Nonmedical exemptions to mandatory vaccination: Personal belief, public policy, and the ethics of refusal

Three Shots at Prevention: The HPV Vaccine and the Politics of Medicine's Simple Solutions

Volumn , Issue , 2010, Pages 196-212

  Berlinger, Nancy ^a   Jost, Alison ^b  

^a HASTINGS CENTER   (United States)

^b YALE UNIVERSITY   (United States)

Author keywords

[No Author keywords available]

Indexed keywords

EID: 84895024082     PISSN: None     EISSN: None     Source Type: Book    
DOI: None     Document Type: Chapter

References (38)

1. Centers for Disease Control and Prevention, "National Immunization Program: Guide to contraindications to vaccination", Sept. 2003, www.cdc.gov/nip/recs/contra indications-guide.pdf.
2. The National Conference of State Legislatures counts twenty states as offering "philosophical" exemptions: Arizona, Arkansas, California, Colorado, Idaho, Louisiana, Maine, Michigan, Minnesota, Missouri, New Mexico, North Dakota, Ohio, Oklahoma, Pennsylvania, Texas, Utah, Vermont, Washington, and Wisconsin; see D. Grady, "Measles in U. S. at Highest Level since 2001", New York Times, May 2, 2008.
3. D. A. Salmon, J. W. Sapsin, S. Teret, R. F. Jacobs, J. W. Thompson, K. Ryan, and N. A. Halsey, "Public Health and the Politics of School Vaccination Requirements", American Journal of Public Health 95(2005):778-783.
4. D. A. Salmon and A. W. Siegel, "Religious and Philosophical Exemptions from Vaccination Requirements and Lessons Learned from Conscientious Objectors from Conscription", Public Health Reports 116(2001):289-296.
5. National Conference of State Legislatures, HPV Vaccine, www.ncsl.org/programs/health/HPVvaccine.htm. According to the Centers for Disease Control and Prevention (CDC), HPV infects approximately 20 million people in the United States and there are 6.2 million new cases each year. There are more than thirty strains of HPV that affect at least half of sexually active people in their lifetime. Most strains of HPV do not produce any symptoms and disappear on their own. Cervical cancer is the second-leading cancer killer of women worldwide. In the United States, nearly 10, 000 women are diagnosed with cervical cancer each year and 3, 700 women die. Most cases occur outside of the United States, where the Pap test is not available. If states make the vaccine mandatory, they must also address funding issues, including for Medicaid and State Children's Health Insurance Program coverage and youth who are uninsured, and they must decide whether to require coverage by insurance plans. The CDC makes the HPV vaccine available through the federal Vaccines for Children (V FC) program in all fifty states and in Chicago, New York, Philadelphia, San Antonio, and Washington, DC. VFC provides vaccines for children ages 9 to 18 who are covered by Medicaid or who are Alaskan Native or Native American children and for some other underinsured or uninsured children in this age range.
6. Centers for Disease Control and Prevention, "Outbreak of Measles among Christian Science Students-Missouri and Illinois", Morbidity and Morality Weekly Report 43(July 1, 1994):463-465.
7. Prince v. Commonwealth of Massachusetts, 321 US 158 (1944).
8. M. D. Hinds, "Judge Orders Measles Shots in Philadelphia", New York Times, March 6, 1991.
9. D. G. McNeil, "Worship Optional: Joining a Church to Avoid Vaccines", New York Times, Jan. 14, 2003.
10. T. Poling, "Vaccines, Autism, and Our Daughter, Hannah", New York Times, April 5, 2008.
11. J. Rovner, "Case Stokes Debate about Autism, Vaccines", NPR, March 7, 2008.
12. John Gilmore, executive director of the group Autism United, claimed, "For the first time the court has conceded that vaccines can indeed cause autism"
13. G. Harris, "Deal in an Autism Case Fuels Debate on Vaccine", New York Times, March 8, 2008.
