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All 50 states require that children be vaccinated in order to go to public school. There are some variations in which immunizations are required and when, but throughout the U.S. there is an expectation that going to school means getting shots.
And in all 50 states, there are ways to get out of being vaccinated.
Some children truly cannot or should not be vaccinated. For children with certain problems with the immune system, or who are taking certain medications, some vaccines may cause health problems. All states understand that, and allow those children to go to school without all the usual vaccines.
But in most states, parents can avoid the immunization requirement by saying that vaccination goes against their religious beliefs — or their personal beliefs. These are the exceptions that public health experts, including the American Academy of Pediatrics, want to stop.
Vaccines prevent illnesses that can cause serious disease — or death. They save lives, plain and simple. Because they don’t work perfectly in every person, and because not every child can get them (because of a medical condition or because they are too young), it’s important that lots of people get vaccinated. When they do, it creates something called “herd immunity”: if enough people are immune to an illness, it makes it very unlikely that the illness will begin — or spread. To have good herd immunity, experts say that about 90% of people should be immunized; for pertussis and measles, which are very contagious, that number is more like 95%. Requiring vaccines for school helps to get and keep those numbers up.
While most children do get immunized, more and more parents are refusing or delaying vaccines. Some worry about side effects, but a recent study showed that a big reason parents are refusing is that they just don’t think vaccines are necessary.
In essence, we are victims of our own success. Vaccines have done such a good job that many people no longer remember polio, chicken pox, measles, epiglottitis (a dangerous, sometimes lethal infection of the throat), and other vaccine-preventable diseases. While complications of these diseases are far more common and worse than complications of vaccines, it’s hard to really understand that if you’ve never seen the diseases.
Another problem is that people who choose not to vaccinate often live in the same communities. This isn’t surprising, given that our social networks influence our choices. But when a bunch of unimmunized people live together, it completely throws off herd immunity. Vaccine-preventable diseases can easily take root — and spread.
While it’s true that parents in general have the right to choose whether or not their child gets a medical treatment — and vaccines are a medical treatment — the vaccination choice is fundamentally different in that it affects not just the child, but the entire community. Choosing not to vaccinate is not only dangerous for the child, it’s dangerous for everyone around that child. Personal beliefs, even religious beliefs, do not give anyone the right to put the health or lives of others at risk.
Personal and religious exemptions allow families to avoid the tough conversations with their doctor — but these are tough conversations we really need to have. So much of this is about building trust and about listening to the fears and concerns of those who want to delay or refuse vaccines. There is so much I and other doctors can say to allay those fears and concerns, if given the chance. I welcome the opportunity to talk with more families about the rigorous process for approving vaccines and monitoring their safety, and about the diseases that vaccines protect us from. I am old enough to have seen many of them; I have seen the difference vaccines can make.
I also welcome the opportunity to have the tough conversations about our responsibility to care for those around us. We belong to each other, and need each other to keep us safe and well. Vaccination is one way we do just that.