What the federal government can actually do about anti-vaxxers

For starters, the president could say there is a problem.

Nurse Lydia Fulton prepares to administer the measles, mumps, and rubella (MMR) vaccine as well as a vaccine used to help prevent the diseases of diphtheria, pertussis, tetanus, and polio at Children's Primary Care Clinic in Minneapolis, MN, Friday April 28, 2017. (Photo Credit: Courtney Perry/For the Washington Post)
Nurse Lydia Fulton prepares to administer the measles, mumps, and rubella (MMR) vaccine as well as a vaccine used to help prevent the diseases of diphtheria, pertussis, tetanus, and polio at Children's Primary Care Clinic in Minneapolis, MN, Friday April 28, 2017. (Photo Credit: Courtney Perry/For the Washington Post)

After virtually eliminating the extremely contagious virus in the United States at the turn of the century, measles are back thanks to anti-vaccination misinformation.

More than 150 people, mostly children, in 10 states, have been infected by measles so far in 2019. These outbreaks are primarily linked to travelers from other countries, like the United Kingdom, who brought the measles into communities with low vaccination rates.

The public health crisis is largely seen as a policy failure: lawmakers have made it too easy for parents to opt out of getting their kids vaccinated. Two doses of the measles vaccine is 97 percent effective, but in order to protect everyone — including infants and people who can’t take the shot for medical reasons — a large percentage of people need to be vaccinated. This concept is called “herd immunity.”

Every state requires students to get vaccinated to some degree, and all grant exemptions to children for medical reasons. But 47 states grant religious exemptions. Seventeen of those also allow personal or philosophical exemptions. Experts are less concerned with the religious exemptions than they are with the personal or philosophical ones, as parents opting out these days are usually doing so because they are distrustful of the government or just misinformed.

(PHOTO CREDIT: National Conference of State Legislatures)
(PHOTO CREDIT: National Conference of State Legislatures)

The question now is what will lawmakers do about it?

Food and Drug Administration Commissioner Dr. Scott Gottlieb garnered a lot of attention after telling CNN he’s skeptical of any vaccine exemptions outside of medical reasons, and if “certain states continue down the path that they’re on, I think they’re going to force the hand of the federal health agencies.”


Dorit Reiss, a law professor at the University of California’s Hastings College of the Law who specializes in vaccine policy and is affiliated with the Immunization Action Coalition, is happy Gottlieb used his platform to call attention to the public health crisis, especially because President Donald Trump has not.

“It would be nice to see other actors in the federal government make that statement,” Reiss told ThinkProgress. “If President Trump says the outbreaks are an issue — that would be nice, but I don’t think that is going to happen.”

But Reiss also noted that it’s not clear what the federal government could do beyond public service announcements. She suggested that the Centers for Disease Control and Prevention (CDC) could apply pressure to states by, for example, adding conditions to the federally-funded Vaccines for Children Program (VFC), which provides free vaccines to children in underserved areas. But she cautioned that state health departments could just drop the program and this could exacerbate the existing problem.

“It makes sense for the federal government to give positive incentives for states to have to have policies that improve vaccine rates… you don’t have to have very coercive policies to improve vaccine rates. For example, a policy that makes it super easy to get an exemption might make people who aren’t vaccine hesitant not vaccinate just because of convenience,” she added.

Former FDA Commissioner Robert Califf told ThinkProgress by email that “the FDA has no real authority over medical practice. That is a matter of state law unless a superseding Federal law was passed. It is possible that CDC or CMS could have control over delivery organizations that could force the issue, but it would be hard.”


ThinkProgress reached out to the Department of Health and Human Services (HHS) for comment, but did not immediately hear back.

Congress is also looking into the issue. The House and Senate are holding hearings about the measles outbreaks on Wednesday and in early March, respectively.

A Democratic aide for the Senate committee on Health, Education, Labor and Pensions, which is holding the “Vaccine Saves Lives” hearing, told ThinkProgress it is important to first “understand what is happening before we take any other steps,” adding that the federal government just “can’t override states.” Right now, Congress is merely gathering information; for example, the Senate sent a letter to HHS asking what measures they are already taking to address vaccine hesitancy.

That said, vaccine laws are primarily a state policy issue. So far, lawmakers in the New Jersey, New York, Iowa, Maine, and Vermont have proposed eliminating religious exemptions for vaccines and Washington state is looking to eliminate personal and philosophical exemptions. Meanwhile, Arizona lawmakers are looking to expand exemptions for kids.

Additionally, tech companies are attempting to address anti-vaccination misinformation. Most recently, Pinterest blocked anti-vaccine content. Try searching “vaccine” and nothing should come up.


Youtube recently demonetized such videos.

Prompt action is needed, as there’s no treatment for measles, a disease that is easy to contract and spread. Before the measles vaccine, one child with measles infected an estimated 12 to 18 other children. Doctors can try to help those who are infected avoid extreme complications, like pneumonia or blindness, and could prescribe antibiotics for less severe cases, like ear and eye infections.

But doctors say the best way to beat measles is to avoid contracting it — that means getting vaccinated. 

This piece was updated to replace a map from the National Vaccine Information Center with a map from the National Conference of State Legislatures.