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FFRSV – Vaccination Aff and Neg

Notes and FAQ


For Questions

CV – cvvitolo@gmail.com

File by

Chirag Jain

Lauren Ernst

Maddie Pieropan

Daniel Joseph

Kevin Le

William Bradshaw

Alternate Plan Texts:

Plan: The United States federal government should regulate K-12 schools that receive public funding
by implementing a law that

-Requires states to adopt mandatory vaccination programs with stringent exemption standards

-Funds the mandate through an expansion of the Vaccines for Children program

-Require education over the benefit of vaccinations in primary and secondary schools.

Plan: The United States federal government should regulate K-12 schools that receive public funding
by requiring states to adopt mandatory vaccination programs with stringent exemption standards in
return for federal funding.

Current ACIP vaccination schedule:

https://www.cdc.gov/vaccines/schedules/hcp/imz/child-adolescent.html
The Vaccines for Children Program (VFC) provides vaccines to those who incur out of
pocket costs.
CDC 16 --- (“About VFC,” https://www.cdc.gov/vaccines/programs/vfc/about/index.html)//ernst
About VFC On this Page The VFC Program: At a Glance Roles of Those Involved Determining Eligibility What is the Cost? Locating a VFC Provider
History of the VFC Program The VFC Program: At a Glance The
Vaccines for Children (VFC) Program helps provide
vaccines to children whose parents or guardians may not be able to afford them. This helps ensure that
all children have a better chance of getting their recommended vaccinations on schedule. Vaccines
available through the VFC Program are those recommended by the Advisory Committee on
Immunization Practices (ACIP). These vaccines protect babies, young children, and adolescents from 16
diseases. Funding for the VFC program is approved by the Office of Management and Budget (OMB) and
allocated through the Centers for Medicare & Medicaid Services (CMS) to the Centers for Disease
Control and Prevention (CDC). CDC buys vaccines at a discount and distributes them to grantees—i.e., state
health departments and certain local and territorial public health agencies—which in turn distribute them at no charge to those private
physicians' offices and public health clinics registered as VFC providers. Roles of Those Involved This site serves 3 main audiences:
The parent or guardian of the child needing vaccines provided by the VFC who needs to know what the
VFC offers them, how to find vaccines provided, and who to contact for answers to questions. The
provider, whether currently enrolled or wants to know the incentives for joining the VFC program,
what’s involved, how to order vaccines, and how costs and fees are handled. The awardee, with the largest
role, that performs the paperwork; distributes vaccines; complies with changing state and federal
regulations; manages the program; recruits and enrolls providers in the program; evaluates
performance; controls, identifies, and differentiates fraud from abuse; provides quality assurance and
improvement, conducts provider site visits; completes surveys; returns, replaces, or files credits for
vaccines, etc. Top of Page Determining Eligibility A child is eligible for the VFC Program if he or she is younger than
19 years of age and is one of the following: Medicaid-eligible Uninsured Underinsured [1] American
Indian or Alaska Native Children whose health insurance covers the cost of vaccinations are not eligible
for VFC vaccines, even when a claim for the cost of the vaccine and its administration would be denied for payment by the insurance
carrier because the plan's deductible had not been met. Footnotes Underinsured means the child has health insurance,
but it Doesn't cover vaccines, or Doesn't cover certain vaccines, or Covers vaccines but has a fixed dollar
limit or cap for vaccines. Once that fixed dollar amount is reached, a child is then eligible. Underinsured
children are eligible to receive vaccines only at Federally Qualified Health Centers (FQHC) or Rural Health
Clinics (RHC). An FQHC is a type of provider that meets certain criteria under Medicare and Medicaid programs. To locate an FQHC or RHC,
contact the state VFC coordinator. For additional details, consult the "Which Children are Eligible" section. What are the Costs or Fees? There
is no charge for any vaccines given by a VFC provider to eligible children. But there can be some other
costs with a vaccination: Doctors can charge a set (or standard) fee to administer each shot. But if the
family can't afford the fee per shot, the fee must be excused. A VFC-eligible child cannot be refused a
vaccination due to the parent's or guardian's inability to pay for shot administration. There can be a fee
for the office visit. There can be fees for non-vaccine services, like an eye exam or blood test. Locating a VFC Provider
Nationwide, there are over 44,000 doctors enrolled in the VFC Program. Each state's VFC Coordinator can provide a
list of doctors enrolled in the VFC Program. Other places that provide vaccinations are Public Health Clinic Federally
Qualified Health Center (FQHC) Rural Health Clinic (RHC) Top of Page History of the Vaccines for Children
Program In 1989 - 1991, a measles epidemic in the United States resulted in tens of thousands of cases
of measles and hundreds of deaths. Upon investigation, CDC found that more than half of the children
who had measles had not been immunized, even though many of them had seen a health care provider.
In partial response to that epidemic, Congress passed the Omnibus Budget Reconciliation Act (OBRA) on August
10, 1993, creating the Vaccines for Children (VFC) Program. VFC became operational October 1, 1994. Known as
section 1928 of the Social Security Act, the Vaccines for Children program is an entitlement program (a
right granted by law) for eligible children, age 18 and younger.
1AC
Disease Advantage
Vaccine preventable diseases are on the rise – without action, more and more children
will die.
Vitolo-Haddad 15 --- is the Director of Debate at the University of Wisconsin-Madison and a doctoral student in the Communication Arts
department, MA in communication from Wake Forest in 2016, BS in Molecular Biology in 2014, University of Central Florida,. (CV, “KAIROTIC
ECLIPSES IN VACCINE LEGISLATION: HOW OVERLAPPING SPHERES OF DISCOURSE CREATE IDEAL PUBLIC POLICY CLIMATES,” December 2015,
https://wakespace.lib.wfu.edu/bitstream/handle/10339/57425/Vitolo_wfu_0248M_10824.pdf)//ernst

Since the introduction of the smallpox vaccine in the seventeenth century, vaccination has maintained a strong public presence. The American
public health system has experienced cycles of vaccine acceptance, such as the height of childhood vaccination rates in the early 2000s, and low
rates accompanied by periods of intense debate and questioning in the 1980’s In
2015, the vaccination debate is once again
heated as the United States struggles to manage a deadly Measles outbreak linked to voluntary
vaccination practices. Arguments over the safety and efficacy of particular vaccines versus the danger of the diseases they prevent have
intensified, so future vaccination policy will require close consideration of personal autonomy and the right to make health decisions absent
government influence. The unique yet repetitive nature of this debate can be attributed in part to the fact that no
other medical
intervention in history has been mandatory for access to basic rights such as education. Some anti-vaccine
activists consider these mandates extreme because they misunderstand the scope of each shot administered. Unlike most preventative
measures, vaccination works cooperatively. Individuals get vaccinated not only to protect themselves, but
also to protect members of their communities for whom vaccination is not an option due to
physiological constraints such as illness or age. Additionally, vaccines are not universally effective and are subject to human
error in production and administration. The measles vaccine, for example, has an 8% long term failure rate; after 25 years, 8% of those who
received a full regimen of measles vaccine will be susceptible to contracting the measles virus. Susceptibility is due to a combination of primary
vaccine failure (no immunity conferred immediately after receiving the vaccine) and secondary vaccine failure (immunity initially conferred, but
diminishes over time). Therefore, in
order for vaccination to improve collective disease response, herd immunity
must be established to decrease the number of available hosts for a disease. The alternative is
vulnerable individuals falling victim to preventable disease. Eventually, if vaccination rates remain high,
targeted diseases are unable to spread fast enough to reproduce and, as a result, die out. When
cooperation diminishes—that is, when individuals fail to understand their own vaccination behaviors in relation to other unprotected,
vulnerable people—serious physical and mental health consequences may impact entire communities. Why
Vaccination? There are many worthwhile public health initiatives, but vaccination is unrivaled in its direct efficacy and scope. At the time I write
this, a young woman from Washington accounts for the first domestic measles death in 12 years. She
was severely immunocompromised and contracted measles from a hospital waiting room . The
wildtype (naturally occurring) measles virus found during her autopsy had been passed between at least 5
unvaccinated individuals before her. This summer, a six year-old boy died of diphtheria in Spain. Doctors,
who hadn’t seen a case in 28 years, no longer stored diphtheria anti-toxin and rushed to import the medicine
from a country where low vaccination rates mean outbreaks still occur. In what feels uncomfortably symbolic, the child
spent 28 days in a Barcelona hospital before being taken off life support. His parents had chosen not
to vaccinate due to fears of adverse side effects. In the days after he was admitted to the hospital his parents
expressed feeling “destroyed and cheated” by the anti-vaccination movement. In January 2010, Callie Van Tornhout
was taken to the pediatrician’s office by her mother for the second time in just a week due to an
“unusual cough.” As her mother held her, Callie stopped breathing and was administered CPR before
being rushed to the emergency room. She was admitted on a Wednesday but, despite improvements, went into respiratory
failure Friday night. At 1:12 AM on Saturday, January 30th, Callie was pronounced dead. An autopsy
revealed the cause to be pertussis, cases of which had spiked in their area of northern Indiana due to parents choosing not to
vaccinate their children. Callie, only 38 days old, was too young to receive the pertussis vaccination. If these
cases seem isolated, consider this: in the year Callie Van Tornhout died she was one of 160,710 reported cases of
pertussis (28,639 in the United States), which resulted in the death of 195,000 children under 5 years old
(13 in the U.S.). Globally, 1.5 million children under the age of 5 died from Pertussis, Hib (199,000),
Measles (118,000), Neonatal Tetanus (59,000), Non-neonatal Tetanus (2,000), Pneumococcal Disease
(476,000), and Rotavirus (453,000), all of which are vaccine-preventable. As the World Health Organization notes,
reported cases only account for a fraction of the total. Underreporting is also prevalent in the United States and much of
the first world where, due to better access to pharmaceuticals, cases of vaccine preventable illness are often diagnosed
as general infections and treated with antibiotics.

Mandatory vaccinations are key now ---


A) Scientists and students prove --- there’s also no negative effects
ERWIN CHEMERISKY AND MICHELE GOODWIN 4/19/2016 --- Erwin Chemerinsky is the founding Dean and Distinguished
Professor of Law, and Raymond Pryke Professor of First Amendment Law, at University of California, Irvine School of Law, with a joint
appointment in Political Science. Harvard Law School, J.D. Northwestern University, B.S Prior to assuming this position in 2008, he was the
Alston and Bird Professor of Law and Political Science at Duke University from 2004-2008, and before that was a professor at the University of
Southern California Law School from 1983-2004, including as the Sydney M. Irmas Professor of Public Interest Law, Legal Ethics, and Political
Science. He also has taught at DePaul College of Law and UCLA Law School. Michele Goodwin is the Everett Fraser Professor in Law at the
University of Minnesota. She holds joint appointments at the University of Minnesota Medical School and the University of Minnesota School of
Public Health. (“COMPULSORY VACCINATION LAWS ARE CONSTITUTIONAL”, Erwin Chemerisky and Michele Goodwin, April 19, 2016, Proquest
599-614)//chiragjain

II. COMPULSORY VACCINATION LAWS ARE ESSENTIAL Many studies demonstrate the enormous value of vaccinations both
in terms of preventing death and avoiding needless suffering.71 An article in the peer-reviewed journal Pediatrics concluded
that routine childhood immunization will prevent approximately 42,000 early deaths and twenty million

cases of disease for those born in the year 2009.72 Such predictions are consistent with the CDC’s reports and
findings, which estimated that between 1994 and 2014, 732,000 deaths of U.S. children were prevented, as well as 322 million cases of childhood illnesses due
to vaccination.73 Moreover, the American Academy of Pediatrics states that “[m]ost childhood vaccines are 90% to 99% effective in

preventing disease.”74 Thus, robust evidence lends strong support to our argument that vaccinations are
essential to save children’s lives. But compulsory vaccinations also are crucial to protect those who
cannot be vaccinated, such as infants, and those for whom vaccinations are medically inadvisable,
such as those with compromised immune systems. Because there always will be a portion of the
population for whom vaccinations will not work, achieving the highest vaccination rates possible for all
others remains important. Herd immunity occurs when a “critical portion” of the population—the
minimum percentage of vaccinated persons essential to provide herd immunity—is vaccinated against a
contagious disease thus creating “little opportunity for an outbreak.”75 As a result, members of the community will be
protected even if they are not vaccinated or their vaccination does not work.76 As Dr. Paul A. Offit explained: “Indeed, when enough people are

vaccinated, these infections simply stop spreading.”77 Dr. Offit warns that “[f]or highly contagious infections—such as measles or
pertussis—the immunization rate needs to be about 95 percent. For somewhat less contagious infections—like mumps and

rubella—herd immunity can be achieved with immunization around 85 percent.”78 The effects of a decline in herd immunity can be

swift. For example, a 2012 outbreak of whooping cough (pertussis) which affected 42,000 people—the largest
outbreak since 1955—occurred in an instance where forty-nine states had dropped below the immunity

threshold of 92%–94% as of 2011.79 As one commentator noted: The decline of communal herd immunity is not a merely academic concern.
Disease outbreaks have already occurred, killing hundreds and hospitalizing thousands more. “Hot
spots” are cropping up in communities across the United States and the rest of the world as well. The
rise of exemptions to compulsory vaccination laws threatens to undermine the public health
achievements made possible by widespread immunizations.80 Given the profound public health threat posed by refusing
vaccinations, why are parents placing their children and others at risk? For some parents their anxieties are steeped in medical

concerns, others claim to oppose vaccination on religious or philosophical grounds, and for another
category of parents, poverty impacts their access to vaccination. It is important then to distinguish between parents who do
not vaccinate and those who undervaccinate. For some it is not a choice, but a lack of access to health care. For those parents, frequently the highly

mobile and poor, their children often receive some vaccinations, but not all, because of homelessness or
frequent moves across cities and states for employment or affordable housing. These parents
“undervaccinate,” and are not the population of parents that refuse to vaccinate. They, of course, are not the focus of this Essay. In those cases, the
solution is to make sure that all have access to vaccinations and the health care system regardless of
where they live or their socioeconomic status. Still other parents may refuse vaccinations based on the
fear of the side effects of vaccinations, including fear of autism and even death. Certainly, all drugs expose patients to
risks of side effects and vaccinations are no exception, even if clearly on balance they are safe, effective, and the benefits justify the risks. To address potential
harms resulting from vaccination, Congress passed the National Childhood Vaccine Injury Act in 1986,81 which created the National Vaccine Injury Compensation
Program (VICP) in 1988.82 According to the Health Resources and Services Administration, “The VICP was established to ensure an adequate supply of vaccines,
stabilize vaccine costs, and establish and maintain an accessible and efficient forum for individuals found to be injured by certain vaccines.”83 The VICP replaced the
conventional tort system with a no-fault alternative under which the U.S. Court of Federal Claims determines who is compensated.84 Yet, the fear of autism
remains deeply entrenched among those apprehensive about vaccination.85 Dr.
Wakefield’s reported link between vaccinations
and a greater risk of autism86 continues to influence some parents’ decisionmaking, despite The Lancet’s
retraction and strong repudiation: “[I]t has become clear that several elements . . . are incorrect, contrary to the

findings of an earlier investigation.”87 The author of the study has since had his medical license
revoked.88 Many studies conducted in countries all over the world debunk Dr. Wakefield’s finding because
none has found any link between vaccinations and autism or anything other than preventing the spread of communicable disease.89 Professor Offit notes that in
response to the Wakefield paper, six large epidemiological research studies conducted by academic and public health communities all found the vaccines, and
specifically thimerosal in them (which Wakefield had pointed to as the causal agent), “didn’t cause autism.”90 Yet, many parents, including celebrities,91 continue
to warn the public that vaccinations either cause or expose children to serious risks of developing autism. As one commentator wrote, “Neither the judicial
decisions, the ethics findings, nor The Lancet’s retraction appear to have shaken the Wakefield faithful.”92 And as Dr. Paul Offit explained, while “[i]t’s very easy to
scare people; it’s very hard to unscare them.”93 Nor has conclusive medical and scientific literature stopped politicians from making statements that have no basis.
In 2015, Kentucky Senator Rand Paul, himself a doctor, said that he had delayed his own children’s vaccinations and claimed that there were “many tragic cases of
walking, talking, normal children who wound up with profound mental disorders after vaccines.”94 Senator Paul cited no medical or scientific literature to back up
his claim. None exists. Did Senator Paul’s political ideology cause him to invent “science” and to lose sight of one of the basic tenets of libertarianism: the
government can act to prevent people from harming others? Dr. Paul Offit expressed it well: “We’ve reached a tipping point. Children are suffering and dying
because some parents are more frightened by vaccines than by the diseases they prevent. It is time to put an end to this.”95 Thus, we propose doing just that. We

advocate that every state amend its law to require that every child be vaccinated and that there be no
exemptions except where medically necessary. We turn our attention to those parents who refuse vaccinations based on their religious
beliefs against medicine96 as well as those who aver medical concerns as their reason for avoiding vaccines. As discussed in Part III, there is no

constitutional basis for exempting children from vaccinations based on the religious beliefs of their
parents. We analyze why compulsory vaccination laws are constitutional. III. COMPULSORY VACCINATION LAWS ARE CONSTITUTIONAL In the discussion of the
California bill to eliminate religious and conscience exemptions from the compulsory vaccination law, opponents repeatedly asserted that there is a constitutional
right of parents to refuse to inoculate their children. The threatened litigation against the law, which seems likely to occur, will be on constitutional grounds.97
Rhetorically, of course, claiming that a bill is unconstitutional is a powerful argument. Also, there is no doubt that opponents of compulsory vaccination sincerely
believe that parents have a constitutional right to refuse to vaccinate their children. They are wrong. No such constitutional right exists. In fact, every court to
consider challenges to compulsory vaccination laws has upheld the statutes. In this Part, we initially review those cases. We then explain why neither the claimed
right of religious freedom nor the asserted right of parents to control the upbringing of their children justifies a constitutional exemption from compulsory
vaccination requirements. A. Courts Have Consistently Rejected Constitutional Challenges to Compulsory Vaccination Laws The Supreme Court has twice considered
constitutional challenges to state laws requiring compulsory vaccination and in both instances rejected the challenges and upheld the laws. Most famously, in
Jacobson v. Massachusetts, the Court upheld a Massachusetts law that required compulsory smallpox vaccinations for adults.98 This case took place during a time
when smallpox was a very real and immediate threat to the population of Massachusetts.99 The Court held that laws promoting public health or safety fall under a
state’s police power and are under the sole discretion of the state unless the law violates the Constitution.100 Additionally, individual rights may need to yield to
the state’s police power in order to preserve the public health or safety. “There are manifold restraints to which every person is necessarily subjected for the
common good.”101 The Court then found that the Massachusetts legislature and the Board of Health had the discretion to enact compulsory vaccination when such
vaccination is necessary for the public health or safety.102 The Court explained that smallpox was “prevalent and increasing” in Cambridge, Massachusetts, and,
therefore, compulsory vaccination appeared a necessity to protect the public health and safety.103 Because the law was enacted to combat smallpox, the means
prescribed by Massachusetts did have a “real [and] substantial relation to the protection of the public health and the public safety.”104 The Court also held that
skepticisms about the efficacy of vaccinations against diseases among the public or some physicians does not mean that a state legislature cannot enact a
compulsory vaccination law.105 The Court found that the common belief among physicians and the public was that vaccinations do prevent the spread of disease
and this common belief was enough to justify the legislature’s actions. The defendant argued that vaccinations could be harmful and that it would be impossible to
tell in an individual case whether a vaccination would be beneficial at all.106 The Court held that because the defendant could not prove that he was in the class of
people who were medically unfit for receiving vaccinations, his argument was not persuasive.107 The Court noted that this case did not concern an adult who
would be harmed by a vaccine. According to the Court, this [was] the case of an adult who, for aught that appears, was himself in perfect health and a fit subject of
vaccination, and yet, while remaining in the community, refused to obey the statute and the regulation adopted in execution of its provisions for the protection of
the public health and the public safety, confessedly endangered by the presence of a dangerous disease.108 In a less well known, but equally important decision,
Zucht v. King, the Court held that a city can impose compulsory vaccination for all children in school, even if there is no immediate threat of an epidemic like there
was in Jacobson.109 In that case, San Antonio, Texas, ordinances required that “no child or any other person shall attend a public school or other place of education
without having first presented a certificate of vaccination.”110 Under these ordinances, “public officials excluded Rosalyn Zucht from a public school because she
did not have the required certificate and refused to submit to vaccination.”111 Public officials also excluded her from private school. Rosalyn’s parents then brought
a suit against the officials in state court. Rosalyn claimed that there was then no occasion for requiring vaccination; that the ordinances deprive plaintiff of her
liberty without due process of law by, in effect, making vaccination compulsory; and, also, that they are void because they leave to the Board of Health discretion to
determine when and under what circumstances the requirement shall be enforced without providing any rule by which that board is to be guided in its action and
without providing any safeguards against partiality and oppression.112 The Supreme Court rejected these arguments and held that “the municipality may vest in its
officials broad discretion in matters affecting the application and enforcement of a health law.”113 The Court declared that “these ordinances confer not arbitrary
power, but only that broad discretion required for the protection of the public health.”114 Therefore, the Court held that a state can constitutionally impose a
compulsory vaccination requirement for school children. These decisions should put an end to arguments that compulsory vaccination laws are unconstitutional.
Not surprisingly, all subsequent challenges to such state statutes have been rejected by both federal and state courts. For example, in Workman v. Mingo County
Board of Education, the United States Court of Appeals for the Fourth Circuit held that a West Virginia law requiring all school children to be vaccinated, with no
exemption for religious reasons, is constitutional.115 The court explained that compulsory vaccination laws are within the state’s police power, even though there
may not be an immediate threat of disease. The court of appeals said that Supreme Court has settled that claims of religious freedom must yield to the compelling
social interest of combating the spread of disease through mandatory immunization programs. The court of appeals rejected the parents’ claim of a religious right to
not vaccinate their children by citing to Prince v. Massachusetts,116 and its holding that “[t]he right to practice religion freely does not include liberty to expose the
community or the child to communicable disease or the latter to ill health.”117 The court said that Jacobson’s holding is not limited to diseases that present an
immediate danger.118 The Fourth Circuit thus concluded that “the West Virginia statute requiring vaccinations as a condition of admission to school [did] not
unconstitutionally infringe Workman’s right to free exercise.”119 Many other federal courts have come to similar conclusions. In McCarthy v. Boozman, a federal
district court upheld the Arkansas compulsory vaccination law and declared: “The constitutional right to freely practice one’s religion does not provide an
exemption for parents seeking to avoid compulsory immunization for their school-aged children.”120 In Sherr v. Northport–East Northport Union Free School
District, a federal district court upheld the New York law and stated: “[I]t has been settled law for many years that claims of religious freedom must give way in the
face of the compelling interest of society in fighting the spread of contagious diseases through mandatory inoculation programs.”121 State courts faced with the
issue have come to the identical conclusion. In Wright v. DeWitt School District, the Arkansas Supreme Court held that it is within the state’s police power “to
require that school children be vaccinated and that such requirement does not violate the constitutional rights of anyone, on religious grounds or otherwise.”122 In
fact, some courts have held that religious exemptions to compulsory vaccination laws are unconstitutional because they impermissibly favor religion.123 In Brown v.
Stone, the Mississippi Supreme Court held that a religious exemption in the Mississippi state compulsory vaccination law for school children was unconstitutional
because it only allowed members of recognized denominations to obtain exemption.124 The court concluded that because a state compulsory vaccination law
could stand on its own without a religious exemption, the law was constitutionally valid without the exemption. The Mississippi Supreme Court found: [T]he statute
in question, requiring immunization against certain crippling and deadly diseases particularly dangerous to children before they may be admitted to school, serves
an overriding and compelling public interest, and that such interest extends to the exclusion of a child until such immunization has been effected, not only as a
protection of that child but as a protection of the large number of other children comprising the school community and with whom he will be daily in close contact
in the school room.125 Compulsory vaccinations are so important for protecting our children and the community against dangerous diseases that “[t]o the extent
that it may conflict with the religious beliefs of a parent, however sincerely entertained, the interests of the school children must prevail.”126 Further, the court
concluded: We have no difficulty here in deciding that the statute is “complete in itself” without the provision for religious exemption and that it serves a
compelling state interest in the protection of school children. Therefore, we hold that the provision providing an exception from the operation of the statute
because of religious belief is in violation of the Fourteenth Amendment to the United States Constitution and therefore is void.127 Because the statute can stand on
its own, the rest of it is constitutionally valid and can continue as law. Therefore, only the religious exemption was struck down. Similarly, in Davis v. State, the
Maryland Court of Appeals held that the state’s religious exemption clause in its compulsory vaccination statute violated the establishment clause of the First
Amendment because it only allowed exemption for children whose parents were members of a recognized church or denomination.128 Moreover, the court held
that the religious exemption clause was severable from the rest of the statute because compulsory vaccination statutes do not need religious exemption
clauses.129 Thus, the cases from courts at all levels and from all jurisdictions are unanimous: state laws requiring compulsory vaccination are constitutional. The
following Sections more carefully examine the constitutional objections to compulsory vaccination laws. B. The Objection Based on Religious Freedom A

frequent objection to compulsory vaccination laws is that they intrude on the right of parents to practice
their religion. Parents who oppose medical care on religious grounds contend that their beliefs require
a constitutional exemption from mandatory inoculation requirements. Under current First Amendment
law this claim is groundless, without even needing to consider whether the state has a sufficient interest in requiring vaccinations. In 1990, in
Employment Division v. Smith, the Court held that the Free Exercise Clause cannot be used to challenge a neutral law

of general applicability.130 In other words, no matter how much a law burdens religious practices, it is constitutional under Smith so long as it does not
single out religious behavior for punishment and was not motivated by a desire to interfere with religion. Smith involved a challenge by Native Americans to an
Oregon law prohibiting use of peyote, a hallucinogenic substance. Specifically, individuals challenged the state’s determination that their religious use of peyote,
which resulted in their dismissal from employment, was misconduct disqualifying them from receipt of unemployment compensation benefits.131 Justice Scalia,
writing for the majority, rejected the claim that free exercise of religion required an exemption from an otherwise valid law. Justice Scalia said that “[w]e have never
held that an individual’s religious beliefs excuse him from compliance with an otherwise valid law prohibiting conduct that the State is free to regulate. On the
contrary, the record of more than a century of our free exercise jurisprudence contradicts that proposition.”132 Justice Scalia thus declared “that the right of free
exercise does not relieve an individual of the obligation to comply with a ‘valid and neutral law of general applicability on the ground that the law proscribes (or
prescribes) conduct that his religion prescribes (or proscribes).’”133 The Court
stressed that it should be the political process, and
not the judicial, that provides for exemptions in laws to protect religious beliefs. Justice Scalia said that: Precisely
because “we are a cosmopolitan nation made up of people of almost every conceivable religious preference,” and precisely because we value and protect that
religious divergence, we cannot afford the luxury of deeming presumptively invalid, as applied to the religious objector, every regulation of conduct that does not
protect an interest of the highest order.134 The Court said that those seeking religious exemptions from laws should look to the democratic process for protection,
not the courts. There is no doubt that Smith changed the test for the free exercise clause. No longer is strict scrutiny used when the challenge is to a neutral law of
general applicability. Such laws are upheld so long as they meet a deferential rational basis test. This applies to vaccination. State statutes requiring vaccinations of
all children are neutral laws of general applicability. They are not motivated by a desire to interfere with religion and they apply to everyone. Therefore, there is no
basis for a First Amendment challenge to compulsory vaccination laws. In response to Smith, Congress adopted two statutes to restore religious freedom rights by
statute. Neither provides a basis for challenging compulsory vaccination laws. Congress adopted the Religious Freedom Restoration Act of 1993 to restore the law to
what it was before Smith: strict scrutiny for claims that the government is significantly burdening religion, even when it is a challenge to a neutral law of general
applicability.135 The Act declares that its purpose is “to restore the compelling interest test . . . and to guarantee its application in all cases where free exercise of
religion is substantially burdened; and . . . to provide a claim or defense to persons whose religious exercise is substantially burdened by government.”136 The key
provision of the Act states: Government shall not substantially burden a person’s exercise of religion even if the burden results from a rule of general applicability,
except . . . [g]overnment may substantially burden a person’s exercise of religion only if it demonstrates that application of the burden to the person . . . (1) is in
furtherance of a compelling governmental interest; and (2) is the least restrictive means of furthering that compelling governmental interest.137 However, the
Supreme Court quickly declared the Religious Freedom Restoration Act unconstitutional as applied to state and local governments. In City of Boerne v. Flores, a 6–3
decision, the Court held that the law was unconstitutional as exceeding the scope of Congress’s powers under Section Five of the Fourteenth Amendment. Justice
Kennedy, writing for the majority, stated that Section Five empowers Congress to enact laws “to enforce” the amendment, but Congress is not “enforcing” when it
creates new constitutional rights or expands the scope of rights.138 The Court held that Congress under Section Five may act only to prevent or remedy the
violation of rights recognized by the courts. Such laws must be narrowly tailored; they must be proportionate and congruent to prevent and remedy the
constitutional violations.139 The Religious Freedom Restoration Act was deemed to fail these requirements and was declared unconstitutional as applied to state
and local governments. It therefore cannot be used to challenge state laws requiring vaccinations. In 2000, in response to City of Boerne v. Flores, the Religious Land
Use and Institutionalized Persons Act was adopted by Congress.140 This law requires that the government meet strict scrutiny when it significantly burdens religion
in two areas: land use decisions and institutionalized persons. Congress justified acting to regulate land use decisions under its commerce power and to regulate
institutionalized persons under its spending power as a condition on federal funds. But state laws requiring vaccinations do not involve either of these areas, so this
statute is inapplicable as a basis for challenges. Thus, under current law, there is no basis for a religious challenge— either under the Constitution or federal laws—
to state laws’ mandatory vaccinations for all children. C. Compulsory Vaccination Laws Meet Strict Scrutiny In addition to claims of free exercise of religion, parents
also challenge mandatory inoculation requirements on the ground that it infringes their constitutional right as parents to control the upbringing of their children.
The Court has recognized this as a fundamental right protected under the word “liberty” of the Due Process Clause. In Meyer v. Nebraska, in 1923, the Supreme
Court declared a state law unconstitutional that prohibited teaching in any language other than English in the public schools.141 The Court invalidated the law, not
on First Amendment grounds, but by using substantive due process and finding that the statute violated the right of parents to make decisions for their children.142
Similarly, two years later, in Pierce v. Society of Sisters, the Supreme Court held unconstitutional a state law that required children to attend public schools.143 The
Court explained that: The fundamental theory of liberty upon which all governments in this Union repose excludes any general power of the state to standardize its
children by forcing them to accept instruction from public teachers only. The child is not the mere creature of the State; those who nurture him and direct his
destiny have the right, coupled with the high duty, to recognize and prepare him for additional obligations.144 Fifty years later, in Wisconsin v. Yoder, the Supreme
Court held that Amish parents had a constitutional right, based on their right to control the upbringing of their children and based on free exercise of religion, to
exempt their 14- and 15-year-old children from a compulsory school attendance law.145 The Court said that: [A] State’s interest in universal education, however
highly we rank it, is not totally free from a balancing process when it impinges on fundamental rights and interests, such as those specifically protected by the Free
Exercise Clause of the First Amendment, and the traditional interest of parents with respect to the religious upbringing of their children.146 The Court gave great
weight to the parents’ claim that additional education would threaten their children’s religious beliefs and to the uniquely insulated nature of the Amish culture.
The Court accepted the argument that applying the mandatory schooling law to 14- and 15-year-old Amish children would interfere with free exercise of religion
and with the ability of parents to make decisions concerning their children. The Court noted that there was no evidence of “any harm to the physical or mental
health of the child or to the public safety, peace, order, or welfare.”147 The Court thus concluded that “[u]nder the doctrine of Meyer v. Nebraska, . . . we think it
entirely plain that the Act . . . interferes with the liberty of parents and guardians to direct the upbringing and education of children under their control.”148 The
Supreme Court most recently considered the right of parents to control the upbringing of their children in the context of a state law protecting grandparents’ rights.
In Troxel v. Granville the Supreme Court declared unconstitutional Washington’s grandparent visitation law as violating the right of parents to control the
upbringing of their children.149 Justice O’Connor’s plurality opinion began by noting the fundamental nature of the right involved: “The liberty interest at issue in
this case—the interest of parents in the care, custody, and control of their children—is perhaps the oldest of the fundamental liberty interests recognized by this
Court.”150 The plurality found that the Washington law, as applied in this case, was unconstitutional as infringing on this fundamental right. There is thus a stronger
claim that state laws requiring compulsory vaccination infringe the right of parents to control the upbringing of their children than there is an argument that such
laws infringe free exercise of religion. However, and quite significantly, the Court also has recognized that the right to make parenting decisions is not absolute and
can be interfered with by the state if necessary to protect a child. For example, in Prince v. Massachusetts, the Court upheld the application of child labor laws to a
nine-year-old girl who was soliciting for the Jehovah’s Witnesses religion at the direction of her parents.151 In Prince, the Court acknowledged that there is a
“private realm of family life which the state cannot enter.”152 But the Court also opined that: [T]he family itself is not beyond regulation in the public interest . . . .
Acting to guard the general interest in youth’s well being, the state as parens patriae may restrict the parent’s control by requiring school attendance, regulating or
prohibiting the child’s labor and in many other ways.153 The Court observed that the need to protect children from being exploited and harmed justified upholding
laws prohibiting child labor, even if the work was at the direction of the parents and even if it was undertaken for religious purposes.154 State laws that require
compulsory vaccination of all children, except when there is a medical reason to not inoculate, meet strict scrutiny. The government has a compelling interest in
protecting children from communicable diseases, which could kill or seriously injure them. In fact, courts across the country have consistently held that states can
require medical care that potentially could save a child’s life, even when the parents object on religious or other grounds.155 As we emphasize in this Essay, the
government also has a compelling interest in protecting others from the spread of communicable diseases. For example, infants and those who cannot be
vaccinated for medical reasons need the rest of the population to be vaccinated in order to be protected from communicable diseases.156 Strong and irrefutable
medical and scientific evidence demonstrates that there is no less restrictive alternative except to require every person to be vaccinated. Only vaccinations can
protect children from communicable diseases. Only by vaccinating every child who medically can be inoculated, can there be protection for those who cannot be
vaccinated, whether by reason of being too young or it being medically inadvisable. In other words, compulsory vaccination laws meet strict scrutiny. As
demonstrated in this Essay, that is why every court to consider them has deemed compulsory vaccination to be constitutional. CONCLUSION Claims
of
personal freedom understandably and deservedly carry great weight in our society. But one of the most
basic principles of liberty is that a person’s freedom does not justify infringing injury on others. Those
who fail to vaccinate their children are unnecessarily risking that their children will be exposed to
communicable diseases that can have serious or even fatal consequences. Those not vaccinated also can
spread communicable diseases to others in society who cannot be vaccinated. ‘Our conclusion is that laws that
require vaccination need not—and should not—have exceptions for religion or for conscience.
Compulsory vaccination laws are unquestionably constitutional without such exceptions. Indeed, we urge
every state to revise its vaccination law to make sure that every child, and every person, is vaccinated
unless there is a medical reason not to do so.

B) The amount of parents refusing to vaccinate their children is rising – triggers


reintroduction of vaccine-curable diseases
Horton 16 -- Dr. Kathryn J. Horton is a senior internal medicine resident at the University of
Washington in Seattle and is currently working in the ABC News Medical Unit. Dr. Shailja Mehta, a
resident in the ABC News Medical Unit, also contributed to this report. [8/29/16, Why Parents Aren't
Vaccinating Their Kids, According to New Study, http://abcnews.go.com/Health/parents-vaccinating-
kids-study/story?id=41716915] MP
The belief that vaccines cause autism -- which has been debunked by the U.S. Centers for Disease Control and Prevention, among others -- is no longer the primary
reason parents are refusing vaccines for their children, according to a new study today from the American Academy of Pediatrics (AAP). Instead, a growing
number of parents believe vaccinations are "unnecessary," researchers found. The AAP surveyed more
than 600 pediatricians in 2006 and then again in 2013, asking them to estimate the percentage of parents
they encountered who wished to refuse or delay vaccines and the parents' rationale for doing so. Pediatricians
were also asked how often they dismi ssed patients from their practice for continuing to refuse vaccines. By 2013, nearly 9 out of 10

pediatricians (87 percent) say they were asked by at least one parent in their practice to alter their
child’s immunization schedule. Pediatricians in the study responded that 73 percent of parents refusing
or delaying vaccines for their children in 2013 were doing so because the parents believed the vaccines
were unnecessary, whereas that number was 64 percent in 2006. Dr. Lolita McDavid, medical director of child advocacy and
protection at the University Hospitals Rainbow Babies & Children’s Hospital in Cleveland, Ohio, said the findings did not surprise her. “In the past, people

were scared of polio and whooping cough, but parents aren’t now because they don’t see it anymore,”
McDavid, who was not involved in this study, told ABC News. “ It’s a very uninformed way to approach a child’s health .” Martin
Shkreli Arrested for Securities and Wire Fraud Dr. Catherine Hough-Telford, lead author on the paper and a pediatrician with the Pediatric Health Care Alliance in
Tampa, Florida, told ABC News that “it
will be interesting to look in future studies at how parents’ perceptions change
after the Disneyland measles outbreak.” Disneyland is owned by Disney, the parent company of ABC
News. Vaccinations have prevented an estimated 322 million illnesses, 21 million hospitalizations and
732,000 deaths for Americans born between 1994 and 2013, according to the U.S. Centers for Disease
Control and Prevention. Communicable diseases that previously afflicted the population are now largely
a distant memory due to the development of vaccines. Pediatricians reported in 2013 being able to
persuade hesitant parents to allow scheduled vaccinations only one-third of the time, according to the
study. Understanding why parents are refusing or delaying vaccines is critical for doctors so they can tailor
their counseling accordingly, researchers said. “When I talk to families ... I always emphasize vaccines are
safe, effective and they save lives,” Hough-Telford said. “We all want the same thing -- for the child to be
healthy.” Other reasons for vaccine delay were parental concern about causing discomfort for the child or concern for burdening the child’s immune system.
The fear of autism as the reason for delaying vaccines fell to 64 percent in 2013 from 74 percent in 2006.
The study did not mention the specific vaccines that parents were refusing, which will be important for health care providers to explore. A study published this month
in the journal Cancer Epidemiology, Biomarkers and Prevention reported that many parents wanted to opt out of the Gardasil vaccine for HPV -- approved by the U.S.
Food and Drug Administration in 2006 -- because they thought the vaccine was unnecessary for their sexually inactive child. It is unclear if parents refusing the HPV
Pediatricians in suburban and rural
vaccine would feel similarly about vaccines that protect against measles, whooping cough and tetanus.

settings were more likely to see children whose parents wished to delay or avoid vaccinations than
parents in urban settings, according to the AAP study, and the percentage of pediatricians "always"
dismissing patients from their practice for continued vaccine refusal nearly doubled from 6 percent to
11 percent between 2006 and 2013. McDavid said she is one of those physicians. “[The parents and I] are
partners, from the child’s newborn exam until they are 18 [years old],” she said. “I can’t treat a child in a
way that I feel is not best for that child.” To help inform parents about the importance of vaccination, McDavid said she gives parents an
assignment to go on a field trip to a graveyard. “I want you to go to an old cemetery, walk through, look at the headstones

of the babies that died at age 1, 2, 3 years of age," she said, but thanks to vaccines, "people don’t see this
anymore, so people don’t know what to be afraid of.” The study was published as the AAP called on public
health authorities today to universally eliminate all vaccine exemptions, unless they are medically
necessary. While public school students in the U.S. are required to receive various vaccinations before
attending classes, in most states the requirement can be waived by "non-medical" vaccine exemption
forms because of a parent's beliefs or religion. Dr. Geoffrey Simon, board-certified pediatrician and lead
author of AAP’s policy statement today, and chairperson of the AAP's Committee on Practice and
Ambulatory Medicine, explained the decision as necessary to protect people via herd immunity, where
the majority of people being protected helps guard against an outbreak. “We disenfranchise children and
adults who are medically unable to receive the vaccine," Simon said of diminishing herd immunity from lowered vaccine rates. "Who’s
to say that creating a risk of developing preventable disease is fair. They deserve a safe school and work environment."

The impact is two-fold


A) Disease kills large amounts of children
Belisle 15 -- director of Child Health Quality Improvement at Maine Quality Counts, a nonprofit
organization dedicated to improving the quality of healthcare. She also serves on the board of the Maine
Chapter of the American Academy of Pediatrics and was recognized as the Maine CDC Childhood
Immunization Champion in 2014 [Amy, Children continue to die from vaccine-preventable diseases. We
can stop that, https://www.theguardian.com/commentisfree/2015/jun/04/children-die-vaccine-
preventable-diseases-we-can-stop-that] MP

As a pediatrician, I have been profoundly affected by watching children suffer and die because of vaccine-
preventable diseases. Over the last 15 years, I have watched a healthy teenager lose his life in 48 hours to
meningococcemia despite heroic efforts to save him. I’ve seen a toddler lose his hearing after suffering
from a spinal infection that could have been prevented with an Haemophilus influenza vaccine. I’ve seen
kids with chicken pox get pneumonia and joint infections. It’s heartbreaking to tell a family that their
child died or is suffering from a disease for which we have vaccinations. But here in Maine, that could happen more often.
Recently there has been a spike in chicken pox and pertussis (whooping cough) cases likely related to
the increased number of families who are opting out of immunization. Last year, Maine’s vaccination
exemption rate for kindergartners rose to 5.2%. “Herd immunity” for communities is at risk when the
immunization rate falls below 95%. In 2014, Maine’s vaccination opt-out rate was the fifth highest in the
United States. The rate of philosophical exemption looks even more stark when we see the wide variations across communities in the state: the Portland Press Herald reported that,
in at least 39 primary schools, both public and private, 80% or fewer students are getting the measles shot. Only

37.5% of children at one kindergarten at a public charter school in Gray received the vaccination. My kids
have two working parents, so I am always first in line to get our four kids vaccinated. I have limited paid
time off to care for our kids when they are sick, and I rely on other children in our daycare and schools
to be vaccinated to ensure that the kids in our community are healthy. Some may argue that the
symptoms of these diseases are harmless. Due to effective vaccinations programs in the United
States, we rarely see the terrible implications of infections like polio, where images of children in iron
lungs once proliferated. So it’s easy to forget that a choice not to vaccinate poses a significant risk to our
youngest children, our grandparents and children attending school with illnesses such as cancer who
cannot be vaccinated and have a compromised immune system. There are another 70,000 moms like
me in our state, and 30,000 more women who are single parents. Other people’s unvaccinated kids don’t just
put my kids at risk for illness; they put many women in Maine and across the country in the
economically precarious position of having sick children and, in some cases, no way to care for them
without losing out on income. In 2010, the Maine Primary Care Association estimated that every dollar spent on vaccines saves $6.30 in direct medical costs and up to
$18.40 in indirect costs to families and communities. It is interesting to note that in Washington County, the county with the

highest rate of children living in poverty in Maine, we also see the highest immunization rates in the
state. As the director of Child Health Quality Improvement at Maine Quality Counts, my colleagues and I
recently worked with 24 practices and 90 physicians to help them improve their immunization practices
and better communicate with families about the importance of vaccines as part of the Improving Health
Outcomes for Children Project. We worked on reducing missed opportunities for vaccines when kids came to the office, contacting families due or overdue for
vaccines and developing educational materials for families. We also worked with the staff at the state immunization registry so that practices could get reports to identify patients who were
not up to date. The Muskie School of Public Service at the University of Southern Maine reports that the project showed an 11.1% increase in immunization rates in those practices over 26

That’s 6,000 additional Maine children vaccinated. The truth is no child need suffer from chicken
months.

pox or any other vaccine-preventable disease. Childhood vaccines are available for free in Maine, thanks
to a Universal Vaccine Coverage Law passed by its legislature in 2010. The only barrier is misinformation
and the fear that it breeds.

Causes extinction---defense doesn’t apply


Arturo Casadevall 12, M.D., Ph.D. in Biochemistry from New York University, Leo and Julia
Forchheimer Professor and Chair of the Department of Microbiology and Immunology at Albert Einstein
College of Medicine, former editor of the ASM journal Infection and Immunity, “The future of biological
warfare,” Microbial Biotechnology Volume 5, Issue 5, pages 584–587, September 2012,
http://onlinelibrary.wiley.com/doi/10.1111/j.1751-7915.2012.00340.x/full

In considering the importance of biological warfare as a subject for concern it is worthwhile to review the known existential
threats. At this time this writer can identify at three major existential threats to humanity: (i) large-scale thermonuclear war
followed by a nuclear winter, (ii) a planet killing asteroid impact and (iii) infectious disease. To this trio might be added climate change
making the planet uninhabitable. Of the three existential threats the first is deduced from the inferred cataclysmic effects of nuclear war. For
the second there is geological evidence for the association of asteroid impacts with massive extinction (Alvarez, 1987). As to an existential
threat from microbes recent decades have provided unequivocal evidence for the ability of certain pathogens
to cause the extinction of entire species. Although infectious disease has traditionally not been
associated with extinction this view has changed by the finding that a single chytrid fungus was
responsible for the extinction of numerous amphibian species (Daszak et al., 1999; Mendelson et al., 2006).
Previously, the view that infectious diseases were not a cause of extinction was predicated on the
notion that many pathogens required their hosts and that some proportion of the host population was
naturally resistant. However, that calculation does not apply to microbes that are acquired directly from
the environment and have no need for a host, such as the majority of fungal pathogens. For those types of
host–microbe interactions it is possible for the pathogen to kill off every last member of a species without
harm to itself, since it would return to its natural habitat upon killing its last host. Hence, from the viewpoint of
existential threats environmental microbes could potentially pose a much greater threat to humanity
than the known pathogenic microbes, which number somewhere near 1500 species (Cleaveland et al., 2001; Taylor et al., 2001), especially if
some of these species acquired the capacity for pathogenicity as a consequence of natural
Recent scientists conclude --- pandemics have the capability of extinction level
impacts --- antibiotic resistance makes it worsee
DANA DOVEY 5/2/2016 --- She has an MA in Journalism and Media Communications and enjoys covering science and technology
stories for Medical Daily. Dana previously worked for Cover Media in London and has contributed to Newsweek magazine. Unversity of
Hertfordshire (“The End Is Near: Report Predicts We're More At Risk Of Death From Climate Change, Pandemic, Than A Car Crash”, Dana Dovey,
May 2, 2016, Medical Daily, http://www.medicaldaily.com/end-near-climate-change-pandemic-human-extinction-car-crash-
384443)//chiragjain

A new report has found that the


average person is five times more likely to die in an “act of human extinction”
than an act of human error. And while this may be good news for those with a fear of driving, for the rest of us the future looks grim.
The media has hinted at the possibility of a huge catastrophic incident such as a disease pandemic
wiping out the majority, if not all, of the Earth’s population. Now, however, scientists have laid the rumors to rest,
crunched the numbers, and shown this tragic end to be a real possibility. The annual Global Catastrophic Risk from
the U.K.-based Global Challenges Foundation uses factors such as climate change and political relations to compute the risk of a “human
extinction event,” or any catastrophic event that kills at least 10 percent of the world’s population. This year’s report found that the average
American is five times more likely to die in a human extinction event than a car crash, and identified climate change and international disease
outbreaks as some of the most likely end-of-world disasters. Humanity is a major part of the Earth’s ecosystem and when the
planet’s health deteriorates, our health suffers as well. Rising temperatures caused by climate change have led to a notable increase in human
health problems. For example, many researchers note that unseasonably warm temperatures have contributed to the
spread of mosquito-transmitted diseases, such as Chikungunya and Zika virus, outside of its normal
range. In addition, warmer and longer summers have also caused spikes in tick populations and widened
their habitat. These rising temperatures may even play a role in the increasing incidence of Lyme disease. Other extreme human health
threats caused by climate change include high levels of air pollution. This problem has been linked to both increased instances of stroke and
respiratory diseases. Luckily, The Stern Review, a U.K. government report on the economics of climate change, estimated that there is a 0.1
percent risk of human extinction every year, but when that is added up over a century, that risk jumps to a 9.5 percent chance of human
extinction within the next century, The Atlantic reported. In addition to climate change, pandemics
also pose a major threat to
human life, and we have already begun to see just how quickly some diseases can spread. In 2014 the
world saw the largest Ebola outbreak in history, The Center for Disease Control and Prevention reported. As of April 13, 2016
there were a total of 15,261 lab-confirmed deaths and 28,652 suspected deaths. Antibiotic resistance has also made once-
treatable diseases now untreatable and the planet has seen a number of “superbug” outbreaks throughout the U.S. alone. One
report predicted that by 2050 antibiotic resistance will likely kill more people than cancer. According to The Associated
Press, many of the patients sick with life-threatening superbugs caught the bugs through contaminated medical equipment.

B) Absent the aff a measles outbreak is inevitable – causes 4 million and incurs
huge costs, causing economic recession
Offit 17 -- Paul A. Offit is a professor of pediatrics at the Perelman School of Medicine at the University
of Pennsylvania and the author of Deadly Choices: How the Anti-Vaccine Movement Threatens Us All
(Basic Books, 2011). [6/24/17; What Makes Trumpcare So Dangerous for Kids,
http://www.thedailybeast.com/what-makes-trumpcare-so-dangerous-for-
kids?source=twitter&via=desktop] MP

Let’s presume that Congress eventually enacts the dramatic cuts in funding proposed by the Senate’s
version of the AHCA and even a fraction of the cuts proposed by the president. The canary in the
coalmine will be measles. Because measles is the most contagious vaccine-preventable disease, it will be
the first to come back. Before the measles vaccine was introduced in 1963, every year measles would
infect about 4 million children, causing 48,000 to be hospitalized and 500 to die. Because of the vaccine,
measles was eliminated from the United States in 2000. Recently, however, more parents have chosen not to
vaccinate their children. As a result, a series of measles outbreaks have occurred in undervaccinated
communities. For example: • In 2014, an outbreak of measles in an Amish community in Ohio affected more
than 600 children. • In 2015, an outbreak of measles starting in Southern California’s wealthy suburbs
spread to 25 states and affected 189 children. • Currently, an outbreak of measles in a Somali
community in Minnesota has caused 76 children to suffer, again because their parents had chosen not
to vaccinate them. Not surprisingly, controlling outbreaks is expensive. The CDC estimates that it costs about $140,000
to contain each individual case of measles ($143.5 million since 2014). Today, according to the CDC, about 1
percent of parents choose not to immunize their children. If this 1 percent were evenly distributed
across the country, the measles virus wouldn’t spread because enough members of the community
would be vaccinated, protecting those who aren’t vaccinated or can’t be vaccinated (so-called herd
immunity). But parents who choose not to vaccinate their children aren’t spread out equally. Pockets of unimmunized children in Ohio or
Southern California or Minnesota were the fertile ground for our most recent measles outbreaks. Imagine, however, if the reason
that children weren’t getting vaccinated wasn’t that parents had chosen not to vaccinate them but that
they couldn’t afford to vaccinate them. And that instead of 1 percent of American parents choosing not
to immunize their children, 5 or 10 or 15 percent weren’t able to immunize them. To prevent the
measles virus from spreading, about 95 percent of children in a given community need to be
immunized. If the nationwide immunization rates drop well below that figure, measles will be back with
a vengeance. And when hundreds of cases of measles a year becomes thousands of cases, children will again start dying from measles. On
June 13, Donald Trump, in a meeting with republican senators, called the AHCA proposals “mean.” He could have added “dangerous.” Because
the only thing that the AHCA and the proposed budget will make great again are the viruses and
bacteria that routinely disabled, hospitalized, and killed our children.

Economic decline causes war – best studies prove


Royal 10 Director of Cooperative Threat Reduction at the U.S. Department of Defense [Jedediah Royal, 2010, Economic
Integration, Economic Signaling and the Problem of Economic Crises, in Economics of War and Peace: Economic, Legal and
Political Perspectives, ed. Goldsmith and Brauer, p. 213-215]

Less intuitive is how periods of economic decline may increase the likelihood of external conflict. Political
science literature has contributed a moderate degree of attention to the impact of economic decline and the security and defence behaviour of interdependent
stales. Research in this vein has been considered at systemic, dyadic and national levels. Several notable contributions follow. First, on the systemic level. Pollins
(20081 advances Modclski and Thompson's (1996) work on leadership cycle theory, finding that rhythms
in the global economy are
associated with the rise and fall of a pre-eminent power and the often bloody transition from one pre-
eminent leader to the next. As such, exogenous shocks such as economic crises could usher in a
redistribution of relative power (see also Gilpin. 19SJ) that leads to uncertainty about power balances, increasing
the risk of miscalculation (Fcaron. 1995). Alternatively, even a relatively certain redistribution of power could lead
to a permissive environment for conflict as a rising power may seek to challenge a declining power (Werner.
1999). Separately. Pollins (1996) also shows that global economic cycles combined with parallel leadership cycles impact the likelihood of conflict among major,
medium and small powers, although he suggests that the causes and connections between global economic conditions and security conditions remain unknown.
Second, on a dyadic level. Copeland's (1996. 2000) theory of trade expectations suggests that 'future expectation of trade' is a significant variable in understanding
economic conditions and security behaviour of states. He argues that interdependent states arc likely to gain pacific benefits from trade so long as they have an
optimistic view of future trade relations. However, ifthe expectations of future trade decline, particularly for difficult to
replace items such as energy resources, the likelihood for conflict increases, as states will be inclined to
use force to gain access to those resources. Crises could potentially be the trigger for decreased trade expectations either on its own or
because it triggers protectionist moves by interdependent states.4 Third, others have considered the link between economic

decline and external armed conflict at a national level. Mom berg and Hess (2002) find a strong correlation
between internal conflict and external conflict, particularly during periods of economic downturn. They write.
The linkage, between internal and external conflict and prosperity are strong and mutually reinforcing.
Economic conflict lends to spawn internal conflict, which in turn returns the favour. Moreover, the presence
of a recession tends to amplify the extent to which international and external conflicts self-reinforce
each other (Hlomhen? & Hess. 2(102. p. X9> Economic decline has also been linked with an increase in the likelihood
of terrorism (Blombcrg. Hess. & Wee ra pan a, 2004). which has the capacity to spill across borders and lead to
external tensions. Furthermore, crises generally reduce the popularity of a sitting government. "Diversionary
theory" suggests that, when facing unpopularity arising from economic decline, sitting governments
have increased incentives to fabricate external military conflicts to create a 'rally around the flag' effect.
Wang (1996), DcRoucn (1995), and Blombcrg. Hess, and Thacker (2006) find supporting evidence showing that economic decline and use of force arc at least
indirecti) correlated. Gelpi (1997). Miller (1999). and Kisangani and Pickering (2009) suggest that Ihe tendency towards diversionary tactics arc greater for
democratic states than autocratic states, due to the fact that democratic leaders are generally more susceptible to being removed from office due to lack of
domestic support. DeRouen (2000) has provided evidence showing that periods of weak economic performance in the United States, and thus weak Presidential
popularity, are statistically linked lo an increase in the use of force. In summary, rcccni economic
scholarship positively correlates
economic integration with an increase in the frequency of economic crises, whereas political science
scholarship links economic decline with external conflict al systemic, dyadic and national levels.' This implied connection between
integration, crises and armed conflict has not featured prominently in the economic-security debate and deserves more attention.
Economy Advantage
The pharma industry is in a state of failure; absent a revival, AIDS, neuroscience,
Alzheimer’s and other diseases will be on the rise
Lutz 1/12/17 --- an award-winning science writer who has been an editor or contributing editor at Scientific American, American Scientist,
The Sciences, and Natural History, editor-in-chief for Muse, and a writer for ChemMatters, The Horn Book, Wisconsin Natural History and
several engineering publications. She has two degrees in English literature (Diana, “”Researcher says pharma industry's ability to deliver new
drugs may be coming to an end,” https://medicalxpress.com/news/2017-01-pharma-industry-ability-drugs.html)//ernst

From reading and hearing news accounts, the general public has a vague impression that some things are amiss
with the pharmaceutical industry—one word: Epipens. But few might consider it an industry in a state of
collapse. Michael Kinch tries to convince otherwise in "Prescription for Change," his history and review of the industry. Kinch is the associate
vice chancellor and director of the Center for Research Innovation in Biotechnology at Washington University in St. Louis, and he brings to this
book (University of North Carolina Press) many decades of research and harrowing personal experience with pharma. The book starts with
some classic tales of the struggle to make sure drugs weren't poisons and actually did what they were said to do. One early antibiotic, for
example, was mixed in a sweet syrup whose main ingredient was antifreeze: 106 died, mostly children. The pace quickens as the struggle
between innovation and regulation becomes fiercer. The
industry spins off, Kinch notes, into new territories, such as
patent extensions, me-too drugs, generics, pay-for-delay, orphan drugs and compendium expansion.
Companies found ways to game the system by gaining FDA approval for an orphan drug under favorable terms and then conducting a small
clinical trial that would allow the drug to be approved for another indication, called "compendium expansion." This was lucrative, Kinch
explains, because orphan drugs could command high "price points" without insurance companies squealing, but the expansion drugs made up
for the small number of patients with orphan indications. Kinch repeatedly emphasizes that decisions like these are rational and not based on
"dark motivations." And the point of the book is really that the
high cost of bringing a new drug to market ($2.6 billion) is
largely the unintended consequence of the desire to make sure drugs are safe. By chapter 10, the author is
describing how such high costs led pharmaceutical companies to cut costs, dismantled their own research and development wings but were
forced to replenish their drug pipelines by buying one another and then biotechnology start-ups. Altogether, Kinch says, the
biotechnology sector was responsible for more than two-thirds of all new medicines in the past decade.
But Kinch says this finesse is already failing. The number of successful biotech companies peaked at 141 in 2000 and had fallen to 60 by the end
of 2014. It is simply easier and less risky for venture capitalists to invest in two guys in a garage writing code, says Kinch, than in a large,
complex biotech lab. As a result, the entire industry, Kinch says, may be "fading to black." To make sure the reader
understands the stakes, Kinch mentions three looming crises in drug therapy. One is antibiotic resistance, which,
some experts say, will break the surface and come to widespread public notice. in 2017. A similar problem, but one that has received less
attention, is the emergence of resistance to AIDS drugs. One in five AIDS patients had a virus that was resistant to at least one
component of the current drug cocktail, Kinch says. Seven of the 10 companies that successfully developed AIDS drugs have dropped research
in this area. And then there is Alzheimer's. Fully 99.6 percent of experimental drugs designed to treat
Alzheimer's failed in clinical trials, according to a 2015 report that Kinch cites. Many pharmaceutical companies, not
surprisingly, have reduced or completely eliminated programs that had been focused on Alzheimer's
disease and other neuroscience indications. What can be done? To survive the current crisis, Kinch says, "we will need to
fundamentally reconsider all aspects of how new medicines are created." To get the ball rolling, he ends his book with a few ideas. For example,
he suggests the potential elimination of the requirement for costly Phase III clinical trials. To those familiar with the history of drug toxicities
and side effects, that may seem like an outrageous proposition. But Kinch would argue that it is better than running off the cliff that seems to
be in front of us—hence, the reference to the expression already used in some places around the industry "The Valley of Death."

2 internal links to the economy ---


A) Vaccines have a unique benefit to the economy
MARK DOHERTY ET AL. 12/20/2016 --- Dr. Doherty Jr. is the Associate Director of Clinical Operations for CMOHS. He is a
2003 graduate of the University Of Pennsylvania School Of Dental Medicine. He did his post-doctoral training at the Boston
University (“Vaccine impact: Benefits for human health.”, Mark Doherty, NCBI, December 20, 2016,
www.ncbi.nlm.nih.gov/pubmed/27773475)//chiragjain
Health economics The systematic health economic evaluation of new vaccines is a relatively recent
development [10] , in contrast with other new therapies where it has been used for half a century [11] . This reflects the difficulty of assessing impact, and
the fact that vaccine development was often pursued as a public good by a limited number of producers,

rendering price comparisons meaningless. However, over the last two decades as pressure on public health
budgets has mounted and new, more sophisticated (and expensive) vaccines have become available,
health economic assessment has become an essential aspect of immunisation programme planning [12-14] . Because
formal health economic analysis for vaccines is a newer discipline than that for drugs, the same
methodologies used for drugs were initially applied to evaluate the economic implications of
immunisation [15] . This is starting to change as new tools are being developed that include the fixed budget within which health authorities operate,
allowing optimisation modelling using objective function criteria and model constraints [16,17] and including assessments such as return on investment considered
from a government perspective; for example, the better economic results when a population remains healthy [18,19] . In other words if a new vaccine reduces the
risk of disease per at-risk individual as compared with the existing situation, how much do we want to pay for that extra benefit? Is there a maximum price to pay,
or do we let the free market decide? To help make these assessments, decision makers define up-front a standard unit of health benefit; usually defined as QALYs
(Quality Adjusted Life Years), the average value of a single disease-free year for one individual. This value varies from region-to-region [20] , and WHO

recommends that any new medical intervention can be considered as being very cost-effective if its
incremental cost-effectiveness result when compared with the existing situation is below the
threshold of one times the Gross Domestic Product (GDP) per capita [21] . That is, the value of one "unit" of health gain (the QALY) in
a country is usually considered to be equal to the GDP per capita of a country. This definition remains controversial, particularly for developing countries where the
cost of new interventions may outstrip the available health budget [22-24] . It has been argued that for situations where resources and money are scarce, avoiding
extra cost may be as critical as gaining additional health [25] . Equitable access to healthcare is also an important factor in many countries. These are all outcome
measures that are relevant for vaccines. However, there are other factors to consider. Vaccines, population and society The type of cost-effectiveness analysis
discussed above is very sensitive to the health evaluation of the individual, as this is what most treatment interventions specifically do: they alleviate the suffering of
an individual patient who is already ill [26] . Preventive activities are different because they are initiated before disease onset: healthy people are at risk of infection
and would therefore benefit from prevention. Which individuals will actually get a disease is unpredictable, and so the benefits of vaccines are most accurately
measured at the population instead of the individual level. Even those who remain unvaccinated benefit from the reduction in transmission after the vaccine has
been introduced (herd protection) [27] . This is very different from treatments for non-infectious disease, and conventional cost-effectiveness analyses do not easily
capture the additional benefits of immunisation [28] . Additionally, infectious diseases can vary from mild to very severe. As the focus is often on a single, most
severe manifestation, much of the disease prevented will not necessarily show up in an economic assessment if a narrow evaluation perspective is considered. A
typical example is rotavirus immunisation which prevents many cases of infant diarrhoea for which no medical advice is sought, but where a parent must be absent
from work in order to stay home and care for the child. For rotavirus, this benefit can be huge, because the total frequency of the disease can be as high as 40% of
children <5years old during epidemic winter periods in temperate countries [29] . Another example is pneumococcal immunisation, where the focus has been on
preventing invasive disease such as meningitis or sepsis, which has a high mortality ,
but where the reduction in acute otitis media
and of antibiotic use after immunisation provides a very substantial additional health and economic
benefit [30] . Much of the benefit when introducing new vaccines is thus to be found at societal level affecting not just patients, but parents, employers, and
the economy as a whole. Vaccines may have a critical impact in the prevention of epidemics at times where healthcare utilisation is already very high. In temperate
regions, rotavirus infections normally peak during winter periods when the incidence of other infections (such as influenza) is also peaking, potentially adding to
workload at what is already a period of high demand for healthcare in hospitals [31] . Introduction of the rotavirus vaccine can therefore result in improvement in
the overall quality of healthcare delivery, through better hospital bed-day management and personnel working conditions [31] . Finally, many of the benefits of
immunisation are realised over decades, and may not be immediately obvious; for example, preventing disease in childhood is linked to better educational
performance and higher earnings later in life [32,33] . Some of the potential benefits identified through modelling may appear years or even decades later, as for
HPV and HBV vaccines, and only when the vaccine has achieved high coverage within the target population [34,35] . So, substantial investment may be needed to
introduce and maintain an immunisation programme before the full return on investment can be defined. All of these aspects of vaccine impact are difficult to
capture in an economic assessment using conventional methodological approaches. The links between individual prevention through immunisation and societal
benefits that may improve the overall economy have been highlighted for infectious diseases that affect all levels of society, such as tuberculosis, malaria, and
pandemic influenza [36,37] . Recognising this, WHO has recently issued an overall scheme of evaluation of vaccines by which the benefit is highlighted from
different angles, not only focussing on health gains. WHO concludes that vaccines have the ability to achieve broad societal or community gains more easily than
any other medical intervention [38] . Remaining challenges A few specific challenges remain that are unique for vaccines. One is the discounting factor that heavily
affects the benefit of vaccines, since that benefit doesn't occur instantaneously after administration, but is spread over time [39] . Discounting is based on the
concept that a benefit today is worth more than a benefit tomorrow, but what discount rate, and whether it should be constant or flexible remains controversial
[40] . A recent review on the value of vaccines categorised the intangible benefits of immunisation into three groups; outcome-related, behaviour-related
productivity gains and community externalities [41] . The process of categorisation helps to define what to measure, when, and how. Estimating the intangible and
long-term benefits of immunisation requires a credible model with transparency in structure, data input and data output, validated against observed data [42,43] .
Finally, economic assessments of vaccines in the developed world are different from that in the developing world [44] , where immunisation is more likely to be
challenged on its priority rather than its value, given that resources are scarce. Budget optimisation or disease portfolio management are tools to specify the
economic value of the new intervention. In conclusion, immunisation is a perfect example of Adam Smith's theory on the invisible hand in the market: a "selfish
desire" to remain healthy by getting vaccinated will increase overall community welfare by reducing the spread of disease [45] . Other ways of assessing the value of
vaccines It has long been known that measures of average IQ at the national level correlate well with GDP and educational achievement [46] . Additionally, in both
developing and developed economies it has been noted that average IQ has risen significantly over the last century (the so-called "Flynn effect") with particularly
sharp rises in average national IQ in the periods of rapid increase in national GDP associated with industrialisation; even when improved access to education is
controlled for [47] . The reasons have been much debated, but immunisation in early childhood is associated with significantly better test results at school, which
are linked with subsequent improved employment prospects [4] . That this is not purely a socioeconomic effect reflecting access to healthcare or education in
resource-limited settings, is shown by a study where Danish children surviving bacterial meningitis subsequently had lower rates of educational achievement and
poorer employment prospects than their peers, an effect that persisted years or even decades after their illness [32] . More recent work [33] suggests that the
burden of disease in the population (drawn from WHO statistics) can explain much, if not all, of the observed IQ differences. The hypothesis is that the energy used
in fighting off infections, and the nutrition lost through common infectious diseases, such as diarrhoea during childhood, can harm the developing brain, with
potential long-term consequences. If correct, this suggests that improving child health through better sanitation and immunisation
may ultimately
provide benefits far in excess of the obvious health gains by also improving educational and
employment outcomes; ultimately contributing to national economic growth. Analysis of the gains seen from the
GAVI immunisation programme suggest that the increase in earnings by vaccinated children when they reach adulthood will exceed the entire cost of the
immunisation programme; even before the obvious benefits such as decreased death and suffering, and reduced medical costs, are figured into the equation [4] .

B) Vaccines are the newest field in pharmaceuticals --- it has the highest profit
margin too
TIMOTHY GUZMAN 1/26/2016 -- Global Segment Director at Freudenberg-NOK Global Research Center --- (“Big Pharma and Big
Profits: The Multibillion Dollar Vaccine Market”, Timothy Guzman, January 26, 2016, Global Research, http://www.globalresearch.ca/big-
pharma-and-big-profits-the-multibillion-dollar-vaccine-market/5503945)//chiragjain

The business of vaccines is soon to become a major source of profits for the world’s largest
pharmaceutical corporations. A press release (Business Wire, January 21st 2016) published by marketwatch.com says that Technavio, one of the
leading technology research and advisory companies in the world predicts that pharmaceutical corporations who produce vaccines will reach an estimated $61
billion in profits by 2020. Today the vaccine market is worth close to $24 billion. The report titled ‘Global Human Vaccines Market
2016-2020’ gives an “in-depth analysis” of the possible revenues and “emerging market trends” globally. According to the Press Release: The report study

indicates that the introduction of new products is fueling the growth of the market. Moreover, the significant
expansion of the current product offerings is also expected to boost the market growth. Due to the increasing
prevalence rates of various infectious diseases such as diphtheria, influenza, hepatitis, pneumococcal diseases, and meningococcal diseases, there has been a
notable increase in the use of vaccines across the globe What is interesting about the report is that Pharmaceutical
corporations are targeting Latin America and the Caribbean with its new vaccines soon to be on the
market. Merck & Co, Pfizer and GlaxoSmithKline (GSK) are expected to dominate Latin America and the Caribbean (Puerto Rico currently operates as a
manufacturing hub for Merck, Pfizer and Abbott Laboratories): In terms of geography, the Americas dominated the global human

vaccines market in 2015, accounting for about 45% of the total revenue. The US was the largest revenue
contributor to this region in the same year, capturing a significant portion of the global market. The Americas
will continue to dominate the human vaccines market during the forecast period because of the increase in the prevalence of infectious diseases and cancers. In
addition, increase in strategic alliances with expected entry of novel vaccines, is also expected to propel the growth of the market in this region The report also says
that there are two types of human vaccines, Therapeutic (cancer, metabolic disorders, chronic illnesses, and infectious diseases) and
Preventable human vaccines markets (pediatric vaccinations) that are estimated to reach $55 billion worldwide. The Atlantic
magazine published an article in 2015 titled ‘Vaccines Are Profitable, So What?’ Author Bourree Lam says: While the main fixation of anti-vaccine groups is an old,
discredited study linking vaccination to autism, another is a conspiracy theory circulated online that both doctors and pharmaceutical companies stand to profit
financially from vaccination—which supposedly leads to perverse incentives in advocating for the public to vaccinate. But that argument is historically unfounded.
Not only do pediatricians and doctors often lose money on vaccine administration, it wasn’t too long ago that the vaccine industry was struggling with slim profit
margins and shortages. The Economist wrote that “for decades vaccines were a neglected corner of the drugs business, with old technology, little investment and
abysmal profit margins. Many firms sold their vaccine divisions to concentrate on more profitable drugs” Maybe it was true at some point in time that
manufacturing vaccines were unprofitable, but in today’s world, it’s all profits. What motivated pharmaceutical corporations to focus on the vaccine market in the
last decade or so according to The Atlantic? Since 2000, the Gavi Alliance has provided vaccination for 500 million children in poor countries, preventing an
estimated 7 million deaths. GlaxoSmithKline reported that 80 percent of the vaccine doses they manufactured in 2013 went to developing countries. Additionally,
vaccines that could turn a profit in high-income countries—constituting 82 percent of global vaccine sales in terms of value, according to the World Health
Organization—hit the market Lam also wrote that there were “two “blockbuster” vaccines also hit the market: pneumococcal conjugate for meningitis and other
bacteria infections, and a vaccine for human papillomavirus (HPV). The industry grew”. Merck is the only pharmaceutical giant licensed to produce and sell the
measles vaccine called Prodquad and theMMR II (also used for the measles, mumps and rubella) and Varivax, a vaccine for the chicken pox. According to Lam, all
three vaccines combined amounted to more than $1.4 billion in sales profits for Merck in 2014. The controversialHPV vaccine, Gardasil also brought in $1.7 billion in
profits for Merck. “While a spokesperson for Merck told The Atlantic that vaccines remained one of its key areas of focus—it generated $5.3 billion in sales in
2014—she did not comment on the profit margins” Lam wrote. Of course the Merck spokesperson would not comment on the profitability of vaccines because
Merck would expose itself to more controversy. Analysts say that the profit margin is“between 10 to over 40 percent.” Lam also says that “while the vaccine
industry is likely more profitable now than in the 1970s or 1980s, this is the result of global market forces”. Lam forgot to mention that billionaire couple Bill and
Melina Gates pledged at least $10 billion for worldwide vaccination programs supposedly to combat polio and the measles, this is where Merck & Co profit. It is also
well known that Bill Gates appointed the former president and CEO of Merck, Raymond Gilmartin to the board of directors of Microsoft which lasted for more than
11 years before he announced his retirement in 2012. Are pharmaceutical corporations motivated by profits? “Profits from vaccine production aren’t a valid
argument against vaccinations—the most important question is whether vaccines are safe and effective, and the answer is unambiguously yes” wrote Lam. In 2015,
Former Merck Employee and whistleblower Brandy Vaughan Spoke out against the state of California’s vaccination mandate bill SB277 and said: The U.S. gives more
vaccines than any other country in the world. Our childhood schedule for under the age of one has twice as many vaccines as other developed countries. What else
do we have? The highest infant mortality rate of any developed nation. Finland has the lowest. They only give 11 by age six. Mississippi has the highest rate of
vaccination in the U.S.–highest infant mortality rate. These numbers do not lie. But you will not hear that on the media, and that is not what Senator Pan will tell
you. What we have with vaccines is the highest profit margin pharmaceutical drug on the market. Drug
companies make more money off vaccines than they do any other pharmaceutical drug, in terms of profit
margin. There is a lack of rigorous safety studies. And they don’t have the incentive to do them because they have no liability. Vaccines are the only

products in the U.S. that do not have liability. You cannot sue for injuries or death. But that is only in the U.S.
Around the world, there are law suits because of serious injuries and deaths because from vaccines. In Spain over Gardasil. In Japan over Gardasil. The flu shot was
taken off the market for under five in Australia after deaths and injury. Prevnar was banned in China. Pfizer’s vaccination program was kicked out of the country.
France just pulled Rotavirus off their schedule after infant deaths and injuries With
a forecast of $61 billion in projected sales, rest
assured new vaccines will be developed for almost anything. Actor and comedian Jim Carrey did say that “150 people die every
year from being hit by falling coconuts. Not to worry, drug makers are developing a vaccine”. With 271 vaccines in production, Jim Carrey’s comments, which were
criticized by the mainstream media, may not be so farfetched after all.

