“Hear This Well” anti-vaccine group misrepresents Colorado legislation

This article, about the anti-vaccine group, Hear This Well, was written by Dorit Rubinstein Reiss, Professor of Law at the University of California Hastings College of the Law (San Francisco, CA), who is a frequent contributor to this and many other blogs, providing in-depth, and intellectually stimulating, articles about vaccines, medical issues, social policy, and the law.

Professor Reiss writes extensively in law journals about the social and legal policies of vaccination. Additionally, Reiss is also a member of the Parent Advisory Board of Voices for Vaccines, a parent-led organization that supports and advocates for on-time vaccination and the reduction of vaccine-preventable disease.

It is not uncommon for anti-vaccine activists, like the Hear This Well group, to misrepresent pending legislation or passed legislation. Striking examples included anti-vaccine activists claiming that SB276, the California law that added a review of medical exemptions, would remove all medical exemptions.

Similarly, these activists proposed a proposition to undo Maine’s law removing the non-medical exemption from school immunization mandates. Opponents, apparently, misrepresented the bill to people, to the extent that some signed thinking they were supporting vaccine mandates

In California, as well, when opponents tried to put SB277 on the ballot, they misrepresented the law by trying to claim it mandated HPV vaccines, which was untrue.

It’s not clear whether the misrepresentations, at least in some of these cases, were out of intentional dishonesty or lack of understanding of the laws or bills in question. The results were the same – misrepresenting the law to others.

Following that tradition, in two posts addressing a newly proposed bill in Colorado, the anti-vaccine page Hear This Well misrepresented the new bill, sometimes just by using hyperbolic, misleading language and sometimes by making clearly incorrect statements.

Whether this was due to misunderstanding of the bill or intentional misrepresentation is impossible to tell, but at any rate, this could lead to people opposing the bill for incorrect reasons or because of misrepresentation.

Photo by Kait Herzog on Unsplash

What does the bill actually do?

The proposed bill – SB163 – does a number of things (obviously, it can change as it goes through the legislative process): 

  1. It combines the religious and personal belief exemption into one category, “nonmedical exemption”, and adds a requirement that to get a non-medical exemption, people must either –
    1. Complete an online educational module about vaccines. Or:
    2. Submit a form signed by a person authorized to administer vaccines.
  2. It creates an aspirational vaccine-protected standard that schools can be measured by, under which each school should aspire to have 95% rates of immunization.
  3. It orders the department to create a standardized exemption form.
  4. It requires schools to proactively inform parents of the exemption rate in the school.
  5. It orders the Department of Public Health and the Environment to evaluate immunization practices each year according to national best practices and recommendations and make a decision about whether (or not) to update Colorado’s school-entry schedule.

All in all, it’s a moderate, carefully-written bill, which does not remove the non-medical exemption, does add some requirements for getting it, but certainly nothing burdensome, and streamlines and standardizes the process. (For a nice summary, see here.)

Photo by Holly Mandarich on Unsplash.

What does Hear This Well present?

In its first post about the bill, Hear This Well stated

Colorado! It’s time to kick some ass again! Murse [sic; I’m not sure if this is a typo or an intentional insult] Mullica has filed his vaccine bill to once again attempt to remove your religious and philosophical rights to bodily autonomy.

While that’s obvious hyperbole, it already misrepresents the bill and its contents. First, the bill does not even remove non-medical exemptions. It just adds an educational requirement. So where is the intervention in any kind of autonomy, if autonomy means not having consequences if you don’t vaccinate?

Second, even strong school mandates don’t force parents to vaccinate. They do impose a consequence if you don’t vaccinate, but even if they were directed at the parents’ bodies and not the children, they wouldn’t be directly interfering in bodily autonomy.

Finally, the bill is about childhood immunization. It does not affect parents’ bodily autonomy, and the children involved don’t have a choice here. Since it seems to need saying, let me say it clearly: parents do not have bodily autonomy in their children.

Photo by Ben Sweet on Unsplash.

Children’s bodies are separate, independent, and the rights parents have over them are not the same as bodily autonomy – for example, parents cannot consent to sex for their five-year-old, and their rights to refuse life-saving treatment (like insulin for diabetics) can be limited by courts.

The right actually affected is parental autonomy to make medical decisions, not bodily autonomy – but that’s a weaker right – the speaker reaches for bodily autonomy because that’s a very strong right. But it’s not applicable here.

So the opening is hyperbolic and misleading.

The post then says that the bill:

Limits what used to be your religious exemption to the TEACHINGS of a religion, rather than your religious beliefs.

That’s not actually true. The bill includes the existing religious and personal beliefs in one non-medical exemption (as the post correctly mentions in the next paragraph), and describes it thus:

“nonmedical exemption” to mean an immunization exemption based upon a religious belief whose teachings are opposed to immunizations or a personal belief that is opposed to immunizations.”

