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State legislatures making vaccine exemptions more difficult to obtain

Outstanding news. Tara Haelle reported in Nature News & Comment that US state legislatures are beginning to pass laws that make it more difficult for parents to obtain so-called personal exemptions to vaccinations before children attend public schools.

According to Haelle, “Each US state sets its own vaccination policies, and most will not generally allow children to attend public school unless they have been vaccinated against diphtheria, tetanus and pertussis (whooping cough); hepatitis B; the Haemophilus influenzae bacterium; measles, mumps and rubella; polio; and varicella (chicken pox).” In general, most states require that students meet the Centers for Disease Control and Prevention schedule (pdf) for children between 0 and 6 years old, which is set by the Advisory Committee on Immunization Practices.

All states allow legitimate medical exemptions from the immunization schedule, because of certain medical conditions that might make vaccinations problematic for young children. Some of these medical issues are: allergies to some of the components in the vaccines, immunocompromised conditions, family history of seizures, and other issues outlined in the General Recommendations on Immunization of the Advisory Committee on Immunization Practices.

What has become more troubling are the “personal exemptions”, which has become a legal loophole through which anti-vaccinationatists have walked with hardly any difficulty. Again, according to Haelle, “20 states — including California, Washington and Vermont — allow exemptions for personal or philosophical belief, and 48 offer religious exemptions. But exemption rates are growing. In Washington, 6% of children entering kindergarten in 2010–11 had an exemption; in Vermont, the figure was 6.2%, compared with the US average of 1.5%. In California, exemptions rates rose by 25% between 2008 and 2010.” Many of these personal exemptions require nothing more than simply filling out a form and signing it without discussing the exemption with a medical professional.

With the increased ease of these exemptions and a concomitant increase in rates of exemptions, there has been a recent rise in outbreaks in vaccine preventable diseases, like the largest whooping cough (Bordetella pertussis)outbreak in the USA for the past 70 years, and the pendulum began to move against easy personal exemptions. Haelle wrote in Nature:

California has tightened the laws that allow parents in the state to opt out of immunization for their children. It now joins Washington and Vermont in requiring parents who want an exemption to demonstrate that they have received factual information about the risks and benefits of vaccination from a health-care practitioner or the state’s health department.

New Jersey is also considering a bill to strengthen exemption requirements, and similar legislation in Arizona has died in previous legislative sessions, but may be re-introduced next year. The issue is not a partisan one: bills have sponsors in both parties. And it has been recognized outside the medical community — although the California sponsor, Richard Pan (Democrat), is a paediatrician, most of the legislators have no medical background.

To increase vaccination rates, law-makers want to make it harder to get an exemption than it is to get a vaccination. “One of the instigators for our laws was the thought that many parents were exempting for convenience,” said Michele Roberts, communications manager for the Washington Department of Public Health. “It was easier to sign the exemption form than to track down records or to get your kid to an appointment.”

Studies seem to support that the existence of exemptions, along with the ease of obtaining them, leads to reduced vaccinations rates and then to an increased incidence of vaccine preventable diseases. Haelle reported that, “Diane Peterson, associate director for immunization projects at the Immunization Action Coalition in St Paul, Minnesota, said that strengthening existing rules, for example by requiring a doctor’s signature on exemption forms or asking for annual exemption renewals, is more effective than trying to eliminate philosophical exemptions altogether. ‘If you don’t have a personal-belief exemption, you will have abuse of the religious exemption,’ she says.”

Haelle also states that “growing disease rates will also encourage more parents to get their children immunized.” Paul Offit, the archenemy of the antivaccination forces and chief of the division of infectious diseases at the Children’s Hospital of Philadelphia in Pennsylvania, believes that “far more compelled by fear than reason”. My personal observation is quite the opposite. Some of the vaccine denialists now claim that because vaccines aren’t working, maybe we shouldn’t be getting them (of course ignoring all evidence to the contrary).

Recently, I reported that after passing a law that made it more challenging for a parent to get a personal exemption for a vaccination for their children, the exemption rate in Washington state has dropped by 25 percent. But, recently, legislatures in Kansas, Mississippi, West Virginia, Massachusetts and South Dakota have attempted to pass legislation that allowed philosophical exemptions for vaccinations, but weren’t successful. Vermont’s Senate voted to disallow personal exemptions this year, but it failed to clear the Vermont House.

Let me repeat what I’ve written before. I am strongly opposed to ALL personal exemptions to vaccines, and that viewpoint is supported in the United States by the Supreme Court ruling in Jacobson v United States which states that the freedom of the individual must sometimes be subordinated to the common welfare and is subject to the police power of the state. In other words, if vaccine denialists want to use public schools, then they must vaccinate. The common good outweighs personal beliefs, especially if that personal belief is unsupported by facts and evidence. Moreover, since the issue usually involves enrollment in public schools, they can choose to enroll their children in private schools, although those schools tend to have tough standards for vaccinations, because those don’t want their children being exposed to diseases that could be prevented by vaccines.

Furthermore, religious exemptions for vaccines should not exist in a secular country. If you want a religious exemption, then please send your child to a religious school, because a public school is a public institution, and according to the Establishment Clause of the First Amendment of the United States Constitution public schools cannot favor one religious group over another. Or over those who don’t care about religion. In fact, the Jehovah’s Witnesses, who are opposed to almost all medical procedures, are not opposed to vaccinations.

It’s time to stop allowing exemptions, which are nothing more than a cynical method for vaccine denialists to opt out of vaccinating their children, but still putting their children in school, putting other children at risk. If these people don’t care about the health of their children, then they should not be allowed to use public schools. That’s it, simple. No exemptions, except under the most narrow of regulations for medical exemptions. No religious exemptions. No personal exemptions. And very narrow medical exemptions approved by several layers of health care professionals to prevent abuse by the denialists.

Vaccines save lives.

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