When students start school, they have to prove
that they were vaccinated against diseases such
as chicken pox, polio, and measles, which can spread quickly through
an unprotected group. Students with compromised immune systems
can be exempted from the requirement because the immunizations
might be dangerous to them. In most states, parents also can get
exemptions based on personal beliefs.
Case 16.2
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266 Economics for Healthcare Managers
California Senate Bill 277, passed in 2015,
eliminated personal-belief exemptions. The law
was prompted by a measles outbreak that started
at Disneyland in 2014 and infected more than 150 people. That outbreak was likely exacerbated by low vaccination rates.
California’s law sought to remove personal-belief exemptions to
increase vaccination rates and herd immunity, a form of indirect protection that occurs when a large percentage of a population has become
immune. Herd immunity helps protect people who, because of medical reasons, cannot be vaccinated and are vulnerable to infections. It
seems to have worked. The percentage of California’s kindergartners
with all required vaccinations rose from 93 percent in fall 2014 to 96
percent in fall 2016 (Lin 2017).
Not everyone supported Senate Bill 277. The president of A Voice
for Choice, a group that opposed the bill, was quoted as saying, “It’s
not right for children to be prevented from going to school because of
their vaccination status” (Siripurapu 2016). This opinion appears to be
a minority view, as a referendum to repeal the law got too few signatures to make the ballot. “It’s going to ensure that all children are safe
in school from dangerous, preventable diseases,” said state senator
Richard Pan, the bill’s author (Siripurapu 2016).
Discussion Questions
• What are the external effects of a vaccine?
• Are people who rely solely on herd effects free riders?
• What are the scientifically verified potential harms of vaccines?
• What are the possible health outcomes of chicken pox, polio, and
measles?
• What are the external effects of these diseases?
• Have vaccination rates risen or fallen in the United States?
• Would too few people be vaccinated if it were not mandatory? Is
there evidence?
• Are vaccination rates lower in states with personal-belief
exemptions?
• What steps do governments take to increase vaccination rates?
• What steps do private companies take to increase vaccination
rates? Why?
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