Vaccine Policy Is Political by Its Very Nature

October 18, 2018 Rene F. Najera

With only a few weeks to go before the midterm elections, I've noticed more and more vaccine-related news having to do with the views and opinions of candidates for office. For example, in Oregon, The Daily Beast is reporting that the Republican candidate for governor "wants weaker vaccine laws":

"Knute Buehler, a physician who currently serves as a state representative, responded to a recorded question about vaccinations by saying that he backed parental rights to opt out even absent a medical basis for doing so.

“As a physician, I certainly believe in the benefits of vaccination but I also think that parents should have the right to opt out,” Buehler said. “To opt out for personal beliefs, for religious beliefs or even if they have strong alternative medical beliefs. And that has been beneficial. I think that gives people option and choice and that’s the policy I would continue to pursue as Oregon’s governor.”

Buehler’s answer is at odds with the vast majority of medical literature, which touts the necessity of a social contract around vaccinations in helping to stop the re-emergence or spreading of infectious diseases. Under current Oregon law, parents are able to exempt children from vaccination under specific circumstances: that they talk to a medical provider or watch an online video about the benefits of vaccines."

The same article pointed to this article about the Republican candidate for governor in Oklahoma, where Mr. Kevin Snitt has been open about his children not being vaccinated and his own views on the government's role in requiring vaccines:

"At an appearance before a conservative political forum this past February, Tulsa businessman Kevin Stitt said he personally did not vaccinate some his own kids and opposed legislation that would require vaccinations for children if they wanted to attend public schools.

“I believe in choice,” Stitt said, “And we’ve got six children and we don’t vaccinate, we don’t do vaccinations on all of our children. So we definitely pick and choose which ones we’re gonna do. It’s gotta be up to the parents, we can never mandate that. I think there’s legislation right now that are trying to mandate that to go to public schools, it’s absolutely wrong. My wife was home schooled, I went to public schools, our kids go to Christian school, and that’s back to a parent’s choice.”"

In West Virginia, The Register-Herald reports that legislators there "are drafting a bill to give doctors the ability to exempt children from vaccine requirements." And, in California, a group of citizens tried to get a ballot measure approved to revise "SB277," a bill signed into law in 2015 making it more difficult to get non-medical exemptions from vaccine requirements in the state. That initiative did not get enough signatures to get on the ballot for November.

Throughout the history of vaccines, there have been opponents to vaccinations for different reasons. Some oppose vaccinations on fears of the ingredients in the different types of vaccines. Others oppose vaccinations out of a sense that naturally-gained immunity (i.e. surviving a vaccine-preventable disease) is somehow better than the "artificial" immunity conferred by vaccines. And others oppose vaccination mandates from the government because, in their view, vaccination should be a personal choice, or a parental choice for children too young to choose.

Opposing views to vaccines come into friction with supporters of vaccines around election time because of the political nature of vaccines. On the one hand, the right to refuse any medical intervention is one of those things we in America hold near and dear. You've probably seen court cases where a judge or jury has to decide if someone can refuse such interventions as chemotherapy or surgery, even if those interventions have a good chance of saving their lives. On the other hand, the right of the public in general to be safe from harm generally supersedes an individual's right to refuse a medical intervention like vaccination.

In 1991, as a measles epidemic spread through the United States, a group of unvaccinated children whose parents attended a church in Philadelphia were ordered to be immunized by a court:

"The court order had taken a few weeks. By the time the vaccines were administered, the measles outbreak was subsiding in Philadelphia. Only nine children from the church were ultimately vaccinated, and Ross says the intervention probably didn't affect the spread of the disease.

In the end, nine kids across Philadelphia died, including six from Faith Tabernacle. The church is still operating the school today but declined to comment.

Some experts say it's rather surprising that the parents were forced to have their children vaccinated.

"There was a law that protected these church members' right to refuse vaccination on religious ground," says Dr. Paul Offit, director of the Vaccine Education Center at Children's Hospital of Philadelphia.

But the U.S. Supreme Court had ruled years earlier that parents cannot deny lifesaving medical treatments to their children for religious reasons. That ruling set a precedent that made it difficult for Faith Tabernacle to find legal representation."

