Forbes | February 11, 2015
By Bill Frist, MD
I last witnessed a measles outbreak in 2011. Thousands were sick with high fevers, dry cough, and a spreading rash. Three quarters of the ill were children under five years old, and the disease was spreading rapidly. Once the outbreak began, immunization response strategies could barely keep up. It took months before even the hospitalized pediatric patients were all vaccinated.
Back then I was in the Dadaab refugee camp, near the border of Kenya and Somalia. I’m horrified to think we are courting a similar outbreak in America.
In the United States, before 1963, there were 400,000 cases of measles per year. One thousand of those children developed measles encephalitis, a serious brain infection, and often subsequent permanent disability. An estimated 400-500 of those children died, and many who lived were plagued with permanent disabilities including deafness.
In 2000, the U.S. had no measles cases. One of the most infectious diseases was eradicated by one of the most effective vaccines we have. The measles vaccine, which is 95% effective after one dose, decreased incidence of the measles in this country by 99%. Thanks to vaccine science, we had achieved a monumental public health milestone.
Now the measles are back, and the disease is spreading quickly. Unlike Ebola, which requires direct contact with contaminated body fluids to spread, measles is airborne and lives in droplets for hours. You can get the measles from walking into the waiting room at the doctor’s office where a measles patient has been coughing before your arrival.
However, compared to our reaction to the Ebola epidemic, the public response to this measles outbreak is perplexing. We called for a rush vaccine for Ebola, for mandatory quarantines. We were outraged at the possibility of getting on a plane and catching Ebola.
However, there were four cases of Ebola in the U.S. There have been 102 cases of the measles since January 1. And most importantly, we already have a vaccine for the measles.
Globally, we still see about 20 million cases of measles a year. In 2013 the virus was responsible for 145,700 deaths. As a physician who has worked with patients all over the world, particularly in the developing world, I am adamantly pro-vaccine.
They save lives. People who live in countries without the healthcare infrastructure to care for measles patients desperately seek a preventative vaccine instead of watching their children suffer and potentially become disabled or die.
As a republican, I am also adamantly pro-vaccine, and this is not something I have to work hard to reconcile. As my friend and colleague Rep. Marsha Blackburn (R-Tenn.) said: "This is far too serious an issue to be treated as a political football."
The republican ethic stands behind our personal rights to make private choices about our life and our health, and vaccine mandates for children attending public schools fall squarely within this ethic. Despite what some people may be postulating, they are certainly nothing new.
In 1905, the Supreme Court held in Jacobson v. Massachusetts that vaccine mandates are clearly within a state’s powers to protect the public health. The court noted that,
“the liberty secured by the Constitution of the United States to every person within its jurisdiction does not import an absolute right in each person to be, at all times and in all circumstances, wholly freed from restraint. There are manifold restraints to which every person is necessarily subject for the common good. On any other basis organized society could not exist with safety to its members.
Because all vaccination laws fall under state jurisdiction, the court was affirming a Massachusetts statute requiring vaccinations for smallpox stating it was reasonable, because it was not “arbitrary or oppressive,” had a substantial relation to the necessity of protecting the community, and was based on evidence. The court noted there needed to be exceptions for absurd consequences like serious risk of death or harm from inoculation. These are the health exceptions we have built into all vaccine laws.
Furthermore, vaccines don’t only protect the individual. Vaccinated individuals, together, create herd immunity. Exemption rates of as little as 2%-4% are sufficient to make a school more susceptible to outbreaks. Frighteningly, we are seeing non-vaccination rates as high as 10% in some counties in California.
I appreciate the need to stand up for personal freedom and defend our liberties. But in the case of a highly infectious and highly contagious disease, the “choice” we are defending is one that allows neighbor to harm neighbor.
Senator Rand Paul, M.D. this week argued that vaccines have been voluntary for "most of our history.” He’s not quite right. Mandatory vaccination law with only health and religious exemptions has been the norm for the last century, which consequently coincides with how long vaccines have existed.
The vaccines are safe. Getting the measles, on the other hand, is definitely not safe. We have the deaths and morbidity to prove it. Being the party that tries to deny these types of facts will result in accusations and extrapolations that republicans are anti-science. And that also, is just not true.
As a lawmaker, I introduced over a dozen bills that touched on vaccines, authoring the Improved Vaccine Affordability and Availability Act of 2003 (S. 754) and successfully enacting the Public Health Security and Bioterrorism Preparedness and Response Act of 2002, which ensured we had a sufficient vaccine stockpile to combat a biological attack or other public health emergency.
I would eagerly vote the same way again. And I will stand up now and say that children should absolutely be vaccinated if they can be. We are a fortunate country with all of the best medications and vaccinations available. We should believe the science—the facts—and avail ourselves of what the rest of the world views as a privilege.