Category Archives: Tools to increase immunization rates

Herd Immunity and Immunization Policy: Response to Holland and Zachary

Blog post:

“This piece is a summary of Herd Immunity and Immunization Policy: The Importance of Accuracy, soon to be published in v. 94 of Oregon Law Review.

In an article that was published in the Oregon Law Review in 2014, authors Holland and Zachary claimed that school immunization mandates are inappropriate because they reject the concept that herd immunity works.

This piece will explain  why Holland and Zachary’s analysis is simply incorrect. And let’s be clear–there is a legitimate debate about  whether school immunization mandates are appropriate, policy wise, as a response to non-vaccination.”


Full article:



This article explains why claims made by Holland and Zachary in their article, Herd Immunity and Compulsory Childhood Vaccination: Does the Theory Justify the Law?, are incorrect and untenable. The authors misunderstand the nature of society’s duty to children, which is not similar to duty in torts but draws from the state’s role in protecting vulnerable children when their parents do not act in their best interests. Their view of herd immunity is also incorrect: the article does not well define the term, ignores data showing that herd immunity works, and their discussion of their two examples is inaccurate: close examination of those examples actually shows the role of herd immunity in protecting against disease. Finally, the authors’ analysis does not support their claim that mandates are unnecessary.”


Measles, exemptions, legal changes

“In reaction to the outbreak, politicians in many states proposed bills tightening exemptions from school immunization requirements.[10] This short article examines the law and legislative trends in this area.

Several states have exemption rates that are too high to preserve herd immunity. Oregon, at 7.1%, is at a high risk.[42] California has a low rate of exemptions overall, but has areas where rates of immunization are low.[43]Maine, Michigan, and Washington all have high exemption rates.[44] These states all face a real risk of disease. At least tightening these exemptions is a powerful idea.

Religious exemptions are completely inappropriate due to their vulnerability to abuse and the unfairness of putting the child at risk for beliefs the parents hold and the child is too young to choose. On the other hand, however, a system that does not leave parents any way to refuse vaccination is too extreme.

At the very least, since the public health argument is not as strong for homeschoolers, it makes sense to exempt children who are homeschooled from immunization requirements. Offering a hard-to-get personal belief exemption is preferable to a religious exemption, but should be harder to obtain than even the educational requirement currently in place.  Ideally, getting the exemption would require a daylong course with a short quiz at its end. The course requirement would help limit exemptions to only the very small set of parents with the strongest feelings against vaccines, parents who believe that asking them to vaccinate is akin to asking them to poison their child.”

Article: Tools for dealing with Childhood Vaccination Crisis

Responding to the Childhood Vaccination Crisis: Legal Frameworks and Tools in the Context of Parental Vaccine Refusal

Dorit Rubinstein Reiss

University of California Hastings College of the Law

Lois A. Weithorn

University of California Hastings College of the Law

March 4, 2015

Buffalo Law Review, Vol.63, August 2015, Forthcoming
UC Hastings Research Paper No. 134 


In spite of vaccines’ impressive record of safety and effectiveness, some families have failed to immunize their children, denying those children protection against vaccine-preventable diseases. In the last years, rates of nonvaccination, as well as rates of partial adherence to vaccination schedules, have been increasing. Predictably, this has led to outbreaks of vaccine-preventable diseases. This article examines potential legal responses to this crisis. It sets out the legal framework governing childhood vaccination policies, highlighting the strength of governmental authority when the state’s police power to protect the public health and its parens patriae authority to protect the health of children and other vulnerable members of society converge, as they do in this context. After describing the phenomenon of nonvaccination, the reasons leading to parental refusals and the effects of those refusals, the article provides a menu of legal tools that can be used to improve vaccination rates.

Tort liability for failure to vaccinate:

These two blog posts and article makes the argument that if one family’s failure to vaccinate harms another, the non-vaccinating family should be liable in torts for the damages.


Tort liability for failure to vaccinate:; see also:

Full article:


Law and Vaccines: A Manual

This is the manual about law and vaccines prepared in collaboration between myself, Amanda Naprawa and Voices for Vaccines. It covers a range of issues.


Legal Topics: 

Vaccines: Regulating the Product

Protecting the Public Health: State and Federal Law

Disease Prevention: The CDC’s Role

Immunization Schedules

School Immunization Requirements

Religious Exemptions

Vaccines: Individual Choice and Community Welfare

Community vs. Individual: Achieving a Balance of Rights

Religion, Employment, and Rights

Parental Rights and the Child’s Right to Health

Informed Consent

Informed Refusal: The Risks of Not Vaccinating

Increasing Immunization Rates: The Role of the Law 


Government-Funded Incentives and Subsidies

Imposing Costs: Civil Lawsuits.

Imposing Costs: No-Fault Options

Limiting Unvaccinated Individuals’ Access

Vaccine Refusal and Criminal Law

Forced Vaccination

Other Issues: 

Vaccine Injuries: Compensating the Rare Adverse Event.

NVICP vs. the Courts

Are Vaccines “Unavoidably Unsafe?”

Rights of the Unvaccinated Child, 2:

The second post in a series published with Shot of Prevention examining the tension between a child’s right to health and parental rights, and what can be done to protect children. This post looks at whether children harmed by a preventable disease because the parent did not vaccinate them can sue the parent.

Funding costs of outbreaks:

Explaining why those who choose not to vaccinate should pay for outbreaks caused by non-vaccination, and proposing a menu of options to impose such costs. Joint paper: Charlotte Moser, Rob Schwartz and myself.


Blog posts:

Full article:

Tort Liability for Failure to Vaccinate

Why parents who do not vaccinate – or an adult who does not vaccinate – should be liable if their decision infects another.


Blog posts, in chronological order: 


Full Article: