Robert Macauley, M.D. is the Medical Director of Clinical Ethics and a palliative medicine physician at the UVM Medical Center.

Every state requires children to receive certain mandatory vaccinations in order to attend day care or school.  Children are exempted from this requirement if:

  • there is a medical reason why the vaccine would not be safe (all 50 states)
  • their parents are part of a religious group opposed to immunization (48 states)
  • their parents express a “philosophical objection” to one or all vaccines (20 states, including Vermont).

The Vermont Senate recently passed a bill (S.199) to remove the philosophical exemption in response to declining vaccination rates, which have led to an increase in the cases of vaccine-preventable diseases, such as pertussis (whooping cough).  The House is currently considering that bill.

As a pediatrician who used to work in Uganda, I’ve seen first-hand the devastating effects of infectious diseases.  It’s a tragedy when any child dies from a disease that could have been prevented.  In Africa there are significant challenges to protecting children (such as funding, access to vaccines, and public health infrastructure), but none of these barriers exist in the United States.  We have the ability to protect our children, so there is no excuse for not doing so.

I’m also the father of a fully-immunized nine-year-old who contracted pertussis, likely because an unusually high percentage of her classmates are not immunized.  Those who oppose immunization requirements often argue that if vaccines are so effective then children who aren’t immunized should be no threat (or, conversely, if vaccines aren’t that effective then there’s no reason to require them).  This argument is flawed because vaccines are highly effective, so that if nearly everyone is immunized, the whole group is protected.  But if significant subsets of children are deprived for this protection, the community is placed at risk.

Finally, I’m an ethicist, and I’m well aware of the emphasis in our society on liberty and autonomy.  But autonomy isn’t relevant to this topic, because the children involved aren’t making any of the decisions; their parents are, based on what they believe to be in the child’s best interests.  And while opponents of the bill view it as an infringement upon their liberty (to not have their children immunized), permitting “philosophical exemptions” infringes on the liberty of the vast majority of parents, who despite doing everything in their power to protect their children, are nevertheless forced to expose them to the risk of preventable disease in school.  Ultimately these bills are less about individual rights and more about our common good, where we work together to foster the health of others, as well as our own.

While science has clearly shown that immunization is in the best interests of both an individual and society, I believe that parents should be free to decide to the contrary for their own children.  S. 199 doesn’t prohibit them from making that choice; instead, it says that objecting parents would not be able to imperil other children by sending their unimmunized children to school with them. This bill simply protects immunized schoolchildren from the growing risk of preventable disease in Vermont.

Robert Macauley, M.D. is the Medical Director of Clinical Ethics and a palliative medicine physician at the UVM Medical Center. 

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Editor’s Note: Please let your legislators know how important it is that children are vaccinated and ask them to support S.199, by calling 802-828-2228 or going to and finding your legislator’s e-mail address.

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