We agree with Prof Silverman and Dr Hendrix1 that the risks of measles outbreaks are to be taken very seriously and call for action to raise the immunization rate. We disagree, however, about how to approach this challenge. The question is if measles vaccination should be a mandatory and rigorously enforced requirement for attending school.
Prof Silverman and Dr Hendrix1 rightly point out that current methods of communication to raise the rates of measles immunization are not sufficient. Yet, this does not necessarily lead to their assumption that “mandates are necessary.” To conclude this is a fallacy, given there are further alternative interventions possible. In fact, a measles vaccination requirement for attending school has been proven to be neither the only nor the most effective intervention for herd immunity.2,3 In practice, this intervention is undermined by high rates of exemptions for philosophical reasons2,4 and also can be evaded through home schooling, a trend gaining in popularity in the United States.5,6 Furthermore, countries without any form of mandatory vaccination still reach high immunization rates.3,7