a social life, hobbies – myriad competing priorities. But supporting science-based legislation doesn’t have to be hard or take up a ton of time. Here are 5 ways you can help support science-based immunization policy in your state:

  1. Be informed. There’s a lot of misinformation out there about what pending legislation will or won’t do. Be sure you understand what legislation is being proposed and what it will mean for you and your loved ones. If you aren’t sure where to start, try contacting your local immunization coalition. They will likely have their finger on what immunization-related legislation is being proposed and how it will impact the prevention of vaccine-preventable diseases in your state.
  2. Tweet at your legislators, or post on their Facebook page. It might not be as personal as a phone call or a letter, but communicating with your legislators on social media has the added benefit of being, well, social. Other people might see your messages and chime in. It’s a small action that can help gather more support for what you’re trying to accomplish and engage those who might otherwise have stayed on the sidelines.
  3. Write an e-mail or mail a letter to your legislators letting them know where you stand on certain immunization-related bills. If you live in Texas, you can find out who represents you by going to The Immunization Partnership’s website (there’s even a ready-made e-mail you can send in support of science-based legislation), or for those outside of Texas (but inside the U.S.), you can find out who represents you by going here. In your e-mail, be sure to share your story about how the proposed legislation will impact you and your community. You don’t have to write a lot – a few paragraphs are enough – but sending them a note is a good way to let your voice be counted.
  4. Make a phone call. The simple act of picking up the phone can go a long way. Often all it takes is 2-3 minutes to let your legislators and/or their staff know why it’s important for them to support science-based legislation when it comes to vaccination policy.
  5. Schedule a visit. It might not always be possible to visit with your legislators in person, but if you can, it can really make an impact. As former British Prime Minister Benjamin Disraeli said, “History is made by those who show up.” A face-to-face conversation with legislators demonstrates that you cared enough to take time out of your busy schedule to talk about these issues, and that carries a lot of weight.

If you support science-based immunization policy, please don’t stand on the side lines. Your voice matters.  Make it heard.

Have anything to add to the list above? Let us know in the comments below!

Children who can’t be vaccinated have rights, too

This post originally appeared in The Texas Tribune’s Trib Talk on March 23, 2015. 

Photo by Pan American Health Organization

Photo by Pan American Health Organization

By Heather Cummings

In 2013 my daughter, Kiera, was diagnosed with cystic fibrosis.

Despite her illness, Kiera, who is 5 years old, is a normal kid who wants to do normal kid things. In fact, children with cystic fibrosis are in many ways healthy and normal. They play sports, ride their bikes, have sleepovers and go to school.

But unlike most other children, their health is fragile, and illnesses, particularly serious infections, pose a substantially greater risk to their health.

Like all parents, my husband and I would do anything to protect our child from danger or harm. And while we may want to shelter Kiera from the dangers of the world, we know we can’t protect her from every potential risk.

But I take my responsibility to protect my daughter and her health very seriously. Unlike some other medically fragile children, my daughter can be and has been immunized. But even with these vaccines, she is still much more likely to become infected, with potentially fatal consequences.

If friends or family members are sick, we ask that they not come to our home. Our family is careful to limit our daughter’s exposure to situations and places where she might become exposed to infectious diseases. We ask for no special accommodations, merely respect for the realities of our daughter’s medical condition. And my daughter is not alone. Thousands of children throughout Texas cannot be immunized or are still at risk for disease even with immunizations.

In recent years, a quiet threat to our daughter’s health — and potentially to her life — has emerged. As more parents choose not to vaccinate their children because of fear, misunderstanding or willful ignorance, the threats to my daughter grow. The decision of other parents not to vaccinate their children threatens the lives of children who cannot be vaccinated and who are medically compromised, like my daughter.

Texans who choose not to vaccinate their children tend to live near one another in neighborhoods and communities. This clustering also concentrates unvaccinated children in specific and fixed locations, like public schools. In Texas and across the country, outbreaks of infectious disease center on these pockets of under-immunization.

