{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,10]],"date-time":"2026-01-10T18:43:58Z","timestamp":1768070638537,"version":"3.49.0"},"reference-count":76,"publisher":"Cambridge University Press (CUP)","issue":"3","license":[{"start":{"date-parts":[[2021,1,1]],"date-time":"2021-01-01T00:00:00Z","timestamp":1609459200000},"content-version":"unspecified","delay-in-days":1827,"URL":"https:\/\/www.cambridge.org\/core\/terms"},{"start":{"date-parts":[[2016,1,1]],"date-time":"2016-01-01T00:00:00Z","timestamp":1451606400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J. Law. Med. Ethics"],"published-print":{"date-parts":[[2016]]},"abstract":"<jats:p>This article examines the rise of the anti-vaccination movement, the proliferation of laws allowing parental exemptions to mandatory school vaccines, and the impact of the movement on immunization rates for all vaccines. It uses the ongoing debate about the Human Papillomavirus (HPV) vaccine as an example to highlight the ripple effect and consequences of the anti-vaccine movement despite robust evidence of the vaccine's safety and efficacy. The article scrutinizes how state legislatures ironically promote vaccination while simultaneously deferring to the opposition by promulgating broad opt-outs from mandatory vaccine laws. This article concludes by offering an alternative legislative approach to specifically combat the anti-vaccine movement's impact on HPV vaccination rates. Lowering the age of consent has not been widely attempted or proposed and provides an alternative statutory mechanism to push back against vaccine resistance.<\/jats:p>","DOI":"10.1177\/1073110516667942","type":"journal-article","created":{"date-parts":[[2017,12,12]],"date-time":"2017-12-12T10:22:15Z","timestamp":1513074135000},"page":"462-473","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":13,"title":["Lowering the Age of Consent: Pushing Back against the Anti-Vaccine Movement"],"prefix":"10.1017","volume":"44","author":[{"given":"Allison M.","family":"Whelan","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"56","published-online":{"date-parts":[[2021,1,1]]},"reference":[{"key":"S1073110500020581_bib44","unstructured":"44. Alaska Admin. Code tit. 4, \u00a7 06.055(b)(3)(West 2015)."},{"key":"S1073110500020581_bib54","unstructured":"54. Id., at xv\u2013xvi."},{"key":"#cr-split#-S1073110500020581_bib67.1","unstructured":"67. Idaho Code Ann. \u00a7 39-3801 (West 2014)"},{"key":"#cr-split#-S1073110500020581_bib67.2","doi-asserted-by":"crossref","unstructured":"N.H. Rev. Stat \u00a7 141-C:18 (II) (West 2014)","DOI":"10.1525\/nr.2015.18.4.141"},{"key":"#cr-split#-S1073110500020581_bib67.3","doi-asserted-by":"crossref","unstructured":"N.D. Code Ann. \u00a7 14-10-17 (West 2013)","DOI":"10.1038\/ndigest.2013.131014"},{"key":"#cr-split#-S1073110500020581_bib67.4","unstructured":"67. Idaho Code Ann. \u00a7 39-3801 (West 2014); N.H. Rev. Stat \u00a7 141-C:18"},{"key":"#cr-split#-S1073110500020581_bib67.5","unstructured":"(II) (West 2014); N.D. Code Ann. \u00a7 14-10-17 (West 2013); Wash. Rev. Code Ann. \u00a7 70.24.110 (West 2014)."},{"key":"S1073110500020581_bib24","unstructured":"24. See, e.g., FDA, Gardasil Vaccine Safety: Information from FDA and CDC on the Safety of Gardasil Vaccine, last updated July 15, 2014, available at <http:\/\/www.fda.gov\/BiologicsBloodVaccines\/SafetyAvailability\/VaccineSafety\/ucm179549.htm> (last visited July 11, 2016). A vaccine is approved and remains on the market only if pre-approval and post-approval data show the benefits outweigh potential risks. Centers for Disease Control & Prevention, \u201cEnsuring the Safety of Vaccines in the United States,\u201d February 2013, available at <http:\/\/www.cdc.gov\/vaccines\/hcp\/patient-ed\/conversations\/downloads\/vacsafe-ensuring-bw-office.pdf> (last visited July 11, 2016)."