14. The Immunization Safety Review Committee of the Institute of Medicine published eight reports over a four-year period. Each report refuted any causal connection between vaccines and harmful aftereffects (such as autism). The reports are available at www.iom.edu/?id=5977.
15. M. Hornig, T. Briese, T. Buie, M. L. Bauman, G. Lauwers, et al., "Lack of Association between Measles Virus Vaccine and Autism with Enteropathy: A Case-Control Study", Public Library of Science ONE 3, no. 9(2008):e3140 doi:10.1371/journal.pone.0003140.
16. J. Steinhauer, "Public Health Risk Seen as Parents Reject Vaccines", New York Times, March 21, 2008.
17. The CDC reports that 1 in 10 children with measles develops ear infections, 1 in 20 develops pneumonia, and 1 in 1, 000 develops encephalitis. CDC, www.cdc.gov/ncidod/dvrd/revb/measles/measles-general-info.htmec-5.
18. J. Barnard, "US Doctors Pay to Hear Ore. Town's Vaccine Views", Associated Press, Jan. 9, 2009.
19. See, for example, the Web sites of the National Vaccine Information Center, www.909shot.com/Default.htm, and of Mothering magazine, www.mothering.com.
20. Statistic cited by Saad B. Omer, Johns Hopkins Bloomberg School of Public Health, in Steinhauer, Public Health Risk, 2008.
21. Editorial, "We Must Vaccinate Kids", Los Angeles Times, April 29, 2008.
22. T. May and D. Silverman, "Clustering of Exemptions as a Collective Action Threat to Herd Immunity", Vaccine 21(2003):1048-1051.
23. Grady, "Measles in U. S. at Highest Level since 2001"
24. Centers for Disease Control and Prevention, "Update: Measles-United States, January 2008-July 2008", Morbidity and Mortality Weekly Report 57, no. 33(2008):893-896.
25. P. J. Smith, S. Y. Chu, and L. E. Barker, "Children Who Have Received No Vaccines: Who Are They and Where Do They Live?" Pediatrics 114(2004):187-195.
26. E. T. Luman, K. M. Shaw, and S. K. Stokley, "Compliance with Vaccination Recommendations for US Children", American Journal of Preventive Medicine 34, no. 6(June 2008):463-470.
27. The National Immunization Survey includes state-by-state comparisons of immunization rates, as well as vaccination rates for specific diseases and other data sets. CDC, www.cdc.gov/nis/.
28. N. Durbach, Bodily Matters: The Anti-Vaccination Movement in En gland, 1853-1907 (Durham, NC: Duke University Press, 2005).
29. H. Norman, "The News in London: Unvaccinated England", New York Times, Dec.18, 1898, 19.
30. W. A. R. Thomson, "Rider Haggard and Smallpox", Journal of the Royal Society of Medicine 77, no. 6(1984):506-512.
31. Durbach, Bodily Matters, 196-197.
32. For descriptions and analysis of recent conscientious-objection cases among soldiers serving in Afghan i stan and Iraq, see the 2007 documentary Soldiers of Conscience and its Web site, POV, www.pbs.org/pov/pov2008/ soldiersofconscience/update.html.
33. T. L. Beauchamp and J. F. Childress, Principles of Biomedical Ethics, 6th ed. (New York: Oxford University Press, 2009), 131.
34. National Vaccine Advisory Committee, "Standards for Child and Adolescent Immunization Practices", Pediatrics 112, no. 4(Oct. 2003):958-963;
35. the implementation guidelines (Maintaining Standards of Excellence: Part 6, A Series in Support of the National Vaccine Advisory Committee Standards for Child and Adolescent Immunization Practices) and related documents, including the "Refusal to Vaccinate" form, are available on the American Academy of Pediatrics's immunization Web site, www.cispim munize.org/.
36. S. Le Blanc, "Parents Use Religion to Avoid Vaccines", Associated Press, Oct. 17, 2007
37. E. A. Flanagan-Klygis, L. Sharp, and J. E. Frader, "Dismissing the Family Who Refuses Vaccines: A Study of Pediatrician Attitudes", Archives of Pediatrics & Adolescent Medicine 159(Oct. 2005):929-934.
38. Benjamin Levi, personal communication to Nancy Berlinger, Hershey, PA, April 2006. See also B. H. Levi, "Addressing Parents' Concerns about Childhood Immunizations: A Tutorial for Primary Care Providers", Pediatrics 120(2007):18-26