Following the recent Disneyland measles outbreak in California, the issue of pediatric vaccine refusal has not only been subject to much debate, but it seems to be far from resolution. In certain regions of the United States, parents have been refusing to vaccinate their children and are activating for the removal of school mandated immunizations. As a result, there have been large outbreaks of preventable diseases, putting many lives at risk, especially those who are unable to immunize for health and age reasons. After much debate across the media, it was soon made clear that the issue was extremely polarized, and that advocates against vaccination and the fear that they instilled in parents would not easily be assuaged. And although doctors and other credible representatives of the health care industry continue to assert that the common beliefs held by “anti-vaxxers” are indeed misconceptions, the advocacy for the elimination of school mandated vaccines seems to be rising.

With many government officials working to impose laws eradicating this issue, the opposition, fueled by the fire of misinformation that is being spread throughout the internet, is matching them with petitions, protests, and exponential growth of support for their cause.

With these circumstances posing a very imminent threat to public health and safety, a solution to this issue is not only imperative, but extremely time sensitive.

In order to combat this pressing issue, however, one must first understand the opposition. With further examination as to why parents are more commonly favoring to not vaccinate their children, it can be seen that “anti-vaxxers” mainly attribute their beliefs to a few key issues. And although these people attribute a range of reasons for vaccine “unsafety”, they all have the same goal of personal freedom when it comes to making the immunization choice.

At first, the goal of personal freedom was primarily an issue rooted in religion. However, it has now evolved into a full-blown political problem, with those leaning more towards the left leading the brigade.

This particular facet of the vaccine crisis boils down to three main groups of opposition: religious groups, political libertarians, and “self-interest maximizers”.

Religious groups originally attributed their protest to the utilization of aborted fetal cells in the production of vaccines. This use, however, is a myth, and some prominent religious leaders are even taking initiatives to promote the distribution of vaccines, emphasizing the priority of public safety.

Political libertarians are the exceptional anti-vaccination group that contain both anti-vaxxers and those who support vaccination. These people, despite their personal decisions when it comes to immunization, stand under the umbrella of pro-choice. Therefore, they care largely about the freedom of the individual rather than the issue of vaccination itself. This group is probably the most difficult to combat as their belief system is rooted in morality rather than science. However, it seems that the most moral decision would be to immunize, as choosing not to would put the many lives of those who are not able to make the choice at risk.

Self-interest maximizers are those who advocate for anti-vaccination based on personal gains alone. These are the infamous internet “trolls” who post fallacious information, aiming to instill fear by preying upon parent’s gullibility. And whether they are driven by financial gains or personal vendettas, the goals of self-interest maximizers lie in their name. With such an objective, it is clear that they have little to no regards for public safety and should be marginalized all together.

These groups, despite their different causes of opposition, all circle back to this same issue of personal freedom. And although these opinions are the same as those that were held over 100 years ago, the current “climates” both in the medical and legal world can be described as polarized at best. With this, experts assert that the solution to this issue must be considerate of both public safety and the freedom of the individual. However, there seems to be a consensus, given the recent spike in regional outbreaks across the United States, that the government must eliminate the existence of belief-based exemptions, and only allow vaccine refusal when medically necessary.

This growing support for the freedom of choice, despite many experts pushing for a solution, is becoming increasing more popular among both sides of the argument due to its political nature. Therefore, with added support for anti-vaccination based on the legal premise of personal liberty alone, it is becoming increasingly more difficult to combat the progressively more aggressive opposition.

Furthermore, the opposition is not only growing in numbers, but its campaigns are seeming to be more hostile in nature. The most recent and perhaps most poignant example of this aggression is a campaign comparing vaccination to rape. With an advertisement reading “FORCED PENETRATION Really — no big deal, if it’s just a vaccination needle and he’s a doctor”, an Australian anti-vaccination group made a chilling analogy that made the public question how far anti-vaxxers are willing to go in order to promote their cause. Not only did this stir up some bad feelings about the drastic analogy to sexual abuse, both among anti-vaxxers and pro-immunizers, but it proved how inclined the group, as well as anti-vaxxers as a whole, is in attempting to manipulate and mislead the public.

Despite the changing nature of the opposition, the overall vaccine debate continues to circle back to the same unresolved issues. At the forefront of these issues is the proposed relationship between vaccination and autism. Since Andrew Wakefield’s thesis in 1998, many parents have chosen to decline the MMR (measles-mumps-rubella) and other vaccines containing thimerosal in fear that it may trigger the onset of autism. And although the scare that Wakefield created was later disproved and even denounced by Wakefield himself, it has remained prevalent as one of the many driving forces of opposition.

