By Rebecca Bradley
“Government exists to protect us from each other. Where government has gone beyond its limits is in deciding to protect us from ourselves.”
–President Ronald Reagan
In the United States, an increasing number of parents are refusing to vaccinate their children.  With the measles outbreak at Disneyland in California in 2015, the Anti-Vaccination Movement has gained more public attention. The outbreak that occurred at Disneyland was the worst measles outbreak in years in the United States.  Parents have given various arguments as to why they refuse to vaccinate their children, including the safety and effectiveness of the vaccines, alternative medicine, civil liberties, conspiracy theories and mortality and religion.  Although there are no federal vaccination laws in the United States, most states individually require children to have certain vaccinations for school and day care.  In 1905, the “Supreme Court endorsed the right of states to pass and enforce compulsory vaccination laws” in Jacobson v. Massachusetts.  By the beginning of the 1980’s, all 50 states had school immunization requirements, which were found to be constitutionally permissible by the Supreme Court in 1922.  However, many states have exemptions to the immunization requirements.  Parents can receive these exemptions for medical, personal or religious reasons.  The states vary on the strictness of their vaccination requirements. Some states, such as Michigan and Wisconsin allow parents to receive exemptions for medical, personal or religious reasons.  Other states such as Illinois, allow for medical and religious exemptions only.  California has a very strict policy and is the only state that allows for medical exemptions only.  While this movement has gained prominence in the United States, parents who refuse to vaccinate their children, also known as “anti-vaxxers,” are not unique to the United States. 
International Vaccination Policies
Various countries have policies on vaccinations for children. These policies vary from a laissez-faire approach to mandatory vaccinations. Pakistan has a very strict policy regarding polio vaccinations for children.  According to the Islamabad Compulsory Vaccination Bill, which was enacted into law recently, parents must get children vaccinated against polio.  Many parents have refused to allow their children to get this vaccination due to religious reasons and fear of Western influence.  The Taliban has also banned these vaccinations in areas under their control.  Under the bill, if parents refuse to get their child vaccinated, they can be arrested and “freed only after a written assurance and proving two guarantors stating that their children would receive the vaccine.”  However, Pakistan does allow for medical exemptions.  In France, parents have also been arrested for refusing to get their children vaccinated.  Children and adults must get vaccinated for polio, diphtheria, and tetanus.  A couple was sentenced to a two month suspended prison sentence for refusing to have their children receive these vaccinations.  Australia has found other ways to reprimand anti-vaxxers instead of being arrested. In 2015 the government passed a ‘no jab, no pay’ policy, which went into effect on January 1, 2016.  More than 39,000 children under the age of 7 were not being vaccinated because of parental objections.  Under this new policy, parents must meet the immunization requirements to be eligible to receive child care benefits from the government.  There are exemptions for medical reasons and a Secretary’s exemption.  Also, religious exemptions can be received but under limited circumstances.  In order to receive an exemption for religious grounds the individual must be affiliated with a group that has been registered and approved by the government. 
On the other hand, Canada, Germany and the United Kingdom all have less stringent policies regarding vaccinations. In Canada, only three provinces have compulsory school-entry vaccination laws for children.  Like the United States, Canada allows for the individual provinces to formulate their own policies instead of having a policy for the country as a whole.  Ontario, New Brunswick, and Manitoba are the only provinces with legislated vaccination policies.  Also, exemptions are easily obtained and allowable.  The United Nations has expressed concern and noted that Canada was “one of the few industrialized countries in the world with a vaccination rate of less than 85%.”  Likewise, in Germany and the United Kingdom, childhood vaccines are not compulsory and there are no school or day care requirements regarding immunizations.  However, in the United Kingdom, levels of immunization are generally high. 
The rise of the anti-vaccination movement in the United States could have international implications. Not only could the arguments and ideas of the anti-vaccination movement spread worldwide, but also the diseases that resurge themselves.
The movement in the United States could cause an increase in the number of parents who refuse to vaccinate their children. With the media coverage and internet, it is easy for individuals in other countries to become aware of the movement in the United States and their supporters’ arguments. These individuals may become persuaded to follow the movement and refuse to vaccinate their children.
Most importantly, the rise in the number of parents refusing to vaccinate their children both in the United States and around the world could lead to the resurgence of various diseases. Many United States citizens travel to other countries and citizens from other countries visit the US frequently. Considering worldwide travel is common, it is likely that diseases could spread easily among those who are not vaccinated. Diseases that reappear in one country could easily be spread to other countries.
