Parents hold fast to exemption for vaccines - VTDigger
 

Parents hold fast to exemption for vaccines

UPDATE: S.199, passed out of the Senate Health and Welfare Committee 3-1-1 on Tuesday and will likely be taken up on the floor of the Senate later this week.

Parents who don’t want their children to be vaccinated are fighting the elimination of a “philosophical exemption” that allows them to bypass Health Department vaccination requirements for children in school or daycare.

S.199, introduced by Sen. Kevin Mullin, R-Rutland, would only allow parents to decline vaccinations for diseases like measles and chicken pox if their decision is based on religious or medical grounds. Another bill introduced in the House by Rep. George Till, D-Jericho, who is a medical doctor, would do the same thing.

Children must receive vaccinations before entering kindergarten or child care facilities unless they decline a vaccine on philosophical grounds. For school, children must have six vaccines that cover 12 diseases; for child care, two additional vaccines are required.

The debate pits public health policy against tightly-held parental rights.

“It’s a real battle because you don’t want to take away from parental rights, but the public health has to be considered,” Mullin said.

Mullin said a national study prompted him to look into the issue when he learned Vermont did not rank well in vaccination rates compared to other states.

Mullin acknowledges the inherent risks in vaccinating children for communicable diseases, but the benefits, he said, far outweigh the potential harms.

“When you look at data as far as lives saved, the benefits far exceed the risks,” he said.

Mullin said the Committee on Health and Welfare should vote on the Senate bill some time this week.

The Department of Health supports the bill.

Health Commissioner Dr. Harry Chen said he is concerned about Vermont’s dip in vaccination rates.

“Vermont is consistently one of the healthiest states,” Chen said. “One of the challenges we face is our mediocre vaccination rates.”

Sixty percent of Vermont children 19 to 35 months old are “adequately vaccinated” according to a 2009 Centers for Disease Control and Prevention survey. This means they received routine vaccinations for diseases like polio, measles and hepatitis B. In addition, the state has one of the highest rates of non-medical exemptions in the country, according to the Department of Health.

“The challenge is that these vaccines are so good that nobody knows what these diseases is,” Harry Chen said. “We’re seeing a product of our own success.”

Vermont is one of 20 states in the country that allows a philosophical exemption.

A rising rate of unvaccinated children, Chen said, could put others at risk. The more children who are not vaccinated the greater the potential for an outbreak of a disease like measles.

The concept is called “herd immunity,” and the basic idea is that the spread of disease will be disrupted if more members of the community are immune to a disease. Unvaccinated individuals are indirectly protected by vaccinated individuals because the latter will not transmit the disease to them even though they are susceptible to it. Hence, the more people who are not vaccinated, the more likely a pandemic is to break out.

While there have been measles outbreaks in Europe and Canada relatively recently, Chen said, “The challenge is that these vaccines are so good that nobody knows what these diseases is. We’re seeing a product of our own success.”

At the request of the committee, Chen offered a sort of middle ground where parents could retain the philosophical exemption as long as they make the decision based on a sort of informed consent with a health care provider.

The problem for some pediatricians, Chen said, is that they do not want the responsibility of taking on patients who decline immunizations because they worry about the safety of the child and possible contagion.

A recent article in the Wall Street Journal highlights the increasing rate of doctors “firing” patients who refuse vaccinations.

Chen says the science behind vaccination safety is rock solid, and ensuring a high rate of vaccination is one of the most important things a government can do to protect public health.

He said vaccinations have prevented many illnesses in the past 30 years. In his personal practice, Chen said, 20 years ago he saw kids die who wouldn’t have today because of vaccines.

But for parents who champion the right to make the decision whether to vaccinate a child on their own, taking away the philosophical exemption cuts into their civil rights.

Furthermore, not everyone is so sure vaccinations are as safe as the government wants people to think.

Jennifer Stella, a member of the Vermont Coalition for Vaccine Choice, said the exemption is a safety as well as a personal choice issue.

