The recent measles outbreak has sparked more media discussion of the trend away from routine vaccination. New Jersey Governor Chris Christie tried to walk a fine line when asked about the issue yesterday, saying parents should have “some measure of choice” over immunizing their kids. I enclose his comments and his staff’s later attempts to clarify below.

Meanwhile, U.S. Senator Rand Paul, who is also a medical doctor, told a popular right-wing radio host yesterday, “I’m not anti-vaccine at all but…most of them ought to be voluntary. […] I think there are times in which there can be some rules but for the most part it ought to be voluntary.” He took a shot at former Texas Governor Rick Perry, who has said it was a mistake for his administration to try to require the human papillomavirus vaccine for pre-teen girls in Texas.

As these and other Republican presidential candidates tour Iowa this year, I guarantee that they will face many more questions about the vaccine issue. In my non-blogging life, I have encountered hundreds of Iowa parents who choose not to vaccinate their children. They are a diverse group and can’t be stereotyped as “crunchy hippie” lefties or religious conservatives. Some don’t trust the government to regulate toxins in products pushed by pharmaceutical companies. Others may not believe vaccines cause autism but fear different adverse reactions. Or, they think “natural immunity” acquired through getting a disease is stronger. Many conservative evangelicals and Catholics shun vaccines because of concerns about the use of fetal tissue in their manufacture (see also here). Although the most influential homeschooling group, the Network of Iowa Christian Home Educators, does not take a position for or against immunizations, my impression is that anti-vaccine views are more prevalent among homeschoolers than among parents who send their children to public or parochial schools. Homeschoolers were a critical base of support for Mike Huckabee’s 2008 Iowa caucus campaign and were courted by multiple presidential candidates before the 2012 caucuses.

Some libertarian-leaning conservatives may not worry about the safety or ethics of vaccines, and may even have their own children immunized, but on principle don’t think the government should tell parents anything about how to raise kids. That group looks like a natural Rand Paul constituency, but they may be open to other candidates who cater to their views.

Regardless of how far the measles outbreak spreads, this issue will remain a minefield for GOP candidates.

Side note: In central Iowa, more and more pediatric practices are rejecting families whose parents want to deviate from the accepted vaccine schedule. In my opinion, that is a huge mistake. There is no one perfect immunization schedule. Medical associations in different countries recommend that babies and toddlers get shots for various diseases at different times. Based on my conversations, many of these parents would agree to most or all of the vaccines eventually; they just feel uncomfortable with so many shots clustered close together. Instead of accommodating those concerns with a delayed schedule, pediatricians are driving families away. So worried parents either stop taking their kids to regular wellness checks, or seek medical care only from chiropractors or alternative health providers.

UPDATE: Added below further comments from Rand Paul on why vaccines should be voluntary.

Likely Democratic presidential nominee Hillary Clinton weighed in on Twitter: “The science is clear: The earth is round, the sky is blue, and #vaccineswork. Let’s protect all our kids. #GrandmothersKnowBest”

A Bleeding Heartland reader reminded me about this report from last year, indicating that “In West Des Moines, 37 percent of home-schooled children are not fully vaccinated.”  

Chris Christie’s initial comments:

“Mary Pat and I have had our children vaccinated and we think that it’s an important part of being sure we protect their health and the public health,” Christie told reporters here [in Cambridge, England] Monday. But the likely Republican presidential candidate added: “I also understand that parents need to have some measure of choice in things as well, so that’s the balance that the government has to decide.”

Later comments:

Christie’s office later sought to clarify his remarks and sent reporters a full transcript showing that Christie made a point not to side with vaccination skeptics when asked if he thinks the shots are dangerous.

“I didn’t say that,” Christie said, according to the transcript. “I said different disease types can be more lethal so that the concern would be measuring whatever the perceived danger is by vaccine and we’ve had plenty of that over a period of time versus what the risk to public health is and you have to have that balance and that’s exactly what I mean by what I said.”

“The Governor believes vaccines are an important public health protection and with a disease like measles there is no question kids should be vaccinated,” Christie’s office said. “At the same time different states require different degrees of vaccination, which is why he was calling for balance in which ones government should mandate.”

Excerpts from Rand Paul’s February 2 interview with CNBC’s Kelly Evans:

“The state doesn’t own your children,” Paul said in an interview with CNBC’s “Closing Bell.” “Parents own the children, and it is an issue of freedom and public health.”  […]

“I guess being for freedom would be really unusual,” he said sarcastically at the start of the exchange.

Paul also acknowledged hearing about cases in which healthy kids were left with “profound mental disorders” after being vaccinated.

Vaccine critics frequently claim that there is a link between immunization and autism, though medical studies have discredited the idea.

“I’m not arguing vaccines are a bad idea,” Paul said, noting that his children were vaccinated on the recommended staggered schedule. “I think they are a good thing, but I think the parent should have some input.”

Paul added that vaccines have been voluntary for “most of our history … so I don’t think I’m arguing for anything out of the ordinary.”