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Should vaccines be required?

GLENN ELLIS | 7/3/2017, 9:18 a.m.
Vaccination has long been a familiar, highly effective form of medicine and a triumph of public health.

Strategies for Well-Being

Vaccination has long been a familiar, highly effective form of medicine and a triumph of public health. Because vaccination is both an individual medical intervention and a central component of public health efforts, it raises a distinct set of legal and ethical issues – from debates over its risks and benefits to the use of government vaccination requirements – and makes vaccine policymaking uniquely challenging. In the United States, state policies mandate certain immunizations, including school entry requirements, which cover significant numbers of children.

The first school vaccination requirements were enacted in the 1850s to prevent smallpox. Federal and state efforts to eradicate measles in the 1960s and 1970s motivated many modern mandates policies. By the 1990s, all 50 states required students to receive certain immunizations, and most states required coverage for older schoolchildren and those in daycare centers and Head Start programs.

All 50 states allow vaccination exemptions for medical contraindications; to address individuals’ beliefs and their varied concerns about vaccination, 48 states allow religious exemptions; and 20 states allow exemptions for philosophical reasons. Many scientific and medical research studies have found that individuals who exercise religious and/or philosophical exemptions are at a greater risk of contracting infections, which put themselves and their communities at risk. Thus, medical and public health advocates often struggle to balance the ethics of protecting individual beliefs and the community’s health.

Never mind that study after study has failed to uncover evidence of a link between vaccination and autism; these parents are weighing the risks and benefits (at least as they understand them) of vaccinating or opting out and trying to make the best decision they can for their children.

The problem is that the other children with which their children are sharing a world get ignored in the calculation.

Before we go any further, let’s acknowledge that people who choose to vaccinate and those who do not probably have very different understandings of the risks and benefits, and especially of their magnitudes and likelihoods.

So, let’s say all the folks in my community are vaccinated against measles except me. Within this community (assuming I’m not wandering off to exotic and unvaccinated lands, and that people from exotic and unvaccinated lands don’t come wandering through), my chances of getting measles are extremely low.

Indeed, they are as low as they are because everyone else in the community has been vaccinated against measles – none of my neighbors can serve as a host where the virus can hang out and then get transmitted to me.

I get a benefit (freedom from measles) that I didn’t pay for. The other folks in my community who got the vaccine paid for it.

In fact, it usually doesn’t require that everyone else in the community be vaccinated against measles for me to be reasonably safe from it. Owing to “herd immunity,” measles is unlikely to run through the community if the people without immunity are relatively few and well interspersed with the vaccinated people. This is a good thing, since babies in the U.S. don’t get their first vaccination against measles until 12 months, and some people are unable to get vaccinated even if they’re willing to bear the cost (e.g., because they have compromised immune systems or are allergic to an ingredient of the vaccine). And, in other cases, people may get vaccinated, but the vaccines might not be fully effective – if exposed, they might still get the disease. Herd immunity tends to protect these folks from the disease – at least as long as enough of the herd is vaccinated.