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Ethical and Legal Implications of Vaccine Exemptions in the US – Vaccine Studies

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id="primary"> <main class="site-main" id="main"> <article id="post-104" class="post-104 post type-post status-publish format-standard has-post-thumbnail hentry category-vaccine-exemptions tag-herd-immunity tag-legal-implications tag-measles-outbreaks tag-pertussis-outbreaks tag-philosophical-exemptions tag-public-health-ethics tag-religious-exemptions tag-vaccine-exemptions tag-vaccine-hesitancy tag-vaccine-preventable-diseases" itemtype="https://schema.org/CreativeWork" itemscope> <div class="inside-article"> <div class="featured-image page-header-image-single "> <img width="800" height="419" src="https://vaccine-studies.com/archive/wp-content/uploads/2024/11/banner-24.jpg" class="attachment-full size-full" alt="" itemprop="image" decoding="async" fetchpriority="high" srcset="https://vaccine-studies.com/archive/wp-content/uploads/2024/11/banner-24.jpg 800w, https://vaccine-studies.com/archive/wp-content/uploads/2024/11/banner-24-300x157.jpg 300w, https://vaccine-studies.com/archive/wp-content/uploads/2024/11/banner-24-768x402.jpg 768w" sizes="(max-width: 800px) 100vw, 800px" /> </div> <header class="entry-header"> <h1 class="entry-title" itemprop="headline">Ethical and Legal Implications of Vaccine Exemptions in the US</h1> <div class="entry-meta"> <span class="posted-on"><time class="entry-date published" datetime="2024-11-18T18:13:25+05:30" itemprop="datePublished">November 18, 2024</time></span> <span class="byline">by <span class="author vcard" itemprop="author" itemtype="https://schema.org/Person" itemscope><a class="url fn n" href="https://vaccine-studies.com/archive/author/vaccine-studies/" title="View all posts by vaccine-studies" rel="author" itemprop="url"><span class="author-name" itemprop="name">vaccine-studies</span></a></span></span> </div> </header> <div class="entry-content" itemprop="text"> <p><span style="font-weight: 400;">The re-emergence of vaccine-preventable diseases, such as measles and pertussis, has revived the controversy surrounding exemptions from vaccination. As more and more parents opt out of vaccinating their children due to religious, philosophical, or personal beliefs, the implications of these exemptions have taken over the circle of individual rights to public health in general. It is with respect to individual liberty and concern for the health of the community that the landscape of ethical and legal considerations becomes very complicated. This paper discusses some of the ethical dilemmas and legal challenges brought about with vaccine exemptions, how they put forward the outbreak of diseases, and what can be done to mitigate these risks.</span></p> <h4><b>Historical Context of Vaccine Exemptions</b></h4> <p><span style="font-weight: 400;">Vaccine mandates in the United States date as far back as the early 19th century, when smallpox vaccination requirements were among the very first. As vaccination programs expanded to include more and more diseases, medical, religious, and  philosophical exemptions were included. These exemptions were built in initially to accommodate people with specific, often rare, contraindications to vaccines or deeply held religious beliefs. The number of nonmedical exemptions, however, has increased over the years, driven by misinformation and fanned by fear and mistrust of the medical system.</span></p> <p><span style="font-weight: 400;">This rise in exemptions has not occurred in a vacuum. It is part of a wider trend of vaccine hesitancy, fanned by claims regarding the safety of vaccines, very often amplified by misinformation on social media and other similar channels. One can see the result of growing hesitancy in the outbreaks of diseases once believed to be almost eradicated within the borders of the United States.