Regulating Vaccination in the United States

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Recent outbreaks of vaccine-preventable diseases fuel debate about vaccine policy.

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Measles cases tripled in the United States this year, despite a readily available vaccine to combat the disease. Although vaccines are not fail-proof in preventing disease, major health organizations consider them crucial in shielding children and adults alike from many otherwise deadly illnesses. But despite the overwhelming benefits of vaccination, vaccine-preventable diseases still account for tens of thousands of illnesses in the United States each year. Indeed, the recent outbreak of measles—a disease declared eradicated from the United States nearly twenty years ago thanks to the MMR vaccine—prompted a federal health agency commissioner to suggest that the federal government intervene to make vaccination compulsory. But scholars caution that vaccine mandates fall squarely within the states’ jurisdiction, and they question whether federal pressure would actually result in increased vaccinations.

This week’s seminar explores recent scholarship on vaccine policy in light of recent outbreaks of vaccine-preventable diseases.

  • Writing for Nature, Liam Drew asserts that a common response of governments to disease outbreaks is to double down on compulsory vaccinations. But “mandates are not as clean a solution as policymakers might hope,” argues Drew.  Because vaccine hesitancy poses a major barrier to vaccine compliance, policies that promote additional information and education about vaccines may be more effective than increasing penalties to force compliance with current state requirements, according to Drew. 
  • In a blog post in Health Affairs, Richard Hughes IV explores potential ways for the federal government to encourage stricter state laws around vaccination. Hughes suggests that, although a congressional act would be effective at preempting state laws, such a law would likely meet legal challenges. In particular, Hughes cautions that conditioning existing federal funding on mandatory vaccination could be viewed as unconstitutionally coercive. Hughes concludes that the best strategy is “translation and dissemination of state and local best practices to lower exemption rates through parental and policy maker education, as well as increased engagement of state and local health officials at every level.” According to Hughes, this approach was successful 60 years ago when the federal government first undertook efforts to encourage states to adopt stricter vaccination requirements.
  • In light of the World Health Organization declaring “vaccine hesitancy” to be one of ten major threats to global health, Y. Tony Yang, David Broniatowski, and Dorit Reiss assert that the federal government should do its part to tackle misinformation about vaccines. In an essay published in JAMA Pediatrics, Yang and his co-authors focus on social media messaging, asserting that despite free speech protections, the federal government has the authority to address any anti-vaccine content that is pecuniary in nature, including any content that promotes alternative remedies to vaccines. They also argue that the federal government could regulate social media platforms to prevent them from amplifying vaccine misinformation. To enact such proposals, Yang and his co-authors point to algorithms as a potential means for flagging misinformation to be removed.
  • Writing for Health Affairs, Christoph Diasio argues that the public sector does not adequately compensate pediatricians for the costs of vaccinating children. For example, Diasio argues that Vaccines for Children (VFC), a federally-funded program that provides free vaccines for children unable to pay, does not cover the administrative fees of vaccines, leaving costs to fall on pediatricians. Diasio further asserts that federal funding does not adequately compensate pediatricians for their time spent convincing parents to vaccinate their children. Diasio suggests addressing these shortcomings by changing billing practices for vaccines and expanding the VFC program to cover the administrative costs of free vaccines.
  • Asserting that immigration detention policies have created crowded populations that are vulnerable to certain disease outbreaks, Brookings Institution researchers John Hudak and Christine Stenglein propose that the federal government run a vaccination program for detainees. They argue that such a program could be cost-effective while also reducing the incidence of public health crises. Hudak and Stenglein recommend that federal officials as well as state public health authorities commit to vaccination of migrants held in their facilities.

The Saturday Seminar is a weekly feature that aims to put into written form the kind of content that would be conveyed in a live seminar involving regulatory experts. Each week, The Regulatory Review publishes a brief overview of a selected regulatory topic and then distills recent research and scholarly writing on that topic.