One positive aspect of religious and personal vaccine exemptions is the implicit support for individual autonoour, a strong cultural value in the United States. Allowing exemptions means that families are free to choose, based on their personal beliefs, what goes into their own and their children’s bodies, without interference from the state.
Many other countries do not place such value on family independence. When we asked a friend born in France what the average French family would do if required to vaccinate its children, he was a bit puzzled by the question. He implied that everyone in France would follow the rules and that no one would dream of not vaccinating his or her child. The value of the public good outweighs individual choice.
A very real, negative aspect of allowing various vaccine exemptions is that it decreases herd immunity. If more people are not vaccinated, there are more susceptible hosts for a given disease, and thus, the illness is able to spread more widely. Studies are very clear that there is a higher incidence of various vaccine-preventable diseases in states with personal vaccine exemptions than in states with only religious exemptions.
So the question our country continues to grapple with is this: At what point is it appropriate for society, in the interest of public health, to overrule an individual family’s choice about vaccination?
As you have already noticed, we am very much in favor of vaccines, but we am also very much in favor of parental choice. In a way, this reflects the two hats we wear on a daily basis. When we am a family physician, taking care of an entire family, we am that family’s advocate. Our goal is to support that family in its decision-making process and respect its final decision, even if we don’t agree.
However, we am also a doctor in a small town of fifty thousand, and we know how the child with pertussis in our office today affects the community. We see that disease being spread to other unvaccinated children. So far we have not had to admit a baby with pertussis to the hospital, but if that ever happens, we will know that part of the reason that baby is in the intensive care unit is that there are a large number of unvaccinated children in our community.
In our opinion, at the present time in the United States, with a minimal presence for most vaccine preventable diseases, we still strongly support parental choice. However, if we were to see children dying during an epidemic, we could easily understand the rationale for mandating vaccines. We have already seen children die of tetanus in Africa and suffering from HiB meningitis in the United States. Whenever we think about someone in the intensive care unit with a vaccine-preventable disease, we am reminded of the rationale for vaccinations.
On February 12, 2009, after extensive review and deliberation of the available scientific evidence, three Special Masters of the U.S. Court of Federal Claims unanimously ruled that the MMR vaccine is not associated with autism or autism spectrum disorders. This is the first ruling in the Omnibus Autism Proceeding. The second ruling, which will evaluate whether there is any association between thimerosal and autism, is due later in 2009.