</span></p> <p></div></div> <div style="background: #f7f7f7;border: 1px solid rgba(0, 0, 0, 0.07);"> <div style="padding: 30px;"><div class="Adblock-main"> <div class="Adblock-head"> <h2>Yearwise Publication Trend on <b>“<a href="https://vaccine-studies.com/publication-trends/index/vaccine exemptions" target="_blank" title="vaccine exemptions - yearwise publication trends">vaccine exemptions</a>”</b></h2> </div> </div><div class="results-container"><div class="chart-block" style="padding:15px;"> <div class="left"> <div id="results" class="results"></div> </div> <div class="right"> <div class="chart-container"><canvas id="publicationChart"></canvas></div> </div> <div class="keywordsdiv"> <div style="text-align:center;"><b>Find publication trends on relevant topics</b> </div> <span class="gp-icon icon-tags"><svg viewBox="0 0 512 512" aria-hidden="true" xmlns="http://www.w3.org/2000/svg" width="1em" height="1em"><path d="M20 39.5c-8.836 0-16 7.163-16 16v176c0 4.243 1.686 8.313 4.687 11.314l224 224c6.248 6.248 16.378 6.248 22.626 0l176-176c6.244-6.244 6.25-16.364.013-22.615l-223.5-224A15.999 15.999 0 00196.5 39.5H20zm56 96c0-13.255 10.745-24 24-24s24 10.745 24 24-10.745 24-24 24-24-10.745-24-24z"></path><path d="M259.515 43.015c4.686-4.687 12.284-4.687 16.97 0l228 228c4.686 4.686 4.686 12.284 0 16.97l-180 180c-4.686 4.687-12.284 4.687-16.97 0-4.686-4.686-4.686-12.284 0-16.97L479.029 279.5 259.515 59.985c-4.686-4.686-4.686-12.284 0-16.97z"></path></svg></span> <span id="keyword-stats"></span> </div> </div></div></div><div class="inside-article"><style> table { margin: 0 0 1.5em; 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if (!statistics || Object.keys(statistics).length === 0) { resultsContainer.innerHTML = '<p>No data found.</p>'; return; } var tableHTML = `<div class='pub-scroll'> <table class='tablediv' border='1' cellspacing='0' cellpadding='0'> <tr> <th>Year</th> <th>Publication Count</th> </tr>`; Object.entries(statistics).sort(([yearA], [yearB]) => yearB - yearA).forEach(([year, count]) => { const displayCount = count === 0 ? 'NA' : count; tableHTML += ` <tr> <td>${year}</td> <td>${displayCount}</td> </tr> `; }); tableHTML += '</table></div>'; resultsContainer.innerHTML = tableHTML; } function displayLineChart(statistics) { var years = Object.keys(statistics); var counts = Object.values(statistics); var ctx = document.getElementById('publicationChart').getContext('2d'); // Destroy existing chart instance if it exists if (chart !== null) { chart.destroy(); } // Create a new chart instance chart = new Chart(ctx, { type: 'line', data: { labels: years, datasets: [{ label: 'Publication Counts', data: counts, fill: false, borderColor: 'rgba(75, 192, 192, 1)', tension: 0.1 }] }, options: { scales: { y: { beginAtZero: true } }, plugins: { legend: { display: true, position: 'top' } } } }); } function displayKeywordStats(keywords) { var resultsContainer = document.getElementById('keyword-stats'); resultsContainer.innerHTML = ''; if (!keywords || keywords.length === 0) { resultsContainer.innerHTML = '<p>No data found.</p>'; return; } var keywordHTML = ''; keywords.forEach((key, index) => { let key_replace = key.replace(/ /g, '-'); key_replace = key_replace.toLowerCase(); keywordHTML += `<a href="https://vaccine-studies.com/publication-trends/index/${key_replace}" target="_blank" title="${key} - yearwise publication trends">${key}</a>`; if (index < keywords.length - 1) { keywordHTML += ', '; } }); resultsContainer.innerHTML = keywordHTML; } // Call the function with the PHP data var statistics = { "2014": 5, "2015": 6, "2016": 4, "2017": 3, "2018": 8, "2019": 12, "2020": 15, "2021": 15, "2022": 15, "2023": 26, "2024": 12 }; var keywordsArray = ["Vaccine exemptions","Public health ethics","Legal implications","Religious exemptions","Philosophical exemptions","Vaccine-preventable diseases","Measles outbreaks","Pertussis outbreaks","Herd immunity","Vaccine hesitancy"]; displayResults(statistics); displayLineChart(statistics); displayKeywordStats(keywordsArray); </script></p> <h4><b>Ethical Implications of Vaccine Exemptions</b></h4> <p><span style="font-weight: 400;">The vaccine exemptions have wide-ranging ethical considerations herewith, including autonomy, justice, beneficence, and nonmaleficence. On one hand, principle autonomy defends individuals decisions on their own bodies and those of their children. However, once these decisions have the potential to cause harm to others, the balance shifts ethically.