Moving From Outbreak to Legislative Outcome: State Efforts to Address Anti-vaccine Sentiment

By Denise Lillvis, MPA and Anna Kirkland, JD, PhD, University of Michigan

Photo: James Gathany

Photo: James Gathany

In our article recently published by Milbank Quarterly, we discuss the trends in state childhood vaccine legislation from 1998 to 2012. We identified 636 bills across the 50 states, coding them by policy type and outcome.

Readers of this blog may be surprised to learn that this time period hasn’t been a coup for anti-vaccine groups. We identified only 20 bills that marked a policy change favored by vaccine-critics in the entire 15 year period, and many of those were insignificant. No state legislature has expanded exemptions from vaccines since 2003. More strikingly, immunization supporters have begun to make headway in state legislatures, passing laws to make it more difficult for parents to opt out of mandatory immunizations in Oregon, Washington, and California. It is important to emphasize the good news and the generally high levels of support for vaccines across all demographic groups because it helps maintain support. Dramatic stories about vaccine-refusing parents may actually weaken support for immunization if ordinary people believe that the social contract has broken down. Our study shows that when state-level politicians consider immunization policies—even in the face of vigorous mobilization by anti-vaccine groups—they are likely to support immunization and to partner with trusted experts.

Nonetheless, vaccine-preventable disease outbreaks are occurring throughout the U.S. Pertussis incidence increased significantly between 2011 and 2012 and measles cases are at a 20-year high. If the political clout of the anti-vaccine movement has been in decline, why are we still witnessing so many vaccine-preventable outbreaks? First, clusters of unvaccinated or late-vaccinated children and their doubting parents still exist even in the face of legislative shifts.

Second, outbreaks occur for multiple reasons, and anti-vaccine sentiment may be only part of the explanation. For example, the measles outbreak at a Texas megachurch in 2013 was sparked both by low MMR uptake in the congregation (and not for religious reasons, but due to fears about autism and “too many, too soon”) and by a traveler who recently visited Indonesia on a mission trip. Measles outbreaks still originate from travel abroad, and mission trips are the kind of travel where one is more likely to encounter measles. More secular vaccine-refusing enclaves may evade measles because of surrounding herd immunity and because no travelers happen to bring it in.

And finally, while pertussis outbreaks certainly got the attention of the state legislators in our study, it is not entirely accurate to blame anti-vaccine activists for our resurgence of pertussis. Few adults get the Tdap dose needed to boost immunity against pertussis. Immunity from both the vaccines and the disease itself wanes after just a few years, leaving a lot of people to contract and transmit the disease.

What can be done at the state and local level to address these outbreaks?

  1. Don’t oversell the story. Good news: the overwhelming majority of parents do vaccinate their children and adolescent vaccination coverage increased from 2012 to 2013. Failure to communicate this effectively leaves individuals with the misperception that anti-vaccine sentiment is taking over. These misperceptions create a polarizing atmosphere that could hinder cooperation with vaccination programs, because no one likes to contribute to the public good if others are shirking their responsibility.
  2. Don’t undersell the story. On the other hand, vaccine-preventable diseases are a real threat in certain communities, and they could be elsewhere if conditions change. Rather than communicating high vaccine exemption rates as an abstract threat, these communities can use disease outbreaks as a rallying cry for action. In our study, we found that even a small outbreak can grab legislators’ attention. Lawmakers are properly focusing on the parts of the country with the highest opt-out rates, and being at the top of the CDC’s list of states with the least-vaccinated kindergarteners was seen as a big embarrassment.
  3. Support pro-immunization politicians with information, contacts, and other resources that tap into professional credibility. We found that pro-immunization efforts don’t always succeed on the first try: it took 3 years of introducing the exemption education bill before it passed in Washington state. Additionally, prominent support from the medical and public health community was essential. Medical and health professionals command a lot of respect, and when they spoke, politicians listened. Finally, recent legislative efforts aren’t necessarily partisan: all three Washington state attempts to increase exemption stringency had bi-partisan support, as did a 2012 effort in Arizona.

About the Bloggers:
Denise Lillvis is a Doctoral Candidate at the University of Michigan where she is pursuing a joint degree in Political Science and Health Services Organization & Policy.

Anna Kirkland is an Associate Professor of Women’s Studies and Political Science at the University of Michigan. She is currently working on a book about the politics of science and knowledge in the U.S. vaccine safety and injury compensation system.

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