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New York City’s New Vaccination Requirement: What Gets Lost in the Debate

posted on Fri, Dec 20 2013 10:38 am by Dan Orenstein

The New York City Board of Health recently voted unanimously to begin requiring children under age 5 in city-licensed preschools and day care centers to be vaccinated against seasonal flu starting in 2014 unless exempt for medical or religious reasons. The new requirement was among the final public health-oriented proposals of outgoing Mayor Michael Bloomberg’s administration, which also proposed initiatives such as an increase in the minimum age for tobacco purchases and a highly controversial restriction on sugar-sweetened beverage serving sizes. The new immunization requirement raised the ire of anti-vaccination groups, who have planned protests and legal challenges, and stimulated a long-simmering national debate over the legal, scientific, and ethical principles of mandatory childhood immunization.

Lost in much of the discussion are two important points. First, mandatory immunization for New York City children is not new. Rather, it is a well-established and highly-effective public health legal intervention to reduce communicable disease transmission. New York, along with all other states, already required that children receive specific vaccinations before attending school or day care. Specifically, state law already required children in day care, nursery, pre-kindergarten, or Head Start programs receive:

  • DTaP (diphtheria-tetanus-acellular pertussis) or DTP (diphtheria-tetanus-pertussis);
  • IPV (inactivated poliovirus) or OPV (oral poliovirus);
  • MMR (measles-mumps-rubella);
  • Hib (Haemophilus influenzae type b);
  • Hepatitis B;
  • Varicella; and
  • Pneumococcal conjugate (PCV).

Second, New York City is not the first jurisdiction to add seasonal flu to the list of required immunizations. Neighboring Connecticut and New Jersey, for example, already required seasonal flu vaccination for children under 5 in day care or preschool.

Seasonal influenza presents a significant public health threat every year. The spread and severity of the flu is highly variable, and flu-related deaths can range from 3,000 to as high as 49,000 per year.  Vaccination is more effective when given early in flu season, making broadly applicable mandates preferable to ad hoc decisions made each year before the severity of the flu season can be known.

The same day the New York City Board of Health approved the new requirements, CDC issued a report illustrating the critical importance of flu vaccination. Last year, CDC estimates that influenza accounted for 31.8 million illnesses, including 381,000 hospitalizations, but immunization prevented an additional 6.6 million illnesses and 79,000 hospitalizations, despite only 45 percent of the population receiving vaccination. The most vulnerable populations are children under 5 and adults over 65, who together account for 69 percent of prevented hospitalizations. Additionally, children under 6 months old are among those at the highest risk for influenza complications, but are too young to be vaccinated. Their best protection is vaccination of other household members and caregivers, as well as improved herd immunity through vaccination of more of the general population.

A recent study found 830 influenza-associated deaths for children under age 18 from 2004–2012, with a median age of 7 years and 43 percent having no high-risk medical conditions. Young, healthy children are at risk from seasonal flu. Immunization helps reduce this risk. Although vaccination is not always effective at preventing flu, it is the best prevention tool available.

For more information about seasonal flu and flu vaccination, please consult CDC web resources and your state or local health department.


This blog post was prepared by Daniel G. Orenstein, J.D., Deputy Director at the Network for Public Health Law – Western Regionat the Sandra Day O’Connor College of Law at Arizona State University.

The Network for Public Health Law provides information and technical assistance on issues related to public health. The legal information and assistance provided in this document does not constitute legal advice or legal representation. For legal advice, readers should consult a lawyer in their state. The views expressed in this post do not represent those of the Robert Wood Johnson Foundation.

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