Pharma industry is key to the economy


Sullivan 11 (Thomas Sullivan, founder of Rockpointe Inc., former political consultant, “Study Shows
Importance of Biopharmaceutical Jobs For US Economy,” Policy and Medicine, July 12, 2011,
http://www.policymed.com/2011/07/study-shows-importance-of-biopharmaceutical-jobs-for-us-
economy-for-every-20-billion-loss-in-revenue.html)

Biopharmaceutical research companies produce the highest-value jobs, the types of jobs Americans want in the 21st century economy, the
kinds of jobs that can drive future economic growth. No other sector has the ability to drive innovation, create

high-quality jobs and provide new life-saving medicines for patients. According to a recent report from
the Battelle Technology Partnership Practice (TPP), “nationwide, the biopharmaceutical sector supported a total
of 4 million jobs in 2009, including nearly 675,000 direct jobs. Battelle is the world’s largest non‐profit independent

research and development organization, providing innovative solutions to the world’s most pressing needs through its four global
businesses. TPP has an established reputation in state‐by‐state assessment of the biopharmaceutical sector, and has recently
undertaken major impact assessment projects for the Human Genome Project, the nation’s biotechnology sector, and major bioscience organizations such as Mayo
Clinic. TPP has also been active in provision of analysis to industry organizations, including the Council for American Medical Innovation, PhRMA and BIO‐the
Biotechnology Industry Organization. Each job in a biopharmaceutical research company supported almost 6 additional jobs
in other sectors, ranging from manufacturing jobs to construction and other building service jobs to contract researchers and child care providers.
Together, this biopharmaceutical sector‐related workforce received $258 billion in wages and benefits in
2009. “Battelle also found that across all occupations involved in the biopharmaceutical sector, the average wage is higher than across all other private sector
industries, due to the sector’s role as a ‘high value-added sector.” Specifically, the annual average personal income of a biopharmaceutical worker was $118,690 in
2009 as compared to $64,278 in the overall economy. Additionally, the biopharmaceutical sector’s total economic output (including
direct, indirect and induced impacts) was $918 billion in 2009. The sector generated an estimated $85 billion tax revenues in 2009—$33 billion in state and
local and more than $52 billion in federal. This impact comprises $382 billion in direct impact of biopharmaceutical businesses and $535 billion in indirect and
induced impacts (an
output multiplier of 2.4—meaning that every $1 dollar in output generated by the biopharmaceutical sector generates another
$1.4 in output in other sectors of the economy). To
put this export volume into perspective, 2010’s total biopharmaceutical
exports of $46.7 billion compares favorably to other major U.S. exports including: automobiles ($38.4 billion in 2010
exports); plastics and rubber products ($25.9 billion); communications equipment ($27 billion) and computers ($12.5 billion). In addition, the U.S. Congressional
Budget Office noted that, “the
pharmaceutical industry is one of the most research‐intensive industries in the
United States and that pharmaceutical firms invest as much as five times more in research and development,
relative to their sales, than the average U.S. manufacturing firm.” At over $105,000 in biopharmaceutical R&D per employee, the sector is way ahead of the average
across all U.S. manufacturing which stands at about $10,000 per employee—and is far ahead of the second and third ranked sectors of “communications
equipment” and “semiconductors, which respectively spend $63,000 and $40,000 per employee in R&D annually. PhRMA Statement on Battelle Report
Consequently, Pharmaceutical Research and Manufacturers of America (PhRMA) President and CEO John J. Castellani issued a statement discussing the results from
this report and the biopharmaceutical research sector’s impact on jobs and the American economy. Castellani asserted that, “at a time when the U.S. is facing a jobs
crisis, evidenced by the terrible employment numbers from last Friday, it is critical that our policymakers embrace dynamic and innovative business sectors such as
the biopharmaceutical research sector and refrain from stifling job growth through shortsighted proposals such as government-mandated price controls in
Medicare Part D.” Specifically, the PhRMA CEO pointed to a new paper from the Battelle Technology Partnership Practice, which underscored the pharmaceutical
sector’s tremendous contribution to America’s economy. Castellani recognized that, “startling potential job losses would result from undermining the business
foundations of biopharmaceutical companies.” He noted that the Battelle report estimated “that a $20 billion per year reduction in biopharmaceutical sector
revenue would result in 260,000 job losses across the U.S. economy” and a $59 billion reduction in U.S. economic activity. As a result, Castellani recognized that, “as
the President and Congressional leaders negotiate an important agreement on the debt ceiling and the future of the nation’s economy, it is critical that the jobs
crisis is not exacerbated.” For example, Castellani noted how “the President and some in Congress have proposed including government-mandated rebates in
Medicare Part D as part of a debt ceiling agreement.” However, he recognized that “such a provision would have a dramatic negative effect on the economy and
patients, and could undermine the success of the Part D program, which has very high beneficiary satisfaction and has cost far less than original government
projections.” He pointed to the “Battelle numbers, which clearly demonstrated that reducing the biopharmaceutical sector’s annual revenue by $20 billion would be
a serious blow to employment.” Castellani added that, “while the research is not specific to any one policy or event, proposals being considered, such as
government-mandated Part D rebates, would be expected to have revenue impact of this magnitude.” Moreover, he noted that, “Part D is an unparalleled success,
providing unprecedented access to life-saving medicines for seniors.” Accordingly, Castellani asserted that PhRMA does not “believe policies that discourage R&D
and cutting-edge science and that will inevitably slow the development of needed new medicines are fair for seniors waiting for new treatments against our most
challenging and costly diseases.” Battelle Report The Battelle Report quantifies the economic impact of the
biopharmaceutical sector on the U.S. economy and jobs using input/output analysis, measures the direct and
indirect impacts of the biopharmaceutical sector, and quantifies the economic impacts that would occur if

biopharmaceutical revenues increase or decrease from significant changes in the business operating environment. The report also
highlights some of the functional impacts of the sector—the wide‐ranging benefits provided through the biopharmaceutical sector’s contributions to
enhancing human health, improving life spans and sustaining the high quality‐of‐life that Americans enjoy—and assesses the contributions of the

biopharmaceutical sector to key areas of importance to our economy— innovation, product exports
and quality of jobs produced. The Battelle Report starts by recognizing that the biopharmaceutical sector has all of the
characteristics for an ideal industry for economic growth and sustainability in the U.S. Specifically, the
biopharmaceutical sector: Grows in output and employment even in tough economic times Provides high wage, good
quality jobs Is innovative and deploys high‐technology to generate comparative advantage for U.S. companies

Generates significant exports that boost the U.S. economy Has a strong supply chain that drives further
economic growth across the economy through “multiplier effects” Builds on America’s long‐standing strengths and
investment in fundamental and applied research Encourages capital flows to sustain growth, and is profitable to provide

funds for reinvestment into the research and development (R&D) cycle; Generates federal, state and local taxes and other
economic contributions that support public services Is sustainable and not a major drain on global resources Is geographically dispersed,

providing opportunities for job creation and economic growth across many areas of the nation, not just a few
selected places Produces a product of value to society, something that improves the quality of life for humankind, including Improved life spans

(personal longevity) Improved productivity resulting from prevention and effective management of disease and

chronic conditions; and Reductions in unnecessary hospitalizations resulting in potential cost‐offsets


elsewhere in the health care system. Fundamental to major progress in human longevity, reducing the marginalization of individuals from
disease and disability, and generally improving our quality‐of‐life, biopharmaceuticals are a unique contributor to societal and individual well‐being. Moreover, the
output of the biopharmaceutical sector is highly valued by society because the sector develops and manufactures a broad‐range of unique products to treat
disorders and diseases that, were they to go untreated, can ruin individual quality of life, personal abilities and productivity. In many instances,
biopharmaceuticals are central to helping to prevent and treat a range of public health issues, address
pandemic risk and thereby support national economic security. For example, innovation in the biopharmaceutical sector, combined with

the diagnostic and treatment skills of U.S. healthcare professionals, has contributed to a lengthening of the average life span of
Americans. In 1900, the expected life span of an American at birth was just 47.3 years. With the advent of more modern medicines and advanced medical
knowledge, life expectancy at birth has seen a steady increase rising to 69.7 years in 1960, and 77.9 years in 2007. In fact, the National Bureau of Economic Research
reports that “there
is a highly statistically significant relationship between the number of new molecular
entities [drugs] approved by the FDA and increased longevity.” Furthermore, Lichtenberg found in a study of FDA data that
"approval of priority‐review drugs—those considered by the FDA to offer significant improvements in the treatment, diagnosis, or prevention of a disease—has a
significant positive impact on longevity.” Additionally, the American Hospital Association (AHA) notes that “advances
in medicine contribute to
national economic growth by helping Americans recover more quickly from injury and illness, avoid lost or
ineffective work time due to flare‐ups of chronic conditions, and live longer with higher quality of life.” Without effective
medicines and treatments for illnesses, injuries, pain and chronic conditions, the productivity of the U.S. economy would
clearly be greatly impaired. Biopharmaceuticals are a key contributor to a more productive and healthy
America and U.S. economy. Beyond direct employment in biopharmaceutical companies, the biopharmaceutical sector is the
foundation upon which one of the United States’ most dynamic innovation and business ecosystems is built.
A large part of the modern biomedical economy is built upon a robust foundation of biopharmaceutical companies that perform and

support advanced biomedical and technological R&D, and act as the funnel and distribution engine for
getting life‐saving and quality‐of‐life‐sustaining therapeutics to the marketplace. Providing R&D impetus and funding, capital resources,

technology licensing opportunities, and a sophisticated market access and distribution system, the
biopharmaceutical sector is of central importance to the much broader biomedical and life sciences
economy. Fueled by private investment capital, venture capital investments, and public/private collaborations, and enabled by the U.S. open market system,
the nation has been able to advance biomedical innovation, which in turn has led to new start‐up
companies, business growth and exports across the world. Conclusion Despite the tremendous success in the biopharmaceutical
industry, emerging infectious diseases continue to present new challenges and a substantial volume of long‐standing diseases such as cancer, diabetes,
neurodegenerative diseases, psychiatric diseases, immunological diseases, etc. continue to demand novel treatments and improved therapeutics. There are millions
of people suffering from diseases and disorders for which a therapy has yet to be found. The need for ongoing biopharmaceutical research and development is
simply enormous. The only way the U.S. economy can stay ahead of international competition is by using advanced R&D and innovation to drive the growth of high
value‐added industries. By leveraging investment in federal lab, university and industry R&D, our nation is able to produce high‐value, typically technologically
advanced products that the rest of the world values highly. In recent decades, life
sciences have come to the fore as a leading driver
of U.S. technological innovation and competitive advantage, and the biopharmaceutical sector is a key foundation
of the life sciences innovation ecosystem. The Unites States’ biopharmaceutical industry produces products that save,
sustain and improve lives, and the sector has a large and significant economic impact, affecting many other key areas

of the U.S. economy. Gains or losses in biopharmaceutical sector revenues will be reflected in gains and
losses across a broad range of additionally important U.S. economic sectors that have robust supply
chain relationships with the biopharmaceutical sector.

Economic decline causes war – best studies prove


Royal 10 Director of Cooperative Threat Reduction at the U.S. Department of Defense [Jedediah Royal, 2010, Economic
Integration, Economic Signaling and the Problem of Economic Crises, in Economics of War and Peace: Economic, Legal and
Political Perspectives, ed. Goldsmith and Brauer, p. 213-215]

Less intuitive is how periods of economic decline may increase the likelihood of external conflict. Political
science literature has contributed a moderate degree of attention to the impact of economic decline and the security and defence behaviour of interdependent
stales. Research in this vein has been considered at systemic, dyadic and national levels. Several notable contributions follow. First, on the systemic level. Pollins
(20081 advances Modclski and Thompson's (1996) work on leadership cycle theory, finding that rhythms
in the global economy are
associated with the rise and fall of a pre-eminent power and the often bloody transition from one pre-
eminent leader to the next. As such, exogenous shocks such as economic crises could usher in a
redistribution of relative power (see also Gilpin. 19SJ) that leads to uncertainty about power balances, increasing
the risk of miscalculation (Fcaron. 1995). Alternatively, even a relatively certain redistribution of power could lead
to a permissive environment for conflict as a rising power may seek to challenge a declining power (Werner.
1999). Separately. Pollins (1996) also shows that global economic cycles combined with parallel leadership cycles impact the likelihood of conflict among major,
medium and small powers, although he suggests that the causes and connections between global economic conditions and security conditions remain unknown.
Second, on a dyadic level. Copeland's (1996. 2000) theory of trade expectations suggests that 'future expectation of trade' is a significant variable in understanding
economic conditions and security behaviour of states. He argues that interdependent states arc likely to gain pacific benefits from trade so long as they have an
optimistic view of future trade relations. However, ifthe expectations of future trade decline, particularly for difficult to
replace items such as energy resources, the likelihood for conflict increases, as states will be inclined to
use force to gain access to those resources. Crises could potentially be the trigger for decreased trade expectations either on its own or
because it triggers protectionist moves by interdependent states.4 Third, others have considered the link between economic

decline and external armed conflict at a national level. Mom berg and Hess (2002) find a strong correlation
between internal conflict and external conflict, particularly during periods of economic downturn. They write.
The linkage, between internal and external conflict and prosperity are strong and mutually reinforcing.
Economic conflict lends to spawn internal conflict, which in turn returns the favour. Moreover, the presence
of a recession tends to amplify the extent to which international and external conflicts self-reinforce
each other (Hlomhen? & Hess. 2(102. p. X9> Economic decline has also been linked with an increase in the likelihood
of terrorism (Blombcrg. Hess. & Wee ra pan a, 2004). which has the capacity to spill across borders and lead to
external tensions. Furthermore, crises generally reduce the popularity of a sitting government. "Diversionary
theory" suggests that, when facing unpopularity arising from economic decline, sitting governments
have increased incentives to fabricate external military conflicts to create a 'rally around the flag' effect.
Wang (1996), DcRoucn (1995), and Blombcrg. Hess, and Thacker (2006) find supporting evidence showing that economic decline and use of force arc at least
indirecti) correlated. Gelpi (1997). Miller (1999). and Kisangani and Pickering (2009) suggest that Ihe tendency towards diversionary tactics arc greater for
democratic states than autocratic states, due to the fact that democratic leaders are generally more susceptible to being removed from office due to lack of
domestic support. DeRouen (2000) has provided evidence showing that periods of weak economic performance in the United States, and thus weak Presidential
popularity, are statistically linked lo an increase in the use of force. In summary, rcccni economic
scholarship positively correlates
economic integration with an increase in the frequency of economic crises, whereas political science
scholarship links economic decline with external conflict al systemic, dyadic and national levels.' This implied connection between
integration, crises and armed conflict has not featured prominently in the economic-security debate and deserves more attention.
Solvency
Plan: The United States federal government should regulate K-12 schools that receive
federal funding by implementing a law that:
-Requires states to adopt mandatory vaccination programs for K-12 schools which
receive public funding according to the Advisory Committee on Immunization
Practices schedule with stringent exemption standards
-Funds the mandate through an expansion of the Vaccines for Children Program.

The plan only works under the federal government, solving herd immunity is an
imminent problem, exemptions are useless, and there’s no tradeoff to buying massive
amounts of vaccines --- this card will blow your mind
PAUL OFFIT 6/30/17 --- Pediatrician specializing in infectious diseases and an expert on vaccines, immunology, and
virology. Co-inventor of a rotavirus vaccine. Offit is the Maurice R. Hilleman Professor of Vaccinology, professor of Pediatrics at
the Perelman School of Medicine at the University of Pennsylvania, chief of the Division of Infectious Diseases, and the director
of the Vaccine Education Center at The Children's Hospital of Philadelphia. Former member of the Centers for Disease Control
and Prevention (CDC) Advisory Committee on Immunization Practices. Offit is a board member of Every Child by Two and a
founding board member of the Autism Science Foundation (ASF). Pandora’s Lab is his ninth book. (“Interview of Paul Offit!”,
Paul Offit, June 30, 2017, Interview with Chirag Jain, Transcribed by Chirag Jain – chiragjain2000@hotmail.com,
https://sites.google.com/a/icstudents.org/debateinterviews/ )//chiragjain

Chirag: Do you think that state governments have the potential of getting mandatory vaccines and how do you think state budgets could
maintain the reimbursement of vaccines that are required by the ACA in the status quo? Paul: States some states mandate various
vaccines other states less. There are only three states that have only medical exemptions, in other words only three states don’t have
non- medical exemptions, so which is a religious or philosophical exemptions. 47 states have religious and philosophical exemptions, or at least
one or the other or both. Whereas 3 states only have medical exemptions. So in the sense so states should mandate vaccines, do I think
states should mandate vaccines? Is that the question? Yes, I do. Because otherwise, I think if you ask other anti-vaccine
groups, what they want, I think they say fake vaccines are an option. And I think when that happens, you will begin to see outbreaks. Chirag: So
right now there was an article two days ago from Illinois that was talking about how state budgets can’t
maintain the reimbursements for the vaccines for doctors, because it’s required by the ACA, so how do you think states
could like maintain that I guess? Paul: I don’t think they can. Chirag: So you think the federal government
should then? Paul: Yes, I think the federal government has to help, it’s -- different states have different
abilities to afford vaccines because bacteria and viruses don’t recognize state lines, I think it’s a
federal issue. Chirag: What kind of vaccine education do you think would be good, so like parents or students, what
do you think would be good? Paul: I think vaccine education should start in elementary school, and that be
continued in junior high and high school. I don’t think children really learn much about vaccines other
than that they hurt, and so I think it would be valuable that education start from the beginning. Chirag: So in
your article “What Makes Trumpcare so Dangerous for Kids” you say that vaccines save 1..65 trillion in societal costs, so do you think that with
the current rate in increases in parent refusal, there would be some sort of impact on the economy in things like healthcare costs? Paul: Sure I
mean if, if Trumpcare comes through, even right now, as it stands, they’re going to eliminate the prevention public health fund, but that’s a big
hit to the CDC. The CDC will also get a hit from the president’s budget, so I think although the Vaccines For Children program that buys 55% of
all vaccines in this country will survive, it appears to be able to survive, administering a program will be much harder because there will be
much less money to do it, do I think that that could result in an erosion of vaccine rates, I DO! Do I think that that could result in outbreaks, I do,
and do I think those outbreaks would be incredibly costly, they always are. So yeah i think it’s pay me now or pay me later I think the
administration they really need to follow through on this or they will end up paying later . Chirag: If anti vaccination activists continue to deter
people from getting vaccinations, do you think that there is a chance of a major epidemic? Paul: Yes, I think it already
happened, if you look at 2014, an outbreak among an Amish community in Ohio involved 680 people again
measles in 2015 there was an outbreak that started in Southern California with measles again in undervaccinated
population spread to 25 states killed 190 people spread to 2 Canadian provinces, and now we have this currently there’s an
outbreak in a Somali population in Minnesota again because people are choosing not to vaccinate so I
don’t think we have to keep learning the same lesson. Chirag: Ok that makes sense. Now as you said you would suggest that the federal
government require vaccinations, now that there’s things like backlash from people, or also the budget question as to how much it would cost
to produce that many vaccines, do you think that there would be a better way of going about that? Like making exemptions really hard and
getting rid of the philosophical exemption? Paul Offit: I think first of all this makes no sense --- so like philosophy,
really? Really? So like
someone just says it's better not to get a vaccine than to get one, i mean some people call them personal belief
exemptions? Vaccines aren’t a belief system, they’re an evidence-based system. Religion is a belief system,
which brings us to religious exemptions. I think that a choice to put your child in unnecessary risk is a profoundly
unreligious thing to do, I think that to put children who your children come in contact with at an
unnecessary risk is an unreligious thing to do. Religion teaches us to care about families, to care about
our neighbors, so I don’t see this as a religious thing. So call it what it is. Which is that I’m scared of vaccines I read a
lot of scary stuff on the internet, I think that Jenny McCarthy knows what she’s talking about, so I’m not gonna get
vaccines. That’s really what it is. I think we just window-dress it with words like philosophy and religion. Chirag:
So I read an article from 2016 that proposes a policy about how airlines could require passengers to get vaccinated, and that would allow most
of the rich white upper class that get’s exemptions to get vaccinated for purposes of family travel or business travel. Do you think that would be
a viable idea so it avoids backlash and Congress and stuff like that? Paul Offit: The point being that most people that choose to exempt are
people that fly? Chirag: Yes Paul Offit: I think that it’s interesting, I think it would be very hard to workout in real life. How are you documenting
whether people have vaccines, I’m sure people would find doctors that would probably be willing to say, that they got vaccines. That’s already
happening in California, where you can buy medical exemptions. You just have to go to the right doctor and for a certain amount of money
they’ll write you an exemption. So it kind of creates a black market for those exemptions, but yeah, I think it would be an interesting idea.
Chirag: So on that note, I read articles about “fringe doctors” that you can buy medical exemptions from. Is there anyway to prevent the black
market exemptions? Paul: yes I think that the state people probably know which doctors they are, In a better world professional societies like
the American Academy of Pediatrics should step forward and make it clear that they shouldn’t do that, and if they do do that, then they should
take away their medical license, its fraud. They’re misrepresenting information, that’s fraud, and that puts other people at risk. Chirag: Right, so
I guess that if the federal government said that vaccinations are mandatory, would that result in a lot of people going to these doctors for
buying medical exemptions? Paul: Right, I think it would. Chirag: More relating to the Trump administration and our Secretary of Health and
Human Services is Tom price, do you think that a mandatory vaccine policy, in the world that it was implemented, would get rolled back or face
major problems because of the administration? Paul: It is a Republican administration, it’s a general they don’t like having the government
involved in this, these are the last people interested in mandates, I don’t think it can ever happen. I’m just hoping the current vaccine policy
survives in this administration. Chirag: If it did get passed, do you think there would be problems related to the Trump administration? Paul: I
don’t think that it wouldn’t get passed. The House of Representatives is Republican, the Senate is republican, and the President is republican, it
would never happen. It’s like imagining a president that wasn’t a misogynistic pig. Chirag: I was also looking at things about herd immunity, do
you think that a the difference in 90% and 95% is an exponential difference even though it’s just 5%?
Paul: So it always depends on the pathogen or the germ, so for highly contagious diseases like measles it would be a fairly high percentage of
people that need to be vaccinated in order to prevent spread. So measles is in this 92-95% range, for polio it’s much less because they aren’t as
contagious. We dramatically decreased the amount of people with polio when we got to 40-50%. It also depends on the efficacy of the vaccine,
it depends on the virus, like if
you took the 5% of people that choose not to get vaccines or didn’t get vaccinated
because they can’t get vaccinated, and you equally spread that out over most of the country, I don’t
think it would have that bad of an effect. But i think it’s the concentration thats the problem, so like
the Amish community, the California community, the Somali community, there you have a significant
percent of people that aren’t vaccinated, like probably even more than 20%. Chirag: That makes sense, so it’s
like the concentrated hot spots that would be the problem? Paul: That’s correct. Chirag: If the federal
government does mandatory vaccinations, it would be globally modeled? Paul: I mean other countries have mandatory vaccinations, like in
Saudi Arabia if you don’t get vaccinated in the first year of life, you don’t get a birth certificate. Some countries are much better at it, like in
Scandinavia almost everyone gets vaccinated because they trust their government, they trust their scientists , they think that those people are
working on their behalf. Germany doesn’t, France doesn’t, England doesn’t, so they don’t mandate vaccines. You have countries that don’t
mandate that have high vaccination rates like Scandinavia, you have countries that have low vaccination rates and you have countries that
basically have compulsory vaccinations. So how does it work in this country, I mean it’s a country that has been found on individual freedoms,
we don’t like to be told what to do, and that’s what’s caused us problems. I mean we could be where France is, where we are routinely facing
epidemics. Chirag: That makes sense, I was wondering about the legality about state based vaccinations relating to the Commerce Clause and
how states can’t set prices to buy vaccinations from other states, would there be a way for states to buy mandatory vaccinations? Paul: I don’t
know, you should ask a lawyer that question. Chirag: So do you think that vaccinations considering that they are a new field in the
pharmaceutical industry, would be a big boost to the pharmaceutical industry if they were made mandatory? Paul: No. Because vaccines are
something you give once or a couple times in a lifetime, and that doesn’t compete with diabetes drugs or psychiatric drugs that are given
everyday, I think vaccinations are never gonna be there, that’s why so few companies make vaccines, only four companies make vaccines for
people in the United States, because there’s so few people. Chirag: So we were looking at proposals
for something that would
have vaccinations bought by the federal government and be provided to schools so that people that
don’t get vaccinations right now can get vaccinations for free of cost. Do you think that would be
economically sustainable? Paul: It’s already happening, that’s what the Vaccines for Children program
does, it was launched in the early 1990s under the Clinton Administration, to buy vaccines for all children that are either
uninsured or underinsured to make sure that everyone in this country can get a vaccine even if they
can’t afford, that’s an entitlement program and its been in place since the 1990s, I don't even think
the current administration would threaten that program, but if it did that would be a big problem
because currently it provides for 55% of vaccinations for children. Chirag: Thank you, you’re okay with this
being published for evidence in debate, right? Paul: Of course, yes. Chirag: Thank you! Paul: Of course, no problem.

Federal government is key and solves – the federal government creates uniform
standards, provides adequate incentive to follow the policy, and has expertise
and financial and scientific resources (this describes exactly what the aff should
do)
Tohanczyn 16 --- Katherine is an associate in the Starfield Smith’s Fort Washington office. She concentrates her practice on
commercial financing, real estate and corporate law with a focus on commercial lending and government guaranteed lending. (“ Katherine
D., “WHO SHOULD CALL THE SHOTS? PROPOSING FEDERAL OVERSIGHT OF MANDATORY CHILDHOOD VACCINATIONS,” winter edition of the
Philadelphia Lawyer 2016,
http://www.philadelphiabar.org/WebObjects/PBAReadOnly.woa/Contents/WebServerResources/CMSResources/ginsburgessay15.pdf)//er
nst

IV. SUGGESTIONS FOR CHANGE: WHY FEDERAL OVERSIGHT IS THE UPSHOT In order to overcome the issues with the current vaccination system, the federal government should adopt and implement uniform vaccination
laws rather than leaving such individualized power to the states . While the federal government does not have inherent constitutional jurisdiction over mandatory vaccinations, such jurisdiction could be

The federal government should limit the availability


overcome by tying vaccines to the federal funding received by every school nationwide.

of exemptions under the model provided by the Affordable Care Act (ACA). Ultimately, this approach is
consistent with current public perception and is a logical extension of the federal government’s current
responsibilities. A. Overcoming Constitutional Barriers to Federal Oversight of Vaccines The largest hurdle to a federal mandatory vaccination program is fitting such a
program within the federal government’s limited powers. According to the Tenth Amendment to the United States Constitution, any power not specifically enumerated to the
federal government in the Constitution is reserved to the state governments.44 Since the power to implement a mandatory vaccine program is not specifically granted to the
, the federal government has argued that its power to act over
federal government, this power is retained by the states. Generally

public health falls under the Commerce Clause, which states that Congress shall have the power “[t]o regulate Commerce with foreign Nations,
and among the several States . . . .”45 The federal government has previously used this authority to pass the National Childhood Vaccine Injury Act (NCVIA). Under the NCVIA,
the Department of Health and Human Services is responsible for overseeing everything from research and development to distribution and use of vaccines.46 In addition, the
NCVIA also establishes two important reporting systems. The first requires health care providers to supply parents with standardized pamphlets on each vaccine prior to
administering the vaccine. 47 The second requires health care providers and manufactures to report certain adverse events from vaccines to the federal government. However,
the federal
the idea that the Commerce Clause extends to a mandatory vaccination program for school admission is a more attenuated argument. Rather,

government would be more successful in creating a unified vaccine program by requiring states to
adopt specific standards as a condition to federal funding for education. This situation is analgous the federal government
has previously done by tying federal transportation funding to alcohol distribution standards. In 1984, Congress passed the National Minimum Drinking Age Act, which withheld
10% of federal highway funding from states that did not maintain a minimum legal drinking age of twenty-one. 49 South Dakota challenged the law but the Supreme Court
upheld the law noting that Congress may “attach conditions on the receipt of federal funds.”50 In coming to this decision, the
Court established a five part test for determining whether such a condition on federal funding is constitutional or amounts to coercion. Ultimately, a condition of federal funding
will be upheld so long as (1) promotes the general welfare, (2) is unambiguous, (3) relates “to the federal interest in particular national projects or programs,” (4) is not in and of
Congress should use this precedent of deferential treatment toward
itself unconstitutional, and, (5) is not coercive. 51

congressional conditional spending to persuade states to adopt mandatory vaccination programs with
more stringent exemption standards as a condition to federal funding for education.52 It is commonly
accepted that the federal government has an interest in maintaining public health, and a mandatory vaccine program
instituted at the federal level relates to the Healthy People 2020 program, which is a federal initiative that seeks to improve the nation’s health through various means, including
increased vaccinations.53 Congress may also seek to tie this vaccine program to specific projects carried out by the Department of Education at the elementary and secondary
levels.54 Given the state precedent on this matter, a federal statute can easily be drafted that is unambiguous. Further, such a program
is not in and of itself unconstitutional because citizens have alternative options (e.g., homeschooling) and will not be

forcibly immunized against their will. The Supreme Court has continually upheld the constitutionality of a mandatory vaccination program at the state
level under a theory of deference to public health. The federal government could argue that it is also entitled to this

protection when similarly acting to promote the public welfare through a mandatory childhood vaccine
program created by the federal government and implemented by at the state level. Finally, such a program is not coercive. While mandatory vaccination is a constraint on
one’s personal freedom (albeit to protect the health and safety of the community), the restriction is with the constitutional powers of the government and the availability of
limited exemptions allows the state to exclude some children without risk of losing funding. Further, states are not required to enact the legislation just as they were not
. Tying Mandatory Vaccination Laws to Federal Funding of
required to implement a minimal drinking age of twenty-one. B

Education The primary responsibility for K-12 education lies with the individual states. However, the
federal government provides annual funding to supplement subpar state funding.55 Authority for this federal funding is
found in the Elementary and Secondary Education Act (ESEA). The ESEA was enacted by Lyndon B. Johnson, in 1965, to grant federal funding and to establish a national
curriculum to hold schools accountable for educational achievements. 56 Under ESEA, funding is allocated for a number of different elementary and secondary programs,
the federal
including programs for low-income children, foreign languages, gifted students, and arts, as well as library and textbook materials.57 Overall,

government contributes 10.8% of the total amount spend nationwide on education each year. While this
percentage seems relatively low, in reality, it amounts to over $100 billion annually.58 This amount is also a necessary supplement to state

budgets, which would not be able to make up the difference if such funding was pulled because of a
failure to implement a mandatory vaccine program. C. Determining Allowable Exemptions 17 In establishing this program, the federal
government must determine what, if any, exemptions will be granted. As previously discussed, an
exemption for individuals with specific medical conditions is necessary and logical. Further, very few individuals meet
the criteria to receive this exemption.59 Therefore, such an exemption should continue under a federal program with the

sole requirement being that a child’s parent or guardian must provide written documentation from a
licensed physician explaining why the child’s medical condition makes him or her exempt from vaccines.
Conversely, philosophical exemptions are ill founded and only inhibit the public goal without any benefit to

the community. As such, this exemption is seen more as one of convenience then of actual belief. A majority of states have recognized the detriment associated with
this exemption and no longer allow parents to opt their children out of vaccinations simply because of a personal belief. Also, as previously mentioned, a number of states that
do still allow for the exemption have proposed bills to eliminate it. It only makes sense that the federal government follow this majority approach and also not allow a
philosophical exemption under a federal program

Federal vaccine policy is uniquely important NOW --- state’s can’t provide for it
KATIE KIM AND LISA CAPITANNI 6/21/17 --- NBC Chicago Reporter for Budget Policy (“Thousands of Kids At Risk of
Not Getting Vaccines”, Katie Kim and Lisa Capitanni, June 21, 2017, http://www.nbcchicago.com/news/local/Doctors-Say-State-
Budget-Crisis-Could-Cause-Preventable-Health-Issues-429815003.html)//chiragjain

Thousands of children in Illinois are at risk of not getting their immunizations this year amid the
ongoing state budget crisis, officials said. More than 100,000 kids on Medicaid in Illinois face potentially not
get their immunizations as the state nears its third year with no budget, according to local officials of the American
Academy of Pediatrics. Under the current plans, vaccines for Medicaid Title 21 children are purchased by their

doctors, who are supposed to be reimbursed by the state through Medicaid managed care
organizations. MCO’s are state contractors. “This spring, things came to a halt in getting compensated,” said Dr. Timothy Wall, Medical
Director and President of Pediatric Health Associates. “We have had to cut back the ages of children we can give vaccines

to.” Montero Says Goodbye to Cubs, Fans in Tweets Wall’s practice is one of the largest Medicaid providers in the western suburbs. He said he’s taken out bank
loans to pay for the vaccines to give to children up to 1-year-old, but “even that’s becoming difficult.” According to the AAP, the backlog is so

burdensome for some doctors, they’ve had to stop providing immunizations altogether. “That’s a
perfect recipe for an outbreak of a vaccine-preventable disease,” said Dr. Edward Pont, who serves as the governmental
affairs chair for the Illinois chapter of AAP. What Happens If Illinois Lawmakers Don't Pass a Budget? Pont says most of the children impacted live in the densely-
populated collar counties and Western Cook County. “These
children are part of the community. They go to the camps.
They participate in schools,” Pont said. “God forbid, an outbreak of a vaccine-preventable disease occurs, it
won’t care what your kid’s insurance status is.” Ten-year-old Diego Ortiz, who is among the children impacted, visited his doctor’s office
last week for an annual summer checkup, but his family was surprised to find his three immunizations were on hold this year. Chief Must Fire Officer Seen Choking
Teen in Video: Activist “I asked why and was told the insurance is no longer covering the vaccines,” Sylvia Ortiz said in Spanish in a joint interview with NBC 5
Investigates and Telemundo Chicago. The Illinois Association of Medicaid Health Plans, which represents the MCO industry, said its members are trying to minimize
the negative impact to Medicaid families but the state hasn’t paid its bills since last fall. “At
this point, we are owed over $2 billion from
the state of Illinois,” said Samantha Olds Frey, Executive Director of IAMHP. “When an industry is owed over $2 billion, there are downstream impacts.”
For Bulls, Blockbuster Trade is All About Direction The state is bound by a consent decree to pay its bills, but the 2-year-long impasse has significantly delayed
payments. “Under current contracts, plans
that are not reimbursed by the state for more than 60 days cannot
generally be forced to immediately pay their providers. Unfortunately, this includes vaccination program payments, as well as
other bills,” said John Hoffman, Director of Communications for the Illinois Dept. of Healthcare and Family Services. Hoffman said the department has submitted
payment vouchers to the Comptroller’s Office, which is “ultimately responsible for the timeliness of state payments.” Maddon Says Cubs Making Informal Trip to
White House In response, the Comptroller’s Office sent NBC 5 Investigates a statement placing blame on the Governor’s Office. “Like the check bouncer who yells at
his bank for bouncing a check from an account he himself emptied, the Governor disingenuously blames the Comptroller for not writing checks from state coffers
that Governor Rauner emptied by failing his constitutional duty to propose a balanced budget,” said Abdon Pallasch, Director of Communications for the Office of
the Comptroller. The back-and-forth bickering does little for families and doctors feeling the pain of cuts. 'I Did It for Nothing': Inmate Details 4 Prison Killings
“There’s probably no medical provider that understands the importance of vaccination (better than pediatricians) but we cannot be expected to continue providing
vaccinations at a financial loss,” Pont said. For the Ortiz family, paying for the three vaccines that Diego needs out-of-pocket would cost more than a week’s worth
of pay. “Imagine paying almost $800…we do not have the resources to cover all that,” said Ortiz. “If I pay for the vaccines, we stop eating.” Video Shows Driver
Moments After Fiery Fatal Crash: Witness Ortiz said without a solution, Diego may not be able to return to the fifth grade in the fall. Gov. Bruce Rauner has called
lawmakers back to Springfield on Wednesday to try to negotiate a state budget before the June 30 fiscal year deadline.

Vaccination can saves millions of children’s lives every year – legislative action key
Vitolo-Haddad 15 CV Vitolo is the Director of Debate at the University of Wisconsin-Madison and a
doctoral student in the Communication Arts department, December 2015, “KAIROTIC ECLIPSES IN
VACCINE LEGISLATION: HOW OVERLAPPING SPHERES OF DISCOURSE CREATE IDEAL PUBLIC POLICY
CLIMATES”,
https://wakespace.lib.wfu.edu/bitstream/handle/10339/57425/Vitolo_wfu_0248M_10824.pdf //DJ

If these cases seem isolated, consider this: in the year Callie Van Tornhout died she was one of 160,710
reported cases of pertussis (28,639 in the United States), which resulted in the death of 195,000
children under 5 years old (13 in the U.S.).10 11 Globally, 1.5 million children under the age of 5 died
from Pertussis, Hib (199,000), Measles (118,000), Neonatal Tetanus (59,000), Non-neonatal Tetanus
(2,000), Pneumococcal Disease (476,000), and Rotavirus (453,000), all of which are vaccine-preventable.
As the World Health Organization notes, reported cases only account for a fraction of the total.12
Underreporting is also prevalent in the United States and much of the first world where, due to better
access to pharmaceuticals, cases of vaccine preventable illness are often diagnosed as general infections
and treated with antibiotics. This is what’s at stake in the fight for childhood immunization. To hear anti-
vaccination activists tell it, there are no epidemics. In a February episode of the podcast “The Vaccine
Agenda,” co-host and ‘vaccine rights’ attorney Alan viii Philips flippantly called measles an “innocuous
childhood disease.”13 I was thrown off guard to hear a pathogen which claims 400 lives every day called
‘innocuous,’ and more so to hear several others agree. How do intelligent people— lawyers, parents,
teachers, and even doctors— get caught up in such thoroughly debunked pseudoscience? The cognitive
biases that allow such dissonance not only prime the brain to believe false information, but also make
anti-vaccine sentiments closely held beliefs extremely resistant to change. Numerous studies published
in Medical Decision Making and Pediatrics have found that attempts to correct misinformation usually
fail or backfire, further ingraining false beliefs.14 15 16 Current incarnations of anti-vaccine sentiment
are responsible for some ominous recent events. Measles is usually the first disease to re-emerge when
vaccination rates decline, due to the relatively high failure rate (discussed above) and ease with which
the disease is spread. Beginning in 2008, cases of measles in the United States began to climb, increasing
from 63 cases per year to 131 in the first six months.17 The rate of outbreaks continues to increase, with
over 600 cases reported by the CDC in 2014 and 176 new cases reported by March 13, 2015.18 Despite
this unfolding public health scare, there remains a manufactured controversy implying vaccination is
open to public debate.19 If the painful reality of polio and tetanus continue to fade from public memory
and the iron lung remains something most doctors have only seen in textbooks, there will be doubts
about why vaccination is necessary.20 Questioning the need for certain vaccinations has been
exacerbated by financial backers and celebrity endorsements that undermine the credibility of
vaccination as a non-maleficent measure. Celebrities, such as Jenny McCarthy, have lent structure to
this previously leaderless movement by ix cultivating discourse about ‘the dark side’ of vaccination
policy and practice.21 Specifically, the anti-vaccination movement has successfully coordinated social
media presence, fundraising events, and lobbying efforts that have sparked declines in overall
vaccination rates in clustered regions of the United States. For example, Oregon Senate Bill 442, which
eliminated non-medical exemptions from school vaccines, was expected to pass before its first public
hearing.22 After pressure from a “vocal group of parents” the bill was abandoned, despite strong
support from medical and public health experts.23 The success of the movement has resulted in a
resurgence of diseases, such as measles and whooping cough, which had been unseen in the United
States since the 1990s. With four outbreaks of measles reaching 27 states in under two and a half
months, dire predictions that the death toll attributable to preventable diseases will only continue to
rise seem frighteningly realistic.24 In addition to tracking outbreaks in the U.S., the CDC’s global disease
tracking infrastructure has found that even slight decreases in vaccination uptakes that cluster
meaningfully produce exponentially larger decreases in herd immunity for a given community. In Japan,
where pertussis (whooping cough) vaccination rates was already low (80%), a 70% decline caused
reported cases to go from 393 per year to 13,000 in just five years.25 Areas vaccinated at lower rates
than the national average see a 100-200% increase in reported cases of pertussis for every 1% decrease
in vaccination rates below the target of 90%.26 To use the recent outbreak at Disneyland as an example,
this means for every 33,000 unvaccinated individuals who pass through Anaheim California, cases of
measles in that community doubles. When a single case has spread to 27 states in under three months,
public health officials must focus their efforts on increasing x vaccination rates. Ironically, decreases in
vaccination—largely fueled by concerns about the efficacy of vaccination as a prevention science—
coincide with the development of a newer, safer vaccine against whooping cough.27 It seems that
better vaccines lack an audience of willing recipients. This discrepancy suggests that the public climate
surrounding vaccination—that is, public understandings of and sentiments about vaccination as a health
option—influences individual vaccination practices in significant ways. Though declining herd immunity
may be associated with flawed individual understandings of vaccine technology, the solution is
definitively legislative. When considering the ease at which heuristics have been shown to overwhelm
thorough scientific evidence, we must accept a small decrease in autonomy to protect public health.
Lawmakers must heed the scientific community’s call to protect the lives of our most vulnerable by
continually re-examining the list of mandatory childhood vaccines and eliminating so-called
“philosophical exemptions.”
School sites with federal intervention in particular are key – empirically proven
Lindley et al 7 -- a National Center for Immunization and Respiratory Diseases, Centers for Disease
Control and Prevention, Atlanta, Georgia; bSan Francisco Unified School District, San Francisco,
California; c Section of Adolescent Medicine and Sports Medicine, Department of Pediatrics, Baylor
College of Medicine, Houston, Texas; dSchool of Nursing, University of Missouri, Kansas City, Missouri; e
Michigan Department of Community Health, Lansing, Michigan; f American School Health Association,
Kent, Ohio [Megan C. Lindley, MPHa, Lynda Boyer-Chu, BSN, MPHb, Daniel B. Fishbein, MDa, Maureen
Kolasa, RN, MPHa, Amy B. Middleman, MD, MPH, MSEdc , Thad Wilson, APRN, PhDd, JoEllen Wolicki,
RN, BSNe, Susan Wooley, PhD, CHESf , for the Working Group on the Role of Schools in Delivery of
Adolescent Vaccinations, August 22, 2007, The Role of Schools in Strengthening Delivery of New
Adolescent Vaccinations] MP

Vaccination in schools was first widely used when the polio vaccine was introduced in 1955, with schools
being the primary site of immunizations for children 10 to 19 years old.10 When rubella vaccine became available in 1969,
school-based programs were used to reach adolescents who had not received the vaccine as infants in
the first attempt to eliminate the disease. Success was inconsistent11: coverage increased and the incidence of congenital rubella syndrome
declined, but rubella was not eliminated in the United States until 2004.12 Nevertheless, collaboration among schools and health care

providers or other partners remains a logical approach to attaining high coverage when new vaccines
are introduced. Most recent experience with delivering vaccines in schools dates from 1992, when public health officials recognized that attempts to reduce
transmission of hepatitis B by targeting vaccination to persons at highest risk were not meeting with great success. Universal infant vaccination, therefore, was
recommended in 1991, and school-based demonstration projects were subsequently implemented to extend protection against hepatitis B to older children who
were not covered by the 1991 recommendation. Successful projects relied
on combined efforts by federal, state, and local
health departments; school employees; parents; private providers; managed care organizations; and
administrative bodies.13–15 Project costs were subsidized by health departments, the Centers for Disease
Control and Prevention, schools, vaccine manufacturers, and other local sources. A review of 9 studies of
vaccination programs in schools (8 for hepatitis B vaccination) revealed that vaccination-coverage rates
increased a median of 58 percentage points.16 Evaluations of these programs have demonstrated that well-organized school-
based vaccination with subsidized vaccine can achieve high coverage.13 However, few pilot programs evolved into statewide
voluntary vaccination programs. Programs to provide catch-up hepatitis B vaccinations to adolescents were intended to run only until high routine childhood coverage
Ultimately, school-entry laws were largely responsible for the dramatic sustained increase in
was attained.

hepatitis B coverage among adolescents in several states17,18 and continue to ensure vaccine
administration (see Fig 2 for current school-entry laws for adolescents19). Recently, growing interest in reducing community
burden of influenza by vaccinating school-aged children has led to pilot tests of schoolbased mass-
vaccination clinics in several states.20,21 Such efforts have involved collaboration by local health
departments or academic medical centers and school districts and use of manufacturer-donated in-
fluenza vaccine. Lessons learned from past school vaccination programs could inform not only school-based catch-up efforts for mandatory vaccines but also
ongoing annual programs for new vaccines. Voluntary school-based vaccination has been most successful when

conducted in response to outbreaks, usually by public health departments. Coverage increases have been
reported after use of school-based vaccination clinics during outbreaks of measles, meningococcal
meningitis, and varicella.22–24 However, the role of new adolescent vaccines in controlling outbreaks
may be limited, because many of the diseases they prevent have long incubation periods.
Disease Advantage
Disease Impact
Impact
Disease spread = Extinction
Yu 9, Victoria Yu, Dartmouth Journal of Undergraduate Science, “Human Extinction: The Uncertainty of
Our Fate”, 5-22-09 http://dujs.dartmouth.edu/spring-2009/human-extinction-the-uncertainty-of-our-
fate

A pandemic could kill all humans. In the past, humans have indeed fallen victim to viruses. Perhaps the
best-known case was the bubonic plague that killed up to one third of the European population in the
mid-14th century (7). While vaccines have been developed for the plague and some other infectious
diseases, new viral strains are constantly emerging – a process that maintains the possibility of a
pandemic-facilitated human extinction. Some surveyed students mentioned AIDS as a potential
pandemic-causing virus. It is true that scientists have been unable thus far to find a sustainable cure for
AIDS, mainly due to HIV’s rapid and constant evolution. Specifically, two factors account for the virus’s
abnormally high mutation rate: 1. HIV’s use of reverse transcriptase, which does not have a proof-
reading mechanism, and 2. the lack of an error-correction mechanism in HIV DNA polymerase (8).
Luckily, though, there are certain characteristics of HIV that make it a poor candidate for a large-scale
global infection: HIV can lie dormant in the human body for years without manifesting itself, and AIDS
itself does not kill directly, but rather through the weakening of the immune system. However, for more
easily transmitted viruses such as influenza, the evolution of new strains could prove far more
consequential. The simultaneous occurrence of antigenic drift (point mutations that lead to new strains)
and antigenic shift (the inter-species transfer of disease) in the influenza virus could produce a new
version of influenza for which scientists may not immediately find a cure. Since influenza can spread
quickly, this lag time could potentially lead to a “global influenza pandemic,” according to the Centers
for Disease Control and Prevention (9). The most recent scare of this variety came in 1918 when bird flu
managed to kill over 50 million people around the world in what is sometimes referred to as the Spanish
flu pandemic. Perhaps even more frightening is the fact that only 25 mutations were required to convert
the original viral strain — which could only infect birds — into a human-viable strain (10).

These tropical diseases can lie dormant for years, spreading through the terrible living
conditions increasing poverty. Its only a matter of time before a mass outbreak
Umair Irfan, Climatewire, 6-4-2012, (Irfan graduated from Columbia Graduate School of Journalism.)
(climatewire supplies information on the debate about climate policy and its effects.)"Exotic Diseases
from Warmer Climates Gain Foothold in U.S.," No Publication,
http://www.scientificamerican.com/article/exotic-diseases-warmer-climate-us-gain/

Diseases once thought to be rare or exotic in the United States are gaining a presence and getting new attention from
medical researchers who are probing. Illnesses how immigration, limited access to care and the impacts of climate change are influencing their spread like schistosomiasis, Chagas disease and
dengue are endemic in warmer, wetter and poorer areas of the world, often closer to the equator. According to the World Health Organization, almost 1 billion people are afflicted with more
than one tropical disease. Caused by bacteria, parasites and viruses, these diseases are spread through bites, excrement and dirty water stemming from substandard housing and sanitation.
Consequently, the United States has been largely isolated from them. But Americans are traveling more, and as tropical vacationers return home, they may unwittingly bring back dangerous

. Immigrants from endemic regions are also bringing in these diseases, some of which can lie
souvenirs

dormant for years. All the while, the flies, ticks and mosquitoes that spread these illnesses are moving north as rising temperatures make new areas more welcoming. In 2009,
dengue emerged in south Florida and infected more than 60 people, the first outbreak since 1934, according to the Centers for Disease Control and Prevention (CDC). Dengue is caused by four
closely related viruses spread by mosquitoes. It results in joint and muscle pain, severe headaches and bleeding. The outbreak was first detected in a Rochester, N.Y., woman who traveled to
Key West, Fla., for one week, with several Key West residents subsequently reporting infections. The infection rate rose to 5 percent, which CDC said indicated "a serious risk of transmission."
According to the Monroe County Health Department, there hasn't been a confirmed dengue case in the Florida Keys since November 2010. "We keep the public aware that they need to be

The outbreak may have been


dumping standing water and wearing mosquito repellent," explained Chris Tittle, public information officer at the health department.

linked to travel from Latin America and the Caribbean, where the disease's incidence has risen fourfold over the past 30 years. In 2010, Puerto
There's a substantial but
Rico faced the largest dengue epidemic in its history. However, not every outbreak is imported, and future epidemics may come from within. "

hidden burden of tropical disease in the United States, particularly among people in poverty," said Peter Hotez,
founding dean of the National School of Tropical Medicine, the first such school in the United States, at Baylor College of Medicine in Texas. Diseases like leishmaniasis often are not tracked

rigorously in this country and are classified as neglected, unlike vector-borne illnesses like Lyme disease that are monitored. Little data or public awareness Since there is a dearth of data , it
is hard to distinguish to what extent neglected tropical diseases are actually endemic in the United
States or are brought by travelers and immigrants. It is also hard to tell if the number of infections is rising or if people are just noticing them more. "In
most cases, we don't know. We're just really getting our arms around how pervasive the disease is," said Hotez, who is studying these diseases in communities along the Gulf Coast. "People
jump to the conclusion that it must be immigration coming up from Mexico or Central America, but we don't think that's the case." Hotez believes some of these diseases may be spreading

indigenously, though other infections do have stronger links to immigration. For example, Chagas disease is a parasitic infection caused by
Trypanosoma cruzi, a single-celled parasite. It causes swelling at the infection site and, if left untreated, develops into a chronic illness that can be asymptomatic or unfelt in most people and
can cause digestive, heart and nervous system failures in others. The disease is spread by triatomines, also called kissing bugs for their tendency to bite on the lips to suck blood. They are often
found in cracks and holes in walls and foundations in decrepit homes. Susan Montgomery of the parasitic diseases branch of CDC said this disease is not new to the United States. "It's been
here for a long, long time," she said. "The vector bugs have been here probably for centuries." She also said this illness is not spreading here the way it does in Latin America because the
vectors are different, though their ranges are influenced by climate. "There is no evidence that [Chagas] is an increased problem at this point. We don't live in the kind of housing that would

Arriving
put us in contact with triatomine bugs," Montgomery said. "Our triatomine bugs live in the brush, they live in the woods. They are not adapted to live in people's homes."

with illegal immigrants Changes in Chagas' prevalence are therefore related to infected people migrating
to the United States. "The concentration of positive blood donors is in areas with larger concentrations of
immigrant populations," Montgomery said. Cases emerge occasionally in Texas and Oklahoma, but triatomines do not seem to be spreading any farther. However, as the
economy improves, immigration may become a greater disease pipeline. "A lot of people don't come here through the so-called legal channels," said Marian McDonald, associate director for
health disparities at the National Center for Emerging and Zoonotic Infectious Diseases (NCEZID) at CDC. "Changes in the global economy have really sort of propelled immigration to the

United States, and that doesn't seem like it would change anytime soon."Since undocumented immigrants are difficult to track, officials
have a hard time measuring and treating infected individuals, especially for diseases like Chagas that can
remain dormant for years. "Overall, the problem for the population that is vulnerable is that they may
not have any idea that they are at risk or that they may have been exposed to it," McDonald said. Legal immigrants from
endemic regions are treated for these diseases when they enter the United States. Poverty is another compounding factor. Undocumented

immigrants tend to live in areas with poor quality housing, intermittent garbage pickup and impure
water, creating havens for infections. These illnesses can also hamper economic development. "They actually are a cause of
poverty because they interfere with child growth and development and pregnancy outcomes," said Hotez, noting
that these complications can follow someone for life. Another disease, Chikungunya, may also set up shop in the United States. The disease's name
means "that which bends up" in the Makonde language in East Africa, since the afflicted are often contorted from joint pains. The disease spreads through mosquitoes, particularly the Asian
tiger mosquito, an invasive species that is expanding from the southeastern United States and may reach as far north as New York. Laura Harrington, an associate professor of entomology at

Cornell University, expects this disease to become a bigger issue in the future . "It's not a matter of if, it's a matter of when," she said. The
disease, which has no cure or vaccine, has been seen in travelers returning to the United States from
endemic regions in 2006 and may find a new home here, since many infected don't show any signs. "The danger of Chikungunya virus being
introduced into the Americas is increasingly real," said a 2011 CDC report.

A tropical disease outbreak would spread worldwide, killing millions quickly. We


aren’t prepared, means warning is crucial
Brian Alexander, 3-10-2009, "Recession may worsen spread of exotic diseases," msnbc,
http://www.nbcnews.com/id/29599786/ns/health-infectious_diseases/t/recession-may-worsen-spread-
exotic-diseases/
To most Americans, diseases with names like dengue fever, chikungunya, malaria, Chagas and leishmaniasis might sound like something out of a Victorian explorer’s
tales of hacking through African jungles. Yet
ongoing epidemics of these diseases are killing millions of people around
the world. Now, disease experts are increasingly concerned these and other infections may become as familiar in the
United States as West Nile or Lyme disease. Few believe Americans face a killer epidemic from tropical diseases. But scientists who specialize in emerging
infectious diseases say such illnesses may become more common here as the economic downturn batters an

already weakened public health system , creating environmental conditions conducive to infectious
diseases spread by insects or other animals. At the same time, such vector-borne diseases are capable of spreading around the world much
more rapidly due to massive south-to-north immigration, rapid transportation, and global trade. “We truly did become a global village,” said Duane Gubler, Director
of the Duke/NUS Graduate School of Medicine Emerging Infectious Disease Program in Singapore. “It has been a sequence of events over a period of 30 years and
has come to a head in the last ten years. So we have sounded the alarm .” Budget cuts over a period of years have left public
health at all levels of government underfunded by $20 billion, according to a report published in the U.S. in October by the non-partisan
Trust for America’s Health. 5 deadly infections The recession has only piled on the pain, with states and counties being especially hard hit. For example,
Washington's King County was forced to cut roughly $19 million out of public health in its 2009 budget. Funding was surprisingly tiny even before the recession.
“When I started at the CDC in the summer of 2001, I was told my branch budget was zero,” said Dr. James Maguire, former chief of the CDC’s parasitic diseases
branch and now a Harvard professor. “It was always pretty sparse.” Currently, the budget for the branch is thought to be less than $75,000, not including staff
salaries. (The agency was unable to provide a definite amount.) The total for all emerging diseases was $130.3 million for fiscal 2008. By comparison the CDC
expects to spend about $103.7 million on anti-tobacco promotions. The 2009 CDC budget for chronic disease prevention, which includes heart disease, diabetes and
stroke, is more than $932 million. A significant amount of the CDC funding for emerging diseases goes to salaries and state and local health departments, explained
Dr. Ali Kahn, deputy director of the National Center for Zoonotic, Vector-Borne and Enteric Diseases at the CDC, “There is no doubt we could do a lot more in the
U.S. and worldwide with additional funds,” said Kahn. Advertise The recession has weakened the government's ability to develop better treatments, vaccines or
prevent an epidemic, experts said. “States do not have resources to keep people on board and these people are monitoring diseases, the epidemiologists doing
shoe leather investigations,” said Jeffrey Levi, executive director of Trust for America’s Health. “You cannot turn them on and off with a switch. If you lose them
you’ve lost them forever.” Once
‘conquered,’ now returning Diseases such as Chagas and leishmaniasis affect
more than 13 million people around the world each year, according to experts. These vulnerabilities in
America’s disease defensive shield comes at a time when worldwide changes have boosted the ability of
such diseases to spread. Cities in tropical Asia and Africa, for example, “have gone from 4 million to 15
million people,” Gubler explained. “These are mega cities that have inadequate housing, water and sewer
treatment, waste management,” Gubler said. “This creates ideal conditions for transmission of all kinds of
infectious diseases.” Video: Bill Gates bugs out Climate change is a wild card . Experts aren’t exactly sure what a warming climate will do. Last year, a
Virginia Tech study predicted that a 1 degree Celsius temperature rise predicted by the Intergovernmental Panel on Climate Change would bring the bugs that carry
Chagas disease into the central U.S. Will insect carriers thrive in the new region? American health officials thought they had conquered most such diseases after
World War II through a combination of mosquito-killing campaigns and public health measures like draining swamps, improved housing, better sewage and waste
control. As a result, medical professionals turned their attention to conditions like cancer and diabetes. “That’s what I call the period of complacency,” Gubler said.
“It set in during the 1970s after the war on infectious disease had been declared won.” But it wasn’t won. In a June 2008 article in the journal PLOS Neglected
Tropical Diseases, Dr. Peter Hotez, chairman of the department of microbiology, immunology and tropical medicine at George Washington University in
Washington, D.C. wrote that Americans
living in poverty, immigrants and those living in medically underserved
regions suffer from a host of such diseases, including Chagas, dengue and leishmaniasis. Increasingly,
these diseases pose a risk to the rest of the country. For example, in 2007, in the middle of a drought that should have prevented
large-scale mosquito breeding, Kern County, Calif. became the national epicenter of West Nile disease, which emerged in Africa and is spread by mosquitoes. At
least 140 confirmed cases, and four deaths, were recorded. At first, public health officials were mystified. They soon realized that because the county was an early
victim in the national housing collapse, foreclosed and abandoned homes sat with partially filled swimming pools and spas serving as mosquito love motels. Ten
years ago, managers of hunting dog kennels in upstate New York began to notice that some of the foxhounds had contracted a mysterious illness. “I got a call from
the caretaker of the dogs at Millbrook Hunt Club,” recalled Richard Ostfeld, an animal ecologist at the nearby Cary Institute of Ecosystem Studies, Millbrook, N.Y.
“The dogs were extremely sick. They were losing their hair, bleeding from their noses and mouths, having seizures, wasting. Some were dying. I wanted to be
helpful, but I didn’t know what to do.” Advertise When experts from the CDC and Walter Reed Army Medical Center in Washington, D.C. finally identified the illness,
they realized foxhounds in New York were dying of visceral leishmaniasis, a parasitic disease usually found in places like Brazil, the Middle East and India. The
disease is transmitted by a type of sand fly. Investigators still aren't sure how the foxhounds caught the disease. At the time when Ostfeld and a group of interns set
traps on the institute's 2000 acres, they found sand flies all over the place. "That was very eye-opening to me, that a tropical disease may not occur (here) but could
potentially occur because the vector occurs outside its current range,” said Ostfeld. “And by the way, we also found literally hundreds of anopheles mosquitoes, the
American malaria mosquito thought to be wiped out in the 1950s.” Diseases knocking on America's door What worries officials most is not
that somebody could step off an airplane with a disease, but that the bugs would become widespread in
the U.S. In the 1980s, an invasive mosquito species known as the Asian Tiger, an aggressive biter, arrived in a shipment of tires. It and another invasive species,
the yellow fever mosquito, have colonized territory from the Mexican border to downtown Chicago. Both can transmit dengue, chikungunya and malaria. 5 deadly
infections Last fall, researchers from Texas A&M and the CDC looking for organisms carrying Chagas, including “kissing bugs,” reported that “over half of the new
specimens found inside or near houses were infected” with the parasite. The bugs were found all over Texas often “in close proximity to human settings,” which
suggested “the presence of an active peridomestic Chagas disease transmission cycle.” There
are more than five tropical diseases
knocking on America’s door that concern public health experts. Leishmaniasis is caused by a protozoa spread through
phlebotomine sand fly bites. The most common cutaneous form of the disease causes skin lesions that can take months or even years to heal. Some forms can
result in terrible facial deformities. Visceral leishmaniasis can cause a swollen spleen and liver, fever, weight loss, anemia, miscarriage and death. Over 1,000 military
personnel serving in Iraq have contracted cutaneous forms of the disease. A few have had visceral forms. Fortunately, both forms can be treated with anti-parasitic
drugs. It also means that veterans can, and do, bring the parasite back into this country. Cutaneous leishmaniasis has occurred in south Texas for years. In April of
2008, doctors in north Texas reported nine cases in people who had not traveled out of the region, meaning it originated in the state. Chagas is a serious and
growing problem in the U.S., although there are no specific statistics of infection rates, according to experts. “We do not have enough data to say what the
magnitude is,” explained Caryn Bern, a Chagas expert at the CDC’s parasitic diseases branch. “ There
is a lot of speculation all over the map,
anywhere from 100,000 to 1 million.” Bern estimates between 100,000 and 200,000 people living in the
U.S. who have undiagnosed Chagas.
Flu pandemic kills millions – and the next one could be in 2025
Offit 6/4 --- MD, is the director of the Vaccine Education Center at the Children’s Hospital of Philadelphia and the author of Vaccinated:
One Man’s Quest to Defeat the World’s Deadliest Diseases (HarperCollins, 2007). (Paul A., “The Next Plague Is Around the Corner,” 6/4/17,
http://www.thedailybeast.com/the-next-plague-is-around-the-corner?source=twitter&via=desktop)//ernst

Tony Fauci is the director of the National Institute of Allergy and Infectious Diseases (NIAID) at the National
Institutes of Health (NIH). It’s Fauci’s job to stop plagues before they start. Recently, Fauci was asked which infection
scared him the most. The questioner assumed that he would say Ebola or Zika or MERS or SARS—all infections for which no vaccines
and no anti-viral medicines are commercially available. But he didn’t. “Pandemic influenza,” he said. Fauci isn’t the only one talking
about pandemic flu these days. On April 7, 2017, Sanjay Gupta hosted a program on CNN titled “Unseen Enemy.” Gupta linked his program to
an article titled, “The Big One Is Coming, and It’s Going to Be a Flu Pandemic”. On April 21, 2017, the Centers for Disease
Control and Prevention (CDC) published a monograph titled, “Community Mitigation Guidelines to Prevent Pandemic Influenza—United States,
2017,” highlighting non-pharmaceutical interventions to stop the spread of flu like face masks, quarantine, and school closures. Our fear of an
influenza pandemic is best explained by the derivation of the word pandemic, meaning “all people.” Several times a century, influenza sweeps
across the globe. For example: • Between 1918 and 1919, Spanish influenza infected up to 40 percent of the
world’s population, killing 50 million people. In the United States, between September 1918 and April 1919, 675,000 people
died from the disease. • Between 1957 and 1958, Asian influenza killed 4 million people in the world and 70,000
in the United States. One reason that Asian flu wasn’t as deadly as Spanish flu was that an American scientist saw it coming
and made a vaccine to prevent it—the first person in history to successfully predict and modify an influenza pandemic. His name
was Maurice Hilleman. Decades later, Hilleman made a predication about the next great influenza pandemic. On April 17, 1957, while sitting in
his office at the Walter Reed Army Medical Research Institute, Hilleman read an article in the New York Times titled “Hong Kong Battling
Influenza Epidemic.” “I saw an article that said that there were 20,000 people lined up being taken to the dispensaries,” he said. “And children
with glassy-eyed stares, tied to their mother’s backs, were waiting to be seen.” Public health officials estimated that the virus had already
infected 250,000 people, 10 percent of Hong Kong’s population. Hilleman put down the paper: “My God,” he said, “This is the pandemic. It’s
here.” One month later, Hilleman received throat washings from a navy serviceman infected with the virus. Hilleman tested sera from hundreds
of civilians in the United States to see whether anyone had antibodies to the virus. No one did. The strain of virus circulating in Hong Kong was
new. Hilleman then sent samples of what was later called Asian flu to six American-based vaccine manufacturers. He figured that if he were to
have any hope of saving American lives, he would have to convince companies to make and distribute influenza vaccine in four months. He also
knew that the production of millions of doses of influenza vaccine would require hundreds of thousands of eggs a day. He urged farmers not to
kill their roosters, even though it was late in the hatching season. Pharmaceutical companies made the first lots of Asian influenza vaccine in
June 1957. Vaccinations began in July. By late fall, companies had distributed 40 million doses. At the beginning of the school year, Asian
influenza entered the United States. The National Health Survey estimated that during the week of October 13 alone, 12 million people were
sick with influenza. Within a few months, influenza had infected 20 million Americans. Although the 1957 pandemic killed only a fraction of
those killed during the 1918 pandemic, the two pandemics shared one sad feature: the disease disproportionately killed healthy young people.
During the 1957 pandemic more than 50 percent of infections occurred in children and teenagers, at least a thousand of whom died from the
disease—numbers that would have been far greater had it not been for Hilleman’s vaccine. Before he died in 2005, Maurice Hilleman
believed that he had detected a pattern in influenza pandemics that allowed him to predict the next
one. The father of modern vaccines, Maurice Hilleman had participated in either the primary research or development on 9 of the 14 vaccines
currently given to young children. He had spent much of his career being right. So his prediction had to be taken seriously. Influenza viruses are
defined in part by a protein that sits on the surface of the virus called the hemagglutinin or H protein. Antibodies directed against this H protein
neutralize the virus. Although 17 different H proteins have been identified, only three have ever caused pandemics: H1, H2, and H3. Hilleman
believed that future influenza pandemics could be predicted from the past: H2 virus caused the pandemic of 1889. H3 virus caused the
pandemic of 1900. H1 virus caused the pandemic of 1918. H2 virus caused the pandemic of 1957. H3 virus caused the pandemic of 1968. H1
virus caused the mini-pandemic of 1986. Hilleman saw two patterns in these outbreaks. First,
the types of hemagglutinins
occurred in order: H2, H3, H1, H2, H3, H1. Second, the intervals between pandemics of the same type were
always 68 years—not approximately 68 years, but exactly 68 years. For example, an H3 pandemic occurred in 1900 and 1968; an H2
pandemic in 1889 and 1957; and an H1 pandemic in 1918 and 1986. Sixty-eight years was just enough time for an entire generation of people
to be born, raised, and die. Using this logic, Hilleman
predicted that an H2 influenza virus, similar to the ones that had caused
disease in 1889 and 1957, would cause the next pandemic—a pandemic that would begin in 2025. As it turns out, Maurice
Hilleman was wrong. The H1 pandemic of 2009, which affected 59 million Americans, causing 265,000 to be hospitalized and 12,000 to die,
didn’t fit into Hilleman’s scheme. When Hilleman made his prediction in 2005, knowing that his death was imminent, he said, “We’ll soon know
whether I was right or wrong. And I’ll be watching. I’ll be looking down—or up—to find out what happened.”
Timeframe
Global pandemics are likely and will cause massive death --- status quo airborne and
transportation means that diseases have rapids tunnels of transportation
BENJAMIN HARACK 3/21/2016 --- Engineering at The Human Diagnosis Project and Omnologist at Earth and Condensed News
(“How likely is human extinction due to a natural pandemic?”, Vision of Earth, Benjamin Harack, March 21, 2016,
www.visionofearth.org/future-of-humanity/existential-risks/human-extinction-by-natural-pandemic/)//chiragjain

A pandemic is the rapid spread of an infectious disease across a large region. Global pandemics will
likely occur in the future, but their danger is very hard to estimate. So far, pandemics have received far more
attention than other natural existential threats and our analysis below indicates that this level of attention is
appropriate. Today, a disease can travel faster than ever before. Thanks to long distance air travel, an
infectious agent can quickly spread to all continents. In fact, most humans are now connected by one or
more of our rapid transportation networks. On the other hand, enormous effort is being expended to
prevent pandemics today. Serious work can be done on many fronts simultaneously because pandemics
arise out of interactions between large numbers of people, animals, and institutions. Unfortunately, this complexity also
means that for the foreseeable future our defenses will not be perfect and our uncertainty will be extreme.1 The
complexity of pandemics is also the reason why straightforward extrapolations from history tend to be
deeply flawed. Human civilization today is unprecedented in several relevant ways. We can’t study past examples of globe-spanning
civilizations who actively tried to protect themselves from this danger. Knowledge of past pandemics is still incredibly
valuable, it’s just very hard to meaningfully generalize to our situation.

Spread of diseases happens rapidly


Hotez 10 (Peter J. Hotez, scientist, pediatrician, and leading advocate and expert in the fields of global health,
vaccinology, and neglected tropical disease control. He serves as founding dean of the Baylor College of Medicine
National School of Tropical Medicine, chief of the new Section of Tropical Medicine in the BCM Department of
Pediatrics and holds the Texas Children’s Hospital Endowed Chair in Tropical Pediatrics. He is also President of the
Sabin Vaccine Institute, headquartered in Washington, DC; and leads the Sabin Vaccine Institute and Texas
Children's Hospital Center for Vaccine Development. Recently, he was named the Fellow in Disease and Poverty at
Baker Institute for Public Policy at the Rice University,
http://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0000680, “Nuclear Weapons and Neglected
Disease: The ‘Ten-Thousand-to-On e Gap’”, April 27 2010)

Bacterial Neglected Diseases: Almost one-half of the world's 60–80 million trachoma cases
occur in nuclear weapons states, with China having the highest number of cases of any nation
[30]. Similarly, India has the highest number of leprosy cases, with more than one-half of the
new infections that occur annually in the world [31]. Following the collapse of the former
Soviet Union in 1991, as a result of the disintegration of the state-run health care system and
other political and socioeconomic changes, the rate of congenital syphilis rose at a rate 34
times higher than was seen in Western Europe [32].
Children Die
Disease worse than vax side-effects
There are far greater risks of preventable disease outbreaks than complications from
vaccines
Reiss 15 Dorit Rubinstein Reiss Professor of Law, University of California Hastings College of Law, “Herd
Immunity and Immunization
Policy: The Importance of Accuracy”, https://law.uoregon.edu/images/uploads/entries/Reiss.pdf //DJ
The authors do not correctly characterize the legal framework behind the state’s responsibility to
protect children, the basis of which is not a tort-like duty. It may be that the term “duty” confused the
authors; “responsibility” might be a better term. Parens patriae, the term used to capture the state’s
duty to its most vulnerable members, is not about whether a state can be sued for failing to protect a
child.4 The issue focuses on the state’s—or society’s—responsibility to safeguard children’s welfare
when parents cannot or will not meet some minimum standard.5 The modern basis of the idea is that
children are not property; they have rights and interests of their own, and the state may regulate
parents’ actions to safeguard those interests.6 Parens patriae is a basic and well-established concept. Its
application in a specific case may be debatable, but the concept itself is not suspect in the least.7 In the
context of vaccines, the question is whether parens patriae justifies mandating vaccines in any way. In
Prince v. Massachusetts, the Supreme Court—addressing a different issue—stated that a parent “cannot
claim freedom from compulsory vaccination for the child more than for himself on religious grounds.
The right to practice religion freely does not include liberty to expose the community or the child to
communicable disease or the latter to ill health or death.”8 The Court here highlights the interest of the
child to be free of a preventable disease. These interests are given short shrift in Holland and Zachary’s
analysis. Part of the problem, as demonstrated in the section regarding “Promotion of a Familial Duty to
Protect Children,” is the seeming assumption that parents’ duty to protect their children applies only to
protection from the potential harms of vaccines.9 The authors ignore parents’ duty to protect their child
against preventable, potentially fatal diseases such as Haemophilus influenzae type b (Hib), polio,
measles, and diphtheria. This problem is especially glaring as the risk of the diseases in question is an
order of magnitude larger than the very rare chance that a modern vaccine will cause a serious, long-
term problem. Examining one vaccine, a recent study of measles-containing vaccines highlighted
problems caused by the vaccines including fever and febrile seizures.10 Febrile seizures should not be
confused with seizure disorders like epilepsy; febrile seizures are caused by fever, are surprisingly
common among children, and, although frightening to parents, generally do not cause long-term
harm.11 The vaccine can also cause temporary low platelet counts in rare cases (about 1:40,000,
according to the Center for Disease Control & Prevention (CDC))12 and, very rarely (about 1.5 to 1.8
cases out of every million doses), can cause a severe allergic reaction.13 In contrast, just one of the
diseases—measles—has a substantially higher rate of serious complications. According to the CDC:
“Before the measles vaccination program started in 1963, we estimate that about 3 to 4 million people
contracted measles each year in the United States. Of those people, 400 to 500 died, 48,000 were
hospitalized, and 4,000 developed encephalitis (brain swelling) from measles.”
Exemptions I/L
Generic
Exemptions destroy the effectiveness of vaccines --- statistics and recent outbreaks
prove
EMILY OSHIMA LEE, LINDSAY ROSENTHAL, AND GABRIEL SCHEFFLER 11/14/13 --- Emily Oshima Lee is a Policy
Analyst with the Health Policy team at the Center for American Progress. Lindsay Rosenthal was a research assistant for Women’s Health and
Rights and Health Policy at the Center. Gabriel Scheffler was a Ford Foundation fellow with the Health Policy team at the Center. (“The Effect of
Childhood Vaccine Exemptions on Disease Outbreaks”, Center for American Progress, Emily Oshima Lee, Lindsay Rosenthal, Gabriel Scheffler,
November 14, 2013, https://www.americanprogress.org/issues/healthcare/reports/2013/11/14/76471/the-effect-of-childhood-vaccine-
exemptions-on-disease-outbreaks/)//chiragjain

Vaccination is one of the most cost-effective and successful public health interventions. Each year, vaccines
save an estimated 6 million to 9 million lives worldwide, including the lives of 3 million children. In the United
States, vaccinations have decreased most vaccine-preventable childhood diseases by more than 95
percent. Vaccines have minimized or eliminated outbreaks of certain diseases that were once lethal to
large numbers of people, including measles and polio in the United States and smallpox worldwide. But because the bacteria and viruses that cause diseases still exist, the public
health gains achieved through vaccines can only be maintained by ensuring that vaccination rates remain high enough to prevent outbreaks. Vaccines are effective not

only because they protect individuals who have been vaccinated but also because they confer a broader protection for

communities by establishing “herd immunity.” When sufficiently high proportion of a population is


vaccinated against communicable diseases, the entire population can obtain protection. As the number of vaccinated people in a given population
increases, the likelihood that a susceptible person will come into contact with an infected person decreases; it ultimately becomes difficult for a disease to maintain a chain of infection.

Herd immunity is
Although the vaccination rate required to achieve herd immunity varies by vaccine, it typically ranges from 80 percent to 95 percent of a given population.

critical for protecting the health of many groups of people who are especially vulnerable to communicable diseases: those who
cannot be vaccinated, either because they are too young or because an immunological condition makes
vaccination too risky; those who choose—or whose parents choose for them—not to get vaccinated for nonmedical
reasons such as religious or personal beliefs; and those who have been vaccinated but whose
immunological response is insufficient to protect them from potential infection. Because children are especially vulnerable to certain diseases and because
vaccines help the body to develop disease immunity over time, many vaccines are most effective when administered to children at a young age and based on a recommended immunization
schedule. A significant number of children in the United States, however, do not receive the fully recommended schedule of vaccinations. These children fall into two broad categories: the
unvaccinated, who do not receive any immunizations, and the undervaccinated, who do not receive the fully recommended vaccine schedule. Unvaccinated and undervaccinated children are

children tend to be
socioeconomically and demographically distinct populations, and separate factors account for why they are not fully vaccinated;. Generally,

unvaccinated due to their parents’ decision to take advantage of vaccine exemptions, whereas many
children are undervaccinated because of barriers to access, such as poverty and the cost of vaccines. Although all states have
vaccination mandates for schoolchildren, in recent years they have granted a growing number of nonmedical exemptions .

