Experts urge vaccination as U.S. measles cases top 1,000

How best to encourage vaccination?
In two commentaries Tuesday in the New England Journal of Medicine, several US experts addressed the complexities of mandating vaccination to prevent diseases like measles.

In the first one, Julie Cantor, MD, JD, of the University of California Los Angeles School of Law, dissects the “bold experiment” of barring unvaccinated students from all schools in Rockland County and mandating measles, mumps, and rubella (MMR) immunization in the Brooklyn borough of New York City in response to those large outbreaks—and she warns that the efforts might at least partially backfire.

In response to New York City’s approach, Cantor cites several legal issues to forced vaccination, including whether children and parents can be restrained, whether families that relocate from Brooklyn risk extradition, and if a second dose should also be mandated. She also asks why officials should wait for an outbreak when hot spots are predictable.

“In my view,” she writes, “the option should be reserved for extraordinary cases, in which the risk of death or disability is overwhelming, after less intrusive options have been exhausted. Though the benefit is clear, I am not convinced that measles prophylaxis meets that test.”

Cantor also argues that, even without forced vaccination, an order against attending school, for example, can be problematic. “A combative stance can stigmatize insular communities, like the Jewish sects tied to the New York outbreaks. Rocky rollouts in both areas of New York State, like changing previously announced orders or instituting bans that lack scientific support, do not inspire confidence. If vaccine hesitancy is linked to distrust of government, these missteps exacerbate that problem.”

She also noted that, by May 29, New York City had issued 123 civil summonses for noncompliance with its order—evidence of defiance. And she says that emergency edicts might not even increase vaccination rates.

Cantor concludes that other measures might serve health officials’ aims better.

“Law shifts culture best through incremental change,” she writes. “To reset vaccination norms, state legislatures could lower the age of consent, eliminate nonmedical exemptions to school-entry vaccination laws, and develop oversight mechanisms for medical exemptions. The federal government could fund research on combating vaccine disinformation.”

She says New York City’s order, though well-intentioned, might have unintended consequences, like impairing government’s relationship with citizens and undermining their sense of security.

The second commentary spotlights the issue of vaccinating teens and preteens over their parents’ objection—such as when, in March, an Ohio high school senior in testimony before the US Congress argued for such a right.

The viewpoint authors—from the Richard M. Fairbanks School of Public Health and Robert H. McKinney School of Law at Indiana University, Indianapolis; the Department of Pediatrics, University of Washington School of Medicine in Seattle; and the Rollins School of Public Health at Emory University in Atlanta—likewise favor the rights of children and adolescents over their parents’ rights, for the good of the public’s health.

The experts conclude, “Allowing adolescents to consent to vaccination despite persistent parental resistance facilitates access to a medically recommended and evidence-based treatment. It promotes the minor’s health, poses minimal personal risk, and offers substantial prosocial benefits, including reinforcement of the norm of vaccination and enhancement of community protection against the spread of dangerous and costly yet preventable diseases.

“Given such benefits, we believe that states should enact laws that expand both access to vaccines and the rights of minors who are at least 12 to 14 years of age to consent to vaccination.”