The results of a 2017 survey from the Centers for Disease Control and Prevention (CDC) were released earlier this month, finding that the percent of U.S. children under two years old who have not been vaccinated has quadrupled since 2001, resulting in 1.3% of children today not receiving any of their recommended vaccines. There are four main reasons why parents don’t vaccinate their children: religious beliefs, personal beliefs or philosophical reasons, safety concerns, and a desire for more information from doctors. One safety concern is being bolstered by a campaign arguing against vaccines by alleging that they cause autism, even though there is no scientific basis for this argument. On the contrary, vaccines protect not only the child who receives the vaccine, but also the community the child is surrounded by. When a community as a whole is vaccinated, if someone carrying one of the diseases vaccines protected against were to become a part of the community, vaccinated individuals would be able to prevent this disease from becoming an epidemic, solely because they are vaccinated. This is due to the fact that once enough of the population is vaccinated (about 93%), it becomes much more difficult for these diseases to be transferred since the number of individuals who can spread the disease is significantly diminished. Thus, vaccines provide a benefit not just for the person getting the vaccine but for the population as a whole.

Currently, there is no federal vaccine mandate – vaccine mandates are only found in state law as prerequisites to enrolling children into school or daycare. However, every state has a vaccine mandate, though the particular diseases covered and the exemptions vary from state to state. All states have exemptions for children who are immunocompromised or who are allergic to components in the vaccine due to the fact that the potential harm of the vaccine outweighs the potential benefits for this small percent of the population. Additionally, thirty states recognize an exemption for parents who cite religious reasons and eighteen states will make special accommodations for parents stating philosophical reasons. For example, Maine will allow an exemption based on “moral, philosophical, or other personal beliefs,” while Minnesota will allow an exemption based on “conscientiously held beliefs of the parent.” These philosophical beliefs are often based upon the parents’ idea that if their child contracts these preventable diseases, they will have a stronger natural immunity after healing compared to the immunity they could get through a vaccine. Other philosophical beliefs include the belief that the child is at a minimal risk of contracting the disease so they would rather not put chemicals found in vaccines in their child’s body. However, parents who do not vaccinate their children for any of the aforementioned reasons do so with the knowledge that if there is an outbreak of a vaccine-preventable disease within the child’s school, the child may be temporarily excluded from school attendance, depending on the state. The process for getting a vaccine exemption differs from state to state as well. Utah, for example, allows for parents to fill out the exemption form online but also mandates that the parents watch an online education module regarding preventable diseases. On the other hand, Connecticut requires an annual notarized statement from the parents specifying their religious objection to required vaccines.

Although states control who must be vaccinated, the federal government controls exactly how these people are vaccinated by regulating how vaccines are manufactured, distributed, and administered to patients. In 1986, Congress passed the National Childhood Vaccine Injury Act (NCVIA) which created an administrative office to serve as the go-between regarding vaccines for the Food and Drug Administration (FDA), CDC, and National Institutes of Health (NIH) – all federal agencies involved in vaccine research, approval, and regulation. In addition, the NCVIA-standardized vaccine protocols created a consistent, informative statement for doctors to give patients (or their parents) regarding the benefits of the vaccine, the risks, and the disease sought to be vaccinated against. The NCVIA also allows for compensation for those who were injured by vaccines on a no-fault basis, reducing the slight financial risk of vaccinating even further.

The fact that states determine who is vaccinated while the federal government controls the approval and regulation of vaccines creates a discrepancy that may be the key to reversing this trend of lower vaccination rates. A major cause of this discrepancy is the consolidation in the market that has occurred due to this regulation – only a handful of manufacturers are putting vaccines on the market at this time. This means that due to the large market share of these manufacturers, there is a diminished incentive towards innovation, both towards making the vaccine process more efficient (imagine what would happen if we had a time released flu shot to last multiple years ?) but also towards making the vaccine itself more effective. Furthermore, for those parents who are hesitant to vaccinate their children due to concerns regarding the regulation of vaccines by manufacturers with monopolies over the market (and thus less likely to take thorough precautions), the monopolization of the vaccine market does nothing to assuage these concerns.

In conclusion, the discrepancy between state laws addressing mandatory vaccinations and the federal government addressing the production and administration of vaccines creates an opportunity for parents to make the decision to not vaccinate their children, even when doing so would be in their best interests as well as the best interest of their community. Merging state and federal laws into a converging approach would allow for more parents to feel confident in vaccinating their children and feel confident in the administration of vaccines as well.