A mandate for vaccines in California

The California pertussis epidemic is on track to be the biggest in the state since 1958. As of mid-June, there were 910 confirmed cases, some 600 more suspected cases and five deaths, all in infants younger than 3 months. There’s also this: California is one of a handful of states that does not require the tetanus-diphtheria and acellular pertussis booster for middle school entry.

Why doesn’t California have a mandate in place for middle school entry? From a public health standpoint, there’s a clear case in favor of it. Pertussis immunity wanes after the childhood vaccination series ends. Adolescents are not only susceptible to pertussis, but they are a transmission vector for vulnerable infants. The clinical illness may not be a major concern for adolescents, but it is enormously problematic for infants—those five deaths to date in California demonstrate that fact.

Without even examining the specifics in California, I can comfortably guess at some reasons for the lack of a mandate there, because they are likely the same reasons we don’t have other necessary mandates — like influenza vaccination of every health care worker in this country. Among them: cost, access, under-appreciation of the potential morbidity and mortality associated with vaccine-preventable diseases and overestimation and misinformation about vaccine adverse events.

But here’s a reason that really makes me cringe — our society puts more value on personal choice than on protecting our fellow citizens. “Mandates” has become a dirty word. We don’t like mandating anything in this country. No, we’re not going to mandate and take away personal choice. But what choice did those five infants have? Does our thirst for individual freedom absolve us of our responsibility to protect them?

This problem becomes as much — or maybe more — of a political issue as it is a public health issue. There are so many reasons — too many reasons — why vaccine uptake is low, but one of them shouldn’t be the fueling of public health decisions by political fears.

Mandates assure that all are protected.

William Schaffner is Professor and Chair, Department of Preventive Medicine, Vanderbilt University School of Medicine, and blogs at Infectious Disease News.

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  • http://mcwendell.blogspot.com Wendel Souza

    Any freedom-loving person (and that is not limited to American citizens) should CRINGE when opinion makers such as Dr. William Schaffner cries out loud ” a reason that really makes me cringe — our society puts more value on personal choice than on protecting our fellow citizens”. This is a terrifying statement! Specially coming from a person, an academic scholar, a person whose profession’s fundamental ethics is never violate a patient.

    I understand that freedom is both a sacred right and a duty whereas my freedom ends where my neighbour’s freedom starts. That’s what makes America great: people exercising their right to personal choice and that includes the right to make bad choices too.

    Although it may be necessary to take public health measures when the health condition of certain individuals poses a serious risk to the society in general, establishing mandates should be the last resort, and YES – political factors should be considered! Two wrongs don’t make one right. If people die because a virus is out there spreading, violating everyone’s else personal choice by establishing a forceful vaccination mandate doesn’t make sense. Much more innocent people die of car accidents every year and we don’t see people asking for a ban on cars.

    If America doesn’t want to end up like Cuba or Venezula (where mandates are established without consulting the population), Americans should fight those who want to stick a needle into them under the name of an utopic “social justice”.

    The ultimate message of Dr. Schaffner is: Give away your freedom and I will protect you. Yeah right. This kind of reasoning can only lead to one place: a totalitarian state, where the only real protection you can get is an eternal grave.

    • http://thedocsquawk.com thedocsquawk

      I still don’t see how giving people life saving vaccines in California will make America end up like Cuba or Venezuela. There’s an awful lot of freedom loving, but not a lot of making sense in what you said.

      • http://www.twitter.com/alicearobertson Alice

        The poster was talking about our constitutional rights…….yes……you will come back with the, “What about the rights of society?” Well, if your herd mentality is a reality you don’t have anything to worry about.

        So you don’t find anything tyrannical about mandates and most of the diseases you are using scare tactics about are gone or almost gone (how many people die a year from Tetanus, Pertussis, some years it’s only one person with measles, other years more, Rubella and polio aren’t a problem…..chicken pox can still be a naturally occurring event that is completely safe for the vast majority of kids……and they get true lifelong immunity the shot doesn’t give)?

        Most parents do immunize. Why call in the big guns over this issue? Considering there are no safeguards in place for the kids that will surely be injured in some manner (even a learning disability is an injury if it didn’t exist before the shot…….but there will be no stats on that…..the media and doctors are so busy maligning the non-immunizers as radical, ignoramuses….and saying a stage full of mothers on Oprah is nonsense…..moms who have no reason to lie….moms who signed away their rights to get a shot that a doctor assured them was safe).

