Kay Johnson: Give vaccine policy a new debate

Editor's note: This commentary is by Kay Johnson, who is a president of Johnson Group Consulting, a national child health policy firm based in Hinesburg. She was a federally appointed member of the National Vaccine Advisory Committee, primary author of national recommendations during the measles epidemic of 1990s, one of the architects of the National Vaccine Program, a consultant to CDC, an adviser to the Office of the Surgeon General (Satcher) on implementation of national vaccine policy, author background papers on vaccines for the Institute of Medicine (IOM), and a founding board member of Every Child by Two. She currently serves on the board of the March of Dimes in Vermont.

[V]ermont’s childhood immunization policy is in need of repair and the sooner the better. The latest numbers from the Centers for Disease Control show we have the second highest rate in the country of parents who are choosing not to vaccinate their children because they simply don’t believe they should — despite all scientific evidence to the contrary. This jeopardizes the health of all our children.

We are one of only 20 states to allow a philosophical exemption for childhood immunizations. Too many of Vermont’s children are just one measles exposure away from contracting the disease — all it takes is a cough or sneeze in a classroom, at a child care facility, on a ski lift, or at the pediatrician’s office.

The need for improved policy is underscored by measles cases spreading across the country. According to the Centers for Disease Control (CDC), in the first two months of this year, 170 people from 17 states and Washington, D.C., have contracted measles, including next door in New York. A majority of cases involve unvaccinated people, and too many are babies not old enough to be immunized. We’ve seen this before, in the 1990s measles epidemic. We can’t afford a replay.

As a national expert who has advised federal health agencies during that epidemic and ever since, (CDC, Office of the Surgeon General and the Institute of Medicine), and who has helped shape national vaccine policy, I see flaws in our state’s current approach. The proof is tangible: states that have eliminated the philosophical exemption have seen opt-out rates drop dramatically along with disease spread. It’s no surprise the two are linked.

Our national immunization system critically depends on having every state hold up its share of responsibility for strong, effective vaccine policy.

Leadership in the Vermont Legislature will be critical to giving full voice to the science, expert opinion, and public opinion. Now is the right time for that.


The goal is to immunize “every child by two” (making exceptions only when medically necessary), not by age 5 when they enter kindergarten. Yet according to our health department’s data for 2013-14, only 67 percent of Vermont toddlers aged 19-35 month had received the full series recommended vaccines. This is an overall coverage rate lower than the national average (70 percent) and the rate for New England states combined (77 percent).

Among our kindergarten students, coverage rates are at 86.9 percent for public and 72.2 percent for private schools. Vermont DOH reports that overall 85.8 percent of kindergarten students entered fully immunized in 2013-14. This does not reach the threshold of 90 percent or 95 percent needed to assure critical herd immunity.

The vast majority of Vermont family exemptions are philosophical, and national studies suggest these are generally parents making decisions based on false, and soundly refuted, information.

All these facts highlight the importance of revising Vermont’s vaccine policy this year.

As a board member of Vermont Division of the March of Dimes, I am charged with raising awareness about good sound health policy to protect our children and families. That includes education on the benefits of vaccines for children. Thankfully most Vermonters seem to agree.

A new poll shows that a strong majority of Vermont residents support eliminating the philosophical exemption for vaccines. For example, 73 percent would support a bill to allow medical exemptions only, and 70 percent do not agree with Gov. Shumlin that the exemption policy should be left alone. Leading organizations such as the Vermont Academy of Pediatrics, Academy of Family Physicians, Association of Hospitals, the March of Dimes and many others, all support the elimination of the philosophical exemption for vaccines in our state.

Unfortunately a small, but vocal, minority of parents who oppose vaccines seeks to continue undue influence over our public health system and policies that protect our children.

Leadership in the Vermont Legislature will be critical to giving full voice to the science, expert opinion, and public opinion. Now is the right time for that. Both the House and the Senate have bills to eliminate the philosophical exemption.

Gov. Shumlin is wrong about leaving the decisions regarding exemptions solely to families. We tried that two years ago and since then the opt-out rate has jumped from 5.4 percent to 6.1 percent. The Department of Health, where professionals understand what the data mean, has its hands tied by the governor’s position. A sensible discussion in the Legislature will be most fair to all of Vermont’s children.

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