I No Longer Oppose Removing Non-Medical Exemptions

Once upon a time, I was against removing personal belief, religious, and non-medical exemptions that are often enshrined in the state laws that require children to receive certain vaccines to attend schools. These exemptions allow parents of under- and un-vaccinated children to send them to school.

I had wanted parents to happily and affirmatively accept vaccines for their children, and thought that by putting more obstacles to exemptions, parents could be given some time to come to the conclusion that vaccines are safe, effective, and necessary.

But time has run out.

In most states, the experiment of allowing parents to opt out of school vaccine requirements is relatively new. Certainly, when I attended school, there was no option to go to school unvaccinated. My Kindergarten Round-Up included swallowing the Oral Polio Vaccine. I am certain some parents in those days did not like vaccines, but that attitude was exceedingly rare.

I’m not going to go into a history of the anti-vaccine movement, but we know that vaccine refusal has become much less rare. And refusing vaccines is even more common in places that make it easy. According to one 2018 study:

[I]n the past decade, the number of philosophical exemptions to vaccination has increased in two-thirds of the states that allow such exemptions. As a result, researchers suggest that these areas are becoming increasingly vulnerable to vaccine-preventable disease outbreaks.

If it were simply a rise in vaccine refusal, though, I still would not have become an advocate of removing the non-medical exemption. I got involved in working on vaccine legislation in Minnesota in 2011, when we were in the midst of a measles outbreak. 2017 saw yet another, larger, measles outbreak. Things have gotten progressively worse:

• In the midst of the outbreak, anti-vaxxers flew out Mark Blaxill for a seminar with the afflicted community on continuing to file vaccine exemptions.
• I have been told stories about the anti-vaxxers hiring students, during the outbreak, to hang “informational” flyers on doors in the neighborhood where measles was spreading.
• I have been told stories about anti-vaxxers going into this neighborhood and telling women that the measles outbreak was fake–a health department trick to get them to vaccinate their children. Appointments to get vaccines were subsequently canceled.
• Anti-vaxxers scheduled the “Vaxxed Bus” to arrive in Minnesota at the end of the outbreak.
• Parents in Minnesota have tried to coordinate measles and chickenpox parties to make their children sick on purpose. Whether or not these parties actually happened, I have no idea.
• Since the outbreak, anti-vaxxers have held “legislator only” events. This year’s featured Robert F. Kennedy, Jr. promoting a conspiracy theory about the Autism Omnibus Proceedings.

In this stew of disease activism, anti-vaxxers are asking for their “rights” to send their unvaccinated children to school be preserved because most parents are still vaccinating. Alternately, they claim their children pose no risk to other children or that herd immunity is fake.

In the meantime, because of anti-vaccine activism across the world, we all saw a 30% spike in measles cases in 2017.  The outbreak of measles in Clark County, Washington has taken attention away from an even larger outbreak in Rockland County, New York. Because measles is our most contagious disease, it is a harbinger of outbreaks of other diseases as vaccine refusal becomes more and more widespread.

Vaccine refusal has real consequences. It makes our communities sicker, and it threatens our classmates and neighbors who cannot be vaccinated or who are medically fragile. We are seeing this threat increase before our eyes. We don’t have the time to wait for parents to change their minds.

Lawmakers need to stop allowing anti-vaccine parents to advocate for their supposed right to rely on everyone else vaccinating in order to stop outbreaks while simultaneously and actively trying to convince parents to stop vaccinating. Their approach is two pronged: let me send my unvaccinated child to school while I work hard to make sure more and more unvaccinated children are going to school.

One pediatrician explained to me that allowing vaccine refusal is much like allowing second-hand smoking. You have the right to smoke, but you don’t have the right to smoke everywhere you want. You also have the right to leave your children unvaccinated. But you do not have the right to bring an unvaccinated child into the place where children are exposed to the most germs and spend the bulk of their day.

And listen–I’m not giving up on convincing parents that vaccinating their children is the best choice. I do still want parents to understand fully the benefits of vaccinating so that they feel good about doing so. This mission is still my primary mission. I want every single one of those children protected from vaccine-preventable diseases.

If we are serious about protecting children, then we really need to bar vaccine refusal at the door to every school. I take no pleasure in asking schools to turn away children, but we have reached a critical point. The anti-vaxxers have forced our hand. We all have to sign on to eliminating non-medical exemptions.

