New York City has taken an unprecedented step to control the spread of measles.
Measles kill approximately 100,000 people worldwide each year, and most of the victims are children younger than five years old. In recent years, as vaccination rates for preventable diseases have decreased in the United States, the global measles scourge has arrived at the homes of many American families. This year alone, officials at the Centers for Disease Control and Prevention (CDC) have confirmed 764 cases of measles in 22 states.
New York City has recently experienced particularly high measles rates. Last month, city officials responded with a dramatic step: Mayor Bill de Blasio (D) declared a public health emergency in four Brooklyn zip codes and issued an order requiring every adult and child without a medical exemption to be vaccinated against measles.
Five parents have reportedly filed a lawsuit challenging the vaccination requirement, stating that it violates their rights. But the New York City Board of Health unanimously upheld the order and extended it indefinitely. A city spokesperson reportedly stated that the city has found itself in the middle of a “preventable” epidemic and is taking lawful action to respond.
All states require children to be vaccinated to attend schools and daycare facilities, and these state-level regulations universally offer medical exemptions for children whose health would be put at risk by vaccinations. But many states—including New York—also allow exemptions for religious reasons or philosophical beliefs, letting parents opt out of immunizations by choice rather than medical need. These non-medical exemptions are now disallowed in certain areas of New York City where the measles outbreak is especially concentrated.
According to the CDC, conditions that justify a medical exemption to immunization include severe allergy to vaccine components, pregnancy, or a weakened immune system resulting from diseases such as cancer or medical treatments such as chemotherapy. For this small group of people, immunization is not an option even if they want to be vaccinated. In addition, the CDC does not recommend the vaccine for children under 6 months old.
Some parents fear that vaccines are more dangerous than the diseases they prevent—citing concerns such as autism. But several studies, including a recent one in Denmark with more than 650,000 participants, have established that vaccines present “no increased risk for autism.” Still, parental resistance to vaccinations persists in certain communities.
Whatever their reasons—medical needs or fears—those who are not vaccinated must implicitly rely on two backup plans: herd immunity, or the availability of effective medical treatment if they contract the disease.
Herd immunity means that if nearly everyone in a community is vaccinated, an unvaccinated person will never be exposed to anyone who is infected. The more contagious a disease is, the more people must be vaccinated in order to maintain herd immunity. The New York City emergency declaration is designed to enhance the herd immunity of at-risk communities in an effort to prevent the further spread of measles.
When herd immunity fails because of insufficient vaccination rates, diseases like measles can take root, exposing unvaccinated children and adults to a higher risk of encountering someone who is infected.
In countries with accessible health care, people who contract measles can be treated with fever reducers, rehydration solution to combat vomiting and diarrhea, vitamin A supplements, and antibiotics to manage subsequent infections such as pneumonia. But without these medical interventions, those who contract measles face the risk of blindness, brain swelling, and death.
For every 1,000 measles infections, approximately one or two victims will die. The majority of measles deaths in 2017 were children under five years old living in poor countries without a well-developed health care infrastructure.
A measles, mumps, and rubella (MMR) vaccine costs approximately $20 in the United States. The World Health Organization provides vaccines for as little as $1 each. But treating a measles infection when an outbreak occurs can cost several thousand dollars per person. The cost of treating the disease far outweighs the cost of prevention, even before accounting for hard-to-calculate expenses such as pain and suffering.
Measles, like other diseases, can be partially contained by preventive measures such as practicing good hygiene and quarantining contagious patients. But people infected with measles are contagious for up to 4 days before the disease’s signature rash develops. That means an infected person can spread the disease to others before anyone knows anything is wrong—and travelers may get on a plane and introduce the disease to a distant community before they even know they are sick.
New York City is one of the most popular travel destinations in the world. In the face of the ongoing spread of measles, government officials argue that they have more than ample reason to mandate immunizations for city residents.