As kids return to school, parents find themselves drowning in paperwork – my daughter’s high school sent us, among other pieces of paper, an emergency contact form, student behavioral contract, weapons policy handout, photo release agreement, and several health forms, all of which need to be completed and handed in before she can enter the building. My toddler son’s daycare is similar (though the weapons policy there might apply only to plastic swords and the sharper Happy Meal toys).
Among the piles of paperwork, for many families, is a form requesting proof that your child is vaccinated against diseases ranging from chicken pox to hepatitis. While state laws vary somewhat, every state requires that students entering public elementary school be vaccinated against the diseases listed on the schedule set forth by the Centers for Disease Control, or else that their parents provide medical, religious, or (in some states) personal reasons to claim exemption. Private schools, though not required by law to ask their students to be vaccinated, tend to adopt similar requirements.
So how did these regulations come into being, and why doesn’t everyone just follow them? Who’s getting vaccinated these days, and who’s not? And what should you know if you have a kid starting school?
Ever since the first vaccine was invented in the late eighteenth century, laws mandating vaccination have met with opposition, sometimes by religious leaders, sometimes by those who object on political or libertarian grounds, sometimes by those who are certain that vaccines do more harm than good. The term “conscientious objector” first emerged during battles over the 1898 Vaccination Act in England, and in the United States, groups such as the Anti-Vaccination Society protested early laws requiring inoculation among schoolchildren in Boston in the mid-nineteenth century.
Some of these early objectors believed that vaccination was itself an affront to the God who had sent disease to punish sinners, while others, like today’s anti-vaccination activists, feared that the shots meant to protect the public good would inflict harm on individuals.
Still, by the twentieth century most states in the U.S. coupled compulsory vaccination with public school attendance (since 1986, all federal vaccine research and safety monitoring takes place under the Department of Health and Human Services’ National Vaccine Program). Through the mid-century, when Jonas Salk invented the polio vaccine, most Americans got their shots without much fuss; most of the diseases now routinely vaccinated against, were still prevalent enough to remind people what the shots prevented.
For today’s parents, though, measles, mumps, and rubella aren’t on the list of most-feared diseases. Autism is. And the rumored link between autism and vaccination, despite frequent and authoritative debunking (including a new study just last month) simply won’t go away. You can blame the Internet, with its echo chamber of like-minded non-scientists posting link after spurious link. You can blame pop culture, with its fondness for elevating the opinions of celebrities to something nearing received wisdom. And you can most certainly blame our scientifically illiterate society, in which most readers can’t evaluate the relative value of competing claims, even when some come from peer-reviewed medical journals and some from non-medical environmental organizations commenting on issues far outside their expertise or, worse, random people on their computers, preying on parents’ worst fears.
Fear of autism is perfectly reasonable. It’s a scary diagnosis, one that’s risen exponentially over the past two decades – though whether through a vast expansion of the diagnosis or an actual increase in numbers is still hotly debated. But it’s natural that a condition with no known cause would inspire concerned parents to go looking for a culprit, particularly one they can protect their children from.
The autism community is itself divided on the matter, with some absolving vaccines of any role, others feeling they may add to an environmental trigger that interacts with genetic predisposition, and others convinced that thimerosal, a preservative once found in vaccines (but removed for good in 1999), is to blame. Although parents have found reasons to object to vaccination requirements since their introduction centuries ago, the current autism-related anti-vaccination movement dates from a 1998 article in the medical journal The Lancet by British surgeon Andrew Wakefield, a controversial figure who has been charged with misconduct and most of whose co-authors have recanted the study.
It doesn’t really matter that there’s no significant scientific debate about the matter (as with evolution and global warming, a vanishingly miniscule number of actual scientists disagree with the majority opinion), many parents still feel that the relationship between autism and vaccines is an open question. And though the number of families opting to exempt themselves from vaccination requirements is overall quite small – less than one percent in most states – it’s a very vocal minority. (A growing movement of parents choose to vaccinate their children, but on a delayed or modified schedule.) Parents who opt out of vaccines tend toward the crunchy; Waldorf Schools are among those with the highest incidence of non-vaccination, and have found themselves the epicenters of childhood disease outbreaks. As with the anti-vaccine movements in Nigeria, American anti-vaxers don’t exactly trust the government to administer public health. They may not fear that vaccines will sterilize their children, or spread AIDS, as the Nigerian Muslims who protested polio vaccination did, but they do share a mistrust of western medicine, “big pharma,” and other forces lined up on the side of vaccination.
Not vaccinating your kids is sort of like not voting.
So what’s the effect of parents’ not vaccinating their children? In communities where most children are vaccinated, one or two who haven’t aren’t enough to disrupt the herd immunity conferred on all children (though if they travel to an area where vaccinations are rare, they are at risk). But once the group vaccination rate tips below a certain point, diseases once nearly eradicated can come roaring back, as seen in this past summer’s measles outbreaks. For this reason, the American Medical Association opposes all exemptions, even religious, to vaccine regulation. (Most Americans who ask for exemptions do so for personal philosophical reasons, though many claim religion because that’s all their state allows for.) Their policy, though commonsensical, seems designed to backfire when addressing parents already primed to mistrust the medical establishment on the issue.
It’s easy to see the opt-out parents as selfish and entitled, as in a New York Times article from 2007 in which one mother proclaimed, “I refuse to sacrifice my children for the greater good.” Against such attitudes, public health concerns – in which the greater good is the common goal – face an uphill battle. And yet many parents have come to their anti-vaccine position after much struggle, and some cite the arrogance of official pro-vaccine spokespeople as one reason.
It’s true that the CDC site barely mentions parental concerns or fears, communicating its “fear not” message in a tone that fails to acknowledge that parenting is an enterprise in which fear and love and emotion, not logic, are the primary motivators. Because public health isn’t about publicizing what all scientists believe, but rather positively impacting the health of the community, doctors and other scientists need to learn to listen to parents, no matter how silly their concerns may sound, before they issue their pronouncements. Health organizations that express empathy for the difficulty of these decisions go a long way toward improving the dialogue.
Not vaccinating your kids is sort of like not voting: it might not make much of a difference, but you’re betting on most everyone else making a different choice, and the outcome is one everyone has to live with. So it’s not surprising that some refer to non-vaccinating families as freeloaders (or, in Amanda Peet’s more incendiary language, “parasites“). But unlike those who fail to vote, parents who opt out of vaccinating their children are doing so for the very best reasons: they love their children and want the best for them. The question is, how fair is it to “protect” your children from vaccines if it puts other kids at risk?