Mandates, Ben Franklin, and Vaccine Injury

On Monday (President’s Day), I flew to Philadelphia to be part of a panel at the Franklin Institute discussing whether or not we should mandate vaccines. The other panelists were Dr. Paul Offit (you may have heard of him) and Dr. David Ropiek. It was an exciting conversation, I learned a ton, and I was grateful to the good people (both for and against mandates) who drove through the evening’s sleet and snow storm to attend.

As you can imagine, before the event began, it was the sources of some controversy. One chiropractor/blogger went to great lengths to explain why the esteemed Franklin Institute should not provide a forum for such a discussion. Most of her letter, of course, was an exhortation about how awful Paul Offit is and how much she disagrees with his science-based approach to vaccines. Her letter, of course, had no effect on the evening at all, but I mention it because we knew going in to the evening that the audience would include people who were not only opposed to vaccine mandates but also opposed to the very existence of vaccines at all.

As a side note, as much as Paul Offit is vilified, he really does deserve none of it. He is as kind a person as you could imagine, spending the time before the event asking how my children were doing and providing updates about his children. He truly cares about children not in the abstract, but about your children and mine (and his).

Because we were prepared for backlash, no questions were taken live. Instead, people used the Twitter hashtag #TalkFI to submit their questions. And that brings me to the one question I want to answer more completely.

Tweet: What do you say to parents who do have a vaccine injured child?

To provide a little bit of context, the question was presented to the panel as “What do you say about mandates to parents who say that their child is vaccine injured?” Phrased that way, the question really could have come from anyone–pro-vaccine, anti-vaccine, vaccine-ambivalent. I did not know that I was answering someone who found what we were saying offensive.

So my answer was, in essence, “Vaccines don’t cause autism.” And why was that my answer?

1. Vaccines don’t cause autism.
2. 90% of the time, when someone asks me about “vaccine injury,” they mean autism. Parents whose children have had adverse reactions to vaccines that match what the science tells us to expect usually do not refer to their children as “vaccine injured.”

From there, Dr. Offit took up the question and gave a fantastic explanation about what a true adverse effect from vaccination entails and how honestly rare it is. His answer was far more eloquent than my blunt response, and I think it provided parents some real insight into why it really is okay to require that children who attend school are vaccinated.

But what about mandates? The problem with a panel discussion is that often one panelist brings up a point that launches a new discussion before the answer can be completely discussed. So here is what I would say to a parent whose child suffered a real and debilitating adverse event after vaccines.

I am sorry that your child had a reaction to a vaccine. In an attempt to protect your child, a medication caused harm, and that was certainly both unintended and unfortunate. Because your child cannot receive this vaccine, or potentially any vaccines, a medical exemption will keep him in school. I will work very hard to make sure all the children around him who can be vaccinated are vaccinated because if a vaccine can injury your child this way, it is possible a disease can do something much worse.

That’s my complete answer. It’s important to note that parents whose children have suffered real adverse effects confirmed by science and evidence often agree that other children should be vaccinated to protect their children. David Salamone is one such child. He contracted polio from the Oral Polio Vaccine and has been permanently disabled since. And yet, he says:

I’m not against vaccinations. I’m pro-vaccinations. We had thousands of people contracting polio prior to the vaccination. We came out with the vaccination, and that number decreased significantly. So less people are getting sick, less people are getting affected, and that’s a good thing.

None of this, of course, will make any difference to the people who came out to the Franklin Institute to confront Dr. Offit or who wrote letter to them ahead of time protesting the forum at all. At the end of the evening, after trying to refute on Twitter the points we were making, Carol had one last point:

Tweet: It’s more than one in a million. Don’t allow them to keep lying.

Could I have given any answer to appease her? No. I look at the evidence about vaccines and think, “This makes sense, and we must shape our policies based on what we know and how we can best protect children.” Vaccine opponents like her look at the evidence about vaccines and say, “This evidence doesn’t line up with what I believe, so there must be other evidence people are hiding. We must make policies based on the evidence we cannot see.”

Policies made to appease people who have beliefs that fly in the face of evidence or who have fallen prey to the misinformation of the anti-vaccine movement are unwise. They are policies that appease the fears of adults rather than protect children against the real and dangerous threat of disease. And while fear can be a powerful motivator, protecting our vulnerable must be more powerful.