Under Texas law, parents who choose not to vaccinate their children are required to report that choice to their public school. However, school districts are not required to report detailed information about campus-level immunization rates. The best available information parents like me have concerns district-level, not campus-level, immunization rates. This does me no good as I seek the best and safest school for my daughter.

This legislative session has included much talk of “school choice.” As the parent of a child with cystic fibrosis, I want school choice, too. I want the ability to choose which school has the highest immunization rates. I want to choose the school where my daughter is least likely to contract an infectious disease that could hurt or even kill her.

State lawmakers are currently considering legislation by Rep. J.D. Sheffield, R-Gatesville, that would make campus-level immunization information available to Texas parents. No privacy will be violated, and other parents and I will never know who in our children’s schools has or has not been vaccinated. Parents of medically fragile children thank Sheffield for understanding our concerns and for fighting for our children’s health and lives.

I respect the rights of parents who choose not to vaccinate. In return, I simply ask for their respect for my right to know the school where my child will be safest. This request is not only reasonable but also literally the least that our vaccine-hesitant neighbors can do to protect others from their choice not to vaccinate their children.

“Doing your research” on vaccines: a how-to guide for finding science-based info online

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Recent outbreaks of measles, mumps and whooping cough have been linked to inadequate immunization rates throughout the United States and abroad. While vaccination rates as a whole remain high across the U.S., there are small pockets of individuals who choose to delay or refuse vaccines altogether, leaving these communities vulnerable to disease.

Why do they choose to opt-out of some or all vaccines? The reasons vary, but a common theme among those who choose to stray from the ACIP recommended immunization schedule goes a little something like this:

“I’ve done my research.”

Unfortunately, this “research” is often done using sources that are not rooted in science. With all the misinformation and half-truths online regarding vaccination, how can parents genuinely interested in finding out more about the true risks and benefits of vaccines wade through the sea of information?

Thankfully, About Health writer and physician Dr. Vincent Iannello recently put together a guide to help direct you to the most science-based information.

Check it out:

Yes you can do Research about Vaccines on the Internet

Folks who are vaccine-hesitant, pro-vaccine choice, anti-vaccine, or whatever they like to call themselves often say that they have done their research. More often than not though, they have done it all on anti-vaccine websites.

If you really want to do your research and make the best decision for your family, in addition to spending that time on anti-vax sites, you should also talk to your pediatrician and:

To learn more about vaccines, I also highly recommend that you:

1. Read the book Deadly Choices: How The Anti-Vaccine Movement Threatens Us All by Paul Offit, MD

Click here to continue reading this article

5 Great resources you can use to #FightFlu (yes there’s still time!)

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It might be spring break, but we aren’t out of the woods yet! Several states in the U.S. are still reporting high levels of influenza-like illnesses. Please continue to encourage your family and friends to get vaccinated (if they haven’t already). Here are 5 great resources to get you started:  

1. Post one of these great #FightFlu memes on social media and let a vaccinated friend know you appreciate them going out of their way to protect themselves and their communities from the flu. Here’s our favorite:

KungFlu_sq_zpsbfb81e73

2. Share this video from Texas Children’s Hospital with a friend. Stories can be a powerful way to demonstrate how important vaccination can be.

3. Let people know that flu can be a very big deal. In fact, many people don’t know that it causes more deaths per year, on average, than all other vaccine-preventable diseases combined. You can share this infographic on social media to help spread the word:

infographics - statistics-flu

4. Send an e-card to show your friends/family/coworkers you care about their health and want them to get vaccinated. The CDC has a whole host of great ones to choose from.

fluecard

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5. Help your yet-to-be-vaccinated loved ones know where they can get a flu vaccine by visiting the Vaccine Finder. Just type in your zip code to find vaccination locations near you.

flushothealthmap


What are some resources you’ve used to #FightFlu so far this season? Let us know in the comments below! 

