In 2018, the global resurgence of measles began in earnest. Worldwide, deaths attributed to measles topped 140,000. In 2019, the pace of spread of measles accelerated, as the numbers of cases rose considerably compared to 2018. It is likely that once the tallying is completed the numbers of deaths in 2019 will exceed the 2018 totals.
In September 2019, a measles outbreak in Samoa made news headlines. As of January 6th, 2020, there have been 5,697 confirmed cases of measles in Samoa and 83 deaths.
In what is considered the world’s worst outbreak of measles in recent memory, 310,000 cases have been recorded since late 2019 in the Democratic Republic of Congo. In January 2020 the World Health Organization (WHO) reported at least 6,000 measles deaths. Notably, this is more than twice the number of Ebola deaths in that country.
In the U.S., in 2019, approximately 1,300 measles cases were reported. This is three times the number of cases in 2018.
In June 2019, the state of New York banned religious exemptions from vaccine mandates for children entering school, after measles had spread in the ultra-Orthodox Jewish community.
Throughout 2019, governors, legislators, and mayors in the U.S. clashed with the anti-vax community. In the U.S., this community is extraordinarily vocal as it demonizes vaccines and, in some cases, threatens doctors who deliver messages urging parents to vaccinate their children. Anti-vaxxers pursue a two-pronged approach. First, they disseminate scientifically spurious and dubious claims regarding the dangers of vaccination. Second, they espouse a radically anti government interference viewpoint. Anti-vaxxers lobby lawmakers (especially at the state level) to maintain exemptions from vaccine mandates, ostensibly for fear of government interference with parental choice. Recent efforts to retain exemptions in New Jersey succeeded. Currently, all states except California, Maine, Mississippi, New York, and West Virginia allow exemptions for religious reasons from otherwise compulsory vaccinations.
Outside the U.S., in the Democratic Republic of Congo, for example, opposition to vaccination stems from distrust toward Western health authorities. Violence has been perpetrated against health workers attempting to inoculate people against measles and Ebola.
The problem is not going away in 2020. Globally, public health authorities aren’t letting their guard down. They can’t, lest they be reminded that before the introduction of the measles vaccine in 1963, major measles epidemics occurred almost every two to three years, each resulting in up to 2.6 million deaths worldwide.
After a period in which measles appeared to be eradicated in many countries and regions, globally vaccination rates began to stagnate a decade ago. The WHO estimates that 86% of children worldwide received the first dose of measles vaccine in 2018, and fewer than 70% received the second recommended dose. This is well below the WHO recommendation which states that at least 95% of children receive two doses of measles vaccine to optimally protect populations from the disease.
Vaccination policies in many European countries are more punitive than they are in the U.S. It’s not just a requirement for children to be vaccinated in order to enroll in school. There are financial penalties for parents who refuse to vaccinate. And, with few exceptions, no religious or other exemptions are permitted.
The anti-vaxxers counter by considering such government interference with freedom to choose draconian and morally wrong. In their view, it violates people’s freedom from government infringement on their right to choose.
But, the vaccinations in question mostly pertain to school age children who are too young to exercise their own judgment. Children are not making choices here, parents are. And, by refusing to vaccinate parents are putting their children in harm’s way.
All of this raises the philosophical question to what extent government can legitimately restrict the choices of its citizens in order to best protect public health. Mandatory vaccination unequivocally restricts parental freedom of choice. Yet, shouldn’t public health prioritize the protection of children from infectious disease and the ensuing herd immunity that result from having as many people as possible vaccinated? After all, the public’s interest is avoidance of preventable, communicable disease.
Convincing a small minority of reluctant, some say “vaccine hesitant,” citizens to fully comply with public health mandates is a difficult task. This is why the WHO has singled out the need to earn the public’s trust with respect to vaccinations. This requires education, positive messaging, and a willingness to confront and debate the anti-vax community civilly and respectfully in a public setting.