On September 3, 2008, the journal PLoS ONE published a case-control study examining a potential link between the Measles, Mumps, and Rubella (MMR) vaccine and autism. The study's results suggested that there is no merit to a contention, common in some circles, that the live measles virus contained in the MMR vaccine can cause gastrointestinal distress that would then cause autism. This strikes a blow to the so-called “anti-vaccination” movement, which has blamed vaccines for causing autism due to the aforementioned viral infection, mercury preservatives, aluminum preservatives, or all of the above.
Every state, as well as the District of Columbia, has some provision requiring that children be vaccinated against various diseases. Some jurisdictions make it a blanket mandate, while others tie the vaccination to education (which may include public, private, and/or home schooling). In both cases, statutes and regulations present various exceptions to the immunization requirement, with the chief foundations of the exceptions being reasons medical and religious in nature. Whether the exceptions are broad enough to encompass the beliefs of anti-vaccination proponents may vary, depending on the particular state's laws. Because North Carolina has fairly strict immunization laws, it presents a useful point of reference in considering the best arguments anti-vaccination proponents might have.
Consider first the possibility of a medical exception. The recent MMR vaccine study is representative of the weight of scientific evidence in the vaccination safety debate. That evidence is given deference by the law of North Carolina in the form of its medical exception to the vaccine requirement, which looks to the General Recommendations of the Advisory Committee on Immunization Practices to provide a list of medical contraindications for which a physician could legally certify an exemption. That document, drafted by the Public Health Services and published by the Centers for Disease Control, provides no contraindication stemming from the risk of autism. To the extent that a state's medical exception provision relies on broad scientific consensus rather than solely on the opinion of a particular physician, more research like the MMR vaccine study reduces an anti-vaccination parent's likelihood of obtaining a medical exemption for his or her child.
The other significant exception is for religious beliefs. Because of state governments’ relative reluctance to curtail religious exceptions for fear of running afoul of the 1st Amendment, the anti-vaccination movement has latched onto religious exceptions as the best way to avoid vaccinations. The anti-vaccination literature advises that parents need not identify a particular religion when claiming a religious exemption, nor even explain it in depth. However, this is not guaranteed to work under all regulatory or statutory schemes. North Carolina's regulations, for example, do allow an exemption in the case of “bona fide religious beliefs.” But they go on to state that “there is no exception to [immunization] requirements for the case of a personal belief or philosophy of a parent or guardian not founded upon a religious belief.” (Emphasis added.) This regulation seems particularly tailored to address persons who claim to have a religious reason to oppose immunization, when in fact they have only secular, personal reasons.
A question still open, though, is whether such a strict legal requirement of vaccination is a good thing. After all, it is a fair assumption that parents have the best interests of their children in mind. If a parent believes that his or her child will be safest unvaccinated, is it appropriate for the government to intercede? This cannot be properly considered without addressing the importance of herd immunity. Herd immunity is an epidemiological phenomenon by which a certain amount of protection from infection is afforded non-vaccinated individuals by vaccinating a sufficiently high percentage of the general population. The theory is that the pathways of infection are blocked by immunized persons, so that even if a disease were introduced, it wouldn't be able to spread. This is extremely important because it serves as one of the only protections for individuals who, for bona fide medical reasons, cannot themselves be vaccinated. Furthermore, herd immunity also provides a level of protection to vaccinate individuals above and beyond their own vaccination. This is because vaccines do not have a 100% effectiveness rate and even vaccinated persons may develop infections if exposed to the disease.
The importance of herd immunity and the scientific evidence showing no link between the MMR vaccine and autism suggest that public health is better served by states' having stricter immunization laws, with narrowly-tailored exceptions.
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