Background:
Washington is one of a minority of states that allow personal belief/philosophical exemptions to school immunizations. Prior to July 22, 2011, obtaining a personal exemption from school immunizations required only a parent's signature. Now the form must be signed by a licensed health care practitioner (physician, naturopath, physician assistant, or an advanced registered nurse practitioner) stating that he or she provided the parent or guardian with information about the benefits and risks of immunizations.
- Immunization laws are state laws. There are no federal immunization laws.
- All 50 states have laws requiring immunizations for school entry.
- All 50 states allow medical exemptions from school immunizations.
- 48 states allow religious exemptions from immunizations (Mississippi and West Virginia do not).
- 19 states allow personal belief/philosophical exemptions.
Washington is one of a minority of states that allow personal belief/philosophical exemptions to school immunizations. Prior to July 22, 2011, obtaining a personal exemption from school immunizations required only a parent's signature. Now the form must be signed by a licensed health care practitioner (physician, naturopath, physician assistant, or an advanced registered nurse practitioner) stating that he or she provided the parent or guardian with information about the benefits and risks of immunizations.
A bill has been introduced into the Washington State Legislature
that would remove the personal belief/philosophical exemptions option, leaving
only medical and religious exemptions from immunizations. A similar bill has
been introduced in California.
I have been conflicted about this bill. As part of investigating
cases of notifiable conditions, I am required to ask if a child with a vaccine-preventable
disease has been vaccinated and, if not, why. Sometimes, parents who have
chosen not to vaccinate their children are hesitant to answer that question. I
also speak to parents who have chosen not to vaccinate in other settings. I am
sincere when I tell them that I respect their decision. I am happy to discuss
the benefits and risks of vaccines with anyone who is interested, but I don't
try to convince parents to vaccinate their children when they tell me that they
have chosen not to.
Every year, schools in Washington are required to
report
their immunization exemption data to the state Department of Health (DOH). This
includes the number of students enrolled, how many students are exempted from
immunizations, and how many students are up-to-date on their immunizations. County-
and district-level data are available on the DOH website. School-level immunization data are available here
and here.
Immunization exemptions for Pierce County are low. There are
a few school districts that have higher percentages of exemptions than others
but, overall, Pierce County has lower percentages of immunization exemptions
than the state as a whole. However, aggregate data can be deceiving.
Several studies, including a recent study in California,
have demonstrated that people who exempt their children from immunizations tend
to cluster geographically (Imdad et al., 2013; Lieu et al., 2015; Omer et al., 2008; Smith et al., 2004). Because no vaccine is 100% effective, these clusters not only increase the risk of
outbreaks of vaccine-preventable diseases among unimmunized people, they also
increase the risk vaccine-preventable diseases in immunized people (Feiken et al., 2000; Omer et al., 2009; Salmon et al., 1999). People who are not vaccinated include babies who are too young to
receive a vaccine and those who have medical contraindications to one or more vaccines. In the U.S., the highest incidence
of pertussis (whooping cough) is in babies less than one year of age who are not old
enough to have completed their primary diphtheria, tetanus, and acellular pertussis (DTaP) immunization series. Babies are
also much more likely to develop complications of pertussis than older children or adults.
Measles is a highly contagious disease. The measles virus is
transmitted by small respiratory droplets that can remain suspended in the air
and infect another person hours later. A person with measles is contagious up
to four days before the onset of rash; that is, before anyone recognizes that
the person has measles.
Measles is a notifiable condition. Investigating a case of
measles requires taking a history of every place the person had been for the four
days before rash onset and every person that the infected person came in
contact with. The health department in required to notify the public of
potential exposures to measles virus. Here are some recent notifications from
Pierce and King Counties:
-
April 2, 2014: Possible measles exposure reported in Pierce, King and Whatcom counties
- June 27, 2014: More measles exposures occurred this week at emergency departments for Tacoma hospitals
- January 9, 2015: Measles makes it to Seattle from Disneyland; several areas risky for infection
- February 4, 2015: Brazilian’s Seattle visit may have exposed hundreds to measles
The authors of a study published last year estimated that,
in 2011, each case of measles costs local and state health departments $11,933
to $29,833. The average length of measles outbreaks was 22 days at a cost of $4,091
to $10,228 per day, depending on the number of contacts to each case (Ortega-Sanchez et al., 2014).