With the rise in the number of parents refusing to vaccinate their children, both in the United States and internationally, individuals should be aware of the effects that decision could have not only at home but abroad. As we have seen in 2015 at Disneyland in California, it is possible for diseases, such as measles, to resurge and spread. It is also important to keep the health of others in mind when making these choices. There are numerous children who cannot receive vaccinations and have weakened immune systems due to medical reasons. As seen in the United States and various countries, when making policy choices it can be difficult for governments to find the delicate balance between safety and individual rights.
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 Marian Olpinski, Anti-Vaccination Movement and Parental Refusals of Immunization of Children in USA, 87 Pediatria Polska 381, 382 (2012).
 Steven Salzberg, Anti-Vaccine Movement Causes Worst Measles Epidemic In 20 Years, Forbes (Feb. 1, 2015, 8:00 AM), http://www.forbes.com/sites/stevensalzberg/2015/02/01/anti-vaccine-movement-causes-worst-measles-epidemic-in-20-years/#1c26221e7ef9.
 Olpinski, supra note 1, at 384.
 See National Center for Immunization and Respiratory Diseases, State Vaccination Requirements, Centers for Disease Control and Prevention (2016), http://www.cdc.gov/vaccines/imz-managers/laws/state-reqs.html.
 Olpinski, supra note 1, at 383.
 National Center for Immunization and Respiratory Diseases, supra note 4.
 See State Law & Vaccine Requirements, National Vaccine Information Center (2016), http://www.nvic.org/vaccine-laws/state-vaccine-requirements.aspx.
 Id. See also Lydia O’Connor, Mandatory Vaccine Bill Passes In California Senate, The Huffington Post (May 14, 2015, 5:29 PM), http://www.huffingtonpost.com/2015/05/14/california-vaccine-bill-passes-senate_n_7286274.html.
 Teresa Welsh, Anti-Vaccine Movements Not Unique to the U.S., US News (Feb. 18, 2015, 12:01 AM), http://www.usnews.com/news/articles/2015/02/18/anti-vaccine-movements-not-just-a-us-problem.
 Stav Ziv, For Parents In Pakistan, It’s Vaccinate or Face Jail, Newsweek (Mar. 2, 2015, 4:08 PM), http://www.newsweek.com/parents-pakistan-its-vaccinate-or-face-jail-310764.
 Islamabad Compulsory Vaccination Bill (2015), (Pak.), available at http://www.senate.gov.pk/uploads/documents/1429077265_147.pdf.
 Ziv, supra note 13.
 Islamabad Compulsory Vaccination Bill, supra note 14.
 AFP, Mandatory Vaccination In France, Vaccination Information Network (Jan. 7, 2016, 3:33 PM), http://www.vaccinationinformationnetwork.com/mandatory-vaccination-in-france.
 THE BLOG, France Launched Vaccination Policy Revamp, Vaccines Today (Feb. 5, 2016, 9:36 AM), http://www.vaccinestoday.eu/vaccines/france-launched-vaccination-policy-revamp.
 AFP, supra note 19.
 Australia to deny benefits to parents refusing to vaccinate their children, Al Jazeera (Apr. 12, 2015, 11:49 AM), http://america.aljazeera.com/articles/2015/4/12/australia-to-deny-benefits-to-parents-refusing-to-vaccinate-children.html.
 No Jab, No Pay- New Immunisation Requirements for Family Assistance Payments, Australian Government Department of Social Services (Jan. 4, 2016), http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/67D8681A67167949CA257E2E000EE07D/$File/No-Jab-No-Pay.pdf.
 Michele Richinick, Australia to deny government child care benefits for anti-vaxxers, MSNBC (Apr. 13, 2015, 11:06 AM), http://www.msnbc.com/msnbc/australia-deny-government-childcare-benefits-anti-vaxxers.
 Erin Walkinshaw, Mandatory Vaccinations: The Canadian Picture, 183 CMAJ E1165, E1165 (2011).
 Catherine Mah, Compulsory School-Entry Vaccination Laws & Exemptions: Who is Opting Out in Ontario & Why Does It Matter?, 5 Healthcare Policy 37, 38 (2010).
 Walkinshaw, supra note 28, at E1165.
 See Mah, supra note 29, at 39.
 Nick Waddell, Should Canada Adopt Australia’s “No Jab, No Pay” Vaccine Law?, Cantech Letter (Sept. 16, 2015), http://www.cantechletter.com/2015/09/should-canada-adopt-australias-no-jab-no-pay-vaccine-law.
 Miriam Fine-Goulden, Should Childhood Vaccination Be Compulsory in the UK?, 8 Opticon 1826 1, 1 (2010); Robert Koch Institut, Statement of the German Standing Committee on Vaccination at the RKI, Epidemiologisches Bulletin 327 (Aug. 24, 2015), http://www.rki.de/EN/conent/infections/vaccination/recommendations/34_2015_engl.pdf?_blob=publicationFile.
 Fine-Goulden, supra note 33, at 1.