Vaccines are arguably the most significant biomedical achievement over the past century. Millions of lives have been saved thanks to their development. The mortality rate for children has decreased significantly and many diseases have all but been eradicated. However, as much good as vaccines have brought, they have also brought fear, concern and other problems such as those with funding and education. Should vaccines be mandatory? The jury’s still out on this question, but it’s an idea worth discussing all the same.
A Debate as Old as the First Vaccine
The debate over whether vaccines should be mandatory dates almost as far back as the first vaccine in 1796. It was then that British doctor Edward Jenner created the smallpox vaccine after also conducting what was the world’s first clinical trial. People immediately began to question the safety and necessity of vaccines, particularly when the government got involved. It was a valid concern since little was known about immunizations at the time. With limited research and questionable ingredients in those early years, people were right to argue over the safety and efficacy of vaccines.
The 1830s ushered in a public anti-vaccination movement. There were a variety of reasons behind the resistance, but the most common one centered on the idea that immunizations were an intrusion into privacy and bodily integrity. There was also a long-held and valid fear that becoming vaccinated in that era could put you at risk for catching other diseases in the process. Working-class Britons viewed mandatory vaccinations as a direct assault from the government and the ruling class. For centuries, many Americans have also shared in these sentiments that making vaccines mandatory is an invasion of privacy and oversteps government boundaries.
Individual Freedom vs. Public Good
But there’s a point at which public safety supersedes individual liberty, at least in the eyes of the government and some citizens. The U.S. Supreme Court ruled in 1905 in Jacobson v. Massachusetts that the protection of public health was greater than an individual’s privacy rights. Since then, this has been consistently upheld by the government as well as the medical and scientific communities. The concept of herd immunity drives vaccine laws. Studies show that if about 85 to 95 percent of the community is immunized, then the entire group will be better protected against the devastating effects of disease outbreaks.
A similar argument on personal freedom could be made for anything that does someone good, such as wearing seatbelts or prohibiting public smoking. It might be argued that wearing a seatbelt and smoking are personal choices that adults can make on their own, but these actions affect the public wellbeing. In many states, public smoking – and smoking in restaurants and other places used communally – has been outlawed since secondhand smoke is a serious risk, and therefore a public health issue.
We won’t get into all of the issues regarding public health vs. private rights here, but it’s worth mentioning that the debate over vaccines shares a similar central conflict. At what point does a person’s individual liberty impede someone else’s right to a safe environment?
But Should Vaccines Be Mandatory?
While America was founded on the values of liberty, freedom and personal autonomy, some rights cannot be granted without following public law. This is especially relevant for school-aged children, who share germs freely and interact at such close levels that one disease can take down a whole community – quickly.
By not vaccinating your child or yourself, you’re putting the health of other people at risk. One argument in favor of mandatory vaccines, at least at the school level, is that children who attend public school should be required to get immunizations. If a parent chooses not to vaccinate, then that parent needs to make other arrangements, such as homeschool. This argument and others in favor of mandatory vaccinations are based on the idea that herd immunity is vital to the safety of the public.
In fact, some doctors see immunizations as so important that they have begun to dismiss children from their practice if the parents refuse to vaccinate. Other physicians are more flexible and agree to let parents forgo vaccines or give them on a delayed schedule.
A Slippery Slope
The problem with allowing federal or state governments to mandate vaccines is that this action could potentially lead them to also mandate less serious actions when it comes to you and your family’s health. While it may be a good idea to have current vaccine mandates with the health of the community in mind, some people worry that this could cause the government to force its hand at other health issues. When would regulations end? Which vaccines would be considered “essential,” and at what point would the government be satisfied that a family had taken proper steps to ensure the community’s good? These and other similar questions are legitimate concerns that need to be addressed when discussing mandatory vaccines.
State Vaccine Exemptions
Currently, vaccine requirements are mandated at the state level through public schools, but every state allows for some type of exemption from the immunization requirement. No matter your state, exemptions usually fall into one of these categories:
Medical
Each state allows for medical exemptions to vaccination. Most require that exemptions of this type have a written statement from a medical doctor or a doctor of osteopathy. These exemptions can be difficult to obtain and are only valid when a vaccine would be detrimental to the health of your child. Sometimes even if your doctor writes for a medical exemption, it can be denied by state public health officials if it does not conform to the Centers for Disease Control federal vaccine contraindication guidelines.
Religious
You have a constitutional right to exercise your religious beliefs, no matter what religion you may practice. As an American, you likely expect that your government will not pass laws that infringe on your freedom to practice your religion as you see fit. However, if you want a religious exemption from vaccinating your children, you need to be prepared to defend it.