“The exemption for parents is really a basic right to protect our kids.” ~ Jennifer Stella

“The exemption for parents is really a basic right to protect our kids,” she said. “It’s a basic duty and a right for us to help make medical decisions for our children.”

Stella is skeptical of the low vaccination rate for children in Vermont and its ramifications. While the state appears to have a low vaccination rate according to CDC statistics, looking to the vaccinations the state requires (as opposed to CDC recommendations), Vermont exceeds the federal recommendations, Stella said.

And she is not so sure vaccines are safe either.

The group cites the case of a 7-year-old Barton girl who died in December a few days after receiving a flu shot.

According to a CDC information statement, one in 1,250 children who had combined doses of measles, mumps, rubella and varicella (chicken pox) vaccine have had fevers and fever-related seizures.

Stella insists that parents who made the decision not to vaccinate their children are not irresponsible. Often they are highly educated and do extensive research.

Stella is a trained microbiologist, and she said she is frustrated by media coverage portraying parents who opt out of vaccines as a little loony.

She points to a 2011 study and law review article sponsored by Pace Law School that recommends further congressional and scientific study into the association between vaccine-induced brain injury and autism and the integrity of the no-fault federal system that compensates people for vaccine injury.

The debate over a discredited British study that showed a link between autism and vaccines continues as well, Stella said. She points to numerous studies that have repeated the work to some extent of the study by Andrew Wakefield, the doctor who performed the study.

The continued controversy over whether to require immunizations reached the federal level this year with the prominent HPV vaccine issue rising to the surface early in the Republican presidential primary. In particular, the medical community issued a quick criticism when candidate Michelle Bachmann made a statement to a reporter that the vaccine could cause mental retardation.

Recently, a cartoon appeared in the weekly newspaper Seven Days picturing a child in a coffin and making fun of the parents for rejecting a vaccine.

Mullin said he saw the cartoon as a cheap shot.

“People who don’t believe in vaccinations just don’t believe in it,” he said. “They’re not bad people.”

For some parents, like Gaelan Brown of Fayston, the philosophical exemption is really a civil liberties issue. Brown’s 7-year-old son has had some vaccinations, and he has used the philosophical exemption for others.

Brown said his son is one of the healthiest in his class. He said he depends on things like a healthy lifestyle help the child’s immune system.

Brown said he sees the campaign to push for more immunizations as scare tactics.

“They’re creating a false issue in an attempt to take away our civil rights and give them carte blanche in the future,” he said.

Regardless of the scientific merits of vaccinating more children, Cheryl Hanna, a constitutional law professor at Vermont Law School said the state may run into legal issues should it take away the philosophical exemption.

Hanna wrote a commentary for Vermont Public Radio last week on the legal ramifications of the law. She emphasized she is not taking sides, but noted that interesting constitutional issues do arise.

Most exemptions to laws that affect the general public are based on religious grounds, Hanna said. For example, the Amish argue their children should not have to go to school beyond age 14. The U.S. Supreme Court found that compulsory education after eighth grade violated their right to freedom of religion.

An interesting wrinkle in Vermont law, Hanna said, is the state takes a harder stance in its constitution on prohibiting the establishment of religion. For example, under federal constitutional law, parents can use state vouchers to pay for their children’s education at religious schools. In Vermont they cannot. So there could be an argument that taking away the philosophical exemption but leaving the religious one would violate the state constitution.

“As a legal matter, the state can probably do all or nothing,” she said. “It’s on solid footing doing what it’s currently doing or by taking away the religious and the philosophical exemption. It’s interesting whether under the state constitution it could take away the philosophical but not the religious.”

Alan Panebaker

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  • “The debate over a discredited British study that showed a link between autism and vaccines continues as well, Stella said. She points to numerous studies that have repeated the work to some extent of the study by Andrew Wakefield, the doctor who performed the study.”

