Are Unimmunized School Children A Threat to Public Health?

Last week the Hamilton County Indiana school district where I substitute teach banned unimmunized students from several of their schools and related activities. In response to the recent measles outbreaks in Indiana and other states the students are effectively quarantined, even though they had not been exposed to any illness, nor had they exposed others. While the state allows parents to decline immunization for religious or personal reasons, recent outbreaks of measles in the state and California have caused some to insist that parents who chose that options for their children should be denied access to public schools; in other words, separate them from the rest of us. Quarantine them! Quarantines are usually imposed on those who have been exposed, not on those who are at risk for exposure. In the last 50 years courts have usually ruled quarantines illegal. Banning children who are legally unvaccinated from the classroom is an unconstitutional denial of their civil liberties, and bad public policy. No one has established that unimmunized children are the source of the recent measles outbreak.

Do unimmunized children pose a risk to immunized ones? Does the success of vaccination programs in this country prove that the immunized children in the classroom are protected from the illnesses the unimmunized may carry? We have been vaccinating people for 250 years, yet a significant portion of the population has always declined vaccination.

Do unimmunized children pose a risk to immunized ones?

Despite a significant population of unimmunized people we have eradicated smallpox, polio, measles, and many other illnesses. There eradication would seem to suggest that the unimmunized in our midst pose no threat to the the vaccinated or to the public health. On the contrary, it would seem to suggest that when a significant percentage of the population is immunized it provides protection for those who are not. If unimmunized people in the population have posed no threat  of outbreaks for two and a half centuries, why do we assume those people are the source of recent outbreaks? Although some claim unvaccinated children put the immunized population at risk, evidence of a connection between unimmunized population and recent outbreaks has never been established. 

A connection between unimmunized population and recent outbreaks has never been established. 

As for my family we support vaccination! My wife and I raised three sons. We vaccinated  each one according to the schedule our physician recommended, and we abided by the immunization requirements of the public schools they attended.  We also support the freedom of a parents to control the medical care of their own children!  I am sensitive to objections to vaccinations. One of my boys actually came down with the illness for which he was immunized after receiving the vaccination. Although recent claims of mercury based vaccinations contributing to autism have been discredited, immunizations are not 100% safe. An immunized person may still catch the disease, although the vaccine usually moderates the illness's effects. Immunization can be used for political manipulation and  and to shape political and cultural agenda such as the recent requirements by the states of Texas  and Virginia to mandate the drug Gardasil for girls as an immunization against cervical cancer.

If the public agencies can deny services to unimmunized children, then children who are only potentially exposed are being quarantined. Courts usually rule quarantines illegal. Parents of quarantined children are no longer in control of their children's education. While acting lawfully they are being denied a right to public education guaranteed them by the constitutions of most states. Making services dependent upon mandatory immunizations denies them their rights without due process.  Although I understand the reasoning behind the bans, they are undoubtedly illegal. But is the right to decline vaccinations irresponsible? Should laws be changed to protect public health?

Although I understand the reasoning behind the bans, they are undoubtedly illegal. 

Often I hear people who have immunized their children disparaging those who have not, calling them irrational or irresponsible.  Yet in my experience parents who decline immunization are far from irrational or irresponsible. I have had families in congregations that I have served who have declined to immunize their children. Each one of them have made informed decisions. They have researched the literature on vaccinations, have discussed options with their doctors. Far from being irresponsible they have found that the science behind immunization is far from settled and believe the risk of immunizing their children is greater than the risk of not. In each case I have disagreed with their conclusions and have counseled in favor of immunization when consulted; however their decision were more objective than mine. 

Those of us who immunize are often at best subjective and at worst irrational. My wife and I vaccinated our children for subjective reasons. We had both been immunized as children without harm as had our siblings and extended families. Our doctors advised vaccination and we never questioned their advice, nor examined implication of our public school policies toward immunization. They seemed reasonable and effective so we went along. Our decision, and that of most people we know who immunized their children, was subjective, based completely on expert advice and experience. We had done little or no research on the subject. It was hardly as well informed a decision as that of any one whom I knew who had declined immunization. We vaccinated our children in lock step obsequiousness. So who are the irrational parents?