</span></p> <p><span style="font-weight: 400;">Vaccine exemptions, especially non-medical ones, pose a huge risk to public health. High levels of vaccination are needed to achieve herd immunity, which includes protection of those unable to be vaccinated for medical reasons. If too many people avoid vaccinations, the immunity of the herd is broken, and populations that are particularly vulnerable to serious illness or death infants, the elderly, and immunocompromised end up bearing a very heavy burden. This raises questions about the justice and fairness of allowing such exemptions at others risk.</span></p> <p><span style="font-weight: 400;">Again, the ethical principle of beneficence, emphasizing the duty to do good and prevent harm, also conflicts with vaccine exemption. Indeed, policies relevant to public health are developed in the interest of the health of the population hence, these exemptions that jeopardize these policies do question the very foundation of public health ethics.</span></p> <h4><b>Legal Frameworks and Vaccine Exemptions</b></h4> <p><span style="font-weight: 400;">State-by-state regulations on vaccine exemptions are very disparate across the United States, with each state deciding who may forgo the mandatory vaccinations and under what circumstances. All states allow medical exemptions these are usually very strict and clearly laid out. Nonmedical exemptions, though, are much more controversial and vary widely in their availability and requirements.</span></p> <p><span style="font-weight: 400;">Some states, such as California, West Virginia, and Mississippi, have taken strong measures to do away with nonmedical exemptions. In 2015, a huge measles outbreak linked to Disneyland brought California to actually pass Senate Bill 277, which eliminated religious and philosophical exemptions for school children. At the state level, it marked a radical step toward that change in perspective regarding public health the law put communal protection above individual choice with respect to vaccination.</span></p> <p><span style="font-weight: 400;">Other states have varying degrees of leniency that range from exempting for religious and philosophical purposes to having varying degrees of scrutiny. Some only require the parents to sign a form others mandate counseling or even education on the risks of not vaccinating. These varying state laws have created wide vaccination disparities and thus vaccine-preventable disease infections.</span></p> <p></div></div> <div style="background: #f7f7f7;border: 1px solid rgba(0, 0, 0, 0.07);"> <div style="padding: 30px;"><div class="Adblock-main"> <div class="Adblock-head"> <h2>Recent Publications on <b>“<a href="https://vaccine-studies.com/recent-publications/index/vaccine exemptions" target="_blank" rel="noopener" title="vaccine exemptions - yearwise publication list">vaccine exemptions</a>”</b></h2> </div> </div> <div class="pb-main"><div class="article-scroll"><div id="results_recent" class="results"></div></div><div class="keywordsdiv" style="margin: 0px 15px;margin-top:20px;"> <div style="text-align:center;"><b>Find publications on relevant topics</b> </div> <span class="gp-icon icon-tags"><svg viewBox="0 0 512 512" aria-hidden="true" xmlns="http://www.w3.org/2000/svg" width="1em" height="1em"><path d="M20 39.5c-8.836 0-16 7.163-16 16v176c0 4.243 1.686 8.313 4.687 11.314l224 224c6.248 6.248 16.378 6.248 22.626 0l176-176c6.244-6.244 6.25-16.364.013-22.615l-223.5-224A15.999 15.999 0 00196.5 39.5H20zm56 96c0-13.255 10.745-24 24-24s24 10.745 24 24-10.745 24-24 24-24-10.745-24-24z"></path><path d="M259.515 43.015c4.686-4.687 12.284-4.687 16.97 0l228 228c4.686 4.686 4.686 12.284 0 16.97l-180 180c-4.686 4.687-12.284 4.687-16.97 0-4.686-4.686-4.686-12.284 0-16.97L479.029 279.5 259.515 59.985c-4.686-4.686-4.686-12.284 0-16.97z"></path></svg></span> <span