    No, not really. There isn’t really a debate over the 1998 Lancet study. It isn’t even part of the public record any more since it was formally and completely retracted.

    Mr. Wakefield has claimd that there are “replications” of his work. People have fact-checked Mr. Wakefield’s claims and found that he has misrepresented the facts
    http://justthevax.blogspot.com/2011/05/still-no-independent-confirmation-of.html

    Mr. Wakefield’s claim that autistic regression with gastrointestinal disease follows MMR vaccination has been shown to just not be true. Even his own original study didn’t support this claim once the real data were made available. His claim of vaccine strain measles virus persisting in intestinal tissues of a large majority of autistic kids with GI complaints is false, based on data even he knew was suspect.

    Whenever someone uses Andrew Wakefield to support their claims about vaccines causing harm, it is time to be suspicious.

    • Maurice Cyr

      If vaccinations protect against disease how can an unvaccinated child give the vaccinated child the disease?
      The medical community is completely in the grasp of the drug company education they get in med school.

  • Eric Davis

    Can someone tell me whether there is any difference among these three situations?

    1. While there are a few scientific studies that claim vaccinations can produce harmful effects in children, the overwhelming consensus of the scientific community is that vaccines are safe.

    2. While there are a few scientific studies that claim smart meters produce harmful radiation, the overwhelming consensus of the scientific community is that smart meters do not produce harmful emissions.

    3. While there are a few scientific studies that claim either climate change is not occurring, or that if it is, it is not induced by human activity, the overwhelming consensus of the scientific community is that human activity is contributing to increases in atmospheric carbon that are harmful to the environment.

    Based on stories I have read in Vtdigger.org and other media, I would guess that there might be some overlap between people who want to continue the philosophical objection to vaccination and people who want to opt out of smart meters. I would guess that there is not much overlap between either of these groups and those who deny that human-induced climate change is happening.

    But is there a principled distinction between points 1, 2, and 3 above?

  • “Safety” is a relative term, so to answer your question, we would have to settle on the meaning of “safe.”

    Nobody seriously suggests that vaccines have never resulted in severe injury. The question is, are vaccines safer than the diseases they protect us against. The answer, undeniably, is yes.

    Anti-vaxers greatly exaggerate the prevalence of vaccine injury, and humans are generally not very good at assessing personal risk.

    And it’s easier to scare people than to unscare them.

  • Why are we giving religious exemptions to a public health and safety issue?

  • I’m disappointed by this article. The article says: “Sixty percent of Vermont children 19 to 35 months old are “adequately vaccinated” according to a 2009 Centers for Disease Control and Prevention survey.”

    You do realize that children 19-35 months old are in daycare, not in school, right? And that children who are not in daycare are not required to get ANY vaccines in VT?

    Further, I hope you understand that the survey in question (The National Immunization Survey) covers 14 recommended vaccines, many not required by VT laws. A child can be totally in compliance with the legally required vaccines in VT and get a fail on that survey. I’ll give some specific examples: the survey looks at rates of acceptance for the Hepatitis A vaccine (2 doses) which is not required for school attendance in VT; it looks at rates of acceptance for the rotavirus vaccines (2 doses) which cannot be required for school attendance in VT because both doses have to be received before age six months or not at all.

    Why in the world are these irrelevant statistics being used to attack the philosophical exemption for attendance at public school?

    How are children in VT doing for public school vaccines? Except for the chickenpox vaccine, by kindergarten the rates are over 90% for all of the required vaccinations. Is this a situation that requires drastic action? I don’t think so.

    For more information I recommend this summary and analysis which has “slides” of all of the relevant statistics taken from the appropriate official sources. http://www.scribd.com/doc/80383332/S199-Commitee-Submission-With-Exhibits

    Thanks for your time!

  • The real story here is not vaccination but the intellectual dishonesty of the Vermont Department of Health in its misrepresentations of this issue. Doesn’t this organization have some ethical or legal obligation to be truthful with the Vermont Legislature, Press, and Public?

