The Politics of Vaccines and Vaccine Refusal

Politicians Influence Vaccine Rates Beyond a Few Silly Soundbites

An aerial view of a crowd waiting for polio vaccines in San Antonio, TX in 1962.
An aerial view of a crowd waiting for polio vaccines in San Antonio, TX in 1962. Photo courtesy of CDC/Mr. Stafford Smith

Thanks to generally high vaccination rates in Texas, a quick response from local and state health departments, and a few vaccination clinics at the megachurch that was at the center of a 2013 measles outbreak, the case count in a North Texas measles outbreak topped out at "just" 21 confirmed cases.

The outbreak did give Rep. Louie Gohmert, a Texas Republican congressman, a chance to push a anti-vaccine myth about Bill Gates, agreeing that it was a "scary thought" when Alan Keyes said that "Bill Gates gave a famous talk back in 2009, which he was talking about actually abusing vaccinations, which are supposed to keep people healthy and alive, and saying how this could lead to a 15 percent reduction in the population of the globe as a way to achieve this result."

Anti-Vaccine Political Sound Bites

Of course, Louie Gohmert isn't the first politician to make anti-vaccine comments and push misinformation about vaccines. Everyone still remembers the anti-vaccine comments made by then Republican presidential candidate hopeful Michele Bachmann, who implied that there was an association between the HPV vaccines and mental retardation because she was told that a little girl "took that vaccine, that injection, and she suffered from mental retardation thereafter."

Rep. Dan Burton, a Republican, also believed that vaccines caused autism, so much so that he endorsed and defended Andrew Wakefield.

More recently, several politicians have made headlines because of their comments about vaccines, including:

  • Sen. Rand Paul (R. Ky), when he said that "I have heard of many tragic cases of walking, talking normal children who wound up with profound mental disorders after vaccines" and admitted that he had his own children's shots "staggered" and thinks that vaccines shouldn't be mandatory.
  • Gov. Chris Christie (R. NJ), when he called 'for "balance" on the measles vaccine debate to allow for parental choice.' Upon clarifying his remarks, he almost seemed to be endorsing some kind of non-standard, parent-selected, delayed protection vaccine schedule - "it depends what the vaccine is, what the disease type is and all the rest."

    Not too surprisingly, Republicans haven't cornered the market on dangerous, anti-vaccine ideas. On the side of the Democrats, you can find Robert "Deadly Immunity" Kennedy, Jr. who pushed the idea that thimerosal caused autism. Of course, RFK, Jr. never did make it to office, he is just a lawyer, so his family pedigree aside, I'm not sure he has equal weighting to any elected officials.

    Fortunately, most politicians support kids getting vaccinated, from Senate Majority Leader Mitch McConnell (R-Ky.) to House Minority Leader Nancy Pelosi (D-Calif.). Protecting kids against potentially life-threatening, vaccine-preventable diseases is not usually a partisan issue.

    Even the idea that most anti-vaccine parents are liberals has been found to be false. One recent study found that except for outliers, members of all demographic and political groups "believe that vaccine risks are low, vaccine benefits high, and mandatory vaccination policies appropriate."

    Sure, we kind of expect some political people who routinely push conspiracy theories to push anti-vaccine ideas, such as Glenn Beck, when he pondered if there was a 'measles hoax' to get everyone to 'grab our children and obey the government.'

    Other conservative pundits that push anti-vaccine ideas include:

    On the other hand, Megyn Kelly at Fox News thinks that parents should vaccinate their kids, vaccines should be mandatory, and that measles vaccine safety is settled science.

    Of course, liberals do have Bill Maher...

    Vaccines and Politics

    Partly because of these types of ideas, we are still dealing with the consequences of the anti-vaccine drama that started in the late 1990's. In Europe, while they once had a goal for for measles elimination by 2015, they have stated what is now obvious, that "the prospect of achieving the 2015 objective is diminishing."

