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Time to get tough on vaccine refusal

Throughout the United States, a potentially lethal war is erupting. It is a war that puts millions of innocent lives in danger and undermines the centuries-long sacred bond between physicians and patients. This is a war between pediatricians and patients and has developed largely because of the anti-vaccination movement. As a public health student at the Johns Hopkins University and a future pediatrician, I am alarmed by the catastrophic consequences this conflict could have on the health of American children.

More and more pediatricians are asking families to leave their practice as a result of vaccine refusal; a recently published study of Connecticut pediatricians reported that 30 percent of 133 doctors had asked a family to leave their practice when parents refused vaccines for their children. This is a drastic increase from 2006, when the American Academy of Pediatrics reported that 16 percent of pediatricians reported sometimes dismissing families for vaccine refusal. This is a worrisome trend because it can result in children missing out on lifesaving vaccines and receiving inconsistent health care during critical development periods.

Innocent children are the ones who get caught in the crossfire. In 2010, a study published in Pediatrics by researchers from the University of Michigan showed that 12 percent of parents in the United States have refused at least one recommended vaccine for their children, using the philosophical exemption to circumvent childhood vaccine mandates. As a result, these children are at a considerably higher risk for vaccine-preventable illnesses. For example, children whose parents refuse the pertussis vaccine are 23 times more likely to get whooping cough than children who have been vaccinated. Furthermore, unvaccinated children who become ill can infect other children who are too young for vaccines or are ineligible to receive vaccines due to immunocompromising conditions such as cancer or HIV.

It is time for the United States to mandate a strict nationwide vaccine policy, with stringent guidelines to obtain religious exemptions and no room for philosophical exemptions. The recommended vaccination schedule issued annually by the Centers for Disease Control and Prevention is no longer sufficient. Although parental autonomy should be respected in many situations, vaccine-preventable illnesses are a public health issue, and parents do not have the right to gamble with their children's lives. Furthermore, they do not have the right to gamble with the lives of other children who may be infected by a child whose parents chose not to vaccinate.

A unified national policy with narrow exemptions would help rectify the growing schism between pediatricians and families. With a standard national policy in place, there will be fewer opportunities for parents and physicians to clash over individual vaccination opinions, especially in the 19 states where philosophical exemptions for school-mandated vaccines are permitted (Maryland is not one of them). New national guidelines can also offer incentives, such as federal tax rebates, to families that vaccinate their children on time.

Another benefit of a national policy would be improved coverage between states. Vaccine-preventable diseases are not contained within state borders, and our vaccine policies should not be either. With the status quo, lax immunization policies in one state can lead to outbreaks in neighboring states. In addition, the national policy would increase equity for children who live in different states. Currently, less than 0.1 percent of kindergartners are exempt from vaccines in Mississippi, a state that does not permit religious or philosophical exemptions. In contrast, 6.2 percent of children are exempt from vaccines in Washington state, a state where both religious and philosophical exemptions are allowed. Geographic location should not influence access to lifesaving vaccines.

Although states may initially object to the policy, past precedents have proved that tying financial incentives to state policies can be quite persuasive. The threat of withholding federal highway funding prompted all 50 states to adjust their legal drinking age, and the threat of withholding federal funds for health care would likely have the same effect on vaccination policy.

Rathi Asaithambi is a student at the Johns Hopkins Bloomberg School of Public Health. Her email is rasaitha@jhsph.edu.

Copyright © 2015, The Baltimore Sun
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