But it does not actually change their separate definitions from existing law. The current statutory language on this is:

By submitting to the student’s school a statement of exemption signed by one parent or guardian or the emancipated student or student eighteen years of age or older that the parent, guardian, or student is an adherent to a religious belief whose teachings are opposed to immunizations or that the parent or guardian or the emancipated student or student eighteen years of age or older has a personal belief that is opposed to immunizations.

Suggesting that this language changes the law suggests, at best, that Hear This Well lacks familiarity with the existing language of the law, or, at worse, intentional misrepresentation (I would suspect, in this case, the former). And this previous language, by allowing both a belief based on the teaching of (personal) religious beliefs and any personal belief, is very broad and has been treated that way.

hear this well
Photo by Holly Mandarich on Unsplash.

The post also says the bill:

Takes your statement of exemption and gives it to the health department, both for a form and for processing. Currently you do not need to involve the health department in your parenting decisions. All exemptions are medical and non-medical. Your relationship with your Creator is gone from the law.

Well, the bill does require the form to be developed by the Department. But the form is to be submitted to the school – the bill says:

A person who wants to claim a nonmedical exemption for an immunization for a religious or personal belief can do so by submitting to the school either…

It does not say to the Department – and this is not a change.

As to “your relationship with your Creator is gone from the law,” it’s unclear how that can be seen as the result of a bill that leaves a religious belief exemption and a personal belief exemption intact. This, too, is an incorrect representation of the bill.

According to Hear This Well:

It would wipe out all current exemptions. Anyone who wants to exercise their religious and philosophical rights must either take an online re-education course or have a doctor give you a certificate allowing you to have rights.

Well, this is a bit hyperbolic, but it’s true that the bill applies to everyone, regardless of whether they had a previous exemption on file. But a previous bill already delegated to the Board of Health the authority to schedule when exemptions must be filed, and for grades K-12, the BOH required parents to submit school exemptions annually (for young infants in the first year, even more frequently). So “wipe out all current” exemptions”, when at least grade school exemptions have to be renewed annually anyway, is misleading.

The state’s vaccine guidelines will be updated every single year. 
The students must be vaccinated according to ACIP recommendations, not what their state has adopted. This means annual flu, hepatitis A, meningitis ACWY, and Gardasil.

That’s not what the bill says. The bill says:

THE DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT SHALL ANNUALLY EVALUATE THE STATE’S IMMUNIZATION PRACTICES, INCLUDING AN EXAMINATION OF UPDATED BEST PRACTICES AND GUIDELINES RECOMMENDED BY THE ADVISORY COMMITTEE ON IMMUNIZATION PRACTICES OF THE CENTERS FOR DISEASE CONTROL AND PREVENTION IN THE FEDERAL DEPARTMENT OF HEALTH AND HUMAN SERVICES. THE STATE BOARD OF HEALTH SHALL REVIEW THE DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT’S ANNUAL EVALUATION AND MAY UPDATE THE STATE’S IMMUNIZATION PRACTICES PURSUANT TO THE DEPARTMENT OF PUBLIC HEALTH AND ENVIRONMENT’S ANNUAL EVALUATION. (Ed. note – it’s in all CAPS because that’s how added text appears in the bill.)

In other words, an annual review is required, but which immunizations are mandated is not dictated – the Department is not bound by ACIP’s recommendations, just has to consider them as part of the picture before it – and again, exemptions are left untouched.

Photo by Adam Rinehart on Unsplash.

The Hear This Well post here, too, misrepresents the bill. The next two parts of the post are kind of right, even if hyperbolic:

It creates a law that EVERY SCHOOL must target 95% of its children being fully vaccinated, despite exemptions being legal. This would be called “The Vaccine-Protected Children Standard. Every school must publish its vaccination rates and DISTRIBUTE THEM to every student and parent.

Yes, well the bill does create an aspirational goal of each school having 95% of its kids protected. It has no penalty for it, but it’s a laudable goal. And it does have to let parents know. Note that under previous law, rates were available on request; this just saves parents the effort of requesting, and makes rates proactively available.

Obviously, Hear This Well thinks that letting parents know the immunization rates of the school they send their children to is a bad thing, but I expect most people would agree parents deserve transparency and information.

What actually bothers me a lot about this requirement is stated in the next line:

Do you see what they’re doing? They’re turning kids on kids. They’re turning school administrations against parents.

The first claim is…strange. Giving aggregate data about school immunization doesn’t name any kids and does not “turn kids against kids”.

The second line assumes school administrators would be so concerned with having high rates that they will target non-vaccinating parents. That’s a tricky assumption.

First, there’s no penalty for having low rates. And if it’s a community with strong vaccine hesitancy, it may not affect the school in any meaningful way. Second, it’s not clear what administrators can do about it. Third, this information already wasn’t secret.

Photo by Sheelah Brennan on Unsplash.

These inaccuracies are also reflected in the talking points the page added in a call to action it put out.

