Health and Human Services Secretary Tom Price said that vaccination should be a state-regulated choice, not a federal requirement, during a CNN televised town hall event on March 15.
State governments should be responsible for public health, according to Price, and for determining “whether or not immunizations are required for a community population.”
Price’s emphasize on individual choice for immunization is especially troubling considering he is a member of the Association of American Physicians and Surgeons ― which, despite its official-sounding name, promotes the thoroughly debunked claim that that vaccines cause autism and considers mandatory vaccination to be “equivalent to human experimentation.”
(During Price’s January confirmation hearing, he conceded that vaccines do not cause autism when he was directly asked.)
“Dr. Price is correct that much of vaccine policy is set at the state level,” Dr. Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine, told The Huffington Post.
“But DHHS has an equally important role in vaccine advocacy,” Hotez said, adding that President Donald Trump’s administration has been mostly silent on the issue.
“In fairness to Dr. Price, DHHS in the Obama, Bush and Clinton administrations were also largely silent. So the conspiracy of silence when it comes to vaccines seem to transcend parties and presidential administrations.”
What Optional Vaccines Could Mean For Public Health
If states decide to make vaccines optional, there could be national public health consequences. Consider Texas, where anti-vaccine views have taken root and nonmedical vaccine exemptions are on the rise, leaving the state vulnerable to a major infectious disease outbreak.
Between 2003 and 2010, there was a 19-fold increase in the number of “personal belief,” or “conscientious,” exemptions permitting parents and guardians to opt their children out of vaccinations ― which translates to 45,000 unvaccinated school-age Texans, according to an October article published in the journal Plos Medicine.
Because measles spreads so easily, with a single case generating 12 to 18 new cases on average, it’s often the infectious disease that crops up first. And Texas is no stranger to measles outbreaks. In 2013, measles infected 21 people in the states, many of them unvaccinated kids.
“When you see drops in vaccination coverage rates, measles is often the first breakthrough [disease],” Hotez said.
“[Measles] tends to be the canary in the coal mine for breakthrough infections.”
Why Vaccine Coverage Rates Matter
Interestingly, vaccine viewpoints don’t track along traditional partisan lines. In parts of Texas, for example, anti-vaccinators have taken up immunization as a civil liberties issue, while left-leaning holistic health devotees in pockets of California and Brooklyn, New York, eschew vaccines for different reasons.
Parents who choose not to vaccinate their children sometimes claim that vaccination is an issue of personal freedom and choice, rather than of public health ― but refusing to vaccinate has public health consequences.
“What about the civil liberties of a young mother or parent with an infant under the age of 12 months? Now they have to be terrified about going into Walmart, or public libraries or shopping malls, because they’re worried their infant is going to contract measles.”- Dr. Peter Hotez, dean of the National School of Tropical Medicine at Baylor College of Medicine
Vaccines are only effective at protecting a community against infectious disease when a critical mass of community members are immunized, creating what’s known as herd immunity.
Because measles is so infectious, 95 percent of a population needs to be vaccinated to protect the group. In smaller communities, that means one or two families unnecessarily opting out of vaccination can put their neighbors who can’t get vaccinated for medical reasons (such as infants who are too young to be vaccinated, or individuals with compromised immune systems), at risk for contracting measles.
Measles is a serious disease. Common measles complications include ear infection and diarrhea. More severe complications, such as pneumonia, brain swelling and convulsions, can result in death, according to the U.S. Centers for Disease Control and Prevention.
“What about the civil liberties of a young mother or parent with an infant under the age of 12 months?” Hotez asked. “Now they have to be terrified about going into Walmart, or public libraries or shopping malls, because they’re worried their infant is going to contract measles.”
Texas Is Poised For A Measles Outbreak
The statewide MMR vaccination rate in Texas clocks in at 92.5 percent, which is above the national MMR vaccination rate of 91.9 percent, according to the American Academy of Pediatrics. But between 2003 and 2016, Texas went from 2,314 conscientious exemptions to 44,716, according to the Texas Department of State Health Services ― and growing pockets of vaccine refusal have public health officials worried.