        Go ahead and cast off the “totalitarian” label, but what do you call a government that takes more and more rights? The framers never intended a government this powerful. Read Thomas Jefferson and James Madison and the Constitutional Debates…..it is thrilling to see great minds at work, and the forethought……it’s magnificent.

        What do you say about Congress exhibiting a right to power that isn’t theirs to take? A Supreme Court that votes on moral issues outside of the law? Forcing citizens to purchase insurance, to get shots, etc., etc.?

        You don’t see a slow chiseling away at rights that are best left to the parents? You see not parental rights loss if this proceeds?

        • stargirl65

          “most of the diseases you are using scare tactics about are gone or almost gone”

          These disease are not gone or even almost gone. USA has a very good immunization rate so we do not see these disease very often due to immunity. Other countries see them much more than we do DUE TO LACK OF IMMUNIZATIONS.

      • http://www.lagunanaturalhealth.blogspot.com ocnaturaldoc

        I agree with Wendell.


        It also seems that many feel overwhelmed and have given up their responsibilities and expect the system to take care of them….but at what cost? Just ask your friends in the EU or Canada how their health care is working out for them…unless they’re 100% healthy and under the age of 25. A friend’s sister-in-law died 3 days before her scheduled doctor’s appointment in Toronto, after waiting 5 months. FIVE MONTHS! and they knew she had been diagnosed with cancer in the US when they scheduled her appointment!

        And if you think our costs will be less, think again….just ask the people of the UK, who are outrageously taxed, and are in personal crisis.

        Here’s a thought….let’s get our congress people to relinquish their LIFETIME perks (salary, health insurance, etc.) that we continue to pay for after they leave their position until they die. And how about those student loans they’re exempt from paying off? Who do you suppose pays for this? There’s more, but I’m already a little off-topic.

        Everyone needs to pull their weight and be responsible for their own health and well being. There is NO magic bullet. NO magic pill. NO magic vaccine. When people realize this, and they also realize that they want to be well, they take matters into their own hands (as they should) and educate themselves and their families about ways to optimize their health.

        If each person who is reading this made just one change to optimize their health every week, it would be safe to say that their health would improve. If they got a friend to make a change, then that friend’s health would improve…. and the ripple effect begins. Imagine that.

        We get out of a program what we put into it….or, we reap what we sow. So plant your health seeds and tend to them with care.

        And thedocsquawk, who’s to say vaccines are ‘life saving’? Have you read VAERS? (Vaccine Adverse Event Reporting System) http://vaers.hhs.gov/index
        This site only provides reported cases….imagine the numbers that go unreported because people don’t know about it.

        I’m not anti-pharm, by any stretch. However, there are proven health risks to vaccines and other drugs. They are released on the market with the manufacturer knowing that there will be adverse reactions, hopefully in small numbers. That said, think about all the pharmaceuticals that have been removed from the market in recent years due to cases of stroke, heart attack and fatalities…..just google them — AND their landmark lawsuits. Totally unnecessary and tragic. Imagine the impact the deaths of these trusting patients had on their families….and the loss.

        There are ingredients in vaccines that people, especially children, have negative reactions to due to sensitivities. There are religious and philosophical reasons why parents would not want their children (or themselves) vaccinated. Many of these people have educated themselves and their families about nutrition and healthy, balanced living. And so, they are not the sick ones.

        It’s unfair of Dr Schaffner to broadstroke this issue, penalizing those who enjoy optimized health, by suggesting a mandating of vaccines — especially when there are no guarantees with vaccines. They also make people less responsible for themselves because those who administer the vaccine give people a false hope that they will be safe from disease. How can a health practitioner make that assessment when they don’t know the patient’s history? Think of those who walk into Walgreen’s or Costco for a vaccine….do those on staff perform a complete physical? I’m asking because I don’t know — I’ve never had a flu shot in my life.

        The simple solution to any immune-related disease is to build the immune function via clean, proper, balanced nutrition, pure water and adequate rest and exercise. If the body is well nourished and the immune system is healthy, it’s able to fight off infection and disease.