P.S. Don’t forget to use the hashtag #BeLikeBen this week to highlight Ben Franklin’s commitment to public health. And if you’d like to watch the entire panel discussion, here you go:

What Does the Latest Anti-Vaccine Failure Mean?

By now, it’s old news that the efforts to get a referendum on the ballot that would overturn the new California vaccine law have failed. The law, SB277, eliminates all non-medical exemptions to school entry vaccine requirements, so that students (without certain IEPs) must be homeschooled if they do not have all of California’s required vaccines.

Opponents to this bill were predictably upset when it passed, and they immediately launched an effort to try to get on this November’s ballot  a measure that would overturn SB277. In order for the anti-SB277 referendum to appear on the ballot, they needed 365,800 people to sign a petition asking for the referendum to be placed in front of voters. According to initial counts, they landed at least 100,000 signatures short.

To put  the petition drive into perspective, California has over 17 million registered voters and a population of 38 million people. As further perspective, a ballot measure that will appear in November in California would restrict how stores use plastic bags. In other words, out of 17 million people, less 2% of registered California voters were motivated to allow unvaccinated children unfettered access to public, private and charters schools. And more were motivated to vote about how the state regulates plastic shopping bags.

You would not have guessed that this would have been the outcome had you followed the legislative hearings surrounding SB277 this spring and early summer. After heated and passionate testimony at committee hearings on both sides, California allows the public to come forward and state their position about the bill to the committee. The lines for those supporting the bill were impressive. It’s not often that people stand publicly and offer their support for a bill.

But the anti-vaccine lines were long. They came to hearing after hearing after hearing, wearing their red shirts, and their lines wound around the building and into the hallways. Their statement of opposition took hours.

In the end, California had a legislative body that was motivated by measles outbreaks sparked in Disneyland and by a science-savvy state senator who knew how to explain vaccines to his colleagues.

And it turns out that the legislators in California were right not to be swayed by the many passionate voices opposing SB277. Because although they were loud, they were a tiny fraction of the voting population in the state–less than 2% of registered voters. And an even smaller percentage of actual California residents.

What does that mean? It would be tempted to declare that it means that we are right and they are losers and we win and they lose so go suck it, Trebek. It is tempting, but it’s wrong. It does not mean that we can be boastful and get our swagger on about a win in California.

It means that there are at least 300,000 people in California who have been scared witless by the lies of the anti-vaccine movement. Their fear makes them very loud, but they are still a tiny minority. It means that now is the time to reach out to them, to befriend them, and to reassure them that they can vaccinate their children and send them to school, and that the risk of something bad happening is very, very, very low.

It means that the death of the referendum efforts are not the end. If we consider it the end, we push the Red Shirts back into their lines and their gated groups and send them back to the echo chambers where they will hear nothing but lies and frightening rumors concerning immunizations. We ask vaccine hesitant parents to wall off their unvaccinated children with other unvaccinated children. And we risk creating new clusters of children who are vulnerable to outbreaks of diseases.

We aren’t done. Don’t pack up your belongings just yet. We have some real work to do.

Anti-Vaccine Petition Fails Gloriously

Anti-vaccine activists fail to accurately assess science as often as they fail to assess their public image. Remember when you learned in junior high that before you ask a parent for something, you should be reasonably certain you know how they are going to respond. Some anti-vaccine leaders never learned that lesson.

In that vein, they petitioned the White House to ask them to “PROHIBIT ANY LAWS MANDATING THE FORCE AND REQUIREMENT OF VACCINATIONS OF ANY KIND” (all caps theirs). They were pretty excited in February when they collected a quarter of the signatures they needed in five days. Things were looking up for woefully misnamed crazy pants organizations like VacTruth.

But six months later, oh the gnashing of teeth as their bubble has burst. Can you believe that the White House is relying on the CDC and not hashtaggers and YouTubers for medical information, citing science instead of conspiracy theory? Their reply to the anti-vaxxers was, in essence, no. Because science.

And what’s more, you should actually vaccinate your children. Yes, you, anti-vaxxer. Vaccinate your children.

We all have a role to play. Vaccinations are one of the great triumphs of science and public policy, and we should make their benefits available to everyone.

As the Surgeon General makes clear, “Vaccines are safe and effective ways to prevent disease and death. They are necessary. They save lives.”

And as the President himself said earlier this year, “There is every reason to get vaccinated, but there aren’t reasons to not.”

If you’re concerned about your health, the science is clear: Vaccinate yourself and your children.

