Outbreaks are expensive. Each measles case, for example, can cost public health agencies $10,000 or more in tax dollars as scientists scramble to track infected people and curb the spread of disease.
Some legal scholars want to make non-vaccinating parents pay for these costs — either by imposing up-front charges, or by sending them a bill if their child infects others.
Up-front charges could be levied through the tax system or by imposing fees, three researchers argued in a paper last year. Alternatively, their report also includes draft legislation that would allow states to send an itemized bill to cover the costs of investigating and containing a preventable disease outbreak, and treating people who got infected.
"We're proposing a menu of options," Dorit Reiss, a professor at the University of California Hastings College of the Law in San Francisco, and one of the paper's authors, told BuzzFeed News. "We're putting it out there and states can choose if they want to do any of this."
According to the draft law, people who don't follow vaccination recommendations promoted by the federal Centers for Disease Control and Prevention are a "public nuisance." It also states that parents could be made to pay even if they qualify for religious or personal-belief exemptions from state-mandated vaccinations.
Imposing these costs is justified, the paper argues, as a deterrent, and to be fair to parents who do vaccinate: It would prevent non-vaccinating parents "from forcing others to pay for the risks created by their decisions."
Reiss and her colleagues haven’t calculated how large no-vax taxes might be. But if a few families were held responsible for a major outbreak, bills sent after the event could be huge.
A 2008 measles outbreak in San Diego involving just 12 cases cost state and local health agencies almost $125,000, according to a study published in the journal Pediatrics. The costs of the current outbreak, which began at Disneyland in Anaheim in December 2014, have not been tallied. But with more than 100 cases in California, and more cropping up in other states, the bill is likely to dwarf the one from 2008.
Measles is highly contagious. The virus spreads mainly through coughs and sneezes, and can survive in the air for up to two hours.
"The investigation of measles cases is extremely resource intensive, as one case may have hundreds of contacts," Gil Chavez, a deputy director with the California Department of Public Health, wrote in a statement to BuzzFeed News and other media that have asked about the costs.
Reiss and her colleagues have sent their proposals to Democratic California State Senators Ben Allen and Richard Pan. On Wednesday, the pair announced they will be introducing a bill to end California's personal-belief exemption.
Pan's office declined to comment specifically on Reiss' proposals, saying that the lawmaker is focused on limiting exemptions.
"Dr. Pan's approach is to remove the option for parents, so all children are protected from diseases that could result in the death of a child," his communications director, Shannan Velayas Martinez, told BuzzFeed News. No price can be put on that, she added.
Others say a no-vax tax is unrealistic, for a variety of legal and practical reasons.
For one thing, tracking the precise chains of disease transmission from one person to another is tricky. So it would be difficult for scientists to pin the blame on particular unvaccinated individuals, Mary Holland, of New York University School of Law, told BuzzFeed News. And if a state allows vaccine exemptions, she added, it's hard to see how parents could be held liable for taking advantage of them. "I just think people would see this as overreaching," Holland said.
Holland's son has autism, and she believes he was injured by the MMR (measles, mumps, and rubella) vaccine. But even health law experts who are pro-vaccine wonder whether taxing or billing parents is the best strategy.
"My own view is that raising the cost of deciding not to be vaccinated is a perfectly appropriate thing to do," Alexander Capron, a specialist in health policy and law at the University of Southern California in Los Angeles, told BuzzFeed News. But he suspects that the idea of sending parents a bill after an outbreak occurs, or imposing hefty taxes on non-vaccination, would be "too heavy handed" to win popular support. "It would depend on the dollar amount."
As the measles case numbers continue to rise, emotions are running high among parents who blame non-vaccinating families. "I've never heard such anger," said Paul Offit, head of the Vaccine Education Center at the Children's Hospital of Philadelphia and a close colleague of one of the legal paper's authors.
"I think the best way to approach this is to hold those who put others at risk financially liable," Offit said. "There's nothing like money to influence behavior."