Vaccine. 2014 Feb 12. pii: S0264-410X(14)00148-0. doi: 10.1016/j.vaccine.2014.01.085. [Epub ahead of print]

Rising rates of vaccine exemptions: Problems with current policy and more promising remedies.

Constable C¹, Blank NR², Caplan AL³.

Author information

• ¹New York University Medical Center, Department of Medicine, 550 First Avenue, New York, NY 10016, United States. Electronic address: catherine.constable@gmail.com.
• ²Department of Population Health, New York University Medical Center, 550 First Avenue, New York, NY 10016, United States.
• ³Division of Medical Ethics, Department of Population Health, New York University Medical Center, 550 First Avenue, New York, NY 10016, United States.

Abstract

Parents of school-age children are increasingly claiming nonmedical exemptions to refuse vaccinations required for school entry. The resultant unvaccinated pockets in many areas of the country have been linked with outbreaks of vaccine-preventable diseases. Many states are now focused on reducing rates of nonmedical exemptions by making exemption processes more restrictive or burdensome for the exemptor. These strategies, however, pose ethical problems and may ultimately be inadequate. A shift to strategies that raise the financial liabilities of exemptors may lead to better success and prove ethically more sound. Potential areas of reform include tax law, health insurance, and private school funding programs. We advocate an approach that combines this type of incentive with more effective vaccination education.