As a result, the risk of infectious disease outbreaks—especially among children—has increased. Clusters of

exemptions have cropped up in certain communities, eliminating those communities’ herd immunity and leading to outbreaks of vaccine-
preventable diseases. While the issues of nonvaccination and undervaccination must be addressed to protect children and their communities from significant health risks, this brief focuses

We survey the research on state childhood


solely on children who are not immunized due to parents’ use of nonmedical vaccine exemptions.

vaccination mandates and exemption categories, focusing on the role that nonmedical exemptions play
in reducing immunization coverage in communities throughout the United States. After reviewing the
evidence, we suggest possible responses at the state and federal levels. Current vaccination and exemption policies All states
currently require children older than age 5 who attend public school or state-licensed day care facilities to receive a series of vaccinations prior to enrollment, though these requirements vary
in terms of the number of vaccines required and the school grades covered. While vaccination mandates exist for certain groups of adults, such as military personnel, employees of certain
health care facilities, and immigrants who are seeking permanent residence in the United States, the majority of vaccine mandates apply to children. Although all state school immunization
laws grant medical exemptions for children who are susceptible to adverse effects from vaccination, states have different policies regarding nonmedical exemptions. Every state except
Mississippi and West Virginia grants some kind of religious exemption, while 17 states allow for“personal belief ” or philosophical exemptions. In addition, the administrative procedures for
obtaining nonmedical exemptions are much more lenient in some states than in others. Some states require that parents renew their exemption annually, obtain a signature from a local

In other states, however, it is


health department official, notarize their exemption form, or write a personal letter explaining their reasons for refusing vaccination.

much easier to procure an exemption. In Maryland, for example, as of 2006, parents could obtain a religious exemption simply by signing and submitting a
prewritten form. According to one study, in 23 states, school officials were not even authorized to deny exemption requests if the requests fulfilled state requirements. In practice—because

there are additional within-state variations in the types of


much of the responsibility for enforcing exemption laws falls on school officials—

exemptions granted and the processes for approving exemptions. For example, one study found that even in
Massachusetts and Missouri, two states that do not allow for personal-belief exemptions, 18.1
percent and 17.0 percent of schools, respectively, permitted personal-belief exemptions anyway.
Administrative procedures can also vary within states. Michigan, for example, has no standard statewide process for
granting exemptions. Even among states that do have statewide exemption procedures, there is significant variation in how those policies are enforced at the school level. The
growth of nonmedical vaccine exemptions In recent years, there has been an increase in state-level rates of nonmedical

exemptions from vaccination mandates for schoolchildren. Nationwide, the ratio of nonmedical exemptions to state vaccination mandates still remains
relatively low, but between 1991 and 2004, the mean state-level rate increased from 0.98 percent to 1.48

percent. Perhaps more significantly, clusters of exemptions have emerged in individual communities, eliminating
those communities’ herd immunity and increasing their risk of experiencing an outbreak. In the
community of Ashland, Oregon, for example, the vaccination exemption rate for schoolchildren during
the 2001-02 school year was 11 percent, compared with a rate of 2.7 percent for the entire state and 3
percent nationwide. These exemption clusters are dangerous because if enough individuals within a particular community receive exemptions, then the community will lose its
herd immunity. In turn, this loss of immunity increases the risk of infection not only for other exemptors—both nonmedical and medical—but also for some individuals who have been

vaccines are victims of their


vaccinated since no vaccine is 100 percent effective. There are a number of factors that have influenced the rise in nonmedical exemptions. To some degree,

own success; they have reduced the incidence of vaccine-preventable diseases so much that a growing number
of people are less concerned about contracting them. At the same time, public concern about the real or
perceived adverse health effects from vaccines has increased. But one important part of the explanation for the rise in nonmedical
exemptions lies in the ways that states have constructed exemptions to their vaccination mandates. More specifically, research shows that the states that grant

philosophical exemptions or make it easy to apply for exemptions have greater numbers of
nonmedical exemptions. In every state for which the Centers for Disease Control and Prevention, or CDC, had data on vaccination rates for children enrolled in
kindergarten from 2009 to 2010, the number of philosophical exemptions exceeded the number of religious exemptions. One study estimated that from 2005 to 2011, the rates of nonmedical
exemptions in states that allowed philosophical exemptions were 2.5 times higher than in states that only allowed religious exemptions. The rates of exemptions in states with easy exemption
policies were 2.3 times higher than in states with rigorous exemption policies. Recent studies, however, suggest that states that only have religious exemptions or moderate or difficult
administrative processes may be catching up. In recent years, the growth rate of exemptions in those states outpaced that of states with philosophical exemptions or lenient application

rise in nonmedical exemptions has contributed to recent


procedures. The impact of nonmedical exemptions on disease outbreaks This

outbreaks and increased rates of vaccine-preventable diseases, such as measles, pertussis, and
whooping cough. In 2008, for example, the CDC reported 131 cases of measles in the United States—more than
double the yearly average from 2000 to 2007. According to the CDC, “This increase was not the result of a greater number of imported cases, but was the
result of greater viral transmission after importation into the United States.” The cases occurred “largely among school-aged children who were eligible for vaccination but whose parents

children who
chose not to have them vaccinated.” A study published in the Journal of the American Medical Association, or JAMA, supports the CDC’s conclusion, finding that

have been exempted from vaccination requirements were 35 times more likely to contract measles than
vaccinated children. Another study found that exemptors were more than 22 times as likely to contract measles. At the same time, pertussis—a disease that was once considered “doomed by
science”—has enjoyed a renaissance. The CDC reports that there were more provisional cases reported in 2012 than in any previous year since 1955, and that 49 states and Washington, D.C.,
reported a rise in reported cases compared to the previous year. In 2010, a pertussis outbreak in California led to the hospitalization of 455 infants and 10 deaths; in 2012, both Washington
state and Minnesota reported pertussis epidemics. Some of this resurgence may be attributable to other factors, such as the acellular pertussis vaccine’s diminished long-term effectiveness.
But there is a substantial body of research showing that the growth of nonmedical exemptions—itself driven in part by philosophical exemptions and lax exemption procedures—has
contributed to an increase in the overall incidence of pertussis and a rise in the risk of pertussis outbreaks in specific communities. Another JAMA study, for example, reports that the incidence
of pertussis was more than twice as high in states that allow personal-belief exemptions as in states with only religious exemptions, and that states with easy exemption procedures had a
incidence of pertussis that was 90 percent higher than states with difficult procedures. Another group of researchers conducted a study of children in Colorado and found that exemptors were
nearly six times more likely to contract pertussis. The impact of nonmedical exemptions has been particularly acute in specific communities where relatively high proportions, or “clusters,” of
individuals utilized available exemptions. One study found that pockets of high exemption rates exist in Michigan despite its high overall state-level rate of vaccination and that those census
tracts with clusters of nonmedical exemptions are three times more likely to have pertussis outbreaks. Another study recently examined rates of religious exemptions in New York state over
time and concluded that counties with higher exemption rates had higher rates of reported pertussis compared to low-exemption counties.
Fake Exemptions Kill Solvency
Exemptions are barely ever for legit reasons --- most parents make sham religions or
philosophical beliefs because they’re lazy
ANTHONY CIOLLI 2008 --- University of Pennsylvania Law School and University of Pennsylvania School of Medicine JD and MBE
(“Mandatory School Vaccinations: The Role of Tort Law”, Anthony Ciolli, 2008, Yale Journal of Biology and Medicine,
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2553651/#R13)//chiragjain

The United States is on the verge of a public health crisis. For decades, all 50 states have required that parents
vaccinate their children against various diseases, including polio and measles, as a prerequisite to enrolling them in public schools [1].
While virtually all states have tailored their immunization statutes to exempt those with religious (and

sometimes philosophical) objections to vaccines from these requirements [2], widespread use of these
exemptions threatens to undermine many of the benefits of mandatory vaccinations, such as
preserving “herd immunity” [3]. Since it is unlikely that state governments will eliminate such
exemptions outright, society must consider other methods of providing incentives for vaccination and
compensating those who have suffered due to a disease outbreak caused by a community’s loss of
herd immunity. This essay will propose using tort law as a mechanism for prevention and victim compensation while still preserving religious and
philosophical exemptions to mandatory school vaccinations. Part I will provide a short overview of mandatory school vaccinations and the dangers posed by
widespread use of religious and philosophical exemptions. Part II will explore the potential role of tort law, with a particular emphasis on private causes of action
against specific individuals and the possibility of defendant class action lawsuits. Part III will examine whether tort law is an appropriate remedy. Go to: An Overview
of Mandatory School Vaccinations Why Mandatory Vaccinations? States
institute mandatory immunization requirements as a
prerequisite to public school enrollment because it is the most efficient method of perpetuating herd immunity. Herd immunity is present in
a community when such a high percentage of its members have been immunized from a particular disease that the disease cannot gain a foothold in the community
[3]. Thus, achieving and maintaining herd immunity protects not only those who have been vaccinated, but
also those with compromised or weak immune systems, such as the elderly, babies, and those afflicted with HIV [3,4,5]. But herd
immunity does not just reduce levels of human suffering. Since achieving herd immunity is an inherently preventive measure, mandating school

vaccinations as a method of perpetuating herd immunity is far less costly for governments, health care
providers, and the economy than treating victims of a disease after it has appeared in a community. The preventable 1989-91 measles outbreak in the United
States, for example, created $100 million in direct medical costs alone [6]. Herd immunity, then, is not only the most efficient method of preventing illness and
human suffering, but also the most cost effective. Religious & Philosophical Exemptions to Mandatory Vaccinations Although many organized religions, including
Catholicism and Judaism, do not prohibit vaccinations,1 several
smaller religious sects, most notably Christian Scientists and the Amish, oppose
vaccination on religious grounds [3]. Other individuals oppose vaccination for other reasons, ranging from non-
religious philosophical or moral beliefs, such as a belief that vaccines interfere with “nature’s genetic blueprint” [8], to unspecified “personal reasons.”2
Religious and other exemptions to mandatory vaccination laws are not required by the U.S.
Constitution.3 However, since 100 percent immunization rates are not needed to achieve herd
immunity,4 most state governments have chosen to exempt certain individuals from their mandatory
vaccination requirements, believing that communities can obtain herd immunity even if such individuals do not become immunized. Most notably, 48
out of 50 states have exempted those whose religious beliefs forbid vaccination [2]. Eighteen states also have made the more controversial decision to exempt
individuals who claim to possess non-religious cultural or philosophical objections to vaccines,5 which in some states are granted merely by checking one box on a
simple form [9]. Such exemptions are not surprising, “[g]iven Americans’ deep respect for individual freedom”
and the fact that “absolutely mandatory immunization laws meet stiff resistance” [13]. However, continuing
recognition of such exemptions may not be sustainable in the long run. The Dangers of Religious and Philosophical Exemptions In recent years, the

core premise behind allowing religious and philosophical exemptions — that communities can still
achieve herd immunity even if such exemptions are granted — has come under significant doubt. Religious
Communities as Disease “Hot Spots.” Governments traditionally have considered “communities” in relatively broad

terms, viewing entire states — or sometimes even the whole nation — as a “community” for herd immunity purposes [14]. However, recent
experiences have demonstrated that actual communities are far smaller. For instance, although nationwide
measles vaccination rates appeared high enough to ensure national herd immunity, disproportionately
low vaccination rates among blacks and Hispanics resulted in measles outbreaks in several large urban
areas, most notably Los Angeles [15]. Religious communities — particularly Christian Science, Amish, and Mennonite
communities — have been the source of many preventable disease outbreaks in recent years. Diseases
from polio [16] to measles [17] to rubella [18] have resurfaced with increasing frequency in the United
States due to herd immunity being lost in such religious ghettos. This comes at a tremendous cost to society, for “vaccine-
preventable diseases impose $10 billion worth of healthcare costs and over 30,000 otherwise avoidable deaths in America each year” [19]. Religious and
Philosophical Exemptions as Exemptions of Convenience. However, those with genuine religious objections to vaccination do not
represent the entirety of the threat to society. Many individuals increasingly have taken such exemptions
not because of genuine beliefs, but because they are simply too lazy to vaccinate their children. Since such
parents “do not bear [the] negative externality costs or harms” of losing herd immunity directly, they “may not take them into account in

making their decision not to be immunized” [20]. In fact, thousands of parents have joined mail-order or
sham religions, such as the “Congregation of Universal Wisdom,” so they can qualify for religious
exemptions and not have to go to the trouble of vaccinating their children.6 The situation is even worse in states where one can
obtain an exemption for non-religious “philosophical” reasons, with such states frequently having the highest vaccination opt-
out rates in the nation [22]. Admittedly, individuals may take advantage of philosophical exemptions for a wide

range of reasons, ranging from “devotion to ‘natural’ or alternative healing” to “libertarian opposition to state
power” to “mistrust of pharmaceutical companies” to a “belief that vaccines are not as safe as experts
claim” [23]. However, there is little doubt that many parents use such exemptions out of mere convenience
rather than sincere belief — for instance, one recent empirical study has shown a significant relationship between

religious and philosophical exemption rates and the level of “red tape” or governmental scrutiny used to
get the exemption, with states with very simple exemption processes having the highest exemption rates and states with very complex procedures having
the lowest [22]. The widespread and growing use of religious and philosophical exemptions for convenience

may, in the long run, jeopardize herd immunity, not just in religious communities, but secular ones as
well.
Any Exemptions = Disease

Exemptions allow disease outbreak hotspots and cause immense healthcare costs
ANTHONY CIOLLI 2009 --- University of Pennsylvania Law School and University of Pennsylvania School of Medicine JD and MBE
(“Religious &(and) Philosophical Exemptions to Mandatory School Vaccinations: Who Should Bear the Costs to Society”, Anthony Ciolli, 2009,
Missouri Law Review, http://scholarship.law.missouri.edu/cgi/viewcontent.cgi?article=3820&context=mlr)//chiragjain

I. THE COSTS OF RELIGIOUS & PHILOSOPHICAL EXEMPTIONS Many scholars fear that "serious
consequences will follow the
proliferation of legally sanctioned exemptions to compulsory vaccinations." 6 Although many who support
religious and philosophical exemptions view the decision to vaccinate one's child as an individual rights issue, such a focus
ignores that the benefits of mandatory vaccination are communal as well as individual. Thus, it should
come as no surprise that the cost of widespread non-compliance with mandatory school vaccinations
will not only result in the loss of such communal benefits, but will also impose significant costs on the
entire community. A. Non-Medical Exemptions Jeopardize Herd Immunity When a critical mass of a community's
members are vaccinated from a given disease, "herd immunity" prevents that disease from gaining a foothold
in the community. The very high percentage of immunized individuals serves as a "protective barrier" that keeps the disease from spreading to
those who are too young to be immunized or have compromised immune systems due to old age or diseases such as AIDS.7 Creating such
a protective barrier through herd immunity has always been one of the major goals of mandatory school
immunization laws - by immunizing virtually all school children in a given community, state governments can
ensure that the "herd immunity" effect will continue in perpetuity, as community immunization levels continue to remain at the
high percentage required to prevent the spread of disease. 8 Religious and philosophical exemptions may jeopardize
herd immunity in certain communities. Although the percentage of the population that must be
immunized to ensure herd immunity varies depending on the disease, it will remain a relatively large percentage - for
instance, more than 90 percent of the population must be immunized in order to provide herd immunity
protection from measles. 9 Given that a certain percentage of the population cannot receive a vaccine for legitimate medical reasons,
even a relatively small number of individuals using religious and philosophical exemptions to exclude their children from mandatory school
vaccinations can eliminate a community's herd immunity against certain diseases.' 0 Not surprisingly, the
loss of a community's herd
immunity may result in an outbreak of that disease in the community. In fact, many such disease "hot
spots" have arisen in communities with a relatively high number of religious exemptions. For example,
America's last two polio outbreaks began in Amish, Mennonite, and Christian Science communities."
Outbreaks of other preventable diseases, such as measles and rubella, have also originated in communities where many parents have not
vaccinated their children for religious reasons.12 B. The Monetary Costs But
such outbreaks have an impact beyond the
suffering caused in those particular communities. The creation of disease hotspots due to widespread use of
religious and philosophical exemptions "deals a serious monetary blow to our cash-strapped medical system."'13
For instance, the U.S. measles outbreak that took place between 1989 and 1991 created costs of more than $100 million in medical expenses
alone. In fact, "vaccine-preventable
diseases impose $10 billion worth of healthcare costs and over 30,000
otherwise avoidable deaths in America each year."'1
AT: Herd Immunity
95% is necessary for herd immunity – 100% should be the aim
Marcel Salathe 15 --- assistant professor of biology and adjunct faculty of computer science and engineering at Pennsylvania State
University. (2-3-2015, "Why a few unvaccinated children are an even bigger threat than you think,"
https://www.washingtonpost.com/posteverything/wp/2015/02/03/why-a-few-unvaccinated-children-are-an-even-bigger-threat-than-you-
think/?utm_term=.3c21c178c18f)//ernst

The measles outbreak traced back to Disneyland has spread to 14 states, with as many as 102 cases
reported. Media outlets are highlighting the rise of anti-vaccination sentiments. Scientists are expressing their dismay at people who reject
sound medical advice and put their families and communities in harm’s way. Measles was considered eliminated in the
United States in 2000. But if the first month of 2015 is any indication, this year will easily beat the record number of measles cases
recorded in 2014. The narrative during this outbreak, or any measles outbreak really, is that measles is a highly transmissible disease. So
transmissible in fact that 90 percent to 95 percent of people must be vaccinated in order to protect the entire population, or achieve what is
called herd immunity. That is partly true. Measles
is highly transmissible, not least because people can be
contagious days before symptoms develop. But there are three problems with this line of reasoning about vaccination rates.
First, the numbers are based on calculations that assume a world of random mixing. Second, the vaccination coverage is not a perfect measure
of immunity in the population. Third, and most problematic in my view, it gives people a seemingly scientific justification for not getting
vaccinated – after all, if not everyone needs to get vaccinated in order to attain herd immunity, can it really be so bad if I opt out of it? What
exactly is herd immunity? Let’s look at the concept of herd immunity first. The basic idea is that a group (the “herd”) can avoid exposure to a
disease by ensuring that enough people are immune so that no sustained chains of transmission can be established. This protects an entire
population, especially those who are too young or too sick to be vaccinated. But how many people need to be immune to achieve this? In
order to calculate the number of people who need to be immune for herd immunity to be effective, we
need to know how many people will get infected, on average, by an infectious person. Imagine that a newly
infected person will on average pass on the disease to two other people. Those two will each infect another two people, who will themselves
pass it on, and so on, resulting in the classical pattern of an exponentially growing outbreak. Without
vaccination, a disease like
the measles can spread rapidly, causing huge outbreaks. (Marcel Salathé) In order to stop the growth in the
number of transmissions, we need to ensure that each individual case causes, on average, less than one
new infection. So, let’s say that one case leads on average to two more infections, but instead we want
that number to be less than one. That means at least 50 percent of the population needs to be immune,
so that at most, only one of the two people who might have been infected by an individual will be. When
the vaccination coverage reaches a certain threshold, full herd immunity can be attained in principle. (Marcel Salathé) How many people need
to get vaccinated to achieve herd immunity? So, how do we calculate what fraction of a population needs to be immune to reach herd
immunity? First, we need to know what the reproduction number, or R, is. That’s how many new cases a single case of an infection will cause.
Imagine that you are infected in a completely susceptible population, and you pass on the infection to five other people (ieR=5). In order to
prevent an outbreak, at least four out of those five people, or 80 percent of the population in general, should be immune. Put differently, 20
percent of the population may remain individually susceptible, but the population would still remain protected. So if you can estimate the
reproduction number for a given disease, you can calculate the fraction of the population that needs to be immune in order to attain herd
immunity. For influenza and Ebola, the number R is about two. For polio and smallpox, it is around five to eight. But for measles it is much
higher, somewhere between 10 and 20. And because of that, the goal for measles vaccination coverage is typically around 90 percent to 95
percent of a population. But there’s a problem with this calculation. The population is not random The
assumption underlying the
calculation for herd immunity is that people are mixing randomly, and that vaccination is distributed
equally among the population. But that is not true. As the Disneyland measles outbreak has demonstrated, there are communities
whose members are much more likely to refuse vaccination than others. Geographically, vaccination coverage is highly variable on the level of
states, counties, and even schools. We’re fairly certain that opinions and sentiments about vaccination can spread in communities, which may
in turn lead to polarized communities with respect to vaccination. And media messages, especially from social media, may make the problem
worse. When we analyzed data from Twitter about sentiments on the influenza H1N1 vaccine during the swine flu pandemic in 2009, we found
that negative sentiments were more contagious than positive sentiments, and that positive messages may even have back-fired, triggering
more negative responses. And in measles outbreak after measles outbreak, we find that the vast majority of cases occurred in communities
that had vaccination coverages that were way below average. The sad truth is this: as long
as there are communities that
harbor strong negative views about vaccination, there will be outbreaks of vaccine-preventable diseases
in those communities. These outbreaks will happen even if the population as a whole has achieved the vaccination coverage considered
sufficient for herd immunity. When
vaccination is not equally distributed, but clustered in communities, large
outbreaks are possible even when vaccination coverage in the overall population is high. (Marcel Salathé) If
negative vaccination sentiments become more popular in the rest of the population as well, we may start to see more sustained transmission
chains. Once those chains are sufficiently frequent to connect under-vaccinated communities, we may again be in a situation of endemic
measles. The solution often proposed is that we should do a better job of convincing people that vaccines are safe. I’m all for it. But I would also
suggest that we should stop basing our vaccination policies on models that made sense in a world of constrained vaccine supply, and aim for
100 percent vaccination coverage among those who can get vaccinated. This would also solve another problem, often glanced over: There
are many people who cannot get vaccinated for medical reasons, either because they are too young, or
because they have other conditions that prevent them from acquiring immunity through vaccination.
Herd immunity against measles requires that 90 percent to 95 percent of theentire population are
immune, whereas vaccination coverage is measured as the percentage vaccinated of the target population – which only includes people who
are eligible for vaccination. This means that to achieve 95 percent immunity in the population for measles,
vaccination coverage needs to be higher than 95 percent. This is the scientific argument for a public health policy that
aims at 100 percent vaccination coverage. More importantly, there is an ethical argument to be made for the goal of 100
percent vaccination coverage. It sends the right message. Everyone who can get vaccinated, should get
vaccinated – not only to protect themselves, but to protect those who can’t, through herd immunity.

Even 5% matters – without immunization, disease spread is rampant – look at the data
Fiona Macdonald, 02-25-17 --- is an award-winning journalist and digital convert ("This Short Animation Explains Beautifully How
Herd Immunity Works," ScienceAlert, http://www.sciencealert.com/this-quick-animation-nails-how-herd-immunity-works)//ernst

One of the most common questions you'll hear from people who don't want to get vaccinated is: "But if the people around me are vaccinated,
why does it matter?" And the answer isn't entirely straightforward, because both the reason this person needs to get vaccinated, and the
reason they feel they don't have to, come down to the same thing - something called 'herd immunity'.

But now very talented Reddit user theotheredmund has created this animation that beautifully breaks down herd immunity in about 20
seconds. And it's the perfect thing to share in response to anyone who ever asks you again why they or their kids need to get vaccinated. The
short answer: it's not about you, it's about vulnerable people that can't get vaccinated, like newborn babies, or
people going through chemo. In the animation above, red is an invading pathogen, and you can see that the more people vaccinated
against it in a community, the harder it is for it to spread and get a foothold in the first place. But as soon as vaccination rates drop
below around 90 percent, the pathogen runs rampant. Which is why it's so important for everyone who can get vaccinated
to do so. Herd immunity is basically the idea that if enough people are immunised against a disease, they'll
create protection for everyone who isn't vaccinated. Most importantly, they'll create protection for people
who can't get vaccinated, such as very young babies and anyone immunocompromised, such as people
with HIV, or those going through chemotherapy. "You can see in the image, low levels of vaccination lead to
everyone getting infected," explains theotheredmund. "Medium levels slow down the progression of the illness,
but they don't offer robust protection to the unvaccinated. But once you read a high enough level of vaccination, the
disease gets effectively road-blocked. It can't spread fast enough because it encounters too many vaccinated individuals, and so the majority of
the population (even the unvaccinated people) are protected." But if everyone who's read something negative about vaccines online also
decides not to get vaccinated and cash in on this herd immunity, then there won't be enough people immunised in a community to keep
anyone safe. This awesome animation was created using a simulation in R - an open-source programming language and software environment
that was specially created for statistical computing and modelling - and put together with ImageMagick GIF stitching. To be clear, these aren't
real data being modelled. But
he calibrated the percentages based on the effectiveness of real herd immunity
in diseases presented in this 1993 paper published in Epidemiologic Reviews. "The project was simulated data, not
real, to demonstrate the concept of herd immunity," explains theotheredmund on Reddit. And we think he nailed it. Herd immunity's
something that affects all of us, but that very few people understand - hopefully this animation changes that. At the end of the day, wiping
out disease in a population is a numbers game, and once those numbers drop low enough, all of us are
in trouble. After all, much of the reason we're all so blasé about diseases such as measles and polio today
is because we don't actually see them in our communities anymore - thanks to herd immunity. So, yes, it
does matter that you get vaccinated.

Rates are too low now – herd immunity is disappearing


Advisory Board citing the CDC, 14 (10/21/14, “CDC: With low vaccine rates, some areas risk losing herd
immunity,” https://www.advisory.com/daily-briefing/2014/10/21/cdc-with-low-vaccine-rates-some-
areas-risk-losing-herd-immunity)//ernst
A new CDC report shows that the vaccination rate for kindergarteners in the 2013-2014 school year varied among states, with rates low enough
in some areas to put communities at risk of losing herd immunity. To maintain herd immunity, communities have to vaccinate enough residents
to protect the small number of people who cannot receive a vaccination for medical reasons. For example, medical
experts say that
between 92% and 95% of children should receive two doses of the measles, mumps, and rubella (MMR)
vaccine to maintain herd immunity against measles. How anti-vaxxers helped breathe new life into old diseases For the
report, CDC examined vaccination data from Washington, D.C., and all states except Wyoming, which did
not provide the information. CDC also assessed vaccination rate exemption data from 46 reporting
states and Washington, D.C. National findings Overall, CDC found that the median rate of vaccination for measles, mumps, rubella,
diphtheria, tetnus, and pertussis was approximately 95%. Specifically: A median rate of 94.7% of kindergartners in the 2013-2014 school year
received the MMR vaccine; A median rate of 95% received the DTaP vaccine, which protects against diphtheria, tetanus and pertussis; and A
median rate of 93.3% received the varicella vaccination, which protects against chickenpox. In some communities, opt out rates are soaring
However, the report also found that more parents are opting out of having their children vaccinated in certain communities, either on
philosophical grounds or because of a belief that vaccines are dangerous to children. How anti-vaxxers helped breathe new life into old diseases
Specifically, CDC found that: MMR median vaccination rates among kindergarteners varied from 99.7% in Mississippi to
81.7% in Colorado, with a total of seven states and Washington, D.C., reporting rates lower than 90%;
DTaP median vaccination rates varied from at least 95% in 25 states to less than 90% in five states and Washington,
D.C.; and Varicella vaccination rates varied from at least 95% in nine states to less than 90% in eight states and
Washington, D.C. In addition, the report found that most states permitted parents to exempt children from
vaccinations for religious reasons, while more than 12 states allowed parents to exempt children for
"philosophical" reasons. Overall, CDC found that the median rate for nonmedical vaccination exemptions was
1.7%, varying from a high of 7% in Oregon and 6.1% in Vermont and Idaho, to a low of less than 0.1% in Mississippi.

Current vaccines are ineffective because not everyone gets them- risks disease
outbreak
Salmon et al 15(Daniel A. Salmon, PhD, Matthew Z. Dudley, Masters of Science in Public Health, Jason
M. Glanz, PhD, Saad B. Omer, Bachelor of surgery, 11/23/15, “Vaccine Hesitancy Causes, consequences,
and a call to action,” American Journal of Preventive Medicine)\\WDB

Effective control of vaccine-preventable diseases requires extremely high rates of timely vaccination. For
example, about 95% of the population must be vaccinated with two doses of measles-containing vaccine
in order to fully benefit from community protection and interrupt disease transmission. The level of
vaccine coverage needed to optimize community protection and effectively control childhood infectious
diseases varies based on the infectivity of the disease, the likelihood of disease introduction, and the
effectiveness of the vaccine. The basic reproduction number (R0), often defined as the average number
of secondary infections in a completely susceptible population, is a frequently used measure of
infectivity. The R0 for measles is extremely high (12–18), yet similarly high vaccine coverage is needed
for other childhood vaccine preventable diseases. Mumps, with an R0 of 4–7, requires vaccine coverage
of about 90% to prevent outbreaks, as the mumps vaccine is a bit less effective than the measles vaccine
(about 88% vs 97%, respectively, for two doses).27,28 Even when this high level of vaccine uptake is
maintained at the state or national level, pockets of low vaccine coverage can result in outbreaks.29,30
Absent global eradication, these high levels of vaccine coverage must be maintained indefinitely.
Vaccine refusal has been associated with outbreaks of invasive H. influenzae type b disease,31
varicella,32 pneumococcal disease,33 measles,34,35 and pertussis.25,26,35,36 Often, these outbreaks
occur in communities with high rates of vaccine delay and refusal, as has been the case in the majority
of measles outbreaks since measles elimination in 2000.25 Vaccine refusal has also been shown to be a
contributing factor to the recent pertussis resurgence, along with waning vaccine immunity.26 Vaccine
hesitancy is an important issue that needs to be addressed given the prevalence of vaccine concerns and
our need to indefinitely maintain high immunization coverage uniformly throughout the nation for many
diseases. Outbreaks of disease as a result of vaccine hesitancy result in the unnecessary suffering and
potential death of young children and are wasteful of limited local health department resources. Many
developed countries experienced drops in immunization coverage with the whole-cell pertussis vaccine
in the 1970s and 1980s, with consequent resurgence of disease.37 There have been ongoing outbreaks
of measles across Europe also attributable to vaccine hesitancy.1 A recent measles outbreak originating
in Disneyland brought national attention to the issue of vaccine hesitancy.38 The potential of vaccines to
prevent illness and save lives has never been greater, yet that potential will only be achieved if we can
address vaccine hesitancy and ensure that parents vaccinate their children with confidence that they are
making the healthiest decision for their children. Vaccination saves lives, not vaccines.
Vaccination rates are dropping- risks outbreaks
Ventola 16(C. Lee Ventola- Masters of Science, July 2016,“Immunization in the United States:
Recommendations, Barriers, and Measures to Improve Compliance”, National Institutes of Health,
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4927017/)\\WDB

Some parents consciously choose to not have their children vaccinated, to delay vaccination, or to use
alternative immunization schedules.6,9 This has caused a resurgence of many infectious diseases due
to the loss of herd immunity, which puts many communities at risk.6,14 Vaccination is compulsory for
school-age children in the U.S.; however, public health officials are increasingly fearful of the option for
parents to claim exemptions from vaccination requirements.9 Because of outbreaks of vaccine-
preventable disease, rising attention has been focused on vaccine hesitancy, causing some state
legislatures to enact new vaccine exemption laws.15 Currently, exemptions are allowed due to medical
reasons in all states; religious grounds in 48 states; and philosophical objections in 20 states.9,16 It has
been estimated that 1% to 3% of children are excused from immunization because of these exemptions,
but in some communities the exemption rate is as high as 20%.9 Even when a low percentage of
children are excused from immunization, the risk of disease outbreaks in schools with exemption
rates as low as 2% to 4% increases.9 Illustratively, in southern Pennsylvania, health care providers have
frequently expressed frustration with morbidity and mortality from preventable infectious diseases that
are traced to many Amish parents’ decisions not to have their children immunized.9

Efforts now to create vaccine legislation – too many kids aren’t vaccinated
Canon 15 --- a Renaissance scholar and graduate of USC, where she also received a master's in Specialized Journalism. (Gabrielle, 3/2/15, “Is
Your State Trying to Outlaw Vaccine Exemptions?,” http://www.motherjones.com/politics/2015/03/vaccine-map-exemption-bills/)//ernst

Rhett Krawitt is seven years old. He is also a cancer survivor. After spending most of his young life battling leukemia, he is
now taking up a new cause: fighting for mandatory vaccines. For close to four years, while he underwent chemotherapy, Rhett couldn’t
be vaccinated against dangerous and contagious diseases like measles and whooping cough. He had to
rely on others around him for protection: As long they were vaccinated, transmissions were unlikely. But
as a student in Marin County, California, an area where many parents file personal belief exemptions enabling their kids to opt out of required
vaccines, Rhett was at risk. In recent years, the number of parents who use nonmedical vaccine exemptions has been on the rise, contributing
to record numbers of vaccine-preventable outbreaks. After
the Disneyland measles outbreak, which accounts for most
of the 150 new measles cases reported across 17 states since the beginning of the year, Rhett and his
family began calling on legislators to put limits on vaccine exemptions—and they weren’t alone. Last Wednesday, in
conjunction with advocacy organization MoveOn.org, Rhett helped deliver a petition, along with 21,000 signatures, calling on California
legislators to support a new bill that would put an end to nonmedical vaccine exemptions and inform parents about immunization rates in
California’s schools. California
has been hit the hardest in the recent outbreak, but it’s not the only state now seeking to
curb vaccine exemptions. Nine
other states—including Oregon, a state with one of the highest percentages of
parents who file exemptions—have proposed legislation that would eliminate either personal belief exemptions or religious belief
exemptions. Other states have introduced vaccine bills that would make exemptions harder to obtain or increase the ability of health officials
to track where vaccination gaps exist. Overall, since the beginning of this year, 79 vaccine bills have been introduced in 29
states. Not everyone is happy about it. The National Vaccine Information Center (NVIC), which describes itself as the “oldest and largest
consumer led organization advocating for the institution of vaccine safety and informed consent protections,” and issues online action alerts
about legislation that would make it harder to opt out of vaccines—and instructs members on how to fight against it. Vaccine advocates,
however emphasize that the new bills are vital to public health. “This is not a matter of private health, like home birth or vitamin choices a
family makes in their own home,” MoveOn member Hannah Henry, a mother of four, wrote in a statement included with the California
petition. “It is not about politics; it is about children’s lives.”
Economy Advantage
Vaccines Key to Growth
Vaccines are an engine for economic growth --- foreign countries prove too
SETH BERKELEY 12/7/12 --- CNN Healthcare Policy Expert and Reporter (“How vaccines save lives, grow economies”, Seth
Berkeley, December 7, 2012, http://www.cnn.com/2012/12/07/opinion/vaccine-gavi-seth-berkley/index.html)//chiragjain

We all know that vaccines save lives by protecting people against disease. What is less well-known is that vaccines
also are an engine for economic growth -- far beyond their health benefits. I am reminded of this in Tanzania this week,
where my organization, the GAVI Alliance, is hosting a conference for its partners. GAVI's mission is to save children's lives and protect people's health by increasing
access to immunization in developing countries. We don't do this alone. We have many partners, including prominent companies that work closely with GAVI. They
recognize that in addition to the humanitarian need, countries
such as Tanzania are emerging markets that can fulfill their
economic ambitions only if they also can ensure good health for their citizens. The private sector is a
critical part of the equation. Our corporate partners know they can do well by doing good. Consider Tanzania. It has an ambitious five-year
development plan that aims to transform the country into a middle-income economy by 2025. The plan includes critical funding to ensure a healthy population by
strengthening the health system, which will significantly improve child and maternal mortality rates. Tanzania already has begun this process by working closely
with GAVI and its partners to significantly increase its routine vaccine coverage rates to above 90% today from 79% in 2001, the year before GAVI began its work
there, according to data from the World Health Organization and UNICEF. At the same time, Tanzania's GDP growth has been astounding, rising to $23.7 billion last
year from $10.2 billion in 2001, according to the World Bank. Is there a connection? Further study is needed in the case of Tanzania. But we know for a fact that
vaccines -- in addition to saving lives and improving health -- are the cornerstone of a vibrant
economy, fuel growth and serve as a magnet for foreign investment. Indeed, research has shown
vaccines to be among the most cost-effective investments in global development. This has been borne
out of several independent studies that look beyond the health impacts toward areas such as cognitive
development, educational attainment, labor productivity and financial attainment. In other words, healthier
children -- spurred by immunization -- attend school more often, learn more while they are there and remain in
school longer. As adults, they therefore are more productive, earn more money, save and invest more,
and live longer. Healthier children also spread less disease through the adult population, further
increasing productivity. These academic papers, including one recently published that focuses on how to measure the economic benefits of the HPV
vaccine, are getting noticed in African countries -- not only by health ministers, but also by finance ministers and other officials. For instance, I attended a landmark
meeting in Tunis in July organized by the African Development Bank, where its President Donald Kaberuka brought together a variety of ministers and experts to
discuss how to allocate budgets and make healthcare a national priority.
Vaccine Healthcare Destroys Economy
Flu shots destroy billions of dollars
LYDIA RAMSEY 8/13/2016 --- Business Insider Reporter and Healthcore Financial Advisor (“People who refuse vaccines
cost the US billions of dollars a year”, Lydia Ramsey, August 13, 2016, Business Insider,
http://www.businessinsider.com/economic-impact-of-vaccine-preventable-diseases-2016-10)//chiragjain

If you haven't gotten your seasonal flu shot yet, here's a multi-billion-dollar reason to get it. A new
study out from the University of North Carolina at Chapel Hill modeled just how much unvaccinated
adults cost the US economy (either in healthcare costs or in loss of productivity). The researchers found that the overall
cost of 10 vaccine-preventable diseases was $8.95 billion in 2015. Those who weren't vaccinated
accounted for 80% of that (about $7.1 billion). The flu alone accounted for $5.8 billion of the costs. The next
costliest disease was pneumonia, which cost the health system $1.86 billion in 2015. Notably, the study was funded by
Merck, a pharmaceutical company that makes flu vaccines among others. Flu season, according to the Centers for Disease Control and
Prevention, runs from October to May. It's key to get the flu vaccine every flu season, because the flu virus
is very good at mutating, meaning last year's shot might not prevent you from getting this year's strain.
(The current flu shot reduces your risk of catching the flu by about 50-60%; its effectiveness varies from year to year.) Most of that $5.8
billion cost came from inpatient costs of treating those who came down with the flu and had to go to
the hospital, followed by the costs of treating those who came down with the virus outside the hospital. "We hope our study will
spur creative health care policies that minimize the negative spillover effects from people choosing not
to be vaccinated while still respecting patients' right to make informed choices," the lead author of the study, Sachiko Ozawa, said in a
release.

Vaccines are key to the economy – especially with recent budget cuts
Offit 17 -- Paul A. Offit is a professor of pediatrics at the Perelman School of Medicine at the University
of Pennsylvania and the author of Deadly Choices: How the Anti-Vaccine Movement Threatens Us All
(Basic Books, 2011). [6/24/17; What Makes Trumpcare So Dangerous for Kids,
http://www.thedailybeast.com/what-makes-trumpcare-so-dangerous-for-
kids?source=twitter&via=desktop] MP

While there is much to debate about the most efficient and effective ways to deliver health care to the
American public, three things aren’t debatable: 1) Vaccines save lives, 2) Vaccines save money, and 3)
Reduced support for vaccines will put children at unnecessary risk. Before vaccines, Americans could
expect that every year diphtheria would kill 15,000 people, mostly teenagers; rubella (German measles) would cause
20,000 babies to be born blind, deaf, or mentally disabled; pertussis (whooping cough) would kill 8,000 children, most of whom were less than
1 year old; and polio would permanently paralyze 15,000 children and kill 1,000. Because
of vaccines, many of these diseases
have been completely or virtually eliminated from the U.S. Smallpox—a disease estimated to have killed
500 million people—was eradicated by vaccines. Further, for each dollar spent on childhood vaccines,
the U.S. saves $10.10. During the past 23 years alone, vaccines have prevented 381 million illnesses,
855,000 deaths, and 24.5 million hospitalizations as well as saved $360 billion in direct costs and $1.65
trillion in societal costs (e.g., time lost from work).

Vaccines save lives and money


ACHI 17 –Arkansas center for health improvement (“Why Immunizations Matter,” January 2017,
http://achi.net/Docs/446/)//ermst
Community Immunity People without individual immunity may be protected from infectious diseases in the community. Community, or herd,
immunity occurs when enough people are immune to an infectious disease (through vaccination and/or prior illness) to decrease the spread of
disease when it occurs. 5 For community immunity to protect people without individual immunity, a
certain number of people
must be resistant to the disease in order to prevent the disease from spreading from person to person
(or at least lower the likelihood of disease spread). 12 This number is the herd immunity threshold. The
threshold varies by the contagiousness of the disease, but most efforts target a goal of 90 percent protected. 12 A case study of a measles
outbreak in 1970 on the Texas-Arkansas border13 highlights two issues: 1) the effectiveness of vaccinations, and 2) the importance of herd
immunity in protecting all individuals (vaccinated or unvaccinated).8-10 Table 1: Vaccine Effectiveness for Four Diseases by Number of Doses
Vaccine Effectiveness Dose(s) Measles 97% 2 Mumps 88% 2 Inactivated Polio 99% 3 Varicella 85% 1 Arkansas policymakers and parents are
asking tough questions about the state’s response to the recent mumps outbreak in Arkansas with more than 2,400 cases under investigation.
1,2 The mumps outbreak has provoked meaningful discussion about the role of public health agencies in detection and
control of infectious diseases. 1 Perhaps more importantly, it has elevated awareness of the critical importance of
immunizations. The number of mumps cases has significantly declined since the initiation of the vaccination program in 1967, 3 but
outbreaks remind us that viral diseases such as mumps are extremely contagious and can lead to serious
complications. 4 This fact sheet describes paths to immunity, the impact of vaccination programs, and immunization safety, effectiveness,
and recommendations. Case Study: 1970 Texas-Arkansas Border Measles Outbreak13 In 1970, there was a measles outbreak in Texarkana, TX
and Texarkana, AR. Of 606 reported cases, 95 percent occurred in Texarkana, TX. Measles immunization was required for children admitted
into school in Arkansas but not in Texas. Vaccination rates for children aged 1-9 were 95 percent in Arkansas and 57 percent in Texas. This
case study demonstrates the effectiveness of a vaccination program in creating community immunity. Fact Sheet: Why Immunizations Matter
Page 2 Copyright © 2017. All rights reserved. An increased level of individualized immunity leads to greater community immunity.
Projections indicate that vaccinations of children born between 1994 and 2013 will prevent 322 million
illnesses, help avoid 732,000 deaths, and save nearly $1.4 trillion in total societal costs, including $295
billion in direct costs.14 Immunizations at Work Before the introduction of vaccinations at the beginning of the 20th century, infectious
diseases exacted an enormous toll on the U.S. population.15 For example, at its peak in 1952, there were more than 21,000 cases of parylitic
polio. 16 During the 20th century, some of the diseases that had caused illness and significant numbers of deaths had been eradicated or
significantly reduced by advances in science.15 Figure 1 (left) shows pre-vaccineera annual reported cases and the most recent reported cases
for select diseases, as of 2010. 17 Incidence
reductions have led not only to health protection but also
tremendous cost-benefit savings.13 These savings highlighted in a 2007 report noted a benefit of $4.76-
$5.61 for each dollar spent on varicella vaccine and a benefit of $1.96 for each dollar spent on hepatitis
A vaccine. 18

Vaccines relieve stress on healthcare system and save $$$$


Lobo 16 (James Lobo - Boston College Law School, 1/28/2016“Vindicating the Vaccine: Injecting
Strength into Mandatory School Vaccination Requirements to Safeguard the Public Health“, Boston
College Law Review, 57 B.C. L. Rev. 261)\\WDB

Vaccines are extraordinarily cost-effective and refusing to take advantage of them could strain an
already burdened medical system. n74 The cost of not vaccinating is hefty: studies show that each
influenza vaccine administered saves an average of $ 117 a year in healthcare costs. n75 The California
measles outbreak of the early 1990s resulted in over $ 100 million in health care costs. n76 In total,
VPDs incur $ 10 billion in health care costs each year. n77 Furthermore, the failure to vaccinate also
affects the economy indirectly because preventable sicknesses sap the country's workforce. n78
Pharma Low
Pharma innovation declining now --- mergers shuts down small scale R&D
F.M. SCHERER 2014 --- Professor of Public Policy and Corporate Management in the Aetna Chair, Emeritus, Harvard
Kennedy School (“Pharmaceutical Mergers and the Decline of Innovation”, F.M. Scherer, 2014 Issue, Harvard Kennedy School,
www.hks.harvard.edu/news-events/publications/impact-newsletter/archives/winter-2012/pharmaceutical-mergers-and-the-
decline-of-innovation)//chiragjain

In 2008, the
combined research and development budget of Pfizer, Wyeth Laboratories, Merck & Co., and
Schering-Plough was $19.6 billion, or 51 percent of all pharmaceutical research and development
spending in the United States, and up to 39 percent of total worldwide spending. In 2009, the pharmaceutical giants
merged: Pfizer bought Wyeth for $68 billion, and Merck bought Schering- Plough for $41 billion. In 2010, Pfizer announced plans to cut r&d
spending by between $6.5 and $7 billion by 2012, a cut of up to 62 percent, while Merck announced the closure of at least three r&d facilities.
In a new paper, F.M. Scherer, Aetna professor of public policy and corporate management emeritus, and William
Comanor, of the University of California, analyzed the effect of those huge mergers on innovation in the
pharmaceutical industry. The mergers took place in the context of a pharmaceutical industry in which
generic products accounted for more than two-thirds of all prescriptions in the United States. And despite
research and development budgets that doubled in the decade prior to 2008, the average number of new molecular entities introduced into
the markets has remained stable at 20 to 30 per year. Furthermore, development programs — which turn promising new pharmaceuticals into
marketable drugs — cost an average of $200 million, according to one analysis. Only one in five drugs that begin substantial clinical testing
results in an application for approval, and fewer still reach the marketplace. This study of the value of and the most productive approaches to
r&d dates back to the 1960s, when, looking at weapons development, Scherer demonstrated the productivity of taking multiple independent
research paths toward a specific technical objective. Parallel
development of drugs has increasingly come to rely on
collaboration between big pharmaceutical and small biotechnology companies, the authors point out, and there
are obvious reasons for these collaborations. Small biotech companies benefit from a rapidly advancing scientific
base, highly educated staffs, and a vast trove of unexploited medical possibilities. Big pharmaceutical companies
have the resources and expertise needed to support large-scale clinical trials and to shepherd the results through the federal approval process.
But as the number of companies available to assist and support these outside projects shrinks, so will
the number of independent research paths likely to be taken. “Permitting horizontal mergers between
large pharmaceutical companies appears to have limited the desirable pursuit of independent parallel
paths in pharmaceutical development,” the authors write. “And it likely contributed to the decline in the
rate of pharmaceutical innovation.” “So important is the development of new pharmaceuticals for
society’s welfare, and so problematic is the ongoing decline in new drug development, that the U.S.
government is considering the establishment of a new federal research center to pursue drug development. There is an important
public interest in promoting rapid pharmaceutical innovation, and policies that foster large numbers of parallel paths
directed towards the development of effective new drugs can be an important step towards that objective.”

Foreign currency translations are destroying Big pharma company stocks


JJ KINAHAN 7/27/2015 --- Chief Strategist for TD Ameritrade and began my career as a Chicago Board Options
Exchange market maker (“Big Pharma's Pfizer And Merck To Feel Pinch Of Strong Dollar, Patent Loss”, JJ Kinahan,
July 27, 2015, Forbes, https://www.forbes.com/sites/jjkinahan/2015/07/27/big-pharmas-pfizer-and-merck-to-feel-
pinch-of-strong-dollar-patent-loss/#1725811a24b5)//chiragjain

Strong dollar headwinds are likely to smack pharmaceutical giants Pfizer Inc. (PFE) and Merck & Co. (MRK)
when they report earnings Tuesday ahead of the market’s opening. Both big pharma firms have a heavy international presence—more than
half of their revenues— and like other multinationals are likely to feel the ravaging financial impact of
foreign currency translations. Ahead of earnings, these stocks tend to trade in similar fashion with volatility on both
measuring in a relatively low 20th percentile range. Pfizer Lost Celebrex, Lipitor Kingpin Pfizer
(PFE), which has a 61% forex
exposure, is expected to turn in earnings of $0.52 a share on revenue of $11.42 billion, according to Thomson
Reuters. That’s below the year-ago results of $0.58 per share and $12.7 billion on the top line as the company grapples with
patent losses on blockbuster treatments including arthritis drug Celebrex and cholesterol drug Lipitor, the best-selling drug of all time. Pfizer’s
$17 billion purchase of Hospira, which makes generic injectable drugs and devices, is aimed at stemming the deep revenue decline. Let’s see
what management might say about next steps. A Dow Jones Industrials Average component, its stock has meandered most of the past year, but
has managed to gain nearly 14% as of Friday’s close, outpacing the Dow’s meager 3.5% gain. Shares of Merck, also a member of the
DJIA, are flat when compared with this period a year ago and have collapsed by 9% since reaching a 52-week
high in January after it upped its annual profit projection. As of Monday morning, short-term options traders are pricing in a
2% move in either direction surrounding Pfizer’s report, according to TD Ameritrade’s thinkorswim® platform. Pfizer has
outdone Street earnings expectations in 20 of the last 22 earnings reports. Also notable, we’re seeing action in the weekly 32.5 puts and the
August 35 calls.Inc. (PFE) and Merck & Co. (MRK) when they report earnings Tuesday ahead of the market’s opening.
Pharma Key to Economy
The pharmaceutical industry contributes more than $1.2 trillion to the economy
TEConomy 16 -- TEConomy Partners, LLC is a global leader in research, analysis, and strategy for innovation-based economic
development. Today we’re helping nations, states, regions, universities, and industries blueprint their future and translate knowledge into
prosperity. (May 16, “The Economic Impact of the U.S. Biopharmaceutical Industry: National and State Estimates,” http://phrma-
docs.phrma.org/sites/default/files/pdf/biopharmaceuticaul-industry-economic-impact.pdf)//ernst

The U.S. biopharmaceutical industry is not only a world leader in the development of new medicines,
vaccines, and diagnostics and one of our nation’s top performing industry innovation drivers, but is also
a highly valuable industry in terms of its economic contributions and impacts. The economic impacts, or
more precisely the revenue and expenditure impacts, of the biopharmaceutical industry are typically measured by using the
well-established regional economic analysis technique of input/ output (I/O) analysis, which tracks the revenues
of a sector and the related economic activity of suppliers to the sector and its personnel. This analysis uses a custom IMPLAN I/O model to
quantify the interrelationships between the U.S. biopharmaceutical industry and the remaining sectors of the U.S. economy. Economic
impacts consist of three types: direct effects (the specific impact of biopharmaceutical industry expenditures in the first round
of spending), indirect effects (the impact of expenditures by suppliers to the biopharmaceutical industry), and induced effects
(the additional economic impact of the spending of biopharmaceutical industry employees and suppliers’ employees in the overall economy
that can be attributed to the direct biopharmaceutical industry expenditures). Taken
together, these three impact effects
combine to form the total impacts. In other words, the I/O analysis models the “ripple effect” that
originates from direct biopharmaceutical industry expenditures in the economy, flows through industry
suppliers as they buy additional inputs, and through workers who spend their wages. The Economic Impact of
the U.S. Biopharmaceutical Industry on the Nation The overall output impact, typically referred to as the “total
economic impact” of the biopharmaceutical industry on the U.S. economy, totalled more than $1.2
trillion in 2014.16 This total impact includes $558 billion in direct effects of biopharmaceutical businesses sales
and $659 billion in indirect and induced effects—meaning that every $1.00 in output generated by the
biopharmaceutical industry generated an additional $1.18 in output in other sectors of the economy
(TABLE 3). This significant output multiplier of 2.18 is due to the high value-added nature of the industry, its extensive The overall output
impact, typically referred to as the “total economic impact” of the biopharmaceutical industry on the U.S. economy, totalled more than $1.2
trillion in 2014. Definition of Impact Variables EMPLOYMENT: The number of individuals whose employment is due, totally (direct employment)
or in part (indirect or induced employment) to the economic effects of the industry. LABOR (PERSONAL) INCOME: Salaries, wages, and the full
cost of benefits including non-cash payments received by individuals in the economy. Includes employee compensation and sole proprietor
income. VALUE-ADDED: The difference between an industry’s total output and the cost of its intermediate inputs; sometimes referred to as the
industry’s “Contribution to GDP”. OUTPUT: The dollar value of production (i.e., sales). PERSONAL TAX REVENUE: The dollar value of taxes
generated due to the creation of personal income; includes company paid portion of social security taxes. 11 supply chain relationships, and the
industry’s higher wage jobs. This total economic impact represented more than 3.8 percent of total U.S. output.17 The
revenues of the
biopharmaceutical industry are responsible for supporting more than 4.4 million jobs throughout the
U.S. economy. These jobs consist of the nearly 854,000 jobs directly in the industry and an additional 3.6
million indirect and induced jobs in 2014. For every one biopharmaceutical industry job, the industry
supports an additional 4.21 jobs, for a total employment multiplier of 5.21. Together, the
biopharmaceutical industry and the workforce of its suppliers and other impacted segments of the
economy received $311 billion in wages and benefits in 2014. The biopharmaceutical industry also is an
important generator of federal, state, and local government revenues through the wages and benefits
provided to its employees. The impact analysis shows that the incomes of biopharmaceutical industry workers,
directly and through the multiplier effect, generated $67 billion in personal tax revenues—nearly $9
billion in state and local personal tax revenue and more than $58 billion in federal personal tax revenues
in 2014.
Vaccines boost the pharmaceutical industry
Associated Press 9 -- American multinational nonprofit news agency headquartered in New York City
that operates as a cooperative, unincorporated association. [ November 17, 2009 at 4:32 PM, updated
November 17, 2009 at 4:33 PM, Vaccines market gives pharmaceutical industry a boost,
http://www.nj.com/business/index.ssf/2009/11/vaccines_market_gives_pharmace.html] MP

Malaria. Tuberculosis. Alzheimer's disease. AIDS. Pandemic flu. Genital herpes. Urinary tract infections.
Grass allergies. Traveler's diarrhea. You name it, the pharmaceutical industry is working on a vaccine to
prevent it. Many could be on the market in five years or less. Contrast that with five years ago, when so many companies had
abandoned the vaccine business that half the U.S. supply of flu shots was lost because of contamination
at one of the two manufacturers left. Vaccines are no longer a sleepy, low-profit niche in a booming
drug industry. Today, they're starting to give ailing pharmaceutical makers a shot in the arm. The lure of big profits, advances in technology and growing government support has
been drawing in new companies, from nascent biotechs to Johnson & Johnson. That means recent remarkable strides in overcoming

dreaded diseases and annoying afflictions likely will continue. "Even if a small portion of everything
that's going on now is successful in the next 10 years, you put that together with the last 10 years (and)
it's going to be characterized as a golden era," says Emilio Emini, Pfizer Inc.'s head of vaccine research.
Vaccines now are viewed as a crucial path to growth, as drugmakers look for ways to bolster slowing
prescription medicine sales amid intensifying generic competition and government pressure to cut down
prices under the federal health overhaul. Unlike medicines that treat diseases, vaccines help prevent
infections by revving up the body's natural immune defenses against invaders. They are made from
viruses, bacteria or parts of them that have been killed or weakened so they generally can't cause an
infection. Investment in partnerships and other deals to develop and manufacture vaccines has been
on a tear — and accelerating since the swine flu pandemic began. Billions in government grants are bringing better, faster ways to
develop and manufacture vaccines. Rising worldwide emphasis on preventive health care, plus the advent of the first

multibillion-dollar vaccines, have further boosted their appeal. While prescription drug sales are forecast
to rise by a third in five years, vaccine sales should double, from $19 billion last year to $39 billion in
2013, according to market research firm Kalorama Information. That's five times the $8 billion in vaccine
sales in 2004. "What was essentially 25 years ago a rounding error now has become real money," says
Robin Robertson, director of the U.S. Biomedical Advanced Research Development Authority. That jump is due to
a couple of new blockbuster vaccines and rising use of existing ones. The government's list of recommended vaccines for children since has more than doubled since 1985 to 17. It now also

The last decade brought breakthrough vaccines against


calls for a half-dozen vaccines for everyone over 18 and up to four more for some adults.

pneumococcal disease and rotavirus — two of the world's top killers — meningitis, cervical cancer and
more. Better technology to create and mass produce vaccines is bringing progress in preventing tropical
dengue fever and new threats like superbugs MRSA and C. difficile, even ending addiction to cocaine
and nicotine. Success on some vaccines in development, particularly for Alzheimer's and AIDS, likely
would bring billions a year in sales. Just this fall and early next year, the swine flu vaccines are expected
to bring their makers at least a couple billion extra dollars. That's despite the five manufacturers for the
U.S. not being able to meet an optimistic plan to first make seasonal flu shots and then produce 120
million doses of swine flu vaccine by mid-October — an unprecedented task. But they are steadily catching up with demand.
Unlike most vaccines now "manufactured" in mammal, yeast or other cells — quickly, purely and at high yields — flu vaccines are still grown over many weeks in chicken eggs because it's

Because swine flu vaccine grew slower than expected, there have
economical and those newer, faster methods aren't U.S.-approved yet.

been shortages — and lines of anxious consumers. But a horde of biotech companies, many using
multimillion-dollar government grants, already are testing state-of-the-art technology for the next
pandemic. Scientists — including some at J&J's new vaccine partner, Holland's Crucell NV — even are
working to develop the holy grail: a universal flu vaccine targeting a part of the virus that doesn't change
year to year. And some future vaccines will come in patches, pills and nasal sprays, rather than painful shots. In the last century, vaccines dramatically lengthened lifespans by
stopping diseases that killed or disabled millions, from smallpox to polio. After all those successes, many pharmaceutical companies

instead focused on lucrative daily pills for chronic diseases. By the middle of this decade, only a handful
were still making vaccines, which are harder to produce than chemical-based pills, making yields
unpredictable. That led to the 2004 fiasco when half the U.S. flu shot supply was lost overnight, plus
continuing periodic shortages of some kids' vaccines. Today, five companies supply flu vaccine:
GlaxoSmithKline, Switzerland's Novartis AG, Australia's CSL Biotherapies, MedImmune, part of Britain's
AstraZeneca PLC, and France's Sanofi-Aventis SA. There's been more research on flu vaccines in the last
five years than in the previous 20, notes Dr. William Schaffner, Vanderbilt University's head of
preventive medicine and a spokesman for the Infectious Diseases Society of America. Now many
drugmakers are rethinking vaccines. Britain's GlaxoSmithKline is gunning to become the world's top vaccine manufacturer by revenue, unseating pioneer Merck &
Co. This spring, Glaxo opened a state-of-the-art vaccine packaging plant in Marietta, Pa., west of Philadelphia, so it can expand in the U.S. market. Glaxo, which sold only one vaccine in the U.S.
13 years ago, now sells 12 here — and 30 worldwide. It has 20 more in human testing, including ones for meningitis and malaria. J&J, which previously avoided vaccines, plans to build a full
vaccine portfolio, starting with universal flu and Alzheimer's vaccines, says research head Dr. Paul Stoffels. Even Pfizer Inc.'s $68 billion acquisition of Wyeth in October was partly about getting

Wyeth makes the most successful vaccine ever, Prevnar, which


its vaccine expertise, now being put to work against Alzheimer's.

protects children from ear infections and potentially deadly pneumonia and blood infections. Prevnar
brought in $2.7 billion in 2008 sales, and with approval of an improved version pending, billions more a
year are expected. Experts call Prevnar the "game changer." It was the first vaccine to exceed $1 billion
in annual sales, followed by Merck's cervical cancer shot Gardasil, with $2.3 billion in 2008 sales.
"Vaccines are now perhaps seen to be more attractive than drugs," says Dr. Stanley Plotkin, a former University of Pennsylvania
professor and industry researcher who helped develop the German measles and rotavirus vaccines. Vaccines command higher prices — roughly $375 for the three-shot Gardasil series — and

For
so are more profitable than in the past. With only one or two makers of most vaccine types, price competition is rare in wealthy countries. Plus, they rarely face generic competition.

flu shot makers, the risk of having to throw out millions of unused doses here come spring has plunged
as U.S. guidelines have steadily widened to include 83 percent of Americans. Use has jumped from 20
million doses in 1990 to 113 million last year. And many companies are partnering with promising
biotechs, the World Health Organization and global charities, or setting up deals with local drugmakers
abroad, to inexpensively manufacture vaccines in developing and middle-tier countries that increasingly
want them to prevent much-higher health care costs. "What you had was, everybody out of the water," says analyst Steve Brozak of WBB
Securities. "Now, everybody's back in the water."
Pharma Key to Stop Disease
Pharmaceutical profits are key to innovation against emerging disease threats – the
impact is extinction
Engelhardt 8 – PhD, MD, Professor of Philosophy @ Rice --- (Hugo, “Innovation and the Pharmaceutical
Industry: Critical Reflections on the Virtues of Profit,” EBrary)
Many are suspicious of, or indeed jealous of, the good fortune of oth-ers. Even when profit is gained in the market without fraud and with the
consent of all buying and selling goods and services, there is a sense on the part of some that something is wrong if considerable profit is
secured. There is even a sense that good fortune in the market, especially if it is very good fortune, is unfair. One might think of such
rhetorically disparaging terms as "wind-fall profits". There is also a suspicion of the pursuit of profit because it is often embraced not just
because of the material benefits it sought, but because of the hierarchical satisfaction of being more affluent than others. The pursuit of profit
in the pharmaceu-tical and medical-device industries is tor many in particular morally dubious because it
is acquired from those who have the bad fortune to be diseased or disabled. Although the suspicion of
profit is not well-founded, this suspicion is a major moral and public-policy challenge.¶ Profit in the
market for the pharmaceutical and medical-device¶ industries is to be celebrated. This is the case, in that
if one is of the view (1) that the presence of additional resources for research and development spurs
innovation in the development of pharmaceuticals and med-ical devices (i.e., if one is of the view that the allure of profit is
one of the most effective ways not only to acquire resources but productively to direct human energies
in their use), (2) that given the limits of altruism and of the willingness of persons to be taxed, the possibility of profits is necessary to secure
such resources, (3) that the allure of profits also tends to enhance the creative use of available resources in the pursuit
of phar-maceutical and medical-device innovation, and (4) if one judges it to be the case that such innovation
is both necessary to maintain the human species in an ever-changing and always dangerous
environment in which new microbial and other threats may at any time emerge to threaten human well-
being, if not survival (i.e., that such innovation is necessary to prevent increases in morbidity and
mortality risks), as well as (5) in order generally to decrease morbidity and mortality risks in the future, it
then follows (6) that one should be concerned regarding any policies that decrease the amount of resources and
energies available to encourage such innovation. One should indeed be of the view that the possibilities for profit, all things being equal, should
be highest in the pharmaceutical and medical-device industries. Yet, there is a suspicion regarding the pursuit of profit in medicine and
especially in the pharmaceutical and medical-device industries

Pharmaceutical profits key to prevent disease outbreak


Lo ‘14
(Chris, Progressive Media Reporter, "Drug prices: profits before patients?" Progressive Media, 6-9, PAS)
Accessed on LexisNexis 9-10-14

A new UCL report questioning the use of off-label drugs to save money has been criticised for propping up an unfair status quo in the pharma industry. Pharma

companies charge high premiums for patented medications to recover costs, maximise profits and help
fund new R&D, but is there another way of funding high-risk research while avoiding budget-busting prices at the other end of the pipeline?¶ The
pharmaceutical industry has been responsible for a host of medical miracles over the past century, from
disease-eradicating vaccines to revolutionary new treatments for a wide range of cancers and long-term
chronic conditions like diabetes. Research undertaken by private pharmaceutical companies and bio-tech firms,
alongside public research institutions, has improved the length and quality of millions of lives.¶ In light of the industry's
achievements, it's natural to think of it as something of a sacred cow, a special case that should, to a certain extent, be given extra leeway to ensure it can continue
bankrolling life-saving medical innovations. That status also makes it easy to forget the price tag that comes with many of these innovations - a price tag that has
been rising steadily over time.¶ In the US, for example, annual cancer care costs are expected to rise from $104bn in 2006 to $173bn in 2020, according to the
American Society of Clinical Oncology. A major component of that increase is the rising number of cancer diagnoses along with other factors, but with data from the
Memorial Sloan Kettering Cancer Center showing that 15 cancer treatments launched in the last five years cost more than $10,000 a month, and many existing
drugs getting pricier every year, the fact remains that the cost of innovative, patent-protected drugs is becoming
Solvency
Squo Insufficient
State regulation is insufficient now- insincere claims and concentration- risks
destroying herd immunity
Bucchieri 16(Rebecca Bucchieri- J.D., George Mason University School of Law, B.A. Law and, Magna
Cum Laude, American University. Summer 2016. “Religious Freedom versus public health: the necessity
of compulsory vaccination for schoolchildren”, The Boston University Public Interest Law Journal, 25 B.U.
Pub. Int. L.J. 265)\\WDB

Clustered outbreaks of vaccine-preventable disease have recently emerged across the country. n142
Unsurprisingly, many outbreaks have been traced back to communities and families who have refused to

vaccinate their children. n143 The recent return of the most serious of these diseases--measles, whooping cough, and mumps--has once again thrust states
with religious and philosophical exemptions to compulsory vaccination laws under medical, societal, and legal scrutiny, rightly pressuring them to rethink whether
such exemptions are in the best interest of public health. n144 The
increase in outbreaks suggests that the current state-by-
state frameworks for controlling the spread of disease are inadequate. Between January 4 and April 2
of 2015, there were 159 cases of measles reported nationwide. n145 Between 2001 and 2011--the time
period immediately preceding the most recent spikes in measles outbreaks--the average number of
measles cases per year was sixty-two. n146 The recent spike is largely due to the January 2015 measles outbreak at the California amusement
park Disneyland, where more than 130 people n147 across seven different states contracted the disease. n148 Experts speculate that an individual who was visiting
from overseas likely initiated the outbreak. n149 However,
the disease was able to spread so quickly and widely due to the
presence of so many unvaccinated children and adults: "[o]f the 131 cases, [*283] the state was able to obtain the vaccination status
for 81 patients [and] [o]f the 81, 70% were unvaccinated." n150 If religious and philosophical exemptions were unavailable across the country, the measles outbreak
likely would have faltered, affecting far fewer individuals. n151 In addition to this recent measles outbreak, which health officials declared over in April 2015, n152
there has also been an increase in whooping cough cases. n153 In 2014, the United States experienced a 15% increase in whooping
cough cases as compared to the previous year. n154 Washington state has been hit particularly hard by whooping cough. n155
Washington has both philosophical and religious exemptions, n156 and also experiences a high anti-vaccination rate of 3.1% to 4%. n157 This high vaccination rate
may be due to the state's low bar to receiving an exemption, as the state only requires a health care professional's signature to procure an exemption. n158 By April
2015, Washington had already experienced 319 whooping cough cases compared to forty-nine whooping cough cases during the same period in 2014. n159 States
like Washington have taken emergency measures to prevent future outbreaks, since recent surges in measles and whooping cough cases have helped lawmakers
understand that religious and philosophical exemption options can be detrimental to public [*284] health. n160 In an effort to prevent infection, a Washington
school district recently "pulled 143 students who lacked documentation proving they had received required immunizations from classrooms . . . ." n161 Similarly, in
California, where the Disneyland measles outbreak originated, lawmakers and concerned citizens pushed for new legislation that would entirely eliminate the
personal and religious exemptions, in the belief that such exemptions escalated the scope and severity of the outbreak. n162 In June 2015, the California Governor
signed a bill into law--becoming the third state to require vaccines for public school attendance regardless of philosophical or religious exemption. n163 When first
introduced, the bill sparked substantial pushback from the anti-vaccination community. n164 Because California previously allowed for philosophical exemptions in
addition to religious ones, the rationale given by the anti-vaccination community regarding why the bill should fail provided insight into the underpinnings of the
community's anti-vaccination beliefs. For example, one objector asserted, " I strongly oppose injection of questionable materials
into the bodies of our children as a condition of education." n165 Another objector, mixing religious
reasoning with non-religious personal beliefs, stated, "We believe that God gave us the ability to heal from within and he gave us all the
tools to heal naturally so we're willing to risk a childhood illness over risking something more serious like autism, . . . ." n166 Although neither of

these claims are supported by medical proof or robust religious doctrine, n167 both of these
justifications would have been sufficient to [*285] receive an exemption in California prior to the new
vaccination law. n168 Previously, state law required only that a parent who objected to vaccinating their
children sign a form along with a healthcare professional's signature attesting that they explained to the
parent the benefits and risks associated with forgoing vaccinations. n169 Interestingly, in states that have both religious and
personal or philosophical exemptions, more individuals exercise the personal belief exemption than the religious exemption. n170 In fact, "opt-out rates in states
that allow personal-belief exemptions are 2.5 times higher than rates in states that only permit religious exemptions." n171 Although offering only religious refusals
may curb the frequency of opt-outs, many
states with only religious exemptions require very little of claimants,
making it easy for parents to evade state law by claiming their beliefs are religious, when in fact they are
based upon other concerns. n172 For example, in Maryland, the objecting parent need only attest that,
"Because of my bona fide religious beliefs and practices, I object to any immunizations being given to my
child." n173 Lax requirements like these do not match the severity of public health consequences if an outbreak occurs. When disease outbreaks such as those
in California and Washington occur, the importance of herd immunity to the protection of public health, especially the public health of the youngest and most
vulnerable schoolchildren, is highlighted. n174 Herd immunity describes "the protection bestowed upon a population against an infectious disease when a critical
mass of that population is immune to the particular disease." n175 Many individuals who forego vaccinations for their children rely on herd immunity as the only
protection against their children catching infectious diseases, and "perceive the risks to each individual child from vaccination as greater than the collective risks to
the population [*286] due to the failure to vaccinate." n176 Most importantly, it does not take many unvaccinated individuals to damage herd immunity: The
required percentage of vaccinations to ensure herd immunity varies by disease; for pertussis (whooping cough), it's between 93 and 95 percent . . . . So if even a
seemingly small number of kids across the state aren't getting their shots, the immunity rate of the entire community can drop below safe levels. n177 Herd

immunity becomes less effective as more individuals opt out of immunizations, resulting in an
increased risk for both the unvaccinated and the vaccinated to contract disease. n178 Many individuals do not
realize that even the most effective vaccinations, such as the measles vaccine, still have a failure rate, and thus those individuals who do not respond properly to the
vaccination will be subjected to infection by those who chose not to vaccinate at all. n179 This occurred recently in California, where six individuals contracted
measles despite receiving their vaccinations. n180 State laws facilitating individual exemptions are not germane only to objecting individuals, they can also
negatively and unfairly impact individuals who took due care to protect themselves by receiving vaccinations. From
a public health perspective,
the risk of erosion of herd immunity is cause for significant concern on the national level. Religious
exemptions pose particular problems because "[e]ven though religiously exempt persons comprise a
small portion of the population, they often form concentrated communities that are more vulnerable to
disease, and often can transmit disease into the larger nonexempt population." n181 For example, in 2010, "California
experienced one of the worst outbreaks of pertussis, more commonly known as whooping cough, in several decades, resulting in 9,120 illnesses and the death of
ten infants who were too young to receive the vaccine." n182 Researchers concluded that vaccine refusals by individuals living in clustered communities throughout
the state fueled the outbreak. n183 Another recurring concern about religious refusals for vaccinations is whether
[*287] the individuals claiming them are sincere. n184 This concern is most relevant in the twenty-eight states that only offer religious
exemptions, without an option to object due to personal belief or philosophical reasons, because there is a greater risk that vaccine-averse

individuals will insincerely claim a religious objection in these states to justify receiving a vaccine
exemption. n185 According to a study that analyzed sixty different preventable disease outbreaks linked to religious communities and eleven of the most
populous religious groups, the three most cited reasons for asserting religious objections were: "(a) violation of prohibitions against taking life, (b) violation of
dietary laws, or (c) interference with natural order by not letting events take their course." n186 Notably,
this study also found that "[i]n
multiple cases, ostensibly religious reasons to decline immunization actually reflected concerns about
vaccine safety or personal beliefs among a social network of people organized around a faith community, rather than theologically based objections per se."
n187 In a separate study, the most commonly cited reason for refusing to vaccinate one's children was not

religious, but was instead concern about vaccine safety. n188 Although there may be sources in scripture that invoke objections to
immunizations, they are few and far between, with the more common reason for objecting to these laws being fear of harm--a non-religious belief that neither of
the First Amendment clauses protect.
Federal Government is Key
Generic
Federal government should mandate mandatory vaccinations --- its key to herd
immunity and it’s a governmental obligation
ELLEN TOLSMA 2015 --- While in law school, Ellen was co-President of the Iowa Student Bar Association and served as the
Senior Administrative Editor as well as a student writer for the Journal of Gender, Race & Justice. University of Iowa, Juris
Doctor 2015 Northwestern College, Bachelor of Arts 2012. (“Protecting Our Herd: How a National Mandatory Vaccination Policy
Protects Public Health by Ensuring Herd Immunity”, Ellen Tolsma, Winter 2015, ProQuest, 337-339)//chiragjain

Having examined the legal and medical history of vaccinations and the current climate in both the legal and medical fields, it
is essential to examine
how to approach mandatory vaccinations going forward. The question of a solution to mandatory
vaccinations arises with the need to honor both public safety and individual liberty. This section offers an analysis
and proposed solution to the issue of mandatory vaccinations. A. Herd Immunity As explained previously,205 herd immunity occurs "[w]hen a critical portion of a
community is immunized against a contagious disease . . . ,"206 Because the majority of those within the population are immunized, those that are not, or those
that cannot be immunized207 are protected.208 "Even those who are not eligible for certain vaccines-such as infants, pregnant women, or immunocompromised
individuals-get some protection because the spread of contagious disease is contained."209 However, for
herd immunity to be effective,
according to the CDC, "[t]he coverage target is [greater than or equal to ninety-five percent] vaccination
coverage for the following vaccines: MMR; diphtheria, tetanus toxoid, and acellular pertussis (DTaP);
poliovirus; hepatits B (HepB); and varicella."210 The CDC conducted a survey of kindergarten students in the United States during the 2011-
12 school year in which only 93% of kindergarten students had been vaccinated against pertussis, and of those who were unvaccinated, .2% were due to a medical
exemption and 2.4% were due to a nonmedical exemption.211 This number falls well below the required percentage for herd immunity to be effective, and those
numbers are linked to the California pertussis outbreak.212 Pertussis is entirely preventable through vaccination and public health officials discovered that
"[v]accine refusal was indeed a factor" in the record-breaking outbreak.213 As the CDC notes, "[t]he best way to prevent [pertussis] is through vaccinations," so the
issue of non-medical exemptions to vaccinations is a serious one.214 Researchers
conducted studies attempting to map the
location and frequency of outbreaks of pertussis and found that "people who lived in areas with high
rates of personal belief exemptions were [two and one half] times more likely to live in a place with
lots of pertussis cases. .. [and] tended to be in neighborhoods with higher levels of education and income."215 Additionally, "[a] study recently
published in the journal Pediatrics indicated that outbreaks of these antediluvian diseases clustered where parents filed non-medical exemptions-that is, where
parents decided not to vaccinate their kids because of their personal beliefs."216 Although vaccine refusal was not the only factor in that outbreak,217 it
contributed.218 In an age when there is access to vaccinations for preventable diseases, there is no reason for death as a result of disease outbreaks. B. The Anti-
Vaccinationist Argument Although many believe the anti-vaccination movement to be a recent development, in reality it has been around since the advent of the
smallpox vaccination.219 Despite the changes in the spread of information, little has substantively changed within the anti-vaccinationist movement in the United
States, Great Britain, and other countries throughout the world.220 As described in Table 1 above, the subtextual categories of the anti-vaccinationist argument
remain largely the same today. While it is important to respect each person's individual liberty ,
the courts have time and again ruled that
the public good comes before individual liberty when discussing vaccination.221 Protecting the larger population by
allowing mandatory vaccinations is an attempt to ensure public health and welfare.222 The argument that a child will be placed at high risk due to a vaccination is
flawed because adverse reactions to vaccinations are extremely rare.223 Complications such as actually developing the disease from the vaccination occur far less
than the disease against which the vaccination protects.224 The vaccination is deemed safe when the benefits so outweigh the risks as to make the risks practically
nonexistent. 225 Such a classification is necessary before it is widely administered. When taken together, the minute risk of experiencing an adverse reaction to a
vaccination, the wide discretion given to states, the ease of avoiding state mandated vaccinations, and the increase in preventable disease outbreaks as a result of
that avoidance, necessitates a better system to regulate the administration of vaccination exemptions. C. The Solution With outbreak statistics in mind,
it is
necessary to ask what measures should be taken to prevent additional deaths due to lack of
immunization using stateauthorized exemptions. While there are many factors to consider, one of the most important is that the courts
have consistently ruled that public health and safety is more important than personal belief or religious exemptions.226 While these exemptions are important and
should be respected, the police power is given considerable leeway. Additionally, it is the role of the state to protect those that cannot protect themselves.227 In
the case of vaccinations, three main groups are at risk when herd immunity drops below the recommended ninety-five percent: pregnant women, young children
below the age of immunization, and the immunocompromised. 228 Each of these groups is absolutely incapable of receiving vaccinations, and therefore is
susceptible to disease when parents choose not to immunize their children. It is for that reason that the State currently steps in to require immunizations.229
However, with the increase in exemptions due to religious and personal beliefs and the ease of obtaining such an exemption, those that are medically unable to
receive vaccinations are placed at risk. In the case of pertussis, the vaccination is given to children at a young age, but wears off by adulthood.230 "[U]ntil recently,
[this] was rarely a problem because the disease wasn't running rampant because of people not vaccinating their kids."231 However, with the anti-vaccination
movement of recent years, pertussis has resurged even in those that were vaccinated at a young age.232 Therefore, the State is unable to protect those that need
protection and those that have received vaccinations to protect themselves in the interest of public health and safety-a legitimate government interest. Finally, in

the interest of justice, those who are able to receive a vaccination and choose not to are needlessly
endangering the lives of fellow human beings. By enabling exemptions with lax regulations, those that truly deserve exemptions (people
with documented medical reasons for not receiving one) are put in danger.233 For the sake of protecting those that cannot protect themselves, the Federal
Government should create a mandatory vaccination schedule, which only allows for exemptions to accommodate universally recognized medical conditions.234 The
CDC recommends a vaccine schedule for children from birth to six years of age. 235 Of the vaccinations recommended, only one needs to be administered more
than once.236 Therefore, the Federal Government should mandate the vaccinations that only need to be
administered once, rather than allow for a religious or personal belief exemption based on the
schedule provided by the CDC.237 This approach will achieve herd immunity and protect those that
cannot protect themselves from preventable diseases. If the government adopts this mandatory vaccination
program, the public health and welfare of the population will be provided for. By mandating these
vaccines on this schedule and not allowing for exemptions unless medically necessary, the Federal
Government protects the public health and protects those that cannot protect themselves. The legitimate government
interest in protecting public health allows the Federal Government to mandate these vaccinations. V.
Conclusion Given the increase in disease outbreaks in recent years linked to an increase in the exemptions to vaccinations for personal and religious beliefs, the

Federal Government should eliminate these exemptions unless medically necessary. By mandating a schedule
similar to the recommendations suggested by the CDC, the Federal Government protects those that cannot protect themselves, while lurthering an important
government interest. If the government follows these recommendations, the number of preventable deaths would decrease. No one lives in isolation,239 and for
that reason the good of the whole outweighs the need for religious and personal exemptions. Mandating vaccinations will save lives and
is a realistic and easy solution to a pressing problem.
Resources
Federal government is key and solves – the federal government creates uniform
standards, provides adequate incentive to follow the policy, and has expertise
and financial and scientific resources (this describes exactly what the aff should
do)
Tohanczyn 16 --- Katherine is an associate in the Starfield Smith’s Fort Washington office. She concentrates her practice on
commercial financing, real estate and corporate law with a focus on commercial lending and government guaranteed lending. (“ Katherine D.,
“WHO SHOULD CALL THE SHOTS? PROPOSING FEDERAL OVERSIGHT OF MANDATORY CHILDHOOD VACCINATIONS,” winter edition of the
Philadelphia Lawyer 2016,
http://www.philadelphiabar.org/WebObjects/PBAReadOnly.woa/Contents/WebServerResources/CMSResources/ginsburgessay15.pdf)//ernst

IV. SUGGESTIONS FOR CHANGE: WHY FEDERAL OVERSIGHT IS THE UPSHOT In order to overcome the issues with the current vaccination system, the federal government should adopt and implement uniform vaccination
laws rather than leaving such individualized power to the states . While the federal government does not have inherent constitutional jurisdiction over mandatory vaccinations, such jurisdiction could be

The federal government should limit the availability


overcome by tying vaccines to the federal funding received by every school nationwide.

of exemptions under the model provided by the Affordable Care Act (ACA). Ultimately, this approach is
consistent with current public perception and is a logical extension of the federal government’s current
responsibilities. A. Overcoming Constitutional Barriers to Federal Oversight of Vaccines The largest hurdle to a federal mandatory vaccination program is fitting such a
program within the federal government’s limited powers. According to the Tenth Amendment to the United States Constitution, any power not specifically enumerated to the
federal government in the Constitution is reserved to the state governments.44 Since the power to implement a mandatory vaccine program is not specifically granted to the
, the federal government has argued that its power to act over
federal government, this power is retained by the states. Generally

public health falls under the Commerce Clause, which states that Congress shall have the power “[t]o regulate Commerce with foreign Nations,
and among the several States . . . .”45 The federal government has previously used this authority to pass the National Childhood Vaccine Injury Act (NCVIA). Under the NCVIA,
the Department of Health and Human Services is responsible for overseeing everything from research and development to distribution and use of vaccines.46 In addition, the
NCVIA also establishes two important reporting systems. The first requires health care providers to supply parents with standardized pamphlets on each vaccine prior to
administering the vaccine. 47 The second requires health care providers and manufactures to report certain adverse events from vaccines to the federal government. However,
the federal
the idea that the Commerce Clause extends to a mandatory vaccination program for school admission is a more attenuated argument. Rather,

government would be more successful in creating a unified vaccine program by requiring states to
adopt specific standards as a condition to federal funding for education. This situation is analgous the federal government
has previously done by tying federal transportation funding to alcohol distribution standards. In 1984, Congress passed the National Minimum Drinking Age Act, which withheld
10% of federal highway funding from states that did not maintain a minimum legal drinking age of twenty-one. 49 South Dakota challenged the law but the Supreme Court
upheld the law noting that Congress may “attach conditions on the receipt of federal funds.”50 In coming to this decision, the
Court established a five part test for determining whether such a condition on federal funding is constitutional or amounts to coercion. Ultimately, a condition of federal funding
will be upheld so long as (1) promotes the general welfare, (2) is unambiguous, (3) relates “to the federal interest in particular national projects or programs,” (4) is not in and of
Congress should use this precedent of deferential treatment toward
itself unconstitutional, and, (5) is not coercive. 51

congressional conditional spending to persuade states to adopt mandatory vaccination programs with
more stringent exemption standards as a condition to federal funding for education.52 It is commonly
accepted that the federal government has an interest in maintaining public health, and a mandatory vaccine program
instituted at the federal level relates to the Healthy People 2020 program, which is a federal initiative that seeks to improve the nation’s health through various means, including
increased vaccinations.53 Congress may also seek to tie this vaccine program to specific projects carried out by the Department of Education at the elementary and secondary
levels.54 Given the state precedent on this matter, a federal statute can easily be drafted that is unambiguous. Further, such a program
is not in and of itself unconstitutional because citizens have alternative options (e.g., homeschooling) and will not be

forcibly immunized against their will. The Supreme Court has continually upheld the constitutionality of a mandatory vaccination program at the state
level under a theory of deference to public health. The federal government could argue that it is also entitled to this

protection when similarly acting to promote the public welfare through a mandatory childhood vaccine
program created by the federal government and implemented by at the state level. Finally, such a program is not coercive. While mandatory vaccination is a constraint on
one’s personal freedom (albeit to protect the health and safety of the community), the restriction is with the constitutional powers of the government and the availability of
limited exemptions allows the state to exclude some children without risk of losing funding. Further, states are not required to enact the legislation just as they were not
. Tying Mandatory Vaccination Laws to Federal Funding of
required to implement a minimal drinking age of twenty-one. B

Education The primary responsibility for K-12 education lies with the individual states. However, the
federal government provides annual funding to supplement subpar state funding.55 Authority for this federal funding is
found in the Elementary and Secondary Education Act (ESEA). The ESEA was enacted by Lyndon B. Johnson, in 1965, to grant federal funding and to establish a national
curriculum to hold schools accountable for educational achievements. 56 Under ESEA, funding is allocated for a number of different elementary and secondary programs,
the federal
including programs for low-income children, foreign languages, gifted students, and arts, as well as library and textbook materials.57 Overall,

government contributes 10.8% of the total amount spend nationwide on education each year. While this
percentage seems relatively low, in reality, it amounts to over $100 billion annually.58 This amount is also a necessary supplement to state

budgets, which would not be able to make up the difference if such funding was pulled because of a
failure to implement a mandatory vaccine program. C. Determining Allowable Exemptions 17 In establishing this program, the federal
government must determine what, if any, exemptions will be granted. As previously discussed, an
exemption for individuals with specific medical conditions is necessary and logical. Further, very few individuals meet
the criteria to receive this exemption.59 Therefore, such an exemption should continue under a federal program with the

sole requirement being that a child’s parent or guardian must provide written documentation from a
licensed physician explaining why the child’s medical condition makes him or her exempt from vaccines.
Conversely, philosophical exemptions are ill founded and only inhibit the public goal without any benefit to

the community. As such, this exemption is seen more as one of convenience then of actual belief. A majority of states have recognized the detriment associated with
this exemption and no longer allow parents to opt their children out of vaccinations simply because of a personal belief. Also, as previously mentioned, a number of states that
do still allow for the exemption have proposed bills to eliminate it. It only makes sense that the federal government follow this majority approach and also not allow a
philosophical exemption under a federal program

Federal key – expertise, money and precedent – the states are inconsistent
Tohanczyn 16 --- Katherine is an associate in the Starfield Smith’s Fort Washington office. She concentrates her practice on
commercial financing, real estate and corporate law with a focus on commercial lending and government guaranteed lending. (“ Katherine
D., “WHO SHOULD CALL THE SHOTS? PROPOSING FEDERAL OVERSIGHT OF MANDATORY CHILDHOOD VACCINATIONS,” winter edition of the
Philadelphia Lawyer 2016,
http://www.philadelphiabar.org/WebObjects/PBAReadOnly.woa/Contents/WebServerResources/CMSResources/ginsburgessay15.pdf)//er
nst

The rationale for implementing a vaccine program with federal oversight includes
D. Why Federal Oversight Is Rational

historical, economical, and logical reasons. In 1813, Thomas Jefferson signed a law that required the federal
government to “guarantee and distribute effective vaccines” in order to prevent epidemics.67 While the federal
government currently retains the right to quarantine individuals and require vaccination of immigrants and military, Congress has since rescinded control of immunizations of
Due to the direct correlation between decreases in vaccinations and increases
children, leaving authority to the states.68

in infectious diseases, the federal government should return to its original position in mandating
childhood vaccines. Such federal oversight makes sense for a number of reasons. First, the current
structure has led to an inconsistent patchwork of laws, standards, and procedures both among and within states.
Further, most of these statutes are outdated and have failed to keep up with trends in scientific and technological advances, as well as judicial

interpretations. In addition, some states are moving in the wrong direction as legislatures in the past two years have proposed bills to
make exemptions even easier to obtain.69 These states include Florida, Georgia, Iowa, Kansas, Massachusetts, Mississippi, New Hampshire, New Jersey, New York, South
, it is imperative that the federal government act to
Dakota, Virginia, and West Virginia. 70 In order to improve the nation’s health

encourage states to implement uniform standards based on a delicate balance of the risk and cost of disease with a burden on individual
autonomy. Such standards are necessary to ensure clarity and coherence among public health officials at all levels and in all states. They also prevent parents from moving to
another state – or often times the neighboring school district – to avoid a poorly implemented vaccine policy, due to false rumors about possible side effects of immunizations,
Just as disease knows no boundaries, our government’s public health initiatives must
including their link to autism.

also look past state lines. Additionally, the federal government is in the best position to create such a
mandate because of their superior financial and scientific resources and expertise. V. CONCLUSION As more and more
parents continue to take advantage of ineffective, unenforced, and overbroad vaccine exemptions, the federal government must proactively

take steps to protect the public’s health. The federal government should develop mandatory
requirements with limited and narrow exceptions that would not be a financial burden on school
districts and public health boards. It should persuade states to adopt and appropriately implement this
policy by tying federal funding of education to its operation. And finally, it must also take steps to educate
parents about the truths and myths regarding vaccines, including how opting their children out of a
vaccine places the community at risk of contracting a vaccine-preventable disease.
Funding
Federal government should require all schoolchildren to be vaccinated and tie this
requirement to federal funding for education
Tohanczyn 16 --- Katherine is an associate in the Starfield Smith’s Fort Washington office. She concentrates her practice on
commercial financing, real estate and corporate law with a focus on commercial lending and government guaranteed lending. (“ Katherine
D., “WHO SHOULD CALL THE SHOTS? PROPOSING FEDERAL OVERSIGHT OF MANDATORY CHILDHOOD VACCINATIONS,” winter edition of the
Philadelphia Lawyer 2016,
http://www.philadelphiabar.org/WebObjects/PBAReadOnly.woa/Contents/WebServerResources/CMSResources/ginsburgessay15.pdf)//er
nst

I. INTRODUCTION The United States was founded on the principle of personal freedom, famously “secur[ing] the blessings of liberty” for
generations. 2 However, it is commonly accepted (albeit sometimes grudgingly) that this freedom is not absolute, as one’s exercise of personal
freedom cannot infringe upon another citizen’s exercise of their own freedom. Federal and state governments are charged, not with
determining whether citizens have freedoms, but rather with drawing boundaries and determining when one’s actions impede the rights of
another. For example, America’s basic principles dictate that one should have the freedom to refuse to be vaccinated for any reason including,
distrust in science or wish to avoid physical discomfort. At the same time, parents have the right to send their children to receive an education
in a safe environment. For over a century, state governments have attempted to toe the fine line between
respecting a citizen’s decision to refuse a vaccine and protecting the public health. Despite consistent scientific
advances in the area of vaccinations, the spread of infectious disease continues today and is likely to remain under
the status quo. With that understanding, the federal government is in a much better position than state
governments to safeguard public health due to its superior financial and scientific resources and
expertise. This Article argues that the current system of excessive vaccination exemptions, coupled with
inconsistent governmental standards and enforcement, inhibits public health goals associated with
compulsory immunization. Part II discusses the development of current vaccination laws, including the three commonly accepted
exemptions to vaccines. Part III examines the negative impact these exemptions have on the public health. Finally, Part IV urges the
federal government to take action by setting stricter standards and influencing states to implement this
program by tying it to federal funding for education.

