As Childhood Vaccination Rates Continue to Fall, Are We Doing Enough to Stop Anti-Vaxxers? These Doctors Say No

Earlier this week Pakistan made headlines around the world when officials announced they’re considering throwing parents in jail for failing to vaccinate their kids among a resurgence in polio cases. 

While such draconian measures are unthinkable in the United States, it’s not hard to imagine a future where the re-emergence of once-eradicated diseases becomes increasingly common.  

In 2000, the Centers for Disease Control and Prevention (CDC) announced that measles was eliminated in the United States, thanks to the success of vaccines that prevent the disease. 

But for months at the end of last year, health officials in the Columbus, Ohio area dealt with the nation’s largest measles outbreak, with more than 80 cases reported in unvaccinated children, according to Columbus Public Health.

And last summer, there was a re-emergence of polio in an unvaccinated person in New York State, the first case detected in the U.S. in nearly a decade.

These outbreaks are a result of falling rates of routine childhood vaccinations, starting years before the COVID-19 pandemic.

“There was this kind of ongoing group of parents who were unwilling to vaccinate their children,” infectious disease expert Michael Cappello, M.D., chair of the Epidemiology of Microbial Diseases department at Yale School of Public Health tells The Messenger.

This decline was exacerbated by the pandemic, rife with misinformation and disinformation about vaccines.

 “I think the increased negative attention that was brought against the COVID vaccines has made some people even less inclined to vaccinate their child,” Dr. Cappello says.

Immunization rates for kindergarteners for the three major childhood immunizations —  measles, mumps and rubella (often called the MMR vaccine); chickenpox; and diphtheria, tetanus and pertussis (called Tdap) —fell from an average of 95% in 2020 to 2021 to 93% in 2021–2022, according to the CDC. 

The rates in many states are even lower, with Alaska falling to 78% for MMR. 

What does this mean for children? In the case of measles, when the vaccination rate dips below 95% – the estimated level needed to prevent the spread of the disease –  there have been and will be local outbreaks.

“The consequences are going to be what we've already started seeing over the last decade or so, which is we'll see outbreaks of diseases for which we have good vaccinations,” Jason Terk, M.D., a Texas pediatrician and spokesperson for the American Academy of Pediatrics, tells The Messenger. 

“Getting your child vaccinated is probably one of the most important things you can do to keep them well,” he continues. “And there are people and organizations that want to undermine the trust that you should put in vaccines.” 

Reverse the decline

Most states allow non-medical exemptions – and the elimination of these exemptions has been shown to boost vaccination rates.  

When California eliminated non-medical exemptions in 2015, the stricter immunization requirements led to more kids getting vaccinated. 

It brought the vaccination rate to 95% in most of the state’s counties, and above the threshold for measles to spread. 

“It’s something that many pediatricians would be very much in favor of,” says Dr. Terk. 

“It doesn't make sense from a scientific point of view to permit people to attend schools and not be protected from vaccine-preventable diseases and therefore increase the risk to everybody else,” he continues.

“We have to do a better job on the public health side of explaining why it's not a good idea to permit non-medical exemptions.” 

Strengthen the bond between health care providers and families

Many parents, even if they are vaccine hesitant, have trust in their pediatrician, says Dr. Cappello. 

But economic pressures faced by providers to see more patients in less time may cause families to not develop “the same deep relationship that they may have had with their pediatrician when they were children,” Dr. Cappello says.

“We really need to make sure that providers are both empowered to provide that information,” he continues, “but also given ample opportunity to spend enough time with their patients and their patients' parents to be able to explain things in a way that families are able to trust the recommendations that they're making.”

Hold the spreaders of vaccine misinformation, including doctors, accountable

“People in my own profession have leveraged their positions to spread information which is incorrect and undermines confidence,” says Dr. Terk. 

“I think that in the medical profession, we have to do a good job ourselves of policing our profession and calling out individuals who say things that they know to be false and which are in fact easily shown to be disinformation,” he continues.

“We have freedom of speech in this country. But if your speech leads to direct harm, it should not be permitted,” he says.

Penalize parents who don't vaccinate?

“We're probably better off using the carrot than the stick,” says Dr. Cappello. “I think we want to create incentives for parents to vaccinate their children rather than thinking up punishments for parents who don't.”

This could include a vaccination requirement for children’s participation in certain community or school-based activities. 

“I think there is room to make clear that we as a society and as parents, myself included, we have to take collective responsibility for ensuring the health of each other,” Dr. Cappello says.