Amid Headlines and Statistics, Stories Still Matter

In the wake of the Disneyland measles outbreak, there’s been a flood of news stories talking about the disease and, subsequently, vaccination. Stats have been cited. Policies have been debated. And a flurry of angry op-eds have cropped up arguing about the balance between choice and obligation.

It’s an important conversation. It’s great that we’re opening up a national dialogue about recent trends in immunization and how we can better protect our communities from preventable diseases. But beyond the bold headlines, striking infographics, and talking heads are real families who are being impacted. Measles can be very, very serious. While thankfully no deaths have occurred yet during this year’s outbreak, it’s not that uncommon in other parts of the world. In fact, measles killed more kids worldwide in 2013 than car accidents or AIDS. Despite having a safe and effective vaccine, it’s still a leading cause of death in young children across the globe. And even for those who survive, measles can leave them with a lifelong disability or even come back to cause an unexpected and rapid decline years later.

With the recent flurry of headlines and statistics, it’s easy to forget that real people are impacted by measles every day. But their stories are important. They remind us why we should be vocal about our support for vaccines. Why we need to encourage our friends and family to make sure they are up-to-date. Why we must continue to be advocates. So that families will never again have to go through what Rachel’s family went through.

Stories like hers are a reminder of where we’ve been. And why we must continue to be passionate, vocal advocates for vaccination. Please take a moment to listen:

4 Striking statistics about vaccination

1. Influenza kills more people in the United States than all other vaccine-preventable diseases combined.

infographics - statistics-flu

In the U.S., we tend to underestimate flu. Perhaps it’s because it’s so common (an average of 5 to 20 percent of the population gets the flu every year), but many people don’t think the flu is that big of a deal. In actuality, the flu can be very deadly — even in previously healthy individuals.

Let’s be clear: all of these diseases can cause potentially devastating consequences. But the flu vaccine is just as important as the other vaccines included in the recommended immunization schedules, yet it is one of the least utilized. Less than half of the U.S. population over the age of 6 months get the vaccine every year.

2. More than an estimated 80 percent of U.S. adults are not up-to-date on their whooping cough vaccination. 

infographics - statistics-tdap

It’s recommended that adults over the age of 18 receive at least one dose of a pertussis-containing vaccine to continue being protected. Yet many adults have no clue whether they are up-to-date and can inadvertently transmit the bacteria to small children without even realizing it. For these infants, pertussis can be incredibly dangerous. In fact, roughly half of children under 1 year old who get pertussis will be hospitalized, and one or two out of every 100 will die.

Pregnant women in particular should talk to their medical provider about getting a dose of Tdap (tetanus, diphtheria and pertussis) vaccine during their third trimester in order to pass protection onto the child before they’re born. This early protection is crucial to protecting young infants during those first few months of life until they can be vaccinated themselves.

3. Vaccines save more lives than seat belts in the U.S.

infographics - statistics-seatbelts

Please don’t get me wrong. This statistic isn’t here to belittle the life-saving impact of seat belts. They are an important safety tool to protect ourselves and our families. But so are vaccines. And when you look at the estimated number of lives saved, vaccines prevent even more deaths than seat belts and child care seats (combined). That’s really saying something.

4. We’re missing out on an opportunity to protect thousands of young women from cancer.

infographics - statistics-hpv

Despite early results demonstrating the high effectiveness of HPV vaccine in preventing cancer-causing HPV, only about 1/3 of young women in the U.S. complete the 3-dose series. According to the Centers for Disease Control and Prevention, “For every year that increases in coverage are delayed, another 4,400 women will go on to develop cervical cancer.” That number is unacceptable. We can do better.

 

To the nurse who “bullied” me into getting the HPV vaccine: Thank you.

Stock image

Stock image

By Robyn Correll Carlyle

My first year of public health grad school, I went into the student health center for my general checkup. My blood pressure was well within range. I was a healthy weight. I exercised three times a week and ate vegetables – Not to brag or anything, but I felt like I was pretty much going to ace the checkup.

