INDIANAPOLIS — A recent federal court of appeals decision should make parents think about the consequences of seeking religious exemptions from schools’ vaccination requirements, said the co-author of an article on “Social Distancing and the Unvaccinated” recently published in The New England Journal of Medicine.
In Phillips v. City of New York, the court affirmed that unvaccinated children can be temporarily excluded from school during an outbreak of a vaccine-preventable illness, “even if doing so overrides a family’s religious freedom with regard to vaccination,” said Ross D. Silverman, a professor of health policy and management at the IU Richard M. Fairbanks School of Public Health at Indiana University-Purdue University Indianapolis. Silverman also holds a secondary appointment as professor of public health and law at the IU Robert H. McKinney School of Law.
The measles outbreak that began in December at Disneyland spread from California to other states, Canada and Mexico. Given that case and the fact that Indiana has outbreaks of measles, chicken pox, whooping cough and other illnesses every couple of years, “I’d like parents to have a greater awareness that if they decide not to have their children vaccinated and an outbreak then occurs at their children’s schools or day care, they may have to keep their children out of school or day care for a while,” Silverman said.
As it stands, Silverman said, that message may not be getting across. “I think it should be more front and center in the conversation.”
Public health authorities are empowered to take necessary steps to minimize the risks of the spread of vaccine-preventable infectious diseases, Silverman said. One of those steps is social distancing, a public health measure that includes exclusion of individuals from schools or day cares.
“We want to make sure that the public health authorities have science-informed processes in place and the scope of authority to take these kinds of steps to reduce infection spread,” he said.
Similar issues also have come up in the relationship between physicians and parents who refuse to vaccinate their children, Silverman said, raising questions as to what physicians legally and ethically can do to protect their other patients from exposure to vaccine-preventable illnesses.
According to the paper, “Although physicians are legally able to deny services to unvaccinated patients in most situations, most medical professionals would probably agree with the American Academy of Pediatrics that such an extreme option should be avoided.”
Nonetheless, there appears to be some latitude within the academy about denying services should certain conditions exist, including a breakdown in physician-patient relations combined with the risk posed to other patients in the practice, Silverman said.
Tony Yang, associate professor in the Department of Health Administration and Policy at George Mason University, is the co-author of the article.