FDA Commissioner Scott Gottlieb last week suggested federal health agencies could look to limit vaccine exemptions if states do not do so.
Gottlieb's comment come amid growing measles outbreaks throughout the United States. Several states have responded to the outbreaks by proposing way to limit vaccine exemptions, but at least one state is considering expanding such exemptions.
Vaccination exemptions vary by state
According to CNN, nearly every state allows children to attend school if they are not vaccinated. Certain states allow parents to opt out of vaccinations for their children via exemptions for medical, religious, and personal belief reasons, though those exemptions vary by states. Currently, 47 states allow parents to opt out of vaccinations for their children because of religious reasons, CNN reports. In addition, 17 states allow parents to opt out of vaccinations for their children because of personal or philosophical believes, according to CNN.
Gottlieb says federal health agencies could take action on vaccine requirements
Gottlieb during an interview Tuesday with CNN said, "Some states are engaging in such wide [vaccine] exemptions that they're creating the opportunity for outbreaks on a scale that is going to have national implications." He added, "[If] certain states continue down the path that they're on, I think they're going to force the hand of the federal health agencies."
According to CNN, Gottlieb did not provide direct details on which actions he thinks the federal government could take on vaccine exemptions. However, he said, "You could mandate certain rules about what is and isn't permissible when it comes to allowing people to have exemptions."
Gottlieb said he hopes states will take action to limit vaccine exemptions. He added that he is "deeply skeptical" of all vaccine exemptions except those based on medical reasons, CNN reports.
Some states look to limit vaccine exemptions, but one state looks to expand them
According to the Washington Post's "Acts of Faith," some states are looking to limit vaccine exemptions amid growing measles outbreaks in the United States.
CDC data show that, as of Feb. 14, there have been 127 confirmed cases of measles in the United States this year. That total is more than the combined total number of measles cases confirmed in 2016 and 2017, which saw 86 and 120 confirmed cases, respectively.
According to CDC, measles cases have been confirmed in California, Colorado, Connecticut, Georgia, Illinois, Kentucky, New York, Oregon, Texas, and Washington so far in 2019. Of those states, CDC has confirmed measles outbreaks in New York, Texas, and Washington, with nearly 50% of all confirmed measles cases this year occurring in Clark County, Washington.
In Colorado, state Rep. Kyle Mullica (D) has begun drafting legislation that would eliminate the state's vaccine exemptions based on personal beliefs. Mullica said, "This is not a political issue, this is about our kids being safe."
But the bill is likely to face opposition from other state policymakers, including Colorado Gov. Jared Polis (D), The Hill reports. A spokesperson for Polis said the governor "is concerned about how low vaccination rates negatively impact public health," but "believes there are successful strategies we can use to increase vaccination rates that don't put big government in the middle of the parent-child relationship and protect our freedom." The spokesperson continued, "Polis believes that forcing people to receive shots they don't want creates mistrust of government, mistrust of vaccinations, and would ultimately backfire and hurt public health."
Elsewhere, state lawmakers in Iowa, Maine, New Jersey, New York, and Vermont in recent weeks have proposed nixing religious exemptions for vaccines, "Acts of Faith" reports. In addition, a state lawmaker in Washington has proposed stricter requirements for religious exemptions for vaccines and eliminating vaccine exemptions based on personal or philosophical beliefs.
In contrast, state lawmakers on Arizona's House Health and Human Services Committee on Thursday voted 5-4 to approve a legislative package that would expand vaccine exemptions in the state. Currently, parents in Arizona can opt out of vaccinations for their children via personal belief and medical exemptions. The legislative package would also allow parents to seek religious belief exemptions (Cohen/Bonifield, CNN, 2/20; O'Reilly, Axios, 2/14; Pulliam Bailey, "Acts of Faith," Washington Post, 2/21; Bowden, The Hill, 2/23; Gstalter, The Hill, 2/22).
The case for improving coordination between behavioral health and pediatrics
The CDC estimates that nearly $247 billion is spent annually on the treatment and management of childhood mental disorders. Further, pediatric patients and caregivers often struggle to access high-quality behavioral health expertise due to a limited number of specialists and fragmented approaches to behavioral health services.
In this presentation, we review the case for improving coordination between behavioral health and pediatrics, and describe four successful models that increase access to behavioral health care.