March 1, 2021

Dear Legislator,

We, the undersigned organizations and individuals, jointly affirm the value, safety, and effectiveness of vaccines in preventing serious illness and saving lives. Immunization is one of the ten greatest public health achievements of the 20th century and has measurably improved the health and life expectancy of people living in the U.S.[1] Yet, in 2019 vaccine hesitancy was declared one of the top ten threats to global health.[2]

Iowa has a history of strong immunization rates. This is thanks to collaboration between our county health departments and community resources, and a state ethic that values looking out for each other. Despite this, outbreaks of vaccine-preventable diseases have been increasing in Iowa and our surrounding states. In 2019, two northeast Iowans contracted measles, the first cases in Iowa since 2011.[3] Nationally, 2019 saw more measles cases in a single year since 1992.[4] This escalation of disease is occurring alongside a surge in the spread of misinformation about vaccines online, and increasing vaccine refusals, not only nationally, but in Iowa as well. In addition, the COVID pandemic has had a significant impact on routine Iowa vaccination rates, decreasing them in the short term to historic lows and putting Iowa at risk of outbreaks of previously eliminated diseases.[5]  Healthcare providers are working as hard as possible to restore safe immunization rates, but any legislation that has the effect of increasing vaccine hesitancy has the potential to hinder this progress and invite dangerous disease to our state.

When everyone is vaccinated, we protect our most vulnerable members of society, including young children, the elderly, and the medically frail. Our schoolchildren are able to learn in the safest environment possible when our schools have strong immunization rates and minimal nonmedical vaccine exemptions.

In order to protect Iowan children and vulnerable adults, and to continue the many successes that have been achieved through immunization, we believe that public policy decisions about vaccination should be based on criteria that will:

  • Reduce barriers to giving safe and effective vaccines. Barriers to vaccination often lead to lower community vaccination rates. Such barriers can arise as a result of lack of knowledge about vaccines, access to immunization services, and missed opportunities for giving all vaccinations that are due at the same time.


  • Encourage adherence to evidence-based vaccine recommendations. Recommendations for the use of vaccines in the U.S. are determined by expert national committees, including the Advisory Committee on Immunization Practices of the Centers for Disease Control and Prevention, and the American Academy of Pediatrics Committee on Infectious Diseases. The immunization schedule is supported by extensive safety and efficacy data, and protects children, adolescents, and adults before they are most at risk for these serious diseases. These science-based decisions have become the standard of care for physicians and other healthcare professionals throughout the country. Additionally, the Iowa Department of Public Health follows these recommendations as the basis for the state’s school and childcare immunization requirements.


  • Support providing accurate, science-based immunization information. In today’s world, people can get immunization information from many sources other than their healthcare provider or public health agency, such as over the Internet, in newspapers and magazines, as well as from friends and other social contacts. Although this wealth of information can help the public make more informed health decisions for their families, it can also be a source of serious misinformation. It is imperative that any information on vaccines and immunization communicated by our state’s government leadership be credible and consistent with the consensus of the science and health community.


  • Be aware of legislation that has the potential to increase vaccine hesitancy. Across the country, we are seeing bills proposed with the public purpose of informed consent or collecting data, but demonstrate a lack of understanding about how vaccine safety systems currently work. Such bills often would have the effect of causing unwarranted vaccination concerns, implying legitimacy of myths about vaccines, or even contributing to the harassment of families who have experienced adverse events unrelated to vaccines.

By supporting public policies that adhere to these criteria, we aim to assure that no child or adult in Iowa will suffer needlessly from a disease that is preventable through immunization.

[1] Ten Great Public Health Achievements — United States, 1900-1999.Morbidity and Mortality Weekly Report. 1999:48(12):241-243.

[2] “Top Ten Threats to Global Health.” World Health Organization. Accessed January 28, 2020.

[3] “Measles (Rubeola).” Iowa Department of Public Health. Accessed January 28, 2020.

[4] “Measles Cases and Outbreaks.” US Centers for Disease Control and Prevention. Accessed January 28, 2020.

[5] Vaccinating During the COVID-19 Pandemic, Iowa Department of Public Health, June 4, 2020



Dr. Nathan Boonstra, MD

Chair of Iowa Immunizes Coalition

Download Letter here:  2021 Joint Letter to Legislators