For example, it tries to claim, by pointing to California, that there is a natural progression from adding an educational requirement to removing exemptions.

That’s not what happened in California. After its initial bill, California faced a large measles outbreak. That was what led to the removal of exemptions. Not the previous bill.

The view that removing exemptions will be easy or feasible in Colorado, given the legislative history, is unfounded. And the current governor made it clear he is opposed to it. So this is an attempt to distract from the reality of the current bill by making the fight about another bill that is not on the table – currently, an imaginary bill.

And honestly, if Colorado faces a crisis (for example, a large outbreak of vaccine-preventable diseases, or a diphtheria death) that leads the legislature to consider removing exemptions, it likely won’t matter either way if an educational requirement was passed first. There was no such requirement in Maine or New York, two other states that removed their non-medical exemptions.

Similarly, the talking points claim that:

It will be all but automatic that children must additionally receive an annual flu vaccine, hepatitis A, meningitis ACWY, and two and three doses of Gardasil to attend school. When they come back to remove all exemptions in a year or two, children will be kicked out of school if their parents refused to vaccinate them with two of the most dangerous vaccines on the market.

But that’s not true.

First, the bill does not tell the Department of Health to add all ACIP (Advisory Committee on Immunization Practices) recommended vaccines, and there’s no good ground to think it will go there. California’s Department of Health has similar powers, and added no vaccines beyond what the legislature added (it did add an additional dose of Tdap, where DTaP was already required, and the second dose of varicella – but no new vaccines).

There are other considerations in mandating a vaccine to school besides ACIP’s recommendations. And again, the bill is not removing any exemptions – the post’s talking points are about a future imaginary situation, not the current bill.

Then the talking points post include this statement, which is beyond inaccurate:

Once exemptions are removed, and they will be, the system will be used to track children down when they’re missing one vaccine and the health department will come knocking at their door. We’ve seen this in New York City already when the mayor declared that Jewish zip codes had to vaccinate children under 12 months with the MMR.

Where to start? First, again, the talking point does not address the current bill but an imaginary future in which exemptions will be removed.

Second, the post misrepresents the situation in New York. New York was not reacting to the removal of exemptions. In fact, the emergency measure in question was before the repeal of its religious exemption, and was a response to a measles outbreak, and targeted not Jewish communities generally, but the communities in the heart of the outbreak.

Further, the measure was not tracking down people and knocking on their doors; instead, it instituted a fine for families whose children were unvaccinated, in the middle of an outbreak that centered on unvaccinated children and put hundreds of them in the hospital. 

Nobody knocked on doors; instead, people got summoned to a hearing where a fine could be imposed. 

This talking point grossly misrepresents the New York situation and uses that misrepresentation to create a hypothetical scenario that has nothing to do with the current bill.

We can hope that legislators would realize that this extreme claim is not a good argument against this moderate bill. And the need to go to this extreme suggests the speaker does not have any good arguments against the actual bill.

The last talking point again takes issue with the requirement of providing parents accurate information about their school immunization rates. Again, the post uses hyperbolic language, claiming:

This bill turns classmates against classmates, parents against parents, and schools against families. Burdening schools with the task of having 95% full compliance in a state that allows three types of exemptions is ludicrous. Directing the schools to print out their compliance statistics and disseminating them to parents and students is akin to putting hundreds of warriors in a ring and demanding that they fight to the death. THIS IS NOT WHAT SCHOOL IS FOR.

This, again, is not a good description of what the bill does. Providing an aggregate rate does not target any children in the school, and names no one.

If the speaker really thinks a substantial number of parents would be that upset and angry to learn their school has low immunization rates (and assumes the parents are already not aware), then the author is acknowledging parents are concerned about non-vaccinating; in which case, they deserve to know if their school has a problem.

hear thisi well
Photo by Tim Dohrman on Unsplash.

If the only thing that prevents parents from speaking up about vaccines rates in their school is that they are kept in ignorance about the problem, and the only way for the speaker to prevent pushback is to keep parents ignorant, they have a deeper problem. And they can no longer pretend to speak for informing parents or for choice when they want to deny parents this information and choice.

Of course, chances are most parents in a school with low rates are already aware of the rates and the aspirational standard would do little to change relationships. If they’re not aware of their rates, well, they deserve to know.

In short, the posts by Hear This Well misrepresent the current bill and are not good arguments against it.

 

Dorit Rubinstein Reiss
This article is by Dorit Rubinstein Reiss, Professor of Law at the University of California Hastings College of the Law (San Francisco, CA), is a frequent contributor to this and many other blogs, providing in-depth, and intellectually stimulating, articles about vaccines, medical issues, social policy and the law. 

Professor Reiss writes extensively in law journals about the social and legal policies of vaccination. Additionally, Reiss is also member of the Parent Advisory Board of Voices for Vaccines, a parent-led organization that supports and advocates for on-time vaccination and the reduction of vaccine-preventable disease.