    Of course, in addition to an occasional sound bite, politicians have even more influence on people getting vaccinated through policies that affect access to vaccines, including those that increase or breakdown barriers to vaccination:

    • Thomas Jefferson, after getting a letter from Dr. Benjamin Waterhouse in 1800, helped in the effort to get people inoculated against smallpox
    • the Polio Vaccination Assistance Act was signed by President Eisenhower in 1955
    • the Vaccination Assistance Act was signed by President John F. Kennedy in 1962
    • Section 317 immunization program (now mostly used for those without public or private insurance) of the Public Health Service Act was established in 1963
    • President Jimmy Carter's National Childhood Immunization Initiative in 1977 which reached its goal of getting at least 90% of children immunized
    • President George H W Bush's immunization action plan in 1991 to once again raise immunization levels to 90% or more after they had fallen in the mid to late 1980s, with federal support for immunizations and vaccination coverage assessment activities reaching a low between 1986 to 1988, just before a resurgence of measles from 1989 to 1991
    • President Bill Clinton's Childhood Immunization Initiative in 1993, which helped preschool age children reach at least 90% immunization rates
    • the Vaccines for Children program (no cost vaccines for children with no insurance and some underinsuranced children that was created by the Comprehensive Childhood Immunization Act of 1993)
    • Obamacare (no insurance fees for vaccines)

    What is remarkable though, is that even in the face of some of the continued anti-vaccine sentiment from a small, but vocal group of people, a more quiet group is making the world a much healthier place for our children.

    It is estimated that worldwide, 548,000 children died of measles in 2000, and that number has already been reduced by 71%. With a little more work, they will hopefully have that number down by 95% in 2015 - the current goal.

    State Immunization Laws and Vaccine Exemptions

    Politicians also influence vaccination rates by creating compulsory immunization laws.

    We have also come a long way from when Boston, in 1827, became the first city to require all children attending public schools to be vaccinated against smallpox.

    Although many cities and states enacted their own laws, by 1969, only 27 states had state laws requiring immunization for a specific disease or diseases before children could attend public, private, or parochial schools. That jumped in the 1970s and 1980s, when health experts recognized a relationship between a lower incidence of measles (up to 51% lower) within states having school immunization laws.

    By 1982, all 50 states and the District of Columbia had school immunization laws. Dr. Walter Orenstein, Director of the National Immunization Program, Centers for Disease Control and Prevention (CDC), stated that these “school laws establish a system for immunization, a system that works year in and year out, regardless of political interest, media coverage, changing budget situations, and the absence of vaccine-preventable disease outbreaks to spur interest.”

    It is thought that this rise in school immunization laws helped to eliminate the endemic spread of measles, an extremely contagious disease that was mostly affecting younger school-age children.

    Laws that allow or limit personal belief vaccine exemptions for attending daycare and school also influence vaccination rates and muck up that system for immunization. In 1969, only five states seemed to have voluntary compulsory immunization laws. In Illinois, Michigan, Missouri, Ohio, and Rhode Island, children could be exempt from getting vaccines "if a parent objects in writing to such requirements for any reason."

    Once the measles outbreaks were over and the endemic spread of measles was declared eliminated in the United States in 2000, some people seemed to forget about the importance of high vaccination levels. Over just a few years, from 1998 to 2000, 15 states added personal belief vaccine exemptions.

    That is now up to 20 states, although in the wake of increasing measles outbreaks, some states are starting to rethink personal belief vaccine exemptions.

    Get Educated. Get Vaccinated. Stop the Measles Outbreaks.

     

    Sources:

    Calandrillo, S. Vanishing Vaccinations: Why Are So Many Americans Opting Out of Vaccinating their Children? University of Michigan Journal of Law Reform, Vol. 37, p. 353, 2004

    Kahan, Dan M. Vaccine Risk Perceptions and Ad Hoc Risk Communication: An Empirical Assessment. CCP Risk Perception Studies Report No. 17. Yale Law & Economics Research Paper # 491. January 27, 2014.

    Jackson, CL. State laws on compulsory immunization in the United States. Public Health Rep. 1969 Sep; 84(9): 787–795.

    Walter A Orenstein. The immunization system in the United States — The role of school immunization laws. Vaccine. Volume 17, Supplement 3, 29 October 1999, Pages S19–S24

    Wexler, DL. Ensuring Access to Vaccines Without Financial Barriers: View of Consumers. Pediatrics 2009;124;S567.

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