| On Tuesday, the Assembly Health Committee heard testimony on a radical proposal that would exempt from immunization requirments children whose parents have "conscientious objections" to vaccinations. The bill, introduced by Charlotte Vandervalk and cosponsored 20 other members of the Assembly, would undermine New Jersey's current and longstanding policy requiring immunization of children attending a school or child care facility in the state.
A the hearing, committee chairman Herb Conaway blocked the bill by refusing to hold a vote on it. Conaway, a physician, called the proposal a "recipe for disaster." Dr. Conaway is right.
Currently, New Jersey permits only religious exemptions from its vaccine requirements. This bill would allow an exemption to children whose parents sign a form that says that they "understand[] the potential benefits of immunization and the risks in not immunizing." The statement accompanying the bill reveals its true implications:
This bill would allow New Jersey to join with other states that grant individuals the right to manage their health or their children's health as they deem appropriate. (emphasis added)
This statement is utterly incompatible with a policy of mandatory immunization. If we allow parents to evade immunization requirements on the grounds that they are "manag[ing] their ... children's health as they deem appropriate," we will subordinate the state's vaccination requirement to each parent's decision about whether getting their children vaccinated against a particular disease is worth the costs and the percieved risks. The very purpose of a mandatory vaccination policy is to take this decision out of parents' hands.
The biggest supporters of the bill back it because they believe that the medical consensus on vaccines is incorrect. They believe that vaccines cause, or at least contribute to, autism. Scientists, doctors, and public health officials overwhelmingly reject this conclusion, and the vast majority of studies have found no link between vaccinations and autism. The anti-vaccine movement has caused vaccination rates to drop, which may be linked with recent outbreaks of pertussis (whooping cough).
What the supporters of the bill are asking for is truly extraordinary. They want the state to exempt from a regulation those who disagree with the policy findings behind that regulation. Needless to say, we rarely allow people to avoid regulation simply because they they think it is bad policy. Schoolchildren who refuse to take the state standardized test are not allowed to graduate, even if they refused because they think the state's test is flawed. If a zoning board denies you a variance to build a shed on your property, you cannot build the shed anyway simply because you think the policies underlying the zoning ordinance is dumb. "I'm a skilled driver who can travel safely at 100 MPH," is no defense to a speeding ticket. No lawmaker would seriously propose that the schoolchild, the property-owner, and the speeder should be exempt from regulation because they disagree with the policy.
While the bill's supporters may portray the bill as a narrow exception, in reality, the bill undermines the state's mandatory immunization policy. Make no mistake, the debate over this bill is really a debate over whether we should require immunizations to begin with. New Jersey's mandatory immunization policy has served the state well, and I think we should keep it. If we do change the policy, we should not change it based on the misinformation spread by the anti-vaccine movement.
Below the fold, I explore the policy rationales for immunization requirements and present a more detailed description of the anti-vaccine movement. |
| The policy rationale for immunization requirements
Why should we delegate the decision of whether children should recieve a vaccine to lawmakers and public health officials in the general case and pediatricians (who determine whether a medical exemption is warranted) in each particular case?
First, parents are generally much less able than doctors or public health officials to weigh the cost and benefits of a particular vaccine. They may be swayed by misinformation and biased presentations, either from well-meaning anti-vaccine activists or profit-maximizing drug companies. They generally know little about the side effects of the vaccines and the harms caused by the disease the vaccine is designed to prevent.
Second, some parents may recognize that a general policy of vaccination is rational, but still decline to spend money vaccinating their children. A few might refuse care out of personal greed. Others may choose to be free-riders, figuring that if everyone else's child is vaccinated, their children will never come into contact with the disease and that vaccination is therefore unnecessary. This is not only unfair to those parents who choose to vaccinate their children, it is also economically inefficient, because a small number of free riders can compromise herd immunity for diseases like pertussis.
Third, a parent's decision not to vaccinate a child puts individuals who, because of their age or medical condition, cannot be vaccinated. Many diseases affect with particular severity populations that cannot be vaccinated. Pertussis is very dangerous to infants, and Rubella strikes children most severely before birth (and, therefore, before vaccination).
