A school in Spartanburg County, South Carolina has a 21% measles vaccination rate. Twenty-one percent. The threshold for herd immunity is 95%. Children in that outbreak have developed encephalitis, brain swelling from a disease we eliminated in the United States in 2000. Voluntary outreach did not prevent this. Transparent risk data did not prevent this. School-entry vaccine mandates, which the state weakened through broadened exemptions, might have. States should reinstate strict school-entry vaccination requirements now, before this gets worse.
I am not someone who reaches for mandates lightly. I'm conservative on recommendations precisely because the asymmetry matters: recommending a coercive policy that backfires is worse than being slow to act. But the data have crossed a line that makes inaction the riskier choice. We have 1,281 confirmed cases as of March 5, and we're barely into the third month of 2026. The 2025 total was 2,283. We are on pace to blow past it. Ninety-three percent of those cases are in unvaccinated individuals. That is not a correlation problem. That is a causation problem with a known solution.
The Voluntary Experiment Has a Result
Kai Brighton will argue, as he does, that mandates breed resistance and that personalized outreach to high-risk clusters is the smarter play. He's right that mandates can provoke backlash. I'll grant that. But the position assumes we have time and trust to spend on persuasion while measles burns through unvaccinated pockets at an R0 of 12 to 18, the most contagious pathogen most Americans will ever encounter.
The evidence on mandates is not ambiguous. A 2018 study in JAMA Pediatrics (Bradford and Mandich, n = 44 states over 10 years) found that states eliminating non-medical exemptions saw vaccination rates increase by 2 to 3 percentage points, enough to cross the 95% threshold in borderline communities. California's SB 277, which removed personal belief exemptions in 2016, pushed kindergarten MMR coverage from 92.8% to 95.6% within two school years (MMWR, 2017). West Virginia and Mississippi, which never allowed non-medical exemptions, consistently maintained the highest childhood vaccination rates in the country for decades.
Compare that track record to the "incentive-based" approach. The CDC allocated $8.5 million to seven outbreak areas this year for contact tracing and voluntary vaccination. That is roughly $6,600 per confirmed case, spent after the virus was already spreading. It's triage, not prevention. Kindergarten exemption rates nationally hit 3.6% in the 2024-25 school year and keep climbing. The voluntary approach is producing a measurable, directional decline in coverage. We are watching it fail in real time.
Children Can't Opt Out of Other People's Choices
The 291 children under five with confirmed measles this year did not make an ideological choice. Neither did the infants too young for their first MMR dose who rely entirely on herd immunity that no longer exists in their zip code. The 698 school-age children, 54% of all cases, are concentrated precisely where mandate enforcement has eroded. Dr. Richard Besser, former CDC acting director, said publicly that achieving 95% coverage is "nearly impossible in many communities due to the political polarization surrounding the issue." He may be right about the politics. He is describing a reason to act through law, not a reason to give up.
The counterargument that mandates "entrench resistance" treats parental hesitancy as a fixed psychological state. The California data show otherwise. Compliance rose. Exemption claims dropped. Some families grumbled. Their children got vaccinated. The schools got safer. A 2020 analysis in Vaccine (Wang et al., n = 8 states with mandate changes) confirmed the pattern: stricter mandates correlate with higher coverage and fewer outbreaks, consistently, across different populations and political contexts.
I understand the discomfort with compulsion. Nobody likes being told what to do. But public health law has always balanced individual autonomy against collective risk, and measles, with its 1 to 3 deaths per 1,000 infected children and its knack for erasing immune memory, sits firmly on the side where collective protection wins. Every week without action is another week of exponential spread in schools that have no business being open with 21% coverage.
Reinstate the mandates. Remove non-medical exemptions. Fund enforcement. The studies say it works. The outbreak data say nothing else has.
