With 2020 legislative sessions kicking off in most states this month, this push and pull between science and skepticism is playing out across the country. More and more lawmakers are proposing bills, seeking to either boost, or limit, mandatory vaccinations for schoolchildren.
"I won't be surprised if we see many pro-vaccine bills this year," said Dr. Sean O'Leary, a member of the American Academy of Pediatrics Committee on Infectious Diseases. "The measles outbreaks were really a wake-up call, showing legislators that maintaining high vaccination rates is not just a theoretical goal."
O'Leary said he won't be surprised if some antivaccine bills are introduced this year, "but I doubt any will pass."
Some want to ban religious exemptions, citing science
And last year, 14 states proposed eliminating religious exemptions for vaccines – a marked increase from years past, according to the American Academy of Pediatrics.
New York, California and Washington state all voted to end some vaccine exemptions for children who attend public schools, and Maine enacted similar legislation, though it won't take effect until September 2021.
"Science is really on the side of vaccinations," said O'Leary, who is an associate professor of pediatrics at the University of Colorado School of Medicine. "They're one of the best public health interventions in history in terms of the numbers of lives saved. The benefits far outweigh the risk."
Others want to ban mandatory vaccinations, citing personal belief
While they are outnumbered, vaccine opponents are a vocal bunch, and they've caught the ears of state lawmakers.
Barbara Loe Fisher is president and co-founder of the National Vaccine Information Center, a group that advocates for vaccine exemption. She sees the issue as a matter of personal freedom.
"We need to have the ability in our country, if we find a commercial pharmaceutical product is not as safe and effective as we're being told it is, we should have the right to make informed consent to use the product," she said .
Where the truth lies
The American Academy of Pediatrics' official stance – one it shares with most other medical organizations and agencies – is that non-medical exemptions should be eliminated completely, O'Leary said. That includes religious and personal exemptions.
"When vaccination rates fall, we see disease, and people suffer. Protecting children in schools is a worthy goal of government, regardless of political affiliation," he said. "There's really no good reason to exempt your child from vaccination – only medical."
"When you choose not to vaccinate, you're putting your child at risk of disease, but you're also putting other people at risk," O'Leary said.
Measles outbreaks have forced states to react
New York, California and Washington state took action after massive measles outbreaks in 2019, a year that saw the highest reported measles cases since the disease was declared eliminated nationwide in 2000.
The stricter a state's vaccination laws, the fewer nonmedical exemptions and fewer outbreaks of vaccine-preventable diseases. When those exemption laws are loosened, the reverse is true.
But bills that seek looser restrictions are "almost universally" killed in committee, O'Leary said.
Supporters of vaccine exemptions see laws like those passed in New York and Washington as "fundamentally a threat to their ability to make informed consent about vaccinations," said Fisher, president of the National Vaccine Information Center.
The organization supported 77 vaccine-related bills during the 2019 legislative session, the most since it began tracking state legislation in 2010. The bills didn't all pass, but they're evidence that "lawmakers are listening to constituents" about anti-vaccination measures, Fisher said.
The vaccine debate doesn't always fall along party lines
The Washington bill was unique: It specifically concerned the MMR vaccine and it wasn't limited to public school students. The state now requires almost every student, at public and private schools and daycare centers, to have the MMR vaccine.
"It's a tough balance, but you're using a public – and private – resource in conjunction with lots of other kids," Harris told CNN. "There are other venues where they can be educated, they can still have their freedom, but they're not going into a public school and spread their disease."
Concerned constituents have told him the law infringes on their personal freedom, he said.
"It's a very vocal minority," he said. "But they aren't being forced to be vaccinated – they just can't come to schools."
Harris believes the science about vaccines is straightforward. He said the state wasn't aggressive enough in its response before the measles outbreaks occurred.