There are schools in Pierce County with high percentages
immunization exemptions and dozens of students who are potentially susceptible
to measles. One student infected with measles could simply walk through the
halls of one of those schools and start an outbreak that would cost taxpayers
hundreds of thousands of dollars. Some of those schools are in my neighborhood,
so my perspective on this situation is both as a public health professional and
a parent.
Our society places high value on controlling
vaccine-preventable diseases. That's the reason elected officials in every
state have made immunizations mandatory for school entrance. Most parents in
this country vaccinate their children. Nevertheless, even parents who vaccinate
have concerns about vaccine safety. Vaccines have side effects. Most vaccine
side effects are minor and self-limiting. Serious reactions to vaccines are
rare.
Parents who vaccinate have chosen to take responsibility for
protecting the health of not only their children, but also the health of their communities. While I respect the rights of parents to
decide what is best for their children, I also recognize that parents who
exempt their children from immunizations benefit from the protection other
parents have provided their communities by vaccinating their children without
taking the extremely small risk of their child having a serious adverse
reaction to a vaccine.
States in which parents can easily exempt their children
from immunizations have higher percentages of exemptions than states with more
stringent requirements for immunization exemptions (Blank et al., 2013; Omer et al., 2006; Rota et al., 2001; Wang et al., 2014). To obtain a personal belief/philosophical exemption from
school immunizations, some states require parents to write a statement
explaining their reasons for seeking an exemption. Some states require parents
to obtain an exemption form from a local health department and/or have the form
notarized before submitting it. Other states, including Washington, require the
exemption form to be signed by a licensed health care provider. Most states do
not allow personal belief/philosophical exemptions from school immunizations.
The World Health Organization (WHO) estimates that
145,700 people died from measles in 2013. Measles is an eradicable
disease. The WHO Region of the Americas has been free of endemic measles since
2002. Other countries and regions are close to achieving measles elimination.
Measles was eliminated from the U.S. by parents who vaccinated their children
against the disease. In my opinion, it would be a disservice to those parents
and their children to allow measles to become endemic in this country again. For
that reason, I support HB 2009. I encourage Washington State residents to
contact your state legislators and let them know your thoughts on HB 2009.
More information:
-
Vaccination Exemptions
- States With Religious and Philosophical Exemptions From School Immunization Requirements
- HB 2009 – 2014-16: Concerning exemptions from immunizations for school-age children
- [Governor] Inslee supports bill to limit vaccine exemptions
References:
Blank, N. R., Caplan, A. L., & Constable, C. (2013).
Exempting schoolchildren from immunizations: states with fewest barriers had
highest rates of nonmedical exemptions. Health Affairs, 32(7).
doi:10.1377/hlthaff.2013.0239.
Feikin, D. R., Lezotte, D. C., Hamman, R. F., Salmon, D. A.,
Chen, R. T., & Hoffman, R. E. (2000). Individual and community risks of
measles and pertussis associated with personal exemptions to immunization.
JAMA, 284(24). doi:10.1001/jama.284.24.3145.
Imdad, A., Tserenpuntsag, B., Blog, D. S., Halsey, N. A.,
Easton, D. E., & Shaw, J. (2013). Religious exemptions for immunizations
and risk of pertussis in New York State, 2000-2011. Pediatrics, 132(1).
doi:10.1542/peds.2012-3449.
Lieu, T. A., Ray, G. T., Klein, N. P., Chung, C,. & Kulldorff,
M. (2015). Geographic clusters in underimmunization and vaccine refusal.
Pediatrics, 135(2). doi:10.1542/peds.2014-2715.
Omer, S. B., Enger, K. S., Moulton, L. H., Halse, N. A.,
Stokley, S., & Salmon, D. A. (2008). Geographic clustering of nonmedical
exemptions to school immunization requirements and associations with geographic
clustering of pertussis. American Journal of Epidemiology, 138(12).
doi:10.1093/aje/kwn263.
Omer, S. B., Pan, W. K. Y., Halsey, N. A., Stokley, S.,
Moulton, L. H., Navar, A. M. et al. (2006). Nonmedical exemptions to school
immunization requirements. Secular trends and association of state policies
with pertussis incidence. JAMA, 296(14). doi:10.1001/jama.296.14.1757.
