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In 1998, British doctor Andrew Wakefield published a study in the British medical journal The Lancet that linked the measles, mumps, and rubella (MMR) vaccine to autism. Wakefield’s finding accelerated the growth of the anti-vaccine movement, which denies that vaccines are medically beneficial and claims that they only bolster big pharmaceutical companies. Despite the discrediting of Wakefield’s findings in 2010, suspicions of the MMR vaccine have taken on a life of their own and certain pockets of the United States have large groups of families who have chosen not to vaccinate their children. As a result, measles, which health authorities claimed had been eradicated in the United States in 2000, is making a comeback. In January, an unvaccinated woman at Disneyland in California caused measles to spread to more than one hundred people, and fears of widespread disease outbreaks due to people not being vaccinated has caused a political firestorm. As a result, extempers should be prepared to talk about the vaccination issue in future rounds.
This topic brief will provide some historical background of the MMR vaccination debate, discuss the political dimension of the issue, and breakdown possible policies that could be implemented to reduce the number of Americans that are not vaccinating their children.
Readers are also encouraged to use the links below and in the related R&D to bolster their files about this topic.
History of the MMR Vaccination Debate
The first measles vaccine was developed in 1963. Prior to this point, according to the Pew Research Center on February 2, it was not uncommon for the United States to have hundreds of thousands of cases of the virus. Measles causes the affected individual to run a fever, cough, and develop a red rash on their body. In serious cases, the virus can cause blindness, inflammation of the brain, and pneumonia. CNN notes on February 4 that one out of every twenty children that acquire the measles gets pneumonia, which leads to two of every 1,000 children that acquire the virus to die each year. The New York Times writes on January 28 that before the measles vaccine – referred to now as the measles, mumps, and rubella vaccine (MMR) – was developed in 1963, four to five million Americans a year got the virus, with 400 to 500 dying. Pew Research Center argues that after the MMR vaccine became common the number of measles cases dropped significantly. For example, in 1958 the United States saw 750,000 cases, but by 1968 the number dropped to 22,000. By 2000, measles cases were so rare that it was deemed eradicated from the United States. This does not mean that the country was completely rid of measles, but health authorities were confident that the virus was no longer within the country’s borders. The New York Times explains that since 2000 the U.S. has seen cases in Utah, Washington, Oregon, and Colorado, but these were very isolated. However, last year there was a growth in measles cases in the United States. Pew explains that in 2014 the United States saw more than 600 cases, which were linked to unvaccinated Amish communities in Ohio and cases that came into the country from the Philippines. The Huffington Post writes on February 4 that the number of measles cases reported in 2015 has already surpassed 100, due largely to an outbreak at Disneyland in California that came from an unvaccinated woman. The virus has spread from there to fourteen states and Mexico.
So why are the number of measles cases rising when the MMR vaccine is available and health authorities were confident that they had eradicated the virus? Part of the reason is due to a growing resistance by parents to have their children immunized with the vaccine. The Washington Post writes on January 23 that in 1998 the British medical journal The Lancet published a study from doctor Andrew Wakefield. Wakefield studied twelve children and concluded that the MMR vaccine could produce bowel disorder and autism. Media outlets in the United States and throughout the world reported Wakefield’s findings and panicked parents began to resist the urging of their doctor’s to vaccinate their children. In subsequent years, media personalities such as Katie Couric and Jenny McCarthy, as well as former Minnesota Congresswoman Michele Bachmann spread the word that vaccines could be dangerous and some of their supporters took their warnings to heart. There was only one problem with all of this, though: Wakefield’s findings were discredited in 2010. British medical officials found that Wakefield manipulated the data in his study and that he received $600,000 from lawyers seeking to identify a link between the MMR vaccine and childhood disorders. The Lancet went on to retract Wakefield’s study and in May 2010, British medical officials revoked his doctor’s license. Nevertheless, Wakefield has continued to give speeches about his research, and his supporters allege that attacks against him are motivated by powerful pharmaceutical interests.
