With the release of Disney’s winter blockbuster “The Return of Eliminated Disease” vaccination has become a hot button issue. So hot, in fact, that many of us are beginning to feel information (and misinformation) overload. It’s tempting to tune it all out, especially when there doesn’t seem to be much we can do about the situation. Kick the feeling of helplessness by taking these four steps.
1. Learn about immunization law.
Laws governing immunization are set at the state level. As “Vaccines and the Law” (created by the non-profit Voices for Vaccines) helpfully summarizes, constitutional options for increasing immunization rates run the coerciveness gamut: from educating to incentivizing to imposing costs to limiting access to criminalizing–and even to physically forcing.
“Imposing costs” is a largely untried approach. It would involve using civil lawsuits, public nuisance laws, new no-fault legislation, or increased insurance premiums to dissuade parents from declining vaccines by shifting the cost of that choice onto their own balance sheets.
“Limiting access,” on the other hand, is already ubiquitously employed. All 50 states require immunization for public schooling (often including daycare and college), and many apply the requirement to private schools as well. The rule can, however, contain gaping exceptions. Although they don’t have to provide a non-medical exemption, 48 states offer a “religious exemption or a philosophical (also known as ‘personal belief’) exemption, or both.”
The California statute contains a non-medical exemption based on personal belief (“PBE”) which only requires checking a box on a form and, as of last January, obtaining the signature of a healthcare practitioner. No doctor’s authorization is required; the signature simply attests that the parent has been provided information regarding the benefits and risks of immunization. New York, by way of contrast, limits its non-medical exemption to “genuine and sincere” religious beliefs and requires a “showing of sincerity” in the form of a written statement fully articulating the belief asserted (and sometimes supporting documentation as well).
Though they currently stop with schools, states may require immunization for access to parks, public transit, and other places where contagion is likely to spread. They can also legislate that employees “in professions where non-immunization is an issue, such as teachers and restaurant workers” must be vaccinated.
Moving right along the coercion spectrum, “[c]riminal law can be used to punish non-vaccinating individuals in the context of a death from preventable disease.” And in the case of an outbreak, states may quarantine unvaccinated individuals and even immunize them by force (and over parental opposition).
2. Figure out where you stand.
Until recently, I thought I wanted to throw the book at anti-vaxxers, to deploy every possible weapon in the legal arsenal in order to protect my baby girl who is too young to receive the MMR vaccine. Then someone asked me to sign a petition seeking to eliminate California’s non-medical exemption. I couldn’t do it.
My Quaker grandfather and uncle both conscientiously objected to serving in the military (during the WWII and Vietnam drafts, respectively). Conscientious objectors were sent to work camps, physically experimented upon, and imprisoned. But they didn’t have to bear arms. As a member of a minority religion with beliefs that many would consider destructive for the community, I don’t want to deny others the same quintessentially American right to conscience.
Moreover, because schooling is compulsory and immunization is required for attendance of all public and private schools (as well as some home schools) in California, a devout Christian Scientist could face criminal sanctions for refusal to vaccinate. This exact squeeze play landed more than one parent in jail in the 1920’s. My problem with this sort of prosecution﹘as with post-hoc criminal actions﹘is that the punishment seems like a tall price for one individual to pay in order to deter others.
That doesn’t mean I support the PBE. I would require a show of sincerity making it extremely difficult to obtain an exemption. I would expand access restrictions to cover anywhere germs quickly circulate. I would readily quarantine the unvaccinated whenever scientifically necessary (this could mean anything from reassigning unvaccinated students to schools with no medically fragile children or entirely separating them from society). In other words, as with pacifists and war, allowing an exception for the very most committed opponents doesn’t have to mean making its exercise pleasant.
If access restrictions and quarantine proved insufficient to protect innocent lives, I would ultimately forcibly vaccinate minors.
(I’m less gung-ho about cost-shifting remedies since they theoretically allow wealthier families to purchase a right to endanger others and price poorer ones out of the market for sincere belief.)
My advice lies not in the substance of these conclusions but in the process. By all means disagree with me, but think about each legal option and decide where you stand.
3. Contribute to the cause.
You can write letters, make phone calls, and stage demonstrations to try to persuade your state senators, delegates, assembly members, and/or representatives.
Or, if you’re like me and can barely keep the many balls you’re already juggling in the air, use a financial donation, small or large, to lobby by proxy. Organizations like the American Academy of Pediatrics and the California Medical Association use donations in part to persuade lawmakers to tighten immunization requirements (you can earmark an AAP donation for the advocacy fund). Other groups–like Voices for Vaccines, the California Immunization Coalition, and Every Child by Two–do no direct lobbying (in order to preserve their non-profit status), but they provide the public and health professionals with science-based information with which they can in turn lobby, making donation a sort of meta-proxy.
Parents have asked how they can subsidize vaccines for low income families. Thanks to longstanding federal programs and the Affordable Care Act (which gets insurance companies lending a hand) there is now basically no financial barrier to immunization. Education, paperwork, and legwork are the primary hurdles to vaccination for underinsured children. Make a donation to a group that performs outreach and walks parents through the process, like the California Immunization Coalition.
Finally, don’t forget that MoveOn.org petition and any other to which you can comfortably put your name.
4. Keep talking.
Though the topic already feels stale, the dialogue is brand new. For years almost all publicity on the subject came from “the vaccine concerned” as those of us who support immunization sat silently by hoping for the best. It is only this year that the quiet majority has spoken up. Yes, the conversation is often as polarizing and frustrating as talking about abortion, but respectful back-and-forth can only help. Even the vitriol and name-calling serve to communicate the gravity of the situation.
As futile as the discussion can feel, social media does change people’s minds on this topic–especially when the risk-benefit analysis shifts thanks to new circumstances (like a sickly Mickey). Furthermore, you’re not just speaking to parents who are committed to a position. Those who are undecided, future parents, teens in control of their own health care, and grandparents (who can exert pressure on their grown children) all scroll through Twitter feeds.
Off-line conversations can make an even more immediate and material impact. After giving birth to my youngest, I took a deep breath and told one of my best friends that I had to cancel my older kids’ standing play date with her undervaccinated boys. They got shots a few weeks later.
Learn, think, contribute, talk. You don’t have to wait for our most fragile loved ones to start dying. You can do one or all of these things today.