This article examines the rise of the anti-vaccination movement, the proliferation of laws allowing parental exemptions to mandatory school vaccines, and the impact of the movement on immunization rates for all vaccines. It uses the ongoing debate about the Human Papillomavirus (HPV) vaccine as an example to highlight the ripple effect and consequences of the anti-vaccine movement despite robust evidence of the vaccine's safety and efficacy. The article scrutinizes how state legislatures ironically promote vaccination while simultaneously deferring to the opposition by promulgating broad opt-outs from mandatory vaccine laws. This article concludes by offering an alternative legislative approach to specifically combat the anti-vaccine movement's impact on HPV vaccination rates. Lowering the age of consent has not been widely attempted or proposed and provides an alternative statutory mechanism to push back against vaccine resistance.
E. F.Dunneet al., “CDC Grand Rounds: Reducing the Burden of HPV-Associated Cancer and Disease,”Morbidity & Mortality Weekly Report63, no. 4 (2014): 69–72, at 69 [hereinafter Dunne et al., “CDC Grand Rounds]; L. E. Markowitz et al., “Reduction in Human Papillomavirus (HPV) Prevalence Among Young Women Following HPV Vaccine Introduction in the United States, National Health and Nutrition Examination Surveys, 2003–2010,” Journal of Infectious Diseases 208, no. 3 (2013): 385–93, at 385 [hereinafter Markowitz et al., “Reduction in HPV Prevalence Among Young Women Following HPV Vaccine Introduction in United States”].
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R. M.Wolfe and L. K.Sharp, “Anti-Vaccinationists Past and Present,”British Medical Journal325 (2002): 430–32, at 430.
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L.Tomljenovic and C. A.Shaw, “Too Fast or Not Too Fast: The FDA's Approval of Merck's HPV Vaccine Gardasil,”Journal of Law, Medicine & Ethics40, no. 3 (2012): 673–81, at 673.
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A. J.Wakefieldet al., “Illeal-Lymphoid-Nodular Hyperplasia, Non-Specific Colitis, and Pervasive Developmental Disorder in Children,”The Lancet351, no. 351 (1998): 637–641. The article was retracted in February 2010; Editors of the Lancet, “Retraction — Illeal-Lymphoid-Nodular Hyperplasia, Non-Specific Colitis, and Pervasive Developmental Disorder in Children,” The Lancet 375 (2010): 445.
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L.Eggertson, “Lancet Retracts 12-Year-Old Article Linking Autism to MMR Vaccines,”Canadian Medical Association Journal182, no. 4 (2010): E199–E200, at E199.
9.
Editors of the Lancet, supra note 7; Eggerston, supra note 8, at E199. Recent studies confirm the lack of a link between vaccines and autism. See, e.g., A. Jain et al., “Autism Occurrence by MMR Vaccine Status among U.S. Children with Older Siblings With and Without Autism,” Journal of the American Medical Association 313, no. 15 (2015): 1534–1540.
P. A.Offit, “The Anti-Vaccination Epidemic,”Wall Street Journal, Sept. 24, 2014, available at <http://www.wsj.com/articles/paul-a-offit-the-anti-vaccination-epidemic-1411598408> (last visited July 11, 2016); see also P. J. Smith et al., “Parental Delay of Refusal of Vaccine Doses, Childhood Vaccination Coverage at 24 Months of Age, and the Health Belief Model,” Public Health Report 126, Suppl. 2 (2011): 135–146, at 144.
12.
F.Zhouet al., “Economic Evaluation of the Routine Childhood Immunization Program in the United States, 2009,”Pediatrics133, no. 4 (2014): 577–585, at 581–582 (2014).
13.
A.F.Dempseyet al., “Alternative Vaccination Schedule Preferences among Parents of Young Children,”Pediatrics128, no. 5 (2011): 848–56, at 850.
14.
A.Kempeet al., “Physician Response to Parental Requests to Spread out the Recommended Vaccine Schedule,”Pediatrics135, no. 4 (2015): 666–677, at 667.
15.
Id. at 669–670.
16.
Id. at 671.
17.
C. S.Louis, “Most Doctors Give In to Requests by Parents to Alter Vaccine Schedules,”New York Times, March2, 2015, at A12. But see B. Mejia, “Doctors Turning Away Unvaccinated Children,” Los Angeles Times, February 10, 2015, available at <http://www.latimes.com/science/la-me-vaccination-policy-20150210-story.html#page=1> (last visited July 11, 2016). Doctors refusing to treat unvaccinated patients do so because they are concerned for their patients who are too young to be vaccinated or cannot be vaccinated for legitimate medical reasons. Dr. Charles Goodman's practice in California, for example, “decided that the patients who are not vaccinated are presenting a clear and present danger.” Id.
