As a pediatrician, infectious diseases specialist, and public health expert, I was grateful for Dr. Peter Hotez’s April 18 opinion piece in the Seattle Times titled “Anti-vaccine misinformation denies children’s rights.” It’s important to differentiate what people want to believe—that somehow parents are protecting their child by not vaccinating—from what we actually know to be true based on science and evidence: that vaccines do not cause autism and do save lives.

Since then—the news is worsening. On June 12, Dr. Hotez published a study in which we learned that Washington has two of the top 10 most under-vaccinated large cities in the U.S., Seattle and Spokane, leaving us increasingly at-risk of a measles outbreak. In late June, we learned of a measles case in Oregon, followed by a second, related case, a few days ago. And this week, we learned of a measles case here in Snohomish County. By all means, it appears the Public Health Department is doing everything right—identifying places and a timeframe that may have led to exposure. Should we be worried?

Yes. But the reason this is more of a worry than it needs to be is that too many kids in our state are unvaccinated—not because of medical ineligibility, but because in Washington, parents are allowed to choose for their kids to NOT be protected from this deadly disease, simply on their own whim or personal beliefs.

But the threat of measles is not one of history—it’s a real and present danger. When I was a medical student, I spent a great deal of time studying microbes and infectious diseases. But the true devastation of measles first became real to me when, as a medical student, I worked in a Zimbabwean rural mission hospital during a measles outbreak. Seeing infants and young children fighting for their lives against severe pneumonia and other devastating complications of measles left an indelible imprint on me. So I am truly worried for the children of Washington, as our vaccination rates in some communities are so low that we are risking outbreaks. And I’ve spoken with several school nurses and front-line doctors who are enormously frustrated by the difficulty of convincing some parents to have their kids vaccinated and the lack of “back-up” from government policies that could require these vaccinations.

The Infectious Diseases Society of America (2012), the American Medical Association (2015), the American College of Physicians (2015), and the American Academy of Pediatrics (2016) have all called for state-mandated vaccinations to attend school and the end of all non-medical exemptions, starting as early as 2012. Despite these expert recommendations, it took a 2016 measles outbreak at Disneyland for the state of California to step up. In reaction, they passed a statewide ban on non-medical exemptions and saw vaccine coverage rates rise dramatically in just one year. Yet 18 states including Washington still allow non-medical exemptions. I sincerely hope that Washington and other states needn’t experience their own outbreaks to follow suit.

As a clinician, I’m acutely aware of how difficult it is for doctors and nurses on the front lines to convince parents to do the right thing—I’ve had some of those tough conversations myself because it’s a doctor’s responsibility that I take seriously. I also know that instituting a government policy that requires children to be vaccinated to attend public and private schools changes that front-line dialogue tremendously—making it easier for parents to do the right thing —both for their own child and also to protect other children in the community. This is, in fact, the role of policy.

We’ve instituted regulations with public safety in mind before. Seatbelts. Airbags. Food safety standards. Workplace standards. Helmet laws. And recall that many of these policies were not popular at first, but we implemented them because they saved lives. And vaccinations for our children must be added to that list. We should demand that our public officials rely on science-based evidence and do the right thing: making vaccinations a requirement before tragedy visits our state.