    How can the Kindergarten 5.08% and 7th Grade 2.43% Philosophical exemption rate result in Commissioner Chen’s claim of a 40% vaccination deficit? “Only 60% of….” Simple, it doesn’t.

    Vermont 7th Graders exceed 98% coverage for all of the vaccines required for school attendance, except Chicken Pox at 88.6%. But the Chicken Pox number is deceptive because of the 10% without shots the majority have natural acquired immunity, and there is no measurement column for that. http://www.healthvermont.gov/hc/imm/ImmSurv.aspx

    Vermont Kindergartners started school in 2010 with over 91% coverage of all required school attendance vaccines (Hep B 95.3%). This is in spite of 10.44% being granted “Provisional” admittance, which means they are missing a dose or vaccine in the required schedule. Vermont law allows a 12-month period for a new enrollee to come into compliance. By first grade the rates exceed 95%. If you add the Kindergarten 91% vaccination rates to the 10.4% Provisional admittance rates with the 5.08% philosophical exemptions you get 106.48%, over 100%. This is because students are accurately being counted in several categories. There is no wholesale rejection of the vaccination schedule. A family who is fully compliant with the traditional Polio, DTP, and MMR requirements but feels Chicken Pox is overkill will show in both categories- as vaccinated but also having an exemption on file for the Chicken Pox vaccine.

    What public health objectives are not achieved with these high 90 percentile plus rates?

    The Philosophical Exemption is part of the Vermont’s original vaccine legislation. The rate was always in the 1-2.5% range until 2008. What happened in 2008? Chicken Pox and Hepatitis B were added to the schedule. Chicken Pox was considered a routine childhood infection so mild it was not a reportable disease prior to the vaccine being developed. The CDC has identified that adding a Chicken Pox shot to an MMR visit increases the normal MMR seizure rate from 1/3500 to 1/2500. Using the MMRV Pro Quad Four in One doubles the rate to 1/1250. Is a parent unscientific if he can substantially reduce his child’s risk of a fever so extreme it provokes a seizure, and a potential emergency room visit, if he can do so through product selection, dose timing or the opting out of a vaccine for a largely benign infection?
    http://www.cdc.gov/vaccines/vpd-vac/combo-vaccines/mmrv/vacopt-factsheet-parent.htm

    What is the origin of the misleading statistic the Commissioner Chen cites? It is a CDC “National Immunization Survey”, of 19-35 month children, who in Vermont have no vaccination requirements (unless enrolled in a state licensed daycare or pre-school, the minority of children that age), for the ENTIRE CDC Recommended schedule, not the Vermont School Attendance Required Vaccines. Changing school exemption rules will have no effect on this statistic.

    NIS surveys can be incredibly restrictive, disqualifying and categorizing as “unvaccinated” children missing a single dose of a series, or even missing a milestone age, i.e. the first Hepatitis B dose outside of 24 hours of birth.

    Commissioner Chen and other Bill proponent’s assertion that philosophical exemptions reduce vaccination rates is demonstrably false within the survey cited. In that CDC 431×331 analysis 3 states tied for top rating at 82%; Louisiana, Ohio and Maryland. 2 of the 3, Louisiana & Ohio, offered philosophical exemptions, directly refuting the assertion. Conversely, of the bottom 7 states scoring below 70%, the major majority, 5, including the lowest rated state, Montana, do not offer philosophical exemptions. This again provides empirical proof that philosophical exemptions do not reduce vaccination rates.

    The NIS survey statistics are not dropping because parents are rejecting the vaccines they grew up with but because of near annual additions to the schedule. The 2010 schedule includes 39 injections and two oral doses for 16 antigens, compared to 9 in 1994 and 7 in 1985. Parents are simply taking time to adopt new recommendations, and considering that perhaps their individual child may not warrant the complete schedule.