        Suffice is to say that optimized health is what the health care campaign should be about, but the ‘interested parties’ haven’t found a way to make $17 Billion off apples and organic foods yet (but Merck did — off HPV, a self-clearing disease that most females contract in their lifetime, and never know it…and only 3% of the population get cervical cancer. I’m sure their profits are way over $17 Billion now….that was their initial number.)

        Check VAERS for cases of Gardasil-immunized girls who never had sex, and now are unable to walk, or have a normal life, or are dead. Merck must have changed their ad campaign when the NY mom got a vanity plate on her car that said “ONE LESS” when her teenage daughter died after having the 3-part intramuscular Gardasil vaccine. Condoms are so much simpler….and they don’t carry a load of 675 mcg of toxic aluminum, either.

        Don’t kid yourself, Doctor…..

        “Let food be thy medicine, thy medicine shall be thy food.”
        - Hippocrates

  • stitch

    Mandating vaccines leads to a totalitarian state.

    If that is not the definition of hyperbole I do not know what is.

    There are requirements for being a part of a society. If you want to go live off by yourself and never interact with other people you are absolutely free to do whatever you want.

    However, communicable diseases are called communicable for a reason: because they spread within communities. And if you live within a community, if you are a member of the community, you have responsibilities as a member of that community. Whether you like it or not. If the community chooses to mandate any kind of action, it does not remove your choices. You have the choice to comply, or you have the choice to leave the community and find another community where there are different requirements. Or you have the choice to leave the community and live on your own.

    The idea that these kinds of requirements “violate” someone’s personal liberty is therefore prima facie false. Not to mention absurd.

  • http://www.chrisjohnsonmd.com Chris Johnson

    I think there is a parallel here with mandatory treatment of a communicable disease, even when the patient objects. This has a long legal precedent in the US. I believe it’s mostly been used with persons who had active tuberculosis and declined any treatment for it. Rather than let them go out and infect others, courts have ordered confinement and treatment until the patient is no longer infectious. So although one may object to mandatory vaccination as a violation of his civil rights, the principle of compelling a person take a treatment they object to for the benefit of the community is not a new one.

  • Michael Rack, MD

    Protecting the public health is a traditional duty of the states. I have no problem with individual states mandating vaccines. As a strong believer in the principles of federalism, I would be strongly opposed to any attempts of the US federal government to mandate vaccines in the future.

  • Primary Care Internist

    what if there was a version of AIDS that was transmitted by respiratory droplets, ie. people in the streets coughing as you walked by them, allowing you to pick it up from them. Then let’s say there is a vaccine to prevent infection, and thus ultimately eliminating all those in-the-street coughers. Should we make that vaccine optional?

    And even aside from applying mandates to individuals for the benefit of the public, what about mandates to protect the individual being mandated? Aren’t those wrong, in the opinions of Wendel and stitch? So why do we make motorcyclers wear helmets, have seatbelt laws, and child carseat laws? Should we eliminate all of those? After all, these eliminate personal freedoms and choice, and “lead to a totalitarian state”.

    • http://Www.twitter.com/alicearobertson Alice

      Did someone mention hyperbole? What you describe could happen with smallpox on a plane. Let’s immediately demand all flights be grounded for the good of mankind. See where logic leads us.

  • Primary Care Internist

    oops sorry i didn’t mean to include stitch in the last past (i just quickly read your first line stitch, and then clearly missed your entire point)

  • Anonymous

    With all of the vaccine refusers adding to the potential disease vectors you can come in contact with, it is in your self interest to get the vaccines, mandate or not.

  • paul

    you can choose not to be vaccinated and not use the public school system. the choice is yours.

    the insurance mandate should be handled the same way. you don’t have to purchase insurance, but in exchange emtala does not apply to you, so you have no access to the safety net (and cannot sue for being turned away). the choice is yours, much like you can choose to not purchase car insurance and not drive. pipe dreams, i know.

    • http://www.chrisjohnsonmd.com Chris Johnson

      The difference is that you can choose not to drive, but nobody can choose not to use healthcare — eventually we all will. Are you suggesting that we leave to die those who chose not to buy insurance? Because many people, especially young people, sunny optimists that they are, will choose not to buy it. Then an episode of, say, complicated appendicitis, will bankrupt them. Not good for them, not good for society.