Everything was going well (and I was feeling pretty good about myself) until the nurse Betty* came into the exam room, looked over my chart and said, “I see you haven’t gotten the HPV vaccine yet, and you’re about to age out. Do you want to go ahead and get it today?”

Wait, what?

Prior to grad school, I had been in the Peace Corps, where they poked me with what I thought was every vaccine conceivable. I didn’t relish the thought of yet another. Besides, I had heard about the HPV vaccine. It was the STD vaccine.

I was engaged, thank you very much. To a guy I had been seeing for four years. I didn’t sleep around. I was pretty sure I didn’t have – nor would I ever get – genital warts. It seemed totally unnecessary. And didn’t the vaccine just come out only a few years prior? That’s a little too new for me. I didn’t want to be a guinea pig.

“Umm, is it something I have to get?” I ask. “For school, I mean?”

“No,” Betty said. “It’s not required. But it is really important. It’s to protect you from cancer.”

I didn’t really hear that last part. I just heard “not required.”

“Then no,” I said confidently. “I’d rather not.”

Betty put down my medical chart and sat across from me, giving me her full attention. “What’s got you nervous about it?” She asked gently.

And then she listened. For every concern I had, she had a response.

The vaccine wasn’t “totally unnecessary.” HPV is very common – most adults in the U.S. will get it at least once. And it doesn’t just affect those with risky sexual behaviors. Most new infections are in young people, just shortly after their first sexual experience. Because it can be transmitted skin-to-skin, condoms don’t fully protect against it either. It didn’t matter that I was about to get married, I was still at risk.

It’s not that new of a vaccine. Prior to licensing, the vaccine had been tested for several years in thousands of people. And what’s more the vaccine technology used to make the vaccine is even older. The HPV vaccine is made using the same technology as the Hepatitis B vaccine – a vaccine that not only has been around since the 80s, but also is so safe that it’s recommended for infants on the day they’re born.

It won’t give me HPV. The vaccine doesn’t contain the whole virus, just a slice of virus DNA. So it’s biologically impossible for the vaccine to give me HPV.

One by one, she patiently shot down each and every one of my concerns until I was fresh out of excuses. She gave me the first of three doses then and there, and then made sure I knew when I needed to come back to finish the series.

I didn’t really appreciate it at the time (in fact, I thought she was bit of a bully), but now I’m grateful to Betty for taking the time to talk to me. It wasn’t until a few years later that I truly understood how grateful I should be.

One day a good friend of mine called me in tears. She had just been into her doctor for her annual checkup when she got the news: she had what is known as high-grade cervical dysplasia. The step right before full-blown, rock-your-life cervical cancer.

She wasn’t even 30.

The thing is she had requested the HPV vaccine from her OB/GYN years before, when she was still eligible to receive it (the vaccine’s approved up to age 26). But her doctor actively discouraged her.  There were potentially serious side effects, her doctor said (not adding that these side effects are very rare). She should really think about it and then come back if she still wanted it.

My friend didn’t push it. After all, she was just the patient. Of course, time slipped by, and it was annoying to make an appointment. So my friend never got the vaccine. And her doctor (as well as every other medical professional she encountered thereafter) never mentioned it to her again.

Now, she was facing the reality that she could be developing cancer – cancer that probably could have been avoided had she been vaccinated. Her doctor told her they would wait six months and check again. “These things can clear up on their own sometimes.” Otherwise, they would need to remove the pre-cancerous cells, an often painful and uncomfortable process.

Much to everyone’s relief, her body did clear the precancerous cells. But it was a terrifying six months. And throughout that time (and in the time since), she wondered what would have happened had she been vaccinated.

Hearing about her experience made me want to chase Betty down and hug her. My friend wanted the vaccine and was discouraged from getting it. But I actively rejected the vaccine, and Betty didn’t give up on me. She pushed me to really understand what made me so nervous and responded to my concerns in a way that I understood. She took the time to talk it through with me. Even though she was busy. Even though she had other patients to see, other things to do. She didn’t have to do that. But she knew how important the vaccine was, and she didn’t want me to miss the opportunity to protect myself simply because I was ill-informed.