id="keyword-papers"></span> </div></div></div><div class="inside-article"> <style> .pb-main{ border: solid 1px #ccc; border-top: none; margin-bottom: 20px; padding-bottom: 25px; background:#fff; } .author-main { border: solid 1px #ccc; border-top: none; margin-bottom: 20px; padding-bottom: 25px; background:#fff; } .publication-block { padding: 10px; margin-bottom: 10px; background-color: #f9f9f9; text-align: left; background: #FFF; border-bottom: solid 1px #ccc; margin-left: 15px; margin-right: 15px; } .publication-block h3 { margin: 0 0 10px; color: #000!important; } .publication-block a { font-size: 16px !important; line-height: 1em; font-weight: 600; text-transform: none; color: #000; padding: 0px; } .publication-block a:hover{ color: #227cdc; text-decoration:underline; } .article-scroll { max-height: 445px; overflow-y: auto; overflow-x: hidden; } ::-webkit-scrollbar-track { -webkit-box-shadow: inset 0 0 6px rgba(0,0,0,0.3); background-color: #efefef; border-radius:30px; } ::-webkit-scrollbar { width: 6px; background-color: #efefef; border-radius:30px; } ::-webkit-scrollbar-thumb { background-color: #ababab; border-radius:30px; } .publication-block p { margin-bottom: .5em; font-size: 15px; color: #000; } h3 { font-size: 18px !important; margin-bottom: 20px; line-height: 1.2em; font-weight: 600; text-transform: none; } a { padding: 5px; color: #a71c49; } #keyword-papers{ margin-top: 20px; text-align: center; } </style> <script> function decodeString(str) { str = str.replace(/\\'/g, "'"); str = str.replace(/\\'/g, "'"); str = str.replace(/\\'/g, "'"); return str; } function displayResults_recent(papers) { var resultsContainer = document.getElementById('results_recent'); if (!papers || papers.length === 0) { resultsContainer.innerHTML = '<p>No recent publications found.</p>'; return; } papers.forEach(paper => { var publicationBlock = document.createElement('div'); publicationBlock.className = 'publication-block'; var title_de = decodeString(paper.title); var publicationHTML = ` <div style="margin-bottom: 10px;line-height: 24px;"><a href="${paper.url}" target="_blank" title="${title_de}">${title_de}</a></div> <p><strong>Issue Release:</strong> ${paper.publishedDate}</p> `; publicationBlock.innerHTML = publicationHTML; resultsContainer.appendChild(publicationBlock); }); } function displayKeywordPapers(keywords) { var resultsContainer = document.getElementById('keyword-papers'); resultsContainer.innerHTML = ''; if (!keywords || keywords.length === 0) { resultsContainer.innerHTML = '<p>No data found.</p>'; return; } var keywordHTML = ''; keywords.forEach((key, index) => { let key_replace = key.replace(/ /g, '-'); key_replace = key_replace.toLowerCase(); keywordHTML += `<a href="https://vaccine-studies.com/recent-publications/index/${key_replace}" target="_blank" title="${key} - publication list">${key}</a>`; if (index < keywords.length - 1) { keywordHTML += ', '; } }); resultsContainer.innerHTML = keywordHTML; } // Call the function with the PHP data var recent_papers = [ { "title": "Procedural Dimensions of Religious Exemptions to Covid-19 Vaccine Mandates: Promoting Clarity, Fairness, and Transparency in Applications.", "url": "https:\/\/pubmed.ncbi.nlm.nih.gov\/38668892", "publishedDate": "2024" }, { "title": "Characteristics Associated With Measles, Mumps, and Rubella Coverage and Exemptions After a School Immunization Law Change in Washington, 2019-2020.", "url": "https:\/\/pubmed.ncbi.nlm.nih.gov\/39434196", "publishedDate": "2024" }, { "title": "School Vaccine Coverage and Medical Exemption Uptake After the New York State Repeal of Nonmedical Vaccination Exemptions.", "url": "https:\/\/pubmed.ncbi.nlm.nih.gov\/38306096", "publishedDate": "2024" }, { "title": "The ethics of natural immunity exemptions to vaccine mandates: the Supreme Court petition.", "url": "https:\/\/pubmed.ncbi.nlm.nih.gov\/39025642", "publishedDate": "2024" }, { "title": "Stakeholders\\\\\\' Perceptions on the Implementation of the HPV Vaccine School-Entry Requirement in Puerto Rico during the COVID-19 Pandemic.", "url": "https:\/\/pubmed.ncbi.nlm.nih.gov\/39066398", "publishedDate": "2024" }, { "title": "Policy