The ongoing spate of measles outbreaks in the United States has shown that many parents remain convinced, despite overwhelming evidence to the contrary, that vaccines are unsafe. Many of these parents have decided to forgo vaccines for their children, which is both dangerous and socially irresponsible.
While overall vaccination rates have risen over the past 10 years, the number of parents opting out of all vaccines has quadrupled. This has led to several outbreaks and has chipped away at the country’s “herd immunity,” which protects the population as a whole — particularly the most vulnerable — from infectious diseases.
Officials are struggling to reverse this trend and convince parents to vaccinate their children. Some state legislators are reconsidering the “philosophical exemption” opt-out (still available in 17 states), while others have broached the idea of allowing minors to be vaccinated without parental consent. Others have suggested that certain government services — such as access to public schools and certain welfare programs — be contingent on vaccinating a child.
Yet many of these policies would only affect cash-strapped families — those who depend on government assistance programs and rarely have a choice beyond public schools. We need to come up with policies that go beyond this demographic so that wealthier families also face incentives to vaccinate.
The truth is, families that rely on government assistance are just about as likely as wealthier Americans to make sure their children have most common vaccinations. In fact, for Black and Latino Americans, vaccination rates are slightly higher among the poor than the rest of the population. Outbreaks of diseases for which we have vaccines aren’t occurring in the inner cities; in fact, the most talked about infectious disease cluster in the past five years — a measles outbreak — took place at the Disneyland resort, where a single day’s tickets for a family of four can easily top $600. In California, the big clusters of children without vaccines live not in poorer ZIP codes, but in upscale locations like Sonoma and Marin counties.
So what to do?
Conservatives and liberals alike should embrace public policies that encourage everyone — poor and wealthy — to vaccinate their children.
First, private health insurers should be allowed to impose a surcharge on parents who opt out of vaccines for non-medical reasons. Current federal law may forbid insurers from taking pre-existing conditions into account when setting rates, but it does allow them to consider whether an individual smokes — and to impose a surcharge on that individual. Like smoking, refusing to have a child vaccinated for a non-medical reason is choice and can have monumental financial costs — one unvaccinated boy in Oregon ran up medical bills over $1 million — meaning that a surcharge on such a decision is justified.
Allowing insurers to impose non-vaccination surcharges would make evident the financial costs of not having a child vaccinated, potentially forcing parents to think twice before opting out. And state regulations could limit surcharges to ensure they don’t put insurance itself out of parents’ reach.
Second, the federal government should fund and encourage states to set up and study vaccination-exemption monitoring programs modeled off existing efforts to monitor drug prescriptions. Currently, a tiny number of irresponsible doctors have embraced discredited theories about vaccines and offer “medical” exemptions to parents who simply ask for them. Unfortunately, there’s no way to spot these doctors, making them difficult to hold accountable. Taking disciplinary action against California pediatrician and anti-vaccine crusader Robert Sears, for example, took four years and probably happened only because Sears himself was so prominent in challenging mainstream science on vaccination schedules.
These programs would provide medical boards with a repository of information about doctors who provide vaccine exemptions. Doctors engaged in practices that routinely require vaccine exemptions — such as pediatric oncologists who administer chemotherapy — would be allowed to continue without any real changes. But pediatricians with typical practices who grant many times more exemptions than their peers might have to answer questions about why.
Hammering out the setup and logistics of such a program will require additional work. As such, it would be useful to allow a few states to experiment in structuring these programs initially. This would allow Americans to arrive at the right balance between ensuring that spurious vaccine exemptions aren’t granted and placing undue burdens on responsible doctors.
Unless they have a sound medical reason not to, parents should always vaccinate their children. The government shouldn’t force anybody to get a vaccination, but it can — and should — do more to encourage all parents to do the right thing for their children and for society.