Recent budget cuts kill states solvency – federal funding is key


Offit 17 -- Paul A. Offit is a professor of pediatrics at the Perelman School of Medicine at the University
of Pennsylvania and the author of Deadly Choices: How the Anti-Vaccine Movement Threatens Us All
(Basic Books, 2011). [6/24/17; What Makes Trumpcare So Dangerous for Kids,
http://www.thedailybeast.com/what-makes-trumpcare-so-dangerous-for-
kids?source=twitter&via=desktop] MP

The Trump White House is on the verge of delivering a one-two punch to one of the most important
health care programs in the United States: childhood immunizations. The first punch would come from the Senate’s
version of the American Health Care Act, which eliminates the Prevention and Public Health Fund (PPHF). The PPHF, which was created in 2010
as part of the Affordable Care Act, was originally intended to supplement several core public-health programs. During the past few years,
however, the PPHF has evolved to be one of the most important government programs in support of
vaccines. In fiscal 2016, for example, $324 million, or about 53 percent of immunization funding to the
Centers for Disease Control and Prevention (CDC), came from the PPHF. The second blow will come from
the president’s proposed budget, which would reduce funds for the CDC to support vaccines, to $521 million in
2018 from $606 million in 2017. Most legislators have claimed that the president’s proposed budget is dead on arrival in Congress.
Nonetheless, his budget makes clear the administration doesn’t value public health. Even if the final cuts are only a fraction of
what is proposed, tens of millions of dollars will no longer be available for immunizations. What would
happen if the CDC’s immunization budget lost $100 million from the proposed budget and $324 million
from the PPHF? One could expect the following: • States will have less money to purchase vaccines. • States will
have less money to train personnel to administer vaccines. • States will have less money to support the staff and
technologies necessary to track immunization coverage. • States will have less money to purchase cancer-preventing
HPV vaccines for teens and pre-teens. • The CDC will have a reduced capacity to respond to outbreaks of
vaccine-preventable diseases, influenza pandemics, manmade disasters, and emerging threats like the
Zika virus. • The CDC will have less money to monitor vaccine safety.

Lack of state funding causes new policies that prevent mandated vaccinations
Lee et al 07 (Grace M. Lee, MD, MPH - Associate Professor of Population Medicine and Pediatrics, Harvard Medical School; Jeanne M. Santoli, MD -
Medical Officer at the Centers for Disease Control and Prevention in Atlanta; Claire Hannan, MPH - She joined the Association of Immunization Managers as its first
Executive Director in 2004. She holds a Bachelor of Arts degree in Political Science from Wagner College in Staten Island, NY and a Masters degree in Public Health
from Johns Hopkins University; Mark L. Messonnier, PhD; James E. Sabin, MD; Donna Rusinak - Research Associate in Medicine at Massachusetts General
Hospital; Charlene Gay; Susan M. Lett, MD, MPH; Tracy A. Lieu, MD, MPH - rector of the Division of Research, Kaiser Permanente Northern California, MD at the
University of California, San Francisco, and was a pediatric resident at the University of Pennsylvania and a Robert Wood Johnson Clinical Scholar in the UCSF-
Stanford program, Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts (Drs Lee,
Sabin, and Lieu, and Mss Rusinak and Gay); Divisions of Infectious Diseases (Dr Lee) and General Pediatrics (Dr Lieu), Children's Hospital Boston, Boston,
Massachusetts; National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia (Drs Santoli and
Messonnier); Association of Immunization Managers, Rockville, Maryland (Ms Hannan); and Massachusetts Department of Public Health, Jamaica Plain (Dr Lett)
“Gaps in Vaccine Financing for Underinsured Children in the United States”, http://jamanetwork.com/journals/jama/fullarticle/208343, August 8 2007)

Immunization program managers from 48 states (96%) participated in the study. Underinsured
children were not eligible to receive publicly purchased meningococcal conjugate or pneumococcal
conjugate vaccines in the private sector in 70% and 50% of states, respectively, or in the public sector
in 40% and 17% of states, respectively. Due to limited financing for new vaccines, 10 states changed
their policies for provision of publicly purchased vaccines between 2004 and early 2006 to restrict
access to selected new vaccines for underinsured children. The most commonly cited barriers to
implementation in underinsured children were lack of sufficient federal and state funding to purchase
vaccines.

There is a lack of state enforcements


Lee et al 07 (Grace M. Lee, MD, MPH - Associate Professor of Population Medicine and Pediatrics, Harvard Medical School; Jeanne M. Santoli, MD -
Medical Officer at the Centers for Disease Control and Prevention in Atlanta; Claire Hannan, MPH - She joined the Association of Immunization Managers as its first
Executive Director in 2004. She holds a Bachelor of Arts degree in Political Science from Wagner College in Staten Island, NY and a Masters degree in Public Health
from Johns Hopkins University; Mark L. Messonnier, PhD; James E. Sabin, MD; Donna Rusinak - Research Associate in Medicine at Massachusetts General
Hospital; Charlene Gay; Susan M. Lett, MD, MPH; Tracy A. Lieu, MD, MPH - rector of the Division of Research, Kaiser Permanente Northern California, MD at the
University of California, San Francisco, and was a pediatric resident at the University of Pennsylvania and a Robert Wood Johnson Clinical Scholar in the UCSF-
Stanford program, Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts (Drs Lee,
Sabin, and Lieu, and Mss Rusinak and Gay); Divisions of Infectious Diseases (Dr Lee) and General Pediatrics (Dr Lieu), Children's Hospital Boston, Boston,
Massachusetts; National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia (Drs Santoli and
Messonnier); Association of Immunization Managers, Rockville, Maryland (Ms Hannan); and Massachusetts Department of Public Health, Jamaica Plain (Dr Lett)
“Gaps in Vaccine Financing for Underinsured Children in the United States”, http://jamanetwork.com/journals/jama/fullarticle/208343, August 8 2007)

Forty-eight state immunization program managers participated in the study for an overall response
rate of 96%. Program managers had been in their positions for a mean of 7.2 years (median, 5.5years),
with a range of 0 to 27 years. Only 34% of states had a health insurance mandate that required
insurers to follow current ACIP or American Academy of Pediatrics recommendations for children and
adolescents. Seventeen percent of states had a health insurance mandate that did not require
insurers to cover all recommended vaccines and 49% of states did not have any health insurance
mandate.
Previous vaccines are from the government but more implementation is needed
Lee et al 07 (Grace M. Lee, MD, MPH - Associate Professor of Population Medicine and Pediatrics, Harvard Medical School; Jeanne M. Santoli, MD -
Medical Officer at the Centers for Disease Control and Prevention in Atlanta; Claire Hannan, MPH - She joined the Association of Immunization Managers as its first
Executive Director in 2004. She holds a Bachelor of Arts degree in Political Science from Wagner College in Staten Island, NY and a Masters degree in Public Health
from Johns Hopkins University; Mark L. Messonnier, PhD; James E. Sabin, MD; Donna Rusinak - Research Associate in Medicine at Massachusetts General
Hospital; Charlene Gay; Susan M. Lett, MD, MPH; Tracy A. Lieu, MD, MPH - rector of the Division of Research, Kaiser Permanente Northern California, MD at the
University of California, San Francisco, and was a pediatric resident at the University of Pennsylvania and a Robert Wood Johnson Clinical Scholar in the UCSF-
Stanford program, Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts (Drs Lee,
Sabin, and Lieu, and Mss Rusinak and Gay); Divisions of Infectious Diseases (Dr Lee) and General Pediatrics (Dr Lieu), Children's Hospital Boston, Boston,
Massachusetts; National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia (Drs Santoli and
Messonnier); Association of Immunization Managers, Rockville, Maryland (Ms Hannan); and Massachusetts Department of Public Health, Jamaica Plain (Dr Lett)
“Gaps in Vaccine Financing for Underinsured Children in the United States”, http://jamanetwork.com/journals/jama/fullarticle/208343, August 8 2007)

In 2006, approximately half of all children aged 0 to 18 years in the United States were considered VFC
eligible (J.M.S., Centers for Disease Control and Prevention, unpublished data, 2007). Certain groups of
children are eligible to receive VFC in any setting, including those who are uninsured, Medicaid
enrolled, or of American Indian/ Alaska Native descent. In addition, underinsured children are able to
receive VFC vaccines when served in federally qualified health centers or rural health clinics.
Unfortunately, these facilities do not exist in every community because of location requirements
related to serving in medically underserved areas, which may limit access to vaccination for
underinsured children.8 For under insured children who are not able to access federally qualified health
centers or rural health clinics due to lack of proximity to these sites, public health clinics have served as
their safety net. Funding for under insured children who seek vaccines in public health clinics has
typically been provided by other federal sources, such as section 317 discretionary grants.5 Some
states have also contributed state funding to purchase vaccines for vulnerable children in public health
clinics. Declines in such funding in recent years combined with increases in the number of vaccines and
higher vaccine costs have led to concerns over the gaps in the availability of new vaccines for the
growing population of children who are underinsured.9,10 Our goal was to evaluate the status of
financing and distribution of new pediatric vaccines at the state level. We achieved this by (1)
describing variation among states in the provision of publicly purchased vaccines to underinsured
children and (2) identifying barriers to state purchase and distribution of new vaccines.

Multiple states are changing their policies regarding mandating vaccinations – makes
it impossible for mandated vaccines at the state level
Lee et al 07 (Grace M. Lee, MD, MPH - Associate Professor of Population Medicine and Pediatrics, Harvard Medical School; Jeanne M. Santoli, MD -
Medical Officer at the Centers for Disease Control and Prevention in Atlanta; Claire Hannan, MPH - She joined the Association of Immunization Managers as its first
Executive Director in 2004. She holds a Bachelor of Arts degree in Political Science from Wagner College in Staten Island, NY and a Masters degree in Public Health
from Johns Hopkins University; Mark L. Messonnier, PhD; James E. Sabin, MD; Donna Rusinak - Research Associate in Medicine at Massachusetts General
Hospital; Charlene Gay; Susan M. Lett, MD, MPH; Tracy A. Lieu, MD, MPH - rector of the Division of Research, Kaiser Permanente Northern California, MD at the
University of California, San Francisco, and was a pediatric resident at the University of Pennsylvania and a Robert Wood Johnson Clinical Scholar in the UCSF-
Stanford program, Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts (Drs Lee,
Sabin, and Lieu, and Mss Rusinak and Gay); Divisions of Infectious Diseases (Dr Lee) and General Pediatrics (Dr Lieu), Children's Hospital Boston, Boston,
Massachusetts; National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia (Drs Santoli and
Messonnier); Association of Immunization Managers, Rockville, Maryland (Ms Hannan); and Massachusetts Department of Public Health, Jamaica Plain (Dr Lett)
“Gaps in Vaccine Financing for Underinsured Children in the United States”, http://jamanetwork.com/journals/jama/fullarticle/208343, August 8 2007)

Ten states reported that between 2004 and early 2006, new limitations in their ability to provide
publicly purchased vaccines for underinsured children had arisen as a consequence of limitations in
federal and state financing for vaccine purchase. Two states that formerly had universal purchase for all
children changed their policies to provide certain newer vaccines to VFC eligible children only. Five
states that formerly had purchased all vaccines for all underinsured and VFC-eligible children began to
provide certain newer vaccines only to VFC-eligible children. Three states that formerly purchased
some vaccines to give to underinsured children changed their policy to provide vaccines only to VFC
eligible children. Interestingly, 1 state was able to advocate for and receive increased amounts of
state funding for pneumococcal conjugate vaccine and thus was temporarily able to provide all
publicly purchased vaccines to underinsured children at that time.

Multiple alt causes to effective state implementation


Lee et al 07 (Grace M. Lee, MD, MPH - Associate Professor of Population Medicine and Pediatrics, Harvard Medical School; Jeanne M. Santoli, MD -
Medical Officer at the Centers for Disease Control and Prevention in Atlanta; Claire Hannan, MPH - She joined the Association of Immunization Managers as its first
Executive Director in 2004. She holds a Bachelor of Arts degree in Political Science from Wagner College in Staten Island, NY and a Masters degree in Public Health
from Johns Hopkins University; Mark L. Messonnier, PhD; James E. Sabin, MD; Donna Rusinak - Research Associate in Medicine at Massachusetts General
Hospital; Charlene Gay; Susan M. Lett, MD, MPH; Tracy A. Lieu, MD, MPH - rector of the Division of Research, Kaiser Permanente Northern California, MD at the
University of California, San Francisco, and was a pediatric resident at the University of Pennsylvania and a Robert Wood Johnson Clinical Scholar in the UCSF-
Stanford program, Department of Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts (Drs Lee,
Sabin, and Lieu, and Mss Rusinak and Gay); Divisions of Infectious Diseases (Dr Lee) and General Pediatrics (Dr Lieu), Children's Hospital Boston, Boston,
Massachusetts; National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia (Drs Santoli and
Messonnier); Association of Immunization Managers, Rockville, Maryland (Ms Hannan); and Massachusetts Department of Public Health, Jamaica Plain (Dr Lett)
“Gaps in Vaccine Financing for Underinsured Children in the United States”, http://jamanetwork.com/journals/jama/fullarticle/208343, August 8 2007)

Limitations in both federal (section 317) and state vaccine financing were reported as the dominant
barriers to states’ providing vaccines to underinsured children. Lack of section 317 funding was cited
as a barrier for 81% (Tdap) to 100% (pneumococcal conjugate) of state immunization programs that
were not able to provide vaccines to underinsured children. State funding was either limited or
unavailable for vaccine purchase for 94% or more of programs that were not able to provide vaccines
to underinsured children. Vaccine supply or allocation was also cited as a barrier to implementation in
this population, particularly for meningococcal conjugate (56%) and Tdap (27%) vaccines. In particular,
monthly federal allocations due to limitations in vaccine supply resulted in some programs delaying the
distribution of vaccine to clinicians until they thought they had been able to purchase an adequate
amount of vaccine. Program managers also described other issues that affected implementation in their
state. Equity was a concern for several immunization programs. Delays in implementation occurred
until funding was secured for the entire population (eg, VFC eligible and underinsured children). Some
program managers preferred not to implement a new vaccine that was replacing an older vaccine
until supplies had been exhausted to minimize waste, such as when Tdap was recommended to
replace tetanus-diphtheria toxoids (Td) vaccine for adolescents. School mandates affected
implementation in both directions. In some cases, a school mandate was helpful in encouraging state
legislatures to provide additional funding to ensure vaccine purchase for underinsured children. In
other cases, program managers thought that they could not pursue school mandates until funding was
sufficient to ensure that underinsured children would have access to vaccine before a requirement was
enacted.
Spillover
Global modelling is key to solving health education around the world – especially in
third world countries
Jukes et al 8 -- a Graduate School of Education, Harvard University, Cambridge, Massachusetts, USA, b
Partnership for Child Development, Department for Infectious Disease Epidemiology, Imperial College
London, UK, and c Human Development Network, World Bank, Washington, DC, USA. [Matthew
Jukesa,b, Stephanie Simmonsa and Donald Bundyc, Education and vulnerability: the role of schools in
protecting young women and girls from HIV in southern Africa, page 1 (introduction)] MP

Education has a potentially important role to play in tackling the spread of HIV, but is there evidence that this potential is
realized? This analysis combines the results of previous literature reviews and updates them with the findings of recent randomized controlled trials and a
discussion of possible mechanisms for the effect of schooling on vulnerability to HIV infection. There is a growing body of evidence that keeping girls in school
reduces their risk of contracting HIV. The
relationship between educational attainment and HIV has changed over
time, with educational attainment now more likely to be associated with a lower risk of HIV infection
than earlier in the epidemic. Educational attainment cannot, however, be isolated from other socioeconomic factors as the cause of HIV risk
reduction. The findings of this analysis suggest that the equitable expansion of primary and secondary schooling for girls in southern Africa will help reduce their
vulnerability to HIV. Evidence of ineffective HIV prevention education in schools underlines the need for careful evidence-based programme design. Despite the
challenges, recent provisional evidence suggests that highly targeted programmes promoting realistic options for young adults may lead to safer sexual behaviour.
Targeted education programmes have also been successful in changing students’ attitudes to people
living with HIV and AIDS, which is associated with testing and treatment decisions. This reduction in
stigma may be crucial in encouraging the uptake of voluntary counselling and testing, a central strategy
in the control of the epidemic. Expansions of carefully designed and evaluated school-based HIV
prevention programmes can help to reduce stigma and have the potential to promote safe sexual
behaviour
Vaccine Education Key
Schools are key to vaccination efforts – especially among adolescents
Lindley et al 7 -- a National Center for Immunization and Respiratory Diseases, Centers for Disease
Control and Prevention, Atlanta, Georgia; bSan Francisco Unified School District, San Francisco,
California; c Section of Adolescent Medicine and Sports Medicine, Department of Pediatrics, Baylor
College of Medicine, Houston, Texas; dSchool of Nursing, University of Missouri, Kansas City, Missouri; e
Michigan Department of Community Health, Lansing, Michigan; f American School Health Association,
Kent, Ohio [Megan C. Lindley, MPHa, Lynda Boyer-Chu, BSN, MPHb, Daniel B. Fishbein, MDa, Maureen
Kolasa, RN, MPHa, Amy B. Middleman, MD, MPH, MSEdc , Thad Wilson, APRN, PhDd, JoEllen Wolicki,
RN, BSNe, Susan Wooley, PhD, CHESf , for the Working Group on the Role of Schools in Delivery of
Adolescent Vaccinations, August 22, 2007, The Role of Schools in Strengthening Delivery of New
Adolescent Vaccinations] MP

Schools offer an opportunity to deliver new vaccines to adolescents who may not receive them in their
medical home. However, school budgets and health priorities are set at the local level; consequently
resources devoted to health-related activities vary widely. Partnering with schools requires soliciting
buy-in from stakeholders at district and school levels and providing added value to schools. With
appropriate resources and partnerships, schools could carry out vaccination-related activities from
educating students, parents, and communities to developing policies supporting vaccination,
providing vaccines, or serving as the site at which partners administer vaccines. Activities will vary
among schools, but every school has the potential to use some strategies that promote adolescent
vaccination. WITH 3 NEW vaccines for adolescents recommended since 2005, and more on the way,
effective mechanisms for delivering adolescent vaccinations are increasingly important. Because
school occupies a significant part of most adolescents’ lives, the potential range of roles for schools in
adolescent vaccination, from education and promotion to vaccine administration, deserves special
attention. Schools must devote significant energy to complying with numerous mandatory
accountability measures as they fulfill their primary educational purpose, but every school has the
potential to promote adolescent vaccination. Including schools as partners in promoting adolescent
vaccination will complement other efforts and offer considerable access to an often hard-to-reach group

Vaccine education is key to prevent health issues of the future generation


Benin et al. 10 – all alumni of Yale School of Medicine [How Can We Communicate About Vaccines
With Adolescents and Their Parents?, Andrea L. Benin, Ann C. Wu, Eric S. Holmboe, Eugene D. Shapiro,
Walter Anyan, http://journals.sagepub.com/doi/pdf/10.1177/0009922809351091, introduction] MP

As new vaccines are added to the adolescent vaccination regimen,1,2 it has become especially
important to overcome the challenges of communicating about risks and benefits of vaccines with
adolescents and their families. These challenges are particularly prominent in light of publicity about
both real and perceived risks of vaccination3-5 and because some vaccines are associated with the
stigma of preventing sexually transmitted infections.1,2,6 Discussing vaccination with adolescents is
especially difficult because of their distorted perceptions of risks and because adolescents spend little
time thinking about preventive measures or risks and benefits of such measures.7 Nevertheless,
adolescents need to understand about vaccines both for their own health and because they are the
next generation of parents; their personal experiences with vaccination can shape their attitudes about
vaccination for their own children (our unpublished data from a previous qualitative study4 regarding
vaccination of infants). Existing studies have not used qualitative techniques to broadly explore attitudes
toward risk and benefits of vaccination from the point of view of the 10-year-old to 14-year-old targets
of adolescent-vaccination programs and their parents.8-16 With the goal of informing strategies for
vaccinating adolescents, we wanted to learn how both young adolescents and their parents perceived
vaccination and the process by which they evaluated the risks and benefits of vaccination. The
objectives of this study were to describe qualitatively both adolescents’ and parents’ (a) understanding
of concepts related to vaccination, (b) decision making about vaccination, and (c) response to the idea of
a vaccine that prevented a sexually transmitted infection.

Teens have no real concern for their bodies – ensures future anti-vaxx rhetoric
Benin et al. 10 – all alumni of Yale School of Medicine [How Can We Communicate About Vaccines
With Adolescents and Their Parents?, Andrea L. Benin, Ann C. Wu, Eric S. Holmboe, Eugene D. Shapiro,
Walter Anyan, http://journals.sagepub.com/doi/pdf/10.1177/0009922809351091, discussion] MP

We described themes in 3 topic areas regarding vaccination of adolescents: understanding of


vaccination, decision making about vaccination, and ideas about vaccines for sexually transmitted
infections. The themes that emerged in each of these areas can inform the planning and implementation of campaigns to vaccinate adolescents. This study is unique in examining the
degree of understanding of the younger adolescent with regard to vaccination. Older adolescents (~18 years old) are known to have poor

knowledge about vaccination9,20 and our findings suggest that younger adolescents additionally have
poor knowledge about vaccination and may be confused about whether they are receiving a vaccine,
depo-provera, a test for tuberculosis, or undergoing phlebotomy. Because teens have little knowledge about vaccines and a limited understanding of the concepts of risks and
benefits, health care providers will need to present information in a very concrete manner. Ideas about decision making regarding vaccination

were dominated by adolescents’ attention to the cleanliness and honesty of providers. Studies have
shown that when adolescents seek health care it is important to them that providers wash their hands
and use clean instruments.21,22 Our observation that adolescents worry that needles used for
vaccinations may be contaminated could be addressed during health care visits as part of a greater
reassurance about and demonstration of the cleanliness of office practices. Existing data also shows that adolescents prefer
providers who are honest and respectful;21,22 we found that adolescents were skeptical of being told that the injection will

not be painful. This experience left them feeling deceived—possibly undermining any positive messages about the decision
for vaccination—and suggests that providers use careful attention to word-choice when explaining
vaccinations or other aspects of health care. Decision making for adolescents was also entangled with their developmental process. Just as other authors
have shown that older adolescents have low self-efficacy regarding hepatitis B vaccination,9,20,23 we found that adolescents are conflicted between

the feeling that the adults should make the decision regarding vaccination for them and the emerging
idea that they should be taking more responsibility for their own bodies. This conflict is appropriate for their developmental stage
and may provide an opportunity to reinforce ideas that they should be learning to take responsibility for their bodies. Because the study was conducted at a time when the approval of the

human papilloma virus vaccine was impending, we were interested in perceptions related to vaccination against sexually
transmitted infections. Several studies examining parents’ perceptions of vaccines for adolescent-sexually transmitted infections have found, as we did, that many parents
will accept these vaccines because they want to protect their children against disease.14,24-30 Our data suggest that even when parents “rejected” their adolescent’s need for a vaccine
against a sexually transmitted infection, these adolescents had received hepatitis B vaccine. This phenomenon may be explained by our finding that parents perceive vaccination to be a
routine part of medical care. In contrast, because the vaccine against human papilloma virus is more overtly targeted at a sexually transmitted disease, vaccination rates have been threatened
by associated stigma and concerns of sexual promiscuity.31,32 From our data, we can speculate that finding ways to administer that vaccine as part of a routine package of adolescent care
may improve uptake.31 Despite a lack of clarity in the literature regarding the extent that directed education about vaccination is effective in improving understanding of vaccination and in
supporting decision making around vaccination,24,33 both adolescents and their parents are interested in using the process of vaccination as an opportunity for education about vaccine-

Educational efforts are challenged by how little time is available during


preventable diseases and about health care in general.

well-child checks34-36: the challenge for taking care of these early adolescents is to develop a way to
integrate educational issues for both parents and adolescents in a manner that is not overly
burdensome for clinicians while also being effective for families. Pediatric providers may be able to use
known predictors of parents who will “reject” vaccination to help identify those who will need extra care
with communication about these vaccinations.14,27,33 In particular, having a standing, trusting relationship with their provider plays an important role
in parents obtaining vaccinations for their children—and reflects the importance of providers’ viewpoints.4,33,37-39 Our findings should be considered in light of limitations to generalizability
and validity. In this study, we included a modest sample of English-speaking participants from families where children were typically vaccinated, who lived in one geographical area, and the
adults were all female. However, the generalizablility of qualitative research is not intended to derive from a random sample of patients who would be statistically representative. Instead, by
using purposeful sampling and sampling to the point of theoretical saturation, a qualitative study describes in-depth a full range of attitudes to create a theoretical understanding of an issue.
Because our data were collected before the vaccine against human papilloma virus was available, we cannot present a robust picture about how parents respond to that specific vaccine
against a sexually transmitted illness. To maximize validity of the explanations of the data we collected, we used the methodological techniques of purposeful sampling, grounded theory, and
coding by two researchers. Moreover, our findings are both credible as well as consistent with those of published studies using varied methodological approaches.

Teaching even basic levels of vaccine education is key to prevent future outbreaks
Benin et al. 10 – all alumni of Yale School of Medicine [How Can We Communicate About Vaccines
With Adolescents and Their Parents?, Andrea L. Benin, Ann C. Wu, Eric S. Holmboe, Eugene D. Shapiro,
Walter Anyan, http://journals.sagepub.com/doi/pdf/10.1177/0009922809351091, implications] MP

Expanding the immunization regimen for adolescents involves addressing controversial issues of politics,
ethics, consent, sexuality, school-entry, and cost-effectiveness, as well as medical home and other
delivery models.2,40-50 As the medical and public health communities work to address these issues, the findings from this study have several implications
that can enhance the communication component of vaccinating adolescents. Even basic concepts should be explained to both

adults and adolescents, communication should be concrete and rely on simple terms, and discussions
regarding the risks and benefits of vaccines can be integrated as part of transitioning to adult decision
making. Perception of the routine nature of vaccination will work in favor of vaccination programs for adolescents. Approaches for including
adolescents in discussions about vaccination should be based on minimizing their sense of deception,
addressing their fears of contaminated needles, validating their fear of pain, explaining vaccination to
them in concrete terms, and acknowledging that parents do not always know what adolescents are, or
will be, doing. Communication regarding new vaccines should address parents’ desires to protect their
children for the future when parents may no longer be nearby and can encourage parents to use
vaccination as an opportunity to teach their children about decision making as well as about sexually
transmitted infections.
AT: Backlash Arguments
Mandatory laws silence antivaxxers --- independent hesitant parents internal link
ROLAND PIERIK 5/18/2016 --- Roland Pierik is Associate Professor of Legal Philosphy at the University of Amsterdam
(“Mandatory Vaccination: An Unqualified Defence”, Roland Pierik, May 18, 2016, Journal of Applied Philosophy,
onlinelibrary.wiley.com.proxy.lib.umich.edu/doi/10.1111/japp.12215/full)//chiragjain

Section 'A Defence of Mandatory Vaccination' presented a normative defence of mandatory vaccination
against the measles, while Section 'A Legal Justification of Mandatory Vaccination' argued that unconditional mandatory vaccination
laws fit within the legal framework of liberal democracies. Some, however, present a pragmatic counter-argument: unconditional mandatory
laws will undermine herd immunity because it would create a public backlash against voluntary vaccination and will galvanise anti-vaccination
groups. This section unpacks this claim by analysing the effect mandatory vaccination laws on three relevant categories of parents: those who
wholeheartedly endorse vaccination, steadfast vaccine denialists, and indecisive parents. It
is unlikely that voluntary
vaccination would be affected by introducing mandatory laws. After all, why would those convinced by
the beneficial effect of vaccination suddenly become civilly disobedient once refusers are also legally
obligated to vaccinate – something they already consider prudent behaviour? Vaccine denialists, on the other hand, are already dead-
set against vaccination and, as discussed in Section 'Vaccination Objectors and their Motivations', will neither be convinced by the consensus in
the mainstream scientific community, nor be open to persuasion by the government. Thus, making vaccination mandatory might not affect the
number of denialists; it will only strengthen their opposition. Governments
seeking to protect robust herd immunity
should primarily focus on the third category: hesitant parents, and separate these parents, who might
still be open to persuasion, from the relatively small – albeit very vocal – group of vaccine denialists who
will cling to their convictions, no matter what. Those on the fence are a heterogeneous group of parents who seek information
about vaccine safety at the precarious moment when having to decide upon the inoculation of their first infant. If it were clear that a legal
obligation would discourage them to vaccinate, this fact would provide a pragmatic argument against such a proposal – despite having argued
in Section 'A Defence of Mandatory Vaccination' above that it is the most justified policy. Although one can never be sure in advance how
citizens will react to a future policy change, empirical
research in adjacent discussions suggests that mandatory
laws will convince hesitant parents to vaccinate, rather then discouraging them to do so. The more vaccinations are
presented as a given by the paediatrician, and the less as a choice, the more hesitant parents are
inclined to vaccinate. The choice to vaccinate ‘is not only complicated by an overwhelming amount of
information, it is also fraught with emotion. It is often easier in these situations to simply accept what is recommended,
especially when that recommendation is made by someone as influential and trusted as their child's pediatrician or family practitioner.’37 By
leaving vaccination within the domain of voluntary choice, the government communicates the message
that parents have a lot of leeway in this issue. Parents might be less hesitant to vaccinate when the government communicates
an explicit message that measles are dangerous for their child and a threat to public health. Horne et al. show that ‘rather than attempting to
overcome vaccination myths by convincing parents of the safety of vaccines, provaccine messages might be more effective if they work to
convince parents of the dangers of failing to vaccinate their children.’38 Government should communicate that refusing to vaccinate is
unacceptable risky behaviour, on a par with not buckling up one's kid in its car seat. One effective way to communicate that message is by
making vaccination a non-negotiable legal duty, outside of the ambit of parental freedom of religion and conscience. Finally, it turns out
that opposition to vaccination is less immune to governmental policies than message of denialists
would suggest. States in the US with stricter regulation and stricter enforcement of exemption laws
have higher vaccination rates than states with less strict regulation.39 When vaccination becomes a legal
obligation, steadfast denialists might stick to their opposition – and might even accept criminal prosecution. Hesitant
parents, on the other hand, might either be convinced by the message that not vaccinating is too dangerous, or might not be willing to risk
criminal prosecution and accept the option of vaccination reluctantly. Mandatory vaccination laws might strengthen the
social norm that responsible parents vaccinate their children, and generate social pressure amongst
parents in day care centres and schoolyards to confirm to this norm. It is very unlikely that it will lead to vaccination
coverage of a 100%; but it will definitely increase vaccination rates, and contribute to a more robust herd immunity. In sum, there is no
reason to assume that mandatory vaccination laws will dissuade hesitant parents to vaccinate; to the
contrary, the arguments above suggest that they might even encourage them. This effect might be strengthened when mandatory laws are
accompanied by encouraging policies, for example, by ensuring that parents are not hindered in their attempts get their children vaccinated.
The government should offer the relevant vaccinations free of charge, and guarantee the availability of a sufficient supply of safe vaccines.
Moreover, the government should set up an effective system of vaccination reminders, and should guarantee that immunisation services are
staffed by well-trained health professionals who are able and willing to discuss the concerns and questions of parents. The legal obligation to
vaccinate might drive a necessary wedge between vaccine denialists and hesitant parents. Anti-vaccination websites disperse the wildest
speculations with anecdotal evidence as ‘alternative medical truths’, while medical specialists can only provide peer reviewed information and
are handcuffed by professional standards in their attempts to counter this fear mongering. Denialists have the freedom of speech to disperse
their views; but there is something unsettling about the fact that the freedom of speech allows their unscientific and ungrounded claims to
have such weight in public debates, diluting the voice of evidence-based science.40 This makes that well-meaning hesitant parents
systematically over-perceive the magnitude of the risks involved, causing them to doubt whether the benefits of vaccinations do outweigh their
dangers.41 The unequivocal message of a legal obligation to vaccinate might make hesitant less susceptible to information from denialists –
their message gets tainted since it incites parents to illegal behaviour. Ironically
enough, it might require an actual first-
hand experience with an epidemic outbreak to end societal complacency towards non-vaccination and
for a political community to question the dominance of the ‘freedom of parental choice’ argument.
Indeed, the Disney outbreak of January 2015 led to an outpour of public indignation over the irresponsible behaviour of non-vaccinating
parents, and the risks they present to public health. A CNN/ORC poll in the wake of the Disney outbreak found that 78 per cent of respondents
believed that vaccinations should be mandatory for healthy children.42 Moreover, in reaction to the Disney outbreak, the state of California
discussed Senate Bill 277 to eliminate all nonmedical exemptions. The proposal led, predictably, to heated opposition by denialists but was in
the end accepted by a significant margin in the State Legislature.43 An initiative to a referendum to overturn the bill fell (far) short of the
number of signatures needed to put the issue on the ballot.44 In addition, legislators and public health professionals have been calling for
similar reforms in nearly 30 other states.45 In sum: the pragmatic
counterargument is less convincing than it might
have looked at first sight. There is no reason to assume that mandatory vaccination laws undermine
voluntary vaccination. They might indeed galvanise straightforward vaccine denialists, but they are immune to scientific consensus and
persuasion by the government anyway. But, most importantly, there are good reasons to assume that mandatory
vaccination laws encourage, rather than discourage hesitant parents to vaccinate their children and to
contribute to robust herd immunity.
AT: Unconstitutional
The federal government has constitutional authority to implement vaccination policy
under the Commerce Clause
JARED COLE AND KATHLEEN SWENDIMAN 5/21/2014 --- Legislative Attorneys at the Congressional Research Service
(“Mandatory Vaccinations: Precedent and Current Laws”, Jared Cole and Kathleen Swendiman, May 21, 2014, Congressional Research Service,
https://fas.org/sgp/crs/misc/RS21414.pdf)//chiragjain

Role of the Federal Government Federal


jurisdiction over public health matters derives from the Commerce
Clause, which states that Congress shall have the power “[t]o regulate Commerce with foreign Nations, and
among the several States....”72 Thus, under the Public Health Service Act, the Secretary of the Department of Health
and Human Services has authority to make and enforce regulations necessary “to prevent the
introduction, transmission, or spread of communicable diseases from foreign countries into the States
or possessions, or from one State or possession into any other State or possession.”73 With regard to interstate
commerce, the Public Health Service Act deals primarily with the use of quarantine and isolation
measures to halt the spread of certain communicable diseases.74 No mandatory vaccination programs are specifically
authorized, nor do there appear to be any regulations regarding the implementation of a mandatory vaccination program at the federal level
during a public health emergency.75

USFG has the authority to do it- legal precedent and constitution


Bucchieri 16(Rebecca Bucchieri- J.D., George Mason University School of Law, B.A. Law and, Magna
Cum Laude, American University. Summer 2016. “Religious Freedom versus public health: the necessity
of compulsory vaccination for schoolchildren”, The Boston University Public Interest Law Journal, 25 B.U.
Pub. Int. L.J. 265)\\WDB

Individuals are exercising non-medical exemptions at an increasing and accelerating rate and the Society
United States is experiencing the consequences in the form of escalating disease outbreaks. n189
Although the police power is generally reserved to the states, the federal government is not immobile in
the face of threats to public health and safety. n190 Congress has federal jurisdiction to pass [*288]
legislation concerning the public health pursuant to the Commerce Clause of the United States
Constitution, which states that Congress has the authority "[t]o regulate Commerce with foreign
Nations, and among the several States . . . ." n191 A long line of cases grappling with the outer limits of
the Commerce Clause have interpreted its powers to be quite broad, extending to many activities that
would otherwise be left up to state regulation, such as the minimum wage, n192 collective bargaining
rights, n193 agriculture production, n194 and the use of controlled substances. n195

Deriving power from the Commerce Clause, Congress in 1944 enacted the Public Health Services Act.
n196 The Act empowers the Surgeon General "to make and enforce such regulations as in his judgment
are necessary to prevent the introduction, transmission, or spread of communicable diseases from
foreign countries into the States or possessions, or from one State or possession into any other State or
possession." n197 Under this Act, and pursuant to the Commerce Clause, the federal government has
exercised broad authority over how the states treat infectious disease and administer immunizations.
n198 Congress has established vaccine clinics to quarantine those who have contracted a virus in order
to prevent the wider spread of infectious disease, has created the National Vaccine Plan, formed the
National Vaccine Advisory Committee, and has instituted the National Vaccine Injury Compensation
Program, which compensates individuals harmed by defective vaccines and preempts state law. n199
Although "[n]o mandatory vaccination programs are specifically authorized [under the Act], nor do there
appear to be any regulations regarding the implementation of a mandatory vaccination program at the
federal level during a public health emergency[,]" that does not mean that there could never be a
mandatory vaccination program, or that there is not currently a need for one. n200 Although the current
rate of infectious disease outbreaks in the United States may not yet have risen to emergency levels,
n201 the nation has experienced near-critical [*289] critical conditions before, and it would be unwise
to assume that such conditions could not happen again, especially given that individuals continue to
seek exemptions for their children. n202 A University of Pittsburgh simulation demonstrated how
quickly an outbreak of measles could spread, supposing only 80% of the country's schoolchildren were
vaccinated. n203 The result would be the loss of herd immunity, gravely impacting public health. n204
The tipping point at which herd immunity is destroyed "occurs when too few people are vaccinated to
protect the community." n205 In the 2013-2014 school year, the vaccination rate for kindergarten-age
children was below 92%, which, although insufficient to destroy herd immunity, certainly approaches
that tipping point given the rising levels of active exemptions. n206 Moreover, although the federal
government's primary concern should be public health, it also has an acute financial interest in the
efficacy of state vaccination policies--especially state enforcement of compulsory vaccination for
schoolchildren, because the federal government is the primary source of public immunization funds.
Vaccinations are expensive, often oppressively so. n207 Whereas in 1986 the average private insurance
cost of fully vaccinating a child to the age of eighteen was $ 100, today it costs an average of $ 2,192.
n208 However, despite the high costs, "[c]hildhood immunizations are so vital to public health that the
Affordable Care Act mandates their coverage at no out-of-pocket cost . . . ." n209 Because the federal
government recognizes the high stakes that accompany low vaccination rates, "federal funds pay for
approximately 95 percent [*290] of all publicly funded vaccinations" to help deflect costs. n210 By
expending significant resources, the federal government is inextricably intertwined with sustaining the
vaccination infrastructure. n211 This infrastructure is weakened by the outbreak of disease because
outbreaks indicate a decrease in herd immunity, which thereby increases costs and the need for future
vaccinations and healthcare. n212 However, disease outbreaks in and of themselves are also
prohibitively expensive--for health care providers who front the cost of purchasing more vaccines, n213
for hospitals responding to outbreaks as they occur, n214 for the federal government funding the brunt
of the vaccination programs, n215 and for the taxpayers who fund the public health resources states
must drain to address outbreaks. n216 These financial losses provide good reason to enact a national
compulsory vaccination law for schoolchildren, because "if a disease is associated with high economic
externalities, including extremely expensive individual care for which the cost must be spread over
society, a mandate has greater justification." n217 And the economic externalities of recent outbreaks
are substantial. n218 For example, "[du]ring [a measles] outbreak in 2008, during which an intentionally
unvaccinated 7-year-old boy returned from Switzerland with the virus, San Diego grappled with 11
additional cases, costing taxpayers $ 10,376 per case." n219 In another example, "[i]n 2011, a case of 16
outbreaks across the country that infected 107 people cost an estimated $ 2.7 million to $ 5.3 million for
just public health systems alone." n220 These prices only promise to rise as the current trend of vaccine-
exempted children continues, providing additional impetus for the federal government to [*291]
intervene in state vaccination policy. n221 As has been established under the Public Health Services Act,
the spread of communicable disease and the efficacy of vaccination has a direct impact on interstate
commerce. n222 Therefore, the federal government has adequate authority to move forward with a
national requirement that all public schoolchildren receive vaccinations upon school entry, especially
considering the fact that the federal government funds both vaccinations and public schooling. n223
AT: Trump rollback
Trump doesn’t have the authority to roll back the plan
Robbins 17 Rebecca Robbins is a reporter covering the business of health and medicine, January 10th,
“What Trump can — and can’t — do to change vaccine policy”,
https://www.statnews.com/2017/01/10/trump-vaccines/ //DJ

Robert F. Kennedy Jr., a prominent doubter of the safety of vaccines, told reporters on Tuesday that he
will chair a commission on vaccine safety and scientific integrity as part of Donald Trump’s
administration. The president-elect’s spokeswoman issued a statement hours later saying “no decisions
have been made” about “forming a committee on Autism.” But the news is already raising concern
about what Trump, who has a long history of questioning vaccine safety, could do to undercut childhood
vaccines. For now, it’s worth taking a look at what’s possible for Trump to change — and what’s not.
Trump does not have direct authority over vaccine schedules The recommendations about which
vaccines children should receive and when they should get them are developed by an advisory panel of
scientists, called the Advisory Committee on Immunization Practices, under the Centers for Disease
Control and Prevention. This is different from the panel Kennedy will chair. Trump has no power to
order the ACIP to make recommendations that are not based in evidence. Trump can appoint agency
staffers who doubt vaccines Trump certainly can fill his administration with like-minded staffers who
could steer agencies like the CDC in a new direction. But keep in mind: He can’t just fill the ACIP with
vaccine doubters. Members are chosen through a rigorous nomination process. And the makeup of the
scientific advisory committee on vaccines doesn’t turn over with the start of a new administration;
vacancies are staggered, as they are in the US Senate. Trump does not have direct authority over vaccine
requirements Requirements about which vaccines children must receive to enroll in school also don’t
fall under the president’s purview. That’s the domain of the states. Consider, for instance, a new law
enacted last year in California, which made it much harder for parents to get out of vaccinating their
children before enrolling them in school.
2AC Add-Ons
Academic Achievement Add-On
Vaccine preventable outbreaks cause students to miss school
HuiLai and Fontaine 6 - Chinese Field Epidemiology Training Program, Chinese Center for Disease
Control and Prevention Division of International Health, Coordinating Office for Global Health, CDC [Ma,
Varicella Outbreak Among Primary School Students --- Beijing, China, 2004,
https://www.cdc.gov/mmwr/preview/mmwrhtml/su5501a10.htm, April 8, 2006] MP

Varicella has been a nearly universal disease of childhood. In temperate climates, nearly 90% of children
had varicella by age 15 years before vaccine became available (1). Before 1995, when vaccine was licensed, an estimated
4 million cases of varicella occurred each year in the United States; approximately 100 patients died and
10,000 persons were hospitalized annually because of varicella and related complications (2). Because varicella is
not a notifiable disease in China, statistics concerning hospitalization and death attributable to varicella are not available. However, since January 1,

2004, varicella outbreaks have been reported to the public health emergency reporting system. During
January--June 2004, a total of 64 varicella outbreaks were reported, accounting for 20% of all
communicable disease outbreaks reported in China; 58 (91%) varicella outbreaks occurred in schools. Varicella vaccine
has been available commercially since 2003, but China has no programs to support routine varicella
vaccination. On June 9, the Chinese Center for Disease Control and Prevention (China CDC) was notified
of a varicella outbreak in a primary school in a suburb of Beijing, affecting approximately 80% of children
in certain classes. Since the school opened in 1999, varicella outbreaks have disrupted activities every year, despite a school policy to isolate students with
a rash at home for 7 days. An outbreak investigation was initiated to identify factors contributing to the high rate

of transmission and assess the effectiveness of control measures.

Missing school is directly correlated with low test scores – independently affect
students of color worst of all
Richmond 14 -- public editor for the National Education Writers Association. She was previously the
education reporter for the Las Vegas Sun [Emily, Yes, Skipping School Correlates With Low Test Scores—
Now What?, https://www.theatlantic.com/education/archive/2014/09/student-absenteeism-putting-
the-spotlight-on-empty-seats/379458/] MP

In a new report, researchers say they found a link between higher rates of student absenteeism and
lower scores in reading and mathematics on a nationwide exam. It’s a finding that isn't likely to surprise many people, least of all
educators in America’s public schools. Indeed, a flurry of recent studies confirm what to many observers seems like little

more than common sense: Students can’t learn if they’re not in class, and too many of them are missing
seat time. The question is whether the growing chorus is getting loud enough for policymakers to take more significant action. The newest addition to the research roundup comes
from the national organization Attendance Works, and ties student absenteeism to lower performance on the National Assessment of Educational Progress (NAEP) exam for grades four and

. Students who said they had missed at least three school days in the month prior to the 2013 exam
eight

scored lower on average in reading and math than their peers in states and districts with better self-
reported attendance rates. When considering these kinds of studies it’s important to remember that correlation is not causation. NAEP represents a snapshot of student
performance on one assessment rather than a definitive statement of their abilities. Indeed the National Assessment Governing Board, which oversees NAEP, has repeatedly warned the
results should not be used to draw conclusions about the merits of a particular educational approach. (So far that hasn’t stopped people from doing exactly that.) With these caveats in mind,

About one in five students nationally missed three or more days of school in
here are some key takeaways from the new report:

the month prior to the NAEP exam; In fourth grade, the absentee students scored an average 12 points
lower on the reading assessment than those with no absences; In eighth grade, absentee students
scored an average 18 points lower on the math assessment; States with the worst absenteeism rates
were Arizona, Montana, New Mexico, Oklahoma, Oregon and Wyoming; California, Georgia, Illinois,
Indiana, Massachusetts, New Hampshire, Texas and Vermont had the strongest attendance records for
the month prior to the NAEP exam. While the percentages varied, the constant was that lower NAEP scores lined up with a higher rate of absenteeism. Attendance
Works’ researchers found lower performance among students with higher absenteeism “at every age, in every subject,

in every racial and ethnic group and in every state and city examined,” according to the report. “In many
cases, the students with more absences have skill levels one to two years below their peers. While
students from low-income families are more likely to be chronically absent, the ill effects of missing too
much school hold true for all socio-economic groups.” It’s no secret that students who face more challenging living situations are typically weaker
performers on standardized tests. But the new report echoes earlier findings that skipping school hurts everyone, including kids living in more affluent households. In the long run,

wealthier students have a better chance of making up that deficit than their classmates from low-
income households. But in the short term “you can be from a high-income family and not a minority, and skipping school still hurts you,” said Robert Balfanz, a researcher and
director of the Everyone Graduates Center at Johns Hopkins University. The new Attendance Works report highlights the challenge of getting students to place a higher value their own

Chronic
learning, Balfanz said, and to helping parents recognize that there can be harm from even sporadic absences that pile up month by month, and year by year. “

absenteeism” is defined as missing at least 10 percent of the instructional time (18 school days in
most districts) over the course of an academic year. Researchers conservatively estimate that 10 to 15 percent of the nation’s K-12 population—
that’s 5 to 7.5 million students each year—are not attending school on a regular basis. Increasingly,
educators and policymakers are focusing on student attendance as a crucial factor in school
improvement efforts. Recent research has found that poor attendance in the early grades can predict whether a student’s reading skills are on track at the end of third
grade—a crucial indicator of future academic success. Long-term studies have also predicted high-school

dropouts by their early records of absenteeism. Absences at the start of the academic year should be
taken particularly seriously, according to one Baltimore study: Nine out of 10 students who missed five
days in September went on to be chronically absent for the year—skipping on average 70 instructional days. (September is also National
Attendance Awareness Month.) In its new report the San Francisco-based Attendance Works says states and districts aren’t doing enough to track chronic school absenteeism, and there’s a

come up with a solution


lack of consistency in both methodology and terminology. That’s making it harder to identify successful strategies and then take them to scale. “To

you have to know you have a problem,” said Hedy Chang, Attendance Works’ director. “Right now many
districts and states don’t realize how serious their absenteeism rates are in part because they’re simply
not tracking the data.” The ill effects of missing too much school hold true for all socio-economic groups.
Chang pointed to research showing that students who are chronically absent become less engaged in learning as the school year progresses—again, not a surprise but still a troubling finding.
Another study found absences in early grades predicted whether students developed the social-emotional skills (popularly referred to as “grit” in some education reform circles) to persevere
later in their academic careers. When asked why they skip school, older students typically give a range of reasons from family problems to outright boredom (an answer particularly common

Remaking schools into a place where students want to be is certainly one


among high schoolers, according toone recent survey).

of the elements of improving attendance. But while many educators are focusing on boosting student
interest and motivation, lawmakers are trying more aggressive tactics to tackle truancy, often with
mixed results. In some states students drivers’ licenses if they’re not in good standing on school
attendance, while in others parents face fines, loss of driving privileges and even jail time for letting
their kids skip class. In a particularly tragic case earlier this year, a Pennsylvania mother died of heart failure while serving out a sentence imposed after she couldn’t pay
$2,000 in truancy fines, evidence that these kinds of tactics are having a lasting impact. The answer isn’t more threats of punishment, said Attendance Works’ Chang, who added that the most
successful interventions have been those that match at-risk students—and their families—with trained mentors and support networks. (Check out a particularly compelling example from New

Classroom teachers are the first line of defense because they’re most likely to notice patterns of
York City.)

absenteeism. But there also need to be early warning systems to alert parents to the risk of even a
handful of skipped days, Chang said, as well as school-community partnerships to help identify and
support families that are struggling to get their kids to school regularly. “If you think a school is just going to scold you or arrest you
for not showing up, that’s not engagement,” Chang said. “What’s needed is a personal connection—someone saying ‘Where were you today? We missed you. How can we help?”
Diplomacy Add-On
There is an international crisis involving vaccines – empirically states follow each other
– specifically the United States federal government – the aff reverses the signal that
the election of Trump sent
Laurie Garrett, 6-26-2017 --- senior fellow for global health at the Council on Foreign Relations and a Pulitzer Prize winning science
writer. ("Science Won’t Save Vaccines From Lawsuits Anymore," Foreign Policy, http://foreignpolicy.com/2017/06/26/science-wont-save-
vaccines-from-lawsuits-anymore/)//ernst

This week, the highest court of the European Union handed opponents of basic public health their greatest legal victory in recent memory. At a
time when a widening measles outbreaks across Europe and a growing pattern of parents refusing to immunize children, the
Court of
Justice of the European Union — the rough equivalent of the U.S. Supreme Court — decided that courts across the
Continent may weigh whether a vaccine caused an illness regardless of whether or not there is any
scientific evidence linking the two. Defining its mission as consumer protection, the CJEU said Europeans ought to be able to sue
manufacturers, “excluding any method of proof,” because of the imbalance of power between individual consumers versus large corporations.
Europe’s courts, the CJEU ruled, have a duty to “protect consumer health and safety and ensure a fair apportionment between the injured
person and the producer of the risks inherent in modern technological production.” The
high court decision comes at a fragile
time for the international vaccine regime. Vaccine supplies are dwindling amid epidemics; manufacturers
are increasingly skittish of vaccine production due to low profits and high liabilities; parents all over the
world are increasingly reluctant to immunize their children; and vigilante violence and assassinations
against vaccination campaigns gain religious sanction. There’s also the fact that the president of the United
States now openly questions the safety and utility of vaccines. Given the new legal vulnerability of existing vaccine
norms, there’s no telling whether they’ll be able to survive, or for how long. Vaccine-Preventable Diseases
Are Surging Those norms have been under assault for some time by a growing culture of anti-scientific paranoia. Immunization
rates across much of Europe have plummeted since the turn of this century, falling below half of all children in
parts of Italy, Spain, Greece, and Eastern Europe. Outbreaks have predictably ensued, especially of measles. In the past 18
months, Romania has reported 6,743 measles cases, 30 of which were fatal; newborns and small children
have been the most susceptible. Ukraine has 735 cases so far in 2017, compared to no measles cases in
2016. Italy has reported 2,988 cases, 237 of them in healthcare workers. Even staid Germany has witnessed
almost 700 measles cases this year, fueled by parental refusal of vaccinations. Of the 44 European
nations, 24 had completely eliminated measles by early 2016, and the Continent was on a path to eradication of the viral
disease. As of June 2017, however, there have been more than 11,000 cases reported in 18 European countries.
This year France has recorded six times more measles cases compared to this time last year. Other vaccine-
preventable scourges are also surging across Europe, including whooping cough, mumps, rubella and hepatitis B, prompting French Minister of
Health Agnès Buzyn to call for nationwide mandatory immunization of all children against 11 diseases. Since 2007 I have been tracking
outbreaks of vaccine-preventable diseases worldwide, available publicly in an that is data-rich and updated weekly. The trends are obvious, as
outbreaks of once-vanquished scourges like mumps and whooping cough have increased in frequency and size across Europe and North
America. Europe is hardly alone in seeing measles, mumps, whooping cough, and other long-eliminated childhood scourges return, thanks
largely to vaccine refusal.
Canada eradicated measles in 1998; today, physicians are battling cases in children
and young adults from Vancouver to Nova Scotia. The cheek-swelling and potentially deadly mumps has been seen this year
from Hawaii to Maine, prompting serious concern about both vaccine efficacy and parental refusals. Upstate New York is fighting
both measles and mumps. Los Angeles County is trying to stop an outbreak that has afflicted 42 infants
this year, and nationwide there have been 3,176 mumps infections as of May 20, compared to 5,833 in the entire year
of 2016 –– the largest number in a decade. Minnesota’s Somali community is struggling with a measles outbreak
that exceeds the national total of 2016 cases, spawned by anti-vaccine activists who counseled the immigrants to refuse to
immunize their children. Whooping cough (or pertussis) was so effectively controlled in the United States by the late 1960s that few
physicians ever saw cases or recognized its symptoms, but since 2012 the numbers of cases have risen steadily, now exceeding
the number reported in 1955. By far the majority of whooping cough cases are in counties in the U.S.
where parents are allowed to file for vaccination exemptions on philosophical or religious grounds. The
Complaint of Mr. J.W. But this climate of paranoia around vaccines doesn’t just affect public health. It also
threatens the viability of vaccine manufacturers. Just seven companies in wealthy countries still make
vaccines, three of them based in the United States. And merely four companies make 80 percent of the
world’s vaccine supply. For these companies, demand is down, hostility is up, and profits are poor. They also face new legal risks.
Consider the European court case against Sanofi Pasteur, which is the world’s second-biggest vaccine-maker and the most willing of its
competitors to manufacture not only immunizations for rich nations, but also those for diseases like yellow fever and cholera that typically
plague only poor nations. The case against Sanofi was brought by the heirs of a French man, designated “Mr. J.W.” who claimed that a series of
hepatitis B vaccine and boosters the man received in 1998 and 1999 caused him to develop multiple sclerosis (MS) in 2000. Mr. J.W. died of MS
in 2011, and his family continued pushing the case through French courts and ultimately to the CJEU. The legal claim, which originated in France
in 2006, seeks damages of an undisclosed amount from the company. The family claimed, as the CJEU decision put it, “that the short period
between the vaccination and the appearance of the first symptoms of multiple sclerosis, in conjunction with the lack of any personal or family
history of the disease, are such as to give rise to serious, specific and consistent presumptions as to the existence of a defect in the vaccine and
as to there being a causal link between the injection of the vaccine and the occurrence of the multiple sclerosis.” The local court in Nanterre
ruled in Mr. J.W.’s favor in 2009, but the appellate court overturned the case in Versailles in 2011. A higher court of appeal in Paris also ruled
against Mr. J.W., noting there was no scientific evidence that MS could be caused by any vaccine; such a side effect had never previously been
noted with specifically the hepatitis B vaccine; and the one-year time scale between his immunizations and onset of MS symptoms was far too
short, as multiple sclerosis takes years to develop. As for Mr. J.W.’s assertion that the lack of a family history of MS lent greater credence to his
claim, the Paris court noted that between 92 percent and 95 percent of multiple sclerosis cases occur without any known genetic link or family
history. By 2015 the legal process hinged on a single issue: the value of scientific evidence. The Paris court opted to toss that question to
Brussels and the CJEU, asking the European Union’s high court to answer whether the plaintiff’s case had to rest on evidence that can
“constitute serious, specific and consistent presumptions capable of proving the defect in the vaccine and the existence of a causal relationship
between it and the disease?” The EU court this week decided that it was unfair to require a plaintiff to provide
“serious, specific and consistent evidence … that there is a causal link between that defect and that
disease.” If there was a burden to prove, or disprove, such a link, it would be placed on the defendants. Voila! Science be damned.
The Future of Compulsory Immunization In reaction to outbreaks clearly tied to parental refusal to vaccinate children, governments
have instituted a variety of policies aimed at making it illegal, or at least socially expensive, to fail to
properly immunize one’s offspring. Among the rich countries the United States led in 1986 with passage of the
National Childhood Vaccine Injury Act, allowing states to mandate immunizations and granting manufacturers immunity from
tort actions akin to Mr. J.W.’s case in France. The law, and protection for the vaccine industry, was upheld in legal challenges at the U.S. Court
of Appeals for the Federal Circuit in 2010 and Supreme Court in 2011. Two years ago, in response to a widespread measles outbreak that
started with unvaccinated children interacting at Disneyland, California
passed a state law mandating proof of full
immunization for all children entering public schools or state-subsidized private schools. Similar
legislation was passed in Mississippi and West Virginia, and across the country courts have upheld liberal
local interpretations of the original 1986 federal legislation. Other states have removed or restricted their older laws that
allowed parents to demand exemption from immunizations. Last month, the Italian parliament passed a law mandating
proof of vaccination against 12 diseases for admission to schools. And this month, the German government
responded to the country’s measles epidemic (of almost 700 cases so far in 2017 versus 33 over the entire year of 2016) by mandating
vaccination, with two tough penalties for noncompliance: a fine of 2,500 euros and expulsion of the child from school. These
tough laws could all be endangered by the EU high court decision. Across Europe, families can now sue their
governments and vaccine manufacturers, arguing — without benefit of scientific evidence — that everything from headaches and diminished
academic performance to seizures and cancer in their children were the result of vaccinations.
In the United States, attorneys are
likely to cite the EU court as grounds for revisiting the National Childhood Vaccine Injury Act and various
state-level compulsion laws; other, non-EU countries would likely follow suit. The anti-vaccine movement
in the U.S. is relentless and newly emboldened by reports that President Donald Trump plans to create a
vaccine reassessment commission headed by Robert F. Kennedy, Jr., a leader in the anti-immunization movement. Science Matters
On my office wall hangs a reproduction of James Gillray’s 1802 cartoon, “The cow-pock — or — the wonderful effects of the new inoculation!”
Published when Britain’s Edward Jenner showed that the cowpox vaccine safely protected people from deadly smallpox infection, the cartoon
mocks public fears that the product would turn them into bovines. Cows ludicrously sprout from people’s noses, mouths, heads, and butts;
false fear of the vaccine supplanted the very genuine causes for dreading the extremely deadly smallpox. Today, in the absence of proof or
rational evidence, well-educated people living in the richest countries of the world believe that hepatitis vaccines cause demyelination of their
musculature, leading to MS; that measles/mumps/rubella combination vaccines reshape babies’ brains, rendering them autistic; that human
papillomavirus vaccines cause mental retardation rather than protecting girls from death by cervical cancer; that “too many” vaccines are given
to babies, making them weak or stunted. And now, thanks to the Court of Justice of the European Union, every one of those crackpot theories
can be presented in a European court of law, absent the merest modicum of evidence.

Vaccine dialogue can help open up foreign policy channels – even the Taliban will
cooperate to resolve disease
Hotez 10 --- is Distinguished Research Professor at the George Washington University and president of the Sabin Vaccine Institute in
Washington, DC. (Peter J., “Peace Through Vaccine Diplomacy,” 3/12/10, http://science.sciencemag.org/content/327/5971/1301.full)//ernst

Can vaccinations help to resolve conflicts and nurture diplomacy? Later this month, Indonesia, the world's
most populous Islamic country, will host U.S. President Obama, a visit that could establish important
scientific ties between the United States and Indonesia and implement a potentially powerful piece of
vaccine diplomacy. The oral polio vaccine is a substantive example of how vaccination diplomacy has
driven cooperation in times of crisis, allowing groups and states to put aside ideological differences to
eradicate disease. Even today, the Taliban leader in Afghanistan is cooperating with the Afghan government and
United Nations agencies to eradicate polio in Afghanistan.* There is now an unprecedented opportunity
to lock the United States and Islamic nations into a meaningful program of vaccine R&D and potentially
improve foreign relations and promote peace. When the United States and Soviet Union entered a deep Cold War chill after
the 1957 Sputnik launch, they also entered into a little-known scientific collaboration that led to one of the most important medical advances of
the 20th century. With both countries suffering horrific epidemics of childhood poliomyelitis, Soviet and U.S.
scientists, led by Albert Sabin, worked together to develop an oral polio vaccine that was deployed worldwide
and ultimately eliminated the disease in most of the world by 2008 (the disease still persists in Afghanistan, India,
Pakistan, and Nigeria). Similar international cooperative efforts with the Soviet Union led to an improved vaccine that eradicated naturally
occurring smallpox by 1977. Today, up to one-half of the world's neglected tropical diseases occur in Islamic countries, mainly Indonesia,
Pakistan, Nigeria, Bangladesh, Sudan, and to some extent Afghanistan, Iran, and Iraq. The most common of these diseases, including hookworm
infection, schistosomiasis, and leishmaniasis are notorious for more than their long-term disabling health effects. Impaired healthy
development adversely affects rural worker productivity and can lead to agricultural insecurity, a condition that increases the likelihood of
conflict among groups and states. Although more than one billion people suffer from neglected tropical diseases, the corresponding vaccines
have essentially no commercial market, relegating their development to nonprofit product development partnerships funded by sources such
as the Bill & Melinda Gates Foundation, the Wellcome Trust, and the U.S. National Institutes of Health. Recently, the pharmaceutical giants
Novartis and Merck also initiated global health vaccine development partnerships. But more needs to be done. Joint
scientific
cooperation between the United States and technologically advanced member countries of the
Organisation of the Islamic Conference (OIC)—especially the Asian OIC nations of Indonesia, Pakistan, and Malaysia, and
selected Middle Eastern countries—could advance vaccine development for treating neglected tropical diseases in
Islamic countries. Indeed, leishmaniasis vaccines are under development in Iran, but these efforts would benefit from greater
cooperation with scientific institutions in the West. Last year, the Obama Administration launched a new Science Envoy
program to Islamic nations to foster scientific collaboration in ways that address economic, social, and
ecological challenges.** In that connection, a vigorous new program of vaccine R&D diplomacy could create
opportunities for the United States to address the world's most terrible disease scourges while
simultaneously creating a new foreign policy venue. The globally beneficial legacy of the oral polio vaccine should spur the
United States and its international product development partnerships to connect with scientists in the Islamic world and produce a new
generation of life-saving products. The
incentive and opportunity to improve international public health, reduce
poverty, and promote global security have never been so clear.
Poverty Add-On
Preventable diseases perpetuate poverty all over the globe
Hotez 13 Peter J. Hotez is the Professor of Microbiology, Immunology, and Tropical Medicine George
Washington University, November 21st, “NTDs V.2.0: “Blue Marble Health”—Neglected Tropical Disease
Control and Elimination in a Shifting Health Policy Landscape”,
http://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0002570 //DJip
The UN is working with governments, civil society, and key partners to advance post-2015 MDGs [53], and in 2012, hosted an important
conference on sustainable development in Brazil, called Rio+20 (also known as Earth Summit 2012) to develop a new set of Sustainable
Development Goals (SDGs) [54]. The SDGs would address important environmental issues not currently covered by the MDGs. In 2012, the UN
Secretary-General announced the formation of a UN Sustainable Development Solutions Network (SDSN) that mobilizes scientific and technical
expertise in support of the SDGs [55]. The NTDs are the most common infections in the world, thriving in the
poorest communities, where they promote and cause poverty. They are the most common afflictions of
girls and women and account for an important, but as yet unmeasured, component of the NCDs. The
concept of blue marble health recognizes that NTDs are pervasive wherever poverty occurs, including not only the
world's most devastated nations, but emerging market economies and wealthy countries in North
America and Europe [40], [56]. It will be essential to incorporate NTDs and blue marble health into the
new framework of the SDGs.

Vaccinations reap huge social benefits in school children – save trillions of dollars in
consumer spending, meaning families have to spend less to stay healthier
Philipson et al. 17 Tomas J. Philipson, PhD; Julia Thornton Snider, PhD; Ayman Chit, PhD; Sarah
Green, BA; Philip Hosbach, BA; Taylor Tinkham Schwartz, MPH; Yanyu Wu, PhD; and Wade M. Aubry,
MD, January 2017, “The Social Value of Childhood Vaccination in

the United States”, http://www.socialvalueuk.org/app/uploads/2017/02/AJMC_01_2017_Philipson-In-


Press.pdf //DJ

The innovation of childhood vaccines has resulted in a decline in infectious disease, as well as gains in
length and quality of life. Smallpox has been eradicated, poliomyelitis is nearly eliminated, and many
other vaccine-preventable diseases have seen declines in incidence.1-3 Although adverse events (AEs)
can occur with vaccines,4-7 and recent research has focused on their rising costs,8-10 the post vaccine
era has seen life expectancy increase 15 to 25 years compared with the pre-vaccine era, and further
gains are expected.3,11 Evidence suggests a large share of these survival gains is due to the control of
infectious disease through vaccination.3 When encouraged by public health policies, vaccination also
provides a benefit to government and private payers by reducing overall costs and increasing population
health. The CDC has cited evidence that common childhood vaccinations save over $5 in direct medical
costs and effects on productivity for every $1 spent.12 Maciosek and colleagues found that preventative
childhood immunization produced annual net medical savings of $267 per person.13 Vaccination also
generates community (herd) immunity by reducing disease incidence and transmission, thus resulting in
a healthier population.14 Because vaccines have been successful at preventing disease, the public is no
longer regularly confronted with many vaccine preventable diseases, and the health and economic
benefits of vaccination may be underappreciated.15 As childhood vaccines have reduced disease
prevalence, real and perceived AEs of vaccination have become more salient to parents than the
vaccine-targeted diseases.16,17 Consequently, vaccination rates in many US states have declined in
recent years.17 As vaccination rates slip, the risk of new outbreaks increases.18 Moreover, although
consumers are insulated from the cost of many vaccines, vaccine cost is an important consideration for
payers and providers and has been criticized.19 This focus on AEs and costs has obscured vaccines’
overall value to individuals and society. Previous research has yet to show how the total social value of
vaccines is divided between innovators who develop these technologies and patients and the broader
society who benefit from them. Therefore, in this study, we sought to measure the social value of
childhood vaccines in the United States and the distribution of that value to manufacturers versus the
rest of society. The concept of social value of therapies and its distribution between manufacturers and
patients has been described in other disease areas. For instance, Grabrowski et al found that statin
usage resulted in a social value of $1.25 trillion, of which patients received 76%.20 Yin et al performed a
similar analysis on tyrosine kinase inhibitors for the treatment of chronic myeloid leukemia and found a
social value of $143 billion—90% of which was retained by patients.21 Recent gains in cancer survival
have provided $1.9 trillion of additional social value, with 81% to 95% of that being retained by
patients.22 Lastly, HIV/AIDS therapies have generated $1.38 trillion in social value, with 95% accruing to
patients.23 Such analyses are net monetary benefit analyses, which is a common economic way of
thinking about value which is distinct from cost-effectiveness analysis. The aim is to measure the total
value a given health intervention generates for society, and how that value is distributed across patients
and manufacturers.

Disease destroy the quality of life


Hotez 10 (Peter J. Hotez, scientist, pediatrician, and leading advocate and expert in the fields of global health,
vaccinology, and neglected tropical disease control. He serves as founding dean of the Baylor College of Medicine
National School of Tropical Medicine, chief of the new Section of Tropical Medicine in the BCM Department of
Pediatrics and holds the Texas Children’s Hospital Endowed Chair in Tropical Pediatrics. He is also President of the
Sabin Vaccine Institute, headquartered in Washington, DC; and leads the Sabin Vaccine Institute and Texas
Children's Hospital Center for Vaccine Development. Recently, he was named the Fellow in Disease and Poverty at
Baker Institute for Public Policy at the Rice University,
http://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0000680, “Nuclear Weapons and Neglected
Disease: The ‘Ten-Thousand-to-One Gap’”, April 27 2010)

Despite this massive expenditure, each of the 11 nuclear weapons states, with the possible
exception of the U.K., also suffers from high rates of neglected tropical diseases (and related
neglected infections of poverty), defined as chronic and debilitating parasitic and other
infectious diseases that occur in association with extreme poverty [4]. In addition to their
health effects, the neglected tropical diseases also cause poverty through their ability to
impair child physical and intellectual development, pregnancy outcomes, and worker
productivity, while simultaneously promoting conflict and war through their agriculturally and
socially destabilizing effects [4], [5]. Although it is common to think of neglected diseases as
confined to low-income countries in sub-Saharan Africa, Southeast Asia, and Latin America, as
shown in Table 2 these infections also, exhibit a high prevalence in middle-income countries
such as China, India, Pakistan, North Korea, Iran, and Syria as well as in selected areas of
poverty found in the US, Russia, and Eastern Europe [6]. Indeed, with the possible exceptions
of the UK, high neglected disease burdens are present in all of the nuclear weapons states,
particularly the helminth infections, leishmaniasis and Chagas disease, toxoplasmosis, and
trachoma.

Control and elimination of disease reduces poverty and international tensions


Hotez 10 (Peter J. Hotez, scientist, pediatrician, and leading advocate and expert in the fields of global health,
vaccinology, and neglected tropical disease control. He serves as founding dean of the Baylor College of Medicine
National School of Tropical Medicine, chief of the new Section of Tropical Medicine in the BCM Department of
Pediatrics and holds the Texas Children’s Hospital Endowed Chair in Tropical Pediatrics. He is also President of the
Sabin Vaccine Institute, headquartered in Washington, DC; and leads the Sabin Vaccine Institute and Texas
Children's Hospital Center for Vaccine Development. Recently, he was named the Fellow in Disease and Poverty at
Baker Institute for Public Policy at the Rice University,
http://journals.plos.org/plosntds/article?id=10.1371/journal.pntd.0000680, “Nuclear Weapons and Neglected
Disease: The ‘Ten-Thousand-to-One Gap’”, April 27 2010)

While some may argue that the trillions of dollars spent on nuclear weapons may have served
as a successful deterrent for an all-out US-Soviet, a Sino-Soviet, or an Indo-Pakistan conflict and
was therefore an actual investment in peace, imagine a world in which the nuclear weapons
states increased their neglected disease control budgets more than 10-fold thereby, reducing
the global nuclear weapon–to–neglected disease gap to 1,000 to 1. Ten billion dollars devoted
to neglected diseases would be sufficient to effect large-scale control or elimination for most
of the high-prevalence neglected tropical diseases in the 56 nations where five or more of
these conditions are endemic [37]–[38]. Among the nuclear weapons states these 56 nations
include India and China, although sufficient funds would remain to tackle neglected infections
among pockets of poverty in the remaining wealthy nine nuclear countries. In addition to the
enormous health impact of controlling or eliminating conditions with a combined disease
burden that exceeds malaria or tuberculosis, because the neglected tropical diseases also
contribute to poverty, reducing this disease burden would help reduce poverty and therefore
help achieve the Millennium Development Goals [38]. Neglected tropical disease control and
elimination would also help stabilize and build nations, reduce civil strife and international
tensions, and contribute to world peace [5], [38]. Control of neglected infections of poverty
would eliminate an important group of health disparities in the US and Europe [6], while
simultaneously providing a vehicle by which nations such as India and China would attain new
status as global leaders.
2AC Answers
2AC AT: Ableism Kritik
Autism is not a bad thing, talking about it is good (pls help bad tag)
Estes 6/23 --- PhD, is the director of the UW Autism Center, committed to clinical services, research, and training to improve the lives of individuals with
autism spectrum disorders and their families across the lifespan. She holds the Susan and Richard Fade Endowed Chair, is a Research Professor in the Department of
Speech and Hearing Sciences, and an Adjunct Research Professor in the Department of Psychology at the University of Washington. She is also a licensed
psychologist in the state of Washington. (Annette, “Vaccines do not cause autism, they save lives,” 6/23/17,
http://www.seattletimes.com/author/annette-estes/)//ernst

Scientific facts are not the only driving force in decision-making. As


a society, we must be able to find common ground to
talk with each other, agree on what we know and don’t know, and at the same time listen to the fears
and experiences of new parents and those who have chosen not to immunize their children. Scientists
and clinicians must be there for parents of children with ASD who are asking a legitimate question: Why did this happen
to my child? And even though we understand that ASD is related to a complex interplay between genes, brain and
development, for the majority of individuals with ASD, we cannot yet specify the exact cause of their autism, leaving
parents to search for the answers. The autism community I know is like a small town. Clinicians and scientists who spend our lives working to
develop evidence-based interventions and searching for causes that can be scientifically verified work beside community members who believe
that immunizations cause autism. We disagree on this point, often passionately, but the
passion that brings us together is
stronger — we love our children, we want to live in an inclusive society, we want all children to get the
best care we can give them, and we know that we need each other to find our way. The autism
community faces many pressing issues, while our society as a whole faces legitimate debates in the arenas
of child health and education. Many of these questions cannot be answered easily or definitively by scientific inquiry. For example,
how can we find a way to talk about immunizations and autism without deepening the polarization in
our society? How can we avoid pushing each other into an “us”-versus-“them” argument and build a
bridge between the “knowers” and the “believers”? How can we address the perceived chasm between
“ivory tower” scientists and the “real people” on the street? We have to inspire a dialogue. There are
certainly many individuals and groups who are not having a conversation. Somewhere the basic elements necessary — mutual respect and trust
— may have been lost, or perhaps the “echo chamber” that has developed in the age of social media, in which people consume news that
meets only their views, is to blame. But in this, as in so many other arenas today, we
must urgently find a way out of our
impasse and rediscover the connections between us so that every child with autism has access to high-
quality intervention and can reach his or her full potential.
2AC AT: Vaccinations Impact Turn
All your vaccinations bad arguments are baseless and terrible
DINA FINE MARON MARCH 6, 2015 --- Dina Fine Maron is an award-winning journalist and the associate editor for health and
medicine at Scientific American. She is also a contributor to the publication's podcasts and Instant Egghead video series. She is based in
Washington, D.C., (“Fact or Fiction?: Vaccines Are Dangerous, Dina Fine Maron, Scientific American, March 6, 2015,
https://www.scientificamerican.com/article/fact-or-fiction-vaccines-are-dangerous/)//chiragjain

Side effects The overwhelming


medical evidence finds that most vaccine side effects among newborns and
young children are mild—swelling, redness and a small, hard lump at the site of the injection—and typically pass within a couple
days. A far less common but serious vaccine side effect, occurring in fewer than one in a million cases, is an immediate
allergic reaction that can be treated with common medications to ease itching or swelling or, in more serious cases, by
administering epinephrine. Rarely, with certain vaccinations there can be other problems. After receiving the first shot of the measles–mumps–rubella (MMR)
vaccination, for example, a child has a roughly one in 3,000 chance of developing a fever that leads to a seizure. Such seizures do not lead to any
permanent neurological damage. Moreover, they also occur more generally when kids develop high fevers—afflicting up to 5 percent of young
children. That does not mean it is not upsetting to see. “It’s hard to watch your child seize,” says Paul Offit, a pediatrics professor at The Children’s Hospital of
Philadelphia. His own daughter had a seizure after receiving the combo vaccine against diphtheria, tetanus and pertussis but he says it’s important to remember
that this type of seizure does not cause long-term consequences. And scientific evidence finds that MMR-related seizures are actually less frequent than ones that
occur as a direct result of the measles infection itself. What’s in a vaccine? When a person encounters a pathogen, there is no way to predict whether it will induce a
mild or severe form of disease nor how the body will react. But vaccines
are selected to contain a weakened or dead form of
the disease-causing germ that can spark an immune response. Exposure will thus allow the body to
build up immunity in a controlled way. The immune system reaction stops this compromised foreign invader in its tracks at the site of
injection. And the key to vaccine success is that, afterward, the immune system starts to create fast-response infection fighters called memory cells that will
circulate throughout the body and be able to recognize (and fend off) that pathogen in the future. These
weak or killed stimulants, called
antigens, are grown in a lab setting, isolated and then mixed with preservatives, stabilizers and a substance like
aluminum that will trigger the immune system to vigorously respond to the vaccine. The process saves lives: Among children born in the past two decades,
vaccinations will prevent more than 20 million hospitalizations and 732,000 deaths, according to U.S. Centers for
Disease Control estimates. Why do vaccines cause any side effects? Like any medicine, immunizations can lead to a negative reaction.

