How Too Much Freedom of Choice Endangers Public Health: The Effect of Nonmedical Exemptions from School-Entry Vaccinations in Texas
Olive, Jackie K.
Matthews, Kirstin R.W.
Vaccination is a robust intervention to prevent infectious diseases on an individual and community level. However, vaccination rates are below recommended levels throughout the world, including in developed countries. According to the National Immunization Survey, only 71.6 percent of children aged 19-35 months in the United States received the recommended combined series of vaccinations in 2014, and 0.8 percent of children were not vaccinated at all (Centers for Disease Control and Prevention 2015). Inadequate coverage is largely due to the increasing number of parents who opt their children out of vaccinations required for school entry. In Texas, approximately 45,000 nonmedical exemptions were filed across all age groups during the 2015-16 school year, a record high in the last decade and a figure that is only increasing. Parents who abstain from getting their children vaccinated often have misguided concerns regarding vaccine safety and utility. Recent outbreaks of vaccine-preventable illnesses, including large measles outbreaks in Texas, reflect the decreasing strength of herd immunity and result in billions of dollars in annual medical expenditures as well as indirect costs accounting for work loss and declines in economic productivity (McLaughlin et al. 2015). As one of the states with the least restrictive vaccine exemption laws in the country, Texas should make obtaining nonmedical exemptions more rigorous in order to avoid the public health risks and costs associated with preventable diseases.