Are Vaccine Mandates On The Horizon?

Published: Friday, April 19, 2019 - 11:54am
Updated: Friday, April 19, 2019 - 1:12pm
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STEVE GOLDSTEIN: This week, New York City declared a public health emergency associated with a measles outbreak, and mandatory vaccinations have been called for, and five parents filed a lawsuit against the city's Department of Health claiming it had gone too far in requiring vaccinations. Arizona also hasn't been free of measles cases. There are so many questions to address when it comes to the next stage — do policies need to change? Is more information needed? Are near-universal vaccination mandates on the horizon? With me to talk about all of that is James Hodge, professor of public health law and ethics at the O'Connor College of Law at ASU. So James, where are we at right now? There is such a variety of vaccination-related laws in different states.

JAMES HODGE: It really does vary quite a bit. But when you get to the stage, Steve, that we're seeing right now, where you've seeing declared emergencies over outbreaks of measles — which is a life threatening condition for certain persons in the community, it can have disabling effects long term for others who may acquire it — at that juncture, the balance starts to skew considerably more towards what can we do to protect the public's health? And a little bit less away from what are your individual opportunities to object to or to resist vaccines that are known to be safe?

GOLDSTEIN: And are those legal questions the same questions as they would be from a cultural standpoint?

HODGE: Yeah they're very much the same. I mean what we're constantly working with under these circumstances are individuals who, you know, are not trying to avoid particular societal expectations. They're just concerned about vaccines, or they have religious or philosophical objections. Those are things we can sustain outside of outbreaks. But when you have outbreaks of preventable conditions, like measles, which is nearly preventable completely through solid vaccination records as we've seen over 30, 40-plus years in the United States, we really have to get to the actual essence of where we stand culturally. That includes giving up a little bit of our individual expectations of specific preferences in favor of protecting the public's health.

GOLDSTEIN: Well, considering we have seen some momentum for an anti-vaccination movement, to whatever extent, does it make it that much harder, then, to, I don't know, get the animals back in the barn as it were, because we had these exemptions, and now when there is a situation like this, a public health emergency, are there enough people who are willing to voluntarily go back on this temporarily and say, "Okay, well obviously I'm not refraining from vaccinating my child because I want to start a public health emergency, this was a personal choice that I will change?"

HODGE: Yeah. You're seeing it right now. I mean we saw, for example, on the other side of the country, opposite New York City, in the state of Washington, a statewide public health emergency declared around some measles outbreak-related issues there, and that emergency alone, just the sheer essence of it, was enough to convince and/or give parents a, you know, a different perspective on what their societal obligation might be. A lot of people got vaccinated on their own accord. This is not a forcible vaccination issue. It was just an emergency recognition. We're at a state where vaccination's all the more critical. Now in New York City, you're seeing the exact same thing — an emergency order that does not forcibly require vaccine. That's obviously a misnomer and that's a very different issue. What we're doing is a mandatory vaccine. That mandatory vaccine effort is really designed to say, "Parents and caregivers, let's look at the opportunity for vaccine. Let's look at it now with a fine attached if you don't want to go that route and/or publicly expose others to measles." But the reality is, people do make decisions based on these types of proclamations. They're very effective for that, and I give a lot of credit to public health authorities that at least just issue the emergency knowing that a lot of persons will voluntarily complete what we're looking to accomplish on the public health end.

GOLDSTEIN: So there's also been the talk that those who do not want to vaccinate their children maybe are under-educated or they got some information that may not be in fact accurate. Does the same thing apply when it comes to the public health emergency? I mean, are there people who maybe didn't realize quite how serious this is, but when you mention the fact that it does affect behavior when a public health emergency is issued, does that indicate in any way reason for optimism for most of society that wants people to get vaccinated?

HODGE: Oh absolutely, Steve. It's a great observation, and it's accurate to a large degree. What you see on the anti-vaccination side that's just regrettable is the sharing and/or spreading of truly false information about risks of vaccines. This is debunked, and yet it still proliferates, even in sometimes very highly educated communities in New York City, Washington State and multiple other places, and notably here in Arizona. Now to that end, however, what you see on the flip side is emergency orders that really have a, sort of, let's say a societal notice and take-affect type of message to them. People don't realize how serious it is until an emergency is declared. Once an emergency is declared, they see the type of media and press attention to it. They see the type of responses including lawsuits related to it. All of that's, I think, taken in by a lot of Americans to the tune of, "Gosh, I really do need to actually think through this vaccination requirement and how significant it is for the health of my children and for the health of every other kid around me." That is something people begin to reassess.

GOLDSTEIN: Let's talk about legislatures, to some extent, and what they can and have done. Arizona's one of the states that has a larger number of exemptions than many other states when it comes to personal exemptions or medical exemptions and whatnot. Do you see any reason to think that we'll see a different sort of approach by various state legislatures because of what we're seeing, because we're seeing some of these outbreaks?

HODGE: Absolutely. Listen — the Disneyland measles outbreak from a few years ago really got the attention of California legislators. And so what they did as a response to that, I believe just two years ago, might have been three, is they basically reversed all prior religious objections or philosophical objections to vaccines. They took them off the legislative books, and as a result, you can't claim one now in California. Net end result of that? Vaccination rates have shot straight up exactly where they need to be to create what we call herd immunity. That is enough people vaccinated that you just could not see an introduction of measles harm even those persons who are unfit candidates. Legislators across the nation need to think about exactly what these outbreaks mean. They mean it's time to reassess those policies to a degree. Now I'm not trying to suggest that all religious objections should be dispensed, nor am I suggesting that all philosophical objections should be done away with. What I will suggest from a policy perspective is, don't make them easy. Do not allow parents to easily seek those objections when it boils down to them doing so against the backdrop of preventable conditions like measles. So there are ways to fine-tune these objections that were legitimate causes can be actually appreciated. But you don't make them easy so that parents can simply just avoid vaccines which in too many states that's what's happened.

GOLDSTEIN: James Hodge is a professor of public health law and ethics and the O'Connor College of Law at ASU. James, good to catch up. Thanks as always.

HODGE: Great, Steve.

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