Omer, S. B., Salmon, D. A., Orenstein, W. A., deHart, P.,
& Halsey, N. (2009). Vaccine refusal, mandatory immunization, and the risks
of vaccine-preventable diseases. New England Journal of Medicine, 360(19).
doi:10.1056/NEJMsa0806477.
Ortega-Sanchez, I. R., Vijayaraghavan, M., Barskey, A. E.,
& Wallace, G. S. (2014). The economic burden of sixteen measles outbreaks
on Unites States public health departments in 2011. Vaccine, 32(11).
doi:10.1016/j.vaccine.2013.10.012.
Rota, J. S., Salmon, D. A., Rodewald, L. E., Chen, R. T.,
Hibbs, B. F., & Gangarosa, E. J. (2001). Process for obtaining nonmedical
exemptions to state immunization laws. American Journal of Public Health,
91(4), 645-648.
Salmon, D. A., Haber, M., Gangarosa, E. J., Phillips, N. J.,
& Chen, R. T. (1999). Health consequences of religious and philosophical
exemptions from immunization laws. Individual and societal risks of measles.
JAMA, 281(1), doi:10.1001/jama.282.1.47.
Shaw, J., Tserenpuntsag, B., McNutt, L. A., Halsey, N.
(2014). United States private schools have higher rates of exemptions to school
immunization requirements than public schools. Journal of Pediatrics, 165(1).
doi.org/10.1016/j.jpeds.2014.03.039.
Wang, E., Clymer, J., Davis-Hayes, C., & Buttenheim, A.
(2014). Nonmedical exemptions from school immunization requirements: a systematic
review. American Journal of Public Health, 104(11).
doi:10.2105/AJPH.2014.302190.
Just to clarify, are you advocating that all children should be vaccinated by law or only those children who want to attend public school be vaccinated?
ReplyDeleteRCW 28A.210.060 through 28A.210.170 apply to day care centers and to both public and private K-12 schools. It does not apply to homeschooled students.
Deletehttp://apps.leg.wa.gov/rcw/default.aspx?cite=28A.210&full=true#28A.210.060
To answer your question, I advocate that both children and adults receive all recommended vaccines for which they have no medical contraindications regardless of state immunization laws.
And I, sir, find your advocating such a law outrageous. You are suggesting that our fundamental right to treat our bodies as we choose is no longer viable. That we are now on the same level as farm animals appears to be fine with you. HOW DARE YOU. I stand with the American Medical Association in insisting that our right to medical choice be protected!
Delete"I stand with the American Medical Association in insisting that our right to medical choice be protected!"
DeleteIn spite of what at least one person claims, "The American Medical Association has policy opposing religious or philosophical exemptions from school-entry immunization mandates."
http://www.amednews.com/article/20121126/profession/311269930/7
http://www.amednews.com/article/20120409/profession/304099960/4
You are entitled to your opinions. You are entitled to disagree with me.
A number of other people who disagree with me have responded to my comments here. All of them have done so respectfully. I ask that you do the same.
As someone opposed to (and vigorously so) this amendment to the current HB 2009 I found this post both well reasoned and with appropriate tone for such a hot button topic. I think the idea that the government would be able to mandate a medical product and procedure should be frightening to all.
ReplyDeleteI'm curious as to your thoughts about the 100's of vaccines in R&D right now. I'm sure you are aware there are 49 doses on the current schedule by the age of 6. How many is too many? Who gets to decide this?
-Kevin Manchester
Des Moines
Thanks for your comments and questions.
DeleteThe CDC's Advisory Committee on Immunization Practices (ACIP) as well as the American Academy of Pediatrics make recommendations on which vaccines should be administered in the U.S. and under which circumstances. Those recommendations are based on the clinical effectiveness, safety, and cost effectiveness of the vaccine as well as the epidemiology of the disease prevented by the vaccine. For example, typhoid, yellow fever, and Japanese encephalitis vaccines are not routinely recommended unless a person is travelling to a country where those diseases are endemic.
