Friday, June 1, 2012

Mostly Good News from Vermont

Back in March, I wrote about how Vermont was moving toward improved public health by putting forth a bill that, if passed,would eliminate philosophical exemptions from school and daycare immunization requirements, while still leaving religious and medical exemptions intact. After a considerable amount of going back and forth, in committee, out of committee, to the House, back to the Senate and so on, Senate bill S.199 was signed into law on May 16, 2012.

As with all things legal and political, there are positive aspects of the enacted law (PDF) as well as some negatives. The big negative, from my perspective, is that philosophical exemptions are still allowed in Vermont. But not all is doom and gloom. The various revisions the bill underwent added significantly to the school immunization laws, going beyond the simple issue of exemptions.

So, what all has changed?

Let's start with the exemptions. There were some minor clarifications regarding just who could sign off on medical exemptions. Specifically, not only must it be a physician licensed in Vermont, but the physician will now also be required to be authorized to prescribe vaccines. This measure seems like it will tighten up the medical exemption a little bit, so that, for example, a chiropractor would not be able to sign off on the exemption.

With regard to religious and philosophical exemptions, parents can, as I mentioned, still get them. But whereas before they merely needed to state their objections in writing and that was that, now parents will be required to submit to the school or day care, every year, a signed statement created by the Vermont department of health. This statement includes a number of elements, indicating that the parent or guardian:
(A) holds religious beliefs or philosophical convictions opposed to immunization;
(B) has reviewed and understands evidence-based educational material provided by the department of health regarding immunizations, including information about the risks of adverse reactions to immunization;
(C) understands that failure to complete the required vaccination schedule increases risk to the person and others of contracting or carrying a vaccine-preventable infectious disease; and
(D) understands that there are persons with special health needs attending schools and child care facilities who are unable to be vaccinated or who are at heightened risk of contracting a vaccine-preventable communicable disease and for whom such a disease could be life-threatening.
Sections B, C and D are all new. So, while the law is not quite what advocates of public health might have hoped, it at least ensures that parents attest to understanding that their religious or philosophical decision has effects beyond their own family.

There were a number of additional elements added to the law. For example, schools will now be required to annually publish aggregate total immunization rates. This would allow parents to see how their school is doing in terms of coverage and whether it is a good idea to keep their kid in that school or not. Coupled with this is the creation of a working group that will examine how best to protect those students who are especially vulnerable to communicable diseases (e.g., by allowing them to enroll in adjoining school districts that have higher vaccine uptake rates than their home district), as well as the feasibility of requiring adults working in schools and day care settings to be properly immunized to protect these students. Their report is due January 1, 2013.

A couple other additions are that the Vermont department of health will be required to report to CDC the school immunization rates for 1st and 8th grades, as well as the number of medical, religious and philosophical exemptions for each required vaccine. The law also extends a pilot program that provides free vaccines to all students. Originally set to expire at the end of this year, it will now run through December 31, 2014.

The new law will take effect July 1, 2012.

While not what I had hoped for, this law has a lot of good stuff in it. My guess is that philosophical exemptions were left in to placate the vocal anti-vaccine minority. Adding the statement of understanding is a step forward, though it does not go quite far enough (e.g., it is not admissible as evidence in any civil court setting). A parent could simply sign the statement, despite having no true understanding of the risks to others as a result of their decision. Ah well, baby steps, I suppose.


  1. Parents of vulnerable children should not have to be the ones to seek other schooling alternatives. Besides, changing schools is not always an option. Legally, religious and philosophical exemptions don't even have to be offered but if lip service wants to be provided by credulous legislators then why not put a cap on how many exemptions/school can be allowed? It's a reasonable compromise.

  2. The decision of whether or not to transfer a vulnerable student to a neighboring district should be up to the parent. However, I don't see why the home district couldn't inform the parents of the current immunization level and neighboring districts' levels, then handle the paperwork and arrange transportation if the parents decide to do the transfer, provided the home districts immunization rates are a) lower than what is required for herd immunity and b) lower than neighboring districts.

    I agree with your statement about no legal need for religious or philosophical exemptions and am frankly of the opinion that they should not be available in any state (though I know that will never happen, unless all of the objectors decide to suddenly emigrate to Ecuador or something). Putting a cap on the number of non-medical exemptions is an intriguing idea. In order to maintain herd immunity, exemptions would be allowed on a first-come, first-served basis up to X% of the total student population. Two ways to implement it: straight, across-the board percentage; or, different percentages allowed depending on the vaccine (e.g., 95% uptake is about the level needed for measles herd immunity, while lower thresholds are acceptable for some other diseases). Interesting idea.

  3. I understand where you are coming from Todd but in reality, most schools are operating above capacity so transfers are rarely optional and slots available only for special circumstances like keeping a child in a school for their last year even though s/he moves out of the district. I suppose it could work for children who have a serious medical condition for which illness could be critical but it's a shame to place that burden on the parents you know? A flat cap on exemptions would solve the problem in my estimation. Medical exemptions would have to factor into that first as they should get preference and once those are accounted for, allow the remaining percentage to the special snowflakes. And bonus, places the burden on the non-vaccinating parents to find another school to accept them.


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