The number of confirmed cases of measles in the United States in 2019 exceeded 1,000. The Centers for Disease Control and Prevention (CDC) reported that this is the largest number of cases since 1992 and since measles was declared eliminated in the U.S. in 2000. This has created pressure to start eliminating MMR vaccine exemptions.
States with the most outbreaks as of June 2019 include New York, Washington, Oregon and California.
Prior to initiation of the measles vaccination program in 1963, 3 to 4 million people in the U.S. contracted measles each year.
Worldwide, there also has been an upsurge in measles, particularly in Madagascar, Ukraine, India, Philippines, India and Nigeria. The World Health Organization reports that in 2016 approximately 7 million people were infected by measles and 89,780 died.
Failure to vaccinate
The reason for measles outbreaks is failure to vaccinate. In the U.S., a significant number of parents have chosen not to vaccinate their children for religious or other reasons. In an ultra-orthodox Jewish community in Brooklyn, for example, several hundred cases have been reported, and the city closed seven orthodox schools that did not comply with vaccination requirements. Some conservative Muslim and Christian groups also oppose vaccinations.
The anti-vaccination movement was fueled by a 1998 article in The Lancet by Andrew Wakefield and his colleagues that linked the measles, mumps, rubella (MMR) vaccination with autism. The article was based on cases of 12 children. The Lancet later retracted the article, stating that “several elements” of the article are “incorrect [and] contrary to the findings of an earlier investigation.”
Wakefield lost his license to practice medicine after the British General Medical Council found that he falsified data and acted unethically in the treatment of the children. In addition, Wakefield did not disclose that his research was funded by lawyers who were suing vaccine manufacturers.
The CDC and multiple other organizations have concluded that MMR vaccinations do not cause autism.
State laws on vaccination
All states have laws requiring students to have vaccinations, including for MMR, but the scope of exemptions from the requirement varies from state to state. The National Conference of State Legislatures reports that all states allow medical exemptions. Medical exemptions include allergy to the ingredients of the vaccination and immune suppressed conditions.
A controversial issue in the vaccine debate is whether exemptions should be granted for religious or philosophical reasons. As of June 2019, most states grant exemptions for religious reasons, and 15 states allow exemptions for philosophical reasons.
States that to not allow either religious or philosophical exemptions include California, Maine, Mississippi, New York and West Virginia.
Medical organizations weigh in
In light of the measles outbreaks, there has been pressure to eliminate exemptions based on religious or philosophical reasons. Both the American Medical Association and American Academy of Pediatrics strongly support elimination of non-medical exemptions for students entering school.
The American Academy of Pediatrics said: “To protect those who cannot be vaccinated, community or ‘herd’ immunity requires at least 90 percent of the population to be immunized (95 percent for highly contagious diseases such as measles and pertussis).”
President of the AMA Barbara McAneny, M.D., issued this statement: “[W]hen individuals are not immunized as a matter of personal preference or misinformation, they put themselves and others at risk of disease. …We are also reminding physicians to talk with their patients about the health risks associated with not being vaccinated and make a strong recommendation for vaccinations, unless medically inadvisable.”
Legal issues regarding vaccinations are not new. In 1905, a case involving smallpox vaccinations came before the U.S. Supreme Court (Jacobson v. Massachusetts). In the early 1900s, smallpox was prevalent and increasing in Cambridge, Massachusetts. Acting under authority of a state statute, the city’s Board of Health ordered vaccination of all inhabitants of the city.
The vaccinations were available at no cost to the recipient. The penalty for not being vaccinated was a fine of $5. Henning Jacobson refused the vaccination, was found guilty of a criminal offense, and was fined.
Jacobson appealed to the Supreme Court, arguing that the statute was an unconstitutional infringement of his liberty. The Court upheld the statute as a legitimate use of the state’s “police power” to “protect the public health and safety.”
The Court acknowledged that, at that time, medical professionals differed about the value of vaccinations. The Court nonetheless said that the legislature and health boards had the power to weigh the evidence and impose vaccination requirements as long as the governmental units did not act in an arbitrary or oppressive manner.
In a later court case not related to vaccinations, the Supreme Court (Prince v. Massachusetts, 1944) commented: “The right to practice religion freely does not include liberty to expose the community or the child to communicable disease or the latter to ill health or death.”
Jeff Atkinson is a professor for the Illinois Judicial Conference and has taught health care law at DePaul University College of Law in Chicago.