If you’re desperately waiting for the pandemic to end, you might have to wait a little longer. “Public confidence in vaccination is fragile,” said Jason Schwartz, a Yale professor published in the New England Journal of Medicine. He’s backed by evidence: Survey responses from 68,000 Americans shows that 10 percent will not get vaccinated, in addition to 14 percent who will likely not get vaccinated against COVID-19. Schwartz fears that “trust in science and expertise are threatened.” With roughly 78.7 million Americans expressing vaccine hesitancy, Schwartz fears correctly — the national response to COVID-19 is threatened.

As a graduate student studying epidemiology with a background in biochemistry and molecular biology, I recognize the effectiveness and utility of vaccination. Vaccine denialists do not and thus threaten our safety.

In 2016, California said “enough” and took a crucial step. After the Disneyland measles outbreak of 2014-15, California pushed Senate Bill 277 forward, becoming the first state in over 35 years to eliminate non-medical exemptions for school-age children. The transition makes California the third state not recognizing non-medical exemptions for school-age children. As a result of the new policy, California experienced reductions in exemptions.

The United States should consider a national policy to eliminate non-medical vaccination exemptions.

Childhood vaccination is considered the single most significant public health intervention to-date. Compared to 20th-century annual cases, smallpox, diphtheria, congenital rubella syndrome and polio all experienced a 100 percent decrease by 2004; tetanus, measles, mumps, and H. influenzae, type B have decreased by 98 to 99.99 percent within the same time frame.

Substantial evidence shows that vaccination significantly lowers population disease risk. National research shows that exempt children were 35 times as likely to contract measles as nonexempt children.

In contrast to reducing risk, an individual actively pursuing non-medical exemptions substantially increases the risk of infection for themselves and others. Local area exemption rates are positively associated with disease incidence, even among vaccinated children. With an exemption rate six times the national average, Utah shows that increased risk of infection falls on the vaccinated as well. 

It feels criminal that the vaccinated are negatively impacted by non-medical exemptions, yet exemption rates continue to rise.

Any reasonable person would ask, “Why are the rates rising?” The answer is simple. Anti-vaxxers do not appropriately recognize or interpret scientific evidence — they cherry-pick research and are untrustworthy to elect vaccination.

Misinformation causes a staggering two-thirds of Americans to express vaccination concerns, a third of whom believe that vaccination causes autism. These claims are false. Substantial evidence has disproven the causal relationship between autism and vaccination. All published claims have been retracted and hold no ground in scientific discourse.

The majority of anti-vaxxers do not use available resources such as the internet to research vaccination, which lends to their belief in outdated nonsense. And while a minority read peer-reviewed medical journals, the majority of anti-vaxxers rely on the media and peers as their primary informants. 

Dichotomized news outlets that use hook and bait tactics to increase their viewer base are to blame. They cover probing topics but not their resolutions. In 2013, an Italian court ruled that vaccines cause autism. Significant media coverage and internet search activity linked with the ruling was associated with a drop in vaccination. The overturning case in 2015 did not have equivalent media coverage.

Denialists should not have an option to acquire non-medical exemptions, especially when multiple studies have shown that geographic aggregation of vaccination exemptions raise local risk of vaccine preventable diseases.

States with enacted non-medical exemption policies should rescind them. While the induction of SB277 has elicited fierce debate, many states have considered bills to change their respective immunization laws after seeing an increase in California’s immunization rates. These states should use SB277 as a model to build more robust, centralized systems intelligible to local health departments.

It would be remiss to neglect “informed” opposing arguments. Anti-vaxxers might look to Arkansas’ non-medical exemption policy, which advises parents and guardians to receive counseling on the harms of exemption, and claim that they did not see an increase or decrease in exemptions. Witty denialists argue that eliminating non-medical exemptions causes distrust in the medical system. They point to examples of clinical fraudulence where exemptions are given without merit, proper review or full adherence to educational protocol. In response, I say research holistically or do no research at all. 

Scientists investigate both sides of any argument, vaccination included. Anti-vaxxers can hardly claim the same. Their research, undergirded with belief perseverance, provides false confidence in wholly dismantled claims.

COVID-19 will not discriminate, and neither will other vaccine-preventable illnesses. Smoke-and-mirror fears of vaccination usurped by anti-vaxxers only exacerbates the dire state of the U.S. and puts you at risk. Fight back. Support legislation to eliminate non-medical exemptions. Write to your representatives. Engage uncertain parties with truths about vaccination. With COVID-19 rising, eliminating non-medical exemptions is necessary to maintain the integrity of current and future vaccination.

While this call to action is intended for the nation at large, Connecticut residents should be aware that religious exemptions are permitted in the state, and attempts to eliminate non-medical exemptions or educate parents have not been successful. But hope is not lost. Last year’s bill to eliminate non-medical exemptions has been reintroduced for 2021 by Sen. Mary Daugherty Abrams. If you support this initiative, practice your rights and urge your state legislator to support the bill.

JOSEPH WILLIAMS is a first-year MPH candidate in YSPH. His column runs on alternate Thursdays. Contact him at joseph.williams@yale.edu. 

Joseph Williams is a first-year MPH candidate in the Yale School of Public Health. His column 'Contemplating health' runs on alternate Thursdays.