S. B.Omeret al., “Nonmedical Exemptions to School Immunization Requirements: Secular Trends and Association of State Policies with Pertussis Incidence,”Journal of the American Medical Association296, no. 14 (2006): 1757–63, at 1760 [hereinafter Omer et al., “Nonmedical Exemptions”].
20.
J.Zipprichet al., “Measles Outbreak — California, December 2014–February 2015,”Morbidity & Mortality Weekly Report64, no.6 (2015): 153–54, at 153; California Department of Public Health, “California Measles Surveillance Update,” Apr. 17, 2015, available at <http://www.cdph.ca.gov/HealthInfo/discond/Documents/Measles_update_4-17-2015_public.pdf> (last visited July 11, 2016).
P.Dees and D. M.Berman, “The Media's Role in Vaccine Misinformation,” in A.Chatterjee, ed., Vaccinophobia and Vaccine Controversies of the 21st Century (Springer, 2013): 383–398, at 383.
FDA, News Release, FDA Approves Gardasil 9 for Prevention of Certain Cancers Caused by Five Additional Types of HPV, December10, 2014, available at <http://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm426485.htm> (last visited July 11, 2016) [hereinafter News Release, FDA Approves Gardasil 9]; see also E. A. Joura et al., “Attribution of 12 High-Risk Human Papillomavirus Genotypes to Infection and Cervical Disease,” Cancer Epidemiology, Biomarkers & Prevention 23, no. 10 (2014): 1997–2008.
26.
P. A.Offit, Deadly Choices: How the Anti-Vaccine Movement Threatens Us All(Basic Books 2011): at 10.
27.
Centers for Disease Control & Prevention, What is HPV? last updated December28, 2015, available at <http://www.cdc.gov/hpv/parents/whatishpv.html> (last visited July 11, 2016); Dunne et al., “CDC Grand Rounds,” supra note 4, at 69.
28.
C.C.Hugheset al., “HPV Vaccine Decision Making in Pediatric Primary Care: A Semi-Structured Interview Study,”BMC Pediatrics11, no. 74 (2011): 1–9, at 5.
29.
L.E.Markowitzet al., “Human Papillomavirus: Recommendations of the Advisory Committee on Immunization Practices (ACIP),”Morbidity & Mortality Weekly Report, No. 63 (RR05) (2014): 1–30, at 20.
30.
See, e.g., D. M.Holmanet al., “Barriers to Human Papilloma-virus Vaccination among US Adolescents: A Systematic Review of the Literature,”Journal of the American Medical Association Pediatrics168, no. 1 (2014): 76–82, at 78.
S.Parker, “The Perverse Politics of Gardasil,”World News Daily, February17, 2007, available at <http://www.wnd.com/2007/02/40218/> (last visited July 11, 2016).
33.
Id.
34.
A. B.Jenaet al., “Incidence of Sexually Transmitted Infections After Human Papillomavirus Vaccination Among Adolescent Females,”Journal of the American Medical Association Internal Medicine175, no. 4 (2015): 617–623. In fact, the vaccine may be associated with protective health behaviors, such as higher levels of condom use and awareness of the need for continued screenings despite vaccination. E. V. Kliewer, “Human Papillomavirus Vaccination and Pap Testing Profile in Manitoba, Canada,” Vaccine 32, no. 1 (2014): 33–38, at 35; N. C. Liddon et al., “Human Papillomavirus Vaccine and Sexual Behavior Among Adolescent and Young Women,” American Journal of Preventive Medicine 42, no. 1 (2012): 44–52, at 49–50; L. Sadler et al., “Comparing Risk Behaviors of Human Papillomavirus-Vaccinated and Non-Vaccinated Women,” Journal of Family Planning & Reproductive Health Care 41, no. 4 (2015): 255–258.
35.
Office for State, Tribal, Local & Territorial Support, State School Immunization Requirements and Vaccine Exemption Laws, Mar. 27, 2015, available at <http://www.cdc.gov/phlp/docs/school-vaccinations.pdf> (last visited July 11, 2016).
36.
K.M.Malone and A.R.Hinman, “Vaccination Mandates: The Public Health Imperative and Individual Rights,” in R. A.Goodmanet al., eds., Law in Public Health Practice (Oxford University Press2006): 338–60, at 344.
Miss. Code Ann. § 41-23-37 (West 2015) (this law was challenged but upheld by the Supreme Court of Mississippi in 1979 in Brown v. Stone, 378 So.2d 218, 223 (Miss. 1979)); W. Va. Code Ann. § 16-3-4 (West 2015); L. Perkins, “California Governor Signs School Vaccination Law,” National Public Radio, June 30, 2015, available at <http://www.npr.org/sections/thetwo-way/2015/06/30/418908804/california-governor-signs-school-vaccination-law> (last visited July 11, 2016).
