Measles are in the news. In some places in the country we are seeing small clusters of cases. In other places, like Ohio, large outbreaks of the disease have been reported. What do almost all of these cases have in common? An unvaccinated traveler.
In Ohio, there are over 80 cases of measles tied to a group of unvaccinated travelers who went to the Philippines – a country in the midst of a measles outbreak estimated to include over 20,000 individuals. In California, 54 of the 58 (93%) reported measles cases reported between January and April 2014, came from travelers to foreign countries. Most of the cases were, not surprisingly, among unvaccinated individuals. Can we blame Jenny McCarthy and her anti-vaccine followers? Yes, in part.
The anti-vaccine movement, girded by the fraudulent work of Andrew Wakefield, has spent the last several years working hard to convince parents that measles-mumps-rubella (MMR) vaccine is the cause of autism. Internet-based charlatans have touted the wonders of natural healing (which, of course, can be bought from said charlatan) and the dangers of vaccination. The media has fueled the anti-vaccine movement, giving platforms for anecdotal stories about vaccine-injuries and purportedly associated rises in autism rates. Parents have been bombarded with anti-vaccine information. It is no wonder that vaccination rates have been declining.
But the anti-vaccine movement isn’t solely to blame. We can also blame ourselves, and our elected officials. We take great pains to ensure that carry-on liquid stay below the 3oz. level, we put infants through metal detectors to search out weapons, we have no-fly lists and strict identification requirements. But when it comes to disease, we’ve dropped the ball. As a country, we’ve made great strides at increasing travel safety, except when it comes to preventing unvaccinated travelers from bringing more than souvenirs home. We ensure that immigrants and refugees to the United States are vaccinated, why don’t we require the same for our own citizens who may choose to travel to places where disease is endemic and may unwittingly bring disease back home again?
We need to reconsider our public health strategy. Polio, measles and mumps may not need a passport to travel, but individuals do. The easiest way to deter unvaccinated individuals from going to countries with disease epidemics is to limit access to passports. In addition to proving your identify and U.S. citizenship, you should have to provide documentation of your immunization status, or proof of a legitimate exemption. Individuals who cannot do that (or won’t) shouldn’t get to have a passport.
This plan won’t be popular. It’s the very nature of many public health initiatives that some individual liberty has to give way for the common good. Stopping the importation of disease through unvaccinated travelers is an essential component of protecting our communal health.