Report recommends universal immunization for schoolchildren

Report recommends universal immunization for schoolchildren

One of the most controversial bills last session was Sen. Kevin Mullin’s proposal to improve immunization rates in Vermont by removing the philosophical exemption — the medical and religious exemptions would remain — and extending a pilot for a free vaccine program statewide.

A grassroots group of activist parents and other vaccine opponents opposed removing the exemption on philosophical grounds and while Mullin’s bill passed easily in the Senate, the House version failed.

With Act 157, the Legislature struck a compromise near the end of the session that allowed parents to continue using the philosophical exemption as long as they signed a new consent form that gave them the choice to opt out.

The health department form requires that a parent review educational material, including “information about the risks of adverse reactions to immunization” and understand that “failure to complete the required vaccination schedule” increases risk to others of contracting a preventable infectious disease. The new form underscores that exposure can be fatal for students with special health needs who are unable to be vaccinated or who are at heightened risk of contracting a “vaccine-preventable communicable disease.”

With that last issue in mind, the Legislature put in place a study group that was asked to evaluate how the state can protect children who are immunocompromised or who have special health needs from exposure to diseases transmitted by unvaccinated children and adults. The interim working group included members from the public health, medical and education communities. The group recently issued a report, now available on the Vermont Department of Health website, along with the minutes of the group’s meetings.

The Legislature asked the working group to consider two options for protecting at-risk children: moving vulnerable students from their local school to one in an “adjoining district” with a higher immunization rate and requiring all adults employed at schools — teachers and staff — to be fully vaccinated.

The report’s conclusion is that neither proposed action is workable for a number of reasons. In sum, the authors of the report write: “The most effective way to protect immunocompromised students in school is to require universal immunization.”

In working their way through the “feasibility” question on moving children from one school to another, the group concluded that while it is logistically possible to move children, that doesn’t mean they will be protected from exposure to disease, as there is no way “to medically demonstrate that an alternate school placement is and will be safer for the purpose of protecting an immunocompromised student.” Students move, Vermont has small schools and small classes, immunization rates change frequently even in one classroom and schools report immunization rates in January while student school assignments are made in the fall.

The study group also reported to the Senate Committee on Health and Welfare and the House Committee on Health Care that, while as yet no state mandates that adults in schools be vaccinated, the only course that would protect vulnerable students would be to recommend an annual flu vaccination and require that adults be immunized. However, since existing exemptions would also apply to adults, vulnerable children, such as those with cystic fibrosis, congenital heart disease or diabetes, remain exposed. And so, the report says, if they are to be effectively protected, “universal vaccination” is required.

Working group members uniformly describe the questions they tackled as “complicated.” Their meetings were buttressed by “extensive homework,” as pediatric infectious disease specialist Dr. William Raszka, of UVM’s College of Medicine put it. The minutes of the meetings show continuing discussion around definition of terms, reliable sources for statistics, laws and policies in Vermont and in other parts of the U.S. and how to be consistent in the recommendations. They include comments by members of the public who were present.

Kate Robinson

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