},{"key":"S1073110500020581_bib70","unstructured":"70. Cal. A.B. No. 599, 2013\u201314 Reg. Sess. (Cal. 2013) (failed to pass) (emphasis added)."},{"key":"S1073110500020581_bib51","unstructured":"51. 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Whelan"},{"key":"S1073110500020581_bib42","unstructured":"42. Miss. Code Ann. \u00a7 41-23-37 (West 2015) (this law was challenged but upheld by the Supreme Court of Mississippi in 1979 in Brown v. Stone, 378 So.2d 218, 223 (Miss. 1979)); W. Va. Code Ann. \u00a7 16-3-4 (West 2015); L. Perkins, \u201cCalifornia Governor Signs School Vaccination Law,\u201d National Public Radio, June 30, 2015, available at <http:\/\/www.npr.org\/sections\/thetwo-way\/2015\/06\/30\/418908804\/california-governor-signs-school-vaccination-law> (last visited July 11, 2016)."},{"key":"S1073110500020581_bib6","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1111\/j.1748-720X.2012.00698.x","article-title":"\u201cToo Fast or Not Too Fast: The FDA's Approval of Merck's HPV Vaccine Gardasil,\u201d","volume":"40","author":"Tomljenovic","year":"2012","journal-title":"Journal of Law, Medicine and Ethics"},{"key":"S1073110500020581_bib12","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1542\/peds.2013-0698","article-title":"\u201cEconomic Evaluation of the Routine Childhood Immunization Program in the United States, 2009,\u201d","volume":"133","author":"Zhou","year":"2014","journal-title":"Pediatrics"},{"key":"S1073110500020581_bib57","unstructured":"57. Id."},{"key":"S1073110500020581_bib20","first-page":"153","article-title":"\u201cMeasles Outbreak \u2014 California, December 2014\u2013February 2015,\u201d","volume":"64","author":"Zipprich","year":"2015","journal-title":"Morbidity and Mortality Weekly Report"},{"key":"S1073110500020581_bib26","unstructured":"26. Offit, P. A. , Deadly Choices: How the Anti-Vaccine Movement Threatens Us All (Basic Books 2011): at 10."},{"key":"S1073110500020581_bib60","doi-asserted-by":"crossref","first-page":"610","DOI":"10.1006\/pmed.1995.1096","article-title":"\u201cPsychological Response to Cervical Screening,\u201d","volume":"24","author":"Bell","year":"1995","journal-title":"Preventive Medicine"},{"key":"S1073110500020581_bib31","unstructured":"31. Lafferty, A. , \u201cNo Mandatory HPV Vaccines for Girls,\u201d Graybrook Institute Blog, Feb. 22, 2007, available at <http:\/\/graybrook.blogspot.com\/2007\/02\/no-mandatory-hpv-vaccines-for-girls.html> (last visited July 11, 2016)."},{"key":"S1073110500020581_bib65","doi-asserted-by":"crossref","first-page":"6016","DOI":"10.1016\/j.vaccine.2012.07.056","article-title":"\u201cEstimates of the Annual Direct Medical Costs of the Prevention and Treatment of Disease Associated with Human Papillomavirus in the United States,\u201d","volume":"30","author":"Chesson","year":"2012","journal-title":"Vaccine"},{"key":"S1073110500020581_bib35","unstructured":"35. Office for State, Tribal, Local & Territorial Support, State School Immunization Requirements and Vaccine Exemption Laws, Mar. 27, 2015, available at <http:\/\/www.cdc.gov\/phlp\/docs\/school-vaccinations.pdf> (last visited July 11, 2016)."},{"key":"S1073110500020581_bib38","unstructured":"38. D.C. Code \u00a7 7-1651.04 (West 2014); Va. Code Ann. \u00a7 32.1-46(A)(12 (West 2014); National Conference of State Legislatures, HPV Vaccine Policies, available at <http:\/\/www.ncsl.org\/research\/health\/hpv-vaccine-state-legislation-and-statutes.aspx> (last visited July 11, 2016)."},{"key":"S1073110500020581_bib8","doi-asserted-by":"crossref","first-page":"E199","DOI":"10.1503\/cmaj.109-3179","article-title":"\u201cLancet Retracts 12-Year-Old Article Linking Autism to MMR Vaccines,\u201d","volume":"182","author":"Eggertson","year":"2010","journal-title":"Canadian Medical Association Journal"},{"key":"#cr-split#-S1073110500020581_bib47.1","unstructured":"47. D.C. Code \u00a7 7-1651.04 (West 2014) (emphasis added)"},{"key":"#cr-split#-S1073110500020581_bib47.2","unstructured":"Va. Code Ann. \u00a7 32.1-46(D)(3) (West 2014) (emphasis added)."