The Legalities and Ethics of the Vaccination Debate

Giving a patient a vaccination
Photo Credit: © thodonal/Dollar Photo Club



How well do you understand the legal, ethical, and political debate surrounding mandatory childhood vaccinations? Most healthcare providers know about the 2014 measles outbreak in the United States, and some have experienced parental opposition to vaccines firsthand. In “Law, Ethics, and Public Health in the Vaccination Debates: Politics of the Measles Outbreak,” Lawrence O. Gostin, JD explains what you need to know via The Journal of the American Medical Association (JAMA).




Legally, mandatory childhood vaccination is principally a state-level matter. Within the federal Centers for Disease Control, the U.S. Advisory Committee on Immunization Practices recommends a series of childhood vaccines; however, only the individual states can require them. Every state mandates that children older than 5 years receive vaccinations prior to enrollment in state-licensed day care facilities or public schools, but there are exemptions.

For example, all 50 states provide exemptions for medical contraindications to immunization. Religious exemptions are available in 48 states, and philosophical exemptions are available in 20. Depending on the individual state, the “philosophical” category can encompass personal, moral, or other beliefs and be as easy to obtain as signing a form. As Gostin claims however, non-medical exemptions needlessly jeopardize public health.

“State exemptions significantly influence vaccination rates and incidence of vaccine-preventable illness,” the Georgetown University Law Center professor explains, and then cites a 2006 study in which “states with easy non-medical exemption processes had 50% higher pertussis rates.” Critics may discount the quality of Goslin’s medical data (and debate terms such as “easy”), but his legal assertion is more compelling – “mandatory vaccination is within the states’ police powers because of its public health importance.”

As evidence, Goslin cites two court cases. In Jacobson vs. Massachusetts (1905), the U.S. Supreme Court upheld a small pox mandate. In Zucht vs. King (1922), the high court upheld vaccine requirements as a condition of school entrance. Mandatory immunization has prompted political resistance, however, and U.S. Senator Rand Paul summarized this sentiment with his recent remark, “The state doesn’t own your children.”

Lawrence O. Gostin’s summary of the legal, ethical, and political dimensions of the vaccination debate is compelling, but it’s becoming clear that parents who oppose vaccines need more than a “nudge” to get their children immunized. They need education about the risks to their child’s health as well as the national and global impact of not vaccinating their children.

As a healthcare provider, have you had to answer questions about exemptions for vaccines? For that matter, how do you answer parents’ questions about whether childhood vaccines are safe?