If only this were a non-issue

Over at Big Think, David Ropeik has some ideas for increasing vaccination rates.  (Via Andrew Sullivan.)

—   Perhaps it should be harder to opt out of vaccination. (Twenty-one states allow parents to decline vaccination of their children simply for “philosophical” reasons. 48 allow a religious exemption but few demand documentation from parents to support claims that their faith precludes vaccination.)

—   Perhaps there should be higher health care/insurance costs for unvaccinated people.

—   Or we could do it in a positive way, with reduced health care/insurance costs for people who do get vaccinated, ‘healthy behavior’ discounts paid for by what society saves by avoiding the spread of disease.

—   There could be restrictions on the community/social facilities unvaccinated people can use, or limits on the social activities in which they can participate, like lengthy school trips for kids, etc.

—   Here’s an idea; vaccination, including boosters, should be required of anyone who wants to work in health care.

Let me begin by acknowledging that I tend to return to this subject a lot.  I apologize if it is tiresome.  However, there are few things that have had such a positive impact on our collective health as vaccinations, and there is probably no single issue that frustrates me more than parents choosing not to vaccinate their children because of irrational fears stemming from debunked, fraudulent claims.  Ropeik lays out the case for vaccination quite clearly in his piece, and I endorse every word of what he said.

I’m going to start with his easiest suggestion first, which is the last one.  It astounds me to learn that some of the health care workers who ended up catching and transmitting measles had not been vaccinated.  At every hospital where I have ever worked, I have had to provide proof of vaccination or immunity to several illnesses, including measles.  (Having lost my vaccine record years ago this means blood tests every few years, which I don’t mind as it’s nice to know I’m still immune.)  I assumed that this was SOP for every hospital in the country.  Anyone working in health care in the United States should be required to be fully immunized.  Period.  If you don’t wanna get vaccinated, find another line of work.  In fact, periodic blood tests to confirm ongoing immunity are probably not a bad idea.

To a certain degree, activities for unvaccinated kids are curtailed.  I imagine it varies state by state, or even school district by school district, but in areas where I have worked, unvaccinated kids are required to stay home from school for a set period of time (usually about a week, in my experience) if there is a case of a vaccine-preventable illness in the school.  The clock gets reset for each new case.  This can lead to a lot of missed school, and this possibility was something I would raise when I worked in a practice that allowed parents to defer vaccines for their kids.  (I am very pleased to have since joined a practice that does not accommodate vaccine deferrals for the most part, with a couple of exceptions.)  I don’t know if there is a good justification for missing other school activities, which seems a bit punitive.  Limited access to extended school trips does make some sense, as school officials or chaperons shouldn’t be forced to deal with preventable illness while traveling with students.I also think it’s perfectly reasonable to raise insurance premiums for people who don’t immunize their kids.  The decision significantly increases the potential for illness both in the patient and the community, which raises costs for everyone.  People who expect the community to provide protective herd immunity for their kid without shouldering any perceived risk should be made to pay for it.

It’s the first suggestion that Ropeik makes that I think would be most difficult.  To what degree should we be able to compel others to be good citizens?  (I consider a decision not to vaccinate one’s kids a failure of citizenship rather than a sign of parental neglect.  As much as I think their reasoning is flawed, parents who don’t vaccinate their kids believe they’re doing right by them.  Rather, they’re expecting everyone else to assume a risk they won’t take, and want to enjoy the benefits of everyone else’s decision.)  It’s not illegal to go to work with the flu, which kills a lot more people every year than measles.  We don’t remove kids from the home if their parents smoke (nor should we).  As much as I think it’s an awful decision not to get one’s kids fully vaccinated, I don’t know if I want the state to have the power to compel them to do so.  Perhaps forcing parents to shell out the cash for private schools if they don’t vaccinate is an appropriate step.

I’m curious.  What do you think?  Where should the line be drawn?  Is preventing these diseases a sufficient reason to override parental objection?