Since the mid-19th century, when the smallpox vaccine was mandated for students in Massachusetts, schools have been where the rubber meets the road in the battle against infectious disease. In the late 1970s, outbreaks of measles in Alaska and Los Angeles drew fresh attention to enforcement. It was observed that strict enforcement led to dramatic reductions in cases, and by 1980-81, all 50 states required students enrolling in school to be vaccinated for diphtheria, measles, rubella, and polio.
Ninety-six percent of New York students in grades K-12 were fully immunized as of 2017-18, the most recent data year available. Like most other states, New York allows exemptions for medical cause and religious belief; the number of medically exempt students is vanishingly small. To obtain a religious exemption, parents state their beliefs in a letter which is filed with school authorities, who must decide whether they've made the case. As New York State emerges as a flashpoint for what has become the second-largest outbreak of measles in the US since the disease was declared eliminated in 2000, schools may end up having the question of who merits a religious exemption taken entirely out of their hands.
"We take no position on vaccination," says Vicki Larson, director of communications and marketing at Green Meadow Waldorf School in the Rockland County village of Chestnut Ridge. "We believe in personal choice and responsibility. We believe in following the law. This is surprisingly controversial; we have people within our own community with all different opinions saying we should be doing something differently."
Green Meadow found itself making regional headlines after Rockland County health officials banned unvaccinated minors from public places. A group of Green Meadow parents retained civil rights attorney Michael Sussman and convinced a judge to overturn the ban. The school itself did not take part in the legal action, nor have they had a single case of the measles within their school community. What has gone viral, says Larson, is the debate.
"We have parents who think vaccination is a public health obligation, parents who believe the school should join the lawsuit, and everything in between. People are being called pro- and anti-vax, and in my experience, very few fall on either pole," says Larson. "At the moment, New York recognizes a religious exemption, and it is our legal right and responsibility to review those requests and grant them to those with a sincere religious belief."
Community-specific culture seems to be the biggest factor in whether exemptions are accommodated easily or grudgingly. Of the 25 public schools in New York with the lowest rates of total immunization, 14 are located in the Hudson Valley, including the entire districts of New Paltz and Onteora, with rates in the lower 90s.
Among private schools, although the median rate remains the same, the situation varies wildly; Green Meadow's rate is now above 95 percent at the high school level, 83 percent in the early grades, up from the 50s a couple of years ago, a good-sized handful of independent Hudson Valley schools have vaccination rates in the 60s, 70s, and 80s, and at one—the Fei Tian Academy of the Arts in Orange County, run by the Falun Gong, a Chinese religious group—only 14 percent of the students are vaccinated; the rest have religious exemptions.
"When my son was born 10 years ago, I was in my third year of med school, at a place in my training when I was saturated in research," says Anna, a 30-something mother of two from New Paltz. "I knew I needed to educate myself on the science before giving my consent to any drugs, and I didn't expect to find what I found—there are no double-blind, long-term inert placebo-controlled studies of vaccines, and that's the gold standard for all pharmaceutical drugs. And the pharma companies have no liability at all."
In the late '70s, questions arose about the pertussis component of the DPT vaccine (diphtheria, pertussis, and tetanus) being implicated in cases of encephalopathy; the incidents were later attributed to infantile epilepsy, but the lawsuits meant skyrocketing liability rates and prices. In 1986, the federal government stepped in with the National Childhood Vaccine Injury Act, requiring information statements with doses, establishing a database of reported of adverse episodes, and shielding manufacturers from liability by establishing a dedicated arbitration court and a fund from which settlements could be paid.
Since then, the number of required vaccines has increased from seven doses to 72 doses of 16 required vaccines. "Vaccine-hesitant" parents like Anna point to the increases in various brain, nervous system, and immunological issues over more or less the same time period and to Merck's recall of Vioxx, in which the pharmaceutical industry and Food and Drug Administration have had to acknowledge problems with previously approved medication.
Vaccine-hesitant parents point out that the National Vaccine Injury Compensation Program has paid out some $4 billion since its establishment; CDC scientists respond with the fact that between 2006 and 2017, there was one compensated claim per million doses of vaccine. Placebo-controlled double-blind studies of vaccines, the kind Anna mentioned, are not done because it's considered unethical to leave an individual wondering whether they have been immunized or not. Other kinds of studies are constantly underway, and have repeatedly vindicated the benefits of mass vaccination for public health.
The Centers for Disease Control agrees that no treatment is completely without risk and that insisting that people inject their babies is a big ask; on their website is a 23-page PDF, Vaccination Mandates: The Public Health Imperative and Individual Rights. The CDC maintains the Vaccine Adverse Episodes Registry as a feedback system. Vaccine-hesitant parents point to the many reports therein; the CDC responds by pointing out that few are actually proven episodes of causality that go beyond a sore arm.
A Conversational Shift Is Needed
Green Meadow School's Larson is struck by the vitriol around the tone of the conversation around vaccination. "A primary concern is: Are we modeling the same values that we're seeking to cultivate in students?"
Voices for Vaccines, a nonprofit advocacy site organized by the Task Force for Global Health, offers first-person accounts of why the hesitant ultimately opted to vaccinate. But they are the exception; the internet is riddled with both anti-vaccine propaganda and smarmy blogs mocking each and every concern.
Bills currently active in the New York State Legislature include one that would eliminate the religious exemption, another that would require parents to sign an affidavit that they'd been advised about risk, and a third that would allow children above the age of 14 to be immunized without parental permission. "Yes, the state is considering a bill that would eliminate the religious exemption, and we don't have a position on that either," says Larson. "Our primary concern is educating children. And we were very happy to be able to welcome our students back."