A paper published this week in Vaccine from the New York Medical Center claims the current attempts to stem the increase in vaccine exemption applications from parents are misguided.
In some states the rate of non-medical exemptions has risen above 5% and this has caused an increase in cases of preventable diseases in ‘pockets’ of vaccinated children across the US. The result is that cases of viruses like measles, pronounced eradicated in the US back in 2000, have risen sharply over the past decade. In the case of measles, the number of cases has rocketed from 60 cases in 2001 to 222 cases in 2011.
Numerous other high profile outbreaks have been linked to these pockets of unvaccinated people, including the 2010 pertussis outbreak in California and the 2012 Washington pertussis outbreak. As a result legislators and policy makers have been trying to reduce the number of vaccine exemptions by making it more difficult for parents to obtain them. But the authors suggest that, of the three types of legislation policy makers have been experimenting with (Mandating vaccinations, philosophical versus religious exemptions, and challenging the sincerity of applicants) none have proved particularly useful or effective. In fact, the author’s remark that in many states it is actually easier and less time consuming to obtain an exemption than it is to stick to the recommended vaccination schedule.
The key is that the efforts put in place have failed to stop successful exemption applications increasing. This is no doubt down to the vague nature of much of the legislation which cannot give states the power to refuse exemption applications for fear of violating a human, ethical or religious right. The authors suggest instead that states should adopt a number of measures designed to nudge parents into getting their children vaccinated through a combination of financial and educational measures: tax breaks, lower health insurance and private school tax credits.
Whilst the evidence surrounding whether trying to educate the unvaccinated actually works, the finance and school based measures suggested in the report do seem to genuinely offer an alternative to concerned policy makers.
Using examples such as the increase in tax on cigarettes in 2009 which lead to a decrease in the number of smokers across the US, the authors suggest that levying a tax upon the unvaccinated should decrease the numbers applying for exemption. Whilst such a strategy will no doubt have its critics, with the San Diego measles outbreak (caused by an intentionally unvaccinated child attending a school with a high proportion of unvaccinated children) costing the tax payer over $10,000 per measles case, it would not be hard to justify a tax penalty against the unvaccinated. Though for a more positive spin legislators may consider taking a hit and offering a tax break to those who stick to the recommended vaccination schedule.
The second suggestion is that, in much the way tobacco use is taken into account, health insurance providers should be free to discriminate against those who are intentionally unvaccinated. If insurers and companies were given the power to incentive vaccinations in order to ensure the good health of its customers and employees.
Lastly the paper remarks that the rate of unvaccinated children is substantially higher in private school than public schools, and that research suggests that this is not in any way dependant on the income level of parents. Citing the San Diego measles outbreak (started in a private school) the authors suggest that the 23 states which currently offer tax credits and funding to parents of children attending private schools, stipulate that funding will be will only be granted if parents stick to the recommended vaccine schedule.
Whilst these measures many will see as an invasion of one’s personal freedom, if legislators are to take seriously the public health threat posed by increasing numbers of unvaccinated people, they need to try something different. And history suggests that money is far more likely to make people look past their own views on vaccination than simply making it ‘harder’ to obtain an exemption.