This exemption is for people who have strong religious beliefs that forcing mandatory vaccinations would infringe on their constitutional right to freedom of religion. Keep in mind that your religious beliefs can be reasonably regulated if they threaten the health and wellbeing of society as a whole. In some states, your religious belief against vaccination may not need to be tied to a defined religion.
Depending on the requirements of your state, you may need a signed affidavit from your pastor or spiritual advisor, or simply a notarized signature on a religious exemption form that attests to your beliefs about vaccination and your religion. As of 2016, all states allowed religious exemptions to vaccination with the exceptions of California, Mississippi and West Virginia.
Philosophical, Conscientious or Personal Beliefs
Fewer than half of the states in the U.S. allow for an exemption to immunizations based on conscientious objection to one or more vaccinations. Requirements for this exemption will vary by state, although some require the child be at least 12 years of age and to object to all vaccines and not just a single one. In Oregon and Washington, you must first get a signature from your doctor or state-designated healthcare professional before filing for this type of exemption.
If your state has such an objection, you can thank the 1898 British Vaccination Act for creating a conscientious vaccine exemption. Since immunizations have the inherent ability to cause injury or death to an otherwise healthy person, it can be successfully argued that it’s responsible and ethical for some parents to decline them based on this fact alone. States that allow for exemptions due to personal or philosophical reasons include:
- Arizona
- Arkansas
- Colorado
- Idaho
- Louisiana
- Maine
- Michigan
- Minnesota
- Missouri (childcare enrollees only)
- North Dakota
- Ohio
- Oklahoma
- Oregon
- Pennsylvania
- Texas
- Utah
- Vermont
- Washington
- Wisconsin
Minnesota and Louisiana do not recognize exemptions for religion alone, but a non-medical reason can encompass religious beliefs in these states.
Proof of Immunity
In some states, you may be allowed to decline vaccinations based on proof of current immunity to the diseases that require immunization. A blood titer test can be performed to determine if someone is immune or not. Your child might be immune due to previous vaccinations, previous exposure to the illness or contracting the natural disease. You will, however, be required to pay for and arrange the blood titer test on your own or through your own doctor’s office.
Note that exemptions and other requirements will vary from one state to the next. Some states also have laws that allow for unvaccinated children to be allowed access to their school during an outbreak of the disease for which a vaccine has been declined.
Vaccine Safety and Efficacy
Since the inception of childhood vaccines, parents have had many concerns about the health and safety of immunizations given to American children. These concerns include:
- General safety
- The number of vaccines given and the short timeframe in which they are given
- Overwhelming the immune system
- Thimerosal, a preservative used in several vaccines during the 1990s, but now only used in the flu vaccine
- The MMR (measles, mumps and rubella combination vaccine)
- Links to autism, which have been consistently proven false
When a new vaccine is created, safety testing begins and continues until the point that it receives approval from the FDA. After it’s licensed, the vaccine is indefinitely monitored as well. Both the Centers for Disease Control and Prevention (CDC) and the American Academy of Pediatrics (AAP) work together to make specific vaccine recommendations. All of the above concerns have been studied several times by multiple studies and organizations. The overwhelming results are that vaccines continually prove to be a safe and effective way to prevent several potentially life-threatening diseases.
Common Vaccine Side Effects
Although serious problems with vaccines are extremely rare, there are some common mild side effects to every type of vaccine. These generally include:
- Fever
- Rashes
- Pain and/or swelling at the injection site
- Shivering
- Fatigue
- Headache
Very few people are allergic to vaccines. In fact, only about one dose out of a million doses causes a serious allergic reaction, meaning it’s unlikely that any harm will come from getting a routine round of immunizations. Even people with egg allergies can safely receive a flu shot, which contains a small amount of egg protein.
If you or your child does have allergies or a medical reason to avoid getting shots, then talk to your doctor about ways to safeguard your family against contracting serious illnesses like the measles or whooping cough.
To Mandate or Not to Mandate
Whether or not federal or state governments should be allowed to mandate vaccines boils down to what your values and priorities are. With government-mandated vaccines, public health is valued over personal autonomy. For the most part, vaccines are a safe way to avoid serious illnesses that can cause life-threatening complications or even death. There is also a large cost savings in the prevention of communicable diseases when compared to the treatment of the diseases themselves. However, this could lead to a slippery slope with the government mandating other medical interventions that may not be as necessary.
On the other hand, if you believe that vaccinations should be an individual choice, liberty and freedom are valued over public health and safety. This keeps the government from overstepping its boundaries but could also potentially bring about disease epidemics. The key lies in government, along with the help of public health officials, striking a balance between keeping the public healthy and safe and still allowing individual choice and freedom when it comes to vaccines and other medical decisions.
