Republicans have learned to dodge questions about climate change by saying, “I’m not a scientist.” When Rand Paul started getting questions about vaccines on Monday, he had no such excuse.
The junior senator from Kentucky has been through medical school and residency, and remains an actively (if occasionally) practicing ophthalmologist. But there Paul was on Laura Ingraham's radio show and then on CNBC Monday, spouting what most public health experts would consider highly misleading information about vaccine safety -- and about how, or at least when, parents should vaccinate their kids:
I don't think there is anything extraordinary about resorting to freedom. I'll give you a good example. The Hepatitis B vaccine is now given to newborns. We sometimes give five and six vaccines all at one time. I chose to have mine delayed. I don't want the government telling me that I have to give my newborn Hepatitis B vaccine, which is transmitted by sexually transmitted disease and/or blood transfusions. Do I ultimately think it is a good idea? Yeah. And so I had mine staggered over several months. I have heard of many tragic cases of walking, talking normal children who wound up with profound mental disorders after vaccines. I'm not arguing vaccines are a bad idea. I think they are a good thing, but I think the parent should have some input. The state doesn't own your children. Parents own the children. And it is an issue of freedom and public health.
To hear Paul tell it, vaccines are a worthwhile preventive measure, but carry significant risks of harm -- enough to warrant spacing them out over time. That’s simply not the case. All medical interventions can cause side effects, but immunizations are among the most effective and the very safest interventions we have, with the risks of adverse consequences exceedingly low.
And while the idea of spreading out vaccinations over time has gained some popularity, experts say this, too, lacks scientific basis. The Institute of Medicine, the nonprofit organization that’s part of the National Academy of Sciences, looked at this question specifically and concluded that there is no reason to delay immunizations. On the contrary, the IOM determined, the recommended schedule from the Centers for Disease Control and Prevention -- the one that requires, yes, multiple shots at once -- makes sense. In fact, IOM said, delaying vaccines could be harmful, since it leaves babies vulnerable to dangerous diseases for longer periods of time.
Paul, on the air, defended his views by saying, "I guess being for freedom would be really unusual." But it's not unusual to argue that your freedom can infringe upon somebody else's. And the argument in favor of vaccination requirements is that, when you decide against inoculation, you jeopardize the health not just of your own child but also of other people in the community. That's because failure to inoculate undermines the “herd immunity” or "herd protection" necessary to keep diseases from spreading, particularly among vulnerable populations like the very young and people with immunological problems.
As Sarah Kliff at Vox has noted, researchers say that it takes immunization rates of 92 to 94 percent in order to establish herd immunity for measles. The rate has already fallen below that in some states, and because anti-vaccination advocates tend to cluster, it’s fallen dangerously below that level in some communities. That’s why measles is starting to make a comeback, even though more than nine out of 10 Americans have gotten measles shots.
The courts understand this -- and have for a long time. Modern law on vaccinations traces back to a 1905 case, Jacobson v. Massachusetts, in which the state fined a preacher who refused to get a smallpox vaccination, and the preacher sued. The case went all the way to the Supreme Court, which ruled that Massachusetts, like all states, had expansive “police powers” to protect the health and safety of its citizens -- and that requiring vaccinations (in this case, under penalty of a fine) was well within the limits of that power. Just a few weeks ago, a federal appeals court dismissed a lawsuit against New York’s vaccination law on the very same grounds -- and issued its decision unanimously just two days after hearing oral arguments, calling the requirement “clearly constitutional.”
Paul isn’t the only presidential aspirant who has sent mixed signals on vaccination. Hours before Paul was on TV, Chris Christie was on MSNBC explaining that he, too, thought vaccines should be optional. (He later issued a statement clarifying that he thought all parents should vaccinate their kids.) Back in 2008, Hillary Clinton suggested the federal government should investigate possible links between vaccines and autism. While this was before the Lancet, the British Medical Journal, fully retracted an infamous medical article alleging such a link, it was after the scientific community had rejected the central finding. (On Monday, Clinton issued a clearer endorsement of vaccines.)
Still, Paul’s status as a physician gives him extra credibility -- and, with it, extra responsibility. The reason vaccination rates have slipped in many states is that anti-vaccination activists have managed to exert enormous political influence. Today 20 states allow parents to exercise philosophical objections to school vaccination requirements. All but two (Mississippi and West Virginia) allow religious exemptions that some parents exploit to avoid vaccines for non-religious reasons.
Anti-vaccine advocates have succeeded because they are focused, vocal and well-organized. But in just the last few years, pro-vaccination advocates have pushed back, and have even won some victories. A recent study in the American Journal of Public Health showed, for example, that the details of vaccination requirements make a big difference. When states require parents to file paperwork and affidavits in order to gain vaccination exemptions for their kids, fewer parents do. That can make a big difference in the communities where anti-vaccination parents tend to cluster. California recently amended its vaccination law to require such steps (though Gov. Jerry Brown, in an apparent nod to anti-vaccination advocates, added a signing statement that may weaken its impact).
As books like Arthur Allen’s Vaccine and Seth Mnookin’s The Panic Virus have documented, the American anti-vaccination movement has been around since at least 1879, when the Anti-Vaccination Society was established. And its shape hasn't even changed that much in 136 years. Henning Jacobson, the Massachusetts preacher whose case established the right of states to require vaccines, believed he and some family members had been injured by previous immunizations -- and according to public law expert Wendy Parmet, he had connections to anti-vaccination advocates of the time.
“We’ve had vaccination laws for a long time, and for as long as they’ve been around they’ve been controversial,” says Parmet, a professor of law at Northeastern University.
National political figures may never convince the most passionate vaccination skeptics, whose views, however unscientific, may be sincerely and deeply held. But what political leaders say can embolden the vast majority of people who believe in vaccines, get them for their children, and recognize anti-vaccination for the public health threat that it is. That’s why Paul’s statements in particular are more than a curiosity or a data point for sizing up the presidential candidates. They are a serious issue in a debate that affects real people’s lives.