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Bioethicist: US children suffer from vaccine exemptions

How easy is it to avoid getting your kid exempt from school shots? Too easy -- if the epidemic of preventable diseases sweeping through many states are any indication.

It's nearly August and that means the start of school and important vaccine shots for kids entering kindergarten, elementary school or day care. Free, back-to-school immunization clinics are opening up nationwide to provide shots, depending on the state, against a whole range of diseases, including  mumps, measles, rubella (German measles), diphtheria, Hepatitis A, pertussis (whooping cough), tetanus, flu and polio.

What you may not know is that a scary number of these diseases are at epidemic levels in the United States. Whooping cough, an illness that many Americans over 30 thought had disappeared, is at the highest rate among children in the US in fifty years. At least 18,000 cases have been reported in 2012, more than twice as many cases as there were at this time last year. Nine infants have died from whooping cough this year. In addition, an estimated 214 children contracted measles last year in the US, the largest outbreak of a nasty infectious disease in 15 years.

Part of the problem is, too many parents are refusing to get their kids vaccinated against whooping cough and the other horrible diseases that have returned, sickening, disabling and killing children.

There are school requirements for vaccination and, undoubtedly, vaccine rates for most children are still very high. But all states permit exceptions. Two states, Mississippi and West Virginia allow parents to opt-out only on medical grounds -- if the child has an immune disease or is violently allergic to eggs. That seems reasonable.

Other states allow vaccine exceptions for parents who claim religious reasons. While there are few religions that are specifically against vaccines, some states, including Maine, Colorado, Washington, Texas, Vermont, Arkansas and Minnesota, allow parents to say “no” to vaccines for any reason, using a so-called "philosophical" exemption. That is a problem.

California, which has had its own miserable experience the last few years with disease outbreaks and deaths in babies, has one of the easiest vaccine opt-outs in the nation, allowing parents to refuse vaccinations for their children because of personal beliefs. Recently, Democratic state representative, Dr. Richard Pan, proposed a law that requires any parent who wants to send a child to school without the required vaccines to document that they have had a face-to-face conversation with a health care provider about vaccine risks and benefits.

That's a pretty simple law that raises the bar a bit on what can be deadly vaccine exceptions. The bill is in committee, but anti-vaccine groups are buzzing like hornets, looking to get it defeated, as they did with similar efforts in Vermont earlier this year.

In fact, in the name of personal freedom, anti-vaccinators have been pushing to make it easier for parents to opt-out of vaccines in a number of states.

The United States is paying the price in death, disability and misery of allowing anyone who wants to, for no reason supported by medical science, deny vaccines for their children. Vaccine refusers put every other kid, baby and immune-suppressed adult at greater risk of getting infected. Freedom of choice is a great thing -- except when that choice leads to a possibly fatal outcome for your child.

 Arthur Caplan is the head of the Division of Medical Ethics at NYU Langone Medical Center.


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