States Rethinking Childhood Vaccine Mandates during Measles Outbreak

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A girl receives a vaccine
Source: Bernard J. Wolfson, “Does It Make Sense to Delay Children’s Vaccines?,”, Mar. 20, 2019

At least six states are considering tightening childhood vaccine mandates during what is now the worst measles outbreak since 1994, when there were 963 cases. The disease was declared eliminated in the United States in 2000. The CDC reported that 704 individual cases of measles in 22 states were confirmed between Jan. 1, 2019 and Apr. 26, 2019. There were 372 cases reported in all of 2018.

California legislature is considering a bill, SB 276, that would require the California Department of Public Health to track medical vaccine exemptions, the only kind allowed in the state, and the doctors who provide the exemptions. Meanwhile, at least 900 students were quarantined at the University of California at Los Angeles and California State University in an effort to contain an outbreak on those campuses.

State Senator and pediatrician Richard Pan, MD, MPH, who authored the bill, stated, “Medical exemptions have more than tripled since the passage of SB 277 [the law that eliminated personal and religious exemptions]. Some schools are reporting that more than 20 percent of their students have a medical exemption. It is clear that a small number of physicians are monetizing their exemption-granting authority and profiting from the sale of medical exemptions.”

Pediatrician Nicole Shorrock, MD, testified against the California bill and stated, “We believe the relationship between a patient and their doctor is sacred. Patients have a right to have their medical treatment determined by their doctor, not a governmental appointee. This bill will essentially destroy the sanctity of a doctor-patient relationship.”

HB 1638, a bill that would eliminate the personal vaccine exemption, awaits Governor Inslee’s signature in Washington state. The governor has indicated support for the bill. Washington has seen 72 cases of measles this year as of Apr. 24, according to the state health department. State Sen. Lynda Wilson opposed the bill, saying that she believed in the “right of parents to have more say than the government does when it comes to their children’s health care.”

Minnesota, New Jersey, New York, and Oregon are also considering bills to tighten childhood vaccine mandates.

A study of Arkansas measles cases in 2018 found that each case of measles cost about $47,962 to treat, a number experts say is consistent nationwide. Multiply that cost by the 704 confirmed cases in 2019 so far and the current outbreak has cost about $33.8 million.

The CDC recommends that children receive the first dose of the MMR vaccine between 12 and 15 months, and the second dose between 4 and 6 years old. All 50 states and DC require a measles vaccine for kindergarten entry.

Discussion Questions
1. Should any vaccines be mandated for public school attendance? Which vaccines? Why?

2. Should religious exemptions be allowed? Why or why not?

3. Should personal belief exemptions be allowed? Why or why not?


CDC, “Measles Cases and Outbreaks,”, Apr. 26, 2019

Casey Decker, “Measles Vaccine Exemptions Could Soon Be Limited in Washington,”, Apr. 26, 2019

Megan Henney, “The Cost of This Century’s Worst Measles Outbreak,”, Apr. 27, 2019

Kaiser Health News, “It’s Official: CDC Confirms Measles Outbreak Is Now The Worst One In 25 Years As Total Hits 695 Cases,”, Apr. 25, 2019

LegiScan, “Minnesota Senate Bill 1520,” legiscan (accessed May 3, 2019)

New Jersey Legislature, “A3818 Aa (1R),” (accessed May 3, 2019)

New York State Senate, “Assembly Bill A2371,” (accessed May 3, 2019)

New York State Senate, “Senate Bill S2994,” (accessed May 3, 2019)

Oregon State Legislature, “HB 3063 B,” (accessed May 3, 2019)

PBS, “California Expands Its Quarantine as U.S. Deals with Worst Measles Outbreak since 2000,” Apr. 26, 2019,

Ruth Schneider, “Bill Takes Aim at Fake Vaccine Exemptions in California,”, Mar. 27, 2019

Jake Thomas, “Sen. Cleveland Plans Stricter Vaccine Bill, Removes Opt-Out for More Than MMR,”, Jan. 31, 2019

Washington State Department of Health, “Measles Outbreak 2019,” (accessed May 3, 2019)

Washington State Legislature, “HB 1638 – 2019-20,” (accessed May 3, 2019)

Hannah Wiley, “Anti-vaccine Families Crowd California Capitol to Protest Bill Restricting Exemptions,”, Apr. 24, 2019