Why don't we give parents a choice in deciding if they want to vaccinate their children?

Protecting a child through immunization is a parent's decision, taken in discussion with their doctor. The Federal Government may recommend that States develop laws or requirements for vaccines, but whether the State includes a given vaccine in its regulations and how informed consent is to be obtained are State decisions. Currently, 48 States allow religious exemptions to vaccination and 15 allow philosophical exemptions, in addition to the medical contraindications that are the same in all 50 States. The rationale for limiting choice is that vaccinations have been a very effective approach to protecting the public's health in the United States. The first article in a series on ten great achievements in public health in the 20th century highlighted the impact of vaccines universally recommended for children (Morbidity and Mortality Weekly Report; CDC 1999;48:243-48).

Because of high vaccine coverage rates today, one may focus on rare, potentially vaccine-associated adverse effects, but before vaccines were introduced there were over 175,000 cases of diphtheria annually (1920-22), over 147,000 cases of Pertussis (1922-25), and over 503,000 cases of measles (1951-54). More recently, an estimated 20,000 cases of invasive infections such as meningitis caused by Haemophilus influenzae type b occurred in 1985. Now, because of vaccination, the number of cases of these infections has been decreased by about 96% to 100%. But lessons from other countries have relevance for the United States - 1) if vaccination rates decrease, the number of cases of infection will increase as occurred in the United Kingdom and Japan after concerns about adverse events associated with the whole cell Pertussis vaccine resulted in decreased immunization (In the U.S. today, less reactogenic acellular Pertussis vaccines are now recommended); and 2) the decrease in disease of 96% to 100% exceeds the level of vaccine coverage. This is because at high vaccination rates, the circulation of a bacteria or virus may be decreased which lessens the chance that even someone who has not been immunized will get disease. This "herd immunity" is important because some persons can not be vaccinated because of illnesses such as cancer and high vaccination rates in the community will protect them from disease.