For more information about vaccination, please visit www.vaccines.gov.

Thanks, Obama. No really, thanks. That is glorious.

But the anti-vaxxers do not think so. In one public anti-vaccine Facebook group, members use dehumanizing and ableist language to bring home the point that vaccine are terrible. Evidence of racism within that group is discussed here. And then they went full on crazy, claiming that the White House is fill of not-humans (“I do not even think this is a HUMSN BEING! Has to be an alien, robot or some kind of android !”) and that that the response was evidence of government fascism:

He’s a liar. I grew up in an era where all children got measles, and I never heard of anyone dying. He’s not a medical consultant. He’s a political shill working for wealthy corporations. He’s disgusting. No government has a right to madate medical procedures. What he says isn’t even based on medical science. He doesn’t represent the people or their best interests. He represents fascists.

Which smacks of the tactic you may have employed in junior high: when you get the answer you didn’t want, throw a fit.

So the Anti-Vaxxers Want CA Governor Jerry Brown to Meet with Dr. Toni Bark

Following the passage through the California Assembly of SB277 – a bill that would eliminate personal belief exemptions to school entry vaccine requirements, the anti-vaxxers have been looking for their Hail Mary pass. And some of them have banded together to buy Illinois Dr. Toni Bark a plane ticket so that she can meet with Governor Jerry Brown. (Read about the other things they are buying, too.)

That’s fine. I have seen Dr. Toni Bark in person and was witness to her Gish Gallop testimony in front of the Minnesota Senate Health and Human Services Committee. It was terrible, and she is not a good representative for any cause. But what was even more amazing was that nearly everything she said was wrong. I have never heard so much wrong in such a short span of time.

Actually, it wasn’t short. Each person giving testimony was supposed to testify for only two minutes. Her testimony went on for twelve, and by the meandering, non-linear nature of it, I am fairly certain it wasn’t planned in advance. But the anti-vaxxers were impressed, and they have been sharing this testimony all over the place.

Here’s some of what she got wrong in twelve minutes of talking:

Before she was enlightened, Toni Bark thought vaccines are safe and effective for all children because that’s what the CDC says.

• Believing that the CDC says that vaccines are (or should be) effective for every child and cause absolutely no adverse health events for any child is a nirvana fantasy. In fact, the CDC acknowledges that some people should not get vaccinated and that while vaccines work very well, nothing is 100% effective. In fact, because not everyone can get vaccinated and not all of those who do respond to the vaccine, it is all the more important that everyone else is vaccinated.

Vaccines are listed as unavoidably unsafe, which means they are defective by nature.

• This isn’t even close to what “unavoidably unsafe” means. According to my good friend and legal expert Dorit Reiss, unavoidably unsafe products are: “NOT defective, and the product’s manufacturer is not liable for the products’ inherent risks….[They] are so valuable – have so many benefits – that the risk associated with their use is justified.” And the risks of vaccines are very, very small.

Vaccines are not tested for effectiveness, only for efficacy – antibody response.

• I don’t know where she got the first part, but I did a 10 second search on PubMed, and this is the first study on the effectiveness of vaccines I saw. Here’s the Wikipedia primer on vaccine efficacy.

Dr. Poland and the paradox of measles.

• During the this hearing, as Toni Bark testified, Senator Carla Nelson (Rochester) called Dr. Greg Poland and asked him for his opinion of Dr. Toni Bark using his study as part of her testimony. He was not supportive of the way she used it.

Most people who get sick in outbreaks are vaccinated.

• Sure. BECAUSE MOST PEOPLE ARE VACCINATED. But if most people who were vaccinated really got sick, then thousands upon thousands of people at Disneyland in January would have contracted measles instead of the hundred mostly unvaccinated people.

Doctors only learn about the vaccine schedule and nothing else about vaccines.

• Dr. Dawn Martin later beautifully countered this point. Anti-vaccine parents like to believe that they know more than pediatricians and doctors when it comes to vaccines, but they simply do not because, as Dr. Martin pointed out, doctors learn about vaccines in medical school.

Vaccine shedding causes illness.

• Shedding of viruses from live vaccines is mostly hypothetical. Dr. Vince Ianelli explains that it is difficult to catch a disease from a recently vaccinated child. Do you know who spreads diseases really easily? Sick people.

People in recent measles outbreaks had the “vaccine viral strain” and not wild measles.

• The vaccine uses genotype A, while the Disneyland outbreak was strain B3. So no and no.

