The debate over vaccines and its imposition to each child in the United States has occurred over many years. In fact, the Disneyland measles outbreak that sickened 147 people as it spread to at least five states this year had caused the government to reconsider the current vaccine laws [1]. Hence, the issue of vaccinations seems to be one of the main concerns for the upcoming election, calling for its candidates to voice out their stands on this issue.

The request for the state to review the existing exemptions for child vaccinations resulted in the revival of the anti-vaccine movement. The movement led by parents who suffered significant side effects of vaccines to their children, will be expected to make its second wave due to the election [2]. The concern began when a rise in the case of autism claimed to be caused by MMR (measles, mumps, and rubella) vaccines, triggering the controversial debate in America [3].

However, the issue seems to be deeper than it seems there is a conflict between the issue of parental freedom and public responsibility. Whether the parents are still given the choice not to vaccinate their children or not, will make a huge difference on the country’s public health policies in preventing contagious diseases. Therefore, it brings us to a more important question; to what extent can public skepticism towards vaccination challenge the scientific authority in the United States?

Vaccine Laws and Exemptions in the United States

In order to understand how big this matter is, one should be clear on the country’s vaccination laws and its implementation, thus giving the sense on how this issue can arise.

During its history, the United States outlined laws mandating the vaccination for chickenpox. By 1922, some states had passed laws requiring that children have to be vaccinated for chickenpox in order to attend school. By the early 1980’s, the CDC (Center for Disease Control and Prevention) recommended that children get 23 doses of seven different vaccines; polio, diphtheria, tetanus, pertussis, measles, mumps, and rubella, resulted to several states mandated the vaccines for children before they go to kindergarten. The policy went on until the year of 2014, the CDC recommended that children get 69 doses of 16 vaccines between day of birth and age 18 [4].

Even though the CDC puts their recommendation to the public, each state can choose their own way in implementing the policy and decide on which vaccines are required. For example, many states mandated that children get 29 doses of nine vaccines in order to attend kindergarten [4].  However, the country is currently giving exemptions from vaccination to the public, thus acknowledging individual freedom in this case. The exemptions includes medical, religious, and personal belief reasons. [4].

Some states like Montana, New York, Pennsylvania, and Nebraska decided to restrict the exemptions excluding personal belief from the list [5]. In fact, due to the rising outbreaks around the country including the one that occurred in Disneyland, California this year, a pediatrician politician intended to introduce new legislation to restrict more of the exemptions. Even after he lobbied in 2013 to pass a bill restricting non-medical vaccine exemption in California [6].

The Exemptions are the Reasons for the Outbreak?

I was not surprised to see how the Disneyland measles outbreak could happen since more parents decided not to vaccinate their children against the disease, as they personally believed it will cause side effects like autism [7]. In fact, the CDC already declared that measles was eliminated from the United States in the year 2000, yet the incident proved that the disease can reemerge into the population when the herd immunity becomes low [1].

The hypotheses that relates the current outbreaks with the exemptions seems to be reasonable and convincing for most of the people in the health care field. Its relationship with the level of herd immunity always being used as the relevant explanation to this issue. Yet, statistical facts disproved the relation, thus putting doubts to the claim.

In 2014, there were 644 cases of measles reported in the United States, even though 95 percent of the children in this country have gotten two doses of the MMR vaccines [1]. The same thing for school children from the age of 13 to 17 years old that were reported to be 92 percent vaccinated against this disease [8]. In fact, in some states, it shows that the MMR vaccination rate is approaching 100 percent [9]. Again, the country still reported a significant number of measles case.

Therefore, by looking at the level of vaccination in the United States, it is sensible to conclude that this country is a very highly vaccinated population, yet the measles outbreak could be happened. Thus, it puts doubts to the claim that MMR vaccine is effective enough to eradicate the disease from the population, and opposing the hypotheses that the exemptions is contributing to the outbreaks.

The People’s Concerns

The concern from the anti-vaccine movement is a significant thing to be discussed, as their concern is not only confined to refuse total vaccination. In fact, most of them decided to partially vaccinate their children. They want to know why there are too much vaccines that have to be vaccinated too early to their children. Over three decades, the CDC increased the vaccine recommendation from 23 doses to 69 which they found irrelevant. If the quality of their health care has improved over the decades, why they need too much vaccines? If the disease of polio has been eradicated all over the world for 99 percent, why they still have to vaccinate their children for polio? These are the questions that the public needs the government to answer, as they believed that the excessive vaccination only brings profit to the pharmaceutical companies.