    How well is the current Vermont system working? The United Health Foundation has again named Vermont as the #1 Healthiest state in the country, specifically citing as a highlight, “In the past year, the incidence of infectious disease decreased from 8.5 to 3.1 cases per 100,000 population”. Vermont has the second lowest infant mortality rate in the nation. So what exactly is the problem this legislation is supposed to fix?
    http://www.americashealthrankings.org/SiteFiles/Statesummary/VT.pdf

    Increasing the absurdity is that Vermont’s population is such that the number of citizens using Philosophical Exemptions in measured in hundreds.

    You can access the charts and other evidence described here at
    http://www.scribd.com/doc/80383332/S199-Commitee-Submission-With-Exhibits
    http://www.scribd.com/doc/82935776/VT-Vaccine-Exemption-Charts

  • Kelly Cummings

    Pharmaceutical companies make lots and lots of money!

    If vaccinations are so great for all of us why do pharmaceutical companies need all these high paid lobbyists to persuade our legislators this is a good thing? I mean isn’t the proof already in the pudding? Guess not. Looks like the pudding has some problems…

    Send in the lobbyists and PR folks! Rev up the ol’ scare tactic campaign, pit everybody against everybody and away we go! First rule of thumb….always ask questions and look past the “fluff” when the big guys and gals send in their paid lobbyists. Take a peek behind the curtain. Who gains? Who loses? Maybe do a little research on vaccines. Look into the laws that protect pharmaceutical companies from lawsuits, etc. Why would a pharma company need protecting against a lawsuit for something that is so safe? Hmmmm.

    Just something to think about.

    • Ted Lemon

      Do you have any evidence at all to support your assertion that the pharmaceutical industry pays lobbyists to persuade our legislators to pass laws favoring vaccination?

      The evidence would suggest the contrary, since this religious and philosophical exemption seems destined to become law, depriving parents who vaccinate their kids of the right to prevent their kids being exposed to unvaccinated kids, and depriving parents of immune-compromised kids of the right to have their kids attend school in a safe setting.

      Vaccines work because of herd immunity: if the vast majority of kids are immunized, the chances of anybody getting infected are much lower, even though they are not zero, and because of this, the chances of a person who has not been successfully immunized contracting the infection are much, much lower, because it’s so much less likely that they will even be exposed.

      When parents choose not to have their kids immunized to “protect” them, they are not only not protecting them, they are putting other kids at risk. Even if such an act were to protect the kids of that parent, what that parent is really doing is taking advantage of all the parents who did the right thing, hoping that their child will be protected by the supposed risk the other parents took on. That’s a pretty awful way to take advantage of one’s neighbors.

  • Pat Davis

    It is very disappointing to read the details of the positions documented in this article.

    Why is a professional science based organization resorting to anecdote and using statistics that are not meaningful? Is is incompetence or an ulterior motive? Either scenario is pretty bad.

    It is equally disappointing reading the comments. The first couple of commenters appear to be lobby types who resort to rhetorical red herrings and name calling.

    On the other side, we have very articulate citizens pointing out what appear to be elementary mistakes in interpreting pretty simple data.

    I really wonder why someone is wasting our government members’ precious time and money on a non-issue?

  • I agree that this should not be an issue. Here is a link to an article by Dr Blaylock that explains how herd immunity is just plain false and not logical. People should have the choice to vaccinate or not. And the vaccinated should not fear the non vaccinate.
    http://www.thenhf.com/article.php?id=1975

  • Jay Davis

    I wonder if there are studies about risks. My cat stays inside. She got a rabbies vax at her adoption, but I fail in boosters. Why ? Because she will never be at risk to transmit or be transmitted to.

    Religion is curious, because years ago, I could not fathom why Vermont Medicaid would pay for a routine circumcision.
    Since, evidence despite pro-circumcisionist studies, shows there is no health benefit except in rare cases, why should public pay. I was rebuked and even a letter from a Ped at FAHC would not make them remove payments?

    What do we conclude? The much hoop-la in medicine and assumed risk, may be a red herring?

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