Don’t make measles great again in Arizona

This year started with a large, multi-state outbreak of measles that reached over a hundred and fifty cases in the first two months of the year. Congress has just held hearings to examine the causes of the measles outbreaks. Many states proposed legislation to tighten school immunization requirements to improve immunization rates.  That is crucial: the more people vaccinated, the greater the protection for children and public health. California’s stronger legislation, for example, led to higher rates.

But Arizona is going in the other, potentially deadly direction. Bills that came out of committee seem aimed at making measles great again rather than shoring up the state’s protections against it.

Arizona makes it very easy to get exemptions from school immunization requirements. All parents have to do is sign a form stating they received information about the risks and benefits of immunization from the health department and have a religious or personal belief to immunization. But one bill would do away even with this simple requirement, allowing parents to submit any document of their own. Easy exemptions make non-vaccinating the easier option, and can mean even children whose parents are not really opposed to vaccines will not vaccinate. Removing even the simple requirement of filling out a form makes that problem worse, skewing the balance in favor of not vaccinating, setting up Arizonans and neighboring states for outbreaks. If passed the legislature would be actively going against the children’s and the community’s health, making it easy for a small but dangerous group of vaccine opponents to choose to put their neighbors at risk. The bill also adds a religious exemption, something the broad personal belief exemption already covers.

Another bill is even more insidious. The bill wants to hand parents materials that include a long insert and a list of ingredients in vaccines before vaccinating.  While pretending to be about informed consent, the bill is actually aiming to scare parents from vaccinating – by misleading them through omission. Consider the following. Would you give your child something with the following list of ingredients: glutamic acid, aspartic acid, lysine, phenylalamine? No? Sounds scary? These ingredients are in a banana. https://www.businessinsider.com/what-chemicals-are-in-an-all-natural-banana-2017-6 How about something containing benzene, methanol, acetaldehyde and hydrogen sulfide? All present in chicken soup. Parents deserve to know the risks and benefits of vaccines, and other information around them, but a list of ingredients in a short visit to a busy doctor’ office, without context and explanation, will not inform them.  As it is intended, it will just scare them. In reality, ingredients in vaccines are there for a purpose, and as the FDA, CDC and pediatrician groups keep reminding us, they are safe.  But the bill would not require parents be told that. https://www.chop.edu/centers-programs/vaccine-education-center/vaccine-ingredients Similarly, giving the long insert, without more, during a short doctor’s appointment may confuse parents into thinking that the list of reported events in the insert reflects the vaccine’s risks – and that’s not quite the case. Inserts include things reported that meet criteria even if they are not caused by vaccines, like teething or deaths from gunshot wounds.

Giving this kind of partial information undermines informed consent and can mislead parents into not vaccinating for the wrong reasons. Misleading parents into leaving children at risk is wrong.

States are moving to restrict exemptions.  As outbursts of measles plague our nation and others, it is strange to see Arizona work to make its children less safe, undermining what courts and public health officials have described as the gold standard for preventing infections–reduced exemptions. It is a time to act to improve protection, and reduce the risk. Legislators in Arizona should stand for children, not disease-causing viruses.

Dorit Rubinstein Reiss, is a law professor at  University California Hastings College of Law and Arthur Caplan is director of the Division of Medical Ethics, New York University