The federal government may step in to enforce drug vaccinations if states don’t do a better job, the U.S. Food and Drug Administration chief said. FDA Commissioner Scott Gottlieb, speaking to CNN on Tuesday, knocked “certain states” for granting “wide exemptions” to vaccine mandates after an outbreak of measles, once eliminated in the U.S., erupted in Washington state in January. “Some states are engaging in such wide exemptions that they’re creating the opportunity for outbreaks on a scale that is going to have national implications,” Gottlieb said. If “certain states continue down the path that they’re on, I think they’re going to force the hand of the federal health agencies.”

ncsl.org Nearly all states grant religious exemptions for people who have religious beliefs against immunizations. Seventeen states also allow exemptions for philosophical or personal beliefs.

It’s unclear how the FDA could force states to crack down on vaccination exemptions. The U.S. Centers for Disease Control and Prevention sets policies recommending childhood vaccinations, but states impose the legal requirements. All states mandate measles vaccinations for children enrolling in public school, but 47 states allow parents to avoid vaccinating their kids for religious reasons. Seventeen of those states, including Washington, also allow parents to opt out if they believe vaccinations would violate their personal or philosophical beliefs. Washington’s state legislature last week passed a bill that would remove parents’ ability to claim a personal or philosophical exemption. House Bill 1683 now heads to the House Rules Committee, Newsweek reported. Measles outbreaks in the U.S. have been attributed to a rise in overseas travelers who contract the virus and then bring it back to the U.S. It also spreads in communities with pockets of unvaccinated people, according to the Centers for Disease Control and Prevention.

Measles is so contagious that if one person has it, 90% of the people close to that person who are not immune will also become infected. U.S. Centers for Disease Control and Prevention

The virus can spread through coughing and sneezing, and can live for up to two hours in airspace where an infected person coughed or sneezed, according to the CDC. “Measles is so contagious that if one person has it, 90% of the people close to that person who are not immune will also become infected,” the CDC says on its website. Last year, there were 17 outbreaks of the virus in the U.S. Three of those outbreaks were in New York state, New York City and New Jersey, and were primarily in Orthodox Jewish communities where people were not vaccinated. The virus was said to have been brought back from Israel, where there was a large outbreak, the CDC said.

#Measles is one of the most contagious diseases on the planet.

When people are unvaccinated, it can very quickly spread https://t.co/AlOBzqsJ4k#VaccinesWorkpic.twitter.com/JAV7AXNgrr — World Health Organization (WHO) (@WHO) February 7, 2019