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Make anti-vaccine parents pay higher premiums

By Rahul Parikh, Special to CNN
  • Rahul Parikh says the idea that autism and vaccines are linked has been totally discredited
  • Parikh says some parents still don't vaccinate their children, putting them and others at risk
  • He says anti-vaccine parents should pay substantially higher health insurance premiums

Editor's note: Rahul K. Parikh is a physician and writer who lives in the San Francisco Bay Area. Follow him on Twitter at

Walnut Creek, California (CNN) -- Evidence disputing any link between autism and vaccines has been gathering for a decade. The anti-vaccine movement's lynchpin, Dr. Andrew Wakefield, has been shown to be nothing more than a grifter in a lab coat, with the prestigious British Medical Journal calling his work "an elaborate fraud."

Two new books, "Deadly Choices" by Paul Offit and "The Panic Virus" by Seth Mnookin, detail the sordid story of the anti-vaccine movement.

Given that, it's hard for me to believe that some parents still refuse to vaccinate their children. But they do, frightened by the rants and raves of anti-vaccine fundamentalists such as Jenny McCarthy, who can effortlessly get on "Oprah" or any other TV talk show to advance what is nothing short of a myth.

It's that fiction and the fear it incites that has challenged and frustrated pediatricians like me for 10 years. I don't foresee any quick shift in the trend among affluent, highly educated older parents against childhood vaccines. As Offit often points out, it's much harder to unscare people once they've been scared. McCarthy has it easy. We doctors have to do the hard part.

Refusing to vaccinate a child is dangerous not just for that child but for entire communities. It's precisely this point a colleague of mine was considering when he had the idea that parents who refuse to vaccinate their kids should pay substantially higher health insurance premiums.

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It makes sense. Insurance, after all, is just a pool of money into which we all pay. In determining how much we or our employers pay, risk is taken into account.

The perfect analogy is smoking. If you smoke -- and want to turn your lungs black and spend a greater portion of that pot of money on your possible chronic lung disease or any cancers you'll get -- then you may have to pay more.

Why shouldn't we impose the same logic on parents who refuse to vaccinate their children?

The link between smoking and lung cancer is as clear as that between refusing vaccines and increasing the risk of infectious disease. And the one between secondhand smoke and a litany of health problems pales in comparison to the link between going unvaccinated and spreading "secondhand disease."

Researchers looking at the 2008 measles outbreak in San Diego, California, showed just how expensive and serious an outbreak of a disease that could have been prevented with a vaccine can be. A child whose parents refused to vaccinate him traveled to Europe and brought home the measles.

That family exposed 839 people, resulting in 11 additional cases of measles. One child too young to be vaccinated had to be hospitalized.

Forty-eight children too young to be vaccinated had to be quarantined, at an average family cost of $775 per child. The total cost of the outbreak was $124,517, about $11,000 per case and substantially more for the hospitalized child. That was just in the money the county and state spent to clean the mess up, and doesn't take into the account the costs to private insurers.

Nothing in this argument should supersede that doctors need to slow down and talk carefully with parents who are worried about vaccines. And none of it should distract from the fact that parents of children with autism deserve answers.

But if the Wakefield-McCarthy tribe had anything to say about this, they may agree. After all, their latest slogan is "vaccine choice."

In reflecting on what happened, the mother of the San Diego child told Time magazine that "we analyze the diseases and we analyze the risks of the disease, and that's how my husband and I made our decision about which vaccines to give our children."

Fair enough. If they want to make a risky choice, let's have this mother and others like her pay more for it.

As an aside, perhaps we could make doctors complicit in that choice pay higher malpractice premiums as well. Perhaps then, the combination of proof, medical crimes, stories like what happened in San Diego and a little moral hazard for patients and doctors will help move the needle toward common sense and preventive medicine.

The opinions expressed in this commentary are solely those of Rahul Parikh.