That’s not surprising because every individual is different. Genetic variations, immune deficiencies and environmental

exposures all contribute to how a person’s body reacts to inoculations against disease. But are so many shots
dangerous? Expert medical bodies including the American Academy of Pediatrics (AAP) urge parents to

vaccinate their kids against 16 diseases. The CDC schedule for childhood vaccinations, which relies on recommendations from the Advisory
Committee on Immunization Practices and is endorsed by APP, is drawn up based on data detailing when the body’s immune system will mount the best response
to the vaccine and, secondly, balanced against the need to protect kids at the earliest age possible. There
is no scientific data suggesting a
medical benefit from spacing out vaccines over a longer period than the official recommendations. Vaccines are also
regularly evaluated for safety. Before they are added to the recommended regimen they must undergo testing to make sure they won’t interfere
with one another. There have also been multiple studies that evaluated vaccines’ cumulative effects. Still, pediatricians face continual pressure from some worried
parents who sometimes want to spread out the recommended inoculation schedule or postpone certain vaccinations, decisions that can prolong the period of
vulnerability to disease. For example, a new nationally representative study published in the April 2015 Pediatrics found that in an average month 93 percent of
surveyed doctors received at least one request from parents to spread out shots. And it happened relatively frequently: more than a fifth of the 534 surveyed
physicians reported that 10 percent of parents made such requests. Parents’ wishes were then often honored—the majority of the surveyed clinicians ultimately
agreed to do so, at least some of the time. Yet fears about a child’s body not being able to handle potent vaccines are
misguided. Children’s immune systems respond to several hundred foreign substances that trigger an
immune response every day. In contrast, the complete schedule of recommended childhood vaccinations includes under 200 antigens. Do vaccines
cause autism? Some concerns about vaccines stem from discredited work that suggested they lead to autism . (The

findings were subsequently retracted and the physician who did that small study was barred from practicing medicine due to ethical lapses.) More than a

dozen studies have added to the body of evidence that this link does not exist. Expert groups including the IOM and
the AAP agree that vaccines do not contribute to children’s autism rates. The vaccine additive thimerosal, a preservative that

contains a form of mercury (organomercurcial, not methylmercury) also does not cause autism. It is now only included in pediatric
vaccines in trace amounts (or not at all) but there is no medical evidence that it causes autism in patients. Can’t children thrive without vaccines? We live in a
crowded, fast-moving world, and disease travels easily. The data is clear: Failure to immunize a child comes
with a much more formidable risk—leaving children vulnerable to contracting a potentially
debilitating or lethal illness. Some children are too sick or too young to receive inoculations, so they remain at risk. If those children or other
unvaccinated kids come into contact with someone else who was not protected against certain microbes, that can set off a wave of disease like the measles
outbreak currently spreading in the U.S. Maladies that have become uncommon, such as polio and measles, can also quickly reappear if
we stop vaccinating against them, particularly when they are unintentionally imported across geographic borders. The measles outbreak
currently rippling through the U.S., for example, has genetic markers that suggest it came from an overseas traveler. Protecting kids actually helps protect everyone.
2AC AT: Neoliberalism Kritik
Mandatory vaccines is a refusal to neoliberal mothering --- everyone makes the
communal effort of herd immunity to save those who can’t get vaccinated
JENNIFER REICH 5/9/14 --- Post-Doctoral Fellowship, Institute for Health Policy Studies. University of California, San Francisco (funded
by the Agency for Healthcare Research and Quality), 2002-2004 Certificate of Training in Clinical Research, Department of Epidemiology and
Biostatistics. University of California, San Francisco, 2003 Ph.D., Sociology, University of California, Davis (Designated Emphasis: Feminist Theory
and Methods from the Department of Women and Gender Studies), 2002 MA, Sociology, University of California, Davis,1997 BA, Sociology,
University of California, Santa Barbara (highest honors), 1993(“Neoliberal Mothering and Vaccine Refusal”, Jennifer Reich, Sage Journals, May 9,
2014, http://journals.sagepub.com.proxy.lib.umich.edu/doi/full/10.1177/0891243214532711)//chiragjain

Vaccine policy promotes a uniform healthcare intervention—administered at the same time in similar
doses for all people. This makes distribution relatively simple and inexpensive. Individuals gain immunity to protect
themselves, but also protect others in the community. A few vaccines solely benefit the individual, like that for tetanus,
which is not contagious but comes from toxin-producing bacteria in the environment. However, the majority of vaccines do not
protect just the child who receives inoculation, but also the disabled, the aged, the immune-
compromised, those too young to receive vaccines or who don’t gain immunity from vaccines, and the
pregnant women whose fetuses could be devastated by exposure to some illnesses. High vaccination rates in a
community create “herd immunity” where virtually all community members are protected from infection. Because 100 percent
protection is impossible, herd immunity means that those who can be vaccinated and generate
immunity will help to protect the most vulnerable. From a public health perspective, vaccines are beneficial and
seem an obvious choice for those who desire to protect their children as well as others. Yet despite much
scientific evidence to the contrary, a growing number of mothers fear potential and putative risks of vaccines,
which they believe include autism, autoimmune disease, generalized weakened health, or unknown
long-term side effects from exposure to chemicals used to manufacture vaccines (Benin et al. 2006; Casiday 2007;
Kaufman 2010; Largent 2012; Poltorak et al. 2005; Streefland et al. 1999; Chowdhury, and Ramos-Jimenez 1999). They view their role
as protecting their children’s bodies, from harm, including from public health intervention. The case of
vaccine refusal as “choice” raises important questions about gender, class, and social responsibility,
including how and whether individuals sacrifice or protect personal freedoms for communal solidarity
and inclusion (Durkheim 1997). Examining resistance highlights these issues as vaccine requirements ask
parents to absorb minimal risk to their own children to protect both their children and others. Public
health lies in direct contradiction to neoliberalism, which “insists that citizens should be ‘empowered’
to pursue their own self-interest as a condition of their rights (and obligations) as consumers of public
resources” (Wilkins 2014). Mothers’ narratives of choice—about feeding, working, or vaccinating—highlight myriad ways neoliberalism
infuses women’s sense of control in their personal lives, but also masks how access to privilege makes choice possible. As privilege
facilitates choice, it also potentially jeopardizes the health and well-being of other children who lack
resources or whose families are more constrained in their options. While Lareau (2003) highlights how privileged
parenting differentially transmits advantage, I argue these women’s “choices” about vaccines carry consequences for other women’s families as
well. It is thus important to understand how and why vaccines, touted as one of the greatest accomplishments of medicine and the cornerstone
of public health, have been rejected by women privileged enough to do so in the guise of good mothering.
2AC AT: Antiblackness Kritik
Black parents have unequal access to vaccination refusal --- the aff’s policy equalizes
exceptions by eliminating them
DAVID SHIH 2/1/2015 --- David Shih, Associate Professor of English University of Wisconsin (“Whiteness and the Anti-Vaccination
Movement”, David Shih, February 1, 2015, David Shih Blog, http://professorshih.blogspot.com/2015/02/whiteness-and-anti-vaccination-
movement.html)//chiragjain

Even in just the past half-century, we


can find ample evidence of the law honoring the preferences of middle-
class white parents when it comes to the interests of their children vis-à-vis education policy. Take the
example of Milliken v. Bradley, a 1974 Supreme Court case that ruled that desegregation busing could apply
only to those school districts whose segregation practices could be proven as deliberate. Like busing
policy, immunization policy also regulates which students can go to school and where. The ease with
which parents receive immunization exemptions, particularly in certain states, represents the
satisfaction of their settled expectations of how state and local authorities should treat their children.
Historically, parents of color--black parents in particular--have had far less success advocating for their
interests when it comes to the treatment of their school-aged children. Their battles for an integrated learning
experience, teasingly promised by Brown v. Board of Education of Topeka, were thwarted by Milliken v. Bradley, which facilitated "white flight"
to suburban districts exempted from integrating inner-city schools. Parents of color have had minimal success eliminating bias from the
informal and formal curricular tracking of their children, which begins as early as kindergarten. And what is the relationship between racism and
Louisiana's policy that those on public assistance may not claim a philosophic exemption? Or between racism and the fact that the
state
with the highest child vaccination rate--because it allows almost no exemptions for immunization, not
even those of a religious nature--is Mississippi?
2AC AT: Religion Rights Kritik
There’s barely any religions that require religious exemptions --- and even those two
have switching opinions from time to time --- this is asinine
MIRIAM KRULE 2/5/2015 --- MBA Candidate Archer Gray, BA --- Wall Street Journal (“Why Is There a Religious Exemption
for Vaccinations?”, Miriam Krule, February 5, 2015, Slate,
http://www.slate.com/articles/health_and_science/medical_examiner/2015/02/religious_exemption_for_vaccines_christian_s
cientists_catholics_and_dutch.html)//chiragjain

During the latest round of vaccine panic, it has become a talking point that all but two states—Mississippi
and West Virginia—allow parents to skip vaccinations for their children for nonmedical reasons. Some states offer a “personal
belief” exemption from vaccination, and most states have the option of a “religious exemption.” (Some states have both.) Slate and many
other outlets have tackled the dangers of vaccine refusal extensively already. But what’s not as clear is why the
religious exemption exists at all. First of all, do any religions actually oppose vaccination? Second of all, what exactly does one have
to do to qualify for a religious exemption, and how is it different from the similar sounding “personal
belief” exemption? It’s almost impossible to find a religion that has a clear anti-vaccine stance. As
articles about religious schools with measles outbreaks are quick to point out, even if one spokesperson
claims vaccination is against the group’s beliefs, there is always a second spokesperson who will
contradict that claim. On Wednesday, WNYC quoted ultra-Orthodox Rabbi Shmuel Kamenetsky, who told a Baltimore paper this past
summer that vaccines are a hoax. But, it should be noted, he didn’t raise any religious objections to them. Avi Shafran, a spokesman for
Agudath Israel, of which Kamenetsky is a member of the board of rabbis, told WNYC in a wavering and inconclusive Chris Christie–style email:
“It would be wrong, I think, to vilify those who opt to not vaccinate their children, or to postpone vaccinations. ... But it would be equally wrong
to ignore the clear science regarding the issue.” Making it pretty clear that while they don’t want to force anyone to vaccinate, they have no
religious objection. Indeed, most religions that are dragged into this debate don’t actually oppose vaccination .
In 2013, John Grabenstein, the executive director for global health and medical affairs for Merck (which may lead conspiracy theorists to claim
he is just shilling for Big Pharma), wrote a paper for the journal Vaccine outlining the purported religious objections. His conclusion: The
only
two religions that have any possible negative stance (though it’s not even clear that they do) on vaccination are
Christian Scientists and the Dutch Reformed Church. It was tougher for me to take the SAT on a Sunday than it is to exempt
a child from vaccination for religious reasons. The Christian Scientists’ stance can be a bit tricky to ascertain, as
they’re known to be excessively secretive about their thoughts on modern medicine. While they believe
diseases can be cured through prayer, they don’t seem to have an official stance when it comes to preventive actions like vaccines. That being
said, Grabenstein quotes Mary Baker Eddy, the founder of the Church of Christ, Scientist, as saying, “Rather than quarrel over vaccination, I
recommend, if the law demand, that an individual submit to this process, that he obey the law, and then appeal to the gospel to save him from
bad physical results.” The Dutch
Reformed Church’s objections seemed to start out as fear of adverse effects,
but, for some, have morphed into a belief that vaccines interfere with the relationship with God, as they
make people less dependent on God. As a result of low vaccination rates in the Dutch “Bible Belt,” more than 1,200 people came
down with measles in a 2013 outbreak. But there is another subset of the denomination that describes vaccinations as a gift from God that
should be used with gratitude. (This interpretation is reminiscent of the famous religious joke about a drowning man who refuses help because
God will save him, only to arrive in heaven to have God tell him, “I sent you a rowboat and a motorboat and a helicopter, what more did you
expect?”) Some people cite the Catholic Church’s objection to certain vaccines, such as the rubella vaccine,
that were initially developed in laboratory cell lines that were derived from aborted fetuses. (The vaccines
themselves contain no fetal cells.) The church has stated that in those instances members should find alternatives
when available but that there is no religious obligation to refuse these vaccines. (Catholic News Service even ends
an article on this subject with the wonderful: “Children and unborn children must not pay the price for ‘the licit fight against pharmaceutical
companies’ that produce immoral vaccines.”) Jehovah’s Witnesses have famously strict rules regarding blood transfusions, based on their
interpretation of the Bible’s commandment to abstain from blood. But they don’t seem to currently oppose vaccination. But does any of this
matter? Not really! Because in order to apply for a religious exemption, you don’t even need to be religious. If you live in Connecticut, for
example, all you have to do is fill out this incredibly simple form—the simplicity of which anti-vaccine websites love to point out. In Florida, all
that is needed is the child’s name, date of birth, and Social Security number—no proof of religion, or even name of a religion, is needed.
There’s like 2 half legitimate religions that say no to vaccines --- the rest is just
personal --- reject this kritik
JOHN D GRABENSTEIN 4/12/2011 --- PhD, is Senior Medical Director for Adult Vaccines for Merck Vaccines (“What the
World's religions teach, applied to vaccines and immune globulins”, John Grabenstein, April 12, 2011, Proquest, Kidlington,
http://search.proquest.com.proxy.lib.umich.edu/docview/1625885150/abstract/45172CD0C4F34CCEPQ/1?accountid=14667)//
chiragjain

Multiple Christian denominations Most Christian denominations have no scriptural or canonical objection to use of vaccines or immune globulins per se, based on
this review (Table 1 C and D). These include Roman Catholicism, Eastern Orthodox and Oriental Orthodox Churches, Amish, Anglican, Baptist, the Church of Jesus
Christ of Latter-day Saints (LDS), Congregational, Episcopalian, Lutheran, Methodist (including African Methodist Episcopal), Pentecostal, Presbyterian, and Seventh-
Day Adventist Church. Exceptions appear in following sections. Roman
Catholicism and some other Christian denominations
have expressed concern about the aborted fetal origins of the principal formulation of rubella vaccine
and some cell lines used to manufacture certain types of viral vaccines, discussed in later sections. The second half of
Table 1 D provides scriptural passages interpreted by a minority as contrary to vaccination. Within a Christian creation-fall-redemption-restoration framework,
immunization advocacy can form a basis for Christian service to humanity. This is consistent with themes of being one's brother's keeper (Genesis 4:9, Table 1 C),
loving your neighbor as yourself (James 2:8, Table 1 D), and acting kindly to strangers, as did the good Samaritan (Luke 10:33-35, Table 1 D). Amish and related
communities The Amish, sometimes called old-order Amish or Amish Mennonites, are a group of Christian fellowships among Mennonite churches. Amish
fellowships began with a schism within a group of Anabaptists in Switzerland in 1693 CE. Related groups in Canada and the northern US are known as Hutterites.
Immunization is not prohibited by Amish or Hutterite religious doctrine, but vaccine acceptance varies from district to district. Districts
that typically
decline immunization reflect a social tradition within these religious communities , related to modernity, more than
a theological objection. Low immunization rates in Amish communities have been attributed variously to limited access to care, limited disease understanding,
higher priority to other activities, and concerns about vaccine safety, with variability among various communities [18,120-123] . They
tend to define
illness in terms of failure to function in a work role, more than in terms of symptoms [19] . Within Amish and
related communities, multiple Haemophilus influenzae type b, measles, pertussis, poliomyelitis, rubella, and tetanus cases and outbreaks have been reported
[11,18,19,26,50,51,56-58,64,67,70-80,83] . District leaders have been more accepting of immunization at times of local outbreaks. Church of Christ, Scientist
Spiritual healing of disease is a central tenet for members of the First Church of Christ, Scientist , founded
in 1879 CE in Boston by Mary Baker Eddy. Christian Scientists frequently decline some or all medical help for disease.

Individual believers often forego immunization, and church members have lobbied governments for
religious exemptions from immunization. Eddy called believers to unmask the devil's lies, one manifestation of which is disease. Disease, in
this construct, is not fundamentally real, but rather something that can be dispelled, to reveal the perfection of God's creation. "Sickness is part of the error which
Truth casts out" [124] . From this arose the Christian Science principle that disease is cured or prevented by prayer that affirms human perfection as God's child and
denies the reality of disease. This principle is featured in Eddy's canon, Science and Health with Key to the Scriptures [124] . Christian Science "practitioners" (who
do not practice medicine) aid believers in focused prayer. In a 1901 interview with the New York Herald, Eddy said [125] : "At a time of contagious disease, Christian
Scientists endeavor to rise in consciousness to the true sense of the omnipotence of Life, Truth, and Love, and this great fact in Christian Science realized will stop a
contagion." Later, she said: "Rather than quarrel over vaccination, I recommend, if the law demand, that an individual submit to this process, that he obey the law,
and then appeal to the gospel to save him from bad physical results" [125] . Outbreaks of diphtheria, measles, and poliomyelitis have been reported among
followers of Christian Science [16,17,23-25,28,50,66] , including repeat measles outbreaks at Principia College and affiliated K-12 schools between 1985 and 1994
[48] . Three measles deaths and hundreds of cases occurred during those outbreaks. The Church has a policy for members to report communicable diseases to
health authorities, but members have limited ability to do so. First, their practitioners and nurses are not trained in disease recognition. Second, members are
taught that disease is healed by convincing oneself of its unreality. As a result, several outbreaks have been recognized only after many people were infected [28,48]
. In such cases, Christian Science parents were more willing to accept immunization after outbreaks were recognized by health authorities. Dutch reformed
congregations Members of certain traditional reformed (bevindelijk gereformeerden) Christian denominations in the Netherlands, founded in the 1570s CE, have a
tradition of declining immunization that dates back to concerns about adverse events after smallpox vaccination from 1823 onward [15,45,59,126] . These
communities were the epicenters of paralytic poliomyelitis, measles, congenital rubella syndrome, and mumps outbreaks between 1971 and 2008
[11,15,34,45,54,58-65,77-80,82,126] . Members of these denominations have familial and cultural ties to associated Christian communities in other countries (e.g.,
Canada, United States), where immunization rates may also be low. These ties have resulted in international transmission of vaccine-preventable diseases (e.g.,
measles, poliomyelitis, rubella) with multiple outbreaks in locations otherwise free of circulating disease [11,58,61,64,78-80,82] . The contemporary basis for the
objection of some members of these churches includes choosing to forego immunization rather than making a person less dependent on God [15,45,59,126] . For a
subset, avoiding interference with divine providence before infection may be paramount; another subset described immunization as a gift from God to be used with
gratitude [15,59] . Arguments against immunization have been refuted by other members of the traditional reformed community [15] , for example by pointing out
that using agricultural practices or raising dikes, to prevent flooding, could also be construed as contrary to divine intent, yet are common practices [45] . Recent
increases in immunization rates in Dutch communities suggest that objections to immunization may be declining [45] . Jehovah's Witnesses The Jehovah's Witnesses
is a Christian denomination tracing its roots to the late 1870s CE. The Watch Tower Bible and Tract Society is its organizing body [127-130] . Since 1945, the Watch
Tower Society has instructed its followers to refuse transfusions of whole blood and certain blood components (e.g., red blood cells, white blood cells, platelets,
whole plasma), which they consider a violation of God's law. This interpretation derives from several scriptural passages ( Table 1 E) [127-138] . Their blood doctrine
has undergone multiple changes since 1945, principally in 1978, 2000, and 2004 [139-142] . By abstaining from blood, Witnesses express their faith that only the
shed blood of Jesus can redeem them and save their life. In this view, those who respect life as a gift from God do not try to sustain life by taking in blood, even in
an emergency [129,130] . While albumin, antimicrobial immune globulins, Rho(D) immune globulin, and coagulation factors VIII and IX have been declared
acceptable to believers since 1978 [137,142] , Witnesses today are taught that the use of various blood fractions are "not absolutely prohibited" and are a matter of
personal choice [128,129,136-138,143-145] . More recently permissible products include those derived from white blood cells (e.g., interferons, interleukins),
cryoprecipitate, cryosupernatant, erythropoietin, and preparations derived from hemoglobin [129,135,146] . It is unclear what proportion of Jehovah's Witnesses
offered such therapeutic products accept them. The Watch Tower Society distributes worksheets and pre-formatted power-of-attorney advance directives, on
which members can specify which allowable fractions and treatments they would personally accept, if any [129,131,132,135,136,144,147] . Important questions
have been raised regarding how much freedom and what degree of information about risks, benefits, and alternatives are available to individual Jehovah's
Witnesses when considering these documents [128,129,131-135,148-150] . Some Jehovah's Witnesses dissent from the blood-product doctrine, including the
Associated Jehovah's Witnesses for Reform on Blood [129,135] . They see no Biblical or ethical wrongness with accepting transfusion of donor blood or with
donating blood for transfusion. This group functions with anonymity, because congregations have ostracized or expelled those who ignore or criticize their doctrine
[128,129,134-136] . The Watch Tower Society denounced vaccination from the 1920s through the 1940s, citing scriptural passages such as those in Table 1 E [127-
129,138,151,152] . The group banned their members from vaccination around this time, under penalty of excommunication [138,151] . The Society revised this
doctrine in the December 15, 1952, issue of The Watchtower, saying that those passages did not apply to vaccination [153] . In 1961, the Society took a neutral
stand, neither endorsing nor prohibiting vaccination. In the 1990s, Awake! magazine began acknowledging the clinical value of vaccination. A contemporary
Watchtower web page acknowledges the efficacy of vaccination in preventing hepatitis A and hepatitis B [154] . Churches that rely on faith healing In addition to
discussion above, several small Christian denominations or churches hold core beliefs that focus on healing
through faith alone (Table 1 D), with active avoidance of medical care (e.g., Faith Tabernacle, Church of the First Born,
Faith Assembly, End Time Ministries) [155] . Several vaccine-preventable outbreaks (and associated deaths) involved

faith healing to the exclusion or neglect of immunization or treatment after infection [27,39,40,50,51,155-157] .
These outbreaks involved both adults who choose not to have themselves immunized and parents who withheld routine vaccines from their children. Islam Islam
professes beliefs articulated by their Holy Book, the Qur'an (the recitation), and through the teachings and example of Muhammad (570-632 CE). Muhammad, the
last messenger of Allah (the God, in Arabic), descends from Abraham (Ibrahim) through his son Ishmael [1,2] . The two major Islamic sects are Sunni and Shi'ah. The
Qur'an and tradition forbid consumption of several animals outright (e.g., "the flesh of swine," Table 1 F), while other animals are permitted (halal) or forbidden
(haram) based on conditions of how they died or were slaughtered. Gelatin made from porcine skin or bones is forbidden as food. Gelatin made from other halal
animals, beef or fish for example, is acceptable as food. Opinions or rulings on interpretation of the Qur'an are issued as fatwas by Islamic scholars (mujtahids), with
varying degrees of strictness. But fatwas are not always widely held to be authoritative, in part because of varying degrees of expertise and also because the
relationship for each Muslim is directly with God. According to the Qur'an, a person is not guilty of sin in a situation where the lack of a halal alternative creates an
undesired necessity to consume that which is otherwise haram (Qur'an 2:173). This is the basis for the "law of necessity" in Islamic jurisprudence: "That which is
necessary makes the forbidden permissible" in exceptional circumstances ( Table 1 F). Opposition
to immunization programs among
selected Muslim communities has occurred during poliovirus immunization programs in Nigeria,
Pakistan, and Afghanistan [158] . The opposition within northern Nigeria, notably in the state of Kano, was particularly long-lasting and an
impediment to the global eradication effort [68,158-163] . Detailed consideration of the Nigerian situation revealed that what was described as ostensibly religious
objections and assertions that vaccines spread the HIV virus or were vehicles for sterilization programs masked deeper struggles related to political power,
inadequate health services, and a controversial clinical trial of an investigational antibiotic [68,159,162] . While the boycott was centered within Islamic social
networks, most of the objections raised related to social issues, rather than theological issues. Eventually, the Nigerian government sent religious representatives to
South Africa, Indonesia, and India to observe quality-control tests of poliovirus vaccines to be used in their areas and then sourced the vaccine from manufacturers
they trusted [68,162] . In contrast, multiple imams and other Islamic leaders issued clear statements and fatwas describing how immunization is consistent with
Islamic principles [68,69,162] . In the Nigerian case, engagement of the Organization of the Islamic Conference (including 17 African countries) and the 15th annual
conference of the International Fiqh Council (a global forum of Islamic lawyers, scholars and philosophers to address the practice of Islam in contemporary life)
provided assurances to Nigerian leaders [68] . Earlier, in 1995, the Islamic Organization for Medical Sciences, a well-regarded set of 112 jurisprudents and medical
experts conducted a seminar in Kuwait on "The judicially prohibited and impure substances in foodstuff and drugs" [164] . Participants included the muftis (experts
in Islamic law) of Egypt, Tunisia, Oman, and Lebanon, the secretary general of the Islamic Fiqh Academy in Jeddah, and many other accomplished Islamic scholars.
Citing the accepted principle of transformation (fundamental change, as from wine to vinegar) within Islam, they concluded that "The Gelatin formed as a result of
the transformation of the bones, skin, and tendons of a judicially impure animal is pure, and it is judicially permissible to eat it" (see also Section 3.2.4 ) [164] . The
full document also addressed issues related to medication capsules, alcohol, pig fat, and porcine insulin. Omar Kasule, professor of Islamic medicine at the Institute
of Medicine University of Brunei Darussalam noted that polio immunization is obligatory (wajib) when disease risk is high and the vaccine shown to have benefits far
outweighing its risks [165,166] . Muslims will be interested in issues of vaccine safety, Professor Kasule explained, because immunization to prevent disease should
not lead to side effects of the same magnitude as the disease. He based this judgment on the purpose of the law to protect life, the principle of preventing harm
(izalat aldharar), and the principle of the public interest (maslahat al-ummah). He noted that the Qur'an uses the concept of wiqaya in multiple situations to refer to
taking preventive action (e.g., against hell-fire, punishment, greed, bad acts, harm, heat) and concludes that prevention is one of the laws of Allah, with obvious
application to medicine. Muslims
may apply additional scrutiny to vaccines required for pilgrims to the annual
Hajj in Mecca, when purity takes on extra significance [167-170] . Another guiding principle comes from the prophetic statement of
Muhammad: "God has not made things that are unlawful for you to consume to be your medicine" [171] .

It’s not gonna get struck down for religious freedom


Chemerinsky and Goodwin 16(Erwin Chemerinsky is Dean and Distinguished Professor, and
Raymond Pryke Professor of First Amendment Law, University of California, Irvine School of Law.
Michele Goodwin is Chancellor's Professor of Law and Director, Center for Biotechnology and Global
Health Policy, University of California, Irvine School of Law, 2016, “Northwestern University Law
Review”, Northwestern University Law Review)\\WDB

A frequent objection to compulsory vaccination laws is that they intrude on the right of parents to
practice their religion. Parents who oppose medical care on religious grounds contend that their beliefs
require a constitutional exemption from mandatory inoculation requirements. Under current First
Amendment law this claim is groundless, without even needing to consider whether the state has a
sufficient interest in requiring vaccinations. In 1990, in Employment Division v. Smith, the Court held
that the Free Exercise Clause cannot be used to challenge a neutral law of general applicability. n130 In
other words, no matter how much a law burdens religious practices, it is constitutional under Smith so
long as it does not single out religious behavior for punishment and was not motivated by a desire to
interfere with religion. Smith involved a challenge by Native Americans to an Oregon law prohibiting use
of peyote, a hallucinogenic substance. Specifically, individuals challenged the state's determination that
their religious use of peyote, which resulted in their dismissal from employment, was misconduct
disqualifying them from receipt of unemployment compensation benefits. n131 Justice Scalia, writing
for the majority, rejected the claim that free exercise of religion required an exemption from an
otherwise valid law. Justice Scalia said that "we have never held that an individual's religious beliefs
excuse him from compliance with an otherwise valid law prohibiting conduct that the State is free to
regulate. On the contrary, the record of more than a century of our free exercise jurisprudence
contradicts that proposition." n132 Justice Scalia thus declared "that the right of free exercise does not
relieve an individual of the obligation to comply with a "valid and neutral law of general applicability on
the ground that the law proscribes (or prescribes) conduct that his religion prescribes (or proscribes).'"
n133 The Court stressed that it should be the political process, and not the judicial, that provides for
exemptions in laws to protect religious beliefs. Justice Scalia said that: Precisely because "we are a
cosmopolitan nation made up of people of almost every conceivable religious preference," and precisely
because we value and [*610] protect that religious divergence, we cannot afford the luxury of deeming
presumptively invalid, as applied to the religious objector, every regulation of conduct that does not
protect an interest of the highest order. n134 The Court said that those seeking religious exemptions
from laws should look to the democratic process for protection, not the courts. There is no doubt that
Smith changed the test for the free exercise clause. No longer is strict scrutiny used when the challenge
is to a neutral law of general applicability. Such laws are upheld so long as they meet a deferential
rational basis test. This applies to vaccination. State statutes requiring vaccinations of all children are
neutral laws of general applicability. They are not motivated by a desire to interfere with religion and
they apply to everyone. Therefore, there is no basis for a First Amendment challenge to compulsory
vaccination laws. In response to Smith, Congress adopted two statutes to restore religious freedom
rights by statute. Neither provides a basis for challenging compulsory vaccination laws. Congress
adopted the Religious Freedom Restoration Act of 1993 to restore the law to what it was before Smith:
strict scrutiny for claims that the government is significantly burdening religion, even when it is a
challenge to a neutral law of general applicability. n135 The Act declares that its purpose is "to restore
the compelling interest test ... and to guarantee its application in all cases where free exercise of religion
is substantially burdened; and ... to provide a claim or defense to persons whose religious exercise is
substantially burdened by government." n136 The key provision of the Act states: Government shall not
substantially burden a person's exercise of religion even if the burden results from a rule of general
applicability, except ... government may substantially burden a person's exercise of religion only if it
demonstrates that application of the burden to the person ... (1) is in furtherance of a compelling
governmental interest; and (2) is the least restrictive means of furthering that compelling governmental
interest. n137 However, the Supreme Court quickly declared the Religious Freedom Restoration Act
unconstitutional as applied to state and local governments. In City of Boerne v. Flores, a 6-3 decision,
the Court held that the law was unconstitutional as exceeding the scope of Congress's powers under
[*611] Section Five of the Fourteenth Amendment. Justice Kennedy, writing for the majority, stated that
Section Five empowers Congress to enact laws "to enforce" the amendment, but Congress is not
"enforcing" when it creates new constitutional rights or expands the scope of rights. n138 The Court
held that Congress under Section Five may act only to prevent or remedy the violation of rights
recognized by the courts. Such laws must be narrowly tailored; they must be proportionate and
congruent to prevent and remedy the constitutional violations. n139 The Religious Freedom Restoration
Act was deemed to fail these requirements and was declared unconstitutional as applied to state and
local governments. It therefore cannot be used to challenge state laws requiring vaccinations. In 2000, in
response to City of Boerne v. Flores, the Religious Land Use and Institutionalized Persons Act was
adopted by Congress. n140 This law requires that the government meet strict scrutiny when it
significantly burdens religion in two areas: land use decisions and institutionalized persons. Congress
justified acting to regulate land use decisions under its commerce power and to regulate
institutionalized persons under its spending power as a condition on federal funds. But state laws
requiring vaccinations do not involve either of these areas, so this statute is inapplicable as a basis for
challenges. Thus, under current law, there is no basis for a religious challenge - either under the
Constitution or federal laws - to state laws' mandatory vaccinations for all children.

Religious convictions change


Bucchieri 16(Rebecca Bucchieri- J.D., George Mason University School of Law, B.A. Law and, Magna
Cum Laude, American University. Summer 2016. “Religious Freedom versus public health: the necessity
of compulsory vaccination for schoolchildren”, The Boston University Public Interest Law Journal, 25 B.U.
Pub. Int. L.J. 265)\\WDB

Moreover, some religions have changed their official stances on vaccinations over the years, coming to
eventually accept the clinical value of vaccinations in more modern times. Jehovah's Witnesses
"denounced vaccination from the 1920s through the 1940s, citing scriptural passages . . . [and] banned
their members from [receiving vaccinations] around this time, under penalty of excommunication."
n257 However, in the 1990s, they "began acknowledging the clinical value of vaccination." n258 Such
drastic changes to religious beliefs call into question whether a religious refusal of one individual--based
upon religious convictions that might be actually impermanent in sincerity and subject to revision based
upon religious authority--are worth compromising the public health. Just as accommodating religious
beliefs opposing the payment of taxes would unduly interfere with the fulfillment of the government's
interest in maintaining a comprehensive social security system, permitting continual religious objections
to school vaccinations would similarly threaten the government's immunization infrastructure and its
efficacy. n259

Not infringing on religious freedom


Bucchieri 16(Rebecca Bucchieri- J.D., George Mason University School of Law, B.A. Law and, Magna
Cum Laude, American University. Summer 2016. “Religious Freedom versus public health: the necessity
of compulsory vaccination for schoolchildren”, The Boston University Public Interest Law Journal, 25 B.U.
Pub. Int. L.J. 265)\\WDB

A federal vaccination law is also likely to survive a RFRA challenge because, irrespective of Brown v.
Stone, such a law would objectively serve a compelling governmental interest today and would be the
least restrictive means of doing so, surviving constitutional challenges despite the substantial [*293]
burden such a law may place on religion. n235 There is ample evidence that the public's immunity to
infectious disease would be optimal when the entire United States population receives vaccinations.
n236 In enforcing vaccination requirements, the government has a particularly compelling interest to do
so by making school entry contingent upon receiving immunizations. n237 Schools are an ideal breeding
ground for the spread of infectious disease, as they gather young children in tight quarters for long
periods. n238 The United States has unfortunate experience with this truth, as nearly every child in the
nation contracted measles by the age of fifteen in the 1950s. n239 While removing religious exemptions
may present religious objectors with a Hobson's choice of vaccinating their child against the tenets of
their religion or not sending their child to school at all, conditioning school entry on vaccinations "does
not force any person to be vaccinated, but rather provides strong incentives (i.e., school attendance) to
seek compliance." n240 Homeschooling would remain an option for any religious objector that wishes to
forgo child vaccinations.

Enforcement with everyone is key – empirics prove


Offit 17 -- Paul A. Offit is a professor of pediatrics at the Perelman School of Medicine at the University
of Pennsylvania and the author of Deadly Choices: How the Anti-Vaccine Movement Threatens Us All
(Basic Books, 2011). [6/18/17; When Parents Force the Government’s Hand on Vaccines,
http://www.thedailybeast.com/when-parents-force-the-governments-hand-on-
vaccines?source=twitter&via=desktop] MP

In the early 1900s, a smallpox epidemic swept through Cambridge, Massachusetts. The Cambridge
Board of Public Health asked all citizens to get a smallpox vaccine; those who chose not to vaccinate
had to pay a $5 fine (equivalent to about $150 today). Henning Jacobson, a Lutheran minister who
believed that God would reward his faithfulness and protect him, refused the vaccine and the fine. His
case worked its way up to the Supreme Court, which ruled that the Cambridge Board of Health had the
right to fine Jacobson for his inaction. Arguing for the majority, Associate Justice John Marshall Harlan wrote, “The liberty secured
by the Constitution of the United States does not import an absolute right to be wholly freed from
restraint. There are manifold restraints to which every person is necessarily subject for the common
good. Society based on the rule that each one is a law unto himself would soon be confronted with
anarchy and disorder.” Seventeen years later, in 1922, the High Court revisited its ruling in Jacobson v. Massachusetts. In the early 1920s, after refusing
a smallpox vaccine, Rosalyn Zucht was expelled from Brackenridge High School in San Antonio. Like Henning Jacobson, Zucht and her case also worked their way up
to the Supreme Court. But the difference was that, unlike Cambridge, San Antonio wasn’t in the midst of a smallpox epidemic. So Rosalyn’s risk of catching smallpox
was negligible. Nonetheless, the Supreme Court, in a one-paragraph opinion, upheld the Jacobson ruling. In the Jacobson and Zucht cases, the
Supreme
Court had ruled that citizens of the United States do not have a constitutional right to exempt
themselves from vaccination or from the price levied for making that choice. Both were also examples of mandatory
vaccination, which differs from compulsory vaccination. With mandatory vaccination, people might have to pay a fine (like Henning Jacobson) or they might be
prohibited from attending school (like Rosalyn Zucht) or from working in a particular hospital or business. With compulsory vaccination, on the other hand, people
are vaccinated against their will or children are vaccinated against their parents will. The most recent example of compulsory vaccination occurred in Philadelphia.
Between October 1990 and June 1991, more than 1,400 people living in Philadelphia were infected
with measles; nine children died. All of this suffering and death occurred despite the fact that a measles
vaccine had been available for about 30 years. The Philadelphia epidemic started when, after returning
from a trip to Spain, a teenager with a blotchy rash attended a rock concert at the Spectrum concert
arena. By Nov. 29, 96 schoolchildren had been stricken with the illness; a week later, it was 124; by the end of December, the number had risen to 258, and the
first child had died. The Centers for Disease Control and Prevention sent a team of scientists to determine
whether the strain of measles circulating in Philadelphia was uniquely virulent. It wasn’t. Investigators
soon found that the measles deaths had nothing to do with the strain of circulating virus and everything
to do with the parents. Two fundamentalist Christian churches—Faith Tabernacle Congregation and First Century Gospel Church—were at the center of
the outbreak. Both were faith-healing groups, refusing vaccination as well as medical care. When their children became ill, these parents

prayed instead of taking them to the hospital to receive intravenous fluids for dehydration or oxygen for
pneumonia. “If I go to God and ask him to heal my body,” said church member Gordon Korn, “I can’t go
to a doctor for medicine. You either trust God or you trust man.” Public-health officials and legislators turned to the courts for help. First, they
obtained a court order to examine the churches’ children in their homes, then to admit the children to a hospital for medical care. Finally, they did

something that had never been done before or since: They got a court order to vaccinate children
against their parents’ will. Children were briefly made wards of the state, vaccinated, then returned to
their parents. At the time of the Philadelphia measles outbreak, a religious exemption to vaccination had
been the law in Pennsylvania for about a decade. What the parents were doing by refusing to vaccinate their children was perfectly
legal. To prevent public-health officials from infringing on the right of faith-healing parents to exempt themselves from vaccination on religious grounds, the pastor
of the Faith Tabernacle Church asked the American Civil Liberties Union to represent them. Although
the ACLU has historically been
willing to take on unpopular causes—like the right of neo-Nazis to march down the streets of Skokie,
Illinois, in the 1970s—they refused to take the case. “There is certainly a free exercise of religion claim
by the parents,” said Deborah Leavy, the executive director of the ACLU of Pennsylvania. “But there is
also a competing claim that parents don’t have the right to martyr their children.” Looking back, it’s hard to believe
that the ACLU would make the choice it did. The parents of these faith-healing groups were acting within the law. But you had to be here. The city of Philadelphia
was in a panic. It was a feared destination. Schools and tourists canceled trips. The
Commonwealth of Pennsylvania spent hundreds
of thousands of dollars creating and distributing educational pamphlets. Public-health officials, nurses,
doctors, and other medical personnel were working around the clock to stem the tide of the growing
epidemic. And children were dying, including those who weren’t members of faith-healing groups. Although
pushback is inevitable, the decision by German public-health officials to fine parents who leave children vulnerable to a potentially fatal infection is arguably the
least they can do. Paul A. Offit is the director of the Vaccine Education Center at Children’s Hospital of Philadelphia and the author of Bad Faith: When Religious
Belief Undermines Modern Medicine (Basic Books, 2015).
2AC AT: Hooker CP
Making exemptions harder to get does nothing --- complete vaccinations are key
MARGARET ROBERSTON 2013 --- BA University of Pittsburgh on Vaccinations and Health Policy (“ANALYSIS OF MANDATORY YOUTH
VACCINATION ENFORCEMENT MODELS, Margaret Roberston, 2013, Masters Paper for University of Pittsburgh Master of Public Health School,
d-scholarship.pitt.edu/27354/1/RobertsonM_Masters Essay_4_2016.pdf)//chiragjain

Six states (AL, CA, MI, OR, VT, and WA) have exemption processes that are minimally accessible. These states require
guardians to receive some form of education on the risks and benefits of immunization in addition to submitting a signed form to school
officials. The types of education include speaking with a medical professional or local health department
officials, and completing online modules on immunization. These more stringent exemption procedures have only
recently been enacted, therefore their effect on non-medical exemption rates is unclear. In addition to the
six states that currently require an education component in their exemption processes, several other states are currently either
implementing or considering including an educational component to their non-medical exemption processes
(Colorado’s Personal Belief Exemption, 2013). Although the accessibility of non-medical exemptions may influence
some guardians’ decision to pursue exemptions, many will likely seek exemption even when the process is
more taxing than receiving the required vaccinations. Furthermore, it is difficult to determine the extent to
which schools comply with exemption processes. Some school administrators may accept exemptions that are incomplete.
Nonetheless, exemption accessibility can be a lurking variable when reviewing enforcement’s impact on vaccination rates, and the process also
require schools to spend more time ensuring students are in compliance.
2AC AT: States CP
Trump would spin the counterplan as a win – his administration wants states to
regulate vaccines, and is inherently anti-vaccination
Belluz 3/17/17 – senior health correspondent at Vox (Julia, “Tom Price says states should decide vaccine
standards. They’ve been doing a lousy job.” https://www.vox.com/science-and-
health/2017/3/17/14958422/tom-price-vaccine-standards-states)//ernst
Health and Human Services Secretary Tom Price was criticized this week for his seemingly limp enthusiasm about vaccines. In an interview on
CNN, Price was asked whether immunizations should be required for all Americans. His response boiled down to:
It’s up to states to enforce vaccine standards. “It’s a perfectly appropriate role for the government —
this happens by and large at the state government, by the way, because they are the ones that have the
public health responsibility — to determine whether or not immunizations are required for a community
population,” he said. In truth, Price was just describing the status quo. Vaccinations do fall under the public health
jurisdiction of the states. It’s up to them to set laws around who gets what shots when, and what kinds
of exemptions are allowed. Sure, Price could have been more forceful in underscoring the scientific consensus that universal vaccine
coverage is ideal — especially at a time when the anti-vaccine movement seems to be emboldened under a
president who’s been doubtful of vaccine safety. But the real missed opportunity here was to point out that states should be
doing a much better job on vaccines. Some have loosened their standards over the years — and it’s helped spark a resurgence of preventable
diseases.

States can’t control drugs prices, or purchase drugs across state lines, including
vaccines
Grant P. Bagley and Rosemary Maxwell 6 --- an obstetrician/gynecologist in Washington, District of Columbia. He is currently
licensed to practice medicine in District of Columbia, Maryland, and California. He is affiliated with MedStar Washington Hospital Center.,
focuses on healthcare compliance and public policy issues, Medicare and Medicaid coverage and reimbursement (including the Medicare Part D
prescription drug benefit), Medicaid rebate calculations and related price reporting requirements, healthcare privacy law, and related
regulatory issues affecting pharmaceutical and medical device manufacturers. (8/4/2006, “DRUG PRICE CONTROL FAILS CONSTITUTIONAL
TEST,” http://www.wlf.org/upload/080406bagley.pdf)//ernst

Allowing importation of low-priced foreign drugs has been described as a roundabout way of importing foreign price controls. The District
of Columbia tried a simpler route: it passed a law directly importing foreign price controls, without the foreign
drugs. And because the D.C. law targets non-retail prescription drug sales that typically occur outside the District, the imported price controls
could reach many sales throughout the U.S. At least for now, the nation’s capital will not become the port of entry for
foreign price controls on prescription drugs. In a recent decision, the U.S. District Court for the District of
Columbia blocked enforcement of the price control law, known as the Prescription Drug Excessive Pricing Act of 2005.
Pharmaceutical Research and Mfrs. of America v. District of Columbia, 406 F. Supp. 2d 56 (D.D.C. 2005). Finding the law an obstacle
to achieving the purposes of federal patent laws, the court held that the law violated the Constitution’s
Supremacy Clause. The court held that the law also violated the Constitution’s Commerce Clause as
applied to prescription drug sales that occur outside the District. While the decision will not be the last word on these
issues (as the District has appealed to the D.C. Circuit), it provides a thoughtful and persuasive analysis of the constitutional questions raised by
the District’s effort to control prescription drug prices. The D.C. Prescription Drug Excessive Pricing Act. The D.C. Prescription Drug Excessive
Pricing Act of 20051 makes it unlawful for a drug manufacturer or licensee, excluding a point of sale retail seller,@ to sell a patented
prescription drug at a price that results in the prescription drug being sold in the District for an excessive price.@ Excessive pricing@ is defined
by reference to prices in four high income countries,@ i.e., the United Kingdom, Germany, Canada, and Australia. Specifically, a prima facie case
of excessive pricing exists where the wholesale price of a patented prescription drug in the District is over 30 percent higher than the
comparable price in any high income country in which the product is protected by patents or other exclusive marketing rights.@ When a prima
facie case is shown, a defendant has the burden of proving that the price is not excessive given demonstrated costs of invention, development,
and production of the prescription drug, global sales and profits to date, consideration of any government funded research that supported the
development of the drug, and the impact of price on access to the prescription drug by residents and the government of the District of
Columbia.@ Because the Act is violated by manufacturer sales that result in@ the drug being sold in the District for an excessive price, it could
make manufacturers liable for downstream prices set by others in the distribution chain. The Act authorizes suits by any person directly or
indirectly affected by excessive prices of patented prescription drugs@ (including any organization representing such persons, any person or
organization representing the public interest,@ and the District government). Violations of the Act can result in injunctions to enjoin the sales
of prescription drugs in the District at excessive prices,@ fines, treble damages, attorney fees, litigation costs, and any other relief the court
deems proper. Thus, the Act authorizes the District government or private attorneys general to sue a pharmaceutical manufacturer for
excessive pricing; to make out a prima facie case by showing that the drug was sold in the District at prices 30% above those in the United
Kingdom, Germany, Canada, or Australia; and to seek injunctive relief and recovery of substantial penalties. The District Court Decision. The
D.C. Prescription Drug Excessive Pricing Act was challenged in separate suits by the Pharmaceutical Research and Manufacturers of America
(PhRMA) and the Biotechnology Industry Association (BIO) that were later consolidated.2 After rejecting the District=s argument that the
plaintiffs lacked standing to bring a pre-enforcement challenge to the Act, the court found the Act invalid on Supremacy Clause and Commerce
Clause grounds, while rejecting the claim that the Act violated the Constitution=s Foreign Commerce Clause.3 The Supremacy Clause and
Commerce Clause rulings are discussed below. The Supremacy Clause Ruling B Preemption by the Federal Patent Laws. The plaintiffs=
Supremacy Clause claim was based on the theory that the D.C. price control law was preempted by the
federal patent laws regulating pharmaceuticals. The court noted that State laws (including District of Columbia laws) can
be impliedly preempted by federal law based on: (1) field preemption (where the federal regulatory scheme is so
pervasive as to leave no room for supplementary State laws); or (2) conflict preemption (where compliance with both State and
Federal laws is impossible, or where the State law Astands as an obstacle to the accomplishment and execution of the full purposes and
objectives of Congress@).4 The
court found that the District=s price control law was an obstacle to achieving
the purposes of the federal patent laws in connection with patented pharmaceuticals. While the patent laws
were designed to spur innovation B by giving inventors the opportunity to recoup their investment in developing a patented product B the law
threatened to undercut that goal by reducing the rewards for innovation in the pharmaceutical sector. The court focused in particular on the
Drug Price Competition and Patent Term Restoration Act of 1984 (commonly known as the Hatch-Waxman Act),5 which restored part of the
patent term lost by pharmaceuticals during the FDA approval process in order Ato create a new incentive for increased expenditures for
research and development of certain products which are subject to premarket government approval.@ 6 Finding that the D.C. law created an
unmistakable obstacle@ to this goal, the court held that: APunishing the holders of pharmaceutical patents . . . flies directly in the face of a
system of rewards calculated by Congress to insure the continued strength of an industry vital to our national interests. Ironically, the factors
Congress weighed in calculating their system of rewards are the very same factors the [D.C.] Act requires manufacturers to litigate . . . in
response to a 8 Commerce Clause Ruling. The court=s Commerce Clause ruling was based on the provisios in the
D.C. law imposing liability for excessive pricing on pharmaceutical manufacturers B but not point of sale
retail sellers@ B and the plaintiffs= evidence that manufacturer sales generally occur entirely outside the District. Specifically, the
plaintiffs presented evidence (apparently undisputed by the District) that their members did not manufacture
drugs, maintain headquarters, or operate warehouses in the District; that members generally either sold
to wholesalers or large retail chains that were neither headquartered in the District nor had warehouses
in the District; and that the only sales by their members to District entities involved a small number of direct sales to hospitals
or physicians within the District.9 Thus, because the overwhelming majority of plaintiffs= members= sales occur
entirely outside the District of Columbia between out-of-state manufacturers and out-of-state
wholesalers@ and the D.C. Act explicitly exempts in-state retailers,@ the Act effectively seeks to regulate transactions that occur wholly
out of state.@ 10Stating that the plaintiffs had challenged the D.C. Act as applied to transactions that occur wholly out-of-state (i.e., between a
manufacturer and an out-of-state wholesaler or retailer), the court ultimately concluded that the Act Ahas a per se invalid extraterritorial reach
in violation of the Commerce Clause as applied to transactions . . . that occur wholly out-of-state.@ 11 The court began its analysis by noting
that astate statute (including a District statute) directly regulating out-of-state commerce is Aper se
invalid and >generally struck down . . . without further inquiry.=@12 The District argued that the Prescription Drug
Excessive Pricing Act does not regulate out-of-state transactions;, since liability is only triggered if a retail sale is made Ain the District@ at an
excessive price. The court disagreed, holding that the Supreme Court in Baldwin v. G.A.F. Seelig, Inc.13 had previously invalidated an analogous
statute involving Athe effective regulation of an out-of-state transaction triggered by an in-state sale.@ 14 Baldwin involved a New York law
that set minimum prices for sales between in-state milk producers and dealers, and prohibited the instate sale of milk bought outside New York
unless the price paid to the milk producer met New York=s minimum price requirement; thus, the only sales that the law literally prohibited
were in-state sales. Nevertheless, the Court found that the law effectively regulated out-of-state prices and held that New York had Ano power
to project its legislation into [another State] by regulating the price to be paid in that State for milk acquired there.@ 15 Finding the Baldwin
analogy compelling, the PhRMA court reasoned that: Like the statute in Baldwin, the D.C. Act is triggered by an in-state sale. If a
manufacturer=s patented prescription drug is never sold in the District, the Act cannot . . . create liability against that manufacturer. But as
soon as that drug is sold in the District, the manufacturer=s out-of-state sale becomes the Act=s primary target. . . . Baldwin . . . found this type
of regulation B which uses an instate hook to affect out-of-state conduct B to be . . . in violation of the Interstate Commerce Clause.16 The
court also rejected the District=s claim that the price control law was valid because it was based on the
District=s police power to regulate matters involving the health and welfare of District residents, holding
that a public health exception to the Commerce Clause would eat up the rule under the guise of an
exception.@ 17 In consequence, the court concluded, Athe District=s reliance on its police powers cannot, alone, overcome the otherwise
unconstitutional reach of the D.C. Act.@ 18 Conclusion. State laws that import foreign price controls on patented pharmaceuticals B especially
when they affect sales prices in other states, effectively extending the price controls beyond the State=s borders B can discourage the
investments fueling the medical advances that Americans have grown to expect. Government and private sector studies have found that
pharmaceutical price controls can inhibit the development of new drugs,19 suggesting that price controls can have high costs for people who
need better treatment alternatives. Perhaps the most important aspect of the District Court=s PhRMA decision is that its preemption ruling
connects these policy concerns with a legal barrier to State-enacted pharmaceutical price controls: because federal patent laws are designed to
reward and encourage pharmaceutical innovation, States may not thwart that goal by reducing the rewards for innovation. Yet the political and
budgetary pressures for individual States to Ado something@ about high drug prices cannot be discounted. The PhRMA case suggests that
States can go too far in mandating discounts on patented medicines; at some point, constitutional limits place a check on State laws that would
confer short-term benefits on the State and its residents at the expense of longer-term advances in medicine.

States aren’t effective – zero policing and no accountability


Bump 17 Philip Bump is a correspondent for The Post based in New York City, March 17th, “Why
mandatory vaccinations are critical, visualized”,
https://www.washingtonpost.com/news/politics/wp/2017/03/17/why-mandatory-vaccinations-are-
critical-visualized/?utm_term=.e23feeace704 //DJ

The mission of the federal Department of Health and Human Services is a simple one: “to enhance and
protect the health and well-being of all Americans.” One of the most effective ways to protect the
health of Americans has proven to be vaccinations against infectious diseases. Before the introduction
of the polio vaccine in the mid-1950s, tens of thousands of people were afflicted. In 1952, nearly 3,200
people died. By 1960, there were a few hundred cases, and 90 deaths. These days, there are usually no
reported cases in a year. Another example. For the first five years of the 1940s, there were a million
cases of whooping cough. When a vaccine was introduced at the end of that decade, the number of
cases fell to 15,000 by 1960 — and 1,700 by 1980. But then the number of cases started to go back up,
as immunization rates fell. Why? In part because a British researcher fraudulently linked vaccines to
autism in 1998, a claim that was later retracted. But the idea took hold, spooking parents and causing
immunization rates to drop. During a town hall on CNN this week, HHS Secretary Tom Price was asked if
he thought that immunizations against infectious diseases should be mandatory. His answer? It’s up to
the states. “I believe it’s a perfectly appropriate role for the government — this happens by and large at
the state government level, because they’re the ones that have the public health responsibility — to
determine whether or not immunizations are required for a community population,” Price said,
“whether it’s growing kids or the like or whether there’s an outbreak of a particular infectious disease,
whether or not an immunization ought to be required or be able to be utilized.” While states are already
in charge of immunization policy — and they require certain vaccines — Price’s less-than-rousing
endorsement of mandatory immunization threatens his organization’s mission. The reason? “Herd
immunity.” Immunizations protect individuals from becoming sick, sure, but if you immunize enough of
the population, you can prevent rampant outbreaks from getting a toehold in the first place. We can
illustrate this easily, using this animated image as inspiration. Adjust the immunization rates on the
chart below and see what happens when you introduce a sick person into the population. (For those
curious, in our simulation an unvaccinated person stands a 50 percent chance of becoming sick if they’re
adjacent to an ill person.)Part of the problem with relying on states to police themselves without
national guidance is that if a state decided to drop the immunization requirement, things can get bleak
in a hurry. You probably notice the “different vaccination rates” toggle above. If the population on the
right has lower vaccination rates than the one on the left, an outbreak can originate in that right state
and spread over to the left easily. If vaccination rates were equally high on both sides, that’s much less
of an issue.

States CP will get rolled back by the Supreme Court - 50 states fiat doesn’t cover
federal government action
Horowitz 11 Ben is a graduate of American University Washington College of Law, “A SHOT IN THE
ARM: WHAT A MODERN APPROACH TO JACOBSON V. MASSACHUSETTS MEANS FOR MANDATORY
VACCINATIONS DURING A PUBLIC HEALTH EMERGENCY”,
http://digitalcommons.wcl.american.edu/cgi/viewcontent.cgi?article=1619&context=aulr //DJ

There is fertile ground for a challenge of a vaccination mandate to reach the Supreme Court. As it stands
now, during a full-scale infectious disease epidemic, an individual in Minnesota may refuse vaccination
without providing any explanation.290 On the other hand, before such an epidemic in Arizona, the
governor could prematurely declare a state of emergency and immediately order law enforcement
officials to compel vaccinations due to inadequate oversight.291 With such disparity among the states,
as well as the recent H1N1 outbreak, growing concerns over the spread of infectious disease, and an
anti-vaccination movement strengthened by today’s information age, it is only a matter of time before
the Supreme Court is confronted with a challenge to a vaccination mandate. Considering evolution in
constitutional jurisprudence, the right to refuse vaccination must be regarded as a fundamental right
demanding strict scrutiny.292 A properly crafted statute, however, can survive such scrutiny when
employed during a public health emergency.293 While the last two decades have seen significant
progress in health law—particularly evolution in the realm of bodily integrity and refusal of medical
treatment—courts continue to follow century-old doctrines that are incompatible with these
developments.294 By synthesizing the doctrines and narrowing Jacobson accordingly, the Supreme
Court can provide clarity to lower courts,295 create an intelligible standard for legislatures to follow,
empower state governments so they are more equipped to deal with the spread of infectious disease,
and require procedures to protect civil liberties and personal autonomy from abuses of power.
2AC AT: Non-Mandate CP
Convincing anti-vaxxers is useless – vaccination needs to become a federally
guaranteed right to protect all children
Danzinger and Diamond 16 Dr. Phoebe Danziger and Dr. Rebekah Diamond are resident physician
sin pediatrics, July 25th, “The Vaccination Double Standard”,
http://www.slate.com/articles/health_and_science/medical_examiner/2016/07/vaccination_should_be
_mandatory_but_it_isn_t.html //DJ

The rise of the anti-vaccination movement and the subsequent return of deadly and debilitating
diseases like measles, whooping cough, and meningitis, is old news. The questions that have been raised
about vaccine safety, efficacy, and necessity have already been asked and answered. The science is
sound, and the immense benefits, accompanied by minimal and well-described risks, have been
demonstrated. As scientists, the medical community has tried valiantly to understand through research
what underlies vaccine hesitancy and refusal, and to design evidence-based interventions and strategies
to resolve it. This has only yielded meek guidelines with unmemorable acronyms and mnemonics on
how to discuss the topic with parents. We have tried campaigns designed to incite fear. We have
disseminated cold hard numbers and frightening, real statistics on infant death. We have tried fun,
relatable analogies, like the fact that there are more antigens—the foreign triggers that stimulate the
body to make protective antibodies—on a single doorknob than there are in today’s entire childhood
vaccine series combined. The most striking finding from a review of the past decade of pro-vaccination
efforts is that nothing has been proven to be more than marginally effective. These well-meaning
studies and initiatives have remained too far removed from the issues at the core of this public health
crisis, and as a result, have produced little actionable insight. We simply do not know how to make
people who are against vaccinations come around to trust and accept the science behind them. And yet,
our current system asks physicians to accept vaccine refusal with impunity because it is a matter of
personal belief. As doctors, we are asked to abandon both our duty to our individual patients, and our
collective responsibility to protect and promote the health of all children irrespective of their parents’
beliefs, skin color, or bank accounts. It is time to acknowledge that we do not know how to bridge the
gap between doctors and vaccine-hesitant parents. Instead of spinning our wheels producing ineffectual
research, the time has come to call vaccine refusal by another name that more accurately sums it up:
medical neglect. We can continue our scholarly inquiry to find more effective ways for convincing
parents that vaccines are worthwhile, but it is time to declare, unequivocally, that vaccination is a
human right no child should be denied. The roots of the anti-vaccination movement are deep and
multifaceted. There is mistrust of the medical establishment and its historically unseemly ties with large
industry. There is awareness of the long history of unethical conduct in both scientific research and
everyday medical practice, which has led often to the exploitation of vulnerable populations. There is,
above all, a profound discontent with the current medical and cultural landscape, marked by over-
medicalization of normal processes; nonholistic care fixated on signs and syndromes rather than whole
people shaped by their social, emotional, and physical environments; a national food system that relies
on the industrial and heavily processed; and broad social and economic policies that fail to support
children, families, and communities. Out of the distrust and discontent has emerged the concept of
patient-centered care, with patient autonomy now representing a fundamental tenet of the practice of
medicine. This is good in theory but risky in practice: At its best, patient-centered care leads to shared
and noncoercive decision-making that prioritizes patient values. But at its worst, we see movements like
the anti-vaccination crusade flourish, arising from a disjointed but seductive compilation of anti-
intellectualism, pseudoscience, and unabashed individualism. The anti-vaccination movement is
spearheaded by the privileged, who rally behind cries of injustice, exploitation, and autonomy. When,
ironically, they are the very people who have been protected from these inequities, which continue to
disproportionately affect the poor, disadvantaged, and otherwise vulnerable. This has dovetailed with
an increasing societal worship of the natural, helped along by the advent of big nature as practitioners
and entrepreneurs exploit fears and identity politics—with profitable results. As a society, we have
decided that parents are the best default surrogate decision-makers for their children. But we have also
decided there is a limit to what parents can choose. Parents must use correct car seats and seat belts for
their children; they must care for them in safe homes and provide sufficient food; they must also follow
basic medical standards for their children’s health. Thus, there is ample precedent for removing the
decision-making capacity from parents who are determined not to act in their child’s best interest. Take,
for instance, the 2009 case of this child with leukemia who was successfully treated with chemotherapy
on court order against her parents’ wishes, because they believed in “natural” treatment for cancer. And
yet, unlike any other aspect of pediatric medicine and child safety, if a parent explains that they have a
personal objection to vaccination, they are allowed to deny their children proper care. It is true that
some promising laws have been passed, such as California’s SB 277, which eliminates personal belief
exemptions. But even these lauded policies have significant loopholes and pitfalls. SB 277 targets only
the vaccines required for school entry and not infant immunizations; children who are homeschooled
are exempt; and there is still the possibility of abuse of medical exemptions. Nationwide, such strong
and enforceable policies are the exception, rather than the rule, and are politically unviable in other
regions of the country. Those who refuse vaccines represent a privileged segment of society, making it
easier for us to turn a blind eye as part of the systemic racism and classism still deeply embedded in
modern medicine. We have spent hours explaining to CPS case-workers that it is impossible for the
homeless parents of a critically ill infant to simultaneously attend medical rounds, to participate in
medical decision-making for their child, and apply for public housing and employment. Then we turn
around and treat a purposefully un-immunized child for a serious brain infection caused by vaccine-
preventable bacterium—requiring weeks of hospitalization with intravenous antibiotics—and watch his
mother continue to refuse vaccines for him or his siblings, and we can’t do anything about it. There is
simply no reason vaccinations should be treated differently than any other form of medical care, and
they must be protected within the same framework that has been created for child protection and
against medical neglect. There are many ethically gray areas of medicine, but this is not one. Our laws
must unambiguously and without loopholes reflect this, and there cannot be conflicting standards of
child protection based on race, wealth, and education. By continuing to allow exceptions, we are fueling
the misconception that vaccinations are an option, a choice, a subjective topic about which people can
have different opinions that ought to be respected, when in fact all of the data proves they are not.
Enacting a policy that is consistent with the science would provide clarity for the parents—the majority
of whom are loving caretakers trying to do the right thing. We are failing our society by creating unequal
standards of parenting, and worse, we are failing our children by not protecting their right to be
vaccinated against deadly, preventable diseases. Competent parenting must include fully immunizing all
children according to the medical standard of care.
2AC AT: Airplanes CP
Doesn’t work --- people get fake documents
PAUL OFFIT 6/30/17 --- Pediatrician specializing in infectious diseases and an expert on vaccines, immunology, and
virology. Co-inventor of a rotavirus vaccine. Offit is the Maurice R. Hilleman Professor of Vaccinology, professor of Pediatrics at
the Perelman School of Medicine at the University of Pennsylvania, chief of the Division of Infectious Diseases, and the director
of the Vaccine Education Center at The Children's Hospital of Philadelphia. Former member of the Centers for Disease Control
and Prevention (CDC) Advisory Committee on Immunization Practices. Offit is a board member of Every Child by Two and a
founding board member of the Autism Science Foundation (ASF). Pandora’s Lab is his ninth book. (“Interview of Paul Offit!”,
Paul Offit, June 30, 2017, Interview with Chirag Jain, Transcribed by Chirag Jain – chiragjain2000@hotmail.com,
https://sites.google.com/a/icstudents.org/debateinterviews/)//chiragjain

Paul Offit: I think first of all this makes no sense --- so like philosophy, really? Really? So like someone just says it's better not to get a vaccine than to get one, i mean
some people call them personal belief exemptions? Vaccines aren’t a belief system, they’re an evidence-based system. Religion is a belief system, which brings us to
religious exemptions. I think that a choice to put your child in unnecessary risk is a profoundly unreligious thing to do, I think that to put children who your children
come in contact with at an unnecessary risk is an unreligious thing to do. Religion teaches us to care about families, to care about our neighbors, so I don’t see this
as a religious thing. So call it what it is. Which is that I’m scared of vaccines I read a lot of scary stuff on the internet, I think that Jenny McCarthy knows what she’s
talking about, so I’m not gonna get vaccines. That’s really what it is. I think we just window-dress it with words like philosophy and religion. Chirag: So I read an

article from 2016 that proposes a policy about how airlines could require passengers to get
vaccinated, and that would allow most of the rich white upper class that get’s exemptions to get vaccinated for purposes of family travel or business travel.
Do you think that would be a viable idea so it avoids backlash and Congress and stuff like that? Paul Offit: The point
being that most people that choose to exempt are people that fly? Chirag: Yes Paul Offit : I think that it’s interesting, I think it would be

very hard to workout in real life. How are you documenting whether people have vaccines, I’m sure
people would find doctors that would probably be willing to say, that they got vaccines . That’s already
happening in California, where you can buy medical exemptions. You just have to go to the right doctor and for a certain amount of money they’ll write you an
exemption. So it kind of creates a black market for those exemptions, but yeah, I think it would be an interesting idea.
2AC AT: Religious Exemption PIC
Religious exemptions are key to effect the vaccination rates --- most HPV rejections
are religious --- PIC fails
RACHEL SHELTON ET. AL 2013 --- Rachel Shelton, ScD, MPH is a social and behavioral researcher with expertise in cancer
prevention and control and health disparities. Dr. Shelton has training in social epidemiology, community-based participatory
research, and intervention development, and uses both quantitative and qualitative research methods. (“HPV Vaccine Decision-
Making and Acceptance: Does Religion Play a Role?”, Rachel Shelton, Anna Snaverly, Maria De Jesus, Megan Othus, Springer
JSTOR, 1120-1130, December 2013)//chiragjain

Introduction Human papillomavirus (HPV) is the most common sexually transmitted infection in the US and can lead to the development of genital warts and
cervical cancer (Dunne et al. 2007). In 2006, the US Food and Drug Administration (FDA) approved a quadrivalent vaccine for HPV for use among females ages 9-26.
This vaccine is protective against some types of HPV (types 6, 11, 16, 18) that are related to cervical cancer and genital warts. Another vaccine has also been
recently approved to prevent cervical cancer among females ages 10-25. As vaccination should ideally occur prior to the onset of sexual activity, The Advisory
Committee for Immunization Practices (ACIP) recommends routine HPV vaccination for girls 11-12 years of age, with 'catch-up' vaccination for females 13-26 years
of age. Uptake of the HPV vaccine has been suboptimal. The Centers for Disease Control and Prevention reported that as of 2008,
37.2% of teenage girls had initiated vaccination but only 17.9% had completed the full three-dose series
(Centers for Disease Control and Prevention [CDC] 2008). Widespread uptake of the vaccine will require understanding

factors that influence parental vaccine acceptance and decisions. In our prior analyses, we found that attitudes and
subjective norms toward the HPV vaccine were strongly associated with parental decision-making and
acceptance of the vaccine (Allen et al. 2010). In this manuscript, we examine the association between religion and
parental vaccine decisions, specific vaccine beliefs, and religious norms related to HPV vaccination. There
can be no doubt that religion is an important sociocultural influence in the US (Gallup Poll 2008; Benjamins 2006a, b). The 2008

American Religious Identification Study (ARIS) found that four out of five US adults identify with a specific religious

denomination, with most self-identifying as Catholic (~25%) or 'Other Christian' ( — 50%) (e.g., Protestant) (Kosmin and Keysar 2009).
The majority of US adults report that their religion is a 'very important' part of their lives (56%) and
are members of a church or synagogue (63%) (Gallup Poll 2008). In addition, 31% of US adults report attending
religious services at least once a week, with 11% attending almost every week, and 13% attending about once a month (Gallup Poll 2008). In
addition to general influences on behavior, religion has also been found to be influential in shaping vaccine decisions .

