Stopping the resurgence of vaccine-preventable childhood diseases: Policy, politics, and law

Mandatory vaccination programs in the United States are generally successful, but their continued success is under threat. The ever-increasing number of parents who opt their children out of vaccination recommendations has caused severe outbreaks of vaccine-preventable diseases. Public health advocates have pushed for changes to state laws, but their efforts have generally been unsuccessful. We suggest that their lack of success is due to public health advocates' failures to contend with the features of the political system that impede change and to propose reforms that are ethically defensible, efficacious, and politically feasible. Based on our earlier public health studies, ethical concerns, and our analysis of the political environment, we suggest that states consider “nudging” hesitant parents to vaccinate their children by marginally raising the costs of nonvaccination. We also offer a comprehensive model law that would implement these changes.