State Rights, Parental Decisions, and Vaccine Exemptions

May 22, 2015 Karie Youngdahl

Policy Event, May 14, 2015How far should state power extend into medical decisions that parents make on behalf of their children? What is a parent’s responsibility to children in the community who have particular susceptibility to harm from infectious diseases? These questions framed the discussion we had last week here at The College of Physicians of Philadelphia on pending legislation in Pennsylvania to eliminate personal belief exemptions to school vaccination requirements. The Honorable James G. Colins, President Judge Emeritus, Commonwealth Court of Pennsylvania, introduced and moderated the event.

Both the bill’s sponsor, Pennsylvania State Senator Daylin Leach (17th District) and Paul A. Offit, MD, argued that personal belief exemptions allow parents to shirk responsibility for keeping their communities safe and healthy. Dr. Offit argued in favor of eliminating even the religious exemption, stating that children should have, under the 14th Amendment, the right to equal protection (from infectious diseases) and that religious exemptions make no sense, given that most religions arose long before the development of any vaccines. (Indeed, many have argued, including Grabenstein, that other than Christian Science, no religions espouse specific doctrinal opposition to vaccination.)

Senator Leach said that he finds it necessary in politics to take incremental steps. While he might support the idea of eliminating the religious exemption, it is much more practical for him to address philosophical exemptions. He argued that individual rights are not absolute – there are limits even to freedom of speech. In the case of protecting children, their rights to remain disease free should not be subject to their parents’ personal beliefs that run counter to accepted medical advice.

Pennsylvania has a relatively low rate of measles, mumps, and rubella vaccination coverage: in 2013-2014, 85.3% of Pennsylvania kindergarteners had received both doses of MMR vaccines, as compared with the nation's median of 94.7%. Leach cited the more than 3,000 current philosophical exemptions to vaccination in Pennsylvania as his target – eliminating those, he said, would go far toward increasing Pennsylvania’s rather dismal rates of vaccination compliance.

Jason L. Schwartz, PhD, the Harold T. Shapiro Fellow in Bioethics at Princeton University, invited the crowd to try to think like a bioethicist when looking at the question of exemptions. He used the metaphor of a safety net when looking at the goal of public health to protect as many individuals as possible from infectious diseases by working toward high immunization rates. And he asked what the best method is for achieving that safety net – he said that nudging parents toward vaccination, perhaps by making personal belief exemptions more difficult to obtain, could be nearly as effective at increasing rates as eliminating the personal belief exemption altogether. Moreover, he said, allowing the very small percentage of emphatic resistors to continue to be able to obtain exemptions would provide a useful safety valve. The right to make medical decisions for one’s family would remain, but using that right to refuse required vaccines would be exercised only by those most opposed to vaccination.

The question and answer period followed with comments about the history of vaccine hesitancy and the benefit of re-framing the night's discussion of state’s rights as societal responsibilities. A few in the audience expressed their strong beliefs that vaccines are unsafe and that they should not have to forfeit their right to public school education for their children given their opinions about vaccines.

Several vaccine resistors  emailed me before the event expressing disappointment that their views were not being represented on the panel. Given that this was a policy discussion and not an event about the safety of vaccines, that The College of Physicians of Philadelphia is an organization of physicians, and that the vaccine resistors' beliefs are not supported by evidence, I did not intend to provide an official place at the table for these views – especially when Schwartz ably and rationally presented the argument for what their policy goal is: to maintain the personal belief exemption.  

We’ll be following the developments in the Pennsylvania legislature as the exemption bill moves through committees.


Posted by Anonymous (not verified)

I strongly oppose the removal of any rights to opt out of vaccination, which is a medical procedure.
In addition, ACA brings goals for hospitals and doctors which includes vaccinations. How can we, as citizens, protect our children, and ourselves, from the coercion tied to reduced reimbursement hosps & doctors could face if their vaccination rates are too low? We can't. Not without philosophical and religious exemptions.
Removal of vaccine exemptions is about as un-American as anything I've ever witnessed.
These bills must end, now.

Posted by J H (not verified)

I would like to know why the discussion of parental rights is not brought up. If I have to pay for the medical care of my child should an illness or poor reaction occur to a medical procedure (i.e. a vaccine), then why don't I have the right to deny the procedure for my child in the first place? I either am or am not my child's guardian.

Another topic I would like to see discussed is why HepB is a required vaccination, especially for newborns not at risk and two year olds. The transmission from biting instances is extremely rare. In one of the links on this website discussing HepB, there is the following quotes: "Such modes of transmission are relatively rare, and sexual activity is still the predominant source of HBV infection among U.S. adults." and "On the average, any baby born in the United States who isn’t vaccinated against HBV has a 5 percent chance of acquiring HBV infection during his or her lifetime. By avoiding obvious means of exposure, people can reduce the odds of becoming infected." I assure you, I will be ensuring that my newborn, two year old and any elementary aged child will not be engaging in sexual activity of any kind.

That said, a parent should have the right to choose which risks they want to take for their child: the disease and the rate and risks of exposure to that disease their specific child has given their family's lifestyle versus the vaccine's risk. Both have their risks.

Since the medical community is hell-bent on adding more and more vaccines (and at younger and younger ages) to the required list for schooling and not taking any off of the list, they and vaccine manufacturers should be held accountable for the risks associated with vaccine use, especially adjuvants in their contents. The National Childhood Vaccine Injury Act (NCVIA) of 1986 (42 U.S.C. §§ 300aa-1 to 300aa-34) needs to be completely revised to reflect this accountability.

For example of one-size-does-NOT-fit all, I do not see the need to make HepB a required vaccine and I refuse to give it to my child. My child has had other vaccinations so I am not anti-vaccine but because there are no alternatives for parents who choose how to provide medical intervention for their child, I have to file an exemption with my state. My child's medical history is our business.

Also, the medical community refuses to promote the use of titer checks before booster vaccinations so once again, you are exposing children unnecessarily to chemicals that add up in their small developing bodies. When I see the medical community SERIOUSLY undertake investigation into vaccine-injured cases and their causes, then I may listen to them again. But instead of directly addressing the parents' concerns (increases in nut allergies, language and mental processing delays, learning disabilities, autism, etc.), the medical community redirects us to projected statistics and what-if scenarios as to why we should give our child every vaccination, every time and age on the schedule, exactly when they say to give it. When you see an outbreak of HepB among newborns and two year olds, give me a call. Otherwise, I am going to use my brain to intelligently weigh the risks associated with medical intervention for my child. It is every parent's right to decide to consent or NOT consent to a medical procedure for their child.

My child is not your guinea pig and over my dead body he/she never will be.

Posted by Anonymous (not verified)

You have a very lucky child. Spread the word so that we can overpower this madness. There is no match for a fierce mom who will protect their children at ANY cost. Due to my standing up for myself when my lawyer just sat there, I have a CA order that says my child is NOT to be vaccinated due to my philosophical and conscientious beliefs. Unheard of but the judge could not resist my assertive plea. They are NO MATCH for us moms! Educated mom's unite!

Posted by J H (not verified)

Re: Article's quote of Dr. Offit applying the 14th amendment to "the right to equal protection (from infectious diseases)"

Here's the 14th Amendment, relevant part of Section 1: No State shall make or enforce any law which shall abridge the privileges or immunities of citizens of the United States; nor shall any State deprive any person of life, liberty, or property, without due process of law; nor deny to any person within its jurisdiction the equal protection of the laws.

You can also interpret this as the "right to equal protection (from forced medical interventions)" Vaccines weren't a common practice when the 14th amendment was written so does that mean I can ignore all of the medical doctors now because the required vaccines weren't invented when the 14th amendment was written? Or that some of these diseases weren't even around then that we know of, such as the sexually transmitted ones?

As well, the article pointed out that Dr. Offit believes that, "religious exemptions make no sense, given that most religions arose long before the development of any vaccines."

I find it interesting that many of the diseases we vaccinate against today weren't known to man when the 14th Amendment was written yet vaccine advocates want to use the Amendment to apply to today's vaccine laws. (Oh, you mean the 14th Amendment still applies to today's laws? Hmmm....) On the other hand, advocates want to deny a religious or thinking person's ability to refuse a vaccination on the same grounds. Maybe religious exemptions do apply after all with this 14th Amendment-applies-to-today logic. Maybe a religious person's rights apply to someone's right to protect their body as he/she sees fit, ability to reason and think for oneself, and avoid inputting ingredients into their body that they think would affect their relationship with their god. Maybe religious and thinking people might have some weight in this same argument and religious exemptions are valid and do apply to today as well.

Posted by Richard Daggett (not verified)

There has always been a social and legal conflict between individual rights and community responsibility. Free speech is a fundamental right under our Constitution. However, the Supreme Court has ruled that free speech does not allow a person to shout “fire” in a crowded auditorium, if no fire actually exists.

Do individual rights usurp community and individual safety? Is it an individual’s right to drive one-hundred miles per hour on a street that is marked with a thirty mile an hour speed limit? Is it an individual’s right to construct an atomic bomb in their own garage?

Individual control of one’s own body seems obvious, but is it? If a person has active tuberculosis, do they have a right to work in a restaurant or a hospital? Who determines the limits between individual rights and community responsibilities?

The perception of rights and responsibilities has evolved over time. In an agricultural society, where most families lived independently and often far apart, there was little conflict. What you did had little impact on your neighbors. As we transitioned to a more urban society, our own actions, or inactions, had greater impact on those around us.

One current example of this conflict is immunization against disease. When do our individual rights to make choices impact the lives of others? Many preventable diseases are highly contagious. Poliomyelitis is one of these preventable diseases. In 1952, approximately 58,000 cases of polio were reported in the United States, and more children died of polio than of any other communicable disease.

If someone was diagnosed with polio they were immediately placed in quarantine. Was this a violation of individual rights? If a person diagnosed with polio was not quarantined, and spread the disease to a neighbor, would the neighbor’s rights be compromised? Whose rights should take precedence?

In the polio epidemic years of the 1940s and 1950s, placing someone diagnosed with polio into quarantine was accepted by society as a necessity. Was society ignoring individual rights, or was society recognizing a need for the common welfare?

Many diseases can now be prevented through immunization: smallpox, measles (rubeola), polio, whooping cough (pertussis) are just a few. Because immunizations have been effective many people have no memory of these diseases. Some confuse German measles (rubella) with the much more devastating rubeola. These individuals might proclaim, “I had measles as a child. It wasn’t that bad.” These misunderstandings are usually the result of a lack of knowledge, or a direct campaign of misinformation.

We in the United States have a long history of individual rights. We also have established restraints on absolute individual rights. As noted above, we have a tradition of free speech. We have also set limits to this right. Does one person have an absolute right to make a decision, if exercising that right puts some other person at risk? Do you have the right to drive on the wrong side of the road, knowing that you will be putting your life in danger, and knowing you could injure or kill some other person?

These are difficult questions. I personally lean toward recognizing the common good. We live in a society, not in a vacuum. We enjoy freedoms, but we must use them wisely.

Do you know anyone who has watched, helplessly, as their child died a slow, painful death; a death that could have been prevented? I have!

If a parent elects to avoid immunization for their child, who suffers? Isn’t it the parent’s right? Explain that to a child who contracts a preventable disease. Yes, you may say, it was the parent’s right. But who will answer the child, when that child asks, “Why, mommy? Did I do something wrong?”