Social Distancing and the Unvaccinated

The following excerpt, found in The Guardian of Public Health,  is from The New England Journal of Medicine 

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In a Perspective article published in the New England Journal of Medicine, authors discuss their views regarding childhood vaccination exemptions and the role of physicians. They feel that unvaccinated children should be barred from school attendance citing several court rulings. These rulings say it is constitutional for state and local public health to institute social distancing to prevent the spread of diseases.  The role of the physician is also to promote social distancing in their practices. This would include having separate waiting areas for sick children. The authors do not support barring unvaccinated children from their practices because it may erode trust for physicians.

If a state allows parents to obtain religious exemptions from vaccination requirements for school entry, can it temporarily exclude unvaccinated children from school during an outbreak of a vaccine-preventable illness without violating the family's constitutional rights? If parents refuse to vaccinate their children, what can physicians legally and ethically do to protect other patients in their practice from exposure to vaccine-preventable illnesses?

In January 2015, a federal appeals court answered the former question with regard to New York State law on immunization for school enrollment, upholding the state's authority to bar unvaccinated children from school during outbreaks, even if doing so overrides a family's religious freedom with regard to vaccination.1 Physicians nationwide are facing the latter question as they respond to the measles outbreak that began at Disneyland in California in December 2014 and had spread to at least 17 states, Canada, and Mexico by late February.2 Both questions invoke the legal and moral authority to use a classic public health measure known as social distancing to attempt to mitigate the spread of an infectious disease (see tableExamples of Social Distancing Measures for Controlling Vaccine-Preventable Illnesses.). Nevertheless, trade-offs between personal freedom and public health are implicit in such measures. Governments and physicians employing social distancing policies must give careful and systematic attention to the ethical and legal issues.


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