For example, parents who file vaccine exemptions on the basis of religious or personal beliefs are able to

delay or refuse childhood immunizations that are mandated for school entry (Etkind et al. 1992; Salmon et al. 1999; Kulig
et al. 2002; Kennedy and Gust 2008). Currently, 48 out of 50 states allow some form of religious exemption for

mandatory vaccinations (Salmon et al. 2005; Omer et al. 2006). Estimates of the prevalence of nonmedical
exemptions are low (~ 1-2%), though rates are as high as 15-18% in some geographic communities or clusters (Omer et al. 2006, 2008). Though not well-
studied, religion may play an even greater role when it comes to influencing vaccine decision-making for

sexually transmitted infections like HPV than for other vaccines. To our knowledge, only one large study among a
random sample of US households has been conducted, with results suggesting that religious
denomination and attendance at religious services are associated with HPV vaccine acceptance
(Constantine and Jerman 2007). Other studies have not found these associations, though several of these studies were conducted outside of the US and, therefore,
may not be comparable (Lenselink et al. 2008; Brabin et al. 2006), and some used racially/ethnically homogeneous or convenience samples (Lenselink et al. 2008;
Bernât et al. 2009). Given these mixed findings, more research is needed to better understand whether religion plays a role in HPV vaccine decision-making.
There are several mechanisms by which religion may influence HPV vaccine decisions. We considered constructs
central to the theory of reasoned action (TRA), including beliefs and subjective norms (Ajzen and Fishbein 1980). Religious practices and

teachings may influence beliefs about the acceptability of certain health behaviors (Benjamins and Brown 2004;
Schiller and Levin 1988), including receipt of the HPV vaccine. For example, some denominations believe in abstaining

from sex until marriage. Because HPV is a sexually transmitted infection, parents may perceive that
vaccinating their daughter is unnecessary, morally inappropriate, or condones sexual activity. More
frequent attendance at religious services may result in stronger religious beliefs or stricter adherence to their
denominational beliefs and may increase parental exposure to subjective norms (pertaining here to religious norms or the social influence of one's place of worship)
that may influence acceptance of HPV vaccination. To
better understand the role of religion in influencing HPV vaccine
acceptance, we conducted a cross-sectional investigation among a national sample of white, Black, and
Hispanic parents to explore associations between religion and vaccine decisions, beliefs, and norms. Specifically, we examined (1) religious denomination
(the specific religious subgroup with whom a person identifies or is affiliated with, e.g., Catholic, Protestant), and (2) frequency of attendance at religious services
(an indicator of religious involvement) (Benjamin 2006) Methods Recruitment and Setting Data were collected in collaboration with Knowledge Networks, Inc. (KN)
(Menlo Park, CA), a national research company that has expertise in Internet-based surveys. Using multistage probability sampling and random digit dialing
methodology, KN recruits a large, nationally representative panel that serves as potential research par ticipants. A number of research studies have been published
using Knowledge Network panels and methodology (Harris et al. 2009; Baker et al 2003). All panel members are provided with free Internet service and a WebTV as
needed to facilitate study participation. Individuals
eligible to participate; (1) self-identified as Black, Hispanic, or white
and (2) had at least one daughter(s) between the ages of 9-17 for whom they were the primary caregiver (referred to in this
paper as parents). Parents with only sons were not eligible because while clinical trials were underway, the vaccine was not

recommended for boys or men when the study was conducted. A random sample of potentially eligible panelists was identified
and invited to participate in the online survey. Interested participants then reviewed the online consent form and completed a brief screener to assess eligibility.
Nonrespondents were sent electronic mail reminders and up to three phone calls to encourage participation. Nonwhite parents were oversampled in an effort to
achieve approximate balance across racial/ethnic groups. A total of 563 out of 836 potential participants consented to participate (mean across racial/ethnic groups
= 67%; 74% whites, 70% Hispanics, 61% Blacks). Among those who consented, 85% were still eligible after completing the screener (n = 476). Details on the sampling
schema and recruitment procedures are provided elsewhere (Allen et al. 2010) Data Collection and Measures Data collection took place between September 2007
and January 2008 through an online self-administered survey. The protocol was approved by the Institutional Review Board at the Harvard School of Public Health,
Boston, Massachusetts. All parents who participated in the survey provided demographic information including race, ethnicity, age, income, education level, and
gender. Religious Factors To assess religious denomination, all parents were asked the open-ended question, 'What is your religion?' For these analyses, responses
were grouped as: (1) Protestant; (2) Catholic; (3) Other Christian; (4) non-affiliated. Religions not classified (5% of parents) were not included in the analyses
because of very small sample sizes (e.g., Buddhists, Muslims). The second question asked about frequency of attendance at religious services (religious attendance).
Participants were asked: 'How often do you attend religious services?' (rarely or never; few times a year; 1-3 times a month; once a week; more than once a week).
Similar to prior studies and based on the distribution of responses (Whooley et al. 2002), participants were categorized in tertiles: (1) 'does not attend': rarely/never
attend; (2) 'moderate attendance': attends a few times a year or 1-3 times a month; (3) 'frequent attendance': attends at least once a week or more than once a
week. Vaccine Decision Parents were asked whether they had ever heard of HPV vaccine before taking the survey and whether their daughter(s) had received three
doses of the vaccine. Among those whose daughter(s) had not received three doses of the HPV vaccine, participants were asked: 'How likely is it that you will try to
get the HPV vaccine for your daughter in the next 12 months?' Based on these questions, responses were categorized as: (1) 'decided against'; (2) 'undecided'; (3)
'intend to vaccinate'; (4) 'already vaccinated'. Beliefs About the HPV Vaccine We first asked at what age vaccination against HPV should start (response options:
earlier than age 9; 9-10; 11-12; 13-14; 15-16; 17-18; 19 or older; or never) (Brabin et al. 2006). We also assessed parental beliefs about the appropriate recipients of
the vaccine (all girls; all boys; all boys and girls; anyone who is sexually active; or no one), adapted from a prior measure (Kahn et al. 2003). Religious Norms
Participants were first asked how much their place of worship would approve or disapprove of their daughter getting the HPV vaccine (definitely would approve;
probably would approve; I don't know; probably would not approve; definitely would not approve; not applicable). Participants were then asked how much the
opinion of their place of worship influenced their decision about getting their daughter vaccinated against HPV (very much; somewhat; not very much; not at all; not
applicable). In accordance with TRA, scores on these items were multiplied, with higher scores indicating stronger norms. Statistical Analysis Parents were the unit
of recruitment (weighted and unweighted, n = 476). Ninety-two parents had more than one daughter in the sample. Of these, 22 had made different decisions
regarding vaccination for different daughters. To account for this variability clustered with parent, daughters were the unit of analysis (unweighted, n = 581;
weighted, n = 579). Post-stratification (or 'case') weights, which correct the sample distribution to reflect the US population according to the 2008 Current
Population Survey, were applied for age, education, census region, metropolitan residence, and Internet access (y/n). Taylor series expansion was used to calculate
standard errors, required due to the clustering of survey responses within parent. A sensitivity analysis removing fathers (unweighted, n = 47; weighted, n = 36) did
not change results, so they were retained. Descriptive statistics were used to characterize sociodemographic characteristics of the sample. The outcome 'vaccine
decision' had four categories; therefore, bivariate and multivariate analyses were computed using multinomial logistic regression. Bivariate and multivariate linear
regression was used to assess relationships between religious norms (modeled as outcome) with religious denomination and religious attendance. The Rao Scott
chi-squared statistic was computed to assess associations between beliefs about the HPV vaccine (outcome) in relation to religious denomination and religious
attendance. Each analysis was conducted using all available (nonmissing) data so sample sizes may be different for each analysis. Analyses were conducted using
SAS statistical software (SAS version 9.1) in 2009-2010. Due to small cell counts, adjusted relationships were not available for all variables. All reported N and %
values reflect the probability-reweighted sample unless otherwise noted. Results Sociodemographic and religious characteristics of the sample of parents are
provided in Table 1. The majority of respondents (92.4%) were female. Thirteen parents had three daughters in the sample, 79 parents had two daughters iri the
sample, and 384 parents had one daughter in the sample. Religious Denomination Bivariate relationship between religious denomination and vaccine decisions is
presented in Table 2. Catholic parents were more likely to have already vaccinated their daughters than to be undecided compared to nonaffiliated parents (OR =
3.34, 95% CI = 1.16, 9.59). This relationship remained significant in multivariate analysis (OR = 3.26, 95% CI = 1.06, 10.06), controlling for race, age, and education
(see Table 3). With respect to beliefs, parental beliefs about preferred age of vaccination varied by religious denomination (Rao-Scott chi-squared P = 0.01, data not
shown). When asked who should receive the vaccine, Protestant parents were more likely to prefer that no one be vaccinated compared to other parents. Other
Christian parents preferred that their daughters be vaccinated at older ages compared to other parents. Catholic parents had more negative religious norms
compared to nonaffiliated parents (P — 0.04, results not shown), on average. This association did not remain significant in multivariate analyses, adjusting for race,
age, and education {P = 0.10, results Religious Attendance Bivariate associations between religious attendance and vaccine
decision are presented in Table 2. Compared to parents who do not attend religious services, parents with
moderate attendance were more likely to have already vaccinated their daughters than be undecided (OR = 3.09,
95% CI = 1.13, 8.43). Parents who reported frequent attendance were more likely to have decided against

vaccination than be undecided (OR = 3.05, 95% CI = 1.41, 6.58). These relationships remained significant in multivariable analyses attendance OR
= 3.07, 95% CI = 1.16, 8.11; frequent attendance OR = 2.92, 95% CI = 1.25, 6.84), adjusting for race, age, and education (see Table 3). Parental beliefs
regarding preferred age of vaccination varied according to religious attendance (Rao-Scott chi-squared P = 0.02, data
not shown). Parents who attended services frequently preferred older ages for vaccination compared to parents who never attend religious services. Parental

beliefs regarding who should be vaccinated also varied by religious attendance (Rao-Scott chi-squared P = 0.02, data
not shown). Parents who frequently attend religious services were more likely to say no one should be vaccinated compared to other parents. Parents who

frequently attended religious services also had more negative religious norms about HPV vaccination,
compared to parents who do not attend services (P = 0.03, data not shown). This association did not remain significant when adjusting for race, age, and education
(P = 0.06, data not shown). Discussion We found that compared with parents who reported no religious affiliation, Catholic parents were more than three times
likely to have vaccinated their daughters (vs. being undecided). Parents from Protestant and Other Christian religious denominations reported more negative beliefs
about HPV vaccination compared to Catholic and nonaffiliated parents. Specifically, Protestant parents were more likely than other
parents to express opposition to HPV vaccination, and Other Christian parents were more likely to prefer that HPV vaccination occurs at
older ages (19 years-!-). These findings are fairly consistent with several prior studies. In one study among

California-based parents, Catholics were more likely to support HPV vaccination, while other Christians,
those reporting no religion, and Born-again or Evangelical Christians were less likely to support vaccination (Constantine and Jerman 2007). In
another large US-based study (n = ~ 1,500), Bernât et al. (2009) found that 'Born-again' Protestants and Catholics had lower levels of HPV vaccine acceptance than
Protestants and Catholics who were not 'Born-again', though this was not significant in adjusted analyses (Barnack et al. 2010). Several
studies have
reported lower HPV vaccine acceptance and more negative attitudes among parents who strongly
identify with religious views that prohibit sex before marriage or adhere to beliefs about monogamy and abstinence (Brabin et al.
2006; Marlow et al. 2009; McCaffery et al. 2003; Katz et al. 2009). Parental concerns that HPV vaccination will contribute to

sexual promiscuity, which is not condoned by most religious traditions, have also been reported (Constantine and Jerman 2007; Marlow et al. 2009a, b).
Taken together, this study contributes to the evidence that religious denomination and beliefs may

influence HPV vaccine acceptance. Moreover, attendance at religious services may affect vaccine decisions. We found that parents who
frequently attended religious services were more likely to have decided against HPV vaccination compared with nonattendees. Parents with frequent attendance at
religious services also held more negative beliefs toward HPV vaccination, including preferring that HPV vaccination occurs at older ages or not at all, compared to
other parents in the sample. Paradoxically, however, our data also suggest that compared with nonattendees, parents with moderate attendance at religious
services were more likely to have already vaccinated their daughters (vs. being undecided).
2AC AT: PICS
Vaccination requires widespread implementation in order to prevent major outbreaks
Vitolo-Haddad 15 CV Vitolo is the Director of Debate at the University of Wisconsin-Madison and a
doctoral student in the Communication Arts department, December 2015, “KAIROTIC ECLIPSES IN
VACCINE LEGISLATION: HOW OVERLAPPING SPHERES OF DISCOURSE CREATE IDEAL PUBLIC POLICY
CLIMATES”,
https://wakespace.lib.wfu.edu/bitstream/handle/10339/57425/Vitolo_wfu_0248M_10824.pdf //DJ

Some anti-vaccine activists consider these mandates extreme because they misunderstand the scope of
each shot administered. Unlike most preventative measures, vaccination works cooperatively.
Individuals get vaccinated not only to protect themselves, but also to protect members of their
communities for whom vaccination is not an option due to physiological constraints such as illness or
age.3 Additionally, vaccines are not universally effective and are subject to human error in production
and administration. The measles vaccine, for example, has an 8% long term failure rate; after 25 yearsx,
8% of those who received a full regimen of measles vaccine will be susceptible to contracting the
measles virus. 4 Susceptibility is due to a combination of primary vi vaccine failure (no immunity
conferred immediately after receiving the vaccine) and secondary vaccine failure (immunity initially
conferred, but diminishes over time). Therefore, in order for vaccination to improve collective disease
response, herd immunity must be established to decrease the number of available hosts for a disease.
The alternative is vulnerable individuals falling victim to preventable disease. Eventually, if vaccination
rates remain high, targeted diseases are unable to spread fast enough to reproduce and, as a result, die
out. When cooperation diminishes—that is, when individuals fail to understand their own vaccination
behaviors in relation to other unprotected, vulnerable people—serious physical and mental health
consequences may impact entire communities.5

Vaccination is only getting worse – the majority of students in some schools are not
being vaccinated
Alexander 15 Lamar Alexander is a US senator, February 10th, “THE REEMERGENCE OF VACCINE-
PREVENTABLE DISEASES: EXPLORING THE PUBLIC HEALTH SUCCESSES AND CHALLENGES”,
https://www.govinfo.gov/content/pkg/CHRG-114shrg93357/html/CHRG-114shrg93357.htm //DJ

Measles used to sicken up to 4 million Americans each year. Many believed that it was an unpreventable
childhood illness. But the introduction of a vaccine in 1963 changed everything. Measles was declared
eliminated, meaning absence of continuous disease transmission for greater than 12 months from the
United States in 2000. Then from 2001 to 2012, the median yearly number of measles cases reported in
all of our country was 60. Today is February 10, 2015. It is the 41st day of the year, and already we have
seen more cases of measles than we would in a typical year. One measles outbreak in Palatine, IL, a
suburb about a half hour from Chicago, has affected at least five babies, all less than 1 year old. Infants
and individuals who are immunocompromised are traditionally protected by what is called herd
immunity, meaning when more than 9 out of 10 of the people around them are vaccinated, so they
don't get sick, and that keeps the babies and others who can't get vaccinated from getting sick. That
herd immunity is incredibly important. Measles can cause life threatening complications in children,
such as pneumonia or swelling of the brain. Our witnesses today will talk more not just about what is
causing this outbreak, but why some parents are choosing not to vaccinate their children. Measles is
only one example. This hearing, which was planned before the measles outbreak, reminds us of the
importance of vaccines. An analysis of immunization rates across 13 States performed by USA Today
found the following: Hundreds of thousands of students attend schools, ranging from small private
academies in New York City to large public elementary schools outside Boston to Native American
reservation schools in Idaho, where vaccination rates have dropped precipitously low, sometimes under
50 percent. California is 1 of the 20 States that allow parents to claim personal belief exemptions from
vaccination requirements. In some areas of Los Angeles, 60 percent to 70 percent of parents at certain
schools have filed a personal belief exemption. In those elementary schools, vaccination rates are as low
as those in Chad or in South Sudan. The purpose of this hearing is to examine what is standing between
healthy children and deadly diseases. It ought to be vaccinations. Too many parents are turning away
from sound science. Sound science is this: Vaccines save lives. They save the lives of the people who are
vaccinated. They protect the lives of the vulnerable around them, like infants and those who are ill.
Vaccines save lives. They protect us from the ravages of awful diseases like polio, which invades the
nervous system and can cause paralysis. I can remember as a child how parents were frightened by the
prospect of polio for their child. I had classmates who lived in iron lungs. Our majority leader, Senator
McConnell, contracted polio as a child. Whooping cough is another example, which causes thick mucus
to accumulate in the airways and can make it difficult for babies to breathe; or diphtheria, a bacterial
infection that affects the mucous membranes of your nose and throat and can, in advanced stages,
damage your heart, kidneys, and nervous system. We have learned that vaccines save lives. They take
deadly, awful, ravaging diseases from horror to history. It is troubling to hear that before we've even
reached Valentine's Day this year, 121 Americans are sick with measles, a disease eliminated in the
United States 15 years ago. It is troubling that a growing number of parents are not following the
recommendations of doctors and public health professionals who have been making those
recommendations for decades. At a time when we are standing on the cusp of medical breakthroughs
never imagined--cutting-edge personalized medicine tailored to an individual's genome, for example--
we find ourselves retreading old ground.
2AC AT: India DA
AT: Link
Vaccines don’t boost the US pharma industry
PAUL OFFIT 6/30/17 --- Pediatrician specializing in infectious diseases and an expert on vaccines, immunology, and
virology. Co-inventor of a rotavirus vaccine. Offit is the Maurice R. Hilleman Professor of Vaccinology, professor of Pediatrics at
the Perelman School of Medicine at the University of Pennsylvania, chief of the Division of Infectious Diseases, and the director
of the Vaccine Education Center at The Children's Hospital of Philadelphia. Former member of the Centers for Disease Control
and Prevention (CDC) Advisory Committee on Immunization Practices. Offit is a board member of Every Child by Two and a
founding board member of the Autism Science Foundation (ASF). Pandora’s Lab is his ninth book. (“Interview of Paul Offit!”,
Paul Offit, June 30, 2017, Interview with Chirag Jain, Transcribed by Chirag Jain – chiragjain2000@hotmail.com,
https://sites.google.com/a/icstudents.org/debateinterviews/)//chiragjain

Chirag: So do
you think that vaccinations considering that they are a new field in the pharmaceutical
industry, would be a big boost to the pharmaceutical industry if they were made mandatory? Paul: No.
Because vaccines are something you give once or a couple times in a lifetime, and that doesn’t
compete with diabetes drugs or psychiatric drugs that are given everyday, I think vaccinations are never
gonna be there, that’s why so few companies make vaccines, only four companies make vaccines for
people in the United States, because there’s so few people.

Indian pharma is already dying in the us- trump, FDA


Siddiqui 17(Zeba Siddiqui is a reporter for Reuters India , 3-17-2017, "Indian drugmakers face squeeze
in U.S. healthcare market," Reuters India, http://in.reuters.com/article/us-india-pharmaceuticals-usa-
idINKBN16O1BH)\\WDB

India's small and medium-sized generic drugmakers say the threat of tougher rules and higher barriers
for outsiders in the U.S. healthcare market will force many to find a niche or focus their expansion
efforts on other countries. India supplies nearly a third of medicines sold in the United States, the
world's largest healthcare market. Cut-price generics sold by India's small- and medium-sized
drugmakers have been critical in bringing down prices there. A more protectionist stance by President
Donald Trump, with the prospect of import tariffs and the U.S. boosting local drug manufacturing, mean
the operating environment for smaller generic players will get worse, executives at Indian companies
said. "If the challenges keep increasing, competition will reduce, and this could actually increase prices
there," said D.G. Shah, secretary general of the Indian Pharmaceutical Association, which represents 20
large Indian drugmakers. J. Jayaseelan, who owns Nuray Chemicals, a maker of drug ingredients, said
many Indian firms are reconsidering, or putting on hold, U.S. expansion plans. Ajanta Pharma (AJPH.NS)
is one such firm. The mid-sized generics drug maker said it had no plans to scale up its U.S. business and
would invest more in Asia and Africa instead. "It's not a major market for us right now ... you've got to
look at the risk-reward ratio," said Rajeev Agarwal, general manager of finance at Ajanta. The risks
comes as U.S. revenue growth for these firms is falling. U.S. revenues for Indian drugmakers rose 15
percent in 2016, half the average annual growth rate of 33 percent between 2011 and 2015, ratings
agency ICRA said. It expects the growth rate to fall further this year. Consolidation among U.S. drugs
distributors and a federal investigation into drug pricing have also reduced the pricing power of
drugsmakers. The U.S. drugs regulator, the Food and Drug Administration, has also banned dozens of
Indian drug factories from supplying the U.S. market following inspections that found inadequate
quality-control practices. Companies have invested significant sums to raise their quality standards.
Firms that want to focus on the United States will have to increase investment in higher-margin niche
therapies, or products requiring specialized manufacturing, said Mitanshu Shah, senior vice president of
finance at Alembic Pharmaceuticals (ALEM.NS). "Smaller companies with a few regular products and no
long-term vision for the United States won't last," Shah said. Even with a vision, the U.S. market is just
getting tougher for companies to operate in, said Vijay Ramanavarapu, the head of the U.S. business of
drugmaker Granules India (GRAN.NS). "You have to fight twice as hard today," Ramanavarapu said. "It
will be harder for new entrants to enter the U.S. market unless they are able to find niche areas."

Trump and Scandals already thump Indian drug industry


Rajagopal 17(DIVYA RAJAGOPAL is an editor at the India Economic Times, 2/18/2017, “Indian pharma
companies still wary of US drug market”, India Times,
http://economictimes.indiatimes.com/industry/healthcare/biotech/pharmaceuticals/indian-pharma-
companies-chary-of-us-drug-market-despite-donald-trumps-cheaper-drug-push-is-good-for-
india/articleshow/57226720.cms)

In 2013 when Ranbaxy, one of India’s oldest drug companies, agreed to the US Department of Justice’s
(DOJ’s) charge of wrongdoing in its manufacturing process, a $500 million fine seemed like a small price
to pay for what was coming. Ranbaxy became a stick for global competitors of Indian drug companies to
beat the industry with the issue of "poor quality". It seemed that Indian companies would immediately
be hit by Ranbaxy’s actions; however, that tide had seemed to have passed, with large Indian drug
makers speeding ahead with their growth in US markets because of the free market policy towards price
control. Cut to 2015, when Indian drug makers’ growth hit a speed bump because of manufacturing
issues. While a couple of India’s biggest pharma firms have their factories under import alert by the US
Food & Drug Administration (USFDA), since November last year, a handful of other companies were put
under investigation by the DOJ over alleged cartelisation. And, with the Donald Trump administration
now in the driving seat, Indian pharma has a new problem: while one view is that the US president’s
determination to reduce drug prices will benefit Indian pharma’s thrust on affordable generics, it is
Trump’s clamour to Make in America that has local drug makers spooked. In his first press conference
after taking charge as the president, Trump lashed out at the pharma industry in the US, which sent
stocks of Indian drug companies in a downward spiral the very next day on Dalal Street, as the possibility
of harsh pricing pressure in the most profitable market loomed. "Our drug industry has been disastrous.
They are leaving left and right. They supply our drugs, but they don’t make them here, to a large extent.
And the other thing we have to do is create new bidding procedures for the drug industry because
they’re getting away with murder," said Trump in January. Trump added that even though the US is the
largest buyer of drugs in the world, the country does not bid properly and it will soon start bidding in a
way that would help it save billions of dollars over time. Trump’s protectionist statements are the last
thing that Indian drug makers need. They are dealing with a spate of regulatory charges from the USFDA
that has wiped out nearly Rs 15 billion worth of market cap of the top five drug companies over the past
one year. The companies themselves, though not directly talking about the Trump effect, are preparing
for a muted year ahead. We continue to have challenges in base and customer business. The market
share in the US is linked to your getting new business. So we have to split into market share and market
supply," said Dilip Shanghvi, managing director, Sun Pharma, India’s largest drug maker. Sun Pharma,
which gets nearly 45 per cent of its revenue from the US, posted a 5 per cent drop in its net profit to Rs
1,472 crore in the quarter ended December 2016. The US market sales registered a 4 per cent growth to
$507 million in that period. "There are three key policies that have been mentioned in speeches and
campaign documents: Removing restrictions on sale of pharmaceutical drugs manufactured outside the
US Repealing Affordable Care Act (ACA). And allowing Medicare to negotiate pricing. Of the three, while
the first is a positive for generics, the last two will be negative for them. We believe the key focus will be
on repealing ACA," wrote analysts from brokerage firm Jefferies in their impact report on Trump and
Indian pharma. Even Dr Reddy’s had a similar outlook. "We continue to face headwinds for our US
business, delay in approvals of major launches coupled with erosion of our base business," said Abhijit
Mukherjee, chief operating officer of Dr Reddy’s in the company’s earning calls in early February.
2AC AT: Autism DA
Vaccines don’t cause autism ---- there’s no link
Estes 6/23 --- PhD, is the director of the UW Autism Center, committed to clinical services, research, and training to improve the lives of individuals with
autism spectrum disorders and their families across the lifespan. She holds the Susan and Richard Fade Endowed Chair, is a Research Professor in the Department of
Speech and Hearing Sciences, and an Adjunct Research Professor in the Department of Psychology at the University of Washington. She is also a licensed
psychologist in the state of Washington. (Annette, “Vaccines do not cause autism, they save lives,” 6/23/17,
http://www.seattletimes.com/author/annette-estes/)//ernst

THE hope, love and anxiety that welcomes a baby into the world is a familiar story experienced by every generation. Our grandparents may
have feared their baby would die of a childhood disease that is now preventable. Mothers and fathers today have a particularly modern fear
that their parents probably never considered: Will my baby have autism? Current estimates are that the
parents of one in 68 infants
will discover, in the first few years of life, differences in their child’s development that signify the early signs of
autism spectrum disorder (ASD). The symptoms — challenges with communication, poor social engagement with people, unusual
interests or repetitive movements — emerge at the same time new parents are learning to navigate the unfamiliar territory of caring for a
young child. Parents may feel overwhelmed, sifting through piles of contradictory advice to ensure they have the most up-to-date information
available to raise a healthy, happy child. However, some
decisions a new parent faces should not be difficult: • We
know beyond a doubt that immunizations prevent serious, even fatal, childhood illnesses. • There is no
scientific evidence that immunizations cause autism. Measles, a serious disease that can cause hearing loss and swelling of
the brain that leads to intellectual disability, is still a primary cause of vaccine-preventable death for children in many parts of the world. Before
1963, measles used to affect 3 million to 4 million U.S. children every year. By the year 2000, measles was considered eradicated in our country
— a true public-health victory. Measles outbreaks are recurring throughout the U.S. This year the Centers for
Disease Control and Prevention reported the highest number of mumps cases in 10 years. More than
400 people in Washington state contracted the illness, including an outbreak among University of Washington students. A
similar story can be told for mumps, polio and a host of other diseases that used to be common, used to
cause lifelong disability and even death, and were largely eliminated in the United States due to childhood immunizations. But as
memories of these illnesses fade, along with the fear they caused new parents, this victory is at risk as
some parents elect not to immunize their babies. To be clear, there is no current scientific debate about
whether vaccines cause autism. Study after high-quality study — carefully conducted and peer-reviewed
— has provided overwhelming scientific evidence that there is no link between childhood
immunizations and autism. However, misinformation about a purported link continues to circulate. A Somali immigrant
community in Minnesota fell prey to this misinformation, and many of these families refused the
vaccine. This spring, the community was hit by the largest outbreak of measles in 30 years that mostly affected unvaccinated children, many
of whom had to be hospitalized. Minnesota health officials link this outbreak to decreasing immunization rates,
from 92 percent of the Somali community in 2004 to about 42 percent today. And what contributed to
this decline is a fear among new parents that vaccines cause autism. Nearly 20 years ago, British
researchers linked the MMR vaccine to autism in a study, since widely discredited and attributed to false
data. The question itself — “Do immunizations cause autism?” — was well suited to be addressed by science. The question of a possible link
mobilized significant public resources to fund scientific studies. The question has been put to rest — at least as far as scientists are concerned.

Nope you’re wrong --- Wakefield had a terrible experiment


Chemerinsky and Goodwin 16(Erwin Chemerinsky is Dean and Distinguished Professor, and
Raymond Pryke Professor of First Amendment Law, University of California, Irvine School of Law.
Michele Goodwin is Chancellor's Professor of Law and Director, Center for Biotechnology and Global
Health Policy, University of California, Irvine School of Law, 2016, “Northwestern University Law
Review”, Northwestern University Law Review)\\WDB

Yet,the fear of autism remains deeply entrenched among those apprehensive about vaccination. n85 Dr.
Wakefield's reported link between vaccinations and a greater risk of autism n86 continues to influence
some parents' decisionmaking, despite The Lancet's retraction and strong repudiation: "It has become clear that several
elements ... are incorrect, contrary to the findings of an earlier investigation." n87 The author of the
study has since had his medical license revoked. n88 Many studies conducted in countries all over the
world debunk Dr. Wakefield's finding because none has found any link between vaccinations and autism
or anything other than preventing the spread of communicable disease. n89 Professor Offit notes that in response to
the Wakefield paper, six large epidemiological research studies conducted by academic and public health communities all found the vaccines,
and specifically thimerosal in them (which Wakefield had pointed to as the causal agent), "didn't cause autism." n90
2AC AT: Federalism DA
Link non unique --- federal government has been taking over health policy for decades
MICHAEL SPARER ET. AL 2011 --- PhD, JD, studies and writes about the politics of health care, with a particular emphasis on the
health insurance and health delivery systems for low-income populations, (“INCHING TOWARD INCREMENTALISM: FEDERALISM, DEVOLUTION,
AND HEALTH POLICY IN THE UNITED STATES AND THE UNITED KINGDOM”, Michael Sparer, 2011, Journal of Health, Politics, and Law,
Proquest)//chiragjain

The Roots of U.S. Federalism For


the framers of the U.S. Constitution, few issues were more important than that of
federalism. The Constitutional Convention itself was a product of dissatisfaction with the Articles of Confederation, under which a weak and nearly bankrupt
federal government watched helplessly as the individual states formed their own navies, issued their own currencies, ignored their fiscal obligations to the national
government, skirmished over boundaries, imposed import tariffs on their neighbors, and seemed on the brink of internal revolt. The goal of the framers was to form
a national union that would hold the fractured pieces together, hardly an easy task given the deep-seated distrust between the larger and the smaller states, and
between the slave-owning and antislavery states. The framers’ task was made even more difficult by differing views over the powers to be delegated to the new
central government. At one extreme were the antifederalists, the advocates for states’ rights, who boycotted the convention and argued that the new constitution
was nothing but a convenient excuse for the imposition of a new monarchy. Although these fears were exaggerated, Alexander Hamilton, James Wilson, and others
were indeed pushing for a strong federal government, fueled by a powerful executive branch. These aggressive nationalists were challenged by Journal of Health
Politics, Policy and Law Published by Duke University Press Sparer, France, and Clinton ■ Inching toward Incrementalism 37 those (such as James Madison) who
lobbied for a large but relatively weak national government, with limited powers, and for institutional barriers (such as the separation of powers) to national
government action. Rather than resolve these differences definitively, the Constitution provides support for each view, leaving to each political generation the task
of engaging in an ongoing federalism debate: national powers are listed and limited (with powers not explicitly mentioned being reserved to the states), but
national law is supreme and federal lawmakers are entitled to enact rules “necessary and proper” to the carrying out of the listed tasks. Beginning in the early
1800s, the Jeffersonian view dominated and limited government, and states’ rights became ingrained as key components of U.S. political culture. Thomas
Jefferson’s administration reduced taxes, eliminated much of the federal navy, and cut the size of the federal bureaucracy. The outcome was an era of dual
federalism, in which federal and state officials operated relatively autonomously, with federal officials primarily concerned with westward expansion, foreign
relations, and national defense, and state policy makers focused on economic development, education, and infrastructure. Where did health and welfare
policy fit in this world of dual federalism? It was barely on the agenda. The federal government did build some hospitals for soldiers and sailors,
and provided small pensions to war veterans. More generally, however, it acted as if services for the poor were outside its

constitutional ambit. The states, in contrast, clearly had the constitutional authority to act, but they typically preferred to delegate to local communities
the task of caring for their own, essentially adopting as a convenient philosophy the English Poor Law tradition. According to this, aid to the poor and

the needy was a local responsibility. Local governments in turn limited their obligations by targeting aid primarily to the so-called deserving
poor, those outside the labor force through no fault of their own (such as the aged, widowed, and disabled). Local initiatives varied

dramatically, with some communities setting up enforced apprenticeship programs for poverty-stricken
children, others creating almshouses (initially for the mentally ill) and public hospitals for the poor, and
still others doing remarkably little at all. During the early 1930s, however, as the nation (and its newly elected president, Franklin Roosevelt)
grappled with the catastrophic economic depression, the issue of what each level of government could (and should) do became critically important. The
conventional wisdom was that local and state governments, aided by the private sector, should take the lead. This was Herbert Hoover’s position at the time of the
stock market crash Journal of Health Politics, Policy and Law Published by Duke University Press 38 Journal of Health Politics, Policy and Law and during the rest of
his presidency. Roosevelt, however, had campaigned on an entirely different platform, insisting that only an empowered and energized federal government could
lift the nation out of its crisis. Local governments presumably were overwhelmed by the needs of the poor and also often unwilling to allocate fairly their limited
resources, especially in those cities dominated by political machines that had long distributed benefits based on party loyalty rather than demonstrated need.
States, too, lacked the resources and the political will to solve the vast set of economic and social welfare problems, especially in the South where most politicians
worried that public assistance might undermine the region’s legacy of plantation economy. Over significant political opposition, Roosevelt engineered the creation
of the New Deal welfare state, in which the federal government (sometimes alone but more often in partnership with the states) became the key driver of both
economic and social welfare policy. Actually there was very little health policy enacted during Roosevelt’s administration (other than a relatively small program to
fund maternal and child health programs), as the physician community fiercely resisted any such efforts as harmful challenges to their income and autonomy.
Nonetheless, by the mid-1940s, both the federal government and the states were significantly expanding
their health care agenda. In 1946, for example, Congress enacted the HillBurton program, which provided funds to state and
local communities to expand the supply of hospital beds. By the early 1950s Congress was providing
states with federal funding for health care services provided to welfare beneficiaries. During the 1960s the federal
government enacted Medicare, Medicaid, and a host of other initiatives as part of President Lyndon Johnson’s effort to
create a “Great Society.” Even President Richard Nixon (in the 1970s) and President Ronald Reagan (in the 1980s)

signed into law new federal health care programs (like the Health Maintenance Organization Act of 1973) or expanded significantly
existing programs (such as the Medicaid expansions in the late 1980s).
2AC AT: Pharma DA
2AC AT: PTX
AT: Link
No link - VFC doesn’t go through congress – it’s a DOH ruling
Hinman et al 4 -- Alan R. Hinman,1 Walter A. Orenstein,2,a and Lance Rodewald2 1 Task Force for
Child Survival and Development and 2 National Immunization Program, Centers for Disease Control and
Prevention, Atlanta, Georgia [Financing Immunizations in the United States, VACCINES INVITED ARTICLE
Bruce Gellin and John F. Modlin, Section Editors] MP

One consequence of the increasing cost of vaccines during the 1980s and early 1990s was that many
families were unable to pay and increasingly went to health departments for immunizations. Many
private providers referred their lowerincome patients to public facilities to receive immunizations [12–
14]. Although this allowed the children to receive needed vaccines, it fragmented their care and led to
missed opportunities to vaccinate [15]. Immunization levels in 5–6-year-old children in the United States have been 90% in every state since the early 1980s, in
part as a result of laws in every state requiring immunization before entry to school. Levels in preschoolers were significantly lower, as shown

by the measles resurgence during 1989–1991. This epidemic, which involved 155,000 cases and 123
deaths, was fueled by unimmunized preschool children, particularly in inner city areas of poverty [16]. In
response to the epidemic, a strategic assessment was made of what would be required to assure that the nation’s

children completed the basic series of immunizations by their second birthday. Immunization Action
Plans were developed by all states and 28 major metropolitan areas; all emphasized the need to
increase the availability of immunization services. As a result, since 1992, Section 317 funds can be used to support
the actual provision of immunization services [1]. To ensure that vulnerable children have access to
vaccines, the Vaccines for Children (VFC) Act was passed in 1993 [17] The VFC Act provides an entitlement to free
vaccines for children who are uninsured, on Medicaid, or who are American Indians/Alaska Natives. It
also provides free vaccines at federally qualified health centers for children who have insurance that
does not cover immunization (i.e., “underinsured” persons). At the time, the VFC Act was a radical and sometimes controversial departure from the vaccine financing
system for children that was in place before 1993 [18–20]. Currently, the VFC Act is the largest of the 3 major government vaccine

financing systems: VFC, Section 317, and state health department funding (table 2). Under the VFC Act,
funding for new vaccines or new recommendations occurs through a vote of the CDC’s Advisory
Committee on Immunization Practices (ACIP). It is unusual that a federal advisory committee has the
power and authority to add benefits to an entitlement program. After ACIP passes a VFC resolution for a
vaccine, the federal government must establish a contract with the relevant manufacturer. Funding is
approved by the Department of Health and Human Services and the Office of Management and Budget
without the need for additional Congressional appropriations. In contrast, funds needed for children
served by the Section 317 program must be sought from and approved by Congress annually.
Neg Stuff
** Counterplans **
States Counterplan
1NC Solvency
Local enforcement circumvents federal policies --- state regulation is necessary
MARGARET ROBERSTON 2013 --- BA University of Pittsburgh on Vaccinations and Health Policy (“ANALYSIS OF MANDATORY YOUTH
VACCINATION ENFORCEMENT MODELS, Margaret Roberston, 2013, Masters Paper for University of Pittsburgh Master of Public Health School,
d-scholarship.pitt.edu/27354/1/RobertsonM_Masters Essay_4_2016.pdf)//chiragjain

5.1 POLICY IMPLICATIONS A national overview of mandatory youth immunization policies reveals significant
variation in states’ exemption and enforcement policies. As state legislatures and agencies analyze their own
immunization policies, other state frameworks may be helpful in finding solutions to improve youth
vaccination rates. Media reports discussed above suggest that enforcement policies do impact vaccination rates,
although evidence points to a stronger relationship between exemption policies, such as the types of exemptions
permitted and the accessibility of non-medical exemptions, and vaccination rates, enforcement policies should still be
considered in efforts to increase vaccination rates. Several policy considerations can be drawn from this report: • When
reviewing policies to improve youth immunization rates, enforcement variables should not be overlooked. Local studies have
found that school officials’ level of enforcement can impact vaccination rates and enforcement is a key component collecting and reporting
accurate data. • Greater emphasis is needed on collecting and reporting accurate youth immunization data.
Media reports have demonstrated that immunization data collection is often flawed. Unreliable data not only
undermine attempts to study variables related to youth vaccination rates, abut also puts students’ safety at risk. Officials must be
able to quickly identify un- or under-vaccinated students in the event of an outbreak. • State officials must provide adequate
training and oversight to ensure school compliance. While student safety is a responsibility for schools,
administrators may need assistance from public health agencies to effectively work with non-compliant students for
best outcomes. Health officials have more authority in advising the public on matters of public health, and they can serve as a third party when
working with guardians to understand their options for vaccinations and the important of immunization. • State
health officials
should regularly communicate with administrators the importance of their work and provide
education on enforcement procedures and best practices. Given the importance of immunization rates in protecting the
health and safety of youth, oversight and auditing should be implemented to ensure these systems work effectively.

Yes the federal government can do the plan --- but the state governments are the ones
who should be doing that, there’s no reason the federal government is key
JARED COLE AND KATHLEEN SWENDIMAN 5/21/2014 --- Legislative Attorneys at the Congressional Research Service
(“Mandatory Vaccinations: Precedent and Current Laws”, Jared Cole and Kathleen Swendiman, May 21, 2014, Congressional Research Service,
https://fas.org/sgp/crs/misc/RS21414.pdf)//chiragjain

Role of the Federal Government Federal jurisdiction over public health matters derives from the
Commerce Clause, which states that Congress shall have the power “[t]o regulate Commerce with foreign
Nations, and among the several States....”72 Thus, under the Public Health Service Act, the Secretary of the Department of
Health and Human Services has authority to make and enforce regulations necessary “to prevent the
introduction, transmission, or spread of communicable diseases from foreign countries into the States
or possessions, or from one State or possession into any other State or possession.”73 With regard to interstate
commerce, the Public Health Service Act deals primarily with the use of quarantine and isolation measures to

halt the spread of certain communicable diseases.74 No mandatory vaccination programs are
specifically authorized, nor do there appear to be any regulations regarding the implementation of a
mandatory vaccination program at the federal level during a public health emergency.75 With regard to foreign countries, the Secretary
has the power to restrict the entry of groups of aliens for public health reasons.76 This power includes the authority to issue
vaccination requirements for immigrants seeking entry into the United States. Currently, certain vaccines specified in statute, and other vaccines recommended by
the CDC Advisory Committee on Immunization Practices for the general U.S. population, are required
for immigrants who seek permanent residence in the United States, and people currently living in the United States who seek to adjust their status to become permanent
residents.77 CDC has determined that two diseases for which vaccines are recommended for routine use by the ACIP—for human papillomavirus (HPV) and zoster (shingles)—do not have the
potential to cause outbreaks, and are therefore not required for admission.78 Vaccination requirements may be waived when the foreign national receives the vaccination, if the civil surgeon
or panel physician certifies that the vaccination would not be medically appropriate, or if the vaccination would be contrary to the foreign national’s religious or moral beliefs.79 Likewise,

the military has broad authority in dealing with its personnel, both military and civilian, including the
protection of their health.80 Military regulations require American troops to be immunized against a number of diseases, including tetanus, diphtheria, influenza,
hepatitis A, measles, mumps, rubella, polio, and yellow fever.81 Inoculations begin upon entry into military service, and later vaccines depend upon troop specialties or assignments to
different geographic areas of the world. Courts have upheld the legality of military mandatory vaccination orders. For example, in United States v. Chadwell, 82 two U.S. Marines refused to be
vaccinated against smallpox, typhoid, paratyphoid, and influenza because of their religious beliefs.83 In upholding the convictions, the Navy Board of Review court (now the Navy-Marine Corps
Court of Criminal Appeals) stated that religious beliefs were not above military orders and that “to permit this would be to make the professed doctrines of religious belief superior to military
orders, and in effect to permit every soldier to become a law unto himself.”84 Federal courts do not appear to contradict this reasoning. One district court, in reviewing a denial of a discharge
decision of the Commandant of the Marine Corps under an “arbitrary and capricious standard,” noted the lawfulness of the military’s anthrax vaccination program, and noted military
commanders’ “overriding responsibility to protect the health and safety of American military personnel by administering appropriate vaccines when faced with the growing threat of biological
and chemical weaponry.”85 Likewise, the Court of Appeals for the District of Columbia Circuit upheld a Department of Defense policy of using unapproved, investigational drugs on military
members in combat situations without their consent.86 Finally, in two recent cases the plaintiffs were discharged from the military for refusing to receive anthrax vaccinations. They brought
claims challenging the Secretary of the Air Force’s denial of their requests to correct the disciplinary records on the matter from their files. In both cases, the District Court for the District of

state and local governments


Columbia ruled that the decision of the Board for the Correction of Military Records was not arbitrary and capricious.87 As noted above,

have primary responsibility for protecting the public health, and this has been reflected in the
enactment of various state laws requiring that school children be vaccinated against certain diseases before enrolling in
school and that health care workers be vaccinated as a condition of employment, as well as laws providing for mandatory vaccination

procedures during a public health emergency. Any federal mandatory vaccination program applicable
to the general public would likely be limited to areas of existing federal jurisdiction, i.e., interstate and
foreign commerce, similar to the federal quarantine authority.88 This limitation on federal jurisdiction acknowledges that
states have the primary responsibility for protecting the public health, but that under certain circumstances, federal intervention may be
necessary.
2NC Solvency
State’s control the vaccinations program --- there’s no reason to put it in the federal realm

DENISE GRADY 2/16/15 --- Health Editor and New York Times Reporter on Science for 19 Years ("Vaccinations Are States’ Call," New
York Times Reporter, February 16, 2015, https://www.nytimes.com/2015/02/17/health/vaccinations-are-states-call.html)//chiragjain

Henning Jacobson just said no. Even though Massachusetts required it, he did not want to be vaccinated. He had had a bad reaction to a
vaccine, and he opposed vaccination in general. Refusing to back down, he fought the state law all the way to the Supreme Court. And Mr.
Jacobson, a minister in Cambridge, lost. He was not forcibly immunized, but he did have to pay a $5 fine for turning down the vaccine against
smallpox. The year was 1905. There had recently been a major outbreak of the disease in Boston, and the court said, essentially, that the state’s
obligation to protect public health trumped Mr. Jacobson’s wish to avoid the needle. Similar fights, pitting personal freedom against the
common good, “have gone on since the founding of the Republic,” said Lawrence O. Gostin, an expert in public health law and the faculty
director of the O’Neill Institute for National and Global Health Law at Georgetown University. The battles continue. Now, with a measles
outbreak that has affected 121 people in 17 states and Washington, D.C. — and an unusually high
number of cases last year, 644 — people who refuse to vaccinate their children have become a focus of
resentment and concern. Laws that allow parents to opt out of immunization are also coming under
scrutiny. Can the government go further? Can officials require that citizens receive vaccines? The answer, legal experts say, is yes. The
authority to require vaccination belongs to the states. “Each individual state really has complete power,” Mr. Gostin said.
There is a common misconception that the federal government controls vaccination, he added. But federal
authority applies only with matters of national concern, such as border crossings or immigration. States generally follow
recommendations made by the Centers for Disease Control and Prevention. All 50 states require that
children receive a certain schedule of vaccinations before they start preschool or school unless the child has a medical
condition — like an immune disorder or cancer — that would make vaccination risky. This type of legal requirement is indirect:
It does not compel vaccination but makes it condition for entering school. In theory, Mr. Gostin said, states could
require vaccination itself. “But there would be something that would be very distasteful about holding somebody down and injecting them,” he
said. More likely more feasible, he said, is “what the law normally requires: a civil or criminal penalty, a modest fine.” Although
every
state requires vaccination for admission to school, 48 states allow parents to opt out for religious
reasons, and 20 allow them to decline for personal or philosophical reasons. “States have the power to
vaccinate, and they don’t have to grant an exemption on religious grounds,” Mr. Gostin said. “The
Constitution doesn’t require it. Mississippi and West Virginia don’t allow it.” In some states, he said, the rules for religious
exemptions are hard to qualify for, requiring that parents demonstrate that opposition to vaccines is part of their religion and that a public-
health officer sign off on the application. “In other states, you just sign a form,” Mr. Gostin said.

States are key to solve --- the aff is insufficient

EMILY OSHIMA LEE, LINDSAY ROSENTHAL, AND GABRIEL SCHEFFLER 11/14/13 --- Emily Oshima Lee is a Policy
Analyst with the Health Policy team at the Center for American Progress. Lindsay Rosenthal was a research assistant for Women’s Health and
Rights and Health Policy at the Center. Gabriel Scheffler was a Ford Foundation fellow with the Health Policy team at the Center. (“The Effect of
Childhood Vaccine Exemptions on Disease Outbreaks”, Center for American Progress, Emily Oshima Lee, Lindsay Rosenthal, Gabriel Scheffler,
November 14, 2013, https://www.americanprogress.org/issues/healthcare/reports/2013/11/14/76471/the-effect-of-childhood-vaccine-
exemptions-on-disease-outbreaks/)//chiragjain

Potential state and federal responses The evidence that states with personal-belief exemptions or easy exemption procedures have more nonmedical exemptions
and a greater incidence of communicable diseases suggests that modifying these exemption laws would help prevent future outbreaks. States must take primary
responsibility for restructuring their vaccine-exemption laws.
One potential reform is for states to eliminate personal-belief
exemptions since there is no constitutional requirement for them to grant such exemptions. Eliminating
personal-belief exemptions would not affect religious exemptors or individuals with strongly held secular objections. But
it could still significantly reduce exemption rates, as there is evidence that many personal-belief exemptions are actually “exemptions of
convenience”—meaning that individuals apply for personal-belief exemptions simply because it is easier than

fulfilling vaccination requirements. States could also redesign their exemption-application procedures
to ensure that exemptors think more deliberately about their decision. Several states have already
started moving in this direction. The Oregon legislature, for example, recently passed a bill requiring that parents demonstrate that they have
consulted a physician or watched an online educational video about the risks and benefits of vaccination before sending their unvaccinated children to school.
Vermont passed a similar law in 2012, and Washington state passed one in 2011. As with eliminating philosophical exemptions, making exemption procedures more
rigorous would not deter those with deeply held convictions against vaccination. But
because many exemptions are exemptions of
convenience, even minimal administrative requirements have significant impacts on exemption rates. To
further prevent clusters of vaccine exemptions from forming, state health authorities could do more to
monitor and publicize the number of nonmedical exemptions at the county level and focus their
education and outreach efforts on counties with exemption clusters. State authorities could also implement uniform
statewide processes for granting exemptions and review school exemption policies to ensure that they comply with state law. The federal government should also
support state efforts. The CDC, for example, could publish a model exemption law as a guide for states interested in strengthening their exemption policies. In
tandem with state efforts, the CDC could also collect and publicize county-level exemption data, perhaps by publishing a list of those counties with the highest
exemption rates and estimating their increased risk of experiencing a disease outbreak. The CDC could help school officials to provide information on school and
countywide vaccine-exemption rates to parents so that they are informed about the level of immunization at their children’s school. Making this data more
transparent and accessible to the public may encourage states or counties with lax vaccine policies to re-examine current laws. It may also foster an understanding
among parents that vaccination is important. Private health insurers could also encourage enrollees to receive cost-free immunizations against preventable diseases
by offering premium rebates to individuals who complete their vaccination schedules on time. At a minimum, insurers should send informational materials and
reminders to patients about vaccine schedules. In designing vaccine mandates, governing institutions must balance latitude for
individuals to make decisions about their own health and the health of their children with protecting the safety and
well-being of the public. Vaccines have the capacity to dramatically improve public health, and an individual’s

refusal to get vaccinated increases the risk of infection for his or her entire community, including those infants and
individuals with medical conditions who do not have the option to receive vaccination. Governments must therefore ensure that

individuals who opt out of immunization are informed of the potential consequences of their decision.
While more must be done to address other barriers to childhood vaccination, such as the cost and supply of vaccines, the initiatives outlined here

are critical steps in addressing a major barrier to effective immunization: excessive parental use of
nonmedical exemptions.

States should eliminate exemptions --- it’s a better way to solve because states have police power

KYLIE BARNHART 2016 --- WVU Law's U.S. Supreme Court Law Clinic (“TAKING ONE FOR THE HERD: ELIMINATING NON-MEDICAL
EXEMPTIONS TO COMPULSORY VACCINATION LAWS TO PROTECT IMMUNOCOMPROMISED CHILDREN”, Kylie Barnhart, Fall 2016, HeinOnline
Jounal, heinonline.org.proxy.lib.umich.edu/HOL/Page?handle=hein.journals/wvb119&div=20&g_sent=1&collection=journals)//chiragjain

The power to eliminate non-medical exemptions to compulsory vaccination statutes is within the
state's police powers. Easily accessible exemptions undermine herd immunity, leading to outbreaks in disease.
Immunocompromised children are at an even higher risk of becoming infected with vaccine-eradicable
diseases.352 Forcing these immunocompromised children into schools, where children spread infections, viruses, and diseases at more rapid
rates, while providing non-medical exemptions, fails to adequately protect the immunocompromised. IV. CONCLUSION States should
eliminate religious and philosophical exemptions to compulsory vaccination laws, like West Virginia,
Mississippi, and California, to protect immunocompromised children. These non-medical exemptions should be
eliminated using the same power that enables states to enact compulsory education laws. Compulsory
education laws exist in every state requiring children to attend school. States have the power to force children to
attend school through their parens patriae power. Historically, education has been seen as so important for the
betterment of society that states allow parents' rights to be infringed upon by requiring their children attend
school until a specific age. Arguably, the health and lives of children are even more important than education.
One proven way to protect the health and lives of children is through the implementation of compulsory vaccination requirements. Vaccination
requirements that provide non-medical exemptions fail to adequately protect society from eradicable diseases. Therefore, states
should,
for the betterment of society, create a safe educational setting for immunocompromised children by
eliminating nonmedical exemptions to vaccination requirements. States can infringe upon parental rights where there
are important interests of children. In the school context, courts have consistently found that states can
infringe upon parental rights for the betterment of society through compulsory school attendance laws.
In turn, states should infringe upon parental rights for the betterment of society by eliminating non-medical exemptions to compulsory
vaccination requirements to promote the health of their citizens. Not only should states eliminate non-medical exemptions to compulsory
vaccination laws, states have an affirmative duty to protect the health of their citizens. The state police powers give states the ability to enact
laws that promote the health, safety, and morals of their citizens. If states enact compulsory vaccination laws with religious and philosophical
exemptions, they fail to maximize the effectiveness of these vaccination laws. This is contrary to the whole purpose behind state police powers
and enacting the vaccination laws in the first place. Furthermore, states
require children to attend school, so states should
have an affirmative duty to provide a safe and healthy environment for immunocompromised children
who are also required to attend school. Numerous families face the same challenges and worries that Maggie's family had to
face. They are forced to endure the struggles of having a sick child and then face the worry of sending their child out into the world to be
exposed to vaccine-eradicable diseases. Hopefully, if states eliminate non-medical exemptions to vaccination requirements, families, like
Maggie's, will face fewer worries and struggles.

Uniform state models work and have precedent


Lobo 16 (James Lobo - Boston College Law School, 1/28/2016“Vindicating the Vaccine: Injecting
Strength into Mandatory School Vaccination Requirements to Safeguard the Public Health“, Boston
College Law Review, 57 B.C. L. Rev. 261)\\WDB

An alternative to encouraging states to strengthen their own existing vaccination requirements is to


create a model or uniform law, which states could [*294] adopt. n219 This section proposes a model
law based on the New York vaccination requirements and practices, described in section B, above, which
utilizes a genuine and sincere requirement. n220 A model law would standardize vaccination policy and
protect the country from an interstate epidemic. n221 A uniform health law is not unprecedented. n222
In response to the terrorist attacks of September 11, 2001, a team from the Centers for Law and the
Public's Health from Johns Hopkins and Georgetown Universities drafted a uniform health law called the
Model State Emergency Health Powers Act ("MSEHPA"). n223 The goal of MSEHPA is to grant power to
state and local governments during health emergencies in order to effectively manage the threat,
including provisions that allow state officials to vaccinate individuals in order to protect them from, and
repress the spread of, contagious diseases. n224 Currently, thirty-eight states and the District of
Columbia have adopted some portions of the Act in their legislation. n225 MSEHPA could serve as a
good model [*295] for a uniform health statute that addresses non-emergency situations, which state
legislatures could adopt. n226 State adoption of independently created standards or model laws has
seen varying degrees of success in other contexts besides health, particularly in areas such as
commercial and criminal law. n227 The area of public health (and in particular vaccination) presents a
compelling case for a uniform set of regulations: like commerce and criminal activity, vaccine-
preventable diseases do not halt at state lines, and uniformity among the inoculation laws across the
entire country would ensure their efficacy by preventing certain states' lax vaccination laws from
rendering residents of other states susceptible to disease.
AT: Legal Authority
There’s a legal precedent for states and they already control it anyways --- two states have already
implemented the aff

DAN STROH 4/14/15 --- Associate Member of University of Cincinnati Law Review - (“Vaccinate All Children: Not Only Is It
Legal, but It Benefits Everyone”, Dan Stroh, University of Cincinnati Law Review, April 14, 2016,
https://uclawreview.org/2015/04/14/vaccinate-all-children-not-only-is-it-legal-but-it-benefits-everyone/)//chiragjain

Currently, there is no federal vaccination requirement, but all fifty states require children in schools to
be vaccinated. The states require vaccinations with three different types of exemptions. Two states, Mississippi
and West Virginia, have medical exemptions allowing children to forgo vaccination if a state-certified physician determines it is unsafe
for the child to receive a vaccine.[4] Most states offer some form of a religious exemption. The exemptions vary on how strictly they are
enforced, with some states allowing a parent simply to sign and submit a form, while others more closely examine the applicant’s claimed
religious views. Finally, some states offer a broad exemption, often called a
philosophical exemption, allowing parents the right to
refuse vaccines for almost any reason they choose.[5] There are two foundational cases for the permissibility of a
state to enforce mandatory vaccinations. In 1905, the Supreme Court ruled in Jacobson v. Commonwealth of Massachusetts
that a state’s police power is properly exercised in mandating vaccines.[6] Following Jacobson, in 1922 the Supreme Court stated directly, “. . .
it is within the police power of a state to provide for compulsory vaccinations.”[7] Importantly, Jacobson and
Zucht’s precedent did not discuss whether a mandatory vaccine violates the free exercise clause.[8] To overcome the elimination of religious
exemptions in the many states that currently have one, a mandatory vaccination law would have to withstand a free exercise challenge.[9]

States can force vaccines- courts


Rosenheim 16(Daniel S. Rosenheim, JD, Florida Coastal School of Law, Spring 2016 “Constitutional
implications arising from federal and state vaccination mandates” ,Florida Coastal Law Review, 17 Fl.
Coastal L. Rev. 479)

The states generally, with exception to preemptory issues, retain the right to enact laws to protect the
health, safety, and general welfare of its citizens. n103 Within this broad category of powers rests the
right of the states to mandate vaccinations. n104 In Jacobson v. Massachusetts--arguably the most
important case regarding a state's power to mandate vaccines--the Court upheld a Massachusetts law
that mandated smallpox vaccination against anyone twenty-one years of age or older and not under
guardianship. n105 More specifically, the Massachusetts law "required the inhabitants of a city or town
to be vaccinated only when, in the opinion of the board of health, that was necessary for the public
health or the public safety." n106 This idea of protecting the public's health and safety is premised on
the same ideology that drives herd immunity. n107 The Court expressed the state's need to enforce this
policy by stating that "a community has the right to protect itself against an epidemic of disease which
threatens the safety of its members." n108
Incentives Counterplan
1NC
The fifty states and territories should
- Offer monetary incentives to parents who choose to vaccinate their children
- Create a monetary disincentive in the form of a tax for parents who choose to take
exemptions for their children
- Make exemptions more difficult to receive
- Increase education about vaccines through public education campaigns
- Increase funding to states for free vaccinations

KEVIN HOOKER 2014 --- Houston Journal of Health Law & Policy, Texas A&M University Bachelor's Degree, University of Houston Law
Center Juris Doctor (J.D.), Law, (“EXEMPTIONS TO VACCINE MANDATES: THE PROBLEM AND POSSIBLE REMEDIES”, Kevin Hooker,2014, Houston
Journal of Health Law and Policy, www.law.uh.edu/hjhlp/volumes/Vol_14/Hooker.pdf)//chiragjain

VI. POTENTIAL PROBLEMS OF ELIMINATING NON-MEDICAL EXEMPTIONS Although 47 states provide for religious
exemptions (California, Mississippi, and West Virginia do not),198 “it is generally agreed upon that they exist[,] not because
school mandates violate the First Amendment[,] but rather to diffuse perceptions of state coercion and to enhance the
sustainability and acceptability of school mandates.”199 Despite the fact that the majority of people
vaccinate themselves and comply with mandates, there are many people who are uncomfortable with
the idea of the mandates themselves. Debates over HPV vaccine mandates and recent discussion concerning whether hospitals
should mandate that all of their health care workers receive influenza vaccinations are examples of this concern over such mandates.200
Moreover, with the recent Supreme Court decision and battle over the Affordable Care Act, that created
a health insurance mandate, people may be increasingly distrustful and wary of what they see as more
government intrusion into their decision making. All of this could lead to an increase in opposition or suspicion to vaccine
mandates that could do more harm than good. Fortunately, there may be other ways to achieve the same results as that of a strict mandate.
The government could: (1) offer monetary incentives to parents who choose to vaccinate their children;
(2) create a monetary disincentive in the form of a tax for parents who choose to take exemptions for
their children; (3) make exemptions more difficult to get; (4) increase education about vaccines and
the risks associated with foregoing the vaccine; or (5) impose liability on parents who choose not to vaccinate their children,
resulting in a child’s illness. All of these possibilities are considered in the next section of this paper.
2NC Solvency
Eliminating exemptions results in extreme backlash --- prefer regulation mechanisms
KEVIN HOOKER 2014 --- Houston Journal of Health Law & Policy, Texas A&M University Bachelor's Degree, University of Houston Law
Center Juris Doctor (J.D.), Law, (“EXEMPTIONS TO VACCINE MANDATES: THE PROBLEM AND POSSIBLE REMEDIES”, Kevin Hooker,2014, Houston
Journal of Health Law and Policy, www.law.uh.edu/hjhlp/volumes/Vol_14/Hooker.pdf)//chiragjain

Vaccines are one of the most useful, effective, and cost-efficient tools available in medicine at present to
stop the spread of certain dangerous communicable diseases. Although vaccine mandates have thus far kept vaccination
rates at high levels, the trend showing increasing percentages of people claiming exemptions is worrisome,
and it is not too early to consider a response to this trend. The federal and state governments should
consider taking steps to prevent or dissuade people from obtaining non-medical exemptions. Actions
available to state includes closing unnecessary philosophical and religious exemptions that individuals
may claim, and even creating a statutory cause of action that can be brought when a parent’s decision not
to vaccinate his child harms someone. Alternative actions, available to both the state and federal
government that do not involve strengthening mandates include, financial incentives, financial
disincentives, increasing the difficulty of obtaining exemptions, or increasing educational campaigns to
inform people about immunization. While eliminating the non-medical exemptions would be ideal, the
potential backlash from such action could do more harm than good. Thus, the alternative measures provided could
be more useful in the long run. Public opinion surveys concerning vaccine mandates and other alternatives might be helpful in discerning the
most effective response.
AT: Tohanczyn
Disappointingly your solvency advocate thinks the counterplan is a good idea too
Tohanczyn 16 --- Katherine is an associate in the Starfield Smith’s Fort Washington office. She concentrates her practice on commercial
financing, real estate and corporate law with a focus on commercial lending and government guaranteed lending. (“ Katherine D., “WHO
SHOULD CALL THE SHOTS? PROPOSING FEDERAL OVERSIGHT OF MANDATORY CHILDHOOD VACCINATIONS,” winter edition of the Philadelphia
Lawyer 2016,
http://www.philadelphiabar.org/WebObjects/PBAReadOnly.woa/Contents/WebServerResources/CMSResources/ginsburgessay15.pdf)//chiragj
ain

Since herd theory requires a significant percentage of the population to be vaccinated in order for that vaccination to be effective, it is in the best interest of the
nation for the federal government to exclude a religious exemption from the mandatory vaccination program. However, given
the social and
political implications, the federal government should grant a limited religious exemption that mirrors
the one provided for under the Affordable Care Act. Specifically, the exemption should apply to those who
meet three requirements: (1) the individual is a member of a religious group whose tenets and teachings
establish that its members are conscientiously opposed to receiving medical treatment, (2) the
individual must waive all Social Security and Medicare benefits, and (3) the religious organization must
pay for the health care and disability costs of its members who contract an illness.64 Requiring parents to have opted
into the ACA’s exemption makes sense because a parent who is against vaccines is also likely to be against medical

treatment generally. Parents who do not properly fit within this exemption and still do not vaccinate
their children would be subject to a tax similar to the penalty under the ACA. 65 The goal of such a tax is
to deter individuals from not vaccinating their children, since it is no longer more convenient than
getting them vaccinated. In addition, the money generated from the penalty can be used to help further the implementation and enforcement of the
mandatory program as well as education regarding vaccinations. While at first this program may seem like unwanted federal intrusion into personal beliefs, twenty-
nine states have recently proposed bills that would eliminate exemptions based on religious or moral beliefs as a way to combat the current measles and pertussis
outbreaks.66 These bills demonstrate that a number of state legislatures, and presumably their constituents, are open to making exemptions harder to receive.
However, since these bills are simply proposals and they are not unanimous across the board, federal oversight is still necessary to achieve elimination or
eradication of vaccine-preventable infectious diseases. D. Why Federal Oversight Is Rational The rationale for implementing a vaccine program with federal
oversight includes historical, economical, and logical reasons. In 1813, Thomas Jefferson signed a law that required the federal government to “guarantee and
distribute effective vaccines” in order to prevent epidemics.67 While the federal government currently retains the right to quarantine individuals and require
vaccination of immigrants and military, Congress has since rescinded control of immunizations of children, leaving authority to the states.68 Due to the direct
correlation between decreases in vaccinations and increases in infectious diseases, the federal government should return to its original position in mandating
childhood vaccines. Such federal oversight makes sense for a number of reasons. First, the current structure has led to an inconsistent patchwork of laws, standards,
and procedures both among and within states. Further, most of these statutes are outdated and have failed to keep up with trends in scientific and technological
advances, as well as judicial interpretations. In addition, some states are moving in the wrong direction as legislatures in the past two years have proposed bills to
make exemptions even easier to obtain.69 These states include Florida, Georgia, Iowa, Kansas, Massachusetts, Mississippi, New Hampshire, New Jersey, New York,
South Dakota, Virginia, and West Virginia. To improve the nation’s health, it is imperative that the federal government act to encourage states to implement
uniform standards based on a delicate balance of the risk and cost of disease with a burden on individual autonomy. Such standards are necessary to ensure clarity
and coherence among public health officials at all levels and in all states. They also prevent parents from moving to another state – or often times the neighboring
school district – to avoid a poorly implemented vaccine policy, due to false rumors about possible side effects of immunizations, including their link to autism. Just
as disease knows no boundaries, our government’s public health initiatives must also look past state lines. Additionally, the federal government is in the best
position to create such a mandate because of their superior financial and scientific resources and expertise. V. CONCLUSION As more and more parents continue to
take advantage of ineffective, unenforced, and overbroad vaccine exemptions, the federal government must proactively take steps to protect the public’s health.
The federal government should develop mandatory requirements with limited and narrow exceptions that would not be a
financial burden on school districts and public health boards. It should persuade states to adopt and appropriately implement this policy by tying federal funding of
education to its operation. And
finally, it must also take steps to educate parents about the truths and myths
regarding vaccines, including how opting their children out of a vaccine places the community at risk of
contracting a vaccine-preventable disease.
AT: Exemptions Complications Fail
Exemptions can be disincentivized through substantially elongating and complicating
the process
KEVIN HOOKER 2014 --- Houston Journal of Health Law & Policy, Texas A&M University Bachelor's Degree, University of Houston Law
Center Juris Doctor (J.D.), Law, (“EXEMPTIONS TO VACCINE MANDATES: THE PROBLEM AND POSSIBLE REMEDIES”, Kevin Hooker,2014, Houston
Journal of Health Law and Policy, www.law.uh.edu/hjhlp/volumes/Vol_14/Hooker.pdf)//chiragjain

Another alternative to a strict mandate is making exemptions more difficult and time consuming to
obtain. Studies comparing vaccination rates between states with easier exemption requirements and
states with more stringent exemption requirements show a noticeable difference in the percentage of the
population who obtain exemptions.213 The methods described as more difficult in these studies included forcing
parents to sign a form that had to be notarized and requiring parents to obtain a form obtained from
a health department along with a written letter from the parent.214 This study found the difficulty to be
significantly associated with the percent of exemptions claimed.215 This suggests that these methods work in
deterring a fair number of parents from obtaining exemptions. Of course, these are not the only methods that could be
used to obtain an exemption. People who want exemptions could first be forced to attend a class informing
them about the benefits and risks of vaccinations, be required to provide a letter from a doctor saying
that they have consulted with a doctor and still want an exemption, or be required to “renew” their
exemption annually by any of these methods thus far listed. All of these methods would complicate
obtaining exemptions enough or be taxing enough that they would deter all but those people most
dedicated to obtaining exemptions.

Public health experts agree


DENISE GRADY 2/16/15 --- Health Editor and New York Times Reporter on Science for 19 Years ("Vaccinations Are States’ Call," New
York Times Reporter, February 16, 2015, https://www.nytimes.com/2015/02/17/health/vaccinations-are-states-call.html)//chiragjain

Some parents use the religious and personal exemptions as a tool or loophole to avoid immunizations
because they fear that vaccines are harmful, a belief for which there is no evidence. “They’re using an anti-
science bias as a subterfuge for religion,” Mr. Gostin said. Marci A. Hamilton, a professor at the Benjamin N. Cardozo School of Law at Yeshiva
University, said the religious and personal exemptions from vaccination were a dangerous consequence of what she called “extreme religious
liberty.” “The United States has a long history of providing exemptions to religious believers from laws that apply to everybody,” Ms. Hamilton
said. “Early in the Republic, we exempted Quakers from military service. We exempted communion wine during prohibition.” She said
some of the vaccine exemptions had their origins during the Nixon administration, when Christian
Scientists asked for exemptions for people who believed in faith healing. Many states, she said, went
along with such requests out of respect for freedom of religion — without anticipating that the exemptions could
eventually lead to the return of childhood diseases that had been largely eliminated. Granting exemptions does increase the
risk of disease. A 2006 study in The Journal of American Medical Association showed that states with easy procedures for granting
nonmedical exemptions had approximately 50 percent higher rates of whooping cough. Some legal and public health experts
say that one solution would be to get rid of personal and philosophical exemptions, and to retain the
religious ones but enforce them strictly. State legislatures would have to vote to eliminate the exemptions; as long as they
remain on the books, it will be difficult or impossible to stop granting them. “I think if you did that, you would see a
significant long-term reduction in outbreaks of childhood infectious diseases,” Mr. Gostin said. “If you don’t do
that, you virtually guarantee that in the future, we will have as many outbreaks if not more of measles, pertussis and a whole range of serious
childhood diseases.”
AT: Empirics
Australia proves that it works
UQA 2011 --- University of Queensland Australia report by Professor on Health Policy (“Compulsory vaccination is not the way forward”,
University of Queensland, UQA, 2011 March, www.som.uq.edu.au/media/311019/Compulsory vaccination is not the way
forward.pdf)//chiragjain

Anti-vaccination sentiment There are some parents who hesitate to vaccinate due to concerns regarding
vaccine safety. These fears are reinforced when another vaccine related horror story is reported in the
media. In the UK, a false connection between the Measles, Mumps and Rubella (MMR) vaccine and the development of
autism saw its vaccinations rates drop by 10%. Although it had almost been eradicated, measles re-emerged to the point
where 1314 new cases per year were reported. Before all this, only 56 cases per year were seen. 2 Parents’ fears are valid to an
extent as adverse reactions do occur, but they are rare. In Australia, out of almost 2 million vaccine doses given to
children in 2009 only 43 adverse events were definitively attributed to the vaccine in question. The benefits of vaccination
outweigh the very small risk of adverse effects due to rigorous testing and trialling. In Australia they are regulated by the
Therapeutic Goods Administration before they can be used on the general public. Yet public rejection in the wake of vaccine
scares is still common and predictable. Another factor in parental refusal of vaccination may be a perceived loss of control in
raising their children. Mandatory vaccination would not only require violation of autonomy, but would interfere with basic civil liberties and
freedom. These are concepts that many have fought hard for and may cause backlash in those who feel
their parental rights are being taken away. A withdrawal from vaccination cannot be risked especially at a time when Australia
is doing so well with immunisation rates. Australia is doing well Australia currently reports the percentage of children
under 2 years of age as “fully immunised” to be higher than 90%. This success is due to a partnership
where each state or territory adapts the National Immunisation Program Schedule for use in its own
demographic and then the federal government provides incentives for parents. Additionally many schools, particularly in
Victoria, require evidence of vaccination status before accepting new children. Financial rewards are
offered to parents who comply in vaccinating their children on time. The vaccine coverage rate
increased by almost 20% after the introduction of these incentives. Interestingly, this was also true in areas that did
not need proof of vaccine status as a condition of school entry and therefore had no perceived requirement for vaccination. But the issue is that
those who choose to opt-out under conscientious objection (philosophical, religious or medical belief) will still receive these payments. 3 While
they take money from the government budget, their unprotected children are relying on their vaccinated peers for protection via herd
immunity, a phenomenon where if most of the population is vaccinated then the disease is less able to spread between individuals. This also
negatively affects social justice, where the unvaccinated avoid the risk of vaccine adverse effects but still benefit because vaccinated children
have accepted the small burden. Vaccination is undoubtedly a powerful tool in eradicating global diseases, but locally in Australia mandatory
vaccination is likely to provoke public backlash. Aside
from improving education in the public about vaccinations,
another possible first step to improve vaccination coverage beyond their currently high rates would
be to only allow financial incentives for vaccinated families and those medically unable to vaccinate. Those parents with
conscientious exemption should not receive the benefit but should not be punished either. As a result we might even see some of these
parents reconsider, sadly even if it is for a more superficial reason than the protection of their children.
AT: Education Campaigns Fail
Empirically vaccination percentages increased through educational campaigns
KEVIN HOOKER 2014 --- Houston Journal of Health Law & Policy, Texas A&M University Bachelor's Degree, University of Houston Law
Center Juris Doctor (J.D.), Law, (“EXEMPTIONS TO VACCINE MANDATES: THE PROBLEM AND POSSIBLE REMEDIES”, Kevin Hooker,2014, Houston
Journal of Health Law and Policy, www.law.uh.edu/hjhlp/volumes/Vol_14/Hooker.pdf)//chiragjain

Educating parents about vaccinations is another option that could be used instead of mandates. As was
briefly mentioned, it could be used in combination with other methods (such as making exemptions more
difficult to obtain) or standing alone. One analysis considered the effect of educational efforts to get health
care workers to receive the influenza immunization.216 The study showed an increase from 13% to 37% in
vaccination rates when facilities used existing, and capitations are expressly contemplated by the Constitution. The Court
today holds that our Constitution protects us from federal regulation under the Commerce Clause so long as we abstain from the regulated
activity. But from its creation, the Constitution has made no such promise with respect to taxes. Another four-year study showed that by
the
end of the study, vaccination rates among one hospital’s health care workers increased from 27% to
52% after the hospital engaged in an educational campaign that focused on the need for vaccinations,
vaccine efficacy, affordability, and reminders.218 Any of these methods could be used to engage the public at large via
internet ads, television ads, or paper mail campaigns. To conserve resources, the government could also focus on the populations that are more
likely to be skeptical of vaccine mandate—non-white, lower income, large households.219
AT: Parent Discussion Fails
Studies prove that improved doctoral communication with parents increases chances
of vaccinations
PATTI NEIGHMOND 12/5/16 --- Correspondent, Health Policy, Science Desk. Award-winning journalist Patti Neighmond is NPR's
health policy correspondent. Her reports air regularly on NPR newsmagazines All Things Considered, Morning Edition and Weekend Edition.
(“Advice For Doctors Talking To Parents About HPV Vaccine: Make It Brief”, Patti Neighmond, December 5, 2016, National Public Radio,
http://www.npr.org/sections/health-shots/2016/12/05/504136418/when-doctors-talk-to-parents-about-hpv-vaccine-make-it-brief)//chiragjain

A full decade after the Food and Drug Administration approved a vaccine to fight the sexually
transmitted, cancer-causing human papillomavirus, almost half of all adolescents have still not received their
first dose. This low vaccination rate is dramatic when compared to other routine childhood immunizations like polio and measles, mumps
and rubella, where compliance is above 90 percent. In order to boost HPV vaccination, doctors should be more
assertive when bringing up the topic with parents, says Noel Brewer, a health and behavior scientist at the University of
North Carolina. Brewer knew from earlier research that doctors contribute to that low vaccination rate
because "most doctors and parents don't want to talk about sex," he says, especially when children are 11
or 12 — the age at which the Centers for Disease Control and Prevention recommends the vaccine be given. Brewer wanted to
figure out a better way for physicians to communicate the value of the vaccine to parents. So he conducted a
study involving 30 North Carolina pediatric and family medicine clinics. The clinics were each divided into three groups of doctors. One
group was trained how to make brief statements that assumed parents were ready to have their child
vaccinated. This involved saying short, direct sentences such as, "Now that Michael is 12 there are three vaccines we give to kids his age.
Today he'll get meningitis, HPV and Tdap [tetanus, diphtheria, pertussis]." Another group of clinic doctors was trained to
engage parents in somewhat lengthy discussions about the timing, safety and effectiveness of the
vaccine. A control group of doctors received no training. It turns out that more talk is less effective: When doctors made
brief statements that presumed parents intended to vaccinate their child, vaccine rates increased by 5
percent. There was no increase in vaccination rates following the lengthy discussions. There was also no increase in the control group. The
straightforward approach — when the message is short, direct and brief — makes the HPV vaccine just like any
other vaccine recommendation, Brewer says. "Having a long conversation seems to communicate that
there's a problem with the vaccine, and that worries parents," he says. The study findings are published online Monday
in the journal Pediatrics. Something else that may help boost HPV vaccination rates is a recent recommendation from the
Centers for Disease Control to reduce the number of doses for younger children. Because the vaccine is more effective at
ages 11 and 12, the CDC now recommends only two doses instead of three. However, if children don't get vaccinated until age 15, they'll still
need the full three doses. "The HPV vaccine is an amazing tool to protect our younger generation against many types of cancer," says Dr.
Margaret Stager, a pediatrician with Metro Health Medical Center in Cleveland and a spokesperson for the American Academy of Pediatrics.
She says strains of HPV are responsible for the vast majority of HPV-related cancers, including cervical cancer and cancers of the anus, vagina
and penis. It can also cause cancer in the back of the throat. So it's an important vaccine for both girls and boys, she says. Preventing
cancer should be the critical take-home message for parents, according to Stager. After all, she says, "HPV
prevalence has already decreased as much as 65 percent among vaccinated youth, dramatically lowering the
odds they will face a life-threatening form of cancer in adulthood."
AT: Financial Incentives Fail
Financial incentives are effective --- ACA shows that it works
KEVIN HOOKER 2014 --- Houston Journal of Health Law & Policy, Texas A&M University Bachelor's Degree, University of Houston Law
Center Juris Doctor (J.D.), Law, (“EXEMPTIONS TO VACCINE MANDATES: THE PROBLEM AND POSSIBLE REMEDIES”, Kevin Hooker,2014, Houston
Journal of Health Law and Policy, www.law.uh.edu/hjhlp/volumes/Vol_14/Hooker.pdf)//chiragjain

An alternative to a statutorily created cause of action would be to create financial incentives or disincentives to
encourage parents to get their children vaccinated. The simplest way to do this would be in the form of a
tax. In fact, countries such as Australia already do this by offering tax-free payments of $129 for each child
between 18 and 24 months that complies with immunization requirements and again for children between the ages of four and five
who meet the requirements.207 In the United States, a similar payment could be instituted in the form of a
refund to be claimed when a person files her federal income tax form. Another benefit of using this
method would be that a tax refund would be unlikely to garner heavy opposition from the public at
large. The only issue would be whether or not the benefit from increasing vaccination levels would be worth the cost. Implementation
of a disincentive in the form of a tax for those who fail to comply with the mandate is an alternative as
long as the cost of the disincentive is prohibitively high. The Supreme Court recently upheld such a tax in
the Affordable Care Act, and a similar individual mandate would be used in this instance.208 The federal
government could simply tax those who fail to comply with the CDC’s immunization recommendations with a fee that would be large enough to
deter even those who object. In
addition to taxing individuals who do not comply with vaccine mandates, there
is the option of taxing private childcare businesses and daycares that enroll unvaccinated children. The
eastern Australian state of New South Wales has recently approved legislation of this type.209 Next year, childcare centers will be able to
refuse to enroll children whose vaccination record cannot be verified.210 Although
children can still be exempted under this
scheme, the centers will be fined if they fail to check the child’s vaccination status to ensure compliance
or proper exemption.211 Similar measures could be enacted by U.S. states. An additional benefit to a tax refund or
penalty is that it could be implemented on the federal level because it would be based on Congress’
broad taxing power. While the federal government most likely does not have the power to mandate immunization, the Supreme Court
has repeatedly acknowledged Congress’ broad power to tax under the taxing and spending clause.212

Incentive system works in Australia --- United States exemptions need to coexist with
an incentive system
ERIN WALKINSHAW 11/8/2011 --- Healthy and Foreign Policy Expert Reporter at the Canadian Medical Association Journal
(“Mandatory vaccinations: The international landscape”, Erin Walkinshaw, November 8, 2011, Canadian Medical Association Journal,
www.ncbi.nlm.nih.gov/pmc/articles/PMC3216445/)//chiragjain

Vaccination policies in countries around the world are so varied and fractured they almost seem Canadian. While some
countries focus on educating their populace about the benefits of vaccination while leaving the choice to individuals, others offer financial incentives or have made
vaccinations mandatory to ensure high coverage rates. Enforcement is another issue. Several countries with mandatory vaccination
policies opt not to enforce them. And most everyone appears to agree that vaccination programs must allow for medical exemptions. As with
three Canadian provinces (www.cmaj.ca/lookup/doi/10.1503/cmaj.109-3992), every state in the United States requires children to

be vaccinated before attending school, says Dr. Lance Rodewald, director of immunization services for the National Center for Immunization
and Respiratory Diseases at the US Center for Disease Control and Prevention in Atlanta, Georgia. Most states allow for medical, religious

and philosophical exemptions but Mississippi and West Virginia have taken their policy a step further and only allowed for medical exemptions.
“There’s a lot of variability state by state on what it takes to get an exemption,” Rodewald notes, adding that in some
states, parents can simply request exemptions, without having to provide a justification, while other states require a notarized signature on a statement indicating
that the parents are aware that they are putting their child at risk. There’s a direct correlation between the ease with which exemptions are granted and exemption
rates, he says, citing a study that also shows there is a link between ease of exemption and disease prevalence rates
(www.ncbi.nlm.nih.gov/pmc/articles/PMC1446650/pdf/11291383.pdf). Most American children do get vaccinated, however, so the role of mandatory vaccination
legislation is essentially to rope in the “stragglers,” Rodewald adds. “That last 10% who may have forgotten to get a dose of vaccine.” Other countries, such as
Australia, offer financial incentives to boost compliance rates. Parents receive nontaxable payments
of A$129 for each child who meets immunization requirements between 18 and 24 months of age,
and again if the child meets requirements between four and five years of age. “Vaccination is not
compulsory in Australia. However, the Maternity Immunisation Allowance and Child Care Benefit are parent incentive payments that
are paid where a child is up-to-date with his/her immunisations or the parent has obtained an
appropriate medical or philosophical exemption,” an immunization coordinator for the Australian Department of Health and Ageing writes in an
email. Australia does not require children to be immunized for school attendance but unvaccinated

students are precluded from attending classes in the event of disease outbreaks. “The implications of
this become apparent when the parents have to take time off work,” Michael Moore, chief executive officer of the Public
Health Association of Australia, writes in an email. Some nations, such as Latvia, say they have mandatory vaccination policies but contend that the notion of
“mandatory” differs from that of other nations. “Vaccination is mandatory for state institutions and vaccination providers but for [the] public is recommended and
offered free of charge,” Jurijs Perevoscikovs, head of the Epidemiological Safety and Public Health division of the Infectology Center of Latvia, writes in an email.
Vaccines that are not mandatory are not publicly funded, so the cost for those must be borne by parents or employers, she adds. Funded vaccinations include
tuberculosis, diphtheria, measles, hepatitis B, human papilloma virus for 12-year-old girls, and tick-borne encephalitis until age 18 in endemic areas and for orphans.
Latvia also appears unique in that it compels health care providers to obtain the signatures of those who decline vaccination. Individuals have the right to refuse a
vaccination, Perevoscikovs says. But if they do so, health providers have a duty to explain the health consequences and if the patient hasn’t been persuaded to
change his mind, “the health care provider should draw up a refusal in writing which has to be confirmed with a signature by the person to be vaccinated.” Slovenia
has one of the world’s most aggressive and comprehensive vaccination programs. Its program is mandatory for nine designated diseases. Within the first three
months of life, infants must be vaccinated for tuberculosis, tetanus, polio, pertussis, and Haemophilus influenza type B. Within 18 months, vaccines are required for
measles, mumps and rubella, and finally, before a child starts school, the child must be vaccinated for hepatitis B. While a medical exemption request can be
submitted to a committee, such an application for reasons of religion or conscience wouldn’t be acceptable, and isn’t allowed, says Alenka Kraigher, head of the
communicable diseases and environmental health center at Slovenia’s National Institute of Public Health. Failure to comply results in a fine and compliance rates
top 95%, Kraigher says, adding that for nonmandatory vaccines, such as the one for human papilloma virus, coverage is below 50%. Kraigher also notes that Slovenia
has a generous no-fault compensation program for those injured from vaccines. Canada and Russia are the only G8 nations without national no-fault compensation
programs (www.cmaj.ca/lookup/doi/10.1503/cmaj.109-3805). Still other countries appear to have much more modest, or disease-specific mandatory vaccination
programs. Belgium, for example, has a mandatory vaccination policy for polio, dating back to 1967, which requires that all children be vaccinated for the disease
before they reach the age of 18 months. “When this policy was legislated it didn’t have to be enforced because it was perceived as the state behaving as a good
father for the population,” says Marc Van Ranst, national flu coordinator and head of the vaccination working group at Belgium’s Superior Health Council. Although
the vaccination environment is now more hostile, compliance rates remain high, Van Ranst says. “Ninety-nine percent of the population doesn’t ask questions and
gets vaccinated. Either they don’t care or they agree with the policy.” Most of those who fail to comply are migrant Roma gypsies, while those who oppose
mandatory vaccination typically are not prosecuted, he adds. “In practice, it’s rarely prosecuted or they’re being let off with a slap on the wrist. … There is really
nobody who will go to jail for not having their children vaccinated.” The World Health Organization (WHO) has no official policy on mandatory vaccinations, Alison
Brunier, communications officer for Immunizations, Vaccines and Biologicals at the WHO writes in an email. “While it is preferable that high community demand
and acceptance make compulsory vaccination programmes unnecessary, WHO understands that some countries may wish to move in that direction when faced
with declining vaccination rates and outbreaks of disease.” But WHO is “very interested in learning from the experience of countries who introduce compulsory
vaccination in order to better understand the impact on immunization coverage and the strengths and weaknesses of such approaches,” she adds.
Airlines Counterplan
1NC
The United States federal government should require vaccinations as per the American Council on
Immunization Practices schedule as a prerequisite to airline travel.

