Washington hopes locking unvaccinated kids out of school will prevent its next measles outbreak

Public health states of emergencies allow health officials to act fast to control these preventable diseases.

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Thirty-six people in Washington have confirmed cases of measles, a highly contagious, sometimes fatal—and with vaccines, preventable—disease. In Washington, the law lets parents refuse to vaccinate their children against the measles for non-medical reasons. Unsurprisingly, all but one of the cases occurred in Clark County, where only 76.5 percent of kindergarteners starting school during 2017 were vaccinated.

The outbreak has prompted the governor to declare a public health state of emergency—a decision that frees public health officials to implement critical disease control measures rapidly, says James Hodge, professor of public health law and ethics at the Arizona State University Sandra Day O’Connor College of Law.

“They make a critical difference in the timing of government interventions,” Hodge says. “Things can’t be done as quickly outside of an emergency.”

Each state has its own laws and policies around what, exactly, public health states of emergencies allow for. Most are modeled off of a CDC document called the Model State Emergency Health Powers Act, which was published after the 2001 anthrax letter attacks as a template to help states draft their own emergency policies. Among other things, it recommends that states of emergency should facilitate disease surveillance, management of pharmaceuticals, testing of people exposed to an infectious agent, and treatment programs—including mandates for vaccinations, and quarantines. “It really sets up a highly balanced approach to how you incorporate civil liberties and emergency response,” Hodge says.

When published, the model act was criticized by, among others, the ACLU, for overstepping civil liberties in its efforts to empower public health officials. Most states, though, have adopted some or all of its provisions. In the state of Washington, for example, a public health state of emergency authorizes aid from other states, charges public health officials with disease surveillance and testing, and requires that physicians report illness. It also allows officials to isolate people who don’t or can’t (for medical reasons) comply with treatment or vaccination for an ongoing outbreak, keep students or staff who are susceptible to disease from school, and close schools.

States of emergency, Hodge stresses, don’t mean that health officials physically force people to be vaccinated against their will. “What we do is say something like, either get your kids vaccinated or they can’t attend school for the duration of the outbreak. Either get your kids, or yourself vaccinated or you can’t go to work,” he says.

These types of mandates can be enough to push people who were reluctant to vaccinate to appreciate the importance of immunizations, Hodge says.

“They don’t really want their kid to get measles. More importantly, they realize if they don’t get their child vaccinated, they might have to be out of school for weeks, and they can’t afford that,” Hodge says. Sometimes it’s convenient for parents to exercise their right to an exemption. “But that convenience is taken away because they can’t attend school, and a lot of parents change their mind because of that,” he says. “It becomes a reality check for parents.”

Some people, though, think vaccination activities during a state of emergency are an overstep, Hodge says. “They perceive that the government is going to intervene in a physically abusive way,” he says. “But nothing you’d see by public health authorities involves anything close to what people perceive.”

That’s why communication during a state of emergency is important. “The messaging is that we are going to implement specific interventions that are consistent with balance of individual rights and community protections,” Hodge says. “We’re going to implement measures designed to ensure everyone is safe from the potential of measles to spread.”

The state of emergency in Washington will likely last until there’s been a period of time with no additional cases of measles. Presuming that officials can locate the source of the outbreak and identify people who might have been exposed, that might happen quickly, because it doesn’t take long for measles to set in and show who actually was infected, Hodge says. Then, the emergency is over, and it’s back to business as usual.

States of emergency are inherently reactionary, and only have to be used for diseases like measles when vaccinated levels drop low enough for outbreaks to occur. “We in public health are reacting to a very real threat: If we allow measles to spread unabated through a community that lacks herd immunity, we’re going to have deaths,” Hodge notes. “What public health authorities are out to accomplish is everyone’s goal. We want this tamped down.”