The CDC only references itself because it plays games. The CDC waives everyone’s Conflict of Interest on their advisory committees. The CDC refuses to study the vaccinated versus unvaccinated. The CDC is not transparent. And the CDC is in all ways evil and nefarious.

• Get the feeling that Toni Bark doesn’t like the CDC? A good villain is always convenient, and the CDC, with its ginormousness and its slightly socially awkward scientists is easily made into a villain. But the CDC is just one governmental agency across the world that supports vaccines. In Australia, Canada, and the UK, the governments support vaccines so much that they offer them for free to their citizens. Millions upon millions of researchers, doctors, nurses, public health officials, NGO workers from thousands of university labs, independent research labs, government agencies, and non-profits endorse vaccines. So she has her work cut out for her making all of them villains
• The CDC relies on studies from all over the world and doctors and researchers with expertise in making decisions. They don’t ask the opinions of people who own websites named Skin and Chocolate.

Dr. Toni Bark is for truth.

• Hogwash. Toni Bark is for Toni Bark.

Pediatricians don’t know about the National Vaccine Injury Compensation Program.

• By federal law, doctors are required to provide parents with a Vaccine Information Sheet. I believe all doctors can read. Every VIS contains this statement:

Doctors cannot diagnose vaccine injuries.

• Here, Toni Bark is being coy. What she means is that doctors will not say that vaccines cause autism. Mostly because they don’t, they do not, they really don’t, and they absolutely do not. So a doctor will not diagnose autism as a “vaccine injury” because it is not. Which leads me directly to her next point.

At one point in her twelve-minute rambling, Toni Bark looked directly at me and said, “Parents whose children are not damaged by vaccines should count their blessings.”

• You know what? Toni Bark doesn’t know anything about me. My children are blessings, and I am happy that they are mine, but she has no idea what kind of challenges or medical issues my children have had. What she should know is that her campaign to spread misinformation leads to cases of children being exposed to illness to sometimes devastating consequences. What a horribly callous statement on her part. When I stared back at her, she meandered back to another point.

The CDC whistleblower was given immunity by President Obama.

• This isn’t even a thing. The President doesn’t grant immunity since genuine whistleblowers are already afforded that protection by law. This point is either a fantasy or a fabrication. But why would she claim that President Obama gave someone at the CDC whistleblower immunity? Onto the next point:

The CDC made researchers omit data that would show that black children catch autism from on-time MMR vaccination.

• The researchers in questions decided to exclude some data that showed that black children who received the MMR slightly later than scheduled had a great risk of autism. This data was excluded because it did not hold up on further analysis, but this tiny nugget was enough to send Brian Hooker and Andrew Wakefield into big dreams that they might finally be vindicated. (Spoiler alert: they weren’t.)

The NFL has a mumps outbreak.

• Okay, this is wrong because it was the NHL, but it is a seriously huge mistake to come to Minnesota and mistake hockey for football. Here’s a bit on why the NHL mumps outbreak happened.

If you think my analysis of Toni Bark was a bit snarky or cruel, keep in mind that this is how she responded to a tweet from a woman named Liz Ditz:

Actually, after rereading what I have written, maybe Governor Brown should meet with Toni Bark. Maybe he should invite a pediatric intensive care doctor along, too. That might just be enough to convince him that the anti-vaccine movement needs to be stopped.

Anti-Vaccine Word Salad: Civil Rights and Vaccines

I was visiting the (dubiously named) National Vaccine Information Center’s Facebook page, when a post caught my attention enough to click on it. As per usual, NVIC had hidden the link behind a shortened URL and a photo posted directly to their page (so that a thumbnail of the link could not be seen), but their intro was short and confusing: “We Will Not Give Up Our Human Rights for Our Civil Rights.” What did that mean? I had to find out, so I clicked away.

It led me to the NVIC newsletter (link brings you to a Do Not Link page) and a word salad-y, lengthy republication of Barbara Loe Fisher’s speech in front of the California anti-vaxxers protesting SB277.

The piece was a mishmash of words like “freedom,” “liberty,” “choice,” mixed with vague sentiments concerning “vaccine injury” and whatnot. I had to slog through the freedom liberty fighting stuff to get to the part that had caught my eye. In context, it asserted: “We will not give up our human rights for our civil rights. We will not give up the human right to informed consent to medical risk taking in order to exercise our civil right to an education and medical care and employment.”