},{"key":"S1073110500020581_bib9","doi-asserted-by":"crossref","first-page":"1534","DOI":"10.1001\/jama.2015.3077","article-title":"Autism Occurrence by MMR Vaccine Status among U.S. Children with Older Siblings With and Without Autism","volume":"313","author":"Jain","year":"2015","journal-title":"Journal of the American Medical Association"},{"key":"S1073110500020581_bib29","first-page":"1","article-title":"\u201cHuman Papillomavirus: Recommendations of the Advisory Committee on Immunization Practices (ACIP),\u201d","author":"Markowitz","year":"2014","journal-title":"Morbidity and Mortality Weekly Report"},{"key":"S1073110500020581_bib21","first-page":"494","article-title":"\u201cSubstandard Vaccination Compliance and the 2015 Measles Outbreak,\u201d","volume":"169","author":"Majumder","year":"2015","journal-title":"Journal of the American Medical Association"},{"key":"S1073110500020581_bib71","unstructured":"71. Mo. Rev. Stat. \u00a7 431.061 (West 2014) (emphasis added)."},{"key":"S1073110500020581_bib62","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1258\/0956462961917618","article-title":"\u201cThe Psychosocial Impact of Human Papilloma-virus Infection: Implications for Health Care Providers,\u201d","volume":"7","author":"Clarke","year":"1996","journal-title":"International Journal of STD and AIDS"},{"key":"S1073110500020581_bib58","unstructured":"58. Centers for Disease Control & Prevention, Genital HPV Infection \u2014 Fact Sheet, last updated May 19, 2016, available at <http:\/\/www.cdc.gov\/std\/hpv\/stdfact-hpv.htm> (last visited July 11, 2016); Centers for Disease Control & Prevention, STDs & Pregnancy \u2014 CDC Fact Sheet, last updated May 20, 2016, available at <http:\/\/www.cdc.gov\/std\/pregnancy\/stdfact-pregnancy.htm#r17> (last visited July 11, 2016)."},{"key":"S1073110500020581_bib43","unstructured":"43. Del. Code. Ann. tit. 14. \u00a7 131 (West 2015); Iowa Admin. Code r.341-7.3(139A)(West 2015); N.J. Admin. Code \u00a7 8:57-4.4 (West 2015)."},{"key":"S1073110500020581_bib16","unstructured":"16. Id. at 671."},{"key":"S1073110500020581_bib52","unstructured":"52. Offit, Deadly Choices, supra note 26, at xvii."},{"key":"S1073110500020581_bib37","unstructured":"37. Centers for Disease Control & Prevention, State Vaccination Requirements, last updated January 29, 2016, available at <http:\/\/www.cdc.gov\/vaccines\/imz-managers\/laws\/state-reqs.html> (last visited July 11, 2016)."},{"key":"S1073110500020581_bib69","unstructured":"69. Cal. Fam. Code \u00a7 6926 (West 2015) (emphasis added)."},{"key":"S1073110500020581_bib68","unstructured":"68. Kan. Stat. Ann. \u00a7 38-123b (West 2014); Ore. Rev. Stat. Ann \u00a7 109.640 (West 2014); S.C. Laws Ann. \u00a7 63-5-350 (West 2014)."},{"key":"S1073110500020581_bib40","unstructured":"40. This chart was created using information compiled from the National Conference of State Legislatures. NCSL, HPV Vaccine Policies, supra note 38."},{"key":"S1073110500020581_bib19","doi-asserted-by":"crossref","first-page":"1757","DOI":"10.1001\/jama.296.14.1757","article-title":"\u201cNonmedical Exemptions to School Immunization Requirements: Secular Trends and Association of State Policies with Pertussis Incidence,\u201d","volume":"296","author":"Omer","year":"2006","journal-title":"Journal of the American Medical Association"},{"key":"S1073110500020581_bib7","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(97)11096-0"},{"key":"S1073110500020581_bib13","doi-asserted-by":"crossref","first-page":"848","DOI":"10.1542\/peds.2011-0400","article-title":"\u201cAlternative Vaccination Schedule Preferences among Parents of Young Children,\u201d","volume":"128","author":"Dempsey","year":"2011","journal-title":"Pediatrics"},{"key":"S1073110500020581_bib23","unstructured":"23. Centers for Disease Control & Prevention, \u201cFrequently Asked Questions About HPV Vaccine Safety,\u201d last updated March 7, 2016, available at <http:\/\/www.cdc.gov\/vaccinesafety\/Vaccines\/HPV\/hpv_faqs.html> (last visited July 11, 2016)."