While some (but by no means all) libertarians might deride mandatory vaccinations as nanny-statism, that policy is only one of many ways (others include compulsory education and child neglect laws) that we limit parental discretion over raising children. We limit parental discretion because we recognize that a parent's right to raise a child how he or she sees fit must accommodate the child's rights to food, clothing, shelter, medical care, and an education.
The anti-vaccine movement
The motivating force behind this bill is the belief that vaccinations cause autism. On one side of this controversy, you have the World Health Organization, national public health agencies including the CDC, the National Academy of Sciences, the AMA, and the American Academy of Pediatrics. On the other side, you have a small group of passionate and well-meaning parents with autistic children, Jenny McCarthy, a discredited researcher, and a debunked study.
The autism-vaccine controversy began in a 1998 paper published in the English medical journal The Lancet by Andrew Wakefield and 12 co-authors. The Wakefield paper examined 12 children with developmental disorders and found that in 8 of them, the onset of symptoms seemed to coincide with the administration of the MMR vaccine. Wakefield held a press conference to publicize the paper, but it initially received little coverage in the press. But Wakefield pressed on with his theory, and it eventually got traction in the UK press.
The controversy arose in the United States not around a particular vaccine, but over a mercury-containing vaccine additive, thimerosal, which was largely eliminated from vaccines in 2001. The issue was thrust into the national spotlight by David Kirby's book Evidence of Harm and an article by Robert F. Kennedy Jr. published at Salon.com and in Rolling Stone. The thimerosal theory never enjoyed any substantial scientific support, and it has been thoroughly discredited as incidence of autism has continued to increase despite the elimination of thimerosal from most vaccines. Vaccine opponents moved the goalposts, suggesting that "vaccine overload", that is, giving too many vaccines at once, is what causes autism. They have also implicated other minor vaccine components in causing autism, including glutamate, which occurs naturally in many foods like soy and cheese and is added to others in the flavor enhancer MSG.
The vast majority of scientific literature rejects link between vaccines and autism. The CDC and public health agencies in the UK and Canada also reject the theory, as do the American Medical Association and the American Academy of Pediatrics.
The autism-vaccine link has caused a great deal of harm. Media coverage of the anti-vaccine movement has caused vaccination rates to decline in the US and UK. This can lead to outbreaks, particularly where the unvaccinated are concentrated in a particular population. In 2005, a rubella outbreak struck unvaccinated groups in Canada and the Netherlands.
Pertussis cases spiked in the middle of the decade to levels not seen in decades, and California is currently suffering its biggest pertussis outbreak in more than half a century. California, incidentally, has one of the most permissive immunization exemption laws in the country.
Most publications have distanced themselves from the vaccine-autism link theory, and its leading proponent has been discredited. A 2004 Sunday Times report revealed that Andrew Wakefield, the author of the Lancet paper, failed to disclose conflicts of interest and suppressed data that conflicted with his theory. In 2010, the UK General Medical Council stripped Wakefield of his license to practice medicine for professional misconduct related to the Lancet study. Wakefield's co-authors have distanced themselves from him, and Lancet has retracted the article. Rolling Stone has whitewashed the Kennedy piece from its website. Salon has also revoked the RFK article, calling the autism-vaccine link theory "debunked and dangerous."
On "Big Pharma"
One final point. Vaccination opponents are quick to paint their opponents as tools of Big Pharma. I believe this is a mistake.
Demonizing pharmaceutical companies is unpersuasive rhetorical tactic. Pharmaceutical companies are not agents of evil. On the contrary, they add an incredible amount of value to our society by researching and producing lifesaving and life-improving drugs which they then sell to members of the public. They advance science and expand the scope of human knowledge, and their contributions enter the public domain once their patents expire. This not to say that pharmaceutical companies are worthy of veneration, or that they confer benefit on society out of altruism or good will. They are corporations, and their primary goal is to maximize profits for their owners (usually, shareholders). Sometimes, a position they take on an issue will coincide with the public interest. Sometimes, it will not.
When doctors, lawmakers, doctor-lawmakers, journalists, commentators, and bloggers all share a position with pharmaceutical companies, it does not mean that the pharmaceutical companies have bought them off or improperly influenced them in any way. It may be that each of these individuals has independently come to his or her own conclusion that the policy in question does in fact promote the public interest. The latter explanation seems far more plausible to me, given the broad consensus on the utility of vaccines among doctors and scientists. |
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