Thursday, February 21, 2013

Oregon Looks to Educate, Improve Public Health

A couple weeks ago, I wrote about two bills introduced in Vermont aimed at improving public health through modifications of the state's religious and philosophical exemption laws. One, H.114, would remove non-medical exemptions for the pertussis vaccine, since Vermont had the second highest incidence of pertussis in the entire nation in 2012. The other bill, H.138, would only suspend non-medical exemptions on a vaccine- and school-specific basis if uptake for the vaccine at the school drops below 90%. Once uptakes improve to 90% or more, non-medical exemptions will once more be allowed.

Now it's Oregon's turn to work on boosting public health.

The Oregon state senate has introduced a bill, Senate Bill 132 (html version here, PDF version here), the aims to improve public health through education and information. Following the lead of their neighbors, California and Washington, SB132 looks to alter current exemption laws to increase parent education regarding vaccines. The state currently allows medical and religious exemptions (no philosophical or personal belief exemptions). While the medical exemptions will remain unchanged, there are a couple of alterations to the religious exemptions.

The way things work right now, parents wishing to opt out of immunizing their child for non-medical reasons simply need to sign a statement that "the child is being reared as an adherent to a religion the teachings of which are opposed to such immunization". That's it. The law does not require any additional documentation or substantiation, nor do the parents need to demonstrate that they understand what their decision means. This has led to Oregon having on average a 6-8% non-medical opt-out rate, with some schools having over 75% of children exempted. Curry and Coos counties are the two worst for average non-medical exemption rates, at 12% and 8% respectively. Montessori schools, not surprisingly, are among the biggest offenders. I predict, and I sincerely hope I'm wrong about this, that we will see outbreaks of measles in Oregon this year unless things really change.

SB132 should correct that, if passed quickly. This bill replaces the religious exemption section with the following:
(c)A  statement,  on  a  form  prescribed  by  the authority by rule and signed by the parent, that the parent is declining  one  or  more  immunizations on behalf of the child. The form on which the statement is submitted must contain one of the following:
(A)  A  signature  from  a practitioner of the healing arts verifying that information about the risks and benefits of immunization has been provided to the parent; or
(B)  A certificate that verifies the parent’s completion of a vaccine educational module offered on the Internet and approved by the authority pursuant to rules adopted under ORS 433.273.
This accomplishes a couple different things. First, before the die-hard anti-vaccine types get all in a tizzy, it does not eliminate exemptions for non-medical reasons. In fact, if my reading is correct, it expands them beyond religious beliefs to all personal beliefs. It doesn't appear that a reason even needs to be given. So this bill will not take away anyone's rights, though I expect anti-vaccine advocates to claim it will.

Second, this will ensure that parents are educated about vaccines, which presumably will include information about how their decision affects not only their child, but the public, as well. This education can come from either a "practitioner of the healing arts" (similar to California's law) or through completing an online module.

While overall I think this bill is a step in the right direction, I do have a couple reservations. The text should be amended to include information on the impact of not vaccinating to clause (A) above. Also, there is potential for people to game the system using the online module. Care must be taken to ensure that a person can't simply click quickly through the module without demonstrating they understand the material. The Oregon Health Authority should include some manner of assessment of understanding at the end of the module.

The bill is currently in committee. I strongly urge any of my readers in Oregon to share this information and contact your legislators to support SB132. You can find your legislators here. There is also a list of committee members here.

Let your voice be heard. Speak out in support of public health, because you can be certain those opposed to vaccines will be vocal.

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