},{"key":"S1073110500020581_bib66","unstructured":"66. See, e.g., Ala. Code \u00a7 22-11A-19 (West 2014); Cal. Fam. Code \u00a7 6926 (West 2014); Del. Code Ann. \u00a7 710 (West 2014); 410 Ill. Comp. Stat. 210\/\u00a7 4 (West 2014); Vt. Stat. Ann. tit. 18, \u00a7 4226 (West 2014)."},{"key":"S1073110500020581_bib33","unstructured":"33. Id."},{"key":"S1073110500020581_bib48","unstructured":"48. See, e.g., Achen, P. , \u201cPassions Run High in Vaccine Debate,\u201d Burlington Free Press, May 5, 2015, available at <http:\/\/www.burlingtonfreepress.com\/story\/news\/politics\/2015\/05\/05\/vaccination-debate-passions-high\/26949023> (last visited July 11, 2016); L. Aliferis, \u201cTo Protect His Son, A Father Asks School to bar Unvaccinated Children,\u201d National Public Radio, January 27, 2015, available at <http:\/\/www.npr.org\/blogs\/health\/2015\/01\/27\/381888697\/to-protect-his-son-a-father-asks-school-to-bar-unvaccinated-children> (last visited July 11, 2016); K. Lant, \u201cPathologist Warns Measles Outbreak Threatens Herd Immunity,\u201d Science Times, May 7, 2015, available at <http:\/\/www.sciencetimes.com\/articles\/6138\/20150507\/pathologist-warns-measles-outbreak-threatens-herd-immunity.htm> (last visited July 11, 2016)."},{"key":"S1073110500020581_bib25","doi-asserted-by":"crossref","DOI":"10.1158\/1055-9965.EPI-14-0410","article-title":"Attribution of 12 High-Risk Human Papillomavirus Genotypes to Infection and Cervical Disease","volume":"23","author":"Joura","year":"2014","journal-title":"Cancer Epidemiology, Biomarkers and Prevention"},{"key":"S1073110500020581_bib10","unstructured":"10. Burns, J. F. , \u201cBritish Council Bars Doctor Who Linked Vaccine with Autism,\u201d New York Times, May 24, 2010, available at <http:\/\/www.nytimes.com\/2010\/05\/25\/health\/policy\/25autism.html?_r=0> (last visited July 11, 2016)."},{"key":"S1073110500020581_bib17","unstructured":"17. Louis, C. S. , \u201cMost Doctors Give In to Requests by Parents to Alter Vaccine Schedules,\u201d New York Times, March 2, 2015, at A12. But see B. Mejia, \u201cDoctors Turning Away Unvaccinated Children,\u201d Los Angeles Times, February 10, 2015, available at <http:\/\/www.latimes.com\/science\/la-me-vaccination-policy-20150210-story.html#page=1> (last visited July 11, 2016). Doctors refusing to treat unvaccinated patients do so because they are concerned for their patients who are too young to be vaccinated or cannot be vaccinated for legitimate medical reasons. Dr. Charles Goodman's practice in California, for example, \u201cdecided that the patients who are not vaccinated are presenting a clear and present danger.\u201d Id."},{"key":"S1073110500020581_bib46","unstructured":"46. Perkins, supra note 42."},{"key":"S1073110500020581_bib45","unstructured":"45. Omer, et al., \u201cNonmedical Exemptions,\u201d supra note 19, at 1760."},{"key":"S1073110500020581_bib27","unstructured":"27. Centers for Disease Control & Prevention, What is HPV? last updated December 28, 2015, available at <http:\/\/www.cdc.gov\/hpv\/parents\/whatishpv.html> (last visited July 11, 2016); Dunne et al., \u201cCDC Grand Rounds,\u201d supra note 4, at 69."},{"key":"S1073110500020581_bib15","unstructured":"15. Id. at 669\u2013670."},{"key":"S1073110500020581_bib63","doi-asserted-by":"crossref","first-page":"469","DOI":"10.4054\/DemRes.2007.16.15","article-title":"\u201cDoes Cancer Affect the Divorce Rate?