The Challenges to the Vaccine Surveillance Systems

A good surveillance system for vaccine is very crucial in analyzing and determining the best vaccine policy to be implemented in America. Furthermore, the systems for safety surveillance are already existed in some developed countries like the United Kingdom and Canada [10].

In the United States, the Vaccine Datalink (VSD) project; a collaborative research enterprise between the CDC and health maintenance organizations (HMO) was already started in 1990 [10]. In the VSD, the patient encounters and diagnoses can be linked to previous vaccine or drug exposures via a patient-specific study ID. In other words, the VSD provides a huge database for the experts to assess the temporal relationship between vaccine exposure and new onset of specific diseases.

This system was established in order to replace the previous passive system, the Vaccine Adverse Events Reporting System (VAERS) that fully depended on reports that were voluntarily submitted by people that experienced the side effects of vaccines. As the result of this new system, the factor of biased comparison groups could be eliminated [10].

Still, there are a few additional requirements need to be met in order for the system to be effective enough to ensure the vaccinations are implemented properly.

1. The data used for this surveillance activities needs to be readily available over time so that the repeated and current epidemiologic evaluations can be done, thus provide a relevant information for the policy makers to determine the suitable vaccine policies.

2. Advanced expertise in biostatistical methodologies are essential in order to conduct a high quality surveillance system. The huge data obtained from the VSD will require many experts in that field, like biostatisticians.

3. It is important for investigators that investigate an outbreak to be independent without any political affiliation. Thus, they can discuss openly their findings without any pressure to attain any particular conclusions that might have significant economic, policy or political effects.

 The Challenges to Educate the People

For the government, the rising number of parents that refused to vaccinate their children will put the country at high risk. Outbreaks and reemergence of rare contagious diseases can happen anytime and anywhere as the herd immunity becomes low. Yet, by forcing the people for vaccination will cause more protests, thus violating the individual freedom in that country.

The challenge for the government to educate the people becomes greater as social media plays a crucial role in shaping the way people perceive vaccination. The public can access any information that they need in order to justify their decision, thus increasing the tendency for information distortion and bias. In fact, the public tend to trust more to viral videos that showed a small portion of the population that showcased vaccine’s side effects, rather than scientific explanations given by the authority like the CDC.

In order to regain public confidence to vaccination, the policy makers need to compete with the social media. Any conventional approaches in delivering the information like distributing pamphlets or fully depending on the official website seem to be ineffective in this effort. It is the time for them to change the way and find another creative alternative to educate people, or let public skepticism override their scientific authority.

The public need to be educated so they know that they are not living in a ‘bubble’ that can protect them from the contagious diseases. They should know that vaccines cannot be treated the same way as drugs, as it signifies a public responsibility when their children are vaccinated. When each child is vaccinated, more people will be protected as the herd immunity becomes stronger. However, the government should convince the people that vaccination is not another platform for the elites to make money by manipulating people’s needs.

Conclusion

The battle whether to impose vaccination or not is not new. In fact, the issue is older than the United States itself. Nevertheless, the challenges become greater as the world is facing a rapid change in information sharing, thus challenging the government and policy makers to catch up with it. The issue of public skepticism on vaccination is a big matter to be concerned about, thus calling for the government to consider for any changes to its current vaccination laws and policies. However, the government and the anti-vaccine movement can decide to continue the ‘war’, compromising with each other’s demands. By that time, the real ‘enemy’ is waiting, and they will come at the right time to invade and start a new outbreak, thus putting a risk at the most fragile portion of the population, which is the children.

Nur Hanis is an Analyst at IRIS Institute and a junior year student at Michigan State University majoring in Genomics and Molecular Genetics. She is currently taking double minors in Sociology and Science, Technology, and Environment Public Policy (STEPP). Her experiences worked with NGOs like MERCY Malaysia and other international volunteer organizations in her university put her interest on the impacts of public policies on society, especially in public health care. Her first work criticized the impact of public health policies in the United States on the American social structure was presented during English and Writing Week in Michigan State University during her freshman year.

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