I might have felt (slightly) bullied at the time, but it wasn’t because Betty was rude or dismissive. She was simply being assertive. Standing up for what her education and training assured her was the right thing to do for me and my health. I was taken aback by her confidence, and uncomfortable because she challenged my (I now realize, totally unfounded) beliefs. I thought I was fairly well-educated on the topic — after all, I was in graduate school studying public health — but I didn’t realize how limited my understanding of the vaccine truly was. Betty wasn’t afraid to share — and assert — her expertise as a medical professional. And she did it in a way that was patient and kind to my misunderstanding of the topic.

To Betty – and to all those nurses and doctors like her – thank you for standing up for (and to) me. It might have saved my life.

 

*Not her real name.


Robyn Correll Carlyle, MPH, is a project manager for educational programming at The Immunization Partnership

Measles Control Made Easy: Stronger Laws Equal Less Disease

This post originally appeared on The Network for Public Health Law on February 4, 2015. 

Virtually no other set of public health laws have had as direct an effect on health as immunization laws. Sbaby-with-rashtrong laws lead to high immunization rates, which in turn lead to lower incidences of disease. Some diseases have been nearly eradicated such as polio, rubella, and until recently, measles. However, keeping immunization rates high takes constant vigilance. Unfortunately over the past two decades there has been a weakening of immunization laws in many states. When immunization laws are weak, it puts the public’s health at risk.  For instance, while all states allow medical exemptions to vaccines, and many allow religious exemptions, there are 20 states that also allow non-medical exemptions, meaning that parents may opt-out of vaccines for any reason and their children may still attend public schools. For years, the public health community has been watching the increase in the number of children not fully immunized, and have warned of a resurgence of dangerous diseases. Sadly, that time has come. Measles is back, and it hit Disneyland, “happiest place on earth.”

It’s not surprising that California, a state that has seen dramatically rising exemption rates, was the setting for the most recent outbreak of measles.  In response to the rising exemption rates, California lawmakers recently passed a law requiring parents opting out of vaccines to obtain the signature of a provider stating that they have been counseled on the risks and benefits of vaccines.  This was an excellent step in the right direction to protect Californians, but considering the extent of the outbreak, it may have been too little too late. The measles outbreak that originated at Disneyland has so far affected 102 people from 14 states and Mexico. Unfortunately, this is not an isolated occurrence. There have been an additional 23 outbreaks over the past year, with cases reported in 27 states and affecting 644 people, the most cases since measles was declared eliminated from the US in 2000.

There are many ways that laws can be strengthened to protect the public from the measles. However, as with most law aimed at protecting the public’s health, individual rights must be balanced against the risk of harm to the community. For example, the risk of harm to individuals and to property is high if a person drives while intoxicated, therefore we prohibit it.  In the context of immunizations, if there are many unvaccinated people in the community, the risk of an outbreak of disease is very high. With the threat of measles returning to the U.S. as a widespread disease, it’s time to have a national dialogue about our social contract with each other and the risk of harm to the general community if immunization rates continue to drop. The risk of harm from immunization to the individual is low. The Measles, Mumps, Rubella (MMR) vaccine has been used for decades and has an excellent track record for safety (despite the misinformation that the anti-vaccine community would like people to believe).  However, the risk to the public is very high if there is an outbreak. According to the CDC, measles is so contagious that if one person has it, 90 percent of the people close to that person who are not immune will also become infected. And it’s not just the children who are unimmunized who pay the price. The very young (under 12 months of age) and those with a weakened immune system and cannot be immunized are at the highest risk. If a person becomes infected with the measles there are severe consequences including pneumonia, brain damage and death.