\u201d","volume":"16","author":"Syse","year":"2007","journal-title":"Demographic Research"},{"key":"S1073110500020581_bib56","unstructured":"56. Centers for Disease Control & Prevention, Estimated Vaccination Coverage with Selected Vaccines among Adolescents Aged 13\u201317 Years, by State and Selected Area\u2014National Immunization Survey-Teen, United States, 2013, available at <http:\/\/www.cdc.gov\/vaccines\/imz-managers\/coverage\/nis\/teen\/tables\/13\/tab01_iap_2013.pdf> (last visited July 11, 2016)."},{"key":"S1073110500020581_bib1","unstructured":"1. Sanchick, M. and Sears, A. , \u201c\u2019The Only Thing Different about that Day Was that Shot:\u2019 Did a Trip to the Doctor Kill a Healthy 12-Year-Old Girl?\u201d Fox6Now, August 7, 2014, available at <http:\/\/fox6now.com\/2014\/08\/07\/the-only-thing-different-about-that-day-was-that-shot-did-a-trip-to-the-doctor-kill-a-healthy-12-year-old-girl\/> (last visited July 11, 2016)."},{"key":"S1073110500020581_bib18","unstructured":"18. National Conference of State Legislatures, \u201cStates with Religious and Philosophical Exemptions from School Immunization Requirements, January 1, 2016, available at <http:\/\/www.ncsl.org\/research\/health\/school-immunization-exemption-state-laws.aspx> (last visited May 23, 2016); K. Goodwin et al., \u201cCalling the Shots,\u201d State Legislature Magazine, Feb. 1, 2015, available at <http:\/\/www.ncsl.org\/bookstore\/state-legislatures-magazine\/trends-february-2015.aspx> (last visited July 11, 2016). 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Id."},{"key":"S1073110500020581_bib22","doi-asserted-by":"crossref","first-page":"383","DOI":"10.1007\/978-1-4614-7438-8_21","article-title":"\u201cThe Media's Role in Vaccine Misinformation,\u201d","author":"Dees","year":"2013","journal-title":"Vaccinophobia and Vaccine Controversies of the 21st Century"},{"key":"S1073110500020581_bib61","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1177\/1090198106292022","article-title":"\u201cExploring the Knowledge, Attitudes, Beliefs, and Communication Preferences of the General Public Regarding HPV: Finding from CDC Focus Group Research and Implications for Practice,\u201d","volume":"34","author":"Friedman","year":"2007","journal-title":"Health Education and Behavior"},{"key":"S1073110500020581_bib39","unstructured":"39. NCSL, HPV Vaccine Policies, supra note 38; W. Goodwin, \u201cIn Texas, Perry's Vaccine Mandate Provoked Anger,\u201d National Public Radio, September 16, 2011, available at <http:\/\/www.npr.org\/2011\/09\/16\/140530716\/in-texas-perrys-vaccine-mandate-provoked-anger> (last visited July 11, 2016)."},{"key":"S1073110500020581_bib53","unstructured":"53. Id., at xv."},{"key":"S1073110500020581_bib28","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/1471-2431-11-74","article-title":"\u201cHPV Vaccine Decision Making in Pediatric Primary Care: A Semi-Structured Interview Study,\u201d","volume":"11","author":"Hughes","year":"2011","journal-title":"BMC Pediatrics"}],"container-title":["Journal of Law, Medicine &amp; Ethics"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/1073110516667942","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/1073110516667942","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/www.cambridge.org\/core\/services\/aop-cambridge-core\/content\/view\/S1073110500020581","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,1,14]],"date-time":"2021-01-14T17:32:24Z","timestamp":1610645544000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.cambridge.org\/core\/product\/identifier\/S1073110500020581\/type\/journal_article"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2016]]},"references-count":76,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2016]]}},"alternative-id":["S1073110500020581"],"URL":"https:\/\/doi.org\/10.1177\/1073110516667942","relation":{},"ISSN":["1073-1105","1748-720X"],"issn-type":[{"value":"1073-1105","type":"print"},{"value":"1748-720X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2016]]}}}