Funding the Costs of Disease Outbreaks Caused by Non Vaccination
Charlotte A Moser
The Children's Hospital of Philadelphia
Dorit Rubinstein Reiss
University of California Hastings College of the Law
Robert L. Schwartz
University of New Mexico - School of Law
June 3, 2014
Journal of Law, Medicine and Ethics, Vol. Fall, 2015
UC Hastings Research Paper No. 106
UNM School of Law Research Paper No. 2014-25
While vaccination rates in the United States are high – generally over 90 percent – rates of exemptions have been going up, and preventable diseases coming back. 2014 is shaping to be one of the worst years for measles since 1994, with outbreaks generally starting from unvaccinated individuals and affecting primarily the unvaccinated. While pertussis is a more complex story, communities with high rates of exemptions are more vulnerable to outbreaks. Aside from their human cost and the financial cost of treatment imposed on those who become ill, outbreaks impose financial costs on an already burdened public health system, diverting resources from other areas. This article examines the financial costs of non-vaccination, showing how high they can be and what they include. It makes a case for requiring those who do not vaccinate to cover the costs of outbreak caused by their choice. Such recouping is justified because the choice not to vaccinate can easily be seen as negligent. But even if it is not, that choice involves imposing costs on others, and there are good reasons to require the actors to internalize those costs.
The article proposes alternative statutory and regulatory schemes to cover the costs imposed on the public purse, focusing on no-fault mechanisms. We consider both ex ante mechanisms like a tax or a fee that will go into a no-fault fund to cover the costs and ex post mechanisms like a statutory authorization for recoupment of those costs by health officials, modeled on statutes allowing government to recoup costs of other types of harms, detailing the strengths and challenges of the various mechanisms.
Number of Pages in PDF File: 52Accepted Paper Series
Date posted: June 3, 2014 ; Last revised: February 19, 2015
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