Vaccinations against life-threatening diseases are one of the greatest public health achievements in history. Literally millions of deaths have been prevented, and manifold more saved from disfiguring illness. While vaccinations carry inevitable risks, the medical, social and economic benefits attained have led all 50 states to enact compulsory childhood vaccination laws to stop the spread of preventable diseases. Today however, vaccines are becoming a victim of their success - many individuals have never witnessed the debilitating diseases that they protect against, allowing complacency to build towards immunization requirements. Antivaccination sentiment is growing fast in the United States, in large part due to the controversial and hotly disputed link between immunizations and autism. The internet worsens fears regarding vaccination safety, as at least a dozen websites publish alarming information about the risks of vaccines. Increasing numbers of parents are refusing immunizations for their children and seeking legally sanctioned exemptions instead, apparently fearing vaccines more than the underlying diseases that they protect against. A variety of factors are at play: religious and philosophical beliefs, freedom and individualism, misinformation about risk, and overperception of risk. State legislatures and health departments thus face a difficult challenge: the need to respect individual rights and freedoms while also safeguarding the public welfare. Nearly all states now allow vaccination exemptions for religious reasons and a growing number provide "philosophical" opt-outs as well. However, in all but a handful of jurisdictions, neither objection is seriously documented or verified. Often, the law requires a parent to do no more than simply check a box indicating she does not wish her child to receive vaccinations. The problem is exacerbated by financial incentives schools have to encourage students to opt out of vaccinations. The rise in parents opting out has caused the AMA grave concern, with many experts decrying the rise of so-called "exemptions of convenience." In some areas, nearly 1 out of 5 children have not received their recommended vaccines. The consequences are serious not only for those unprotected children, but for the rest of society as well. "Herd immunity" is threatened as more and more parents free ride off of the community's dwindling immunity, and outbreaks of diseases thought to have been conquered have already occurred. Lawsuits against vaccine manufacturers threaten them with bankruptcy, costs are being externalized onto our healthcare and legal system, and vulnerable populations are suffering harm and occasionally death. In the interests of social welfare, state legislatures and health departments should consider methods to ensure that the exemption process is carefully tailored to prevent check-the-box opt-outs of convenience, while still allowing exemptions for those with earnest and informed convictions or medical reasons