      • stargirl65

        You can choose not to use health care. We all die eventually but it may be that your death will come earlier by your choice not to use healthcare. It is an extreme approach but valid. Remember, insurance is you taking out a safety net for something you don’t think will happen. If you choose not to insure, then you can pay cash for your care or elect not to have care.

        Currently our society does not have this approach. If you buy health care then your insurance covers your care. If you have NO money then the government pays for your health care. If you are in between then you cross your fingers, but if something happens then it bankrupts you and the health system that provided you with “free” care since you cannot pay them back.

        So the people buying insurance get screwed. They pay for insurance, their taxes are higher to pay for those that can’t, and some of their costs of their care are higher to cover those that don’t/can’t pay.

        Everyone should be required to carry some insurance for those catastrophic event they cannot predict.

    • http://www.twitter.com/alicearobertson Alice

      I homeschool, but that misses the point. Ideas have consequences….it won’t just be kids and shots soon. It will be mandatory flu vaccines, etc.

      I am shocked at the lack of information in the poster’s positions. We just believe the commercials from the pharmaceuticals……so do most doctors. Doctors who scream they can’t handle the insurance companies breathing down their necks, but want more regulations on the general public under what I consider a bit of ignorance.

    • stitch

      Sounds like a good plan to me. If you choose not to be insured, then you will need to pay up front for any costs you incur should you subsequently choose to access the healthcare system. And that means if you have multiple trauma, or severe MRSA sepsis (things that “young, healthy” people can incur but don’t plan for) then you will need to put down tens of thousands of dollars up front, when you come into the hospital.

      In this country, healthcare is the only thing which is required to be provided to anyone who accesses the system. Nothing else, not food, not clothing, not water, not shelter. And it is to be provided without regard to the ability to pay.

      So we’ve gotten into this screwy position where everyone wants, and expects, gold plated healthcare on their own terms, and no one wants to pay for it. FUBAR.

      Thanks for the comment.

    • http://Www.twitter.com/alicearobertson Alice

      I am thinking this is a very good thing. If more kids were home schooled we would have a healthier population that is better educated (that is assuming doctors have researched and know that homeschoolers average out higher on standardized tests). I like this particular idea. My own kids attend private school part time, and the pharmacist who teaches anatomy knows more than the doctors here do. My sixteen year old actually knows what is in the shots and how it works. Knowledge..it is powerful when you seek it.

  • Greg

    Sad to see Jenny McCarthy’s chickens come home to roost. She, David Kirby, and the less-then-his-clan-deserves Robert Kennedy have been endlessly demonizing vaccines based on very poor science which has been refuted multiple times. Now, babies are dying in California, while they make tons of money off of the book deals and fear rallies. No doubt their minions would be the ones in the forefront blindly protesting any sort of mandate on vaccination, public health be damned. Talk about a society which feeds on it’s own children.

  • http://www.twitter.com/alicearobertson Alice

    Greg what poor science is that? Have you really read what she promotes? I can’t defend her on a personal leve, but I have read her story…….so you don’t think her diet is a good choice?

  • Greg

    I have serious concerns about her anti-vaccine propaganda, and insistence that vaccines cause autism, despite multiple negative studies. Through “Generation Rescue” and other activist organizations Jenny McCarthy and the others mentioned discourage vaccination of children, and promote unproven/untested “alternatives” to vaccines instead. These, while profitable to these organizations, leave vulnerable populations unprotected, and decrease herd immunity, putting others at risk who cannot be vaccinated due to age or illness.

    One place to start for the other side of the story is:

    Also, just in general, I wouldn’t recommend anybody taking advice from an author or the internet based on “their personal story” or anecdotal accounts. Remember, the plural of anecdote is not data.

  • http://www.twitter.com/alicearobertson Alice

    Thanks for responding. I tend to agree with some of what you said, but then again she isn’t anti-vaccine as she has been labeled. I think my doctor sums it up well at the pre-op visit before surgery when I said my daughter isn’t immunized. His wife is a doctor who didn’t want to immunize either. He said he isn’t against vaccines…he is against ignorance and there is a lot of that on both sides.

    That said Jenny’s videos are interesting because they document what she is saying. She has some good information amidst more controversial stuff. Because the anti-vaccinaters screamed so loud about the “safe” shots they did remove mercury from some of the shots, but in some cases it’s been replaced by a type of antifreeze. That’s not comforting, and the flu shots still have thimerosal.

