Poking a Wasp Nest

A couple weeks ago, I wrote about two bills that had been introduced in the Vermont House of Representatives, H.114 and H.138, that would improve public health by tightening up religious and philosophical exemptions in public schools and, in the case of H.114, child care facilities. The first bill was introduced as a result of the pertussis epidemics going around the country, with Vermont being the second-hardest hit in 2012, with 100.4 cases per 100,000 people, roughly 7.5 times the national average of 13.4 cases per 100,000 people. This outbreak was driven by several potential factors: waning immunity in teens (necessitating an additional booster), possible mutations in the bacteria (rendering the vaccine less effective), pockets of low vaccine uptake (e.g, a 13.16% overall opt-out for philosophical reasons among kindergarteners [Excel file] in Vermont private schools in the 2011-2012 school year, and a 9.73% opt-out among middle schoolers), and adults whose immunity had waned (nationally, adults have historically had poor pertussis vaccine uptake). The second bill focuses on keeping herd immunity at necessary levels within public schools, by implementing temporary bans on religious and philosophical exemptions on a vaccine- and school-specific basis when immunization rates fall below 90%.

As I mentioned in my previous post, both bills face an uphill battle. Some legislators, like Rep. Mike Fisher, chair of the House Committee on Health Care, and gubernatorial appointees, like Health Commissioner Harry Chen, seem not to want to deal with the headaches that come part-and-parcel with the topics of immunizations and exemptions. Last year, they got an earful from individuals opposed to vaccines, resulting in the blunting of a bill that took a small step toward improved public health. This year does not look to be much different, as the same people, the Vermont Coalition for Vaccine Choice, are once again rallying their forces to lobby legislators to oppose these bills.

Vermont Rolls Up Its Sleeves Again

Last year, Vermont legislators debated a bill that tried to eliminate religious and philosophical exemptions from school immunizations. It was rather hotly contested, with anti-vaccine activists up in arms and the misnamed National Vaccine Information Center urging people to write to their state congresscritters to oppose the bill. In the end, a sort of compromise was reached. The bill was signed into law, but with rather significant revisions. Parents in Vermont can still get a religious or philosophical exemption for their child, but they must sign a statement indicating that they have reviewed the educational material provided to them and that they understand that their decision increases the risk of disease for their child and those around them, including children with special health needs in the child's school who may suffer serious complications if infected. It's one of the more strongly worded laws requiring education before an exemption is granted. It would have been better if the law had passed as originally written, but baby steps.

Well, it looks like the sponsor of that bill is back in action this year. Rep. George Till (D-Chittenden) and others have introduced two new bills (H.114, full text available here, and H.138, full text here) that are more narrowly focused. While still addressing the concerns of religious and philosophical exemptions, the bills focus on pertussis immunization and individual schools, respectively.

Parents' School Vaccination Lawsuit in WV Dismissed

This year has seen quite a bit of anti-vaccine sabre rattling when it comes to state laws and rules around school vaccinations. We saw Vermont trying to strengthen public health by eliminating philosophical exemptions, which was met by a fact-challenged tirade from a homeopath. That aspect failed, but requirements were put into place that parents review educational materials and attest to understanding the risks their decisions have not only for their kids, but for the community at large. In California, a bill was introduced requiring that parents get a signed statement from a health care provider indicating that the provider discussed the risks and benefits of vaccination (and vaccine refusal) with parents before a philosophical exemption will be granted. That bill was signed into law, despite anti-vaccine activists erroneously claiming that it violated and removed parental choice, revealing that they really are not in favor of informed consent. There had also been another bill that California Gov. Jerry Brown vetoed that would have required clinic employees to get the flu vaccine or take other reasonable precautions to minimize the risks of influenza in a health care setting. That bill (SB1318) is back with the Senate for consideration of the governor's veto.

And then there was the activity in West Virginia back in August. When I was launching my series of Vaccine Preventable Disease Wanted Posters, I mentioned in passing that a group of parents were suing the West Virginia Department of Health and Human Services (DHHS) over a new requirement that 7th graders and high school seniors get a Tdap booster and meningococcal vaccine. Well, there's been a new development with that.

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?

Quick Legislative Update: Vermont and California

I just wanted to give my readers a quick update on where things stand with vaccine exemption-related legislation in Vermont and California. If you'll recall, Vermont's Senate passed a bill that would remove philosophical exemptions from school immunization requirements (leaving in place religious exemptions). California introduced a bill that would require parents in that state to get a written, signed form from a physician, surgeon, nurse practitioner or physician assistant stating that the health care provider gave the parent information about the risks and benefits of vaccines before a philosophical exemption from school immunization requirements will be granted.

The Vermont bill (S.199) was referred to the state's House of Representatives (H.527), where it is currently in committee. I urge any of my readers in Vermont to contact their representatives and ask them to support this bill.

The California bill (AB 2109) is also currently in committee. As with my Vermont readers, I would ask any of my readers in California to please ask your assembly member to support this bill.

Vermont Steps Toward Improved Public Health

Vaccination requirements for entry to day care programs and schools tend to be a bit of a touchy subject among those who, for one reason or another, are opposed to immunization. They tend to view such requirements as violations of their personal rights, all the while ignoring the rights of their own children, to say nothing of the rights of the other people around them, to not be infected with diseases that can be quite serious. As I recently wrote, the state of Alaska Section on Epidemiology came out with several recommendations following a chicken pox outbreak at a day care facility, which started after an unimmunized child infected their infant sibling who attended the day care. In my post, I suggested that the recommendations did not quite go far enough, arguing that philosophical or religious exemptions should require speaking to a physician before being granted. Personally, I don't think that there should be exemptions for anything other than legitimate medical reasons, but that's a topic for another post. In the meantime, requiring discussion with a medical professional seems, to me, to be a reasonable compromise for the time being.

The issue of philosophical exemptions came up last summer, as the Massachusetts state legislature considered a proposal to add philosophical exemptions to that state's immunization laws. It's a proposal that pops up just about every year in Massachusetts and is consistently, and, in my opinion, correctly shot down. Well, it looks like the state's neighbor to the north, Vermont, is considering making its laws similar to those of Massachusetts. A bill was recently passed by the Vermont state Senate, in a vote of 25-4, to remove philosophical objections as a reason to forego immunization, leaving only medical and religious exemptions. As the bill goes to the House for consideration, there is, not surprisingly, a vocal few who see the legislation as a Bad Thing^TM.

Take, for example, Charlotte Gilruth, who wrote in to the Barre-Montpelier Times Argus with her opinion in a letter titled "'Herd immunity' is misleading". From the second sentence, her letter is a treasure trove of errors and misinformation. Before I delve into it, go ahead and click on her name above to read her thoughts. See how many mistakes you can find.