Countries like Italy and Australia are tired of measles outbreaks — so they're moving to fine anti-vaccine parents.
There’s a school of thought that refusing vaccines on behalf of your children amounts to child abuse, and that parents should be punished for their decision. We know vaccines are overwhelmingly safe and effective at preventing the spread of disease. And yet failing to immunize children can put them (and vulnerable people around them) at tremendous risk of illness or even death when outbreaks get rolling.
Now it seems Australia and a number of countries in Europe are fed up enough with vaccine-refusing parents that they’re experimenting with punitive measures. We haven’t quite reached the level of child abuse charges, but moms and dads in these countries may face fines if they fail to give their kids the recommended shots. In Australia, the directors of schools that let the unvaccinated kids in would be fined too.
This marks a pretty aggressive shift in how we manage vaccine refusers and the costly, deadly outbreaks of diseases like measles and whooping cough they help spark.
Here’s a quick roundup of the global crackdown on vaccine-refusing parents:
- Italy’s parliament passed a law this summer that makes 10 childhood vaccinations mandatory for kids up to age 16, and requires parents to prove their children are immunized before entering school or else face a €500 (about $600 USD) noncompliance fine.
- Germany is also cracking down on vaccine-refusing parents: Its parliament approved a law that obliges administrators at kindergartens to report parents who refuse counseling from their doctors about vaccines. Health ministries can then also fine the vaccine-hesitant parents up to €2,500 (about $3,000 USD).
- In France, the health ministry is making 11 vaccines — up from the current three (diphtheria, tetanus, and polio) — mandatory for children by 2018, though there’s no talk of a fine there yet.
- In Romania, the government recently adopted a draft bill that requires parents prove their children are vaccinated before kids can go to school.
- Further afield, New South Wales Australia passed “no jab, no play” legislation in September: Effective January, the law bans unvaccinated kids from preschool and day care and fine the directors of schools that admit un-immunized children $5,500 Australian dollars ($4,400 USD). The law in South Australia is modeled on similarly stringent laws in other Australian states, and across the country, parents with children who aren’t immunized aren’t eligible for child care benefits.
Europe has long struggled with a vaccine mistrust problem (more on that here), and these new laws and policy proposals arose in the context of ongoing, unprecedented measles outbreaks across the continent. Italy has recorded more than 4,400 measles cases this year and three deaths — including one in a child whose immune system was compromised because of chemotherapy for cancer. Romania, meanwhile, has been battling Europe’s deadliest measles outbreak, with more than 8,000 cases and 32 deaths since January.
Australia has also dealt with its share of vaccine-preventable disease outbreaks, and the government crackdown is part of a push to get 95 percent of Australian children vaccinated with routine immunizations, above the current rate of 93 percent.
Before we consider punishing American parents, we might try this
The anti-vaccine landscape in America isn’t all that different. Here, vaccine skeptics have also been persuading more parents in a number of states to refuse shots for their children. So is the US ready for a similar crackdown?
“I think we're not there in the US, unless there is an outbreak of a serious epidemic requiring a public health emergency,” said Baylor College infectious disease researcher Peter Hotez.
Punishing parents for doing things that could harm their kids is not without precedent in the US, either. For example, there are laws in various states requiring parents to use car seats or seat belts for their children or else pay a fine or be docked driver's license points. Same goes for firearm storage laws.
But before we start fining anti-vaxxers, there are some much more basic steps the US could take that would improve vaccination rates. And they involve simply making it harder for parents to opt out of routine shots on behalf of their kids. California offers an instructive example of what that could look like for the rest of America.
The US is currently a patchwork of vaccine laws, and states with tougher laws have lower rates of vaccine refusals
Vaccines fall under the public health jurisdiction of the states. And there’s currently a lot of variation across the US when it comes to immunization requirements.
All 50 states currently have legislation requiring vaccines for students — but almost every state allows exemptions for people with religious beliefs against immunizations, and 18 states grant philosophical exemptions for those opposed to vaccines because of personal or moral beliefs. (The exceptions are Mississippi, California, and West Virginia, which have the strictest vaccine laws in the nation, allowing no philosophical or religious exemptions.)
“States expect that in order to access public resources, like schools, camps, or child care centers, individuals must give up some autonomy to make sure everyone in the community is safe,” said University of Colorado Denver sociologist Jennifer Reich, who studies the anti-vaccine movement.
Perhaps unsurprisingly, the parts of the country that make it easier for people to opt out of their shots tend to have higher rates of ... people opting out of vaccines. So a lax regulatory environment can create space for more parents to refuse vaccines.
California has made it tougher to opt out of vaccines — with great results
Some states have been moving to crack down on this trend — most notably California — and they’re already seeing success in terms of boosting vaccine coverage rates.
California Gov. Jerry Brown signed a controversial bill in 2015 that required almost all schoolchildren in the state to be vaccinated, unless they have a medical reason for opting out. The law, SB277, was a response to a large measles outbreak that originated at the Disneyland theme park, and it means parents can no longer refuse to vaccinate their children for religious or philosophical reasons.
Early data from the California state health department suggest the law appears to have an impact — even before it went into effect. For the 2015-’16 school year, 93 percent of kids received all of the required vaccinations, up from 90 percent in 2014 and 2013.
Immunization rates in Mississippi and West Virginia — the other two US states with strict opt-out policies — suggest there are real public health benefits to making it harder for parents to refuse vaccines. In the 2014-’15 school year, more than 99 percent of kindergartners in Mississippi had their measles-mumps-rubella and diphtheria-tetanus-pertussis shots — the highest rate in the US. The rates for those vaccines were 98 percent for kindergartners in West Virginia. These figures are much higher than the national averages (85 percent for diphtheria-tetanus-pertussis and 92 percent for the measles-mumps-rubella vaccines).
So there’s a lot of room for improvement at the state level to toughen up vaccine requirements, even before the US starts considering fines.
“It's looking like in California, simply closing nonmedical exemptions is having a desired effect in terms of boosting vaccine coverage in public schools,” Hotez said. “Based on that evidence, I think that needs to be the focus — closing nonmedical exemptions in the 18 states that still allow it.”