When I see concerned, well intentioned parents refuse to vaccinate their children for "personal" reasons I wonder how naive and ill-informed they have become, and how they have become unwitting perpetrators of what really is a subtle form of bioterrorism and child endangerment.

I am a pediatrician and a public health advocate. In 35 years of practice I have seen firsthand the dramatic lifesaving impact of immunizations, which is why I'm frightened at the direction of the current debate.

The distortion of rumor, inaccurate reports on vaccine side-effects, imaginary thinking that disease is better than prevention, and a narcissistic defense of that bad reasoning have all been at the root of this elitist trend. Even more incredibly, it has been manipulated and perpetuated by misguided celebrities, the media, and even some health professionals who have delusions that they are doing something smart.

There is no easy answer to the problem of vaccine refusals, but it may be time to demand some solutions that might stem the tide. It will take continuing scrutiny of vaccine effect and side effect, with safety and the individual and public health at the center. We will need to develop educational materials that adapt to the needs and beliefs of various ethnic, religious, and philosophical groups and are reinforced at all stages of life, from school-age through adulthood.

Unfortunately, we know there will be parents who are not going to change their thinking whether it be a distrust of authority, a disregard for the public health benefits, or just plain obstinate ignorance. The most important way to protect the majority: all schools and day care settings should require up-to-date immunizations for all who do not have a medical contraindication.

There should be no exceptions, and it could be stronger by including fines and/or child protective social intervention. If an unvaccinated child becomes infected with a vaccine preventable disease, their family should be responsible for the cost of the public health responses and, if there is harm to others, they should be liable for the cost and outcome much like other personal injury cases.

The government should create a compensation fund that parallels the VICP (vaccine injury compensation program) and pays for the care and public health costs associated with vaccine preventable diseases funded by penalties assessed on health insurance plans that do not have 95% immunization rates for all children by age 2 years.

The ACA provides that all insurance plans have first dollar coverage of all ACIP (standard) recommended vaccines and no copays or out of pocket cost for well child visits. The federal government should encourage parents to immunize their children through additional tax credits for those who pay for their insurance or other rewards for those who get free coverage. We should also consider a penalty for those who have not had a minimum of recommended immunizations by age 2 years.

Physician Oversight

Some physician practices have indulged the parents who refuse vaccination or assume an alternative schedule based upon the cosmic inspiration and irrational reasoning of an outlier practitioner. Unfortunately, this too places their children at risk for catching a disease they could have been immune to and, by virtue of the unfounded claim of "overloading their immature immune system," are splitting vaccines and turning one uncomfortable experience for the child into two or three.

These physicians claim to be looking out for the child patient "victim" who needs access to good care. Unfortunately, these caring physicians are also putting their most vulnerable patients at risk of exposure by simply sitting in their waiting or exam room.

State medical boards must decide if the actions of healthcare practitioners who advocate against vaccination and undermine the public health efforts of their communities warrant investigation and intervention. There are a number physicians and other licensed healthcare professionals who trivialize and discourage immunization, whether it be for philosophical, financial, or self-promotional reasons.

When the patients they influence contract preventable disease and have bad outcomes or they cause the spread to a vulnerable population, they should be held liable for malpractice. If it is in the midst of an outbreak or epidemic, medical boards need to sanction or suspend licenses.

It is not a far stretch to compare this to the disastrous outcome of a terrorist ideology using social media and emotional propaganda to influence the thoughts and actions of susceptible citizens who then do harm to others.

People overstep First Amendment "free speech" when someone inspires converts who then, when their children get a serious and contagious disease, cross the line of individual rights to one that adversely affects the lives of the people around them.

Russell C. Libby, MD is founder and president of Virginia Pediatric Group, a primary care pediatric practice with three offices in northern Virginia, and president of the independent practice association HeathConnect IPA.