Feedback and the Politics of Childhood Vaccine Mandates: Conflict and Change in California, 2012-2019.", "url": "https:\/\/pubmed.ncbi.nlm.nih.gov\/38836417", "publishedDate": "2024" }, { "title": "News Brief: Vaccine exemptions for kindergartners at highest levels yet.", "url": "https:\/\/pubmed.ncbi.nlm.nih.gov\/38270409", "publishedDate": "2024" }, { "title": "Lived Religion in Religious Vaccine Exemptions.", "url": "https:\/\/pubmed.ncbi.nlm.nih.gov\/38662066", "publishedDate": "2024" }, { "title": "Coverage with Selected Vaccines and Exemption Rates Among Children in Kindergarten - United States, 2023-24 School Year.", "url": "https:\/\/pubmed.ncbi.nlm.nih.gov\/39418212", "publishedDate": "2024" }, { "title": "School staff as vaccine advocates: Perspectives on vaccine mandates and the student registration process.", "url": "https:\/\/pubmed.ncbi.nlm.nih.gov\/36631362", "publishedDate": "2023" }, { "title": "Mandatory COVID-19 vaccination for healthcare workers: The experience of chaplains evaluating religious accommodation requests from coworkers.", "url": "https:\/\/pubmed.ncbi.nlm.nih.gov\/37506485", "publishedDate": "2023" }, { "title": "Predictors of SARS-CoV-2 Infection and Severe and Lethal COVID-19 after Three Years of Follow-Up: A Population-Wide Study.", "url": "https:\/\/pubmed.ncbi.nlm.nih.gov\/37766201", "publishedDate": "2023" }, { "title": "Vaccination Coverage with Selected Vaccines and Exemption Rates Among Children in Kindergarten - United States, 2021-22 School Year.", "url": "https:\/\/pubmed.ncbi.nlm.nih.gov\/36634005", "publishedDate": "2023" }, { "title": "From iatrogenesis to vaccine skepticism: US mothers\\\\\\' negative vaccine perceptions and non-vaccination practices as reverberations of medical harm.", "url": "https:\/\/pubmed.ncbi.nlm.nih.gov\/37161842", "publishedDate": "2023" }, { "title": "Factors Associated with COVID-19 Vaccine Hesitancy and Case Status among New Jersey Secondary Educational Professionals.", "url": "https:\/\/pubmed.ncbi.nlm.nih.gov\/38005999", "publishedDate": "2023" }, { "title": "Provisional Entrants, Exemptions, and Kindergarteners Up-to-Date on Vaccination Before and After a Regulatory Change in Pennsylvania, 2015-2019.", "url": "https:\/\/pubmed.ncbi.nlm.nih.gov\/36927265", "publishedDate": "2023" }, { "title": "Education components of school vaccine mandates: An environmental scan.", "url": "https:\/\/pubmed.ncbi.nlm.nih.gov\/37923695", "publishedDate": "2023" }, { "title": "COVID-19 vaccine uptake before and after a vaccine mandate at a major academic hospital: Trends by race\/ethnicity and level of patient contact.", "url": "https:\/\/pubmed.ncbi.nlm.nih.gov\/37517911", "publishedDate": "2023" }, { "title": "Making salient ethics arguments about vaccine mandates: A California case study.", "url": "https:\/\/pubmed.ncbi.nlm.nih.gov\/37792305", "publishedDate": "2023" }, { "title": "Coverage with Selected Vaccines and Exemption from School Vaccine Requirements Among Children in Kindergarten - United States, 2022-23 School Year.", "url": "https:\/\/pubmed.ncbi.nlm.nih.gov\/37943705", "publishedDate": "2023" } ]; var keywordsArray = ["Vaccine exemptions","Public health ethics","Legal implications","Religious exemptions","Philosophical exemptions","Vaccine-preventable diseases","Measles outbreaks","Pertussis outbreaks","Herd immunity","Vaccine hesitancy"]; displayResults_recent(recent_papers); displayKeywordPapers(keywordsArray); // function stripslashes(str) { // if (typeof str === 'string') { // return str.replace(/\/g, ''); // } // } </script></p> <h4><b>The Role of Vaccine Exemptions in the Outbreak of Diseases</b></h4> <p><span style="font-weight: 400;">It is evidenced that there exists a clear link between vaccine exemptions and outbreaks of diseases. Studies have shown that as nonmedical exemption rates are higher, so are the rates of outbreaks higher in terms of frequency and severity for such diseases as measles and pertussis. These outbreaks are not just about a failure of individual responsibility but a systemic issue exacerbated by permissive exemption policies.