A measles outbreak that has affected 71 people in Washington and4 people in Oregon has ignited public health discourse over vaccinations. Vaccination rates in the Pacific Northwest are among the lowest in the nation. Both Washington and Oregon allow personal belief exemptions from immunizations for school-age children. The outbreak, which continues to spread, may lead Oregon and Washington to follow California’s example of eliminating personal belief exemptions. Eliminating personal belief exemptions, however, may not be the panacea that lawmakers seek. The rise in medical exemptions for vaccines in California indicates the need for a comprehensive vaccination framework.