    In truth, I seriously doubt most doctors know the compounds in the shots, haven’t read the brochures where the pharmaceuticals admit to problems, claim it’s completely safe yet make you sign a waiver, then we see about $2 billion paid in claims to injured children or the deceased family. Safe? Who is ignorant?

  • http://www.twitter.com/alicearobertson Alice

    Also, just in general, I wouldn’t recommend anybody taking advice from an author or the internet based on “their personal story” or anecdotal accounts. Remember, the plural of anecdote is not data. [end quote]

    I don’t recommend anyone taking the advice of a doctor without studying. The days of complete reliance on one doctor are over (thankfully), but then again, I don’t think relying on the government is a good idea. If we take the mandate for vaccines to the logical conclusion (most doctors don’t) we would have to mandate against obesity. Isn’t childhood obesity much more costly monetarily and physically (and emotionally) and causing much more harm than any fallacy about shots? It’s inconsistent on that level for doctors (or the public) who want to think in health care terms only. You want to protect the general public? There are much better and fruitful ways than this garbage! :)

    This is why maybe people should look at Jenny’s diet. It’s a rough way to go, but the days of denial over the genetic predisposition are over (a neurologist whose child was given an MMR shot that caused her rare form of autism already proved it in court. And it helped that his wife was a nurse/attorney. A match that even the pharmaceuticals and faulty research couldn’t ignore. Their daughter had a genetic predisposition and I believe the NY Times covered this and the testing that is moving along in this area. That’s where we should be looking instead of stomping on those who want the shots cleaned up [which by-the-way I am not. I am for education of the parents to understand what is in the shot]. Let’s find out who can be hurt and the parents will be more inclined to get the shots and supposedly save all of mankind. You won’t need a governmental mandate……parents want to do what is best for their child).

    Jenny and Imus do a lot more charity work than I do and contribute a lot more money than I can to helping with autism. I say kudos to them for doing what they can and putting their money where their mouth is.

  • http://www.twitter.com/alicearobertson Alice

    who want the shots cleaned up [which by-the-way I am not. I am for education of the parents to understand what is in the shot] [end quote]

    Egads……what a typo. I homeschool so talking to kids means a split brain (I talk to animals too……ha….you know how weird those homeskoolin’/non-immunizers are! :) Okay……I’ll get serious…….um….). I left a section out……I meant to say I am not an anti-vacciner…..well…a bit…….no really I just want every parent to know exactly what they are doing. I think doctors are supposed to inform parents before giving the shot (no time for that type of non-sense…..and some doctors here at Kevin’s claim they have no time for such debates…..just time to quickly give that shot….it’s supposedly their contribution to mankind…..impressive), but few do, but somehow they never forget that waiver. Umm…..clever child! Yes, I was immunized……now do you know why I complain?

  • Alice

    Stargirl…I know how frustrated doctors get…I imagine not one here gives me any credibility…that is alright…I speak to moms because most doctors think a doctorate gives them special abilities. How I wish doctors would research better before blabbering away about mandates that keep biting you back. Research will show the diseases were on the decline before the shots. Sanitation and antibiotics have saved many more lives than vaccines. You cannot give sole credit to vaccines…and why haven’t doctors read ALL the research before getting their knickers in a twist?

  • http://Www.twitter.com/alicearobertson Alice

    What does the author and all the other self proclaimed humanitarians think about this case that went before the Supreme Court? If precedents mean anything it just tells me that doctors who say the public isn’t educated may need to join the ranks of those who don’t research. Information is powerful….good thing it (and the patients) doesn’t wait on you.

    Jacobson v. Massachusetts, 197 U.S. 11 (1905), was a case in which the Supreme Court of the United States upheld the authority of states to pass compulsory vaccination laws. The Court’s decision articulated the view that the freedom of the individual must sometimes be subordinated to the common welfare.

  • gzuckier

    Luckily, we don’t need to mandate vaccines, as we have the Second Amendment which of course allows us to protect ourselves against all Evil.

    • stitch

      if not shots of one kind, then of another, eh?

      • http://Www.twitter.com/alicearobertson Alice

        Gunshots? Ha! Hmmm…….I am against socialized medicine…but not a gun zealot…..yet! :)

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