July | August 2017

States Take a Shot at Vaccine Opt-Outs

Washington Sen. Karen Keiser tried for years to strengthen the requirements that allow parents to opt their children out of immunizations.
A vocal group of opposition stalled her efforts. Things changed when lawmakers considered her bill, Senate Bill 5005, this year.
“We had two people die from whooping cough last year, for heaven’s sake. Totally preventable,” Keiser said. “The current practice (of exemption allowance) has been so convenient for parents that it was just easy for individuals to not get their children immunized.”
The law, which took effect in July, requires parents to talk with their pediatrician about the risks of not immunizing their children before they could get an exemption for medical, philosophical or religious reasons.
Washington’s rate of immunization exemptions has steadily been rising, and in June, a Centers for Disease Control and Prevention report confirmed the state had the country’s highest immunization exemption rate for kindergartners. More than 5,000 children—a full 6.2 percent of kindergarten students—lacked the immunizations the state requires for new students.
“It’s just a real alarming trend,” said Keiser.

Opting Out

In some cases, parents’ religious affiliation—such as Christian Scientists—prompt them to seek an exemption. In other cases, it’s misinformation, such as the now-discredited stories of a link between immunizations and autism.
Dr. Andrew Wakefield of Great Britain, in a 1998 paper, linked the MMR—measles, mumps and rubella—vaccine to autism. That paper, published in The Lancet, a well-respected British medical journal, garnered a lot of attention. But in January 2010, the General Medical Council ruled Wakefield had committed “serious professional misconduct” for inappropriate actions related to the study and banned him from practicing medicine. The Lancet officially retracted that study from publication.
But Wakefield’s misinformation lives on. Michael Weinstein, director of communications for the New Jersey Chapter of the American Academy of Pediatrics, said the link is “lessening but is still part of the dialogue.”
Keiser said Wakefield “did terrible damage.”
She said many people still use that reasoning to prevent immunization of their children.
“People who are really convinced of their point of view will go online somewhere on the Internet to find information that supports their point of view,” she said. “People don’t believe science anymore.”
In the U.S., the National Institute of Medicine reviewed the extensive available research and concluded in 2004 a link between autism and vaccines did not exist.
Now immunization opponents are finding other reasons to support exemptions.
“They are shifting to public rights—‘can the government tell us to do this?’” Weinstein said of the opposition.
New Jersey lawmakers are considering two bills addressing vaccination exemptions for children. One makes exemptions stricter and the other would make it easier for parents to skip their child’s vaccinations.
In March, a Senate committee passed Senate Bill 2625, sponsored by Sen. Loretta Weinberg. The bill would establish stricter guidelines for parents to obtain a religious exemption. It requires parents to submit a letter to their child’s school explaining how the state’s vaccine requirements conflict with the “bona fide religious tenets or practices of the student.” Weinstein expects legislators to pick up the dialogue on the bill in November.
The other bill under consideration, Assembly Bill 243, would create a conscientious objection to vaccination. New Jersey only allows exemptions for medical or religious reasons. The bill has been in the hopper for seven years and finally got a hearing this spring. Assembly Health and Senior Services Chair Herb Conaway, a medical doctor, refused to hold a vote on the bill after powerful testimony from pediatrician Dr. Jeanne Craft, who has treated children with vaccine-preventable diseases.

Importance of Immunizations

Vaccinations protect individuals from acquiring a disease, but also prevent them from transmitting the disease to others who may not be able to be vaccinated. This so-called “herd immunity” protects the entire community. But experts say this group protection is only effective if immunization rates are at or above a certain level.
That specific rate can change according to the disease. For example, diphtheria requires 85 percent of the population to be vaccinated, while pertussis and measles vaccination rates must approach 94 percent before herd immunity becomes effective. A high rate of exemption among children can become a public health threat, experts say.
“It’s really scary, because people become ill-informed and they risk not only their children’s health but also the health of other children,” said Keiser.
Consider this: In October, a 6-week-old California child died of whooping cough. It was the 10th child to die last year in a resurgence of whooping cough in California. According to the CDC, nearly 10,000 cases of pertussis, commonly called whooping cough, were reported in California in 2010, the highest number of cases in 65 years.
The infants who died from whooping cough were too young to have received their vaccinations, but experts point to these episodes as examples of how herd immunity might work to protect everyone in a community. Unimmunized children can pass on the disease to those too young to receive the immunizations. The same is true of adults. For this reason, CDC is now recommending adults who are around very young children receive a whooping cough booster.
In the measles outbreaks in the early part of this year, 105 of the 118 people who came down with the disease were unvaccinated. That included 24 children whose parents claimed a religious or personal exemption and six adults who declined vaccination because of philosophical objections to vaccination.