</span></p> <p><span style="font-weight: 400;">For example, the Disneyland measles outbreak in 2015 reflected the risks of having numerous nonmedical exemptions. The outbreak flowed into many states, infecting hundreds of people from the unvaccinated individual. It took very little time for the diseases to spread in communities where exemption rates were very high because the herd immunity had been tampered with.</span></p> <p><span style="font-weight: 400;">Another such case is pertussis, where the consequences of vaccine exemption are deadly. Even with overall high vaccination coverage in states with high exemption rates, pertussis outbreaks have occurred, particularly among school-aged children. The combination of waning immunity from the pertussis vaccine and the clustering of unvaccinated individuals has created pockets of vulnerability where the disease can take hold.</span></p> <p><span style="font-weight: 400;">These outbreaks have important implications for public health in terms of morbidity and mortality rates but also in their economic costs of control. Substantial resources, therefore, go into quarantine measures, vaccination campaigns, and public health investigations during outbreaks. The indirect costs involve lost productivity and long-term health consequences that burden society as a whole.</span></p> <h4><b>The Legal and Ethical Case for Restricting Vaccine Exemptions</b></h4> <p><span style="font-weight: 400;">These risks justify a number of legal and ethical restrictions on vaccine exemptions, particularly the nonmedical exemptions, to public health. The state has a legally compelling interest in protecting public health, which may justify limitations on individual freedoms. This was upheld by several court cases where courts ruled that the interest of the state in preventing disease outweighed the individual claims of religious or philosophical exemptions.</span></p> <p><span style="font-weight: 400;">This can also be viewed, from an ethical perspective, as an extension of the principle of justice that no person, or group of persons, bears a disproportionate share of the burden of vaccine-preventable diseases. It also falls squarely in line with the principle of nonmaleficence in that it prevents harm to others, especially those most vulnerable.</span></p> <p><span style="font-weight: 400;">But it&#8217;s also painstakingly hard to restrict vaccine exemptions. One major worry is that such efforts may, in fact, fuel further resistance and more deeply entrenched vaccine hesitancy. Hence, public health officials must strike a balance between stringent vaccination requirements and measures meant to build trust with the public and educate them on the benefits of vaccines.</span></p> <h4><b>Conclusion</b></h4> <p><b></b><span style="font-weight: 400;">The debate about vaccine exemptions in the United States is quite literally at a crossroads. More and more vaccine-preventable diseases appear as a threat, largely in communities with higher exemption rates. At the same time, ethical and legal justifications for limiting these exemptions grow stronger. The challenge is to devise policies that meet all requirements in terms of protecting public health, respecting individual freedoms, and also addressing concerns underlying vaccine hesitancy.</span></p> <p><span style="font-weight: 400;">This means that in the future, tightened exemption laws, public education, and addressing the root causes of vaccine hesitancy are further measures to be implemented by policymakers. The United States will ensure that the obtained milestones in controlling vaccine-preventable diseases are not reversed through a preventable resurgence.</span></p> <p></p> <h4><b>References</b></h4> <ol> <li>Gostin, L.O., 2015. <a href="https://jamanetwork.com/journals/jama/article-abstract/2119391">Law, ethics, and public health in the vaccination debates: politics of the measles outbreak. </a><i>Jama</i>, <i>313</i>(11), pp.1099-1100.