I have no regrets about our immunization decision, even though it was less well informed than that of those who declined. No parent can research every potential decision. There are lots of choices we make based on family history, advice of experts, moral values and our gut. We all make some choices based on the experience of our families of origin, and most of us pay our doctors to be informed and to inform us. We trust their recommendations. Responsible parents stand on both sides of this issue. Some chose to immunize, some do not. All are acting in what they think is in the interest of their children and in accord with law. Is denying someone who is acting responsibly and legally access to education denying them life, liberty and property without due process of law? Access to equal education is a civil right protected by the 14th Amendment to the Constitution and the constitutions of most of the states. States that give parents a choice about immunization are duplicitous to then deny them opportunity? Those of us who believe in Constitutional liberty must oppose the quarantining of the unimmunized.

I am neither joining the anti-vaccination movement nor decrying it.  I am disparaging the notion made popular by the media that parents who decline immunization are irresponsible kooks and bad parents.  There is no evidence that  they are putting the health of immunized children at risk. How can the courts prevent states from quarantining carriers of the Ebola virus, then allow the quarantining of people who only have a remote possibility of exposure? School district who act to deny services to the unimmunized will see their actions overturned. These actions are both illegal and bad public policy.

So how can public policy regarding recent measles outbreaks protect both the health of students and liberty of parents? Unless a link between recent measles outbreaks and the unimmunized school children can be established there is little or no legal or moral basis to quarantine children who decline vaccination for religious or personal reasons. Public policy needs to be based on facts

The facts are these: recent measles outbreaks  in California and other states came from an infected overseas visitor to an amusement park, not from unimmunized school children. The outbreak poses little risk to children or adults who are vaccinated. Vaccinated children are not exposed to illnesss because they share classrooms with unimmunized children. Protection from exposure is the reason they were vaccinated in the first place. As illness are eradicated due to vaccinations, unimmunized children have benefited and been protected by the immunized ones. Current public policy recognizes parental choice and protects public health. Yet we must recognize that freedom of choice is never absolute. When children's lives are at risk because of parental actions or beliefs (for example in faith healing or in denial of blood transfusions) the legal system can intervene. So if one can demonstrate that the recent outbreaks originated from unimmunized children in school, then a case might be made for limiting parental choice. 

Unimmunized children in school pose negligible risk to vaccinated children, but do they pose a significant risk to each other? Such would only be the case if the source of the outbreaks was the children themselves. The Center for Disease controls attributes many of the outbreaks among unimmunized populations to  travelers to the US from abroad. The danger of exposure in our schools appears not to come from unimmunized children but from those coming into the country and into the schools with these diseases from outside the country.

Liberal travel and immigration policy appears to pose a greater risk to the health or our children than parents exercising liberty responsibly. Banning unimmunized children from classroom protects neither them nor the vaccinated students from diseases brought from outside the country. The reaction of Indiana educators was based on hysteria not data or history. There does appear to be a connection between the increase of serious illnesses and lax border controls. The most common source of origin for measles outbreaks in the era following what CDC calls the post elimination period, after measles was eliminated, is from outside the country.

Since last summer's Enterovirus is likely related to an influx of undocumented children in the country, since Ebola came to the US for the first time from immigrants or missionaries who brought it into the country, the  appropriate policy may be to question the relationship between open borders and the measles outbreak?  Local states and federal government do have a responsibility to protect the public health. But protection need not come in the form of quarantining those who are responsibly exercising their rights. The way to stop an epidemic is to eliminate the source of the infection. In the case of measles the solution is not to quarantine children who are neither sick nor exposed to sickness. To protect the next generation from a measles scourge we need to prevent it from coming into the country. A healthy population has secure borders and has no need to quarantine the unimmunized.  Protect our children: close the borders now.