Even before Wakefield’s findings came disseminated, there were other media reports that created concerns about vaccinations. The Los Angeles Times notes on January 27 that in 1982, an NBC report warned Americans about the side effects of the pertussis vaccine, which guarded against whooping cough. As a result of the report, doctors got into fights with mothers over the necessity of vaccinating their children. Elena Conis of Emory University has written a book entitled Vaccine Nation: America’s Changing Relationship with Immunization that documents these battles, arguing that anti-vaccine culture is rooted in modern feminism, with women remembering the negative side effect of birth control pills that some medical officials hid from them in the 1960s and 1970s, and the modern environmental movement, which warned that the risks of using new technologies such as DDT and asbestos was only revealed once those technologies were put into action. The hysteria about vaccines was compounded by the way media portrayed the issue. The Economist on February 5 alleges that when news media argue that there is a “vaccination debate” that they give legitimacy to both sides, thereby complicating efforts by medical officials to get proper facts to families.
Those who receive the MMR vaccine are typically between nineteen and thirty-five months of age. All states have a requirement that children who attend public school be vaccinated. The Supreme Court upheld these policies in 1922. The 1922 decision stemmed from a precedent in the case of Jacobson v. Massachusetts in 1905 when the Court ruled that states could legally mandate that their residents receive vaccinations. The public school vaccination requirement is in place to protect children who cannot be vaccinated for medical reasons, largely due to immune system deficiencies. The Atlantic explains on February 5 that vaccinations only work if enough people get them. This creates what is called herd immunity, which can stop viruses from spreading between enough people to prevent a widespread outbreak, thereby helping to protect those who cannot be vaccinated. Medical officials argue that 92% of a given population needs to be vaccinated against a disease to foster herd immunity, with that number rising to 95% if the virus in question is highly contagious. However, there are exemptions available to parents if they do not vaccinate their children. The Atlantic goes on to say that by 1970 states had policies that allowed people to claim a religious exemption from vaccination, with most of these policies requiring families to receive documentation from a religious official. However, courts found some of these policies unconstitutional because it gave the state a role in determining which religions were valid, thereby violating the First Amendment. In response, states crafted exemptions for individual beliefs and today, nineteen states allow for broad exemptions that encompass religion or personal belief. Only two states – Mississippi and West Virginia – prohibit exemptions on any ground except for medical reasons.
One of the alarming aspects of policies that allow for broad exemptions for personal belief, and even religion, is that they are poorly enforced. The religion issue is problematic because, as Slate notes on February 5, states such as Florida do not require any proof of a family attending a certain religious institution (once again this is likely due to avoiding First Amendment issues). Connecticut also makes families fill out a simple form. Slate goes on to explain that the idea that certain religions do not want their followers vaccinated is problematic because there are lots of conflicting voices within religions about vaccination. For example, Jehovah’s Witnesses oppose blood transfusions, but do not oppose vaccinations. Elements of the Dutch Reformed Church and Christian Scientist branches are divided about whether vaccinations interfere with one’s relationship with God or whether vaccines are a gift from God that should be used. The Los Angeles Times also notes on February 2 that in California families can enroll their children in public school without all of their vaccinations, promising to get them later. However, the California Department of Public Health recently stated that schools rarely follow up on these so-called “conditional” enrollees, thereby allowing some families to get around the vaccination requirement. Part of this is blamed on the lack of school nurses in the state’s schools, as most schools used to have them but no longer due as a result of budget cuts. In addition, The Huffington Post explains on February 5 that 50% of American states do not require home-school students to be vaccinated, which is a concern because a growing number of American schoolchildren – 3% as of 2011-2012 – are home-schooled. Critics argue that this is a public health concern because in 2013, Texas had a measles outbreak that was linked to home-school students.
