County officials in measles-wracked Rockland County, NY took the extraordinary step today of banning unvaccinated minors from entering public places. If vaccine-preventable diseases continue to flare up in pockets of unvaccinated people across the country, these types of bans might become the new normal.

The ban is part of the county’s efforts to curb the spread of measles, which has infected 153 people so far — mostly unvaccinated children under the age of 18. International visitors brought the virus to Rockland starting in September 2018, and the virus spread. Since the Rockland outbreak started, nearly 17,000 people in the county have received measles, mumps, and rubella vaccinations, and unvaccinated children have been banned from local schools, according to a statement from the New York State Department of Health.

Progress on fighting the spread of measles has stalled, however, according to a Rockland County press briefing today. “As this outbreak has continued, our inspectors have begun to meet increasing resistance from those they’re trying to protect,” county executive Ed Day says in the briefing. Now, the county is taking the more drastic step of declaring a state of emergency that will ban unvaccinated children from all public places starting at midnight tonight.

“We’re not going to be asking for anyone’s vaccination records on the streets.”

The ban lifts in 30 days, or, for individual unvaccinated kids, it lifts when they get their first measles shot. Children who can’t be vaccinated for medical reasons are excluded from the ban altogether. Officials won’t force teens to turn over their medical information, according to Rockland spokesperson John Lyon. “We’re not going to be asking for anyone’s vaccination records on the streets,” Lyon tells The Verge. Instead, the plan is to enforce the ban after the fact, Lyon says. If an epidemiological investigation turns up an unvaccinated minor in, say, a shopping mall, that kid’s parents could be charged with a misdemeanor and face a $500 fine or 90 days in jail, Lyon says.

Jailing people isn’t the goal, Day says: “This is not something we’re looking to do.” Instead, the goal is to raise awareness about the importance of vaccines in a county where measles has been spreading for the past six months, particularly among orthodox Jewish communities. “We’re doing it in such a way to just get attention at this point so that people understand the seriousness of what they are doing — and not doing,” he says.

“We’re already seeing that chilling factor of people not cooperating with us.”

Rockland County officials considered the risk that this ban might make people who are sick with measles reluctant to seek medical care, Lyon says. But they need people to work with doctors as the county tries to identify people who may have been exposed to measles. They hope that the threat of consequences will motivate parents to either get their children vaccinated, or at least get people to cooperate with public health investigators. He points to an infected individual who exposed people at a Target and who later stopped helping the investigators narrow down when the exposure might have happened. “We’re already seeing that chilling factor of people not cooperating with us,” Lyon says. “So from our perspective, this gives us more tools to get them to cooperate with our investigators.”

Curbing the spread of this dangerous virus could require using these drastic measures we’re seeing in Rockland more often, according to vaccine expert Peter Hotez, dean for the National School of Tropical Medicine at Baylor College of Medicine. In another outbreak, officials announced today that at least 18 people have been infected with measles in Oakland County, Michigan, WXYZ Detroit reports. “It may take extraordinary measures to stem the increase in the number of cases we’ve been seeing,” Hotez says. “Otherwise they’re not going to get their arms around it. It’s just going to continue to infect large cohorts of people.”

“It may take extraordinary measures to stem the increase”

Restricting movement can help prevent diseases from spreading during emergencies, according to Leila Barraza, an assistant professor at the University of Arizona’s Zuckerman College of Public Health. Quarantine laws can force people who have been exposed to stay in their homes. Isolation laws can make people who are sick stay isolated in places like hospitals, for example. And other social distancing laws can also make sure people aren’t congregating at places like schools, workplaces, or public events. “It’s a way to create a distance between people so they can’t spread disease,” Barraza says.

These laws have been upheld on a smaller scale in other cases. When Rockland County banned unvaccinated students from schools where fewer than 95 percent of the students were vaccinated, a group of parents sued the county health department. But earlier in March, a federal judge said the school ban could stay. “It really is to protect those individuals. Because if you’re unvaccinated for measles, you have a high chance of contracting measles if you’re exposed to it,” Barraza says.

Places like France and Italy have also instituted school bans. But Rockland’s new ban is different, Barraza says. “It’s a new, more expansive measure than just excluding unvaccinated students from schools,” she says. “I think that’s why it’s getting so much publicity.” And she could see this being the first of more, similar bans in the future. “I think this definitely could be a new trend as we have more unvaccinated children,” she says. “If there’s evidence this has worked, then I think it will probably be tried again.”

“This is a self-inflicted wound.”

Oscar Alleyne, chief of programs and services for the National Associations of County and City Health Officials, hopes that the spread of vaccine preventable diseases won’t get to that point. “I would hope that it is not the new normal because we know that we have a tool and a technique that can work, that has worked, that has saved lives.” He’s talking about vaccines, and he and Hotez agree that failing to use this tool is a consequence of the spread of anti-vaccine misinformation. “It’s the new normal in America, now that measles seems to be coming back,” Hotez says. “This is a self-inflicted wound.”