ACIP meeting are open to the public.
http://www.cdc.gov/vaccines/acip/meetings/meetings-info.html
That being said, the CDC is not a regulatory agency. State legislatures decide which vaccines to include in school immunization requirements. States are not required to mandate any vaccine for school admission. Although the ACIP recommends human papillomavirus (HPV) vaccine for females and males 11-12 years of age, Washington State does not require it for school admission.
http://www.doh.wa.gov/CommunityandEnvironment/Schools/Immunization/VaccineRequirements
There is an article that was published in Pediatrics titled "Do Multiple Vaccines Overwhelm or Weaken the Infant’s Immune System?"
http://pediatrics.aappublications.org/content/109/1/124.full
Although my 2-year-old son has received more vaccines than I did when I was a child, he has received far fewer antigens than I did. The reason is that two vaccines are no longer used in the U.S.: smallpox, which contained around 200 antigens, and whole cell pertussis vaccine, which contained around 3,000 antigens. Acellular pertussis vaccines contain 2 to 5 antigens. Hepatitis B vaccine, which Andrew received shortly after he was born, contains a single protein – 1 antigen.
http://fullyvaccinated.blogspot.com/2012/11/hepatitis-b.html
From the moment we're born our bodies are confronted with hundreds of antigens. The amount of antigens in the vaccines that children receive is miniscule compared to what they encounter just being kids.
http://www.cdc.gov/vaccinesafety/Vaccines/multiplevaccines.html
It's not about antigen counts. This is about freedom vs. tyranny (loss of freedom). What sort of "man" promotes loss of freedom for the individual? Does this "man" prefer to hand control over his life to corporate entities? The CDC, FDA and EPA are corrupt. Why do you trust them? Because they create an industry that feeds your family?
DeleteAnonymous,
DeleteI addressed immunization laws in a previous post: http://fullyvaccinated.blogspot.com/2012/07/immunization-laws.html. You may also read to my response to RicoSuave below for further discussion on immunizations and individual rights vs. public good.
I have no interest in defending the CDC or FDA and I don't know how the EPA is relevant to this discussion. Whether I trust those agencies is also irrelevant to this discussion. Neither the CDC nor the FDA published the sources I referred to and cited in this post.
I would argue that public health, the "industry" that feeds my family, created the CDC and FDA, not the other way around.
I think you and I agree on more than we disagree. I find it interesting that you support this bill however. You are saying that you are comfortable not only with the current vaccine schedule but also whatever is added by our state legislature with your support of this bill.
ReplyDeleteI do not trust them to do anything other than believe what is put in front of them. Science is not only about data but about the questions asked. I do not believe they have the training or collective know-how to digest science. I certainly don't want them doing it on my behalf. I do not trust them to decipher the motivation or methodology behind the studies used by pharmaceutical companies to PROMOTE the use of their products. That may sound like a tinfoil hat perspective but there are $3 billion+ reasons that were levied in fraud cases recently to support my skepticism.
Do my children stand to benefit from a high percentage of children they go to school with being vaccinated? Likely
Is that enough to remove the rights of parents (educated parents are the primary refusers and modifiers of the schedule) to research on their own and discuss vaccines with their doctors before making this decision? Not in my mind. And it's not close.
It's never been a passion of mine to speak out about vaccines. This will change that. This bill passing will do more harm than good for your cause (assuming I'm interpreting "Fully Vaccinated" correctly). I expect this will take the already vocal minority and throw gas on their fire. This legislation will pass. I expect it will have the same effect that the 2011 version had on vaccination rates. None.
Kevin Manchester
kevin.manchester@gmail.com
I will read your links tonight. I was extremely unproductive in my clinic today and honestly didn't have time. In between patients I was emailing the House :)
Kevin,
DeleteThanks for your comments.
Saad Omer, who coauthored a number of the papers I cited in this post, wrote an op-ed in the New York Times about this issue. I encouraged my colleagues at the health department and members of the Pierce County Immunization Coalition to read it.
http://www.nytimes.com/2015/02/06/opinion/how-to-handle-the-vaccine-skeptics.html
I am comfortable with the current immunization schedule. Holly and I decided to vaccinate Andrew according to the current schedule and I started this blog to discuss vaccines both as a public health professional and a parent. I disagree that my support of HB 2009 means that I would be comfortable with "whatever is added by our state legislature." Many of our lawmakers in both the state and federal government do not have "training or collective know-how to digest science," but some of their constituents do. I would not hesitate to contact my state legislators or even drive to Olympia to voice my opposition to the addition of a vaccine if I believed its risks outweighed its benefits.
I'm not certain that this bill will pass in its present form and I am concerned that what you said may be true; it may do more harm than good. I encourage you and others who share your concerns to contact your state legislators. Maybe you can help them find an acceptable middle ground.