With the outbreak that originated in Disneyland continuing to spread, states clearly have a compelling interest in strengthening immunization laws to protect those among us who are too sick or too weak to be immunized. The time has come to develop more aggressive strategies for protecting the public’s health. Some strategies that could be considered:

Reduce or eliminate non-medical exemptions: In the U.S., all states have requirements for kindergarten entry and many have also added adolescent vaccines to the school requirements. School entry requirements are highly effective in achieving and sustaining high immunization rates, yet the allowance of non-medical exemptions and the ease in obtaining these exemptions have slowly chipped away at the protections these requirements provided. And now the rate of disease is climbing. We must eliminate or significantly reform the laws allowing non-medical exemptions. While non-medical exemptions are permitted in 20 states, there is no constitutional requirement that these exemptions be permitted. In fact, the majority of states (30) do not permit non-medical exemptions. Some states have or are currently taking steps toward limiting or eliminating non-medical exemptions. For example, a 2012 bill in the Vermont Senate proposed the removal of philosophical exemptions from the state’s school vaccination requirements. Also, several states including Washington (Wash. Rev. Code § 28A.210.090) and Oregon (Or. Rev. Stat. § 433.267), now require parents who request a non-medical exemption to provide evidence that they were advised by a health care provider about the risks and benefits of immunization.

Pursue Tort Claims: Some legal scholars have suggested examining the viability of bringing a cause of action against parents who refuse to immunize, and whose decision results in the spread of a vaccine-preventable disease. Much has been written about the potential for such a cause of action to be successful, how the case might be built, who might have standing to bring a cause of action and the likely outcomes in different scenarios. In the face of the current measles epidemic the viability of this type of legal action could be tested in an effort to compel parents to take responsibility for immunizing their children and for protecting others.

Actively engage in foreign relations: As concerning as the measles cases are in the U.S., there is an even scarier scenario playing out in Europe and other parts of the world. Unlike the U.S., most countries do not require any vaccines for school entry. Children in other countries get their immunizations on a recommended schedule, usually determined by the country’s public health officials. If they have not received a vaccine by the time they start school, there is no mechanism to compel their parents to get them up to date.  Last year there were 4,151 cases of measles in Europe, compared with 644 in the U.S. Since measles was declared eradicated in the U.S. in 2000, every outbreak has been tied to someone who traveled overseas and brought the disease home with them. Vaccine-preventable diseases are high in many countries in Europe and across the developing world. With infectious diseases, what happens in one country has far reaching effects in the U.S. This is why we have put so many resources into eradicating polio.  Until there are no more cases, we are all at risk because diseases can and do reemerge.

In order to truly impact the diseases coming into this country, we need to take an active role in helping other countries overcome their challenges in the fight against vaccine-preventable diseases. Access to care, affordability, logistics and education are all factors that contribute to low immunization rates in other countries. Additionally, with the rise of Neglected Tropical Diseases(NTDs) in the U.S., new opportunities for international collaborative research and vaccine development are possible. In order to protect Americans there needs to be increased efforts to address all of these challenges through vaccine diplomacy, vaccine development partnerships, increased support for immunization programs abroad and encouragement to implement strong laws and policies in other countries.

Note: The Network and the CDC Public Health Law Program will present a webinar on February 19 to examine the current measles outbreak in the U.S. and associated legal issues. Speakers will describe current vaccination recommendations, provide an overview of vaccination laws and exemptions, explore state temporary exclusion laws related to unvaccinated students, and highlight lessons learned by LA County in implementing legal disease control measures. More details here.

This guest post was prepared by Anna C. Dragsbaek, J.D., President/CEO of the Immunization Partnership, a nonprofit organization that educates individuals, parents and providers about the importance of immunizations, and advocates for evidence-based public policy and fosters collaborative efforts among immunization partners.

The Network for Public Health Law provides information and technical assistance on issues related to public health. The legal information and assistance provided in this document does not constitute legal advice or legal representation. For legal advice, readers should consult a lawyer in their state.

Support for the Network is provided by the Robert Wood Johnson Foundation (RWJF). The views expressed in this post do not necessarily represent the views of, and should not be attributed to, RWJF