Measles outbreaks across the country are pushing state legislators to consider removing immunization exemptions for religious and personal beliefs claimed by parents of some children.
Experts and public health officials attribute the exemptions to one of the reasons why states are seeing an increasing number of measles cases.
"What you consider a religious choice could possibly have negative consequences on the health of other members of your community and society," said Pat Burke, legislator of a Democratic State in New York, which militates for the elimination of the religious exemption of the state.
The laws allowing parents to avoid vaccination were created by states trying to strike a delicate balance between religious freedom, personal choice and public health.
But the most recent measles outbreaks, which infected 159 people in 10 states, mostly unvaccinated, are pushing some states to reconsider their decision.
"It goes beyond freedom of religion," Burke said.
Each state requires that students be vaccinated to enroll in school, and all states grant waivers to children who are too sick to receive vaccines or whose immune system is weakened.
Most states also allow exemptions for religious reasons and 17 states, including Washington and Texas, allow exemptions for religious, personal or philosophical beliefs, according to the National Conference of State Legislatures. Washington and Texas have both witnessed measles outbreaks this year.
Lawmakers in Iowa, New Jersey and Vermont, who already prohibit personal or philosophical exemptions, are now discussing proposals to eliminate religious exemptions.
Proposals in Maine and Oregon would eliminate both exemptions, while measures in Minnesota, Colorado, and Washington State, where 66 cases of measles were confirmed this year, would only remove personal exemptions and leave religious exemptions in place.
All major medical and health organizations oppose religious and personal exemptions and have been urging state legislators for years to eliminate them.
"To protect the health of our communities, it is necessary not to allow individuals to be vaccinated for convenience or misinformation," said Barbara McAneny, president of the American Medical Association. statement to The Hill.
"This is why we urge policymakers to eliminate non-medical exemptions from vaccination and all children and adults to be vaccinated, except in the case of medical risk."
In states with broader vaccine laws, non-medical exemptions have grown in popularity over the years, as misinformation about vaccine risks spreads online, said Dr. John Cullen, president of the United States. American Academy of Family Physicians, which opposes religious and personal or philosophical exemptions.
"In communities where vaccination rates are low, it's the preparation for a measles outbreak," Cullen said.
"We are losing sight of how serious these epidemics are because we now have generations who have never lived through them."
Proponents of vaccine exemptions argue that parents should be able to make their own decisions about the health of their children.
"We believe that deviating from the vaccine legislation and derogating from personal beliefs is a violation of human rights, including freedom of thought, conscience and religious belief," said co-founder Barbara Loe Fisher. and President of the National Vaccine Information Center.
The Centers for Disease Control and Prevention (CDC) believe that the MMR vaccine, which protects against measles, mumps and rubella, is "very safe" and effective, and is recommended by all major medical associations.
"This is an area in which it is important to have scientific evidence peer-reviewed. This does not exist for the anti-vax movement, "he said.
According to CDC data, the median exemption rate for kindergarten children during the 2017-2018 school year was 2.2%, marking a slight increase for the third consecutive academic year.
The CDC says it's hard to know why, but suggests that this could be related to the ease with which it is possible to obtain exemptions and parents' reluctance towards vaccines .
But it may be difficult for state legislators to take action on such a delicate, politically controversial issue.
According to the CDC, there were 17 measles outbreaks in the United States in 2018, with a total of 372 confirmed cases.
But this was not enough to bring about a change of legislature: no state has been able to adopt measures to eliminate or limit exemptions, according to the National Vaccine Information Center, which opposes such proposals.
Some states have actually proposed a bill expanding the exemptions: Arizona, Iowa, Hawaii, Mississippi, Rhode Island and West Virginia.
According to the CDC, until now, in 2019, there have been six outbreaks in four states: New York, Illinois, Texas and Washington. The CDC defines as epidemic three or more cases in a state.
According to the CDC, the epidemics are mainly related to unvaccinated travelers reporting measles to the United States from other countries, such as Israel and Ukraine, where large epidemics are continuing.
Outbreaks can occur in communities where the percentage of people vaccinated is not high enough.
Called "collective immunity" by public health experts, at least 94% of people in a community must be vaccinated against measles to prevent the disease from spreading.
Herd immunity protects people with weakened immune systems, babies who can not be vaccinated or those who are too sick to get vaccines.
But according to experts, more and more parents are calling for vaccine exemptions, the disease is more likely to spread.
And federal officials said the government could step in if state legislatures did not do it.
"Some states have made such huge exemptions that they create epidemics of a magnitude that will have consequences at the national level," commissioner Scott Gottlieb of the Food and Drug Administration told CNN.
If "some states continue their momentum, I think they will force the hand of the federal health agencies."
The House and Senate Health Committees are scheduled to hold hearings on measles outbreaks this month.