Matthew
Matthew,
ReplyDeleteI have very much enjoyed your blog post and debate today. Honestly it was the only thing that kept me sane. If there were more conversations like this we might actually be able to find resolution. As it is now I see the loons come out from both sides and too often shift the debate in to a venom spitting contest. It's frustrating for me to see every conversation turn into "Doctors are money hungry morons who don't care if they hurt your kids" vs "Jenny McCarthy and Andrew Wakefield tricked you into thinking vaccines cause autism". I think most rational people think they are too good for debating on the internet. To some degree I think they are right :)
It certainly wasn't my intent to put words in your mouth about supporting the bill. I do think you are overvaluing the voice of the minority. Should the legislature (advised by the majority in medicine) decide to add a vaccine that you don't like in the future, you might understand what I'm saying. It's a quite helpless feeling to be so sure about something (sure that I'm unsure about vaccines, if that makes sense) and have little to no power.
As for the hope for middle ground, I thought we were already there. Everyone had to go sit through a lecture with their pediatrician to get an exemption. There is no middle ground with no option. You are either banned from school because you don't have vaccinations or you are not. It seems like a black and white issue. I hope I'm wrong.
Just a little FYI. Don't ever cite a paper whose primary author is Mr. Offitt. He is the worst nightmare and easiest target for someone who wants the freedom to chose what is put into their child's body. He is your Jenny McCarthy I guess. An ally that the other side doesn't respect. Yeah, I just compared him to Jenny McCarthy, and it felt great.
I think the only hope for middle ground is a safety study that compares the health of the fully vaccinated child to an unvaccinated child. I know that it would be difficult but the money is there and so are the participants. The CDC's stance that it would be unethical is pathetic. It would take people a lot smarter than me and it would have to have oversight from big players on both sides of the issue. I know it can be done and would put to bed the safety debate for good. I personally think I know why they won't do the study but maybe that's just because my foil hat is strapped on too tight....
While we might be under 3% in Washington there are a lot of those people in positions of influence. It will be interesting to see what happens when the gloves come off. It takes me less than 30 seconds to get someone to think for themselves about this issue. I currently approach the topic with a measured caution because I'm truthfully not sure what the right course of action is. Right now I think a majority of the non-vaccinating parents think they get some marginal benefit from a high vaccination rate. We as humans are programmed to put our families first. Discussing this in any public forum right now sets your family up for judgment and ridicule. I truly think that keeps the more successful/influential/calculating parent out of the debate. HB2009 will change that for some. I can think of one for sure.
Would you mind emailing me? I have a personal question for you about travel and vaccines. Kevin.manchester@gmail.com
Thanks Kevin,
DeleteI've enjoyed our discussion as well.
I agree that discussions about vaccines tend to be very polarized and it's unfortunate that sometimes those with more extreme positions get more attention than they deserve. I respect Paul Offit, but his aggressiveness (putting it mildly) can make him a liability.
I've read a lot about vaccine hesitancy over the years. Two authors who have written extensively on the subject who stand out in my mind are Allison Kennedy and Deborah Gust, both of whom I cited in my first post on this blog. http://fullyvaccinated.blogspot.com/2012/01/happy-new-year.html
Kennedy and Gust (together and separately), along with a number of other authors, put a lot of effort into understanding parents' concerns about vaccine safety, the reasons some parents avoid vaccinating their children, and how to address parents' concerns about vaccines. Their work was one of the reasons I started with blog.
I am not a parent who vaccinates my son simply because it's what the ACIP or Andrew's pediatrician recommend. I read the ACIP recommendations. I read textbook chapters on vaccines and vaccine-preventable diseases. I read epidemiological studies on the effectiveness of vaccines in populations. I also look at the sources of funding and the affiliations of the authors of vaccine efficacy studies and do not accept studies funded or conducted by pharmaceutical companies as the final word on the subject of vaccine safety or efficacy.
(Incidentally, in epidemiology, there is a difference between efficacy and effectiveness. Efficacy is what happens under experimental conditions. Effectiveness is what happens in the real world.)
That being said, I don't consider myself to be a vaccine "expert," but, since I make an effort to learn as much as I can about vaccines and vaccine-preventable diseases, I offer what I have learned in hopes that other parents might benefit.
You've raised some challenging questions that deserve more attention that I can give them in this discussion and I thank you for that. I place a very high value on comments from my readers. It makes me better at what I do.
