Last month, for the first time in nearly 21 years, South Carolina reported a case of measles. SCDHEC has not yet stated whether the individual was vaccinated or whether this case is connected to the wider outbreak in the U.S., but, regardless, this is troubling news.
While vaccination rates in South Carolina roughly match the U.S. average, religious exemptions have “more than tripled” since 2010. This is a problem as unvaccinated children, if infected with a preventable illness like measles, can easily spread it to their peers who may be too young or medically unable to receive vaccination themselves. Regardless of the danger, however, these children are still allowed to attend schools alongside their unvaccinated peers, an altogether irresponsible and untenable state of affairs.
The central problem here is that parents in South Carolina have, essentially, been given carte blanche to keep their kids unvaccinated. Parents can get a religious vaccination exemption, sanctioned under Department of Health and Environmental Control Regulation 61-8. That allows parents to keep their kids unvaccinated if they sign the appropriate wavier.
The catch? This wavier amounts to no more than a permission slip. The parent signs it and the state must allow their children to attend school. Nowhere on this form is anything that actually certifies these parents have a legitimate religious gripe with mandatory vaccinations. In fact, this exemption allows anyone, religious or not, to avoid vaccinating their kids.
Now, I’m not suggesting in any way that there should be some sort of arcane religious test to receive a religious vaccination exemption. Besides almost certainly being a first amendment violation, the practicality of such a test is dubious. After all, if the goal is to vaccinate as many children as medically feasible, then this test would still likely allow a significant minority of people to avoid it.
Instead, we must do away with religious vaccination exemptions entirely.
People choose to not vaccinate their kids for a variety of reasons, nearly all of them rooted in an irresponsible, selfish, arrogant and, above all else, ignorant mindset that places their child’s theoretical well-being above established medical and public health realities. Frankly, I believe that if you don’t think your kids should be vaccinated, you are categorically unfit to be a parent, full stop.
Rant of a frustrated public health major aside — parents not vaccinating their children is a serious problem in much of the U.S. The parents who choose to do this have their reasons, but we can point to one central driving factor — Andrew Wakefield.
Andrew Wakefield is possibly one of the most abhorrent people in modern medicine, and for good reason. Wakefield was a doctor in the U.K. who claimed in a paper that the MMR (measles, mumps and rubella) vaccine was correlated with autism. After an exhaustive study in 2003 refuted his claims, his article was pulled from the esteemed medical journal, "The Lancet," and his medical license was revoked. Again, not without cause. Wakefield committed a variety ethical and scientific offenses ranging from not disclosing his funding sources (lawyers who were suing vaccine makers) to manipulating his data.
All of this, however, didn’t dampen the doubts he manufactured. These doubts, though thoroughly debunked, have been carried on by anti-vaccination activists. While brain-dead celebrities tend to be the most vocal critics of vaccination (including our president, for God’s sake), the largest group of people who still harbor anti-vaccination beliefs tend to be more conservative and religious according to polling data (though most conservatives, religious people and Americans support vaccination). In my opinion, this last group is primarily responsible for the continued persistence of religious exemptions throughout the U.S. and South Carolina.
The primary problem with these religious exemptions is twofold. For one, it allows parents to be the central deciding factor in public health decisions that impact the whole population. Individual parents choosing not to vaccinate their kids may not be a major public health crisis in and of itself, but, collectively, they can do major damage, particularly to herd immunity. Herd immunity is the concept that if a certain amount of a population is immune to a disease (though vaccination or previous illness), the disease will not spread effectively.
How much of the population that needs to be immune varies from disease to disease but, with many childhood illnesses, the percentages can be incredibly high. Measles, for instance, requires around 83 to 94 percent of the population to be immune. Therefore, the collective action of a minority of parents can put the majority at risk. In fact, a recent study found that even as little as a 5 percent drop in immunity coverage from the MMR vaccine could result in a “threefold increase in measles cases and cost the public sector millions of dollars.”
The second major problem with religious exemptions is the individual harm they can result in. Many childhood illnesses are highly infectious — measles infects “9 out of 10 susceptible persons with close contact to a measles patient” and pertussis (whooping cough) patients “can infect up to 12 to 15 other people.” This can make allowing unvaccinated children in schools particularly dangerous. If infected, they can easily infect every other unvaccinated child in their school, including those with medical exemptions.
Furthermore, they can also infect many others in the community, including many infants who are too young to be vaccinated. The end result is a debilitating, potentially deadly and, above all else, preventable illness. Measles, mumps, rubella, pertussis and a host of other nasty illnesses are largely preventable, but only if kids are vaccinated. The parents who choose to use a religious exemption put everyone else’s kids at risk.
Removing religious exemptions would save lives and mitigate the effects of these horrible illnesses. It would also very likely stand up to a legal challenge. Following a serious measles outbreak in 2014, California removed personal-belief exemptions (largely analogous to religious exemptions). While the change was challenged in court, the court found in favor of the state as vaccinations fall into the government interest (see Prince vs. Massachusetts) and that the law "did not violate freedom of religion or the right to an education.” As a result, California vaccination compliance skyrocketed in comparison to previous years. South Carolina would be wise to follow their example.
Parents who have decided to utilize the religious exemption may be a tad upset they’d be required to actually be a functioning member of the community, but that’s a small price to prevent senseless deaths and hospitalizations. Public health cannot be held hostage by anti-science loons who have nothing but their own selfish interests in mind. South Carolina is better than them and better than this.