The U.S. government may have to take steps to reduce vaccine exemptions for children if states don’t do it, the head of the Food and Drug Administration suggested. His comments come as measles outbreaks rage in a number of states.

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Those outbreaks could have been prevented if children had all been vaccinated. But nearly all states allow kids to attend school even if their “anti-vax” parents opt out of inoculation programs, CNN reported.

“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,” FDA Commissioner Dr. Scott 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,” he told CNN.

At least 67 people have been sickened in a measles outbreak in Washington and three neighboring states. It began in Washington, where vaccine exemptions are especially popular. New York state is struggling with its largest measles outbreak in decades. It began in October and there have been more than 200 cases so far.

The federal government could “mandate certain rules about what is and isn’t permissible when it comes to allowing people to have exemptions,” Gottlieb told CNN.

He expressed hope that the current measles outbreak would make state officials realize that they need to tighter vaccine exemptions for children.

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