Editorial: When ‘choice’ undermines public health

There’s little to celebrate about the measles outbreak now hitting the nation, with most of the reported cases in California. But one positive outcome is the level of attention being given to laws that allow parents to opt out of immunizing their children – and the risks that option poses not only to the unvaccinated kids but to the community at large.

The reasons parents give for their decision not to have their children immunized vary, and can be complicated. Some argue that such parents are scornful of science, which has debunked misinformation that’s come out in the past about vaccines, including that they cause such ills as autism.

But perhaps the anti-vaccine phenomenon results not so much from a mistrust of science as from an under-appreciation and ignorance of history. Many of these parents weren’t even born when measles and other diseases plagued the population, before immunization regimens made them almost unheard of.

A historical reality check leaves no doubt that contagious diseases such as measles, chickenpox and polio caused significant suffering, and sometimes lifelong consequences or death before effective immunization protocols were put in place. The spotlight turned on the current outbreak reveals that many children who have not received the measles vaccine haven’t been vaccinated against other possibly even more dire diseases, such as polio. It’s ironic, then, that parents who have decided that the risk of vaccination is greater than the risk of the diseases are drawing their conclusion from a place of ignorance about the diseases themselves – illnesses nearly wiped out by the very vaccines the parents are now saying aren’t necessary.

Locally, Peninsula School in Menlo Park has the highest rate of unvaccinated children, with 30 percent of this year’s kindergartners not immunized under the state’s “personal belief” exemption, according to state records. Other schools with high rates of kids who have opted out of vaccinations with personal-belief exemptions are Las Lomitas (6 percent), Laurel (5 percent) and Encinal (4 percent) in Atherton; and Philips Brooks (5 percent) in Menlo Park.

State and federal legislators are responding to the current measles outbreak by urging state officials to reconsider the state’s immunization exemption law – which allows parents to opt out of immunizing their kids for medical reasons or for personal beliefs – and with a proposed state law that would end the personal-belief exemption. No one is suggesting an end to the medical exemption, which applies to children with a compromised immune system. But the other category must be rigorously reviewed.

The current law does have serious consequences – non-immunized children without an exemption may not attend school or day care, whether public or private. Current law gives any non-exempt student without all the required immunizations for their age only 10 school days after notification before being barred from attending.

State senators Richard Pan and Ben Allen last week introduced a bill taking away a parent’s option to opt out of immunizing a child for personal beliefs. Sen. Pan stands on particularly solid ground to judge the seriousness of the problem. A recent San Francisco Chronicle article quoted him thus: “As a pediatrician, I have personally witnessed children suffering lifelong injury or death from vaccine-preventable infection. This doesn’t have to happen.”

U.S. senators Barbara Boxer and Diane Feinstein are going one step further, asking state health officials to reconsider not only the personal-belief exemption but also urging that religious exemptions not be allowed. Currently parents whose religious beliefs do not allow immunizations may apply for an exemption under the personal-belief exemption. Although ending the exemption for personal beliefs may be an easier sell and, we believe, the right thing to do treading on parents’ religious beliefs might meet some stiff resistance. But a thorough debate over that issue is certainly needed as the state comes to terms with the long-term consequences of the current exemption law.

Meanwhile, public education is key to this issue. Interestingly, Sen. Pan, the pediatrician, successfully wrote a bill that went into effect in January 2014 requiring parents applying for a personal-belief exemption to talk first with a licensed health care practitioner about the impacts to their children and the community. Although it will take longer than one year to determine whether the law is effective, it’s encouraging to note that the rate of personal-belief exemptions went down this year for the first time in many years. Dr. Eric Weiss of the Village Doctor in Woodside told the Almanac that he believes assurances by a trusted doctor can go far in allaying parents’ fears about vaccinating their children. He notes that at his clinic, where doctors take the time to talk about the risks of not vaccinating kids, there are no families who have opted out of immunization.

More public awareness is critical, but lawmakers must also take action now to stem the growing problem of non-immunized children who are at risk of preventable disease, and putting the wider community at risk. Public health must trump parental choice in this matter.