That solves --- most people are incentivized to vaccinate for airline travel --- sufficiently reaches herd
immunity --- avoids education based disads

CHRISTOPHER ROBERTSON ET AL. 2016 --- The University of Arizona James E. Rogers College of Law (“Vaccines and Airline
Travel: A Federal Role to Protect the Public Health”, Christopher Robertson, July 2016, University of Arizona, UMich Lib, Pages 544-
570)//chiragjain

In the near future, when a new vaccine is quickly developed to respond to


Adult vaccination has become increasingly important.9

a specific outbreak of a more exotic disease, adult vaccination may be essential. It may not be sufficient
to rely on school vaccinations and the smattering of adult vaccination programs, such as those for
healthcare workers. Nor will an optimal adult vaccination strategy be random. It will instead follow the same human network of
interactions that spread disease, targeting nodes in which a vaccination may have the greatest disruption of the transmission of disease.10 Airports and
airlines are arguably one of the most important nodes. On average, Americans take 2.1 airline trips each
year.11 The United States airlines move approximately two million people every day.12 If unvaccinated,
these travelers are more likely to carry infectious diseases with them. This problem can be viewed as
one of externalities, flowing across jurisdictional borders: a state’s sovereign prerogative to have robust
vaccination laws that protect its residents is undermined if unvaccinated individuals from other states
cross its borders daily.13 Because vaccines can only provide imperfect protection to those who receive them, and some individuals are unable to be vaccinated at all (due to
other medical problems), those who choose to be unvaccinated pose a public health threat.14 Leading voices in

public health law have warned about cramped legal conceptions of federalism, which may undermine
the government’s ability to protect its citizens.15 Of particular concern is NFIB v. Sebelius, a recent United States Supreme Court decision. The Court held
that the Commerce Clause of the United States Constitution does not support a congressional mandate requiring individuals to purchase health insurance.16 Some have argued that this

the larger conception of federalism it represents, erodes the constitutionality of core public
decision, and

health functions of the federal government.17 A vaccination mandate, tracking the channels and instrumentalities of interstate commerce, may
reinvigorate Commerce Clause doctrine for public health. This Article is the first scholarly assessment of three issues: (1) whether airline travel is itself an important vector for the spread of
infectious disease; (2) if so, whether airlines have market-based and liability-based reasons to require that passengers be vaccinated; and, (3) whether the federal government has the legal and
constitutional authority to either encourage or mandate that airlines do so. The scientific literature suggests that by disrupting the spread of disease at key network nodes where individuals
interact with each other and then connect with other geographic regions, a vaccine screen could be an effective tool for the protection of public health.18 The legal analysis suggests that a
vaccine screen could be a legally viable tool for the protection of public health, falling squarely within the authority of the federal government. Of course, vaccinations are not our only tool to
address the problem of air travel and infectious disease.19 In particular, the CDC maintains a “Do Not Board” list, which prohibits certain individuals from flying domestically or internationally
if they have a communicable disease that presents a public health risk.20 A primary limitation of such policies is that they are only effective for patients that have become symptomatic and
have received a diagnosis that was passed on to the CDC for a decision about whether to list the person. For contagious but asymptomatic people, or symptomatic people who have not yet
received a diagnosis, the Do Not Board list is ineffective. Another possibility is to use body scanning technologies or simple contact thermometers to attempt to identify infected persons who
may have higher body temperatures, but this strategy also has practical limitations, raising many false positives and false negatives.21 For the purposes of this initial foray into the question, let
us remain agnostic about the particular vaccines that would be included in such a screening policy (whether for measles, influenza, or Ebola), the logistics of implementing such a screen
(including the documentation required, ranging from documented immune response to a vaccine registry to a simple affirmation under penalty of perjury), and the scope and procedures for
any potential exemptions (medical, religious, or philosophical). These variations will be important practically, politically, and legally, but a more general analysis is useful to frame the question.
II. AIRLINE TRAVEL AND INFECTIOUS DISEASE Consider three mechanisms by which air travel may affect the spread of infectious disease. First, passenger-to-passenger transmission by contact
(i.e., touching, coughing, sneezing, etc.) is increased during air travel. Second, regardless of what happens between passengers on the airplane, the air travel of infected passengers is an
extremely efficient mechanism for rapidly distributing a disease across state borders and worldwide. This Article proposes a third, novel mechanism for air travel to reduce the spread of
infectious disease. If airline travel were the predicate for a vaccination mandate, it could serve as an important incentive for people to get vaccinated, thereby creating spillover benefitbis

The popular media portrays airline travel as if it were a


beyond the domain of air travel. A. PASSENGER-TO-PASSENGER TRANSMISSION

journey into an apocalypse, with disease at every turn. One headline reads: Horrific Hygiene On Flights Revealed: Poo On Tray Tables, Urine On
Seats And 80 Million Bacteria Living On Your Suitcase. 22 CNN reports that some tray tables are infected with MRSA (Methicillin-resistant Staphylococcus Aureus) at five times the rate of New

Mass media often


York subway poles, and warned about the airplane “lavatory as a major danger area for the spread of disease during the H1N1 flu and SARS epidemics.”23

cites survey data, which suggests that flying on an airline dramatically increases—by over 100 times—
the chances that an individual will be infected with any of the roughly 200 viruses known to produce the common cold.24 The scientific literature is
more sober and relatively undeveloped, but it leaves grounds for concern.25 Means of microorganism transmission can be organized into

four main categories: contact, airborne, common vehicle, and vector borne.26 Contact transmission includes both direct and
indirect body-to-body contact, as well as transmission by large droplets spread by an infected person sneezing, coughing, or talking.27 Of concern to air travelers are
those diseases that are airborne and spread by contact, such as diphtheria, pertussis, pneumococcal
disease, various forms of influenza, poliovirus, measles, mumps, rubella, varicella, tuberculosis,
meningococcal disease, SARS, smallpox, and Ebola.28 Diseases with fecal-oral transmission can also be of concern to air travelers, but this is more
likely to occur as the result of airlineassociated spread through food served on board.29 Airlines recycle about fifty percent of the cabin air,

which would seem to be an obvious vector for disease delivery.30 However, airlines usually filter and deliver the air vertically, from the
ceiling of the cabin, drawing it downward and out, before filtering it and mixing it with fresh air.31 Thus, the scientific literature suggests that when the ventilation system is working properly,

air quality probably does not contribute significantly to the passenger-to-passenger transmission of infectious diseases.32 Nonetheless, “[t ]ransmission becomes
widespread within all sections of the passenger cabin when the ventilation system is nonoperational, as shown by an influenza outbreak when
passengers were kept aboard a grounded aircraft with an inoperative ventilation system.”33 Scientists have also expressed worry that the low

levels of humidity aboard an aircraft may dry out the passengers’ mucous membranes, which
undermines the body’s natural ability to capture and destroy viruses and bacteria.34 Transmission of
diseases spread by contact—which includes large respiratory droplets from sneezing, coughing, or talking—is more worrisome.35
Tuberculosis is the most studied disease for spread aboard an aircraft; documented cases include a passenger traveling between
three American cities and infecting the skin of four of fifteen fellow passengers but not leading to any cases of active disease.36 The greatest “risk of disease

transmission is associated with a flight time of more than 8 [hours] and sitting within two rows of the
index passenger.”37 There have been reports, however, of diseases spreading more extensively. Measoterles infections, for instance, have been shown to spread to patients as
far as sixteen rows away.38 In another measles outbreak, an infected patient appeared to have infected another person flying on the same aircraft, as well as five other people who had merely
“visited at least one common departure gate.”39 On the other hand, over the course of a seven hour flight from Japan to Hawaii, a passenger with measles caused zero infections in 336
exposed passengers, presumably because the vast majority were immunized.40 There have also been various examples of transmission of SARS onboard an aircraft.41 Physical proximity to the
infected person during the flight was clearly correlated to risk of transmission.42 In one example, a flight attendant was infected after interacting with and touching the tray and food of an

Norovirus was
infected person.43 In another case, one infected person on a flight of 119 people was associated with potential transmission to twenty-two fellow passengers.44

also probably transmitted passenger-to-passenger on an airplane, but by a different mechanism:


contamination of the restrooms.45 Due to the specific epidemiology of norovirus, and because vomiting was contained to the restrooms, it is unlikely that airborne
droplets were the cause of transmission.46 Interestingly, all passengers suspected of norovirus infection reported that the restrooms were clean.47 This suggests that maintenance for the

prevention of disease transmission requires more than apparent cleanliness. T he flu has similarly been documented to spread aboard
airline flights. A 1972 outbreak of influenza A/Texas strain on a plane, where passengers were kept aboard for three hours without an operable ventilation system, “resulted in 72%
of all passengers about the airline contracting influenza within [three days].”48 The illness then spread to twenty percent of their family members within two weeks.49 Other cases of influenza

Finally, in addition to the


contamination on airplanes have involved patients seated as far as five rows away from the patient who brought the disease on board.50

accidental spread of disease person-to-person, there are real concerns that airline flights could be an
efficient way to distribute bioterrorism agents among hundreds of people in very close vicinity. Smallpox is
particularly worrisome in this regard. In one outbreak in Sweden the spread of smallpox was linked to an in-transit exposure that led to "24 secondary cases and four deaths."51 In short,

There are few other instances in


although the person-to-person spread of disease is not peculiar to airline travel, this context intensifies this risk factor.

modern social life where an individual person is in such closely proximity to strangers for such an
extended period of time while eating, drinking, and using the restroom. On the other B. THE FLIGHT AS A MEANS OF SPREADING
DISEASE ACROSS STATE LINES “Perhaps the greatest concern for global health . . . is the ability of a person with a

contagious illness to travel to virtually any part of the world within 24 [hours].”53 After the terrorist attacks of September
11, 2001, the ban on airline travel and the subsequent depression of the air travel market provided a natural experiment that demonstrated how air travel contributed to the rate at which a

disease spreads across the country. 54 We now know that the volume of travel is directly related to the rate at which influenza viruses spread within the United States.55 There are
documented cases of measles being spread around the country in this way. For example, in 1982 a young naval officer from San
Diego acquired the disease from a two-year-old child there, and then traveled to Washington State, where he then infected nine others.56 Only one of these individuals met him face-to-face;
the others were infected because they were on the same flight or in the same parts of the airport.57 More recently, a single outbreak of measles at Disneyland was then spread across the

The severe acute respiratory syndrome


country by travelers, creating 189 cases, spread across twenty-four states and the District of Columbia.58 “

(SARS),” which caused 774 deaths, “spread rapidly around the world, largely because persons infected with the SARSassociated
coronavirus (“SARS-CoV”) traveled on aircraft to distant cities.”59 As the CDC explains in its retrospective, “SARS, for the United States, was a travelassociated illness.”60 On an international

the spread of H1N1 has been correlated to the volume of international flights to and from a
scale,

destination.61 The implication of this study is that commercial airports can be mapped and the connections can be used as a means of limiting the spread of infectious diseases in the
future.62 Another study, also looking at H1N1, reached a similar conclusion: the volume of international traffic of a United States airport can be used to predict the United States arrival time of
a disease based on the disease’s point of origin.63 Similarly, Ebola was spread from West Africa and brought to and around the United States by airline travel, where the first patient then
infected two healthcare workers.64 One of those healthcare workers then traveled on a domestic airline to Ohio, where she was diagnosed.65 No transmission of the disease to fellow
passengers was documented.66 Overall, then, even if there was no risk of passenger-to-passenger spreading of disease on the airline, there are important concerns that airlines efficiently
move passengers from one geographic region, where there may be an outbreak, to another. Unvaccinated passengers are more likely to be so infected. C. FLYING AS AN INCENTIVE FOR

VACCINATION The foregoing discussion has shown that airline travel is an important way for a contagion to
quickly spread through contemporary society. Aside from blunting those causal mechanisms for the spread of disease, a vaccination
policy focused on airline travel could have secondary benefits for public health generally, since such a
mandate may cause more individuals to become vaccinated overall. On the margin, these higher rates of
vaccination will benefit public health in all the other areas where individuals may spread contagion,
including trains, subways, healthcare settings, restaurants, sporting events, and workplaces. Virtually
all Americans will want to fly at some point during their lives, and most Americans want to fly every year.67 Indeed, as of 2003,
only eighteen percent of survey respondents reported that they have never flown, and many of that small percentage were
younger individuals who simply have not yet had the opportunity to fly.68 Interestingly, families who refuse to vaccinate their children are also

more likely to have higher incomes and higher levels of education,69 and this is the profile of most
airline travelers.70 Some individuals will receive medical exemptions to any vaccine mandate, and a mandate keyed to airline travel may also recognize some religious or
philosophical exemptions, even though there is no constitutional requirement to do so. The remaining non-exempt individuals will likely number in the millions, depending on which vaccines

are targeted and the scope of any exemptions. These individuals will face the vaccination mandate as a choice between
either (a) not flying, or (b) becoming vaccinated. Some portion of those individuals will find the prospect of life without airline travel to be less
attractive than the prospect of life fully vaccinated. The size of this portion is an empirical question. We can hypothesize that the number of

individuals who become vaccinated due to an airline mandate may be substantial, since the benefits of
airline travel are so great. In qualitative terms, airline travel allows both leisure (seventy-eight percent of
all trips) and business (twenty-two percent of all trips).71 The leisure category involves visits with family, cultural traditions
such as Thanksgiving, and celebrations such as weddings. Because only thirty-seven percent of Americans
still live in their hometowns, there is an imperative to travel back to visit family and friends and to participate in important life events.72 The leisure
category also includes cultural attractions, such as museums and vacations to a wide range of
destinations. For example, twenty-one million Americans enjoy snow skiing or snowboarding every year, and
fifteen million Americans enjoy snorkeling, scuba, or sailing every year.73 A substantial portion of these individuals do not live near
locations where those sports are possible, and airline travel may be necessary to enjoy those activities.74 The business category involves a wide range of

opportunities, including sales, promotions, professional development, and conferences. In 2015,


estimates placed American business travel at over 492 million trips.75 For some jobs, a refusal to use airline
travel may be deeply problematic to career advancement or even retention. Another way to measure value is by assessing
the amount that individuals spend on airline travel. In 2011, Americans spent on average $342 per person on airfare.76 Basic economic theory suggests that the airline travel was worth at least
that much to these individuals, or else they would have been unwilling to spend it (preferring instead to keep the money).77 In this sense, $342 per year represents the minimum value of
flying, and therefore is a decent floor for our estimate of the incentive effects of an airline vaccine mandate. Of course, the airfare was likely only a means to an end—one part of a vacation

individuals
plan that may cost a few thousand dollars. For destinations where driving is infeasible, the actual value of the flight may be much greater than its airline fare. Of course,

facing a vaccine mandate will weigh it against the out-ofpocket costs involved with purchasing the
vaccine and any hassle involved in doing so. For individuals who have health insurance subject to the essential health provisions of the Affordable Care
Act, vaccines are covered without cost-sharing.78 Still, some individuals will lack such coverage and find the costs prohibitive, even
though they could otherwise afford to fly. This raises larger questions of health policy: is it rational to have a healthcare system where costs deter some individuals from securing vaccinations

that provide a collective benefit to the population? At least in times of an outbreak, it would be sensible for the government to fund the
vaccination out of general tax revenues. The similar context of vaccine mandates in healthcare workplaces provides analogical evidence as to the behavior of
people subject to a mandate. In a systematic review of twelve prior studies concerning such employer mandates, scholars found that six of the studies documented terminations and voluntary

Against these losses of workers, the mandates


resignations of 0.02-0.15% of the workforce.79 Other studies found between three to four percent.80

showed significant increases in vaccinations, often in the double digits, with all hospitals achieving greater than ninety-four percent
rates of vaccination among workers covered by the mandate.81 Whether these mandates alone are effective in reducing the spread of disease is another question.82 Similarly, there is
anecdotal evidence from physicians who have required that their patients choose between vaccination and finding another doctor. The phenomenon is surprisingly common—in one study of
Connecticut doctors, thirty percent fired patients for vaccine refusal.83 One doctor reports that upon instituting the discharge policy, approximately fifty to one hundred patients agreed to be

Overall then, an
vaccinated who otherwise would not have.84 Nonetheless the research on this phenomenon is surprisingly sparse; it should be a priority for future study.

unvaccinated, non-exempt person facing an airline vaccination mandate will have to heavily weigh the
costs of being non-vaccinated, including both the increased risk of disease and the inability to travel by air. Future survey research could provide more precise
estimates as to the scale of the effect that an airline vaccination policy may have on overall vaccination rates, and thus the effect on public health more generally. However, it is plausible that

a vaccine screen focused on airline travel would increase the levels of vaccination and thus have a
salutary effect on the control of infectious disease. III. THE EXISTING IMPETUS FOR AIRLINES TO ADOPT A VACCINE SCREEN This Part examines
whether reasons already exist for airlines to adopt a vaccination mandate policy. It considers market-based and liability-based reasons. A. MARKET-BASED REASONS AND LOGISTICS
Before examining the need for government intervention, it is worthwhile to consider whether the
airlines, as rational profit-seeking enterprises, may have marketbased incentives to adopt some sort of
vaccination policy. From the outset, it must be acknowledged that this is an odd inquiry: how could it possibly be in the airline industry’s interest to refuse some paying
passengers? Airlines are very sensitive to any suggestion that airline travel may be unsafe, and infectious

disease poses precisely such a threat to safety. During the Ebola outbreak in 2014, for example, airline
stock prices tumbled, destroying billions of dollars of company value based on fears that passengers
would stay away from airline travel if the outbreak were uncontrolled.85 Between September 2 and October 15, the airline index lost
sixteen percent of its value, more than double the losses of the S&P 500 during the same period; American Airlines alone lost more than a quarter of its company value.86 Similarly, during the

SARS outbreak of 2003, North American airlines lost over one billion dollars in revenue due to reduced passenger traffic.87 Scholarly surveys add weight to
these concerns: over three-quarters of respondents say that they would avoid public transportation
during a pandemic.88 As a strategy of managing a specific disease outbreak for which there is a vaccine available, it is plausible to imagine an
airline requiring passengers to be vaccinated in order to reassure the other passengers that it is safe to
fly. It is more difficult to assess whether airlines may have an interest in doing so for more routine infectious diseases, like measles or varicella, outside the context of a crisis. As noted
above, however, there may still be an incentive to avoid negative publicity about airline travel being

unhealthy, which appears in the mass media on a regular basis.89 So far, we have focused on the potential for infectious disease to
reduce air travel generally, but it is also possible for particular airlines to distinguish themselves from their competitors by adopting a vaccine policy. Such airlines could thereby brand
themselves as the cleaner, safer airline for passengers that prefer to fly with others who are similarly vaccinated. Of course, airlines also share airline terminals and security screening lines,

which prevents them from making a strong claim about relative infectious disease safety. Of concern for airlines will be the logistics of enforcing
any vaccine policy, as well as who will bear those costs. After the September 11 attacks, Congress created a $2.50 per leg of trip security fee,
which paid for the enhanced screening; previously, the airlines bore most of these costs themselves.90 Similarly, the cost of screening could be spread to

passengers, and could be performed collectively for all airlines. Alternatively, it could be borne by taxpayers
as a whole or by the airlines themselves. For a vaccine screen, these burdens could be minor or quite significant, depending on the modality used for checking
vaccination status and the scope of any such screen, whether applied to a particular, highly salient vaccination (e.g., Ebola) or to a wide range of vaccinations (some of which a passenger may

The move towards electronic medical records could facilitate this sharing of
have only received decades ago).

information about vaccine status, especially if the federal government specifies a particular standard
for data sharing, which otherwise also protects patient privacy. If airlines cooperated together to create such a standard, or if the federal
government actually did so, then an economy of scale could be achieved. Alternatively, for a particular, highly salient vaccine (e.g., Ebola or seasonal flu), providers could issue a card or

Another modality would be to simply provide the vaccination at the


electronic token that recipients could display at check-in.

airport itself, as some airports already do for the annual seasonal flu shot.91 While such a practice is
maximally efficient to reach all flyers at the point of service, the vaccine typically will not be immediately
effective.92 Nonetheless, it would be valuable as a rollout for the many flyers that travel repeatedly. The least onerous method would be simply
to require passengers to attest, under penalty of perjury, that they have received whatever vaccines the
airline wishes to screen, perhaps supported by random audits (similar to tax enforcement). There will, of course, be a
trade-off between how rigorous any protocol will be to ensure its accuracy, and the costs and burdens of having that level of screening. Herd immunity does not

require 100% attainment, which suggests that a low-hanging fruit strategy may be optimal, at least initially. A
vaccine screen may also have a different impact on domestic travelers, the vast majority of whom may
already have a particular vaccine, as opposed to the millions of international travelers annually, who may have much lower base rates of vaccination.93 Currently,
American immigration law requires vaccinations for those applying for permanent residency status, but
does not require vaccinations for temporary travel to the United States.94 Foreign travelers may also have difficulty showing
compliance with such a mandate if their healthcare providers do not speak English. Still, the World Health Organization (“WHO”) already plays a role in facilitating the communication of such
health information across borders.95 The U.S. State Department could also integrate such a mandate in its visa issuance and passport review procedures. Given that the index patients may

Aside from those administrative


well come from abroad, the effectiveness of any airline vaccine screen may depend on working out these logistics in particular.

costs and complications, the bottom line for a rational airline is whether a vaccine mandate would
ultimately increase or decrease the number of seats filled. This empirical question in part depends on what proportion of currently
unvaccinated and non-exempt passengers would stop flying rather than become vaccinated, and whether allayed fears of infectious disease would increase the number of flights taken by

On the other hand, it should be reassuring that the vast majority of Americans do not object to
others.

vaccinations,96 but more specific data about the likely behavior of consumers under such an airline screen is currently unavailable. If airlines do move towards a vaccine screen, they
may do so collectively. The airline industry suffers from market concentration, which makes competition along this
dimension less likely.97 B. LIABILITY-BASED REASONS If the market fails to produce an optimal level of vaccinations,
background liability rules may do so. In particular, tort law imposes upon airlines a duty of care to passengers
as well as to others on the ground who are foreseeably injured by airline operations. To be sure, although the airlines
are heavily regulated by the Federal Aviation Administration, state tort law remedies have not been altogether preempted. However, the
courts are split as to whether federal law substitutes the common law standard of care for a different, arguably lower, standard, which may be sufficient to incentivize airlines to take
precautions. We first review that common law standard, then consider the federal standard, and the divided authority as to which one applies. 1. The Duty to Screen Research does not reveal

Under state tort laws generally, as a common carrier, airlines


any case law directly on the point of airline liability for infectious diseases.

have a duty of care to their passengers to protect them against unreasonable risk of physical harm.
Traditionally, common carriers were held to an exacting standard approaching strict liability: “a duty of utmost care and

diligence to their passengers.”98 For example, as one court explained, “whether it be termed 'the highest standard of care,' 'highest degree of vigilance, care

and precaution for the safety of those it undertakes to transport,' or 'the strictest diligence,’” airlines
faced significant liability for their passengers’ injuries.99 The modern trend is towards a reasonableness standard that extends to risks that are
peculiar or heightened by the special relationship of trust and dependence, which exists between carrier and passenger.100 This special relationship would make it difficult for an airline to

Airlines also have duties to people on the


claim “nonfeasance,” as if it had no duty to protect one person from an infection caused by another.

ground. For example, an airline may be held liable for damages if the plane crashes into a car on the ground.101
In one case, the Second Circuit held that an airline could be liable for failing to adequately screen passengers against terrorists.102 The September 11 case discussed below is perhaps the most

airlines have themselves recognized their prerogative and duty


noteworthy such holding. With regard to ill passengers in particular,

with regard to the spread of disease. Many airlines already have a contract of carriage with a refusal to transport clause that specifies the airline’s ability to
prevent customers from flying if they have a contagious illness that may be transmittable to other passengers.103 Under the Federal Aviation Act (“FAA”), airline carriers also have specific
duties of care. The FAA enables the Administrator of the Federal Aviation Administration (an operating mode of the Department of Transportation) to prescribe “regulations and minimum
standards for [] practice, methods, and procedures the Administrator finds necessary for safety in air commerce and national security.”104 When prescribing these regulations, the

The actual duty of care


Administrator must “consider . . . the duty of an air carrier to provide service with the highest possible degree of safety in the public interest.”105

proscribed by the regulations, however, seems to be lower, merely prohibiting an airline from “operat[ing] an
aircraft in a careless or reckless manner so as to endanger the life or property of another.”106 Arguably, an airline
could act unreasonably even without being careless or reckless. More particularly, section 44902(b) of the FAA provides that an air carrier has discretion to

“refuse to transport a passenger or property the carrier decides is, or might be, inimical to safety.” 107 On
the basis of this statutory authority, for example, the FAA has promulgated regulations for the Secure Flight Program, a counterterrorism watch list.108 Under a prior version of the statute, a
state appellate court interpreted section 44902(b) to also allow the airline to refuse passage to a sick individual so as to not interfere with the airline’s duty to other passengers.109 But no

It is clear that the


such case has dealt with the issue of an airline’s potential liability to injured passengers for failure to refuse passage to a sick or unvaccinated individual.110

plaintiff’s right to a private cause of action has not been preempted by federal law.111 The FAA’s “savings” clause provides
that “[a] remedy under this part is in addition to any other remedies provided by law.”112 Nonetheless, authority is split on whether the federal

standard of care preempts the state common law standard of care.113 Moreover, the analysis depends on the particular theories of
breach asserted by plaintiffs.114 After the September 11 attacks, Congress created a victim’s compensation fund, which immunized the airlines from any claims by those who had taken such
compensation, but alternatively allowed non-claimants to recover from the airlines under state tort law, subject to a damages cap equal to their insurance coverage.115 The resulting litigation
is particularly instructive. The plaintiffs, consisting of classes of passengers as well as individuals injured on the ground by the crashing planes, claimed that the airlines were negligent in failing
to screen passengers; they never should have allowed passengers on board with box cutters.116 On motions for summary judgment, the trial court considered whether the airlines had any
duty at all to those on the ground and whether the terrorist acts were within the scope of that duty.117 The court held that “the Aviation Defendants controlled who came onto the planes and
what was carried aboard. They had the obligation to take reasonable care in screening precisely because of the risk of terrorist hijackings, and the dangerous consequences that would
inevitably follow.”118 On the preemption question, the court conceded that this was a domain where there “has been a history of significant federal presence,”119 and noted that courts had
“taken different positions on the scope of preemption in the aviation context.”120 The court dismissed any concern about preemption because the “[d]efendants ha[d] not shown any
inconsistency between the law of duty provided by New York law and federal statutes or regulations.”121 Therefore, the state law claims were allowed to proceed.122 The foregoing legal

to the extent that the risk of spreading contagious disease is foreseeable, airlines may
analysis suggests that,

face significant liability in at least some of the federal circuits if they fail to act reasonably with regard
to that risk. We leave to the side a more specific analysis regarding what sorts of precautions would be required under the circumstances as a fact-intensive question for a jury. But
the specter of liability seems real, at least so far. 2. The Duty Not to Discriminate In its grant of rulemaking authority to the FAA Administrator, while
requiring the “highest degree of safety” and, in particular allowing screening of passengers for safety, Congress also required that rulemakers weigh “the public right of freedom of transit
through the navigable airspace.”123 There is no regulation that restricts the airlines’ ability to screen on vaccination status in particular, but there are a range of policies related to
discrimination on disease status, which could indirectly implicate such a policy. The regulations do prohibit an air carrier from discriminating against a passenger with a disability, which
includes those that have a communicable disease or infection unless the air carrier “determine[s] that the passenger’s condition poses a direct threat.”124 The airline may assess the condition
of a “direct threat” by relying on “directives issued by public health authorities (e.g., the U.S. Centers for Disease Control or Public Health Service; comparable agencies in other countries; the
World Health Organization)” and by “consider[ing] the significance of the consequences of a communicable disease and the degree to which it can be readily transmitted by casual contact in
an aircraft cabin environment.”125 The regulation provides examples of direct versus non-direct threats such as the common cold, which is highly transmissible but lacks severe health
consequences; thus, it does not pose a direct threat.126 This is in comparison to SARS, which is highly transmissible and has severe consequences, thus posing a direct threat to other
passengers.127 Applying these principles, in Adamsons v. American Airlines, Inc., the Court of Appeals of New York held that an airline permissibly refused passage to an individual in extreme
pain due to an undiagnosed, mysterious illness.128 There, the passenger was stricken with an illness while visiting Haiti, and the illness left her in a wheelchair with a catheter.129 While
boarding the plane from her ambulance, she cried out in pain and the airline decided that the plaintiff's health, as well as the safety of the other passengers, would be jeopardized if she was
allowed to travel on that flight.130 Reading § 44902, the court found that Congress “makes it abundantly clear that the decision to accept or refuse a passenger for air carriage lies exclusively
with the airline.”131 Based upon considerations of safety and problems inherent to air travel, as long as the airline exercised discretion in good faith and for rational reasons, the decision must
be accepted.132 On the other hand, airlines must transport a passenger with a communicable disease or infection if he or she presents a medical certificate, ensuring that the infection is not
communicable to other persons during the flight or describing conditions or precautions that would prevent transmission, and if the airline can feasibly carry out such measures.133 But, even
with a medical certificate, the carrier maintains the discretion to require the passenger to undergo additional medical review by the airline itself if the certificate “significantly understates the
passenger’s risk to the health of other persons on the flight.”134 The agency’s response to public comments under the final rule as promulgated clarifies that the “additional review would
have to be conducted by medical personnel (e.g., members of the carrier's medical staff or medical personnel to whom the carrier referred the passenger)” and does not give unbridled
discretion to “staff to disregard medical certificates presented by passengers from their own physicians.”135 Formally, these provisions are irrelevant to a screen based on vaccination status,
since a passenger’s decision not to vaccinate is not itself a disability.136 Of course, some individuals could successfully claim that they have a medical condition, such as a compromised
immune system, which is a disability.137 If the disability prevents the passenger from safely receiving the vaccine, then the airline’s screen could be discriminatory.138 So, unless the
unvaccinated individual poses a “direct threat,” current law likely requires that any vaccine policy include such medical exemptions. Indeed, the fact that some passengers will remain
unvaccinated for bona fide reasons increases the importance of getting everyone else vaccinated. More generally, however, it would be odd for a regulation to allow screening of a passenger
because she is not vaccinated against a given disease, but disallow the airline to screen passengers that are actually infected with that same disease but present a medical certificate. One could
argue for such a generally applicable policy, however, as being consistent with the spirit of the regulations, which discourage airlines from discriminating on the basis of actual disease status,
which may also be a legally protected disability. Screening of vaccination status may better protect fellow passengers, since the risk of contagion may exist even when symptoms are not yet
manifested at a level noticeable by airline personnel. The airlines are also prohibited from discriminating against passengers on the basis of religion.139 An exceedingly small number of
Americans are members of religions that actually prohibit vaccinations, but in some contexts, “religion” has been interpreted very broadly.140 Whether a generally applicable vaccine mandate
by a private party (i.e., the airline) burdens religion is another question.141 As the Supreme Court said in Prince v. Massachusetts, “the right to practice religion freely does not include liberty
to expose the community or the child to communicable disease or the latter to ill health or death.”142 If necessary, airlines could offer religious exemptions, but the scope and applicability of
those exemptions would need to be resolved in a way that does not undermine the effectiveness of the vaccine screen.143 For present purposes of considering the airlines’ liability for failing
to screen unvaccinated passengers, discrimination law presents no barrier. 3. Other Elements for Liability The foregoing has made it clear that, with regard to communicable diseases, airlines
do have a duty to passengers and others on the ground, regardless of whether that standard is given by state law or federal law. Beyond duty, for civil liability to apply, an injured person must
also show: (1) a breach of that duty; (2) that the breach was the proximate cause of the injury; and, (3) damages.144 Of these, breach and causation are most interesting. With regard to the
failure of an airline to screen on vaccination status, a plaintiff would have to show that screening was reasonable under the circumstances, which is to say that the airline knew, or should have
known, about the risk of exposing passengers to unvaccinated fellow passengers.145 This element would be easier to prove during a particular contagious disease outbreak. In weighing
breach, the court could consider the relative costs, such as administrative burdens, against the benefits of such precautions, such as the proven effectiveness of any particular vaccine at

Airlines know, or should know, that simply screening passengers who are obviously very sick, or
issue.146

who self-disclose their sickness, is not sufficient to exclude those carrying communicable diseases . On the
other hand, some older case law continues to be cited for the proposition that “to hold an individual negligent for transmitting an infectious disease, ‘it must be proved that the defendant
knew of the presence of the disease.’”147 On this doctrine, mere knowledge of the increased risk due to a passenger being unvaccinated would not suffice. Furthermore, the fact that airlines
are not presently screening on this basis would be relevant as an industry standard, although it would be considered by the factfinder as mere evidence of non-breach since the standard of
care is objective.148 Airlines could also benefit from the fact that leading texts on infectious disease and air travel have not recommended, or even focused upon, vaccination (until now).149
The airlines’ discretionary authority to exclude passengers provides a double-edged sword, which courts may read to either reiterate the airlines’ responsibility in this regard, or to give
deference to an airline if it does so in good faith, as in Adamsons discussed above.150 The causation requirement would also be challenging for a plaintiff, who would have to show that the
airline’s failure to screen was a but-for cause, or a substantial factor, in causing the plaintiff’s own infection. Case law provides no direct guidance here. Cases involving illnesses on cruise ships
are instructive, although research has failed to uncover cases focusing on failure to screen unvaccinated cruisers. Nonetheless, in Pettit v. Celebrity Cruises, Inc., the District Court for the
Southern District of New York found that, even if the cruise ship failed to sanitize passenger cabins, plaintiffs did not prove causation for upper respiratory tract infections (“URTI”) when only
3.3% of 1934 passengers visited the ship's infirmary with cold or URTI symptoms.151 The passengers’ close contact with each other before and during the cruise, both within and outside the
cruise ship, also confounded the causation analysis.152 Similarly in another case, a cruise passenger alleged that she had acquired meningitis, bacteremia, and osteomyelitis from a cruise
where the ship operator failed to screen crewmembers and properly filter the air. 153 Her case was dismissed for failing to plead causation in a way sufficient to satisfy Iqbal and Twombly,
which the court suggested would have, at the very least, required specific pleadings on information and belief that that other passengers or crewmembers were infected with the same

it will be challenging for an airline passenger to show causation unless she has both a
diseases.154 Accordingly,

molecular diagnosis of her own sickness and some evidence showing transmission or circulation by the
airline. The situation may be different when a major outbreak affects a large portion of passengers.155 At least for fairly exotic diseases like SARS and Ebola, public health authorities and
researchers routinely identify the specific infected passengers, specify their seats on the airlines, and then trace other passengers who were proximate to them, often using genomic analyses
to distinguish particular strains of the disease.156 Nonetheless, the literature in this domain is more suggestive than conclusive, depending on retrospective analyses, rather than anything like
the gold-standard of randomized trials.157 Still, a factfinder could find causation under the preponderance of the evidence standard (i.e., more likely than not) for a plaintiff who can identify
the particular patient who was allowed to board her same flight and then show both her own proximity to that patient and her subsequent, timely contraction of the disease with the same

it seems that the airline industry has some prudential market-based reasons to seriously
genetic profile. Overall,

consider screening passengers for vaccination status, at least when a potential outbreak is imminent
or happening. If a passenger, or person on the ground, is injured due to the airline’s failure to screen, then state laws, even if applying federal standards, do provide some bases for
holding airlines liable. Still the case for liability would be far from clear, and thus likely insufficient to cause airlines to fully internalize the costs of reasonable precautions to reduce the risk of

spreading infection. IV. A FEDERAL MANDATE FOR AIRLINE PASSENGERS TO BE VACCINATED A. NEW FEDERAL RULES UNDER EXISTING STATUTES As shown above, Congress has
authorized the Federal Aviation Administration to prescribe “regulations and minimum standards for
[] practice, methods, and procedures the Administrator finds necessary for safety in air commerce and
national security.”158 As of yet, no regulation has addressed the issue of passenger vaccination status. But under general statutory authority, both the FAA and the Department
of Health and Human Services may have sufficient authority to impose an airline passenger vaccination mandate. Even under current statutes, there are several mechanisms for doing so. One
attractive route would be for federal agencies to provide non-binding guidance for airlines, which advises them on how they should exercise their nowexisting rights to refuse to transport a
passenger they deem may be “inimical to safety.”159 Similarly, under the ACAA, an airline may refuse to board a passenger, who presents a medical certificate from her own doctor attesting
that she is not a danger to other passengers, if the airline nonetheless finds that the condition poses a “direct threat.”160 Arguably, the Federal Aviation Administration could issue
administrative guidelines and interpretive rules setting forth acceptable discretionary actions an airline could take in denying passage to unvaccinated individuals. This mode of regulation is

This mechanism of regulation


familiar to health law scholars, most notably because it is a primary mechanism used by the Food and Drug Administration.161

would not require the robust procedures for notice and comment, and would largely avoid judicial
oversight. In Association of Flight Attendants v. Huerta, the court held that the FAA’s notice concerning use and stowage of portable electronic devices aboard commercial and other
aircraft was not a “final agency action” subject to judicial review on petition by a union representing flight attendants.162 Because the notice did not impermissibly and substantially alter or
effectively amend the regulation that pertained to carry-on baggage on an aircraft, it did not violate the notice and comment requirements of the Administrative Procedure Act.163 Thus, the
court reasoned that the challenged notice was not a legislative rule carrying the force and effect of law because the guidance offered therein reflected nothing more than a statement of
agency policy or interpretive rule, and notice was not contrary to existing regulations.164 Here, the FAA could follow the justifications stated in Association of Flight Attendants and issue a
notice in accordance with 49 U.S.C. § 44902(b) and 14 C.F.R. § 382.21(b) providing guidance as a statement of agency policy to require passenger vaccination.165 Just as current guidance
outlines the parameters for a highly contagious and serious disease, like SARS, to be properly considered a “direct threat,” the agency could expand upon this type of example to include
situations where passengers are unvaccinated for communicable diseases, which are then prevalent and dangerous.166 By articulating specific directives for or against the screening of
passengers on vaccination status, federal guidance could also effectively create a safe harbor for airlines against potential passenger-plaintiffs who either become infected by an unvaccinated
passenger or complain of discrimination. An agency interpretation extending the “direct threat” language to individuals without proof of vaccination would facilitate plaintiffs’ negligence
claims for airlines that failed to comply, even if the interpretation was non-binding. Such an interpretation could support potential negligence claims that: (1) the airline failed to foresee risks
of a dangerous condition; (2) it failed to protect against it; or (3) the airline’s lack of a vaccination mandate was the proximate cause of a passenger’s contracted illness. One feature of such an
approach is that it may lead to airlines performing vaccine screening, without the judicial scrutiny that comes with state action.167 Federal agencies could also undertake formal rulemaking.
Interestingly, federal law imposes a particular sort of cost-constraint on FAA regulations, requiring the Secretary of Transportation to consent to those regulations likely to impose $250 million
or more on the industry or broader economy.168 It bears emphasis that Congress has also required that the FAA’s rules weigh “the public right of freedom of transit through the navigable

The TSA coordinates with


airspace.”169 The Transportation Security Administration (“TSA”) and the CDC are other potential rulemakers with existing statutory authority.

the FAA on aviation safety, including establishing protocols for notifying the FAA of suspected threats to
airline or passenger safety.170 It has established, in partnership with the CDC, a public health Do Not Board (“DNB”) list, which restricts certain individuals who meet
specific criteria from boarding commercial aircraft with communicable diseases.171 Vaccination status could be similarly

considered. Under the Public Health Service Act, the Secretary of Health and Human Services (“HHS”)
is authorized to take measures to prevent the entry and spread of communicable diseases from
foreign countries into the United States and between states.172 The authority for carrying out these functions has been delegated to the
Surgeon General and the CDC.173 Their rulemaking authority is remarkably broad in the domain of communicable disease. As the authorizing statute provides: [T]he Surgeon General, with the
approval of the Secretary, is authorized to make and enforce such regulations as in his judgment are necessary to prevent the spread of communicable diseases from foreign countries into the
States or possessions, or from one State or possession into any other State or possession. For purposes of carrying out and enforcing such regulations, the Surgeon General may provide for

such . . . measures, as in his judgment may be necessary.174 Overall, it is clear that federal agencies already have broad authority to require
vaccinations as a condition of airline travel. Whether, in any given case, such an exercise of authority would be reasonable is an open question. B. A NEW
STATUTORY MANDATE If airlines themselves do not begin vaccination screening, or if federal agencies do not exercise current authority to compel them to, then Congress could exercise its
authority under the Interstate Commerce Clause to impose vaccination screening on a national basis. In NFIB v. Sebelius, the Supreme Court considered whether Congress had the power
under the Commerce Clause and the Necessary and Proper Clause to require that individuals purchase health insurance, and answered the question in the negative.175 The Court “read
carefully” these clauses “to avoid creating a general federal authority akin to the [states’] police power.”176 The Court reiterated that, “our precedents read that to mean that Congress may
regulate ‘the channels of interstate commerce,’ ‘persons or things in interstate commerce,’ and ‘those activities that substantially affect interstate commerce.’”177 For the individual mandate,
the government’s theory was that “Congress may order individuals to buy health insurance because the failure to do so affects interstate commerce and could undercut the Affordable Care
Act's other reforms.”178 The Court struck down the “individual mandate [because] it does not regulate existing commercial activity,” but instead required individuals to purchase a product—
health insurance.179 The Court redeemed the mandate, nonetheless, under the taxing power of the federal government. A mandate for airlines to screen passengers for vaccine status has
none of these constitutional infirmities, and thus need not be framed as a tax. The proposed mandate is itself predicated on commercial activity: the purchase of an airline ticket. It applies only
to “those who by some preexisting activity bring themselves within the sphere of federal regulation.”180 And furthermore, it regulates channels and instrumentalities of interstate
commerce—the airlines, airplanes, and their passengers.181 Such a screening mandate would thus receive constitutional authority regardless of whether any particular flight crosses state
borders.182 Finally, if a vaccine reassures the travelling public and supports the many industries and consumers that depend on a stable airline industry, it also affects interstate commerce in a
way that is much more direct than the insurance mandate did.183 The federal government already imposes an intrusive security search on all travelers, and nobody supposes it is beyond the
Commerce Clause power.184 There can be little doubt that Congress has constitutional authority to regulate in favor of an airline vaccine screen. The Supreme Court has long recognized that
the Commerce Clause includes a power to regulate the spread of disease, by means including prohibiting travel in interstate commerce.185 Specifically, the federal quarantine and isolation
power rests on the authority of the Commerce Clause.186 In 1886, the Supreme Court recognized that Congress would have the power to undertake a “general system of quarantine,” which
would have the effect of abrogating all state laws on the subject “so far as the two are inconsistent.”187 Since 1944, the federal government has enjoyed this quarantine power, for a list of
diseases specified by the President’s executive orders.188 In one case, for example, a district court dismissed a habeas petition filed on behalf of an airline passenger who was ordered to
isolation in the United States after returning from Stockholm, Sweden, which was then suffering from a smallpox outbreak.189 The traveler was held in isolation during the incubation period
for the disease because she failed to produce a certificate proving vaccination.190 An airline travel vaccine mandate could theoretically impinge the right to travel (“RTT”), a concept found in
the penumbras of the Constitution. The Supreme Court has explained that: [T]he ‘right to travel’ . . . protects the right of a citizen of one State to enter and to leave another State, the right to
be treated as a welcome visitor rather than an unfriendly alien when temporarily present in the second State, and, for those travelers who elect to become permanent residents, the right to
be treated like other citizens of that State.191 Accordingly, most of the RTT cases have involved state restrictions, which tended to undermine the unity of the national government and the
equality of citizens hailing from different states.192 The proposed vaccine screen for airline travel does not tread on the interests actually protected by this right. Moreover, the hypothetical
mandate for vaccine screening restricts interstate travel, but only in one particular mode of transportation; individuals are still free to travel by other means.193 Ultimately, it would be
anomalous to suppose that this unenumerated right somehow constrains the power of the federal government to exercise its enumerated power to regulate the channels and
instrumentalities of interstate commerce. Finally, the Supreme Court has held that the right to travel only protects against “unreasonable” burdens.194 The RTT is no obstacle to an airline
screen. The Religious Freedom Restoration Act (“RFRA”), however, may be more of an impediment to such a mandate.195 This statute applies greater scrutiny than the Supreme Court’s First
Amendment doctrine when applied to laws of general applicability that only incidentally burden religion.196 RFRA applies when a federal law “substantially” burdens a person’s exercise of
religion, even if the law is neutral and generally applicable, such as a vaccine mandate keyed to airline travel.197 In Burwell v. Hobby Lobby Stores, the Supreme Court held that the Affordable
Care Act’s contraceptives mandate substantially burdened the exercise of religion for forprofit corporations, and that the contraceptives mandate did not satisfy RFRA’s leastrestrictive means
requirement.198 The court specifically distinguished future cases that may involve vaccinations, and no subsequent case has applied Burwell to strike down a vaccination mandate.199
Nonetheless, the ruling casts a shadow over all public health regulation, given that virtually any objector can cloak their objection in religious garb.200 If RFRA were interpreted to impinge on a
vaccination mandate, the government or the airlines could offer exemptions. If these were applied broadly, however, the vaccine screen may have little marginal benefit for public health over
existing incentives for vaccination. Instead, any such exemption should be narrow and onerous, in order to minimize the number of flyers who successful opt-out.201 Under RFRA, no such
exemption would be necessary if the vaccine mandate were understood to serve a compelling government interest and were also the least restrictive means of serving that interest.202 The
vaccine mandate arguably fits that bill. Finally, it is important to remember that RFRA is simply a statute, which Congress could overturn at any time. International law also limits federal
prerogatives in this domain. In 2005, the United States joined the International Health Regulations, (“IHR”) a WHO program, which, among other things, endeavors to develop public health
interventions at airports to prevent the spread of infectious disease and to minimize disruptions in international trade by “limiting unnecessary health based restrictions on international traffic
and trade.”203 The primary thrust of IHR focuses on the former goal, building state capacities and coordination of information and efforts to fight infectious disease.204 The IHR does,
however, also limit states from overreacting to an infectious disease outbreak, and instead purports to limit states from unilaterally imposing travel restrictions. 205 The IHR is unlikely to
present a real impediment to an airline vaccine screen. The United States already requires fourteen vaccinations for United States immigration.206 And, the WHO already recommends the
most common vaccines, especially for travelers.207 Thus it is not clear that there would be any conflict in an American policy mandate that applied a vaccine screen to airline travel, e.g., any
flight operated by a United States carrier, or landing or departing from a United States airport. Even if there were a conflict with the IHR, it would not be debilitating to such a policy. During the
Ebola outbreak, for example, Canada stopped issuing visas to residents and nationals of Ebola-affected countries.208 The WHO invoked the IHR to demand an official explanation from
Canada.209 When Canada clarified that its travel ban did not prohibit travel by Canadians themselves or to others already holding visas, it appeared to placate the WHO.210 Similarly, it is not
clear that the WHO would oppose a vaccination screen as a targeted method to reduce the spread of infectious disease, since it is not an outright ban on travel to or from and infected country.
Regardless, even if the WHO saw an American vaccine screen as non-compliant, it is clear that the IHR has no sanctioning mechanism.211 Over the longer term, a conflict with the United
States could erode the global consensus on the IHR, but it presents no practical impediment to implementation of a reasonable vaccine screen policy by the United States federal government.

Scholars and policymakers have overlooked the potential to screen airline passengers for
V. CONCLUSION

vaccine status as an important public health tool that can reduce the spread of disease between the
millions of people that fly on airplanes each year. Such a policy could also reduce the distribution of
disease inter-regionally, and potentially create an incentive for vaccination that creates positive
spillovers. Although airlines already have some market-based and liability-based reasons to adopt such a
vaccine screening policy, these may be insufficient. Federal rulemakers have authority to require
airlines to adopt such a policy, but if Congress chose to enact a new statute for this purpose, it would also enjoy validity under the Constitution and international
law.
Disease Advantage Counterplan
1NC
Text: The United States federal government should fine parents who fail to vaccinate
their children, excluding those who cannot do so for medical reasons.

Solves the disease advantage – empirically proven


Offit 17 -- Paul A. Offit is a professor of pediatrics at the Perelman School of Medicine at the University
of Pennsylvania and the author of Deadly Choices: How the Anti-Vaccine Movement Threatens Us All
(Basic Books, 2011). [6/18/17; When Parents Force the Government’s Hand on Vaccines,
http://www.thedailybeast.com/when-parents-force-the-governments-hand-on-
vaccines?source=twitter&via=desktop] MP

Germany is in the midst of a measles epidemic. By mid-April this year, the country had suffered 504
cases of measles, compared with 33 in the same period a year earlier. It isn’t a trivial infection—measles
often causes dehydration and pneumonia and occasionally encephalitis (inflammation of the brain). A 37-year-
old mother of three living in Essen has died from the disease. “Continuing deaths from measles cannot
leave anyone indifferent,” said Health Minister Herman Gröhe. Germany isn’t alone in its suffering. In March, the BBC reported
that measles epidemics were also occurring in France, Italy, Poland, Romania, Switzerland, and
Ukraine. No country, however, suffered more than Romania: During the first three months of 2017, it
had more than 3,400 cases and 17 deaths. In response to the outbreak, German health officials took an
unusual step: choosing to fine parents as much as €2,500 ($2,800) for failing to vaccinate their children.
To determine which parents could be penalized, Germany now requires kindergartens to report children
who aren’t vaccinated. Fining people to compel vaccination isn’t new. Indeed, one of the landmark cases in public health in the United
States centered on whether state or local governments, acting through their police powers, had the right to do it.
Scientific Diplomacy CP
1NC
Possible CP – have the US engage with other countries over vaccine implementation
Hotez 6 Peter J. Hotez is the Professor of Microbiology, Immunology, and Tropical Medicine George
Washington University, “The “Biblical Diseases” and U.S. Vaccine Diplomacy”,
https://www.brown.edu/initiatives/journal-world-affairs/sites/brown.edu.initiatives.journal-world-
affairs/files/private/articles/12.2_Hotez.pdf //DJ

Previous articles have discussed the theoretical and practical bases of incorporating vaccine research
and infectious disease control as a component of U.S. foreign policy.42 The modern era of vaccine
diplomacy began when the U.S. virologist Dr. Albert Sabin collaborated with his counterparts in the
Soviet Union to develop and test the live oral polio vaccine (OPV). After OPV was developed in the
United States in the mid-1950s, it was tested in millions of Soviet schoolchildren before being licensed in
the United States. Therefore, the development and testing of OPV was a joint U.S.-Soviet venture
occurring at the height of the cold war, shortly after the Sputnik launch in 1956.43 Conquering polio was
followed by additional U.S.-Soviet cooperation that led to improved formulations of the smallpox
vaccine and eventually to the global eradication of smallpox in 1977. Some of our greatest medical and
public health achievements were brought about because of back-channel scientific collaborations
between cold war adversaries. McNamara and Blight calculate that 160 million people died in twentieth
century wars.44 Ironically, this figure approximates the number of people whose lives have been saved
by vaccines since the start of the global Expanded Program on Immunization in 1980.45 Could similar
bilateral and multilateral biomedical research efforts apply to new U.S.- and European-based product
development public private partnerships (PD-PPPs) focused on developing improved control tools for
NTDs? PD-PPPs such as the Institute of One World Health46 and the Drugs for Neglected Diseases
Initiative47 are pioneering the development and financing of new chemotherapeutic drugs for NTDs,
while the Leishmaniasis Vaccine Initiative48 and the Human Hookworm Vaccine Initiative49 are
developing first-generation NTD vaccines.50 As they are researched, new generation NTD vaccines will
be incorporated into existing chemotherapy-based strategies. An important component of these drug
and vaccine development efforts includes cooperation with “innovative developing countries” (IDCs), i.e.
middle-income countries such as China, India, Indonesia, and Iran, which have the curious combination
of having achieved a high level of innovation and yet have great pockets of poverty and endemic tropical
diseases.51 Product development partnerships with these IDCs may represent a new theme of tropical
disease diplomacy. A second component of vaccine and medical diplomacy is an association noted
between the prevalence and incidence of endemic infectious diseases, infant mortality rates, under-five
childhood mortality rates, and the risk of a nation engaging in armed conflict.52 Since 1990,
approximately 80 percent of all wars have been fought in sub-Saharan Africa, Asia, and the tropical
regions of the Americas where multiple NTDs are co-endemic.53 Since many nations with the worst
health indicators are members of the Organization of the Islamic Conference (OIC), it is worth exploring
the impact of tropical infectious disease control as a component of foreign policy with OIC countries.5
Former secretary of state Henry Kissinger has pointed out that for a humanitarian intervention to be
effective, it must both be sustained by U.S. domestic opinion and, at the same time, resonate with the
international community.55 The biblical legacy of the NTDs, together with their enormous impact on
global health and poverty and the relatively low cost of NTD intervention efforts, satisfies these criteria.
Joseph Nye, Jr. has emphasized the high probability of success (“good consequences”) as an important
motivating principle for humanitarian intervention.56 The identification of deworming and other NTD
control measures as possible “quick wins” relative to other global health programs provides additional
optimism for their likely success as a form of U.S. humanitarian intervention.57 Incorporating NTD
control efforts and tropical disease diplomacy into a larger U.S. foreign policy framework is both a moral
imperative and an effective, low-cost means to better the human condition worldwide. Through the
new $15 million federal appropriation for integrating NTD control, the Bush administration and the U.S.
Congress are making a modest first step toward the front lines of combat against a group of forgotten
diseases afflicting people in the rural areas of lowincome countries. Expansion of this package in order
to incorporate NTD control into PEPFAR and other big three global health initiatives offers an
opportunity for the United States to assume leadership in this important area of international diplomacy
** Disadvantages **
India Pharma DA
1NC
Indian pharmaceuticals are being watched now --- it’s an aspiring regional leader
SHAMIM MONDAL AND VISWANATH PINGALI 11/2/15 --- Indian Institute of Management Programme Chairperson
PhD, Research and Publications & Professor. (“Competition Law and the Pharmaceutical Sector in India”, Shamim Mondal and
Viswanath Pingali, November 2, 2015, IIM, https://library.iima.ac.in/assets/snippets/workingpaperpdf/19305828832015-11-
02.pdf)//chiragjain

The Indian pharmaceutical industry is one of the major pharmaceutical industries in the world, both in
terms of volume of consumption and value of production. Further, given its critical importance, this industry has attracted
significant policy attention. Given the ever changing policy environment, it is only appropriate to assume that the

firms also adapt their strategies as per the policy environment, thereby altering the industry dynamics itself. For example, the Indian Patent Act in
the 1970s that had stipulated that there could only be process patenting as against product patenting, has led to the emergence of the generic pharmaceutical
industry, which
became a key player not just within India, but also around the world. Lots of research on
pharmaceutical markets was published; however, most of it is developed world centric. In spite of India being a huge market for
pharmaceuticals with the complete potential not being fully realized, precious little research work that characterizes the dynamics of this market has been
undertaken as of now. We conclude this chapter by discussing some of the important questions that need to be addressed in this market both from research and
public policy point of view, taking developing countries‟ perspective (more specifically, India). First issue that needs to be resolved is the trade-off between
availability of medicine at cheaper price with availability of innovative modern medicine. Differential pricing or negotiated pricing between the innovator and the
government might be the way forward. Further, incentivizing pharmaceutical companies to produce drugs that are meant for India specific problems (through
patent extensions, subsidizing R&D, etc.) might be a way forward. Further,
encouraging innovators to invest in research and
development, and manufacturing within India for indigenous consumption could be another way in
which prices for innovative medicines can be lowered.60 Such initiatives might work with the current government‟s schemes like
Make in India and Atal Innovation Mission. Another issue that needs to be addressed is the price-quality paradox. Ensuring highest quality requires huge
investments, which is often reflected in the price. Given that majority of India does not have prescription insurance, this high price drastically reduces affordability.
On the other hand, lack of quality medicines involves other side effects from spurious medicines, which could be difficult to comprehend. Therefore, is the answer
to this debate universal, or is it therapeutic area specific, becomes a relevant question to be answered. This question becomes even more pertinent with regards to
expensive and complicated medicines like biological drugs. The other area where the policy needs to focus on is advertising. Pharmaceutical advertising can be of
two kinds: informative and persuasive. While informative advertising informs the physician of the new advances, persuasive advertising, as the name suggests is
intended at persuading the doctor to prescribe a particular brand. While informative advertisement can be useful, persuasive advertising can be modelled as
prisoners‟ dilemma. All pharmaceutical companies invest in it, and as a result no one gains substantially. However, these expenses are recovered through higher
drug prices, thereby harming total welfare. As long as branded generics exist, persuasive advertising is likely to continue as various pharmaceutical companies vie
for doctors‟ attention.61 It also generates other externalities.
But can India afford to move from branded generics to pure
generics market (as is the case in the US, for example)? And under what conditions is such move even possible? One of the offshoots of
advertising is that it can act as a significant barrier to entry. At the same time, lack of promotion can be counterproductive to health outcomes, especially where
quality is not uniformly regulated.These are some of the questions that need to be addressed globally. There is a substantial difference in affordability of medicines
in India across geographies, income classes etc. A major question that arises in this case is, whether or not innovative pricing mechanisms can be used as a means
through which this gap can be addressed. A more pertinent question is whether or not differential pricing (between urban and rural, for example) is indeed
sustainable in a country like India. One could, for example, consider negotiated pricing for government hospitals across various geographies. For such differential
pricing to work seepages across markets have to be plugged so that arbitrage opportunities that arise of difference in pricing are not prevalent. These questions are
not just important from the Indian standpoint alone; any developing country that aims at a robust pharmaceutical industry that aims at fostering competition,
innovation and welfare needs to contemplate on these issues. Therefore, the
policies adopted by the Indian authorities are being
keenly watched in the international arena; this may provide India with an opportunity to exhibit
thought leadership to countries like China, Russia, Brazil, etc.

Vaccines are the newest field in pharmaceuticals --- it has the highest profit margin
too
TIMOTHY GUZMAN 1/26/2016 -- Global Segment Director at Freudenberg-NOK Global Research Center --- (“Big Pharma and Big
Profits: The Multibillion Dollar Vaccine Market”, Timothy Guzman, January 26, 2016, Global Research, http://www.globalresearch.ca/big-
pharma-and-big-profits-the-multibillion-dollar-vaccine-market/5503945)//chiragjain

The business of vaccines is soon to become a major source of profits for the world’s largest
pharmaceutical corporations. A press release (Business Wire, January 21st 2016) published by marketwatch.com says that Technavio, one of the
leading technology research and advisory companies in the world predicts that pharmaceutical corporations who produce vaccines will reach an estimated $61
billion in profits by 2020. Today the vaccine market is worth close to $24 billion. The report titled ‘Global Human Vaccines Market
2016-2020’ gives an “in-depth analysis” of the possible revenues and “emerging market trends” globally. According to the Press Release: The report study

indicates that the introduction of new products is fueling the growth of the market. Moreover, the significant
expansion of the current product offerings is also expected to boost the market growth. Due to the increasing
prevalence rates of various infectious diseases such as diphtheria, influenza, hepatitis, pneumococcal diseases, and meningococcal diseases, there has been a
notable increase in the use of vaccines across the globe What is interesting about the report is that Pharmaceutical
corporations are targeting Latin America and the Caribbean with its new vaccines soon to be on the
market. Merck & Co, Pfizer and GlaxoSmithKline (GSK) are expected to dominate Latin America and the Caribbean (Puerto Rico currently operates as a
manufacturing hub for Merck, Pfizer and Abbott Laboratories): In terms of geography, the Americas dominated the global human

vaccines market in 2015, accounting for about 45% of the total revenue. The US was the largest revenue
contributor to this region in the same year, capturing a significant portion of the global market. The Americas
will continue to dominate the human vaccines market during the forecast period because of the increase in the prevalence of infectious diseases and cancers. In
addition, increase in strategic alliances with expected entry of novel vaccines, is also expected to propel the growth of the market in this region The report also says
that there are two types of human vaccines, Therapeutic (cancer, metabolic disorders, chronic illnesses, and infectious diseases) and
Preventable human vaccines markets (pediatric vaccinations) that
are estimated to reach $55 billion worldwide. The Atlantic
magazine published an article in 2015 titled ‘Vaccines Are Profitable, So What?’ Author Bourree Lam says: While the main fixation of anti-vaccine groups is an old,
discredited study linking vaccination to autism, another is a conspiracy theory circulated online that both doctors and pharmaceutical companies stand to profit
financially from vaccination—which supposedly leads to perverse incentives in advocating for the public to vaccinate. But that argument is historically unfounded.
Not only do pediatricians and doctors often lose money on vaccine administration, it wasn’t too long ago that the vaccine industry was struggling with slim profit
margins and shortages. The Economist wrote that “for decades vaccines were a neglected corner of the drugs business, with old technology, little investment and
abysmal profit margins. Many firms sold their vaccine divisions to concentrate on more profitable drugs” Maybe it was true at some point in time that
manufacturing vaccines were unprofitable, but in today’s world, it’s all profits. What motivated pharmaceutical corporations to focus on the vaccine market in the
last decade or so according to The Atlantic? Since 2000, the Gavi Alliance has provided vaccination for 500 million children in poor countries, preventing an
estimated 7 million deaths. GlaxoSmithKline reported that 80 percent of the vaccine doses they manufactured in 2013 went to developing countries. Additionally,
vaccines that could turn a profit in high-income countries—constituting 82 percent of global vaccine sales in terms of value, according to the World Health
Organization—hit the market Lam also wrote that there were “two “blockbuster” vaccines also hit the market: pneumococcal conjugate for meningitis and other
bacteria infections, and a vaccine for human papillomavirus (HPV). The industry grew”. Merck is the only pharmaceutical giant licensed to produce and sell the
measles vaccine called Prodquad and theMMR II (also used for the measles, mumps and rubella) and Varivax, a vaccine for the chicken pox. According to Lam, all
three vaccines combined amounted to more than $1.4 billion in sales profits for Merck in 2014. The controversialHPV vaccine, Gardasil also brought in $1.7 billion in
profits for Merck. “While a spokesperson for Merck told The Atlantic that vaccines remained one of its key areas of focus—it generated $5.3 billion in sales in
2014—she did not comment on the profit margins” Lam wrote. Of course the Merck spokesperson would not comment on the profitability of vaccines because
Merck would expose itself to more controversy. Analysts say that the profit margin is“between 10 to over 40 percent.” Lam also says that “while the vaccine
industry is likely more profitable now than in the 1970s or 1980s, this is the result of global market forces”. Lam forgot to mention that billionaire couple Bill and
Melina Gates pledged at least $10 billion for worldwide vaccination programs supposedly to combat polio and the measles, this is where Merck & Co profit. It is also
well known that Bill Gates appointed the former president and CEO of Merck, Raymond Gilmartin to the board of directors of Microsoft which lasted for more than
11 years before he announced his retirement in 2012. Are pharmaceutical corporations motivated by profits? “Profits from vaccine production aren’t a valid
argument against vaccinations—the most important question is whether vaccines are safe and effective, and the answer is unambiguously yes” wrote Lam. In 2015,
Former Merck Employee and whistleblower Brandy Vaughan Spoke out against the state of California’s vaccination mandate bill SB277 and said: The U.S. gives more
vaccines than any other country in the world. Our childhood schedule for under the age of one has twice as many vaccines as other developed countries. What else
do we have? The highest infant mortality rate of any developed nation. Finland has the lowest. They only give 11 by age six. Mississippi has the highest rate of
vaccination in the U.S.–highest infant mortality rate. These numbers do not lie. But you will not hear that on the media, and that is not what Senator Pan will tell
you. What we have with vaccines is the highest profit margin pharmaceutical drug on the market. Drug
companies make more money off vaccines than they do any other pharmaceutical drug, in terms of profit
margin. There is a lack of rigorous safety studies. And they don’t have the incentive to do them because they have no liability. Vaccines are the only

products in the U.S. that do not have liability. You cannot sue for injuries or death. But that is only in the U.S.
Around the world, there are law suits because of serious injuries and deaths because from vaccines. In Spain over Gardasil. In Japan over Gardasil. The flu shot was
taken off the market for under five in Australia after deaths and injury. Prevnar was banned in China. Pfizer’s vaccination program was kicked out of the country.
France just pulled Rotavirus off their schedule after infant deaths and injuries With
a forecast of $61 billion in projected sales, rest
assured new vaccines will be developed for almost anything. Actor and comedian Jim Carrey did say that “150 people die every
year from being hit by falling coconuts. Not to worry, drug makers are developing a vaccine”. With 271 vaccines in production, Jim Carrey’s comments, which were
criticized by the mainstream media, may not be so farfetched after all.
Pharmaceutical industry is key to maintain the indian economy
JIM BUTSCHLI 8/20/2013 --- Editor in Chief of Healthcare Packing Chief Reporter on Economic Policies --- (“India in financial free fall?”,
Jim Butschli, August 20, 2013, Healthcare Packaging, www.healthcarepackaging.com/article/trends-and-issues/global/india-financial-free-
fall)//chiragjain

The story adds, “India is grappling with a huge budget deficit…Economic growth slowed to a dismal 5 percent
last year, the lowest in a decade. Prices are spiraling. Foreign investors are no longer lining up; some are even packing up.” Despite such
pessimistic economic news, recent studies suggest an optimistic future for the country’s
pharmaceutical sector. An Aug. 20 press release entitled, “World’s pharmaceutical development manufacturing
base moving to India,” reports that the India Brand Equity Fund (IBEF) predicts that the “Indian pharma market is now at
the precipice of the next stage in its development, having seen manufacturing innovation and development technologies
rise—thanks to the explosion in generics production.” (Related: Hospira Recalls Already-Scarce Sodium Bicarbonate) The press release says,
“Over the last three years exports of pharmaceuticals (largely generics) have grown at over 21.5%
[Compound Annual Growth Rate] and now account for over $13bn in annual sales. Highlighting India’s dominance, nearly 40% of Abbreviated
New Drug Applications (ANDA) received by the [U.S. Food and Drug Administration] in 2012 were from India, with a further 87 confirmed and
another 25 already received between January and June 2013. “This
huge growth in generics production has seen the
country become a hotbed of manufacturing innovation—India has over 3,000 DMFs registered with FDA—which
coupled with increased investments in R&D means India is now ready to challenge traditional big
pharma and start producing more patented products. A natural evolution of the success of the generics market has been the rise in
supergenerics across India where much R&D spend is currently being invested.” (Related: FDA Denies Pfizer’s Epogen Biosimilar… Again)
Wikipedia’s online description of India’s economy notes, “The pharmaceutical industry in India is among the significant emerging markets for
[the] global pharma industry. The Indian pharmaceutical market is expected to reach $48.5 billion by 2020. India's R & D spending constitutes
60% of [the] biopharmaceutical industry. … India is among the top 12 Biotech destinations of the world.” It adds, “According to a 2011
Pricewaterhouse Coopers report, India's GDP at purchasing power parity could overtake that of the U.S. by 2045. …During the next four
decades, Indian GDP is expected to grow at an annualized average of 8%, making it potentially the world's fastest-growing major economy until
2050. (Related: As Physicians Shift From Private Practice To Hospital-Based Practices, Drug Advertising Increasingly Targets Consumers)
Manufacturing and packaging Drilling down to the packaging function, Freedonia’s June 2013 “World Pharmaceutical Packaging Market”
predicts world pharmaceutical packaging demand to increase 6.4% annually to $90 billion in 2017. “Among
all countries,” the report
says, “India and China will record the fastest growth in product demand due to rapidly expanding
pharmaceutical manufacturing capabilities, burgeoning drug exports, and the phasing-in of an extensive government program
designed to upgrade the quality and integrity of nationally produced medicines. (Related: Global Control Preferences Color New
Serialization/Aggregation Lines) In its “World Corrugated Boxes” study, Freedonia forecasts global demand for corrugated boxes to increase
4.2% per year to 234 billion square meters in 2017. The report says, “The fastest increases in demand for corrugated boxes will occur in
developing regions; the Asia/Pacific region and the Africa/Mideast region will both outpace the global average. India and China will see the
fastest gains as a result of strong growth in industrial output and consumer product markets.”

Indian economy is key to stability --- cascades to Indo-China and Indo-Pakistani


conflicts
DAVID ROBINSON 6/17/2010 --- Edith Cowan University, School of Communications and Arts, Faculty Member, Ph.D
(“India’s Rise as a Great Power”, David Robinson, lFort Blog, June 17, 2010, https://lfort.wordpress.com/2010/06/17/indias-
rise-as-a-great-power/#_ftn21)//chiragjain

Over the last decade there has been an increasing focus on India’s economic and military expansion, and
its consequences for South Asia and the world. India is rapidly rising to become a great power, but its
ascent depends on maintaining relative domestic stability, and carefully crafting its policies towards the
United States and its neighbours Pakistan and China. All four states are nuclear powers, so the
consequences of any conflict between them are potentially dire.[1] India has found the post-Cold War
international environment amenable to expansion of its bilateral ties with all the major powers
simultaneously, and has thus pursued a strategy of ‘poly-alignment’ – seeking to be a ‘bridging power’ between the sometimes competing poles of the
United States, Russia, China, and the European Union.[2] This inverts India’s traditional non-alignment policy, allowing India
to reap the benefits of closer economic and strategic ties while maintaining the same spirit of balanced
international relations.[3] To a degree this arises from uncertainty about the shape of the emerging international order, and India’s own lack of a
credible vision of its place in that environment.[4] Nonetheless, its growing wealth and population is now enabling India to

build up its military might, and as “a multi-cultural, multi-ethnic democracy … India is being asked to shoulder global responsibilities in consonance
with its rising global stature”.[5] This paper will consider India’s rise as a global power, and the likely regional and global implications, through a specific focus on its
relations with its strategically significant neighbours Pakistan and China, and argue that fundamentally the balance of power between them will not change
dramatically in the near future. The Rise of India: As Indian power increases it will inevitably challenge existing political, economic and military patterns, but as
Harsh Pant argues, “India
continues to be ambivalent about power, it has failed to develop a strategic agenda
commensurate with its growing economic and military capabilities … throughout history, India has failed to master the
creation, deployment and use of its military instruments in support of its national objectives”.[6] From independence in 1947 Indian Prime Minister Jawaharlal
Nehru pursued a strategy of non-alignment that sought to avoid participation in the Cold War, prioritising multilateral institutions and the Non-Aligned Movement.
Indian policy was always opposed to the use of military force in international relations.[7] However, as India begins to assert itself as a regional power it is today
moving to convert its ‘brown-water’ navy into a ‘blue-water’ navy and is expanding the reach of its air force, moving beyond border control and demonstrating
greater concern for strategic issues, such as the protection of shipping lanes.[8] While maintaining constructive relations with the United States, India has also been
involved in trilateral dialogue with China and Russia, increasingly sharing their vision of a multipolar world based on consensus among the major powers. India has
also become a non-voting member of the Shanghai Cooperation Organisation (SCO), through which China and Russia have sought to strategically counterbalance
NATO advancement into the Middle East and Central Asia.[9] At the same time, it is China’s
conventional and nuclear capabilities that
many argue remain the primary military threat to India’s security and the key motivation for India’s own
nuclear weapons program; while the United States, under the G.W. Bush administration, negotiated a substantial deal that would assist India’s
‘civilian’ nuclear development. India’s other major challenge comes from its unstable neighbour Pakistan, with which full-scale war and nuclear exchange have been
avoided despite clashes in the Kargil region of Kashmir in 1999, and attacks on India by Pakistani-backed terrorists in 2001 and 2008.[10] The
collapse of
the Soviet Union and the 1991 Gulf War confronted India with an unprecedented financial crisis, as India
simultaneously lost access to Eastern European markets, global oil prices spiked, and over 100,000
Indians were repatriated from the Gulf region, thus precluding their remittances. These economic shocks forced a
dramatic rethink of Indian economic and foreign policies. Under Prime Minister Narasimha Rao India steered towards greater
economic liberalisation and diplomatic diversity. The Rao government sought greater engagement with the United States

and China, as well as making overtures to Israel and seeking improved relations with Southeast Asia through a ‘Look East’ policy.[11] Since then India’s
average GDP growth rate has hovered at around 7 percent, and the Asian Development Bank (ADB) has
predicted that in spite of the global financial crisis, India’s growth should remain at 6.5 percent in
2010.[12] Not only has India maintained this amazing economic growth, but it is also envisaged that in the next two decades India’s population “will surpass
China’s to make it the world’s most populous country, and its rapidly expanding middle class may constitute up to 60 percent of its 1.3 billion-plus people”.[13]
Internationally the Indian diaspora now numbers over 20 million, and is relatively affluent, successful, and well-integrated –
spreading India’s ‘soft’ cultural influence.[14] While the approximately 3.7 million Indian nationals now living in the six Gulf (GCC) states specifically remit around $8
billion annually.[15] Despite India’s meteoric economic development, it can be said
India has both the best of the First World and the
worst of the Third World within its borders, and faces unprecedented human security challenges.[16] India
now has 410 million people living below the U.N. poverty line – 37.2 percent of its population and actually 100 million more people than in 2004 – and millions of
India’s rural poor are faced with food price inflation of up to 17 percent.[17] 60 percent of Indian labour is still agricultural, and the integration of hundreds of
millions of peasants into a modern economy may be an extremely painful process.[18] And while
Indian infrastructure such as roads, civil
aviation, ports, and telecommunications have experienced noticeable improvements in recent years,
electricity, railways, and irrigation all still need significant investment; and India continues to lag in social infrastructure, such
as education and healthcare.[19] These social inequalities have fuelled the widespread ‘Naxalite’ Maoist insurgency affecting vast areas throughout eastern and
central India, and whose 20,000 insurgents current Prime Minister Manmohan Singh identified as the “greatest internal security threat” facing the nation.[20]
These internal issues pose the first challenge to India’s rise as a great power, as external projection must be based on
a firm foundation of domestic stability. The requirements for domestic stability also shape India’s international needs .

