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April 19, 2019

Safe Vaccinations for a Healthy Nation: Increasing US Vaccine Coverage Through Law, Science, and Communication

Author Affiliations
  • 1O’Neill Institute for National and Global Health Law, Georgetown University Law Center, Washington, DC
  • 2Mossavar-Rahmani Center for Business and Government, Harvard Kennedy School, Cambridge, Massachusetts
  • 3Journal of Health Communication: International Perspectives, Washington, DC
  • 4Departments of Immunology and Infectious Diseases and Global Health and Population, Harvard T.H. Chan School of Public, Boston, Massachusetts
JAMA. 2019;321(20):1969-1970. doi:10.1001/jama.2019.4270

Memory can be dangerously short. Measles once accounted for 2.6 million deaths globally every year. In the 1950s, 400 to 500 individuals in the United States died annually, with 3 to 4 million infected. With the discovery of a measles vaccine, the number of deaths plummeted to 110 000 deaths globally in 2017.1 Measles was officially eliminated from the United States in 2000. Yet, misinformation has influenced parents to refuse vaccination for their children. Most measles cases have occurred among unvaccinated children.

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2 Comments for this article
Preparation for Response to Parental Refusal of Immunzations on Religious/moral Grounds.
Doug Corrie, MD |
It would be helpful to describe the parental religious or moral concerns parents are presenting when they refuse otherwise obviously beneficial immunizations so we can have a cogent response to their concerns.
Mitigating Contagious Infections
Paul Nelson, M.D., M.S. | Family Health Care, P.C.
As we encounter the cost and quality problems of our nation's healthcare, the currently evolving measles epidemic could be viewed as representing a sentinel event for our nation's health. Among the applicable world-wide issues, there would be virtually no end to the implications. Upon returning home, the travels of Voltaire's Candide discovered his niche by "tending his garden." Two basic issues apply to this or any other vaccine mitigating contagious illness.

First, our nation's loss of social cohesion during the last 30 years is profound. It's likely the underlying disturbance for maternal and infant mortality,
homelessness, adolescent suicide/homicide, and declining longevity at birth. I offer a definition for social cohesion: a broadly shared belief among a nation's citizens that the citizens of each other's home community are trustworthy and that each of these communities maintains their own survival commons (aka safety net) with sufficient social capital for achieving their community's contribution to the norms of trust experienced by every national citizen within their own community.

Second, the front-line immunization processes occur principally through primary healthcare that is equitably available to and ecologically accessible by each citizen within their own community. Unlike virtually all other well-developed nations, our nation has no commitment to assure that this level of primary healthcare exists for every citizen. In effect, yes, a trustworthy relationship with a primary physician is the best strategy to assure "herd immunity." So goes the best analysis for the measles outbreak as sentinel event.