I agree that HB 2009 is heavy-handed. As I said, I have been conflicted about it and am not entirely comfortable with it. I was hesitant to express my support for it publically because I felt that doing so might negatively impact conversations I have with non-vaccinating parents.
Nevertheless, I spend several weeks each year looking at the immunization exemption data for Pierce County. I would be much less concerned about the numbers exempted students if they were distributed evenly throughout the county and throughout the schools, but they're not. My support for HB 2009 is both as a public health professional and a parent. There are schools in my neighborhood that have the potential to be ground zero of a very large measles outbreak.
I'd be happy to answer your questions about travel and vaccines.
Matthew
Measles is not some sort of "killer." The people who die from this are statistical anomalies. 300,000 people die every year from cancer. Why not spend your time digging into that, instead of going after measles? Doctors are not statisticians. You are a businessman at the end of the day. Stop pretending to know mathematical probability. You are clueless in that realm.
DeleteAnonymous,
DeleteI agree that most doctors are not statisticians. I am not a doctor and I don't claim to be a statistician. I have, however, taken statistics courses for both my baccalaureate and postgraduate degrees.
People who die from measles are not statistical anomalies. They are people. Their deaths are not anomalous. Their deaths fall within the normal range of expected outcomes of measles. While relatively few people die from measles in the U.S., hundreds of people die from measles every day worldwide.
http://fullyvaccinated.blogspot.com/2015/02/measles-deaths-united-states-1999-2013.html
http://www.who.int/mediacentre/factsheets/fs286/en
I am not a businessman. I'm a public health nurse.
Speaking of cancer, 20% to 30% of cancers in low-income countries and 5% to 10% of cancers in the U.S. are caused by infectious agents (bacteria, viruses, parasites), some of which (e.g., hepatitis B, HPV) are vaccine-preventable.
Deletehttp://www.ncbi.nlm.nih.gov/pubmed/25523895
I disagree about you not being an expert. There are a lot of people that sell themselves as experts and educators that are clueless. While there is a very wide gap between where you and I stand, I have little doubt your ideas and practices are well researched and I have zero question of your intelligence, integrity, or motivation. I'd have a beer with you. You would have to buy your own beer though.
ReplyDeletePerhaps I'm naive but I think a common ground could be met on the issue if you and I were put in charge. I'm only half joking.
Kevin Manchester
Thanks!
DeleteWhen I was in Sierra Leone, I was surprised to see some of my nursing and physician colleagues smoking. They all told me, "I only smoke when I'm in Africa."
I only drink beer when I'm in Africa.
Matthew,
ReplyDeleteI want to challenge you to work from the base principle of this bill. As I see it, it come down to the question
"Does the goverment have the right to tell an individual what they can and cannot do with their own body?"
Your premise in your article would suggest that if it puts others at risk and could cost society money, then the answer would be yes.
First, our country is founded on the principle that "all men are created equal and are endowed by their creator with unalienable rights". All men are equal therefore I have no rights as an individual over you as an individual. If I have no right to force you to get a shot then neither does the government. Our government derives its powers from the consent of the governed. In essence, we lend our rights to the government for the protection of those rights. We don't give the government more rights than we have as individuals. This is a protection for us.
If all it takes to violate the rights of the individual is to show risk to others and cost to society, then during a famine we would have grounds to institute a 1 child law, like China because I could show how every child born but others at risk for getting less food. My point is that it can be used to justify any violation of individual rights. What about faith? Many countries deemed Christianity as a risk and certainly a cost to society. This was the reason Paul was persecuted in Ephesus. If our country decided and could show that it put people at risk, many Christians die, and it would cost society money, do they have the right to ban Christianity? Or dictate a certain "safer" religion?
I might also bring up driving. Car accidents kill far more people than diseases in America but I don't see anyone passing bills to stop driving. Car accidents are very preventable if there are no cars.
I personally have made the decision to vaccinate my kids. My wife and I evaluated all the info available and came to that decision but it was our decision.
However, because I believe in freedom I also believe that every business including schools have the right to refuse to accept students or patrons who are not vaccinated. There are consequences to all choices. If this bills was simply said you had to be vaccinated to attend public school, I'd be good with that but it goes further into telling private schools and businesses what they must do and that violates their rights.
Rico,
DeleteThanks for your comments.
