Back to School: The Quest to Eliminate Vaccine Mandates

If successful, children in the United States will once again start dying from measles.

In the wake of angry battles against Covid-19 vaccine mandates, resistance to school mandates has grown. According to a recent survey by the Kaiser Family Foundation, 35 percent of parents now oppose school mandates for all vaccines. The pushback against mandates appears to be less about vaccine safety—80 percent of parents believe vaccines are safe and effective—and more about a parent’s right to choose. Because measles is the most contagious of the vaccine-preventable diseases, it will be the first to come back should vaccine rates erode.

The measles vaccine first became available in 1963. At the time, every year in the United States, 3-4 million people would be infected with measles, 48,000 would be hospitalized, and 500 would die. Deaths were primarily caused by pneumonia, severe dehydration, or encephalitis (inflammation of the brain). By the late 1960s, measles vaccination led to a 95 percent drop in the incidence of the disease. By the early 1970s, however, immunization rates had become stagnant. Measles cases increased. In 1971, about 150,000 cases were reported. Although the number of states requiring vaccines for school entry increased from 25 in 1968 to 40 in 1974, health officials hadn’t enforced them.

Several measles outbreaks in the 1970s showed the importance of school vaccine mandates:

            · In 1976, during a massive measles outbreak in Alaska, state health officials prohibited children from attending school until they were vaccinated. Fifty days later, when more than 7,400 students hadn’t complied, school officials barred them from school. Within a month, fewer than 50 children remained unvaccinated and the epidemic ended.

            · In 1977, during a measles outbreak in Los Angeles, thousands of children were infected; three had measles encephalitis, and two died. On March 31, the county health director barred 50,000 unvaccinated children from school. Within days, most were back with proof of vaccination, again ending the epidemic.

            · The most dramatic example of the power of school vaccine mandates occurred in Texarkana, a city that straddles the border between Texas and Arkansas. Between June 1970 and January 1971, Texarkana suffered more than 600 cases of measles. Arkansas required vaccines for school entry; Texas didn’t. Predictably, 96 percent of the cases in Texarkana occurred on the Texas side; 4 percent on the Arkansas side.

By 1981, all 50 states had school immunization requirements. By 2000, measles was eliminated from the United States. Unfortunately, in large part because a critical percentage of parents have now chosen not to vaccinate their children, measles is coming back.  At the end of December 2022, schools and daycare centers in Columbus, Ohio, reported 85 cases of measles; 32 children were hospitalized; all were unvaccinated. During the first 5 months of 2023, the number of measles cases has increased 5-fold compared to a similar 5-month-period in 2022.

The case-fatality rate for measles is about 1 in 1,000. If return to a time when measles infects thousands of people, children will once again die from a disease that is entirely preventable. As is so often the case, it is the most vulnerable among us who suffer our ignorance.