The current measles outbreak — the largest in almost three decades — has resulted in more than 60 suspected cases this year in Massachusetts, and 764 across the United States. Measles’ revival is nothing less than a public-health tragedy: In 2000, the United States had declared the potentially fatal disease eliminated. Now that it’s back, states have been left scrambling to adjust to this unexpected new reality.
There are two practical steps the Legislature should consider, especially if the outbreak continues to worsen. The first is to sharply limit or eliminate the religious exemptions that have allowed some parents to skirt mandatory vaccination rules for school-age children. The second is to allow teenagers to get vaccinations without parental consent, just as teens can already consent to a handful of other medical services on their own.
Neither idea would be especially radical: California eliminated nonmedical exemptions in 2015, and South Carolina, Oregon, and Pennsylvania allow teens to receive vaccinations on their own. Both responses are tailored to the root cause of the disease’s confounding comeback: parents who withhold vaccines from their children.
Low vaccination rates in parts of the country have created pockets of vulnerability and provided space for outbreaks to gather steam. Vaccine-hesistant parents don’t just put their own children at risk: When measles spreads unchecked, people who cannot receive the vaccine — either because they are too young, or because of a medical condition — suffer the consequences. Measles is extremely contagious, and fatal in about 1 or 2 out of every 1,000 cases.
The law says that school kids must be vaccinated against measles and other diseases, but there are exceptions in almost every state, and those exceptions seem to have been abused. In Massachusetts, parents can forego the shots by claiming a religious exemption. No major religion opposes vaccines, but the percentage of Massachusetts children unvaccinated for supposedly religious reasons has increased more than fivefold since the 1980s. Because the state’s overall immunization rate remains high, there’s been little momentum on Beacon Hill to close this loophole. If nothing else, the state should be a lot stricter about such exemptions, and require parents to demonstrate a bona fide religious objection (and no, anti-vaxxer misinformation on Facebook doesn’t count as religious teachings).
New York, which has been hit hard by the current outbreak, is weighing another change that Massachusetts should consider: Lawmakers there are moving legislation that would allow teens over 14 to get shots without parental consent. “Young people are often more conscious about the misinformation on the internet and can in many cases disagree with parents who have bought into unfounded and dangerous anti-immunization diatribes and pseudoscience,” according to a memo from the New York chapter of the American Academy of Pediatrics in support of the bill.
It’s impossible to know how many teens would take advantage of that right, but anecdotal accounts suggest that many minors would prefer not to bear the brunt of their parents’ superstitions. Earlier this year, an Ohio teen, Ethan Lindenberger, made national news by getting vaccinated on his 18th birthday. A 15-year-old in Minnesota documented his (unsuccessful) effort to get a shot against his parents’ wishes.
Right now, anyone under 18 in Massachusetts generally needs permission from a parent or guardian for any medical procedure, but the law already contains several common-sense exceptions. For instance, a teen can consent to addiction treatment, receive treatment for sexually transmitted diseases, or seek family planning services without parental permission.
There is also a catchall provision that allows a doctor to determine that a child is a “mature minor” who can make sound decisions for him or herself. A teenager in Massachusetts who wanted a vaccine could get one that way, by finding a doctor willing to provide it under the mature minor provision.
But requiring that evaluation is a needless extra hurdle. It would be better if the state explicitly exempted vaccines from age-of-consent laws, much like the current addiction and STD exemptions.
It’s flabbergasting that a preventable disease like measles is back, and that state legislatures have been as slow as the rest of us to wake up to a threat that shouldn’t be happening at all. But it is happening. The United States has seen the most measles cases in a year since 1994, and it’s only May. A multipronged strategy to increase immunization rates should put pressure on parents to vaccinate — and, when that pressure fails, give their children a way to protect themselves.