Jun 20, 2019

The intensifying national debate over vaccine exemption rules

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Data: Immunization Action Coalition; Map: Aïda Amer/Axios

As measles spreads and public officials try to prevent the disease from becoming endemic in the U.S. again, a debate is heating up nationally over whether to mandate vaccines or keep in place laws that allow for more individual choice.

The latest: Anthony Fauci, head of the National Institute of Allergy and Infectious Diseases, tells Axios instead of mandating vaccines, it's time for states to tighten their exemptions — "the flexibility has gone too far."

Driving the news: Trust in government and in the health care system tends to be linked to people's belief that vaccines are safe, according to Imran Khan, Wellcome Trust's head of public engagement, who discussed their Global Monitor Report on a panel on Wednesday.

  • But, the report also found highly industrialized nations — particularly in France, U.S., U.K. and Japan — showed a relatively high level of distrust in vaccine safety, mostly due to what Khan calls the "complacency effect."
  • The problem is high-income people are living in nations where the disease hasn't been endemic for a while and forget how bad the illness can be. And this is compounded by feeling the health care system is "robust" enough to heal them when they do get sick, Khan adds.
  • Of note: The report was based on a large Gallup World Survey conducted in 144 nations of more than 140,000 people 15 years and older. Methodology is here.

The big question: Agnes Binagwaho, a Rwandan pediatrician and the vice chancellor of the University of Global Health Equity, asked her fellow panelists at the Wellcome briefing...

"All those people who discredit vaccination — and kill people — why don't you make them accountable?"

This led to a panel discussion on whether vaccines should be mandated.

  • Binagwaho said, "Never make them mandatory, create the demand [instead], because [making it mandatory] is believing they are bad parents, and that's just not true." (Rwanda has one of the highest levels of trust on vaccination safety, at 94%. This compares with North America at 72%, per the survey.)
  • Julie Gerberding, EVP and chief patient officer of Merck, said the exemptions have led to a rate of immunization lower than society needs to protect its citizens, but more attention must be paid to "understand what the hesitation is all about ... but at the end of the day, children need to be protected."
  • Khan pointed out that "even if we want to go down that route [of mandatory vaccinations], we'd still have to care about people's perceptions."
  • Mae Jemison, who's the first woman of color in space and principal of the 100 Year Starship Initiative, said, "It's a difficult problem ... I've started to fall down on the side of ... mandatory in places where it will do harm to others if this group of people [is] not vaccinated. However, I think one of the major issues we're seeing is that the scientific, medical and governmental community has been very poor at responding to false information and telling the story in such a way that people understand."

Fauci said philosophical and religious exemptions need a "good look."

  • "If you look closely at religious exemptions, a lot of people are really claiming philosophical exemptions" because the religious mandate may not be there, Fauci says. New York is working on this topic with the Jewish community there.
  • Philosophical exemptions in particular need to be tightened, he added. "We can't have that and have a health care situation that's gotten out of control."

Seth Berkley, CEO of Gavi, the Vaccine Alliance, who also was not part of the Wellcome report, agreed that the Western world has a level of complacency that's allowed an "environment where misinformation can spread" about vaccines.

  • Another interesting finding from the report, he pointed out, is that people worldwide with the lowest household income also had less confidence in hospitals and health care systems.
  • "This could be a problem" in the U.S., Berkley added, as "this is the community leading some of the populist movements in some places" when people feel disenchanted with the governmental system.
  • Regarding the question on making vaccinations mandatory, "I personally think that is a good strategy, but it's really hard for me to say ... every society needs to decide on that."

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Illustration: Sarah Grillo/Axios

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