Inside the Vaccine War: Measles Outbreak Rekindles Debate on Autism, Parental Choice and Public Health

The federal government has confirmed more than 100 people across 14 states have now developed measles. Public health officials suspect the outbreak, which is concentrated in California, began when an infected person visited Disneyland in Anaheim in December. In recent years, a growing number of parents have opted not to have their children vaccinated, claiming a link between vaccines and autism. The prestigious medical journal Lancet published a study in 1998 showing such a link, but the study was later retracted and has been widely discredited. According to the Centers for Disease Control and Prevention, one in 12 children born in the United States is not receiving their first dose of MMR (measles, mumps and rubella) vaccine on time. Several potential Republican presidential candidates have weighed in on the debate. Sen. Rand Paul of Kentucky, an ophthalmologist, said he had heard of instances where vaccines caused “mental disorders.” New Jersey Gov. Chris Christie said vaccinating kids is a matter of “parental choice.”

We spend the hour discussing the vaccine debate and public health with three guests: Dorit Rubinstein Reiss is a professor at the University of California, Hastings College of the Law, and co-author of the report, “Funding the Costs of Disease Outbreaks Caused by Non-Vaccination”; Mary Holland is the mother of a child with regressive autism who, she believes, was injured by the MMR vaccine. She is also a research scholar at New York University School of Law and co-editor of the book, “Vaccine Epidemic: How Corporate Greed, Biased Science, and Coercive Government Threaten Our Human Rights, Our Health, and Our Children”; and Dr. Paul Offit is chief of the division of infectious diseases at the Children’s Hospital of Philadelphia and a professor of pediatrics at the Perelman School of Medicine at the University of Pennsylvania. He is author of “Autism’s False Prophets: Bad Science, Risky Medicine, and the Search for a Cure” and “Deadly Choices: How the Anti-Vaccine Movement Threatens Us All.”

TRANSCRIPT:

This is a rush transcript. Copy may not be in its final form.

NERMEEN SHAIKH: The federal government has confirmed over a hundred people across 14 states have now developed measles. Public health officials suspect the outbreak, which is concentrated in California, began when an infected person visited Disneyland in Anaheim in December. On Wednesday, Dr. Jeffrey Gunzenhauser, Los Angeles County’s interim health officer, updated reporters on the outbreak.

DR. JEFFREY GUNZENHAUSER: The outbreak of measles that we’re currently experiencing is the largest that we’ve had in this county and in this state in 15 years. Public Health is doing all we can to identify cases and to isolate contact so as to prevent spread; however, to end this outbreak, we need to do more, and we need help. I encourage everyone to review their vaccination status and, if needed, to get the vaccine now.

NERMEEN SHAIKH: Fifteen years ago, the Centers for Disease Control and Prevention proclaimed victory over measles, but in recent years there’s been an increase in outbreaks as a growing number of parents have opted not to have their children vaccinated, claiming a link between vaccines and autism. The prestigious medical journal Lancet published a study in 1998 showing such a link, but the study was later retracted and has been widely discredited. According to the CDC, one in 12 children born in the United States is not being vaccinated as recommended.

On Wednesday, two California lawmakers announced a bill to eliminate, quote, “personal belief exemptions” that allow parents to refuse to vaccinate their children. The state has allowed such exemptions since 1961, when it first required all public school teachers and students to be inoculated against polio. But since 2000, the rate of parents seeking exemptions has tripled to about one in every 40 children. Meanwhile, Senators Dianne Feinstein and Barbara Boxer asked state health officials to go further and eliminate, quote, “religious exemptions.”

AMY GOODMAN: Several potential Republican presidential candidates have also weighed in on the debate. On Monday, Kentucky Senator Rand Paul, an ophthalmologist, said he had heard of instances where vaccines caused “mental disorders.”

SEN. RAND PAUL: The hepatitis B vaccine is now given to newborns. We sometimes give five and six vaccines all at one time. I chose to have mine delayed. I don’t the government telling me that I have to give my newborn hepatitis B vaccine, which is—

KELLY EVANS: Understood.

SEN. RAND PAUL: —which is transmitted by sexually transmitted disease and/or blood transfusions. Do I think it’s ultimately a good idea? Yeah. And so I had mine staggered over several months. I’ve heard of many tragic cases of walking, talking normal children who wound up with profound mental disorders after vaccines. I’m not arguing vaccines are a bad idea; I think they’re a good thing. But I think the parents should have some input.

KELLY EVANS: OK.

