Measles Outbreak Prompts State Debate on Vaccine Exemptions

Family vacation time in Disneyland has started a nationwide conversation about vaccinations against measles and other preventable diseases. 

Since Jan. 1, 2015, 121 people from 17 states and the District of Columbia are reported to have the measles, according to the Centers for Disease Control and Prevention. Eighty-five percent of these cases are linked to holiday visits to the California amusement park. 

Measles is a vaccine-preventable disease that many believed had been virtually eliminated in the United States. 

“Measles is pretty much gone in the United States,” Dr. Melinda Wharton, director of the Immunization Services Division of the National Center for Immunization and Respiratory Diseases at the CDC, said in an April 13, 2013, Web lecture. 

That is no longer the case. 

“This is a disease that my parents’ generation knew and feared and that people my age remember. We heard the relief of our parents when the vaccine came out,” Wharton told CSG. 

Wharton said the CDC recommends two doses of the measles, mumps and rubella—or MMR—vaccine for all children. The first dose is recommended between 12 and 18 months old; before that, the child carries immunity from their mother. The second dose is given when the child is between 4 and 6 years old, before they begin school. 

Every state provides a health exemption for immunization requirements. All states but Mississippi and West Virginia also provide a religious exemption. Another 19 states allow for parents to claim an exemption based on their philosophical beliefs. 

Exemptions from immunization requirements have grown in the past two decades. A Lancet journal article published in 1998 linked the MMR vaccine to autism and, although the article and its author have been thoroughly discredited, some parents still believe the link exists. 

Since the Lancet article, Wharton said, science has confirmed the safety and effectiveness of the measles vaccine and debunked the link between the vaccine and autism. 

“The science is reassuring,” she said. 

In the 2013-14 school year, according to CDC data published in October 2014, slightly more than 90,000 children entering school were granted exemptions from MMR immunization. For 12 percent of those children, the exemption was for medical reasons. Another 40 percent had religious exemptions, but nearly half the children—48 percent—were exempt for philosophical reasons or personal beliefs. 

A high number of unvaccinated individuals negatively impacts what public health experts call herd immunity, which provides protection for those who are unable to be vaccinated

 “As long as there is no chain of people who are susceptible between you and where the virus is, you won’t get the disease. You want to be surrounded by immune people who can’t pass on the virus,” Wharton said. 

She said the proportion of the population in general that needs to be vaccinated to prevent the spread of the measles microbe is about 95 percent. 

The national rate of MMR immunization for children entering school, according to the 2013-14 CDC data, is 94.7 percent. Among the states and territories, only 24 have rates of 95 percent or more. In seven states—Arkansas, Colorado, Idaho, Kansas, Maine, North Dakota and Pennsylvania—and the District of Columbia, the rate is below 90 percent. 

Statewide statistics, however, can mask communities with lower coverage, Wharton said. 

In fact, that is the case in California and these communities with particularly low rates of MMR immunization led to a 2012 change in the law for personal belief exemptions. Parents were required to receive counseling and health care professionals had to sign off on the exemption. The San Jose Mercury News reported that exemptions dropped 20 percent after that change. 

Now, Sen. Richard Pan, a pediatrician and sponsor of the 2012 bill, is seeking to eliminate California’s personal belief exemption. The San Jose Mercury News reported that Gov. Jerry Brown is in favor of the move. 

In Colorado, Sen. Tim Neville has introduced a Parents’ Bill of Rights to guarantee parents’ rights to decide against vaccinating their child. While Colorado already allows for a personal belief exemption, Senate Bill 15-077 would reinforce the fundamental rights of parents to direct the upbringing, education and care of their children, according to Neville. 

“In the course of speaking with thousands of constituents during the election campaign, the subject of government overreach into areas of parenting came up repeatedly, often with very harmful outcomes,” Neville told CSG. He said the purpose of the bill isn’t just to address the issue of vaccines, but to cover many other issues voiced by concerned Colorado parents.

The Colorado bill would provide for parents to make all health decisions for their children, including mental health and sexual health services, until they turn 18. 

Wharton welcomes the recent attention to childhood diseases and preventive immunizations. 

“If there is any silver lining in the current cloud of measles that we are dealing with, I hope it is that it makes people think about what vaccines their child may need,” she said. “If they have fallen behind, or they have decided not to vaccinate, they can take a hard look at that decision and go back to their pediatrician and see what they can do to get up to date.”