Eliminate nonmedical exemptions to vaccines, and strengthen data collection

MANILA, PHILIPPINES - OCTOBER 14: A parent brings her child to be administered an oral polio vaccine, during a mass vaccination campaign to combat the resurgence of the polio virus, at a slum area on October 14, 2019 in Manila, Philippines. The Philippines is aiming to vaccinate over 9 million children after the country's health department announced an outbreak of polio, 19 years after the World Health Organization declared the country free of the infectious disease. Health Secretary Francisco Duque has blamed poor immunization coverage and lack of proper sanitation and hygiene as the cause of the resurgence of the disease. The Philippines has been struggling to regain the publics trust in vaccines since 2017, when it was discovered that a dengue vaccine manufactured by French firm Sanofi could cause health risks to people who had not previously had the disease. Recently, the country declared a dengue epidemic after hundreds have died of the mosquito-borne disease. (Photo by Ezra Acayan/Getty Images)
Ezra Acayan/Getty Images
A parent brought her child to be administered an oral polio vaccine last week during a mass vaccination campaign to combat the resurgence of the polio virus in Manila.

Massachusetts legislators waded into a contentious dispute this year, introducing two bills that would make it more difficult for parents to withhold standard vaccinations from their children. The stricter of the two bills, filed this summer by state Representative Andy Vargas, is the better approach. But his legislation could be improved by borrowing elements of the second bill. If it acts soon, the Legislature can create a strong law that would protect kids — and all Massachusetts residents — from a handful of infectious diseases that are making a tragic comeback.

The stats are troubling, and getting worse. The United States has reported 1,250 cases of measles so far this year, already the highest total in more than 25 years. Just this month, Boston had its first case of measles since 2013. The disease, which can be fatal, was virtually eliminated 20 years ago, but has reemerged as more parents reject vaccines.

Massachusetts still has a relatively high immunization rate. But pockets of the state have vaccination rates that are now low enough to create the conditions in which an outbreak could occur, and the legislative attention to the problem is welcome.


Under current state law, parents have to vaccinate their children against a list of diseases to enroll them in school. Mandatory vaccination exists not only to protect those children, but also to establish so-called herd immunity. When most of a population is vaccinated, it prevents sicknesses from taking root. That protects members of the “herd” who, for medical reasons, can’t receive vaccines.

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State law now makes two exceptions. The first, common-sense exemption is for children who are too sick — for instance, they are being treated for cancer — to receive a vaccine. The other is for parents who object to vaccination on religious grounds. No major religion opposes vaccines, yet the number of religious exemptions has skyrocketed in the last two decades. Parents persuaded by online conspiracy theories that vaccines are dangerous, or an affront to their all-natural lifestyle choices, appear to be abusing the religious exemption in order to avoid shots for their children.

Responding to the reemergences of measles and whooping cough, five states — including Maine and New York, which acted earlier this year — have eliminated nonmedical exemptions completely. Massachusetts would become the sixth under the Vargas bill, which is backed by the Massachusetts Medical Society and national pediatric groups.

The second bill, introduced by state Senator Becca Rausch and state Representative Paul Donato, would have a lighter touch. Too light: It would leave the religious exemption in place but make it more difficult for parents to claim. The Department of Public Health would have to approve each exemption individually.

The stricter Vargas bill has aroused the ire of vaccine opponents, but barring religious exemptions altogether makes the most sense. That would be true even if the religious exemptions were legitimate — which they probably are not. Parents don’t have an absolute right to endanger their children and the rest of the community when it comes to most public safety laws, even for religious reasons, and it’s hard to understand why vaccines should be any different.


But there are other parts of the second bill worth adding to Vargas’s proposal. The proposal from Rausch and Donato makes summer camps, colleges, and child care centers subject to the immunization rules. It also makes collection and distribution of data on immunization mandatory.

The Legislature should add the data-collection parts of the second proposal to the Vargas bill, and then act on them soon. Just this month, the United States came dangerously close to losing its 19-year-old measles elimination status, a designation given by the World Health Organization to countries where the highly contagious disease hasn’t been transmitted continuously for at least 12 months. All the trend lines point in the wrong direction, and the Legislature is right to take proactive steps to stop an outbreak here before it starts.