Pant asserts that, “The biggest challenge for India remains that of continuing to achieve the rates of

economic growth that it has enjoyed in recent years. Everything else is of secondary importance. … Unless India can
sustain this momentum, its larger foreign policy ambitions cannot be realized”.[21] The political stability
of India (and similarly its neighbour China) “is absolutely dependent on continued economic
dynamism,
2NC Link
Vaccines are boosting the pharmaceutical agency in the status quo
AP 11/17/2009 --- Associated Press is a non partisan news agency – cites experts on the pharma industry (“Vaccines market
gives pharmaceutical industry a boost”, Associated Press, November 17, 2009. TrueJersey,
http://www.nj.com/business/index.ssf/2009/11/vaccines_market_gives_pharmace.html)//chiragjain

Malaria. Tuberculosis. Alzheimer's disease. AIDS. Pandemic flu. Genital herpes. Urinary tract infections. Grass allergies. Traveler's diarrhea. You
name it,
the pharmaceutical industry is working on a vaccine to prevent it. Many could be on the market in five
years or less. Contrast that with five years ago, when so many companies had abandoned the vaccine business that half the U.S. supply of flu shots was lost
because of contamination at one of the two manufacturers left. Vaccines are no longer a sleepy, low-profit niche in a booming

drug industry. Today, they're starting to give ailing pharmaceutical makers a shot in the arm. The lure
of big profits, advances in technology and growing government support has been drawing in new
companies, from nascent biotechs to Johnson & Johnson. That means recent remarkable strides in overcoming dreaded
diseases and annoying afflictions likely will continue. "Even if a small portion of everything that's going
on now is successful in the next 10 years, you put that together with the last 10 years (and) it's going to be characterized as
a golden era," says Emilio Emini, Pfizer Inc.'s head of vaccine research. Vaccines now are viewed as a crucial path to growth,
as drugmakers look for ways to bolster slowing prescription medicine sales amid intensifying generic competition and
government pressure to cut down prices under the federal health overhaul. Unlike medicines that treat diseases, vaccines help
prevent infections by revving up the body's natural immune defenses against invaders. They are made from
viruses, bacteria or parts of them that have been killed or weakened so they generally can't cause an infection. Investment in partnerships and

other deals to develop and manufacture vaccines has been on a tear — and accelerating since the
swine flu pandemic began. Billions in government grants are bringing better, faster ways to develop and
manufacture vaccines. Rising worldwide emphasis on preventive health care, plus the advent of the first multibillion-dollar vaccines, have further
boosted their appeal. While prescription drug sales are forecast to rise by a third in five years, vaccine sales should double, from $19 billion last year to $39 billion in
2013, according to market research firm Kalorama Information. That's five times the $8 billion in vaccine sales in 2004. "What
was essentially 25
years ago a rounding error now has become real money," says Robin Robertson, director of the U.S. Biomedical Advanced Research
Development Authority. That jump is due to a couple of new blockbuster vaccines and rising use of existing ones. The
government's list of recommended vaccines for children since has more than doubled since 1985 to 17. It now also calls for a half-dozen vaccines for everyone over
18 and up to four more for some adults. The
last decade brought breakthrough vaccines against pneumococcal disease
and rotavirus — two of the world's top killers — meningitis, cervical cancer and more. Better technology to create and mass
produce vaccines is bringing progress in preventing tropical dengue fever and new threats like superbugs MRSA and C. difficile, even ending
addiction to cocaine and nicotine. Success on some vaccines in development, particularly for Alzheimer's and AIDS, likely would bring billions a year in sales. Just this
fall and early next year, the swine flu vaccines are expected to bring their makers at least a couple billion extra dollars. That's despite the five manufacturers for the
U.S. not being able to meet an optimistic plan to first make seasonal flu shots and then produce 120 million doses of swine flu vaccine by mid-October — an
unprecedented task. But they are steadily catching up with demand. Unlike most vaccines now "manufactured" in mammal, yeast or other cells — quickly, purely
and at high yields — flu vaccines are still grown over many weeks in chicken eggs because it's economical and those newer, faster methods aren't U.S.-approved yet.
Because swine flu vaccine grew slower than expected, there have been shortages — and lines of anxious consumers. But a horde of biotech
companies, many using multimillion-dollar government grants, already are testing state-of-the-art
technology for the next pandemic. Scientists — including some at J&J's new vaccine partner, Holland's Crucell NV — even are working to
develop the holy grail: a universal flu vaccine targeting a part of the virus that doesn't change year to year. And some future vaccines will come in

patches, pills and nasal sprays, rather than painful shots. In the last century, vaccines dramatically lengthened
lifespans by stopping diseases that killed or disabled millions, from smallpox to polio. After all those successes,
many pharmaceutical companies instead focused on lucrative daily pills for chronic diseases. By the middle of this decade, only a handful were still making vaccines,
which are harder to produce than chemical-based pills, making yields unpredictable. That led to the 2004 fiasco when half the U.S. flu shot supply was lost
overnight, plus continuing periodic shortages of some kids' vaccines. Today, five companies supply flu vaccine: GlaxoSmithKline, Switzerland's Novartis AG,
Australia's CSL Biotherapies, MedImmune, part of Britain's AstraZeneca PLC, and France's Sanofi-Aventis SA. There's
been more research on flu
vaccines in the last five years than in the previous 20, notes Dr. William Schaffner, Vanderbilt University's head of preventive
medicine and a spokesman for the Infectious Diseases Society of America. Now many drugmakers are rethinking vaccines. Britain's GlaxoSmithKline is gunning to
become the world's top vaccine manufacturer by revenue, unseating pioneer Merck & Co. This spring, Glaxo opened a state-of-the-art vaccine packaging plant in
Marietta, Pa., west of Philadelphia, so it can expand in the U.S. market. Glaxo, which sold only one vaccine in the U.S. 13 years ago, now sells 12 here — and 30
worldwide. It has 20 more in human testing, including ones for meningitis and malaria. J&J, which previously avoided vaccines, plans to build a full vaccine portfolio,
starting with universal flu and Alzheimer's vaccines, says research head Dr. Paul Stoffels. Even Pfizer Inc.'s $68 billion acquisition of Wyeth in October was partly
about getting its vaccine expertise, now being put to work against Alzheimer's. Wyeth makes the most successful vaccine ever, Prevnar, which protects children
from ear infections and potentially deadly pneumonia and blood infections. Prevnar brought in $2.7 billion in 2008 sales, and with approval of an improved version
pending, billions more a year are expected. Experts call Prevnar the "game changer." It was the first vaccine to exceed $1 billion in annual sales, followed by Merck's
cervical cancer shot Gardasil, with $2.3 billion in 2008 sales. "Vaccines are now perhaps seen to be more attractive than drugs," says Dr. Stanley Plotkin, a former
University of Pennsylvania professor and industry researcher who helped develop the German measles and rotavirus vaccines. Vaccines command
higher prices — roughly $375 for the three-shot Gardasil series — and so are more profitable than in
the past. With only one or two makers of most vaccine types, price competition is rare in wealthy countries. Plus, they rarely face generic competition. For flu
shot makers, the risk of having to throw out millions of unused doses here come spring has plunged as U.S. guidelines have steadily widened to include 83 percent
of Americans. Use has jumped from 20 million doses in 1990 to 113 million last year. And many companies are partnering with promising biotechs, the World Health
Organization and global charities, or setting up deals with local drugmakers abroad, to inexpensively manufacture vaccines in developing and middle-tier countries
that increasingly want them to prevent much-higher health care costs. "What you had was, everybody out of the water," says analyst Steve Brozak of WBB
Securities. "Now, everybody's back in the water."
2NC UQ
Indian pharmaceuticals are being watched now --- it’s an aspiring regional leader
SHAMIM MONDAL AND VISWANATH PINGALI 11/2/15 --- Indian Institute of Management Programme Chairperson
PhD, Research and Publications & Professor. (“Competition Law and the Pharmaceutical Sector in India”, Shamim Mondal and
Viswanath Pingali, November 2, 2015, IIM, https://library.iima.ac.in/assets/snippets/workingpaperpdf/19305828832015-11-
02.pdf)//chiragjain

The Indian pharmaceutical industry is one of the major pharmaceutical industries in the world, both in
terms of volume of consumption and value of production. Further, given its critical importance, this industry has attracted
significant policy attention. Given the ever changing policy environment, it is only appropriate to assume that the

firms also adapt their strategies as per the policy environment, thereby altering the industry dynamics itself. For example, the Indian Patent Act in
the 1970s that had stipulated that there could only be process patenting as against product patenting, has led to the emergence of the generic pharmaceutical
industry, which
became a key player not just within India, but also around the world. Lots of research on
pharmaceutical markets was published; however, most of it is developed world centric. In spite of India being a huge market for
pharmaceuticals with the complete potential not being fully realized, precious little research work that characterizes the dynamics of this market has been
undertaken as of now. We conclude this chapter by discussing some of the important questions that need to be addressed in this market both from research and
public policy point of view, taking developing countries‟ perspective (more specifically, India). First issue that needs to be resolved is the trade-off between
availability of medicine at cheaper price with availability of innovative modern medicine. Differential pricing or negotiated pricing between the innovator and the
government might be the way forward. Further, incentivizing pharmaceutical companies to produce drugs that are meant for India specific problems (through
patent extensions, subsidizing R&D, etc.) might be a way forward. Further,
encouraging innovators to invest in research and
development, and manufacturing within India for indigenous consumption could be another way in
which prices for innovative medicines can be lowered.60 Such initiatives might work with the current government‟s schemes like
Make in India and Atal Innovation Mission. Another issue that needs to be addressed is the price-quality paradox. Ensuring highest quality requires huge
investments, which is often reflected in the price. Given that majority of India does not have prescription insurance, this high price drastically reduces affordability.
On the other hand, lack of quality medicines involves other side effects from spurious medicines, which could be difficult to comprehend. Therefore, is the answer
to this debate universal, or is it therapeutic area specific, becomes a relevant question to be answered. This question becomes even more pertinent with regards to
expensive and complicated medicines like biological drugs. The other area where the policy needs to focus on is advertising. Pharmaceutical advertising can be of
two kinds: informative and persuasive. While informative advertising informs the physician of the new advances, persuasive advertising, as the name suggests is
intended at persuading the doctor to prescribe a particular brand. While informative advertisement can be useful, persuasive advertising can be modelled as
prisoners‟ dilemma. All pharmaceutical companies invest in it, and as a result no one gains substantially. However, these expenses are recovered through higher
drug prices, thereby harming total welfare. As long as branded generics exist, persuasive advertising is likely to continue as various pharmaceutical companies vie
for doctors‟ attention.61 It also generates other externalities.
But can India afford to move from branded generics to pure
generics market (as is the case in the US, for example)? And under what conditions is such move even possible? One of the offshoots of
advertising is that it can act as a significant barrier to entry. At the same time, lack of promotion can be counterproductive to health outcomes, especially where
quality is not uniformly regulated.These are some of the questions that need to be addressed globally. There is a substantial difference in affordability of medicines
in India across geographies, income classes etc. A major question that arises in this case is, whether or not innovative pricing mechanisms can be used as a means
through which this gap can be addressed. A more pertinent question is whether or not differential pricing (between urban and rural, for example) is indeed
sustainable in a country like India. One could, for example, consider negotiated pricing for government hospitals across various geographies. For such differential
pricing to work seepages across markets have to be plugged so that arbitrage opportunities that arise of difference in pricing are not prevalent. These questions are
not just important from the Indian standpoint alone; any developing country that aims at a robust pharmaceutical industry that aims at fostering competition,
innovation and welfare needs to contemplate on these issues. Therefore, the
policies adopted by the Indian authorities are being
keenly watched in the international arena; this may provide India with an opportunity to exhibit
thought leadership to countries like China, Russia, Brazil, etc.
AT: Not about Vaccines
Indian pharma is becoming one of the biggest in the world --- other countries are
threatening and India is a leader in vaccines in the status quo
PWC 2013 --- PricewaterhouseCoopers is a multinational professional services network (“Global pharma looks to India: Prospects for
growth”, PWC, 2013, Cites Litany of Statistics and Political Scientists, http://www.pwc.com/gx/en/pharma-life-sciences/pdf/global-pharma-
looks-to-india-final.pdf)//chiragjain

The pharmaceutical industry’s main markets are under serious pressure. North America, Europe and
Japan jointly account for 82% of audited and unaudited drug sales; total sales reached US$773 billion in 2008,
according to IMS Health. Annual growth in the European Union (EU) has slowed to 5.8%, and sales are increasing at an even more sluggish rate
in Japan (2.1%) and North America (1.4%).1 Impending
policy changes, promoting the use of generics in these key
markets are expected to further dent the top- and bottom-line of global pharma majors. The industry is
bracing itself for some fundamental changes in the marketplace and is looking at newer ways to drive
growth. Further, higher R&D costs, a relatively dry pipeline for new drugs, increasing pressure from
payers and providers for reduced healthcare costs and a host of other factors are putting pressure on
the global pharmaceutical companies. Pharma companies are looking for new ways to boost drug
discovery potential, reduce time to market and squeeze costs along the whole value chain. How can industry leaders best face these
challenges? Analysis by PricewaterhouseCoopers (PwC) shows that several regions offer considerable promise, either as places with untapped
demand for effective drugs or as suitable areas for conducting research and development (R&D) and/or clinical trials. In this paper we shall
examine the opportunities available in India. India’s
population is growing rapidly, as is its economy – creating a
large middle class with the resources to afford Western medicines. Further, India’s epidemiological
profile is changing, so demand is likely to increase for drugs for cardio-vascular problems, disorders of
the central nervous system and other chronic diseases. Together these factors mean that India represents a
promising potential market for global pharmaceutical manufacturers. More than that, India has a growing
pharmaceutical industry of its own. It is likely to become a competitor of global pharma in some key
areas, and a potential partner in others. India has considerable manufacturing expertise; Indian companies are
among the world leaders in the production of generics and vaccines. As both of these areas become more
important, Indian producers are likely to take a large role on the world stage – and potentially partner with
global pharma companies to market their wares outside of India. Indian companies have also started
entering into the realm of R&D; some of the leading local producers have now started conducting original research. India has
the world’s second biggest pool of English speakers and a strong system of higher education, so it should
be well-positioned to serve as a source for research talent. A new patent regime provides better protection of intellectual property rights,
although some issues remain. Clinical trials can also be conducted here much more costeffectively than in many developed nations, and some
local companies are beginning to develop the required expertise. All of these factors add up to a strong case for partnering with Indian
companies around R&D, including clinical testing. Further, healthcare has become one of the key priorities of the
Indian Government and it has launched new policies and programmes to boost local access and affordability to quality healthcare.
Global players in the pharma industry cannot afford to ignore India. The country, many predict, will be the most
populous in the world by 2050. India will make its mark as a growing market, potential competitor or partner in manufacturing and R&D, and as
a location for clinical trials.
AT: US Pharma Bigger
India is the best investment market for global pharma investment --- doesn’t have to
be the best in the squo
PWC 2013 --- PricewaterhouseCoopers is a multinational professional services network (“Global pharma looks to India: Prospects for
growth”, PWC, 2013, Cites Litany of Statistics and Political Scientists, http://www.pwc.com/gx/en/pharma-life-sciences/pdf/global-pharma-
looks-to-india-final.pdf)//chiragjain

The Indian market is impossible to ignore, given its economic prospects. Foreign companies view India
as a potential significant contributor of future sales and are ramping up their investments in the country accordingly. India’s
domestic market looks promising for global pharma looking to launch new products. The country’s
growing capabilities in contract manufacturing, R&D and clinical trials also make it a preferred
outsourcing partner for global pharma at every stage of the value chain. So what strategy should foreign pharmaceutical
companies eager to enter the country or expand their existing operations adopt? One approach is to call on India’s increasing

expertise in biotechnology, bioinformatics and clinical testing. Several overseas companies have outsourced research and clinical trials to Indian
contractors, while others have entered into collaborative R&D arrangements to supplement their R&D productivity. Many foreign companies have also already
initiated research on neglected diseases. We believe that many more will do so, as the patent regime is strengthening. This will enable them to capitalise on the cost
savings to be gained from shifting some research activities to India, without jeopardising their most valuable intellectual property. Another approach is to tap into
the growing domestic market. Foreign companies with a product portfolio spanning across different therapeutics segments can look at bringing newer products in
India by entering into collaborative networks across the value chain, from sourcing and manufacturing to marketing and distribution. These companies will have to
understand how to get their product to market and develop a realistic pricing strategy, particularly as India is still far away from a widespread shift to an insured
payer model. India’s pharma market is highly fragmented and remains extremely price sensitive. Affordable healthcare continues to pose a challenge, although
there are a number of healthcare initiatives by the Government underway to improve the situation for India’s vast population. Indian courts and regulatory
authorities are very sensitive to pricing issues in making decisions around intellectual property. Pharma companies coming into India may need to consider a
differential pricing. They will need to evaluate access to medicines, a volume-based pricing strategy and take into account gradually increasing per capita incomes to
come up with acceptable price levels for their drugs. Global pharma companies will then need to decide how to manufacture their products, and identify and
develop strong local partners. One way to build a presence in India may be through an increased presence in the OTC market. Promoting a range of OTC products
could serve as means of building brand awareness and as a source of new revenues. Indigenous producers dominate the generics business, and about 97% of all
drugs sold in India are already off patent. The OTC market is, by contrast, relatively undeveloped. Indian consumers already pay privately for the lion’s share of their
healthcare, and the Government is too hampered by budgetary constraints to reverse this pattern. In future, then, it seems likely that access to OTC medicines will
be improved and the market will continue to expand. The pharmaceutical business model is witnessing a paradigm shift, moving from a fully integrated company
structure towards a future where companies use a wide range of outsourcing, partnership initiatives and other contractual and relationship arrangements to create
networks of collaboration and discovery. Investing in India will be a vital component of this networked future. Companies that will be most successful in doing
business in India will be those that are most adept at managing and mixing a range of contractual relationships and partnership strategies. Some practical
issues will need to be addressed, regardless of the business model selected. Infrastructure deficits continue to exist, although some are being
addressed. Intellectual property protection has improved substantially but some holes remain. And while the regulatory environment in India has improved
substantially in recent years, the industry still faces a number of question marks. Finalisation of Government policies around drug price control, access to OTC drugs,
tax policy, intellectual property protection and infrastructure spending is still pending. Nonetheless, India’s
appeal is growing rapidly in a
number of respects. It has long been a formidable player in pharmaceutical manufacturing, but its
socio-economic strengths provide even greater grounds for optimism. If the economy outpaces that of
every other emerging country for the next half century, as many commentators expect, large portions of the
population will be able to afford modern medicines. India’s increasing scientific expertise will also equip
it to play a significant role in researching and developing those drugs. It has a large pool of highly educated, English speaking
scientists who can undertake research and conduct trials more cheaply and in some cases faster than their Western peers. These are major

advantages in a world where drug development costs are soaring and getting to market fast is vital.
AT: China Pharma Bigger
India is the biggest upcoming pharma market --- nothing thumps because it has US
cooperation on pharma --- beats China
TUSHTID JOSHI AND AMUL MISHRA 14 --- 1 B. N. Law College, Udaipur 2 B. N. Institute of Pharmaceutical Sciences,
Udaipur (“Role of India in global pharmaceutical sector with emphasis on USA”, Tushtid Joshi and Amul Mishra, Journal of
Chemical and Pharmaceutical Research, www.jocpr.com/articles/role-of-india-in-global-pharmaceutical-sector-with-emphasis-
on-usa.pdf)//chiragjain

India’s pharmaceutical industry has evolved from almost non-existent to a world’s leader in the
production of highquality, low-cost non-branded or generic drugs, accounting for nearly 20 percent of
the world’s production. Indian companies should focus on developing follow-on biologics, Challenging IPRs on regulated markets,
investing in R&D for proprietary NCEs. Many mid-level Indian producers can turn to contract manufacturing,
outsourcing, contract research, contract clinical trials, or other tie-ins with MNCs. These alliances and
millions of dollars spent on establishing domestic and foreign-based manufacturing facilities, acquiring foreign drug manufacturing
firms, as well as marketing and sales networks, will enable India’s leading pharmaceutical producers to re-direct large
sums of their cash flow to R&D and move up the value-added chain. These foreign acquisitions will
enable Indian companies to gain a foothold in Western regulated markets, diversify their portfolios, acquire
recognized brands, and gain R&D capabilities. The United States has some of the highest drug prices in the world
and has attracted imports of generic drugs from India and a number of low-cost countries. However, severe price
compression and growing competition from other low-cost countries is forcing Indian majors to offset
their losses by shifting their attention to Western Europe. India has the potential to become the
region's hub for pharmaceutical and biotechnology discovery research, manufacturing, exporting and
health care services within the next decade. India's continuing failure to provide data protection needs to be rectified
urgently.
2NC Key to India Econ

Indian pharmaceutical industry is key to economy writ large


A) It’s the only success among other failures in the global economy
AJAY DSOUZA 5/12/2013 --- The Hindu Economy Reporter and Expert (“World economy in a tizzy, but Indian pharma flying high”, Ajay
Dsouza, May 12, 2013, The Hindu, http://www.thehindu.com/business/Industry/world-economy-in-a-tizzy-but-indian-pharma-flying-
high/article4706605.ece)//chiragjain

Although global economic recovery still remains fragile and the road back to normalcy is a long and
difficult one, the fortunes of India’s pharmaceutical industry remain upbeat. Whereas the financial year gone by
has been a dismal one for companies in most sectors, domestic pharmaceutical companies have not only bucked the
trend but have seen huge growth in their market capitalisation. In 2012-13, the BSE Healthcare Index returned 21 per
cent compared to the modest 8 per cent rise in the Sensex, and the stocks of 6 of the top 10 pharmaceutical companies (by market cap)
outperformed the broader index. This strong performance was underpinned by an amalgam of strong exports to the U.S. and the depreciation
of the rupee against the dollar. In
fact, the growth story of the industry is a more long-term phenomenon; it has
grown consistently at a compounded annual growth rate (CAGR) in excess of 15 per cent over the last five years. This robust
growth not only indicates the industry’s inherent strengths in the global landscape, but is also a
reflection of improving healthcare standards in the country. The constant demand for reduction in
manufacturing costs globally has presented Indian companies with ample growth opportunities, specifically
in developed markets. Exports have been the cornerstone of growth of the Indian pharma industry, with the
global pharmaceuticals market offering strong opportunities to Indian players. This upbeat trend in formulation exports is expected to continue
in future too, with 14-16 per cent CAGR envisaged between 2012-13 and 2017-18. Over the next five years, drugs with sales of more than $100
billion are expected to lose patent exclusivity and open up to generic competition. Healthcare expenditure is also spiralling the world over, and
the steepest rise is seen in the developed markets of the U.S. and Europe, which traditionally contribute the largest share to global medicine
sales. With India’s key strengths of cost-competitiveness and advanced process chemistry skills, Indian players are well-placed to tap into this
opportunity and increase their presence in the generics market. Critical market The most critical export market continues to be the U.S. For
instance, Wockhardt earns more than 75 per cent of its revenues from global markets, with U.S. operations contributing 40 per cent. Sun
Pharma and Lupin, similarly, have a strong presence in the U.S. market, earning 35-40 per cent of revenues from there. Healthcare
reforms initiated by the U.S. government, aimed primarily at reducing healthcare spending and extending public healthcare to
a larger proportion of the population, are expected to continue driving growth in the generics market.

B) Foreign investment in Indian pharmaceuticals is specifically key


IBEF 11/27/14 (India Brand Equity Foundation “Indian Pharmaceutical Industry”, November 27th, 2014,
www.ibef.org/industry/pharmaceutical-india.aspx)//chiragjain

Globally, the Indian pharmaceutical industry is ranked third largest in volume terms and 10th largest in
value terms. The sector is highly knowledge-based and its steady growth is positively affecting the Indian economy. The
organised nature of the Indian pharmaceutical industry is attracting several companies that are finding it viable to increase their operations in the country. The
Indian pharmaceutical industry is highly fragmented with about 24,000 players (330 in the organised sector). The top ten companies make up for more than a third
of the market. Indian pharma companies have a large chunk of their revenues coming from exports. While some are
focusing on the generics market in the US, Europe and semi-regulated markets, others are turning their attention to custom

manufacturing for innovator companies. Biopharmaceuticals is also increasingly becoming an area of interest given the complexity in
manufacture and limited competition. India's drugs and pharmaceuticals industry is expected to grow at a compound annual growth rate (CAGR) of 14 per cent to
reach a turnover of Rs 2.91 trillion (US$ 47.06 billion) by 2018. The domestic drugs industry, which is valued at Rs 1.6 trillion (US$ 25.87 billion) at present, according
to Care Ratings, is also expected to grow in the local market with aggressive rural penetration by drug makers, increased government spending on health, and
growing health awareness among people. India exports pharmaceutical products to more than 200 countries. Pharmaceutical exports are expected to cross the Rs 1
trillion (US$ 16.17 billion) mark this year. " The growth would be around 15 per cent and is driven by formulation
exports," said Dr PV Appaji, Director-General, Pharmaceutical Export Promotion Council (Pharmexcil). During 2013-14, pharma exports stood at Rs 90,000 crore
(US$ 14.55 billion). Out of this, the share of formulations was 71 per cent. India currently exports drug intermediates, Active
Pharmaceutical Ingredients (APIs), Finished Dosage Formulations (FDFs), bio-pharmaceuticals, and
clinical services across the globe. The allowance of foreign direct investment (FDI) in India's pharma
sector has been well received by foreign investors. According to data released by the Department of Industrial Policy and Promotion
(DIPP), the drugs and pharmaceutical sector attracted FDI worth US$ 12,688.71 million between April 2000 and September 2014.
2NC Impact
Indian economic decline enhances the chance of conflict with Pakistan
MURSHED MAMOON 2010 --- Director (Monitoring and Evaluation), Pakistan Institute of Trade and Development (PITAD), Ministry
of Commerce, Islamabad, Pakistan, and Murshed, Professor of the Economics of Conflict and Peace, Institute of Social Studies, the Netherlands
(“The conflict mitigating effects of trade in the India-Pakistan case, Murshed Mamoon, 2010, Econ Gov, https://link-springer-
com.proxy.lib.umich.edu/content/pdf/10.1007%2Fs10101-010-0074-y.pdf)//chiragjain

However, if
India is able to export or import more, this would at least put a check on any rise in the severity
of conflict and hostilities would adjust to some average level. Any decline in Indian trade will enhance
hostilities. The current low levels of bilateral trade between Pakistan and India is conflict enhancing, so
more trade with increased exports by both sides to each other should be encouraged. More access to Pakistani markets on the Indian side may
not lead to conflict mitigation if Pakistan is not able to also export more to India. A rise in education expenditure puts a check
on hostilities, as seen in Graph 1e. Graph 1f is the standard representation of India-Pakistan conflict, and not only best fits historical trends
but also explain the rationale behind recent IndiaPakistan peace initiatives with decreasing hostilities when not only India but Pakistan also has
had economic growth rates as high as 7% per annum. The forecasts
suggest that conflict will rise, even if there is a
significant increase in combined democracy scores, if growth rates plummet. Both Pakistan and India have seen
many such years, when hostilities between both countries rose significantly when at least one of the
countries is performing poorly, but were channeling more resources on the military as a proportion of their
GDPs. The forecasts favour the economic version over the democratic version of the liberxal peace. Thus one
may look at current peace talks between both countries with optimism as both are performing well on the
economic front and channeling fewer resources on the military as a proportion of national income, while
at the same time having a divergent set of political institutions, though recently Pakistan has edged towards greater democracy with elections
in February 2008
US Pharma Bad – Environment
Big pharma exposes the environment to excess drugs – kills fish supply, key species
and increases microbial resistance
Owens 15 --- a freelance science writer based in New Brunswick, Canada, published in the Pharmaceutical Journal (Brian, 2/19/15,
“Pharmaceuticals in the environment: a growing problem,” http://www.pharmaceutical-journal.com/news-and-
analysis/features/pharmaceuticals-in-the-environment-a-growing-problem/20067898.article)//ernst

When Rebecca Klaper searched for signs of pharmaceuticals in Lake Michigan, she got a surprise. The
most common drug she found was one she hadn’t even considered looking for — metformin, a diabetes
drug. “It wasn’t even on our radar,” says Klaper, a freshwater scientist at the University of Wisconsin-Milwaukee in the United States. “We
only found it because the Environmental Protection Agency just happened to add it to the detection assay we used.” Perhaps even more
surprising was how far the drug had spread from the point it entered the lake via treated sewage. “Lake
Michigan is huge, so we expected a big dilution effect, but we were still finding drugs, including metformin, three miles from the
sewage treatment plants,” she says. Klaper was also interested in what effect the drug might be having on
fish in the lake. Metformin is used to treat diabetes, so she looked at the metabolism of fish exposed to a similar concentration of
metformin in the laboratory, but saw no metabolic changes. Instead, she found that a gene related to egg production was
being expressed in male fish, which indicates hormonal changes. She concluded that metformin could be
having a feminising effect on male fish, and may decrease their ability to reproduce. Lake Michigan is far
from being an isolated case. A 2014 global review of pharmaceuticals in the environment, commissioned by Germany’s environment
ministry, found that of the 713 pharmaceuticals tested for, 631 were found above their detection limits. They
are found all over the world — in 71 countries across all of the United Nations’ five regional groups[1].
They were found mainly in surface waters, such as lakes and rivers, but also in groundwater, soil,
manure and even drinking water. Scientists are studying the effect of these drugs on ecosystems, and
are trying to find ways of preventing the problem, for example by the correct disposal of unwanted
medicines, improving the treatment of sewage and, ultimately, designing more environmentally friendly
drugs. “It’s a real, growing problem, and it’s only going to get worse as the world’s population ages,” says
Gwynne Lyons, policy director of the CHEM Trust, a UK environmental charity. We probably have an incomplete picture of the problem,
however, because we don’t have detection methods for all of the thousands of pharmaceuticals in use
around the world, and the analytical methods are not standardised internationally, so detection limits may vary,
Lyons adds. But some drugs are worse than others because of their potential to affect wildlife or people. They
include antibiotics, antidepressants, anti-inflammatories and analgesics, beta-blockers, oral contraceptives and hormone replacement
therapies. Drug delivery There are three main ways that pharmaceuticals make their way into the environment.
By far the biggest contribution comes from drugs taken by people or animals that are then excreted in urine or
faeces. “A good proportion of any drug is excreted,” says Lyons — between 30% and 90% of the active ingredient in an
oral dose. And the metabolites of many drugs can also remain active in the environment after being
excreted. The improper disposal of drugs also makes a contribution — when people fail to complete a prescription or
clean out their medicine cabinet and throw the leftover drugs in the sink or down the toilet. In both cases, drugs end up in sewage treatment
plants, which were generally not designed to remove such pollutants from wastewater. Depending on the drug, removal efficiencies
range from 20% to more than 80%. A 2014 report by UK Water Industry Research found that in most of 160 sewage treatment
works studied, several common drugs were present in the final effluent in concentrations high enough to potentially affect ecosystems[2]. The
drugs included the anti-inflammatories ibuprofen and diclofenac, the antibiotics erythromycin and oxytetracycline, and the female sex
hormone 17b-estradiol. Some drug manufacturing facilities have also been shown to release active ingredients
into nearby waterways, creating localised hotspots of pharmaceutical pollution. In 2009, Joakim Larsson, an
environmental pharmacologist from the University of Gothenburg in Sweden, found high concentrations
of antibiotics downstream of several drug manufacturing facilities near Hyderabad in India — in some cases
the levels were equivalent to doses given therapeutically[3]. Two years later, Larsson found high levels of known antibiotic
resistance genes in the bacteria there. Population crash In most cases, however, the concentrations of
pharmaceuticals found in the environment are much lower than the therapeutic dose. In rivers and lakes that
receive treated wastewater, drugs are typically found in concentrations of 0.1 mg/L to 1.0 mg/L. Klaper found concentrations of metformin in
Lake Michigan of around 40 mg/L close to the sewage treatment plants, but only 0.012mg/L offshore. Because of these low
concentrations, it can be difficult to determine what, if any, effect the drugs are having on the
ecosystem. Much of the time the affected organisms are not in the public eye, for example algae or sea lice, or the effects are mild enough
to go unnoticed if researchers aren’t specifically looking for them. “We generally don’t have the degree of surveillance we
need until there is a population crash in a larger animal,” says Lyons. Such a population crash occurred
between 1996 and 2007, when millions of vultures in India were killed by exposure to the anti-
inflammatory drug diclofenac, driving the birds to near-extinction1. The drug was given to cattle to treat pain and
fever, and because people in India do not eat beef, the carcasses of dead cattle were left for the vultures
to feast on, including cattle recently given high doses of diclofenac. It turns out that vultures from the genus Gyps are
particularly sensitive to diclofenac, and between 10 million and 40 million birds died from abdominal gout and acute kidney failure. Three
species of Gyps vultures are now critically endangered in Asia. Similar toxic effects have been seen in
Gyps vultures in Africa and Europe, although without the same population decline. But such dramatic and clear-
cut links between pharmaceutical exposure and harmful ecological effects are rare. Indeed, the case of diclofenac and vultures is the only one
in which the environmental impact in the wild has been solely attributed to a drug, according to Jason Snape, principal environmental scientist
at pharmaceutical company AstraZeneca. Other ecotoxicological effects of drugs in the environment have been
found — the veterinary anti-parasite drug ivermectin, for example, has been found to reduce the
number and variety of insects in cow dung, which can delay dung degradation and potentially reduce
the amount of food available to birds and bats[4]. But the consequences are generally milder, and the cause-and-effect
relationship is less clear. And few drugs have been studied outside laboratory experiments. Laboratory studies have found that anti-
depressants can alter the spawning behaviour of clams, disrupt movement in snails, cause altered
aggressive behaviour in crayfish, and affect learning in cuttlefish4. The anti-inflammatory drug ibuprofen has
been reported to affect reproduction in fish, including the delayed hatching of eggs, in the laboratory4. A
measuring glass Create infographics Feminised fish One of the human pharmaceuticals whose environmental effects have been studied
extensively is ethinylestradiol, the active ingredient in many contraceptive pills. It has
been shown to affect the sexual
development of male fish at extremely low concentrations in the laboratory, and intersex fish have been
found downstream from sewage plants in rivers around the world. A seven-year, whole-lake experiment in Canada
found that chronic, low-level exposure to the drug could affect both male and female fish, and led to a near-
extinction of the study population, although the concentration in the experiment was higher than that generally seen in rivers[5].
But John Sumpter, an ecotoxicologist at Brunel University in London, says that the evidence that estrogen from contraceptive pills is feminising
male fish in the wild is not conclusive, and there is no evidence for population-level effects. “The concentrations required for a population crash
are much higher, sometimes by several orders of magnitude, than those seen in rivers,” he says. The issue is complicated by the fact that the
same feminising effects can result from exposure to many other hormone-like chemicals that might be present in the water, including
bisphenol A, that have been shown to have endocrine-disrupting properties. “Pharmaceuticals in the environment is a very active field, and
there have been many papers recently claiming effects at environmentally relevant concentrations,” says Sumpter. “But I have serious
questions about the quality of many of those papers.” Sumpter recently led a large, EU-funded project called PHARMAS on the effects of
pharmaceuticals in the environment. It focused on anticancer drugs because little was known about how they might affect ecosystems. In a
rare bit of good news in this field, Sumpter and his colleagues found no serious effects at the low concentrations typically seen in the
environment. “Anticancer drugs do not appear to be of environmental concern,” he says. Both Sumpter and Lyons agree that much more
research needs to be done to determine what drugs are out there and which ones are causing problems in the real world. “There is a real lack
of field studies,” says Lyons. Cocktail party In particular,
there is a need to study the ‘cocktail effect’ — the way different drugs
can interact to produce adverse effects. Pharmacists and doctors warn patients that they should not mix ibuprofen
with beta-blockers, but a fish swimming in a soupy mixture of drugs and other chemicals in a polluted
river doesn’t have that option. Multiple kinds of similar drugs could also have an additive effect, says Sumpter. “If we have six
different beta-blockers, maybe we should do the risk assessment on their combined concentration,” he says. One forthcoming study could help
to answer these questions. The Otter Project at Cardiff University has received funding to screen for pharmaceuticals in the carcasses of otters
from around the UK. Traces of diclofenac and ibuprofen have previously been found in otters, says Elizabeth Chadwick, the project’s director,
and the team is now considering which other chemicals and drugs to look for. Otters are a good species to use for such a study, says Chadwick,
because they are relatively long-lived and are at the top of the food chain, which gives the drugs time to accumulate in their system.
“Chemicals in water can be very transient, so water testing is hit and miss,” she says. “Studying biota means they
are captured in situ.” The project will also allow Chadwick to consider potential drug interactions. “Ecological research looks at the whole
cocktail,” she says. Chadwick isn’t sure what effects she will find in the otters, but she is expecting to see some feminising effects, such as a
reduction in sperm count, as has been found in fish. “There is a diverse range of potential health effects,” she says. “Until we have good data,
we won’t know which ones are happening.” Growing concern The issue of pharmaceuticals in the environment is gaining
more attention around the world. The Strategic Approach to International Chemicals Management (SAICM), an initiative run by the
United Nations Environment Programme that aims to foster the responsible use of chemicals, is considering whether to list environmentally
persistent pharmaceutical pollutants as an emerging policy issue at its next meeting in September 2015. The European Union has included
three drugs — diclofenac, 17a-ethinylestradiol (used in oral contraceptives) and 17b-estradiol (used in hormone replacement therapy) — on a
‘watch list’ for further study. The EU already requires companies to conduct an environmental risk assessment (ERA) for all new drugs, but it
applies only to those authorised after 30 October 2005. As a result, says AstraZeneca’s Snape, only about 500–600 of the roughly 3,000 drugs in
use in Europe have a full ERA with data on the chronic effects. Once those assessments are completed, they can quickly become dated and may
not reflect the latest science, adds Snape. “From an environmental perspective, there is no requirement for anything like the pharmacovigilance
that goes on after a drug is approved,” he says. “You do your ERA, then once the marketing approval is given, you put it in a drawer.”
AstraZeneca, however, has developed a system of ‘ecopharmacovigilance’, in which it tracks new data on the environmental effects of its drugs
so it can keep risk assessments up to date. “It protects the environment, but also our reputation,” says Snape. But even if an ERA finds a high
risk of environmental harm, it cannot prevent the marketing of a drug — and few would want it to. The needs of humans should not come
second to environmental concerns, says Lyons. “But
we need to look at the best option to reduce the risk.” In some
cases that might mean ‘source control’ — reducing the quantity of pharmaceuticals that enter sewage
systems. This can be done by educating people about the possible environmental effects of what they stock in their medicine cabinet, and
encouraging them to return unused drugs to the pharmacy for proper disposal. But Snape says this goal is hampered by the tendency of
television dramas to show people flushing pills down the toilet. In Sweden, drugs are graded on their environmental effects, and doctors are
required to prescribe a less damaging drug where the option exists. Lyons would like to see this system rolled out more widely. A more long-
term solution might lie in the concept of ‘benign by design’, in which drugs are designed from the start to be less harmful to the environment.
Many drugs include molecules that are not found in biology — such as halogen groups — that make them more persistent in the body and the
environment. Sumpter wants environmental scientists to be involved much earlier in the drug discovery process to advise on how to balance
efficacy with environmental concerns. “Before we go and tack another fluorine on the molecule, we should ask, are there other ways?” he says.
Snape says that the pharmaceutical industry is moving in that direction. Several companies have invested in a project under the EU’s Innovative
Medicines Initiative to develop tools to screen environmental properties earlier in drug development. The increasing importance of biologic
drugs, which break down more readily, will also help. But it will be a long process. “A lot of the drugs that will be entering the market five years
from now have already been discovered,” Snape says. In many cases, for the foreseeable future the only option will be to improve sewage
treatment to reduce the amount of drugs that reache rivers and lakes. But that will be expensive. Lyons wants the drug industry to bear much
of the cost in a ‘polluter pays’ scheme. “The pharmaceutical companies should take more responsibility for their products over their life cycle,”
she says. Klaper
agrees that more care needs to be taken to keep pharmaceuticals out of the environment
as much as possible. She says: “In most cases, we don’t even know what they are doing to the
ecosystem or to people.”
US Pharma Bad – Bioterror
Boosting big pharma trades off with small pharma – key to prevent bioterrorism
Harack 5 Joanne Harack is the vice president Affinium Pharmaceuticals, DDN News, September 2005,
“Q&A: Joanne Harack, vice president, Affinium Pharmaceuticals”, http://www.ddn-
news.com/index.php?newsarticle=367 //DJ

Affinium Pharmaceuticals is a small structure-guided drug discovery company founded in 2000 that is
focused on the development and commercialization of novel anti-infective medicines. Recently,
company vice president Dr. Joanne Harack and the scientific team at Affinium took the time to talk to
Executive Editor Randall C Willis about the current state of the anti-infectives market. DDN: How has the
anti-infectives market developed over the years and what challenges does it face? Harack: The first half
of the last century was truly a golden age for the discovery of anti-infective compounds. Interestingly,
however, at the same time that market opportunities were expanding in the latter half of the century,
companies began to focus more on incremental developments in drugs, tweaking compounds from
existing drug families and focusing less on identifying entirely novel chemical entities. Similarly, the
economics of drug discovery, combined with consolidation in the industry, has caused Big Pharma to
turn away from anti-infective market toward the chronic disease and "lifestyle" markets, and to search
for "blockbuster" drugs rather than niche anti-infectives. At the same time, "bugs" (e.g., bacteria,
viruses, fungi) have become "smarter", mutating and developing resistance to the current crop of drugs.
The rapid development of resistance/mutation means that there is a very real and very urgent need for
novel antibiotics and new antivirals and antifungals. That need is clearly articulated by infectious disease
clinicians and various public interest groups. Resistance creates unmet medical needs that clinicians and
patients look to the industry to fill. In the post-9/11 era, there is increased interest on the part of the U.
S. government in the development of drugs targeting infectious diseases to combat potential
bioterrorism. The challenge for the industry is to be "smarter" and "faster" than the bugs. Speed and
agility are not necessarily associated with Big Pharma, however, so small, more agile biopharmaceutical
companies have taken up the cause of anti-infectives. As well, developments in genomics and
proteomics mean that we can design drugs more specifically and more efficiently than previously. We
have not reaped the benefit from this yet, in part, because of issues such as regulatory approval of
"unvalidated targets", which will be slower than that for incremental development of existing drugs.
Many products will come off patent soon, and that is certainly fuelling some interest in developing
completely new drugs.
Federalism DA
1NC Link
States have the natural power --- decks federalism
CATHERINE MCCARTY 2003 – Harvard Law Review (“Mandatory Vaccines: Questionable Federal Policy
Informing Questionable State Laws [*], Catherine MCcarty, 2003, Harvard Law Review,
https://dash.harvard.edu/bitstream/handle/1/8846795/McCarty.html?sequence=1)//chiragjain

Our government is a system of federalism. By design, federalism consists of a division of powers that
preserves both national and state governments. The powers of the national government are delineated
in the Constitution, while the state, under the Tenth Amendment[2] keeps the remaining sovereign powers. As stated by James
Madison, “The powers delegated by the proposed Constitution to the federal government are few and defined. Those which are to remain in
the State governments are numerous and indefinite.”[3] Among
the powers retained by the states are what have
become known as the police powers. The police powers include the power of the state government to
promote the public welfare by restraining and regulating private individual’s rights to liberty and uses
of property.[4] Public health regulation has long been regarded as one of the state’s primary and most
important police powers.[5] The validity of public health laws and regulations at both the state and
federal level depend on two constitutional questions; first, does the government entity have the constitutional power to act
in the interest of the public heath, and secondly and more interestingly, does the specific manner in which the government has acted violate or
exceed any constitutional principles or individual rights?[6]
2NC Link
State governments should be doing this --- they change the balance of power to the
federal government
JARED COLE AND KATHLEEN SWENDIMAN 5/21/2014 --- Legislative Attorneys at the Congressional Research Service
(“Mandatory Vaccinations: Precedent and Current Laws”, Jared Cole and Kathleen Swendiman, May 21, 2014, Congressional Research Service,
https://fas.org/sgp/crs/misc/RS21414.pdf)//chiragjain

Role of the Federal Government Federal jurisdiction over public health matters derives from the
Commerce Clause, which states that Congress shall have the power “[t]o regulate Commerce with foreign
Nations, and among the several States....”72 Thus, under the Public Health Service Act, the Secretary of the Department of
Health and Human Services has authority to make and enforce regulations necessary “to prevent the
introduction, transmission, or spread of communicable diseases from foreign countries into the States
or possessions, or from one State or possession into any other State or possession.”73 With regard to interstate
commerce, the Public Health Service Act deals primarily with the use of quarantine and isolation measures to

halt the spread of certain communicable diseases.74 No mandatory vaccination programs are
specifically authorized, nor do there appear to be any regulations regarding the implementation of a
mandatory vaccination program at the federal level during a public health emergency.75 With regard to foreign countries, the Secretary
has the power to restrict the entry of groups of aliens for public health reasons.76 This power includes the authority to issue
vaccination requirements for immigrants seeking entry into the United States. Currently, certain vaccines specified in statute, and other vaccines recommended by

the CDC Advisory Committee on Immunization Practices for the general U.S. population, are required
for immigrants who seek permanent residence in the United States, and people currently living in the United States who seek to adjust their status to become permanent
residents.77 CDC has determined that two diseases for which vaccines are recommended for routine use by the ACIP—for human papillomavirus (HPV) and zoster (shingles)—do not have the
potential to cause outbreaks, and are therefore not required for admission.78 Vaccination requirements may be waived when the foreign national receives the vaccination, if the civil surgeon
or panel physician certifies that the vaccination would not be medically appropriate, or if the vaccination would be contrary to the foreign national’s religious or moral beliefs.79 Likewise,

the military has broad authority in dealing with its personnel, both military and civilian, including the
protection of their health.80 Military regulations require American troops to be immunized against a number of diseases, including tetanus, diphtheria, influenza,
hepatitis A, measles, mumps, rubella, polio, and yellow fever.81 Inoculations begin upon entry into military service, and later vaccines depend upon troop specialties or assignments to
different geographic areas of the world. Courts have upheld the legality of military mandatory vaccination orders. For example, in United States v. Chadwell, 82 two U.S. Marines refused to be
vaccinated against smallpox, typhoid, paratyphoid, and influenza because of their religious beliefs.83 In upholding the convictions, the Navy Board of Review court (now the Navy-Marine Corps
Court of Criminal Appeals) stated that religious beliefs were not above military orders and that “to permit this would be to make the professed doctrines of religious belief superior to military
orders, and in effect to permit every soldier to become a law unto himself.”84 Federal courts do not appear to contradict this reasoning. One district court, in reviewing a denial of a discharge
decision of the Commandant of the Marine Corps under an “arbitrary and capricious standard,” noted the lawfulness of the military’s anthrax vaccination program, and noted military
commanders’ “overriding responsibility to protect the health and safety of American military personnel by administering appropriate vaccines when faced with the growing threat of biological
and chemical weaponry.”85 Likewise, the Court of Appeals for the District of Columbia Circuit upheld a Department of Defense policy of using unapproved, investigational drugs on military
members in combat situations without their consent.86 Finally, in two recent cases the plaintiffs were discharged from the military for refusing to receive anthrax vaccinations. They brought
claims challenging the Secretary of the Air Force’s denial of their requests to correct the disciplinary records on the matter from their files. In both cases, the District Court for the District of

state and local governments


Columbia ruled that the decision of the Board for the Correction of Military Records was not arbitrary and capricious.87 As noted above,

have primary responsibility for protecting the public health, and this has been reflected in the
enactment of various state laws requiring that school children be vaccinated against certain diseases before enrolling in
school and that health care workers be vaccinated as a condition of employment, as well as laws providing for mandatory vaccination

procedures during a public health emergency. Any federal mandatory vaccination program applicable
to the general public would likely be limited to areas of existing federal jurisdiction, i.e., interstate and
foreign commerce, similar to the federal quarantine authority.88 This limitation on federal jurisdiction acknowledges that
states have the primary responsibility for protecting the public health, but that under certain circumstances, federal intervention may be
necessary.
Politics Links
1NC Link

Extreme political resistance to destroying exemptions --- its publicly accepted as a


right
ABIGAIL LOWIN AND JAMES COLGROVE 2/2016 --- JAMES COLGROVE is associate professor in the Center for the
History and Ethics of Public Health at Columbia University's Mailman School of Public Health. Columbia Law School, JD (Harlan
Fiske Stone Scholar) , 2016 Columbia University Mailman School of Public Health, MPH, 2013 Columbia College, Columbia
University, BA, 2011, Bar and Court Admissions at New York Bar Right Now (“A Tale Of Two States: Mississippi, West Virginia,
And Exemptions To Compulsory School Vaccination Laws”, Abigail Lowin and James Colgrove, February 2016,
ProQuest)//chiragjain

When nonmedical exemptions became commonplace in the 1960s, little consideration was given to the
effect they might have on herd immunity. In recent years, however, several studies have shown the connection
between the ease of obtaining vaccine exemptions under a state's law and the number of exemptions
in the state3,33 and, in turn, between high rates of exemption and the risk of outbreaks of vaccine-

preventable disease.34-37 Nevertheless, many in the public health community have supported nonmedical
exemptions on the grounds that although they weaken public health protection, they serve an
important political function: that of a "safety valve." According to this argument, unless states provide some
mechanism to allow strongly opposed citizens to opt out of compulsory vaccination, the laws will provoke
organized opposition, resulting in divisive, time-consuming battles that will erode trust in vaccines and
public health more generally.38,39 The experiences of Mississippi and West Virginia suggest that contrary to conventional wisdom, it may be
politically tenable to limit exemptions to only medical reasons without damaging either the stature of public health or the immunization system. Health officials in
both states report that overwhelming majorities of the public support their policies and that opposition comes from a very small number of people who are
extremely vocal and persistent. Opponents have used various legal and legislative strategies to attack the laws, but in neither state have these efforts been
successful. Over the past decade opponents have repeatedly won the introduction of legislation to add exemptions, but no bills have passed. Legislative activity
around immunization has been extremely common in states across the country in recent years, and the number of vaccine-related bills introduced in Mississippi and
West Virginia from 1998 to 2012 was not out of line with the experiences of many other states.2 The political configuration of antivaccination advocacy looks much
the same in Mississippi and West Virginia as in other states, as do the arguments put forth. Coalitions made up of lib- ertarians, parents who believe their children
have been harmed by vaccines, and devotees of natural or alternative medicine have made overlapping claims related to parental rights, antistatism, and
scientifically disproven theories of vaccine-related harm. In neither state have their arguments carried the day legally or legislatively. Antivaccination

sentiment may be less prevalent in the two states, and political resistance there less successful,
because of demographic factors. Research suggests that parents who refuse vaccines tend to have higher levels
of income and formal education than nonrefusers.40-42 Among US states, Mississippi and West Virginia rank
fiftieth and forty-ninth, respectively, in median income,43 and forty-ninth and fiftieth, respectively, in the percentage of people ages
twenty-five and older who have completed a bachelor's degree.44 Thus, the states may have a smaller number of residents who

are likely to hold antivaccination views and to have the political and social capital to undertake
successful efforts to influence their legislators. A key to both states ' success in fending off challenges to
their policies has been health officials' maintaining close connections and effective working relationships
with legislators, along with the active support of the states' medical professional organizations. Changes to the
political composition of both legislatures in recent years, especially the arrival of strongly antigovernment legislators, have made this task more difficult. The
experiences also highlight the important roles played by the chairs of health committees, who may prevent a bill from advancing to a floor vote. One strategy that
antivaccination activists in both states have used is attempting to have bills reviewed by other committees, such as education, where members have less familiarity
with public health issues and lack established relationships with health officials. These
lessons learned about maintaining a
nonmedical exemption policy are also relevant to states that might seek to remove nonmedical
exemptions: Health departments and legislators, especially committee chairs, should be prepared to
work closely together in the effort. Recent changes that both states have made to streamline the
process of receiving a medical exemption may help defuse some of the opposition. An additional factor in
maintaining the laws has been that both states rank poorly on many indicators of population health, and their no-nonmedical-exemption policy enables health
officials to point with pride to high rates of childhood immunization as a rare positive achievement that is worth maintaining. As noted above, Mississippi and West
Virginia rank first and fourth, respectively, in kindergarten immunization rates. Although
the experiences of Mississippi and West
Virginia show that sustaining a policy of not offering nonmedical exemptions is politically feasible,
changing to such a policy is likely to be fraught with difficulty. Revoking a legal right that people have
previously enjoyed presents a different set of political circumstances than maintaining a status quo in
which the right has never existed. In both Mississippi and West Virginia, the absence of nonmedical
exemptions predates the rise of contemporary vaccine controversies and highly mobilized antivaccination groups. It was in
the mid-1980s that concerns about the pertussis vaccine led to the emergence of contemporary political agitation around vaccination, which grew more
acrimonious after the 1998 publication of the later-discredited study linking vaccines with autism.7 Thus, the
states' no-nonmedical-
exemption policies were well established by the time such policies began to come under more
sustained and widespread criticism nationwide. This is a key difference between the experience of Mississippi, where the revocation of
nonmedical exemptions in 1979 raised virtually no public outcry, and that of California, where the change in the law in June 2015 has provoked a political firestorm.
Antivaccination activists in California hoped to overturn the law via referendum, but that effort failed to gain enough signatures to qualify for the ballot. A parallel
attempt to recall the state senator who authored the bill eliminating nonmedical exemptions also failed to qualify for the ballot.45 Public health advocates will be
closely watching events in California and other states that have recently acted on this issue.46 Just a few months before California changed its law, similar bills to
narrow the scope of exemptions failed in both Oregon and Washington State.47 Although some scholars have argued that the effectiveness of antivaccination
lobbying is growing weaker, the power of small but very vocal advocacy groups and antigovernment rhetoric should not be underestimated. Conclusion Health
officials in both Mississippi and West Virginia anticipate the reintroduction of bills attempting to add nonmedical exemptions to their laws, and the legislative
battles nationwide over exemptions show no sign of abating. According to the National Conference of State Legislatures, at least twelve states considered bills on
the subject in 2015.48 Forstates concerned about high rates of exemptions but reluctant to run the risk of
inflaming activist opposition, there are alternatives to eliminating nonmedical exemptions entirely.
Many public health professionals have instead recommended retaining nonmedical exemptions but
making them more difficult to obtain-for example, requiring parents to receive educational counseling from a licensed health care provider or
to renew the exemption annually.49,50 These may be more politically feasible solutions that also strengthen public

health protection. Before it eliminated nonmedical exemptions entirely, California had passed an education requirement for parents seeking exemptions;
Oregon, Washington, and Michigan have also done so in recent years.51 Ultimately, these debates highlight the challenging issues that arise from compulsory
strategies to safeguard health. Legal compulsion can be an effective public health tool, but it can also trigger resistance to which health officials and policy makers
must devote time and resources. The question is whether these efforts are justified by a commensurate benefit. In the case of childhood immunization in both
Mississippi and West Virginia, the answer seems to be yes, but policy makers in other states may make a different calculation.
2NC Link
Mandatory vaccine policy is completely unpopular under this administration --- Trump
PC
PAUL OFFIT 6/30/17 --- Pediatrician specializing in infectious diseases and an expert on vaccines, immunology, and
virology. Co-inventor of a rotavirus vaccine. Offit is the Maurice R. Hilleman Professor of Vaccinology, professor of Pediatrics at
the Perelman School of Medicine at the University of Pennsylvania, chief of the Division of Infectious Diseases, and the director
of the Vaccine Education Center at The Children's Hospital of Philadelphia. Former member of the Centers for Disease Control
and Prevention (CDC) Advisory Committee on Immunization Practices. Offit is a board member of Every Child by Two and a
founding board member of the Autism Science Foundation (ASF). Pandora’s Lab is his ninth book. (“Interview of Paul Offit!”,
Paul Offit, June 30, 2017, Interview with Chirag Jain, Transcribed by Chirag Jain – chiragjain2000@hotmail.com,
https://sites.google.com/a/icstudents.org/debateinterviews/)//chiragjain

Chirag: More relating to the Trump administration and our Secretary of Health and Human Services is Tom price, do you think that a
mandatory vaccine policy, in the world that it was implemented, would get rolled back or face major
problems because of the administration? Paul: It is a Republican administration, it’s a general they don’t
like having the government involved in this, these are the last people interested in mandates, I don’t
think it can ever happen. I’m just hoping the current vaccine policy survives in this administration.
Chirag: If it did get passed, do you think there would be problems related to the Trump administration? Paul: I don’t think that it
wouldn’t get passed. The House of Representatives is Republican, the Senate is republican, and the
President is republican, it would never happen. It’s like imagining a president that wasn’t a misogynistic pig.

HPV and other vaccines requirements face public backlash --- only 57% potential
support
ED SILVERMAN 7/23/16 --- Ed Silverman, senior writer and Pharmalot columnist, has covered the pharmaceutical industry for the past
two decades. He previously worked at The Wall Street Journal, The Star-Ledger of New Jersey, New York Newsday and Investor’s Business Daily,
among other publications. Along with several former Wall Street Journal colleagues, Ed was a Pulitzer Prize finalist in explanatory journalism for
a series of stories on prescription pricing. He earned an accounting degree from Binghamton University and a master’s in journalism from New
York University. (“Parents remain leery of schools that require HPV vaccination”, Ed Silverman, August 23, 2016, STAT Pharmalot News,
https://www.statnews.com/pharmalot/2016/08/23/parents-leery-hpv-vaccine/)//chiragjain

A decade after first becoming available, the


HPV vaccine is still a hard sell. A new study finds that only 21 percent
of parents believe that a law requiring vaccination for attending school is a good idea, and 54 percent
disagreed with the notion of such a requirement for school entry altogether. What might make them change their minds?
Well, 57 percent reported that they could live with the requirement, but only if there is an opt-out
provision. The results suggest that such legislative requirements may accomplish very little. “Opt-outs
lead to a large number of parents choosing not to vaccinate their children, and that makes requirements ineffective
in raising vaccination rates,” said Noel Brewer, a coauthor and associate professor in the UNC Gillings School of Global Public Health, in a
statement. So far, just two states — Rhode Island and Virginia — and the District of Columbia, require HPV vaccination for
entering school. To what extent such legislative efforts will spread around the country seems unclear. Only New Jersey has such a bill
pending, while legislation died recently in Hawaii and Maryland, according to the National Conference of State Legislatures. “It would be
hard for lawmakers to enact a policy that has 21 percent support,” Brewer acknowledged. We should note that the
study was funded by Merck, which sells the Gardasil HPV vaccine, and that Brewer has received HPV vaccine-related grants from or served on
paid advisory boards for Merck. Interestingly, the study also found 32
percent of parents felt the vaccines are promoted
to make money for drug companies, and only 40 percent believed the vaccines are effective in
preventing cervical cancer. (The vaccines are designed to thwart human papillomavirus, or HPV, which can lead to cervical cancer).
More than 1,500 parents of 11- to 17-year-olds were queried, by the way. The findings, which were published late last week in Cancer,
Epidemiology, Biomarkers & Prevention, underscore the difficulties that public health officials have encountered since Gardasil, the first HPV
vaccine, was approved by the US Food and Drug Administration a decade ago. From the start, some parents objected to the cost of the
treatment, which requires three shots, costing a total of about $530. Others expressed concerns that getting an HPV vaccine may lead teenage
girls to think it may be safer to have casual sex, although a subsequent study found there is no evidence to suggest the vaccines —
GlaxoSmithKline sells another called Cervarix — leads to risky sexual behavior. Those anxieties were initially fueled by a surreptitious Merck
marketing campaign. Even before regulators approved Gardasil, Merck tried to persuade lawmakers to require school districts to make
vaccination mandatory. The effort failed and created lingering distrust of the company, which only two years earlier was ensnared in scandal
over its withdrawal of the Vioxx painkiller amid controversy over the extent to which side effect data about cardiovascular risks was properly
disclosed. Most of all, the vaccines have been plagued by numerous reports of side effects. The issue prompted
European regulators to investigate although they did not find evidence the vaccines cause chronic pain or dizziness. Earlier this month,
meanwhile, 63 young women in Japan filed a class-action lawsuit seeking $9 million in compensation from the central government and the
manufacturers over side effects, pain in various parts of their bodies, difficulty walking, and impaired eyesight. Study says doctors passively
discourage HPV vaccines Physicians have also been affected by the criticisms. A study last fall, which was based on a survey of 776 US doctors,
found that a quarter did not strongly endorse the need for HPV vaccination with parents of 11- and 12-year-olds under their care.
Consequently, uptake has been slow. The US Centers for Disease Control and Prevention reported that about 7 percent of girls and 22 percent
of boys aged 13 to 17 years of age had completed all three recommended doses as of 2014. The low vaccination rates have frustrated public
health officials, as well as Merck, which earlier this summer began running the first Gardasil television ad campaign in several years. The ads,
however, have generated some controversy of their own. Instead of specifically promoting the product, the message tugs on parental heart
strings by focusing on the hazards of contracting HPV. Merck began the ad campaign amid declining Gardasil sales in the United States. For the
first six months of this year, the vaccine generated $770 million, down from $785 million during the comparable period in 2014. On an
annualized basis, the figures suggest sales may lag behind the $1.9 billion in revenue that Gardasil generated in 2015.
Turns Case
Trumpcare kills vaccine funding – turns case
Joanne Kenen, 5-9-2017 --- thee health editor at Politico, is AHCJ’s topic leader on health reform and curates related material at
healthjournalism.org. ("ACA repeal, Trump budget threaten expanded spending on public health," Association of Health Care Journalists,
http://healthjournalism.org/blog/2017/05/aca-repeal-trump-budget-threaten-expanded-spending-on-public-health/)//ernst

The House’s ACA repeal bill finally passed last week. It potentially will have a significant impact on public
health if the Senate’s version runs along the same lines. That’s because the Obama-era Affordable Care Act had a big
impact on the Centers for Disease Control and communities, even if it was overshadowed by the ongoing national debates about coverage and
the role of government in providing health care. Tucked into the GOP’s American Health Care Act is a provision to repeal the Public Health and
Prevention Fund that was part of the 2010 health law. The fund has been a frequent target of the GOP, which characterizes it as a public health
slush fund. This CDC chart shows how the money has been spent, which includes expansion of immunization programs, disease outbreak
monitoring, tracking antibiotic resistance, helping hospitals reduce infection risk, and community-based health and prevention programs. (A
recent Trust for America’s Health report has more detail on public health investment – and the lack thereof – as well as some state-by-state
breakdowns.) The proposed AHCA would cut 12 percent of the CDC budget, or $931 million for 2017. The
House bill won’t pass the Senate in its current form – but it is too soon to know what public health funding will survive. As of now, the Public
Health Fund will still exist. However, President Trump in his budget proposal spelled out further deep cuts to public health. The House and
Senate so far have not embraced them. The $1 trillion spending bill for the rest of fiscal 2017 includes funding for the Prevention and Public
Health Fund and a small $22 million bump in CDC funding. But public health officials and advocates are deeply worried. “This is about
protecting Americans, so this is about saving lives,” CDC Acting Director Anne Schuchat told Lena Sun of the Washington Post
after a briefing on the threat of drug-resistant superbugs that took place shortly after the bill was made public. Sun wrote a good wrap-up of
the cuts at the time. “An outbreak can happen anywhere,” Schuchat noted. “It’s not a red- or blue-state kind
of thing. And we want to sustain the defense of Americans’ health from these new emerging threats.”
The prevention fund last year allocated $324 million to the CDC’s immunization program. “The money is sent directly to states
and local communities to improve immunization infrastructure, such as registries that allow providers to
know which patients have received what vaccines,” Sun wrote. “Money from the prevention fund
accounted for about 40 percent of the CDC’s total immunization program funding last year.” It is not at
all clear how states would keep up immunization levels and surveillance if these funds were to
disappear.
**Kritiks**
1NC Biopower Link
Mandatory vaccination leads to excessive abuses of biopower – only an alternative
understanding of biopolitics can solve the aff
Engels 16 Kimberly S. Engels is a candidate and lecturer in the Marquette University Philosophy
Department, September 2016, “Biopower, Normalization, and HPV: A Foucauldian Analysis of the HPV
Vaccine Controversy”, Journal of Medical Humanities September 2016, Volume 37, Issue 3, pp 299–312
//DJ

My aim was to show through a Foucauldian analysis that the development of the HPV vaccine is a
strategy of biopower that affects adolescents, parents, and the human species as a whole. This strategy
also potentially introduces new medical and behavioral norms and introduces new techniques for
understanding the disease. Through incorporation of Foucault’s and Hardy’s analyses of smallpox
elimination, I have shown that triumph over and elimination of a disease requires the shaping of both
medical and behavioral norms. It was vital to educate the public about the disease, and to facilitate the
cooperation of citizens, especially parents, in immunizing their children and following other protocols to
bring down rates of smallpox. This implies that the development of a vaccine must be implemented
alongside other practices in order for the disease to be effectively controlled and for lives to be saved. In
addition, the HPV vaccine must be accompanied by other power mechanisms in the form of standard
precautionary measures: an understanding of the risk of multiple sexual partners, knowledge of
partners’ sexual history, condom use, regular cervical screenings and pap smears, etc. The practice of
vaccination can only result in the elimination of the disease if these additional mechanisms are in place,
exercised by and through individual subjects. The combination of medical practice (vaccination) and
these other aspects of the process can refocus the debate: First, we must recognize that the HPV
vaccine is a form of biopower and entails a form of normalization—establishing what is normal and
abnormal. It is not a neutral medical procedure. Second, while biopower introduces power over bodies,
not all forms of biopower are detrimental and can lead to eradication of deadly diseases like smallpox,
or the containment of diseases like measles, mumps, rubella, tuberculosis, diphtheria, etc., which are all
prevented through usual childhood vaccines. In these cases, an alteration of bodies cannot be equated
with harm. Third, when new forms of biopower and normalization occur, adolescents should be part of
the conversation so that they are included in the decision-making process and exercise power over their
own bodies. Fourth, parents, who are legally and morally responsible for adolescents have to be part of
the conversation and the decision-making process so that the biopower and normalizing processes are
not external anonymous forces but are recognized, discussed, and susceptible to parents’ and
adolescents’ assent or dissent. HPV is a serious and prevalent STI that affects millions of people each
year and leads to the deaths of 4,000 women annually. Reduction of HPV has the potential to save lives,
prevent painful genital warts, and save billions of healthcare dollars. However, making the vaccine
mandatory is a new form of biopower and strategy of normalization, and with new mechanisms of
power come new attitudes, concerns, and controversy about health, behavior, relationships and norms.
These strategies affect the development of individual human subjects and shape who we are and what
we become. Only when we take this into consideration can we properly refocus the issue on how the
vaccine can potentially serve as an affirmation of life, power over death, and a mechanism that
positively affects the species.
** Case **
Solvency
1NC Circumvention
Fringe doctors means that the aff fails --- exemption circumvention is inevitable
PAUL OFFIT 6/30/17 --- Pediatrician specializing in infectious diseases and an expert on vaccines, immunology, and
virology. Co-inventor of a rotavirus vaccine. Offit is the Maurice R. Hilleman Professor of Vaccinology, professor of Pediatrics at
the Perelman School of Medicine at the University of Pennsylvania, chief of the Division of Infectious Diseases, and the director
of the Vaccine Education Center at The Children's Hospital of Philadelphia. Former member of the Centers for Disease Control
and Prevention (CDC) Advisory Committee on Immunization Practices. Offit is a board member of Every Child by Two and a
founding board member of the Autism Science Foundation (ASF). Pandora’s Lab is his ninth book. (“Interview of Paul Offit!”,
Paul Offit, June 30, 2017, Interview with Chirag Jain, Transcribed by Chirag Jain – chiragjain2000@hotmail.com,
https://sites.google.com/a/icstudents.org/debateinterviews/)//chiragjain

Paul Offit: I think that it’s interesting, I think it would be very hard to workout in real life. How
are you documenting whether
people have vaccines, I’m sure people would find doctors that would probably be willing to say, that
they got vaccines. That’s already happening in California, where you can buy medical exemptions. You
just have to go to the right doctor and for a certain amount of money they’ll write you an exemption.
So it kind of creates a black market for those exemptions, but yeah, I think it would be an interesting
idea. Chirag: So on that note, I read articles about “fringe doctors” that you can buy medical exemptions from. Is there anyway to prevent the
black market exemptions? Paul: yes I think that the state people probably know which doctors they are, In a better world
professional societies like the American Academy of Pediatrics should step forward and make it clear that they shouldn’t do
that, and if they do do that, then they should take away their medical license, its fraud. They’re
misrepresenting information, that’s fraud, and that puts other people at risk. Chirag: Right, so I guess that if
the federal government said that vaccinations are mandatory, would that result in a lot of people going
to these doctors for buying medical exemptions? Paul: Right, I think it would.

States and schools circumvent --- only local or state policies can solve, feds fail
MARGARET ROBERSTON 2013 --- BA University of Pittsburgh on Vaccinations and Health Policy (“ANALYSIS OF MANDATORY YOUTH
VACCINATION ENFORCEMENT MODELS, Margaret Roberston, 2013, Masters Paper for University of Pittsburgh Master of Public Health School,
d-scholarship.pitt.edu/27354/1/RobertsonM_Masters Essay_4_2016.pdf)//chiragjain

Enforcement is an important variable at multiple stages of the mandatory youth vaccination system.
School officials can enforce students’ and guardians’ compliance with mandatory vaccination
requirements, health officials can audit schools’ compliance with record keeping and reporting, and education agencies can
enforce accreditation and attendance policies. For this analysis, enforcement is focused on state and local
health agencies’ auditing and enforcement policies related to school authorities’ compliance with
mandatory vaccination laws. Public health agencies’ enforcement procedures include auditing schools’ immunization records,
publicly releasing immunization rate data by district or school, and imposing penalties for noncompliance. Many states assign school
officials sole responsibility for enforcing students’ and guardians’ compliance with youth immunization
policies. While some states require health agencies to provide officials forms for immunization records and exemptions, and maintain
databases for schools to report immunization data, schools are ultimately responsible for reviewing records and
excluding non-compliant students from attending school. For this analysis of health agencies’ enforcement models, states’
enforcement policies were divided into three categories (low, moderate, and high enforcement) based on the reporting and auditing
requirements imposed on schools (see Table 2 for enforcement models.) A
majority of states require schools to submit
annual reports to a local or state health agency that include the number of students in compliance with
immunization laws, the number of students granted exemptions, and the number of students provisionally admitted or who are
noncompliant. Based on these models, three states, Delaware, Kentucky, and Tennessee, and D.C. fall into the most limited enforcement
category. Schools in these areas are either not required to submit annual reports on students’ immunization data or are not audited by a local
or state health agency (see Figure 5 for enforcement model map.) A majority of states have moderate enforcement policies. These states
require schools to submit students’ aggregate youth immunization data and also have some type of auditing policies in place to monitor
schools’ compliance with data collection and reporting. For example, the Pennsylvania Department of Health’s auditing procedures focus on
reviewing school reports and auditing only outlier data (Lattanzio, 2015). Seven states (CA, IL, MN, MS, NJ, OK, and WV) have enforcement
policies that not only require data reporting and auditing, but also enact additional enforcement measures. In addition to annual reporting
requirements and auditing, several states publish schools’ data on state websites for the public to view or require schools to provide
immunization data to guardians if requested. The California Department of Public Health not only publishes school data publicly, but also ranks
schools from “safest” to "most vulnerable” on its website based on each school’s immunization rates (How Is Your School Doing?, 2015). Other
states in the high enforcement category do not publish school data publicly, but do have clear penalties for school officials who do not comply
with immunization policies. For example, if school officials in New Jersey do not correct deficiencies identified during an audit by the local
health department, they may be subject to fine between $50 and $1000 per offense (Sample Enforcement Letter, 2015). Similar to the data on
states’ exemption accessibility, it is difficult to assess the reliability of these enforcement measures. States’ auditing procedures may not be
implemented as intended. Furthermore, some state regulations call for random sampling of schools for auditing, others audit all schools, and
some mention auditing but do not include clear procedures. Penalties for enforcement noncompliance also may not influence school
administrators’ behavior. Research on the state enforcement policies did not turn up any examples in which state administrators penalized
school administrators for noncompliance with youth immunization laws. 5.0 THE EFFECT OF ENFORCEMENT ON VACCINATION RATES
Although several aforementioned studies of local enforcement of youth immunization laws found a
correlation between enforcement variables, such as the accessibility of exemptions, and vaccination
rates this correlation is less clear on a national scale. Regressing states’ MMR rates with their provisional admittance
periods, the number of exemption types available, exemption accessibility, and their enforcement models does not find produce any
statistically significant relationship (see Appendix B for regression output.) However, the signs of the coefficients are what would be expected if
MMR vaccination rates increase with lower provisional periods, fewer exemptions, and lower exemption accessibility. The coefficients also
support a direct relationship between MMR rates and higher levels of enforcement. Local studies may be more effective in
measuring enforcement variables. Language from state policies may not be reflective of actual
enforcement measures. De facto procedures used in enforcing mandatory youth vaccinations may differ
significantly from the language in state policies due to institutional norms, leadership, and individual
behavior. Previous studies that found a relationship between vaccination rates and enforcement used survey data from
school administrators. Regardless of the statistical data, media reports demonstrate that there is shared concern among
states that schools are not reporting accurate immunization data or adequately enforcing existing
policies, which could undermine efforts to improve vaccination rates. Although the findings are not statistically significant, the
modeling of exemption and enforcement variables provides a useful national framework for
understanding mandatory immunization policies
2NC Circumvention
Aff can’t solve fringe practitioners
NEAL GOLDSTEIN ET AL. 3/2017 --- Neal D. Goldstein, PhD, MBI is an infectious disease epidemiologist at Christiana Care Health
System (“The Politics of Eliminating Nonmedical Vaccination Exemptions”, Neal Goldstein, March 2017, AAP News and Journals Gateway,
http://pediatrics.aappublications.org.proxy.lib.umich.edu/content/139/3/e20164248)//chiragjain

It is not inconceivable that widespread


elimination of exemptions could have an opposite effect and give rise
to medical exemptions granted by fringe practitioners or an increase in homeschooling, undermining
legislative efforts to improve vaccination rates. There are a host of proposed alternatives that require
less drastic (and polarizing) legislation, including stricter exemption policies and financial disincentives.
Internationally, Australia has recently received attention for limiting child-care benefits for parents who philosophically object to vaccinating
their children.3 Domestically, an annual nonmedical exemption fee has been proposed acknowledging the challenges of altering exemption
laws.4 Nonmandated approaches may be the path of least resistance to achieve the ultimate public
health goal of increased vaccination rates.
1NC Alt Causes
Too many hurdles to solve – parents, infrastructure, consent, and liability issues
Perman et al 17 -- Department of Applied Health Research, Clinical Operational Research Unit [Sarah
Perman, Simon Turner, Angus I. G. Ramsay, Abigail Baim-Lance, Martin Utley and Naomi J. Fulop, School-
based vaccination programmes: a systematic review of the evidence on organisation and delivery in high
income countries, https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-017-4168-0, 3
March 2017, Access Date: 6/29/17] MP

Schools have become an increasingly important setting for delivery of immunisation programmes in
high income countries. Beginning in some countries with polio vaccination in the 1950s, generations of
children have received vaccinations through school-based programmes. Many countries have recently
expanded their childhood immunisation programmes to incorporate new vaccinations such as annual
intranasal influenza vaccine for healthy children and Human Papillomavirus (HPV) vaccination for
teenage girls [1]. Schools are an attractive venue for providing these vaccines because of their ability to reach large numbers of children in a short period of
time. Evidence from a wide range of studies shows that school-based vaccination is effective in achieving

high uptake and completion rates [2, 3, 4, 5]. This evidence comes from different types of school-based programmes: routine and booster
immunisation programmes, catch up programmes for unvaccinated and partially vaccinated young people, and vaccination in response to an outbreak of disease.
Research also shows that school-based vaccination is successful in reducing the burden of disease in the
wider community as well as in the vaccinated population [4, 6, 7]. Studies have found school-based
vaccination to be acceptable to education staff, health professionals, parents and students even when
programmes involve new vaccines and parental concerns figure strongly [8, 9]. There are, however,
considerable political, organisational and logistical challenges to delivery of such large scale programmes
in schools. Challenges include which organisational and funding models should be selected, questions
about vaccine supply and distribution, issues around staff capacity and workload, as well as how to
inform parents, obtain consent, and minimise anxiety and distress to students. The exact nature of these challenges
and approaches for successfully overcoming them are not currently well understood. With the advent of further new vaccines on the

horizon, it is likely that mass vaccination programmes will be a more frequent event in the school
timetable [10]. Understanding the processes that influence school-based vaccination programmes is
important information for shaping strategy and policy for future programmes. Our review aims to
identify the factors that influence successful delivery in order to support more effective programme
design and implementation. We aimed to identify the contextual and organisational influences, enablers
and barriers which impact on the delivery of programmes in school-based settings.
2NC Alt Causes
Parental backlash is an alt cause - empirics
Perman et al 17 -- Department of Applied Health Research, Clinical Operational Research Unit [Sarah
Perman, Simon Turner, Angus I. G. Ramsay, Abigail Baim-Lance, Martin Utley and Naomi J. Fulop, School-
based vaccination programmes: a systematic review of the evidence on organisation and delivery in high
income countries, https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-017-4168-0, 3
March 2017, Access Date: 6/29/17] MP

The first organisational factor that we identified was the impact of national or regional policy on the
implementation of programmes. Studies described the influence of two categories of policy — those that had a direct impact
on programme delivery, such as the rationale for the programme or the choice of target group, and
those that had an indirect and sometimes unanticipated impact on the vaccination programme, such as
national policies on education or on health service delivery. Among our studies there was little evaluation of the actual impact
policies had; studies tended to describe rather than evaluate the effect of policies on the school vaccination process and programme outcomes. Several US

studies of H1N1 vaccination provided examples of the direct impact that the federal government’s
emergency-driven response to pandemic influenza had on the delivery of school-based programmes and
public attitudes towards this [14, 28, 30, 32]. For example, one paper explored how the declaration of a public health emergency, and the
associated federal legislation that was enacted, gave some schools enough assurance for important

programme enablers to be adopted such as school nurses acting as vaccinators [27]. Two papers from the
US considered how the public responded to a visible and sometimes prominent government role in
vaccination programmes [23, 32]. Cooper Robbins’ systematic review found that the public’s low
acceptance of government involvement in immunisation programmes may have decreased uptake [23].
Examples of policies having an indirect influence included a qualitative study from the UK that
positioned the school-vaccination programme within a broader context of government policy which
favoured schools as a setting for reducing health inequalities and social exclusion. School nurses were expected to
play an important role within this broader policy framework [19]. Another descriptive study from the UK briefly described

nurses’ fears that recent educational reforms, which allowed for the creation of new schools
independent of local government control, might make the organisation of school-based vaccination
more difficult [48]. There was already evidence from the UK that school autonomy could indeed be a problem as two faith schools had refused to participate
in a school-based HPV programme [8].
Economy Advantage
1NC Vaccines Not Key to Pharma
Pharma profits from vaccines are overblown
Simpson 4/12 Michael Simpson has over 25 years’ experience in marketing, business development,
and product development in the medical products industry, 2017, “The myth of Big Pharma vaccine
profits – it’s not what they say it is”, https://www.skepticalraptor.com/skepticalraptorblog.php/the-
myth-of-big-pharma-vaccine-profits-updated/ //DJ

Still, US$10.5 billion sounds like a boatload of cash, but let’s see what happens to that boatload. Every
drug, whether a new vaccine or new drug for erectile dysfunction, costs around US$2.8 from discovery
to regulatory approval (although other analyses show a cost of US$3.8 to 11 billion) each to fully
develop, depending on the drug and the market. But despite what some believe about Big Pharma, drug
development is not a slam dunk. For example, for many drugs, only around 12% gain final approval
from the FDA, so the vast majority of drugs that enter clinical trials end up as failures. Since Big Pharma
funds its own R&D, it has to pay for both its successes and its failures. Using financial data from a typical
broad-based pharmaceutical company like Johnson & Johnson spends about 11.4% of REVENUES (not
profit) on R&D (pdf). So out of the US$24.0 billion in Big Pharma vaccine revenue, about US$2.7 billion is
removed from the net profit for R&D expenses (which are not counted in the administrative expenses
for this exercise), so we’re down to US$7.8 billion. One of the mistakes made by individuals with no
experience in business finance make two falsehoods. First, they assume that risk capital, the money to
finance operations, including R&D, is free. And it is freely available. But it’s not. Second, the fail to
understand that Big Pharma needs to finance future R&D operations from its own cash reserves (or
borrow at high rates). Big Pharma also has to pay taxes on the net profit. And because Big Pharma has
manufacturing, R&D, and administration facilities in modern nations (they need access to intelligent,
well trained employees), they have a more difficult time in moving revenues outside of taxing
authorities. They usually pay around 40% in taxes on the net profit. And they have to depreciate all of
their capital, whether its buildings or equipment, because eventually they have to replace it Companies
need to acquire technology too, which costs money. Back to Johnson & Johnson (JNJ). They weren’t
much of a player in vaccine manufacturing and sales until 2011, when they paid US$2.4 billion for
Crucell, a manufacturer of vaccines. In other words, JNJ expended one year of profits for every vaccine
sold in the world, just to purchase one vaccine manufacturer. And that expenditure has to be expensed
(out of cash reserves, but is accounted for over some period of time, possibly seven years). When all is
said and done, that US$24 billion Big Pharma vaccine revenue becomes around US$2.5 billion in net
vaccine profits (usually stated in accounting terms as EBIDTA). It may actually be quite a bit less, because
I’m ignoring things like cost of risk capital (even though Big Pharma is mostly self funded, it’s not always
so, and if that capital could make more money invested in gold or something, it’s a lost opportunity).
Given this level of profit, and spread over 50 or so vaccines, it’s hard to imagine that Big Pharma
executives are sitting in that Boardroom laughing at how they’re printing cash and storing gold bars
because of vaccines. Just for some additional perspective about Big Pharma efforts – Lipitor, probably
the #1 drug in revenues ever, sold US$10 billion worldwide in 2011. That’s one drug, with one type of
manufacturing facility. In just a few locations. Those Big Pharma execs would rather have Lipitor once or
twice over than vaccines.
2NC Vaccines Not Key to Pharma
Vaccine shortages are inevitable --- pharma companies hate making them and its
unsustainable
PAUL OFFIT 2005 --- Pediatrician specializing in infectious diseases and an expert on vaccines, immunology, and virology.
Co-inventor of a rotavirus vaccine. Offit is the Maurice R. Hilleman Professor of Vaccinology, professor of Pediatrics at the
Perelman School of Medicine at the University of Pennsylvania, chief of the Division of Infectious Diseases, and the director of
the Vaccine Education Center at The Children's Hospital of Philadelphia. Former member of the Centers for Disease Control and
Prevention (CDC) Advisory Committee on Immunization Practices. Offit is a board member of Every Child by Two and a founding
board member of the Autism Science Foundation (ASF). Pandora’s Lab is his ninth book. (“Why Are Pharmaceutical Companies
Gradually Abandoning Vaccines?”, Paul Offit, May 2005, Health Affairs,
http://content.healthaffairs.org.proxy.lib.umich.edu/content/24/3/622.full)//chiragjain

Recent vaccine shortages are not coincidental, nor do they represent short-lived, easily fixable problems in the vaccine
industry. Rather, several market forces explain why pharmaceutical companies are gradually abandoning
vaccines. Small market for vaccines compared with drugs. Vaccines are used at most several times in a lifetime;
drugs are often used every day. Therefore, the market for drugs is much greater than the market for
vaccines. For example, the conjugate pneumococcal vaccine for children (Prevnar), the highest-revenue-generating
vacci