All of these forces have combined to lower the vaccination rate in recent years. The Wall Street Journal explains on February 4 that 91.9% of children between nineteen and thirty-five months of age were given the MMR vaccine. This is above 2000 levels, when 90.5% of American children in that age group received the vaccine, but down from 2006 levels, when 92.3% of Americans received it. Medical experts are alarmed at the low rates of vaccination in some states such as Montana (87.3%), Ohio (86%), and West Virginia (86%). The Centers for Disease Control and Prevention (CDC) also notes that Ohio, Missouri, West Virginia, Connecticut, and Virginia have seen declines of 5% or more among vaccinated children between 2006-2014. With seventeen states having less than 90% of children vaccinated with MMR there are worries that outbreaks could occur because this is below the 92% herd immunity threshold. These worries extend to public schools as Oregon, Idaho, Michigan, Vermont, and Maine have more than 5% of children enrolled in kindergarten that have not been vaccinated as a result of a choice made by their parents.
The Political Dimension of the Vaccination Controversy
With growing medical concerns over the lack of vaccinations for children, combined with the Disneyland measles outbreak, the vaccination issue has become a political one. Politico explains on February 2 that President Barack Obama used time during his Super Bowl pregame interview on NBC to encourage parents to get their children vaccinated. The President argued that the science behind vaccinations is “pretty indisputable.” Former Secretary of State Hillary Clinton also urged parents to vaccinate their children, taking to Twitter to tell followers that “The science is clear: The earth is round, the sky is blue, and #vaccineswork. Let’s protect all our kids. #GrandmothersKnowBest.”
In contrast, Republican presidential contenders stumbled when it came to the vaccine issue last week. The Guardian writes on February 3 that Kentucky Senator Rand Paul ignited a firestorm when he told CNBC that parents needed to be given input into whether their children were vaccinated and that vaccines could produce “profound mental disorders.” Political analysts warned that vaccines present a problem for Paul’s political views as he wants to appear libertarian, which would welcome more parental choice, while not appearing radical by disregarding established science. The New York Times on February 4 explains that Paul later walked back his comments, getting a hepatitis A booster on Capitol Hill while being photographed by a Times reporter. Paul said that he finds the science behind vaccines as definitive and that he has vaccinated his children, but the Times went on to explain that when he ran for the Senate in 2009 he spoke to the Association of American Physicians and Surgeons (AAPS), a group that has warned against vaccinations and says that there is a risk of breast cancer for women who get abortions.
New Jersey Governor Chris Christie also erred when he called for “balance” in the debate over whether children should be vaccinated, arguing that parents “need to have some measure of choice.” Politico on February 3 explained that this is not the first medical controversy for Christie, who got into a fight with federal officials over Ebola last year when he attempted to forcibly quarantine a nurse who returned from West Africa. In an interesting twist, the nurse that Christie had quarantined argued that it was necessary for children to be vaccinated, thereby putting she and Christie on opposite sides of a medical question once again.
Politico on February 4 recapped the positions of other Republican presidential hopefuls, who took different stands. Texas Senator Ted Cruz said that he believes in vaccinations, although he says it is best for states to create a policy that best suits them. Former Texas Governor Rick Perry said that immunizations rose in his state, although The Huffington Post on February 4 argues that he signed into law legislation allowing people to claim a vaccine opt-out for their children on the grounds of personal conscience (Governor Perry’s defenders say that he had to sign the bill to get other healthcare reforms enacted in Texas and could not eliminate this provision in question because he did not have a line-item veto). Former Florida Governor Jeb Bush, one of the frontrunners for the Republican nomination, argued that vaccination policy should be a settled issue and The Hill writes on February 2 that Dr. Ben Carson says it would be silly for people to neglect to vaccinate their children.
It would be easy to argue in a speech that the vaccine debate has the potential to alienate the Republican brand from moderate voters, who might take the comments by Christie and Paul as unscientific and irrational. However, things are much more nuanced than that. Both President Obama and Secretary Clinton raised concerns about vaccines in their 2008 presidential run. For Clinton’s part, she floated the idea of having more investigations into whether there was a link between MMR and autism. This was something that conservative bloggers raised last week in response to Clinton’s tweet.
