How to Solve the Vaccination Problem: Two Politically Feasible Proposals

My last post, “Is It Constitutional and Desirable to Require Vaccinations?“, asked serious questions about what at this rate is still probably not necessary. Here, I make two proposals that would be good policy right now, and would also be politically palatable.

After all, roughly 92% of American children are getting their MMR vaccine. How do we deal with the other 8%? This matters to everyone because vaccines are not 100% effective, and infants and some other folks can’t get vaccines for health reasons.

1. Eliminate, or at least harden, non-medical exemptions for school students

There are already two states, Mississippi and West Virginia, that only accept medical exemptions for public schools — not even religious exemptions. Little wonder, then, that Mississippi has a 99.7% MMR vaccination rate among kindergartners. It has been more than 20 years since either state had a case of measles.

This is good policy, and it should be adopted by the other 48 states. If your personal or religious beliefs are so strong that you insist on ignoring the advice of the collective, virtually unanimous opinion of medicine writ large, fine. You have to find another way to educate your children, at your own expense.

There is a bill in the California state legislature to do exactly this.

It’s getting some pushback from vaccine fear mongers, of course, but also from libertarian types. Here’s the thing, though: You don’t get to take advantage of a public service,  provided at public expense, and then tell the body politic that some very reasonable conditions placed on that service are a violation of your individual liberty.

It’s against policy to smoke anywhere on a K-12 campus in most if not all states — including in North Carolina, for G-d’s sake — and this infringement of liberty has come about with broad if grudging acceptance even among the gravelly-voiced crowd.

If you believe in this extreme of a version of personal liberty, you’re probably a follower (at least indirectly) of Ayn Rand. So take that reasoning to its conclusion. Rand didn’t even think public schools should exist. Until we abolish public schools and live in an objectivist utopia, then, there are just some times — from vaccines to seat belts to food safety inspections — that your liberty to do things “your way” might be curtailed.

Again: It’s constitutional to require vaccines, period, on penalty of a sizable fine. Requiring vaccines as a condition of using a public service? Sorry, not a violation of your basic rights.

But, you might say: What about private schools? Won’t all these well-off anti-vax families just pony up to send their kids elsewhere? A number surely will. The state should therefore also make private schools publicize their vaccination policies, exemption rates, and number of confirmed cases of vaccine-preventable diseases per year for the last five years. They should have to share this, in writing, with all current students’ parents and with any potential new students’ families.

A number of softer-hearted souls have proposed merely hardening the rules on personal exemptions — making it harder for parents to get the forms, making them resubmit every year, making them complete online learning modules, and so on. This has been partially effective, but it does not go far enough in my view.

“Resisting vaccination isn’t a matter of laziness; it’s actually time-consuming and expensive,” writes Whet Moser. Which means the same kind of parent who clings to anti-vax believes is also the kind of parent who will do “anything” for their kid. (Except, you know, make the single easiest decision a parent can make.) Instead of daring these folks to jump through more hoops, just keep the kids out of public schools, period.

If you want to compromise on the religious exemption, that is more reasonable — or, at least, less subject to the whims of changing opinions. I would, however, add a mechanism for sniffing out sham churches set up for this purpose.

I don’t feel particularly compelled to give on even this point, however. We have all sorts of rules in public schools that might conflict with a sincerely held religious belief, from mixed-gender classrooms to not letting kids get out of biology class because they don’t believe in evolution. If parents want something different on these counts, they have to find a school that meets their beliefs, and putting vaccinations on this list is perfectly reasonable.

2. Medical Isolation

Many people are talking about school policy changes, but I’m also concerned about infection at the doctor’s office — where you’ll find a disproportionately large share of infants and immunity-compromised children.

Thus, I propose that all medical offices have to post their vaccination policies prominently, and those caught not sticking to theirs are subject to a serious fine.

Imagine walking into the office and seeing this:

Statement of Office Policy on Vaccinations

XThis office only accepts patients that are up to date on their vaccinations (barring medical exemptions), and we verify.
This office only accepts patients that are up to date on their vaccinations (barring medical exemptions), but we do not verify.
X(If either of the above is checked) This office has after-hours "catch up" vaccinations.
This office accepts patients regardless of their vaccination status.

In today’s climate, that would be very reassuring to see. And if I make an appointment, show up, and instead it’s Box 4 that’s checked? My kid and I are going elsewhere.

If I discover this, I should leave, and I shouldn’t be forced to pay a cancellation fee. Such an office should also have to get written assent to this choice from all patients before they can bill for dollar one.

Box 2 would probably work well enough as long as patients/parents have to sign a statement, under penalty of perjury. Which brings up another important point: Verification would work best if states require that all immunizations be submitted to the state database. Vaccinating doctors are not required to submit this information in some states, such as (I’m very sorry to see) California, so it would be a good bit of extra work to be a Box 1 office.

I would probably be comfortable taking my child to a Box 2 medical office, but he’s 10, vaccinated, and healthy. If I had an infant or other especially vulnerable child, though, I’d really try to find a verified-immunization office.

It would be hard to find a doctor who’s willing to advertise to their patients that the unvaccinated are explicitly welcome in their office. Sure, even the occasional anti-vax quacks can be found, but it’s becoming hard to find doctors who will even see anti-vax parents. (Even without a mandate, if I were a doctor, I’d post a prominent “must be vaccinated” notice in my office, and I suspect we’ll start to see this soon in any case.)

So that’s my proposal: No public school without vaccinations or a valid medical excuse, and mandatory notice about medical office policies.

If you’re not vaccinating your children, you’re free-riding on herd immunity (to say nothing of harming your own child!), and the herd should try to limit the damage that your adorable little disease vector can do to the rest of us.








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