SEN. RAND PAUL: The state doesn’t own your children. Parents own the children. And it is an issue of freedom.

AMY GOODMAN: That’s Senator Rand Paul on Monday. Since then, he has backtracked on his comments. On Tuesday, he was photographed receiving a hepatitis A booster shot at the Capitol to show his support for vaccinations. But Senator Paul has deep ties to vaccine skeptics. For 20 years, he was a member of the Association of American Physicians and Surgeons, which has backed a moratorium on vaccine mandates.

Meanwhile, another possible Republican presidential candidate, New Jersey Governor Chris Christie, was questioned about vaccines during his trip to England.

REPORTER: Do you think Americans should vaccinate their kids? Is the measles vaccine safe?

GOV. CHRIS CHRISTIE: Well, all I can say is that we vaccinate ours. And so, you know, that’s the best expression I can give you of my opinion. You know, it’s much more important, I think, what you think as a parent than what you think as a public official. … What I said was that there has to be a balance, and it depends on what the vaccine is, what the disease type is and all the rest. And so, I didn’t say I’m leaving people the option. What I’m saying is that you have to have that balance in considering parental concerns.

AMY GOODMAN: New Jersey Governor Chris Christie’s spokesman later said the governor believed kids should be vaccinated against measles.

Well, for more, we’re joined by several guests today. Later in the broadcast, we’ll speak with Mary Holland, the mother of a child with regressive autism who, she believes, was injured by the measles, mumps, rubella vaccination, known as the MMR vaccine. And we’ll speak with Dr. Paul Offit, professor in the Division of Infectious Diseases and the director of the Vaccine Education Center at the Children’s Hospital of Philadelphia.

NERMEEN SHAIKH: But first we’re joined now from San Francisco by Dorit Reiss, professor of law at UC Hastings College of the Law. She specializes in legal issues related to vaccines, including exemption laws. She co-authored a report last year about, quote, “Funding the Costs of Disease Outbreaks Caused by Non-Vaccination.”

Professor Reiss, welcome to Democracy Now! So could you lay out for us what you think the key issues are regarding exemptions on children getting vaccinated?

DORIT RUBINSTEIN REISS: Of course. So, first, thanks for having me. The starting point is that we have a tension between three important values. The first is parental rights. Parents have rights. We care about their ability to take care of their children, guide their children. The second is the public health. We want to make sure that the public is protected against infectious diseases and other problems. And remember, the public includes other people. Other parents and other children have rights to be protected against diseases, as well. And the third is the right of a child. Given the incredible imbalance between the risks of vaccines and the risks of not vaccinating, with the risks of vaccines very small and the risks of not vaccinating much larger, there’s a strong argument that the right of health—right to health of a child means that the child should be vaccinated.

The combination of that is part of what supports the state’s right to impose school immunization requirements. School immunization requirements have been in the states since the 19th century, at least. And in the first years, we didn’t have exemptions. Exemptions are relatively new, during the 20th century. And in terms of exemption, as you probably know, we have three types. We have medical exemptions, which all states have. We have religious exemptions, or personal belief exemptions, also known as philosophical exemptions. And 48 states, every state except as West Virginia and Mississippi, have either a personal belief exemption or a religious exemption or both. The issues that come up is how much—how broad should the exemption be? And states vary dramatically on that. California, for example, is right now one of the broadest. And that’s part of the reason behind the change.

AMY GOODMAN: So, this issue, for example, of Mississippi, even though something like two dozen lawmakers wanted to support this exemption based on conscientious beliefs, they are in the vast minority here of states—48 states, as you said, allow for a conscientious objection—saying no public or private school student can go without a vaccine.

DORIT RUBINSTEIN REISS: That’s correct. Most states allow either personal belief or religious exemption, and that has been—started around the ’60s, as well. Mostly, my best reading, it’s because of the high value we place on personal freedom and on religious values. And I would expect that most states that adopted religious exemption expected them to be very limited, mostly to Christian Scientists and other small sects. That’s not what happened. In many states, religious exemptions are used much more broadly than by the very small sects that have strong views against vaccination. And our jurisprudence makes it very hard to limit religious exemptions only to those religions that really object to vaccination.

NERMEEN SHAIKH: But do you believe, Professor Reiss, that with the latest outbreak, now states will reconsider the extent and range of these exemptions?

DORIT RUBINSTEIN REISS: Yes, I think we are already seeing that. We’re seeing several states consider following the Western states—California, Oregon and Washington—and adopting an educational requirement, in addition to the personal belief exemption. We’re seeing this discussed in Maine, in Minnesota and in other states. And as you’ve seen, California has recently been reconsidering its own exemption law. So I would expect a move to more restrictive exemptions. And given what we’re seeing, the rise of outbreaks, that’s all for the good.