Nevertheless, while it is unlikely that vaccines will become an issue for the 2016 presidential campaign, Democrats and Republicans want to be careful not to appear as “science deniers.” Such rhetoric rarely meshes with the American public and this is a bigger concern for Republicans as they have a base with some elements more skeptical of science. In addition, conservative anxieties about government control play into the vaccine debate, with some favoring parental choice because they do not want the government interfering unnecessarily in the parent-child relationship (this is why the Republicans scoffed at Clinton’s suggestion in the 1990s that “it takes a village” to a raise a child). The Pew Research Center finds that Democrats are more inclined to favor the government over parents, with 22% saying parents should have a role in vaccinating their children versus 34% of Republicans and 33% of independents. Therefore, the debate about vaccines might tie into other issues that have a scientific dimension for 2016, which could include stem cell research and climate change. It could also factor into libertarian fears of a large, powerful government, which ties into hostility toward the Affordable Care Act.
Policies to Enforce Vaccinations
Aside from the politics of the issue, extempers also need to be aware of ways that state or local officials could move to confront the vaccination problem. Knowing about the different ways to enforce vaccinations can help extempers answer “How” and “What” questions on the topic.
One way that states can work to fix their policies is to tighten the requirements for obtaining a non-medical exemption. Although states might be on shaky constitutional ground to completely eliminate their religious exemptions, states such as California are making it more difficult for people who have a non-medical and non-religious exemption. In January 2014 the state enacted legislation that requires parents to receive a doctor’s signature if they wish to not vaccinate their children. Before signing, doctors have to inform parents about the risks of not being vaccinated. The Los Angeles Times on January 27 says that this policy has resulted in a slight uptick in vaccination rates for the first time in a decade.
Another solution is for states to completely eliminate personal belief exemptions. This would apply to the nineteen states that allow for exemptions on non-medical and non-religious grounds, yet it could produce a problem for state legislators. One of the interesting things about vaccination is that conservative areas are not necessarily leading the anti-vaccination movement. Politico explains on February 3 that non-vaccination rates are actually rising in liberal areas. Nevertheless, legislators have to ponder whether a complete elimination of personal belief policies would be okay with voters. California is now moving after the Disneyland incident to eliminate its personal belief exemption, but it is unclear whether it will pass the state legislature. If measles continues to become a public health problem it is likely that more states will eliminate their personal belief exemptions, but going on a state-by-state basis might take more than a decade.
Since changing state policy might take time, and since the federal government has limited influence in education because it is not an expressed power granted to the federal government in the Constitution, the battle over vaccinations might take place at the local level. The Globe & Mail reports on February 5 that the vaccination debate has become a full-fledged culture war and local battles will likely increase between the parents of unvaccinated children and those whose children cannot be vaccinated for medical reasons. This is already starting to play out in California where a father of a six-year-old boy in a Marin County school is pushing that school district to prohibit children who are not vaccinated for anything other than a medical reason from attending classes. The boy in question is recovering from leukemia and has an immune system that is still too weak for the MMR vaccine. The justification for such a far-reaching policy would be to establish a safe level of herd immunity. Opponents of a far-reaching prohibition like the one suggested would say that their personal choice in being violated. Some have even gone so far as to adopt liberal language, saying that their choice not to vaccinate their children is about “diversity” and that schools need to be tolerant of their views. Just as sex education and textbook battles were prominent on the local level in school districts such as Anaheim’s in the 1960s and 1970s, vaccinations may become the new battleground in America’s ever changing culture wars. Thus, as extempers follow this issue, they may want to pay attention to what local school districts are doing.
One final piece of advice that I would give extempers facing a question on vaccinations is to make sure to explain both sides. This is a great strategy for a domestic social question. Although in this case, I would recommend it not because you do not want to offend a judge, but more so that you can best explain why the anti-vaccine campaign has the views that it does. If you can breakdown their views and illustrate why they are grounded in misrepresentations of science, you can better justify why a certain vaccination policy is in the best interest of public health. Make sure to present the harms not vaccinating children can have on the country and if you have to recommend a policy, make sure you clearly state how it will solve those harms.