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Policies to prevent outbreaks such as those in New York and Washington are under the purview of state legislators, who have made it easier, rather than more difficult, to opt out of vaccinations.

As a result, officials are resorting to emergency mandates, an inevitable outcome of laws that have permitted vaccination exemptions to flourish in recent years, according to Ross D. Silverman, Professor of Health Policy & Management IU Fairbanks School of Public Health Professor of Public Health & Law IU McKinney School of Law.

In a story for Wired magazine, Professor Silverman commented on how laws are structured and enforced on infectious disease control.

"As a society we've said we'll allow a little bit of flexibility in our laws in order to give people a wider berth to exercise their personal beliefs. And for decades that vaccine policy has been largely effective," Professor Silverman said.

Recent analyses have shown that since 2009, the number of nonmedical exemptions rose in 12 of the 17 states that relaxed their laws to allow for philosophical objections as well as religious ones, according to the April 10 Wired article, “New York’s Vaccine Order Shows How Health Laws are Failing Us.”

In some anti-vaccine hotspots, exemption rates are nearing double digits. "It's been a pretty recent phenomenon that people are now saying their concerns about vaccination outweigh their concerns about infectious diseases," says Silverman. "And it's starting to test the balancing act most states are trying to pull off."