AMY GOODMAN: Well, explain why that is so important, why parents shouldn’t be able to opt out. In a moment, we’re going to hear from a parent who feels very differently from you.

DORIT RUBINSTEIN REISS: So, remember what we’re talking about. We’re not talking about telling parents, “Whether you wish to or not, we’re going to tie your child down and vaccinate them.” That’s something that, if done, is done in only extreme circumstances. We’re talking about the question whether a parent can send a child to a school, a public or private, unvaccinated. If a child is sent to school unvaccinated, first of all, the child herself is at risk. But in the atmosphere of the school, this child also puts others at risk. First, directly, if the child who is unvaccinated and higher risk of disease contracts the disease, they may infect someone else. And second, by reducing the level of immunity at the school by undermining herd immunity, the school is more vulnerable to an outbreak. And then—

AMY GOODMAN: When you say that—just for people who are not familiar with this debate, Professor Reiss, when you say “herd immunity,” explain what you mean.

DORIT RUBINSTEIN REISS: I hope Dr. Offit will talk about this more in detail, but basically the idea is that if we have a certain number of people immunized in the school, those people form kind of a ring around the few that aren’t immunized and prevent the disease from reaching them. That’s the idea of herd immunity. If you have enough people immunized, even if one person who is infected comes into the school, the disease won’t spread.

NERMEEN SHAIKH: You’ve also suggested, Professor Reiss, that parents who choose not to have their children vaccinated are almost always negligent under the law. So do you think that there should be legal consequences for parents who choose not to have their children vaccinated?

DORIT RUBINSTEIN REISS: Yes, I do. And my point of view is less focused on the parent that doesn’t vaccinate—we need the behavior to be negligent to impose consequences—but more on those harmed by the decision. If one parent chooses to reject expert opinion, to choose for their own child the bigger risk, the risk of not vaccinating, over the smaller risk of vaccinating, and something happened that harms another family, I think it’s unfair to make the other family pay for the costs of the first family’s decision. Again, think about the situation. A child is left unvaccinated, contracts measles, passes it to an immunocompromised child that suffers serious complication. The family of that child has emotional costs. The child that suffers pays a physical price. And they have financial costs. Why should they have to pay for someone else’s choice?

NERMEEN SHAIKH: Is there any kind of legal precedent for that, though?

DORIT RUBINSTEIN REISS: Not at this point. The case has simply, to my knowledge, not come up. We have other cases of a liability for infectious disease. We have a case of a liability when someone went into a boarding house that has—produces whooping cough and wasn’t told that there was whooping cough, and his children caught whooping cough. We have liability for sexual-transmitted diseases, if there was negligent nondisclosure. So we have a history of liability for infectious disease, but this context hasn’t come up yet.

AMY GOODMAN: Are you saying that parents—what should happen? What should be the consequence for a parent who doesn’t immunize their child, vaccinate their child? Are you saying they should be jailed?

DORIT RUBINSTEIN REISS: No, I’m not. There’s a whole range of possible consequences. I’ve heard the idea of jailing parents in that situation, and I think that’s going substantially too far. A parent making the decision is making the decision on their best judgment. There’s a lot of misinformation out there. And it’s natural for the parents to make their own decision for their child. And it’s a decision that puts their own child, first and foremost, at risk. I don’t think the level of culpability is high enough to justify criminal law.

But I think it’s fair to tell the parents, “You made the decision, you internalize the consequences. Take personal responsibility. Nobody else should have to pay for that. You’re going against expert opinions. You’re going against the science. You’re going against the credible data. Why should others carry the cost?” And that’s true for another family, if they’re infected, or the public health. These outbreaks cost a lot of money to contain. And that money comes from somewhere. Public health departments are cutting other budget and not doing other things in order to track down and contain measles. Why should the public pay, rather than those that made the decision that led to the outbreak?

AMY GOODMAN: Dorit Reiss, we want to thank you for being with us, professor of law at UC Hastings College of Law, specializing in legal issues related to vaccines, including exemption laws. We’ll link to your piece, “Funding the Costs of Disease Outbreaks Caused by Non-Vaccination.” When we come back, a very different view. We’ll be joined by another lawyer, by Mary Holland, a research scholar at NYU School of Law, adviser to Health Choice. This is Democracy Now!, democracynow.org, The War and Peace Report. Back in a minute.