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Vaccine Exemptions and the Federal Government’s Role

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With the number of measles cases rising across the country, FDA Commissioner Scott Gottlieb raised the prospect of federal intervention over exemptions to state-level immunization school-entry requirements. While not specifying what role the federal government would play, Gottlieb stated, “You could mandate certain rules about what is and isn’t permissible when it comes to allowing people to have exemptions.”
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According to the Centers for Disease Control and Prevention (CDC), there have been 228 confirmed measles cases in 12 states so far this year. In 2000, the CDC declared measles “eliminated” in the US. Since then, outbreaks have spiked, a trend that many studies have linked to exemptions from vaccination requirements.

History indicates that federal intervention in vaccination requirements can have a powerful effect on state practices. After measles outbreaks in the 1960s were attributed to the school setting, the CDC urged states to tighten their school-entry requirements. In response, state legislatures and health agencies moved to require vaccination for schoolchildren against measles and other diseases. In 1970, around half of the states required vaccination as a condition of school entry. Just over a decade later, every state required immunization against at least a subset of diseases.

Former commissioner Gottlieb’s comments could be read either as a suggestion that states strengthen their vaccination rules or as an indication that the federal government is considering some form of intervention. This area of public health policy is traditionally left to the states, but there are several distinct legal pathways for federal intervention. I encourage you to read my recent Health Affairs blog post describing 4 distinct legal pathways the federal government can take to intervene in public health vaccination policies.

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