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while allowing exemptions for medical reasons. Forty-four states and the district allow exemptions based on religious grounds and 15 states allow exemptions for personal, moral or other beliefs. Five states—New York, California, Maine, Mississippi and West Virginia—do not allow religious or philosophical exceptions.²²

      Chronology

      900s-1920s Early efforts to immunize against disease are developed.

      900-1000 The variolation technique—deliberate infection with a disease—is developed in China to inoculate against smallpox.

      1796 After noticing that milkmaids who contract cowpox appear immune to smallpox, English scientist Edward Jenner inoculates an 8-year-old boy with pus from a cowpox blister on the hand of an infected milkmaid. The boy does not contract smallpox. Two years later, Jenner publishes his work on the development of a smallpox vaccine.

      1800 Benjamin Waterhouse, a Harvard professor of medicine, performs the first vaccinations in the United States on his children and works to encourage public immunization.

      1885 French biologist Louis Pasteur prevents rabies in a 9-year-old boy with a live rabies vaccine. … Spanish physician Jaime Ferrán develops a live cholera vaccine, the first immunization against a bacterial disease.

      1898 Greater regulation of pharmaceutical companies and advances in microbiology lead to increased vaccine safety and production.

      1899 British military uses early version of typhoid vaccines during the second Boer war.

      1902 After 22 children die from contaminated diphtheria and smallpox vaccines, Congress enacts the Biologics Control Act to establish government oversight of the purity of biological treatments.

      1914 U.S. scientists develop vaccines for typhoid, rabies and tetanus.

      1915 Vaccine against pertussis (whooping cough) is approved.

      1923 Diphtheria vaccine is licensed.

      1940s-1960s Scientists develop additional vaccines.

      1945 The first influenza vaccine is approved in the United States for military use, and in 1946 for civilian use.

      1949 The last case of smallpox in the United States is reported. … A combination vaccine to immunize against diphtheria, pertussis and tetanus is licensed.

      1952 The worst polio epidemic in U.S. history results in 57,628 reported cases.

      1954 American scientist John Enders and pediatrician Thomas Peebles isolate the measles virus in cell culture.

      1955 American scientist Jonas Salk licenses the first polio vaccine. … Six years later, Albert Sabin’s oral polio vaccine is licensed for use in the United States.

      1962 The Vaccination Assistance Act allows the Centers for Disease Control and Prevention (CDC) to launch mass immunization campaigns.

      1960s-2000 As more vaccines are developed, questions are raised about the safety of immunization.

      1963 Measles vaccine is introduced.

      1964 The U.S. surgeon general creates the Immunization Practices Advisory Committee to review the childhood immunization schedule and recommend newly licensed vaccines.

      1966 The CDC announces the first national measles eradication campaign. … Two years later the incidence of measles has fallen by more than 90 percent.

      1967 The U.S. Food and Drug Administration approves the mumps vaccine.

      1971 A combined measles, mumps and rubella (known as German measles) vaccine (MMR) is developed.

      1977 The Department of Health, Education and Welfare launches the national Childhood Immunization Initiative, which aims to achieve 90 percent vaccination levels among all U.S. children.

      1980 The United Nations’ World Health Assembly certifies that the world is free of naturally occurring smallpox.

      1986 The Department of Health and Human Services establishes the Vaccine Adverse Event Reporting System to accept reports of suspected adverse reactions to vaccines against measles, mumps, rubella, polio, pertussis, diphtheria and tetanus.

      1988 Congress establishes the National Vaccine Injury Compensation Program to compensate victims of vaccine-related injury or death.

      1998 British medical journal The Lancet publishes a study linking vaccines to autism, an article it retracts 12 years later.

      2000-Present Despite advances in vaccines, immunization rates fall and measles makes a comeback in some areas as new controversies and fears arise about vaccine safety, largely spread via the internet.

      2000 The CDC declares measles eradicated in the United States.

      2005 The CDC announces that rubella is no longer regularly found in the United States.

      2014 U.S. measles cases spike to 667—up by more than threefold from the previous year’s total—much of it due to an outbreak among unvaccinated Amish communities.

      2018 Measles cases start to rise, up threefold from 2017.

      2019 The CDC reports 1,241 measles cases in the United States as of Sept. 5, the highest number in 27 years. … The World Health Organization lists reluctance to undergo vaccination as one of the 10 greatest threats to global health.

      According to the CDC, children should receive the MMR vaccine shortly after their first birthday and a second dose between the ages of 4 and 6. This schedule confers immunity to measles, mumps and rubella to 97 percent of vaccinated children. The remaining 3 percent may still contract one of those diseases, though often with milder symptoms.

      While vaccines have saved millions of lives over the years, some people have, in fact, been injured by vaccines. The federal government in 1986 established the National Vaccine Injury Compensation Program to compensate people injured by vaccines. By establishing the program, the government also exempted vaccine manufacturers from liability for injuries caused by vaccines. The program’s online database indicates that the MMR vaccine is extremely safe compared to other vaccines: Of the 4,400 people compensated for injuries caused by the 3.5 billion vaccine doses distributed in the United States between 2006 and 2017, only 123 were compensated for injuries due to the MMR vaccine.²³

      Vaccines have often stirred controversy, with public reactions ranging from awe to skepticism and outright hostility.²⁴

      In 1998, the British medical journal The Lancet published a paper by Wakefield asserting a link between the MMR vaccine and autism, a condition characterized by challenges with social skills, repetitive behaviors, speech and nonverbal communication. Many parents seized on the study as proof that the vaccine was dangerous. But in 2010, after years of controversy, The Lancet retracted the paper, saying that several elements were incorrect. Wakefield later lost his medical license in the United Kingdom.²⁵

      Nevertheless, many anti-vaccine activists still cite that article as evidence that vaccines are dangerous. Experts say the internet and social media have greatly increased the ability to spread misinformation, taking a once-fringe issue mainstream.

      In addition to the many sincere anti-vaccine activists, more nefarious actors have used social media to spread the message, Blumberg says. “This anti-vaccine message has been amplified by Russian bots because it creates conflict and creates discord,” he says. “It’s not surprising that the Russians would want U.S. children to be vulnerable to disease.”

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