I'm not a legal expert, so I'll delegate legal arguments to those who are more qualified to make them. I have done some reading on the subject and know that, for more than a century, state and federal courts in the U.S. have upheld mandatory immunization laws.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1449224
Public health is based on the principle of social justice; as Gostin & Powers put it, "the fair disbursement of common advantages and the sharing of common burdens."
http://content.healthaffairs.org/content/25/4/1053.long
In the case of vaccines, the common advantage is herd immunity and the burden is the risk of vaccine-associated adverse events.
http://fullyvaccinated.blogspot.com/2012/05/community-immunity-herd-immunity.html
http://www.cdc.gov/vaccines/imz-managers/guides-pubs/downloads/vacc_mandates_chptr13.pdf
Feiken et al. wrote, "The decision to forgo vaccination must balance individual rights with social responsibility."
http://jama.jamanetwork.com/article.aspx?articleid=193407
Omer et al. (2006) wrote, "States must balance parental autonomy with the tremendous public health benefit of vaccines when considering the types of exemptions allowed and how policies are implemented."
http://jama.jamanetwork.com/article.aspx?articleid=203593
HB 2009 does not affect the state's religious exemption from school immunizations.
The purpose of this post is to state my reasons for supporting HB 2009. I realize that this is a sensitive issue for many people and that stating my support for HB 2009 may alienate or even anger some of my readers and even some of my friends who have chosen not to vaccinate their children, so it's something that I considered very carefully.
Matthew
Matthew,
ReplyDeleteMy response above was not one of anger although you are right that this can be a very sensitive topic. When I read your article, I found it to be one that is well reasoned and thought through. My goal was to ask you to consider principles that you had not addressed in that article and see if they had any effect on your conclusions. I did appreciate your honesty about your struggle with this issue and thought maybe I could ask some questions about the deeper principles behind such issues. I commented because I believe it is important as Americans to have these discussions and challenge ideas so we are fully aware of the implications of our actions not just on the current issue but that we anticipate the end results of those actions. I don't believe the laws we pass can be looked at just for their present effects but must also be analysed for the future potential effects. To many laws have been passed in this country and others with good intentions but that in the end, led to terrible results. I hope my questions about your core beliefs about freedom would be taken in this light. I will continue to read your blog and look forward to more discussions.
Thank you
Rico
what are your thoughts on Dr. William S. Thompson from the CDC coming forward claiming the cdc skewed the results to cover the link between vaccinations and autism. what is your thoughts an the adjuvants and preservatives added to the vaccines (like thymerisol, msg, aluminum ...etc) effects and many news agencies report that high level gov around the world receive "clean vaccines". Also because vaccinated persons can and do spread the strain they've been injected with, should vaccinated people be quarantined for a period of time. and with events like the polio vaccine being contaminated with cancer causing sv-40, why should we trust these companies? what about vaccines suppressing cellular immunity.
ReplyDeleteThanks for your questions.
Delete"what are your thoughts on Dr. William S. Thompson from the CDC coming forward claiming the cdc skewed the results to cover the link between vaccinations and autism."
The CDC addressed that issue here: http://www.cdc.gov/vaccinesafety/Concerns/Autism/cdc2004pediatrics.html
As I recall from my reading on that subject, Brian Hooker did not tell Dr. Thompson that he was recording their conversations. I don't know where Hooker interviewed Dr. Thompson but, in Washington State, recording a conversation without the consent of both parties is a crime. At the very least, it was morally reprehensible. The journal that published Hooker's analysis of the data in question quickly withdrew it because of "concerns about the validity of the methods and statistical analysis."
http://www.translationalneurodegeneration.com/content/3/1/22
http://www.snopes.com/medical/disease/cdcwhistleblower.asp
"what is your thoughts an the adjuvants and preservatives added to the vaccines (like thymerisol, msg, aluminum ...etc) effects"
I plan to write a post on immune responses to vaccines that will include a discussion on adjuvants. I wrote a post on thimerosal three years ago: http://fullyvaccinated.blogspot.com/2012/01/everything-you-need-to-know-about.html
As for other preservatives, I am not aware of any evidence that suggests that the small amount present in some vaccines is sufficient to cause harm to recipients who do not have hypersensitivity reactions to those components.
"and many news agencies report that high level gov around the world receive "clean vaccines"."
I have not heard those reports and don't know what you mean by "clean vaccines."