The court order took weeks because it was appealed to the federal courts, by the way.

The way Public Health is set up in the United States is that the authority to enact and enforce laws to protect the public's health fall to the state and local governments as part of their police powers given in the Constitution. Three cases decided by the Supreme Court explain this power of the government:

"In the 1905 case Jacobson v. Massachusetts, the Supreme Court upheld the authority of the states to enforce mandatory vaccination laws under the police power of the states. In the opinion, Justice John Marshall Harlan explained that personal liberties might be suspended in cases where the interest of the “common good” of the community are of paramount importance.

The Court in Jacobson did, however, recognize that for some individuals a vaccine requirement could be harmful, creating room for medical exemptions where vaccines would be unduly harmful to the individual.

In a 1922, the Court further clarified in Zucht v. King that a school system could refuse admission to a student who did not meet vaccination requirements, and that this would not be in violation of the 14th Amendment’s Equal Protection Clause for singling out a particular class of individuals.

Then in 1944, in Prince v. Massachusetts, the Court held that states may require vaccination regardless of a parent’s religious objection, stating that, “the right to practice religion freely does not include liberty to expose the community or the child to communicable disease or the latter to ill health or death.” This case made it clear that religious exemptions offered by states are elective, rather than mandated by the First Amendment’s right to free exercise of religion.

While the Supreme Court authorized the states to pass these laws mandating vaccinations, it was in no way required for the states to do so. Federal authority on vaccines only applies to situations of national concern, such as the quarantine of foreign disease and regulation between states."

So we're left with 50 different legislatures (plus the governing bodies of the associated territories, like Puerto Rico) each making its own policy on vaccination. Within those states, there is the authority of the health officers within different health districts. That means that there are dozens of people setting vaccination policy, and most of them are elected to their position. During elections, the issue of vaccination can come up, and then the whole thing becomes political. That's just the system we live under in the United States.

I'll leave it for a different post at a later time how we compare to other countries in this regard, but I'll give you a preview based on this article in Maclean's (my emphasis in bold):

"When a group of doctors and professors from Nova Scotia took a trip to Cuba in 2006 to study how the country managed infectious diseases, they were struck by how knowledgeable the average person was about vaccines, and decided to conduct an informal experiment: Quiz random passersby on the streets of Havana about their basic knowledge of their country’s vaccine safety program (the process by which vaccines are created and made safe) and their personal immunization records.

“Without fail, everyone knew exactly what immunizations they already had, the scientific evidence behind them, and at what ages they needed to be updated,” says John Kirk, professor of Spanish and Latin American studies at Dalhousie University, whose research focuses on Cuba’s health care system.  The research team also asked the Cubans their opinion on anti-vaccine movements in countries such as Canada and the U.S. “They were dumbfounded. They thought we were joking,” Kirk recalls. “I guarantee you won’t meet a single person there who has doubted vaccines for a moment. For Cubans, vaccines aren’t only seen as a basic human right, but also as an obligation.”

...

The numbers say it best. According to the World Health Organization (WHO)’s 2014 global summary on vaccine-preventable diseases and academic studies, Cuba has not had a single reported case of measles since 1993, nor rubella since 1989. Five cases of mumps have been reported since 2000; the last one was in 2010. And pertussis hasn’t been reported since 1994. In contrast, Canada has had 2,203 cases of measles, at least 1,529 cases of mumps, and 21,292 cases of pertussis reported since 1990."

Header photo by Michigan Municipal League (MML) on Foter.com / CC BY-ND

Comments

Posted by Dorit Reiss (not verified)

I think you're completely right that vaccines have always been political, for exactly the reasons you mention. What does  bother me is that the discussion appears to have become more partisan - and there's no real reason for that. Support for preventing disease has been, and should be, bi-partisan. 

Posted by Truth (not verified)

This is a widely circulating misquote. Kevin Stitt vaccinates his 6 kids. He said he believes vaccines are between a parents and their children, *however* he does not support changing OK law.

Here's the words from his own mouth: https://www.youtube.com/watch?v=i5CtuHj6B-A

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