Now some counties and schools in Texas are reporting alarmingly low vaccine coverage rates.
Gaines County, Texas, which has a population of approximately 18,400 people, had a personal belief vaccination exemption rate of 4.83 percent between 2015 and 2016 for measles. That puts the county dangerously close to the 95 percent coverage tipping point, even without accounting for community members who can’t be immunized for medical reasons.
In some Texas private schools, vaccine exemption rates are downright dangerous. Three Texas private schools reported a vaccine exemption rate of 30 percent or higher among students.
“If one of those kids is incubating an infectious disease and the other kids aren’t vaccinated, then it’s going to spread like wildfire,” Catherine Troisi, an infectious disease epidemiologist at the University of Texas Health Science Center at Houston told NPR in November.
It’s not just Texas. National nonmedical vaccine exemption rates rose 19 percent between 2009 and 2013, from 1.6 percent to 1.9 percent, according to the American Journal of Public Health. (Oregon had the nation’s highest exemption rate of 6.4 percent, up from 3.4 percent four years prior.) Texas’ nonmedical exemption rate was 1.2 percent.
And troublingly, even states with good overall vaccination rates are at risk for infectious disease outbreaks if clusters of unvaccinated individuals come in contact with an infection.
Conspiracy Theories Are Alive And Well
States dealing with rising vaccine exemption rates and outbreaks are also handling them differently. When measles broke out at Disneyland in 2014 and 2015, the California state legislature eliminated its personal and religious belief exemptions for vaccines.
It could be hard for similar legislation to gain traction in Texas, which Hotez and others say is one of the best-organized and most active anti-vaccine states in the country.
And it’s no coincidence that the kingpin of the anti-vaccine movement, disbarred former doctor Andrew Wakefield, lives in Austin.
Wakefield spurred the anti-vaccine movement with his 1998 British Medical Journal study linking vaccines to autism. (The BMJ later retracted the study, calling it “fatally flawed both scientifically and ethically.”)
Wakefield’s latest publicity stunt is “Vaxxed: From Cover-Up to Catastrophe,” a movie he directed and co-wrote, which rehashes claims from his debunked study and accuses the CDC of a massive coverup of the autism-vaccine link.
“Those of us who have spent any time in government know how federal agencies work,” Hotez said. “Even if they wanted to engage in this conspiracy theory, they are just not set up to do that kind of thing.”
Improbable though Wakefield’s claims might seem, he has a loyal following in Texas.
The Future Of Vaccines Under Trump
It’s also unclear if the United States’ federal vaccine policy will change under Trump, who has yet name a science adviser and CDC director or confirm his choice for FDA director, any of whom could potentially influence vaccine policy.
To the chagrin of scientists, Trump has already promoted misinformation about the nonexistent link between vaccines and autism.
Hundreds of state and national medical groups, including the American Medical Association, the American Academy of Family Physicians and the American Academy of Pediatrics, sent Trump a letter in February, laying out the science behind vaccine safety:
“Claims that vaccines are unsafe when administered according to expert recommendations have been disproven by a robust body of medical literature, including a thorough review by the National Academy of Medicine,” they wrote.
But for now, anti-vaccine proponents in Texas aren’t going down without a fight. One such group, a nascent political action committee called Texans for Vaccine Choice, mobilized to kill a bill that would have removed vaccine exemption in 2016.
Rep. Jason Villalba (R), who filed the bill, told the Texas Tribune that he never expected it to be controversial.
“The animus that was leveled against me for that was very surprising to me,” Villalba said. “These people, they literally said it to my face — they hate me. That was troubling. Because I get it, they care about their children — but I care about my children too, and the children of the community.”
“While they do not have a whole lot of money, they have a lot of people that they can deploy to interfere in primary campaigns,” Anna Dragsbaek, head of a pro-vaccine advocacy group in Texas called the Immunization Partnership, told Science in December. “They made Villalba’s primary campaign very, very difficult.”
And with a handful of vaccination-related bills to be decided on in the Texas legislature this spring (some would loosen rules for vaccine exemptions and others would tighten exemption rules), the debate in Texas could get ugly.
As Hortez put it, “There’s a battle about to ensue.”