</li> <li>Outbreaks, G.M., <a href="https://scholar.google.com/scholar?hl=en&amp;as_sdt=0%2C5&amp;q=Measles+Cases+and+Outbreaks&amp;btnG=">Measles cases and outbreaks</a>.</li> <li>Omer, S.B., Salmon, D.A., Orenstein, W.A., Dehart, M.P. and Halsey, N., 2009. <a href="https://www.nejm.org/doi/full/10.1056/NEJMsa0806477">Vaccine refusal, mandatory immunization, and the risks of vaccine-preventable diseases</a>. <i>New England Journal of Medicine</i>, <i>360</i>(19), pp.1981-1988.</li> <li>Kowalik, M., 2022. <a href="https://jme.bmj.com/content/48/4/240?fbclid=IwAR0vzrG03UhYcnqncRFz4oaLlqPLdNAoSj6Vf3dJIjzL14m5RLduMtKILIA">Ethics of vaccine refusal.</a> <i>Journal of Medical Ethics</i>, <i>48</i>(4), pp.240-243.</li> <li>Mello, M.M., Studdert, D.M. and Parmet, W.E., 2015. <a href="https://www.nejm.org/doi/abs/10.1056/NEJMp1508701">Shifting vaccination politics—the end of personal-belief exemptions in California.</a> <i>New England Journal of Medicine</i>, <i>373</i>(9), pp.785-787.</li> </ol> <p></div></div> <div style="background: #f7f7f7;border: 1px solid rgba(0, 0, 0, 0.07);"> <div style="padding: 30px;"><div class="Adblock-main"> <div class="Adblock-head"> <h2>Top Experts on “<b style="color:#000;font-size:22px;">vaccine exemptions</b>“</h2> </div> </div><div class="author-main"><div id="results_author"></div><div style="text-align: center;"><a class="register-button" href="https://vaccine-studies.com/expert-search" target="_blank" rel="noopener">Find experts on any field</a></div></div><div class="inside-article" style="background: none;border: none;box-shadow: none;margin-top: -70px;"> <style> .author-block { padding: 15px; margin-bottom: 10px; text-align: left; font-size: 15px; line-height: 1.2; background: #FFF; border-bottom: solid 1px #ccc; margin-left: 15px; margin-right: 15px; } .author-block h3 { margin: 0 0 10px; color: #227cdc; } .author-block p { margin: 5px 0; } .author-b { display: flex; justify-content: space-between; flex-wrap: wrap; margin-bottom:10px; } .author-b .ainfo { flex: 1 1 30%; box-sizing: border-box; text-align: left; background: #dcdcdc; padding: 7px 14px; border-radius: 5px; margin-top: 3px; margin-right: 10px; } @media (max-width: 768px) { .author-b .ainfo { flex: 1 1 100%; margin: 10px 0; } } </style> <script> function displayResults_author(authors) { var resultsContainer = document.getElementById('results_author'); resultsContainer.innerHTML = ''; if (!authors || Object.keys(authors).length === 0) { resultsContainer.innerHTML = '<p>No authors found.</p>'; return; } Object.values(authors).slice(0, 10).forEach(author => { if (author.affiliation.length > 400) { return; } var authorBlock = document.createElement('div'); authorBlock.className = 'author-block'; var author_name=author.name; let key_replace = author_name.replace(/ /g, '-'); key_replace = key_replace.toLowerCase(); var authorHTML = ` <h3><a href="https://vaccine-studies.com/author/index/${key_replace}\/${author.aid}" target="_blank" title="${author.name}">${author.name}</a></h3> <div class="author-b"> <div class="ainfo"><strong>H-Index:</strong> ${author.hindex}</div> <div class="ainfo"><strong>Publication Count:</strong> ${author.paper_count}</div> <div class="ainfo"><strong>Citation Count:</strong> ${author.citation_count}</div> </div> <p><strong>Affiliation:</strong> ${author.affiliation}</p> `; authorBlock.innerHTML = authorHTML; resultsContainer.appendChild(authorBlock); }); } function displayKeywordAuthors(keywords) { var resultsContainer = document.getElementById('keyword-authors'); resultsContainer.innerHTML = ''; if (!keywords || keywords.length === 0) { resultsContainer.innerHTML = '<p>No data found.</p>'; return; } var keywordHTML = ''; keywords.forEach(key => { let key_replace = key.replace(/ /g, '-'); key_replace = key_replace.toLowerCase(); keywordHTML += `<a href="https://vaccine-studies.com/expert-search/index/${key_replace}" target="_blank" title="${key}">${key}</a>`; }); resultsContainer.innerHTML = keywordHTML; } // Call the function with the PHP data var authors_data = { "Au1mK4wBWBy50K-rqFKd": { "aid": "Au1mK4wBWBy50K-rqFKd", "name": "V. 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