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April 11, 2019

NYC is mandating vaccinations in response to a measles outbreak. Is that legal?

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    New York City Mayor Bill de Blasio on Tuesday declared the measles outbreak affecting the city a public health emergency and is requiring all residents of certain ZIP codes to receive the measles, mumps, and rubella (MMR) vaccine—prompting legal questions, the New York Times reports.

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    de Blasio declared the public health emergency following an increase in measles cases reported in the city and throughout the country. Since October 2018, 285 cases of measles have been reported in Brooklyn and Queens, marking the largest measles outbreak in the city since 1991. The same outbreak has been responsible for 168 measles cases in Rockland County, New York, and 15 cases in Orange County, New York, CNN reports.

    According to Oxiris Barbot, New York City's health commissioner, 246 of the 285 cases reported in the city have involved children. Barbot blamed the outbreak on "a small group of anti-vaxxers in these neighborhoods" who "have been spreading dangerous misinformation based on fake science."

    Barbot also warned New York City residents not to hold so-called "measles parties," in which parents expose their unvaccinated children to individuals infected with measles as a way immunize them without a vaccination. "We are concerned about families having measles parties," Barbot said, adding, "we don't want children or adults to be unnecessarily exposed to measles."

    Nationwide, measles cases are being reported at a record-setting pace. As of April 4, there have been 465 measles cases reported in the United States, putting this year on pace to set the record for the largest measles outbreak since the disease was eliminated from the country in 2000, according to CDC. The largest measles outbreak in the United States since 2000 occurred in 2014, when there were 667 measles cases reported.

    As of April 4, there were measles outbreaks currently ongoing in five states, with measles cases in 15 other states reported to CDC.

    NYC mandates vaccinations

    Under New York City's public health emergency, the city is mandating that residents living in certain ZIP codes receive the MMR vaccine.

    Under the mandate, members of the city's Department of Health and Mental Hygiene will check the vaccination records of every individual who might have been in contact with a patient infected with measles. Those who have no evidence of immunity and who do not receive the MMR vaccine could receive a $1,000 fine.

    "Every hour, every day matters here. If people would just go and get vaccinated, there's no cause for a fine," de Blasio said. He added, "It's not our goal to issue violations. We want to simply solve the problem."

    The mandate caused some to question whether city officials legally can mandate vaccination, the Times reports. According to the Times, while the government cannot vaccinate anyone by force, it does have the legal ability to punish citizens for refusing vaccination.

    According to Daniel Salmon, director of the Institute for Vaccine Safety at the Johns Hopkins Bloomberg School of Public Health, a 1905 Supreme Court ruling in the case Jacobson v. Massachusetts determined states have the authority to compel vaccinations on the grounds that an individual's freedom could be bypassed for a greater good in a dangerous situation (Scutti, CNN, 4/9; Burke, The Hill, 4/9; AP/Los Angeles Times, 4/9; McNeil, New York Times, 4/9; Allen/Cherelus, Reuters, 4/9; Hassan/Oppel, New York Times, 4/9; CDC website, 4/8).

    From outbreaks to hurricanes: How can hospitals prepare for disasters?

    Hospitals must be prepared for myriad disasters that can stress health care systems to the breaking point and disrupt delivery of vital health care services.

    Advisory Board has compiled step-by-step procedures for various threats your facility may encounter—though we hope you'll never need to use them.

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