Multiple measles outbreaks in states with lax vaccine laws may prompt the Food and Drug Administration to take federal action, overriding state exemptions to ensure that fewer children are permitted to skip their shots.
“Some states are engaging in such wide exemptions that they’re creating the opportunity for outbreaks on a scale that is going to have national implications,” Dr. Scott Gottlieb, the commissioner of the FDA, told CNN. He warned that continued outbreaks and broad state-level exemptions could “force the hand of the federal health agencies.”
Medical groups have been urging states to tighten their exemption laws for years. A small drop in the vaccination rate in a given community can dramatically increase infection — and fatality — rates due to the disease. Experts estimate that high rates of MMR vaccination alone saves over a million lives every year.
“Protecting community health in today’s mobile society requires that policymakers not permit individuals from opting out of immunization solely as a matter of personal preference or convenience,” the American Medical Association wrote in 2015. The American Academy of Pediatrics was even more blunt, calling on “all states to use their public health authority to eliminate non-medical exemptions.”
Nonetheless, 47 states and the District of Columbia allow vaccine exemptions for religious beliefs. Seventeen states take matters one step further, and even allow exemptions for nonreligious “personal beliefs”.
The federal government taking action on vaccine exemptions would be a major shift, one certain to be challenged by anti-vaccination activists and those who distrust the federal government. Vaccination rules are traditionally the domain of state governments, which usually control standards for school enrollment and safety. Perhaps in deference to this status quo, Gottlieb avoided spelling out what a national, FDA-driven intervention might look like. The self-avowed state rights proponent also expressed hope that states would tighten their laws on their own.
Stricter state vaccination laws do make a difference. The three states that don’t allow religious or personal exemptions (Mississippi, West Virginia, and California) are unsurprisingly among those with the highest vaccination rates in the country. Outside of these three havens, states that allow broad, nonmedical vaccine exemptions are seeing nearly eradicated diseases return with impunity. There were 372 cases of measles reported nationwide last year, but preliminary CDC data shows that the United States is on track for 1,100 measles cases this year. That would be a decade-high, nearly double the 667 cases reported in 2014.
In the face of a dramatic spike in measles cases and the overwhelming evidence that vaccines are safe, it will become harder for politicians to ignore the crisis. Absent decisive action from the state governments, the federal government may indeed have no choice but to step in, or stand idly by while infection spreads across the country.