"Also because vaccinated persons can and do spread the strain they've been injected with,"
That's not true. Recipients of oral polio vaccine and rotavirus vaccine transiently shed vaccine virus in stool. Oral polio vaccine is no longer used in the U.S. and I am not aware of a contact of a rotavirus vaccine recipient developing illness as the result of transmission of vaccine virus.
http://fullyvaccinated.blogspot.com/2013/01/polio.html
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5802a1.htm
There is no evidence of measles vaccine virus transmission from MMR recipients and no evidence that contacts of MMR recipients have developed illness from measles, mumps, or rubella vaccine viruses. In fact, the Advisory Committee on Immunization Practices recommends MMR for household contacts of immunocompromised individuals.
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr6204a1.htm
"should vaccinated people be quarantined for a period of time."
No, that's completely unnecessary.
"and with events like the polio vaccine being contaminated with cancer causing sv-40,"
That occurred in the mid 1950s through the early 1960s. It's likely that I received polio vaccine that was contaminated with SV40 and I'm not the least bit concerned about it. Current technology makes if highly unlikely that a viral contaminant in a vaccine would go undetected.
https://www.iom.edu/Reports/2002/Immunization-Safety-Review-SV40-Contamination-of-Polio-Vaccine-and-Cancer.aspx
"why should we trust these companies?"
I am not an apologist for the pharmaceutical industry. Personally, I am disappointed that the industry doesn't seem to be putting much effort into developing more effective influenza and pertussis vaccines. Pharmaceutical companies are not charitable organizations and, if there's no profit motive, there's not much incentive to invest in vaccine research and development.
"what about vaccines suppressing cellular immunity."
Do you mean cell-mediated immunity? Can you give me an example of what you mean?
If you want to make a difference then get involved. Contact your State representatives and voice your opinion. Ideas not coupled with action never become bigger than the brain cells they occupied.
ReplyDeleteI wrote a personal letter voicing my opinion on the subject and sent it to our representatives for consideration. I also phoned their offices. I can only hope my letter isn't sitting in an inbox buried under a hundred others or filtered out as spam.
Along with my letter I sent additional information on the subject, a list of references and an article from Vaccine Choice Canada "A Case Against Immunizations." I would like to share that information with this forum if it's welcome. Please tell me how I can do that. Thank you for your consideration.
Megan,
DeleteI'm glad to hear that you contacted your state representatives about HB 2009.
I started this blog to inform parents about vaccine-preventable diseases and address their concerns about vaccine safety and effectiveness.
I realize that my position on HB 2009 is in conflict with other people's values and beliefs. Although it was not my intention to attract attention, this entry has generated a lot of traffic to my blog and I'm grateful for that. I'm happy to discuss issues with people who disagree with me.
Although I encourage my readers to reference their sources of information, this is not a forum for sharing information from outside sources. I have neither the time nor the interest to write a critique of an article that was published in the Journal of the American Institute of Homeopathy over 30 years ago (if you're interested, I would be willing to offer my critique of homeopathy).
If you have specific concerns about vaccine safety or effectiveness, please feel free to post them here or in response to any of my other blog entries.
Respectfully,
Matthew
Does anybody know the status of this bill?
ReplyDeleteI had heard last week that the bill was dead in the water.
Delete"An effort to remove personal or philosophical opposition to vaccines as an authorized exemption from childhood school immunizations died in the House after failing to come up for a vote before a key deadline."
http://www.komonews.com/news/local/Immunization-bill-dies-at-cut-ff-295999481.html
That's unfortunate, but not surprising.
The Disneyland measles outbreak called the public's attention to our vulnerability to measles outbreaks. Given the increasing number of cases seen in the U.S. over the last couple of years, I suspect this won't be the last time.
As I said above, I had been conflicted about this bill. A number of my colleagues were not comfortable with HB 2009. There are other options other than removing personal belief exemptions that are used by other states to reduce the number of students with non-medical exemptions. We'll also watch California Senate Bill 277, which is similar to HB 2009.
This post has received more "hits" than any I have published in the last three years. I didn't write it to stir up controversy. It started out as a summary I was writing for the health department. I wrote it out of a deep concern I have that we will have an explosive measles outbreak in Pierce County.
I'm grateful for the web traffic to my blog. People who have responded have been respectful.
I thank everyone who has taken the time to read my posts.