With this concern at hand, there have been countless epidemiological studies conducted examining the proposed relationship. Susan Coffin, an attending physician in the Division of Infectious Diseases at The Children’s Hospital of Philadelphia and an assistant professor of Pediatrics at the Perelman School of Medicine at the University of Pennsylvania, has extensively studied Wakefield’s thesis, and with experiment has concluded that it is indeed false. Asserting the “importance of distinguishing observation from scientific investigation” in this situation, Coffin also combats the recently raised concern of the autism “spike” in today’s youth. Concluding that the number of children diagnosed has increased due to better education and symptom recognition, Coffin aids the fight against anti-vaccination.

Furthermore, studies conducted by the Immunization Safety Review Committee have also rejected the hypothesis that there could be some correlation to the causation of autism and the MMR vaccine. Supporting Coffin and the current agenda of vaccine administration, the I.S.R.C. also rejected the suggestion of a possible relationship between vaccines containing thimerosal, a mercury derived preservative no longer used in the production of vaccines, and autism. This catalogue compounded with the findings of Coffin and others is particularly important because it not only combats the autism misconception, but it points out that some of the potential risks that anti-vaxxers continue to cite often have no scientific ground.

Branching off of the autism debate is the constant questioning of the overall safety of vaccination. With many vaccines containing live viruses, the public is often more concerned with the potential risks that some immunizations pose. In addition, many individuals feel that the companies that produce the vaccines only have their own financial interests in mind, rather than being focused on the quality and safety of their product. And with rumors circling the internet of vaccine related deaths, most people are apprehensive when it comes to agreeing to immunize their children.

With many statistics twisted to paint a picture of imminent danger, it is often difficult for a concerned and ignorant parent to stay focused on reality. However, the many “facts and statistics” that anti-vaxxers use in what appears to be a scholarly article is often just an opinion piece in disguise. And with the authors of these pieces often pointing out “problems” in vaccines that habitually do not exist, it becomes evident with some research that these sources not only lack credentials, but provide incorrect information all together.

Director of the Vaccine Education Center at the Children’s Hospital of Philadelphia as well as the Maurice R. Hilleman Professor of Vaccinology and professor of pediatrics at the University of Philadelphia, Dr. Paul Offit, addresses these sources of anti-vaccination. Emphasizing the previously mentioned information, Offit recognizes that the safety concerns typically pointed out by anti-vaccination authors have little to no scientific ground, and that the maintenance of public health can only be achieved by squashing all miscommunication and faulty information surrounding the issue by asserting the safety of immunizations.

However, this issue is not only impacting those who choose not to vaccinate. Instead, it is creating an even larger issue of public safety. That is, the growing trend of immunization refusal is putting those who rely on “herd immunity”, or those who cannot vaccinate due to health and age reasons, at risk. Not only is this extremely dangerous to both parties, but it is violating the very premise of freedom of choice that anti-vaxxers hold so close to their hearts. With those who lack the choice to vaccinate often being the ones most affected by this situation, anti-vaxxers are not only contradicting their very core beliefs, but they are the reason why this particular facet of the overall public health crisis exists.

Fueling this fire of ignorance is the lack of public education about immunization. Intensified by the spread of misinformation via the internet, public misconceptions surrounding vaccines are only seeming to become more prevalent. Those who spread this misinformation take advantage of the public’s ignorance and gullibility so that whatever they support can gain momentum. With these previously mentioned “self-interest maximizers” instilling fear of immunizations among readers, the choice among parents to not vaccinate their children has become increasingly more popular, causing an even larger public health crisis.

With these extenuating circumstances, it seems that the issue of vaccine refusal is not only a practical problem, but a conceptual one as well. With this, health care professionals as well as pro-immunization advocates not only need to address why this is happening, but how to eliminate miscommunication about vaccines all together.

Eliminating this miscommunication and the overall spread of misinformation about vaccines can only be achieved through the establishment of a strong relationship between doctor and patient. In order to accomplish this, however, public confidence in vaccines must be built through appropriate public communication and education. Proper community engagement will lead to better awareness of safety of vaccines, and thus the improvement of vaccines themselves. Urging health care professionals to address the vaccine refusal in a respectful and constructive manner, rather than the common discontinuation of communication after refusal, will ensure higher vaccine uptake rates, and thus eliminate the risks that refusing to be immunized creates.

This solution of establishing a stronger relationship between patient and health care professional is widely promoted by several sources. Not only will this solution mitigate this particular public health crisis, but it will also diminish the opposition as a whole. With the medical industry allowing patients to make an educated decision when it comes to choosing immunization, the opposition should not only decrease in numbers, but become less aggressive in the process. Reinforced with state and federal legislation mandating pediatric immunization, the pressing public safety issue that anti-vaxxers create will hopefully drastically diminish. And with the numbers of infected individuals only growing as a result of the aggressive opposition, it is clear that the establishment of this solution is imperative in restoring the condition of public health.