43.
Del. Code. Ann. tit. 14. § 131 (West 2015); Iowa Admin. Code r.341-7.3(139A)(West 2015); N.J. Admin. Code § 8:57-4.4 (West 2015).
U.S. Department of Health & Human Services, Community Immunity (“Herd Immunity”), last updated March3, 2016, available at <http://www.vaccines.gov/basics/protection/> (last visited July 11, 2016) [hereinafter HHS, Community Immunity (“Herd Immunity”)]. 472 journal of law, medicine & ethics Allison M. Whelan
S.Stokleyet al., “Human Papillomavirus Vaccination Coverage Among Adolescents, 2007–2013, and Postlicensure Vaccine Safety Monitoring, 2006–2014—United States,”Morbidity & Mortality Weekly Report63, no. 29 (2014): 620–624, at 622; see also L.D. Elam-Evans et al., “National, Regional, State, and Selected Local Area Vaccination Coverage Among Adolescents Aged 13–17 Years—United States, 2013,” Morbidity & Mortality Weekly Report 63, no. 29 (2014): 625–633, at 625 (discussing other ACIP-recommended vaccines for this age group).
See, e.g., S. N.Tabriziet al., “Assessment of Herd Immunity and Cross-Protection After Human Papillomavirus Vaccination Programme in Australia: A Repeat Cross-Sectional Study,”The Lancet Infectious Diseases14, no. 10 (2014): 958–66.
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See S. Bellet al., “Psychological Response to Cervical Screening,”Preventive Medicine24, no. 6 (1995): 610–16, at 610; M.J. Campion et al., “Psychosexual Trauma of Abnormal Cervical Smear,” British Journal of Obstetrics & Gynaecology 95, no. 2 (1998): 175–81; L. Lagana et al., “Psychosexual Dysfunction Among Gynecological Cancer Survivors,” Journal of Clinical Psychology in Medical Settings 8, no. 2 (2001): 73–84, at 74; J. M. B. Landstra et al., “The Psychological Impact of Anal Cancer Screening on HIV-Infected Men,” Psychooncology 22, no. 3 (2013): 614–620, at 614–615; T.W. McDonald et al., “Impact of Cervical Intraepithelia Neoplasia Diagnosis and Treatment on Self-Esteem and Body Image,” Gynecologic Oncology 34, no. 3 (1989): 345–49; K. E. Rogstad, “The Psychological Impact of Abnormal Cytology and Colposcopy,” British Journal of Obstetrics & Gynaecology 109, no. 4 (2002): 364–368.
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A.L.Friedman and H.Shepeard, “Exploring the Knowledge, Attitudes, Beliefs, and Communication Preferences of the General Public Regarding HPV: Finding from CDC Focus Group Research and Implications for Practice,”Health Education & Behavior34, no. 3 (2007): 471–485, at 475; B. Lichtenstein et al., “The Stigma of Sexually Transmitted Infections: Knowledge, Attitudes, and an Educationally-Based Intervention,” Health Education Monograph Series 25, no. 2 (2008): 28–33, at 32.
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P.Clarkeet al., “The Psychosocial Impact of Human Papilloma-virus Infection: Implications for Health Care Providers,”International Journal of STD & AIDS7, no. 3 (1996): 197–200, at 198.
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A.Syse and Ø. Kravdal, “Does Cancer Affect the Divorce Rate?”Demographic Research16 (2007): 469–92.
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W.Atkinsonet al. eds., Epidemiology and Prevention of Vaccine-Preventable Diseases (Centers for Disease Control & Prevention 2011): at 142–43.
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H.W.Chessonet al., “Estimates of the Annual Direct Medical Costs of the Prevention and Treatment of Disease Associated with Human Papillomavirus in the United States,”Vaccine30, no. 42 (2012): 6016–19, at 6016–17.
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See, e.g., Ala. Code § 22-11A-19 (West 2014); Cal. Fam. Code § 6926 (West 2014); Del. Code Ann. § 710 (West 2014); 410 Ill. Comp. Stat. 210/§ 4 (West 2014); Vt. Stat. Ann. tit. 18, § 4226 (West 2014).
67.
Idaho Code Ann. § 39-3801 (West 2014); N.H. Rev. Stat § 141-C:18 (II) (West 2014); N.D. Code Ann. § 14-10-17 (West 2013); Wash. Rev. Code Ann. § 70.24.110 (West 2014).
68.
Kan. Stat. Ann. § 38-123b (West 2014); Ore. Rev. Stat. Ann § 109.640 (West 2014); S.C. Laws Ann. § 63-5-350 (West 2014).
69.
Cal. Fam. Code § 6926 (West 2015) (emphasis added).