If I were not thinking, it might sound like she had a case. In essence, the argument is that by eliminating the personal belief exemption in California, parents will no longer be given informed consent before their children are given vaccines, and therefore they will not know the risks; the purpose of foregoing consent would be to enroll their children in school (and then the slippery slope of seeing a doctor and getting a job).

First of all, hogwash.

Informed consent happens at the doctor’s office, and it happens when parents receive the Vaccine Information Sheet (VIS). Furthermore, it is federal law that a VIS be given to a parents before their children receive vaccines. Eliminating an exemption to school-entry vaccine requirements will not make doctors decide to chuck federal law and jab away at kids without handing the parents a copy of the VIS. Assertions otherwise are ludicrous fantasy-laden conspiracy theories.

The language Fisher uses in asserting that children will be denied their access to education goes beyond simple concerns about schooling. She frames it as “human rights” and “civil rights” issues. According to this anti-vaccine speech, receiving a VIS is a human right, and being educated in a school with other children is a civil right.

When used in reasonable discourse, being given full information about a medical procedure could be considered a human right inasmuch as experimenting on a human being or subjecting a human being to medical procedures without their knowledge is a violation of human rights.

However, when I perused the Universal Declaration of Human Rights, I found nothing about abstaining for immunization. The UDHR does touch upon a human’s inherent rights to be free from servitude, torture, fair justice, asylum, nationality, and so forth. Just to remind readers, the assertion is that by eliminating personal belief exemptions to school entry, a denial of “informed consent” (receiving the VIS?) will ensue akin to torture, slavery, and being jailed without a fair trial. The language is inflammatory enough to scorch the fields of any possible civil conversation.

The allusion to civil rights is just as inflammatory. When most people think of civil rights and education, they think of black students in the 19050s braving protests as they became the first students to be integrated into white public schools.

Soldiers from the 101st Airborne Division escort the Little Rock Nine students into the all-white Central High School in Little Rock, Ark.

For too many decades after the passage of the 13th and 14th amendments to the U.S. Constitution, students had been denied a decent education simply because of the color of their skin. Undoing this injustice was the beginning of the Civil Rights era, and the beginning of our learning about the evils of discrimination.

To be clear, let’s look at the definition of civil rights by Cornell University Law School:

A civil right is an enforceable right or privilege, which if interfered with by another gives rise to an action for injury. Examples of civil rights are freedom of speech, press, and assembly; the right to vote; freedom from involuntary servitude; and the right to equality in public places. Discrimination occurs when the civil rights of an individual are denied or interfered with because of their membership in a particular group or class. Various jurisdictions have enacted statutes to prevent discrimination based on a person’s race, sex, religion, age, previous condition of servitude, physical limitation, national origin, and in some instances sexual orientation. [emphasis mine]

Civil rights and equal protection under the law are denied to people because they are easily identified by their membership in a group. Unvaccinated children and their parents do not suffer discrimination on the order of any of the other classes of human beings listed above. Furthermore, unvaccinated children are unvaccinated because their parents chose not to vaccinate them*.

All schools in the United States have requirements for entry. These requirements are not civil rights violations. They are checkpoints to make sure our children are prepared for school and are being cared for. Common requirements include proof of age with a birth certificate, proof of residence, signature of a doctor who has performed a physical exam, a readiness screening, and an immunization form. These requirements keep our schools safe and help them function fairly and well.

Parents who do not want to fulfill any of the above requirements are asking for the school to make exceptions to the law, and schools will usually only do so for good cause (such as a homeless student who has no proof of residence). For many years, we have allowed exceptions to proof of immunization for no other reason than the parents heard a scary rumor and decided to follow it instead of their doctor’s advice.

Disallowing parents from seeking an exception to immunization school entry requirements is not a civil rights violation. It is fair to debate whether or not this is the best strategy to raise immunization rates, but it is not a civil rights violation.

It is offensive to claim that ending the personal belief exemption in California is asking parents to trade their human rights for their civil rights. Real people in the world have to deal with human rights and civil rights violations. We live in a world where people are being deported from the home in which they lived their whole lives or are being gunned down in churches because of their race.

The anti-vaccine movement once again betrays its tendency toward using its privilege to see itself as a victim when they equate themselves with the real threats people face in the world. We should not let them chop up the verbiage of rights and freedom in order to make their own wrongheaded salad of righteous indignation.

Who’s Your Herd?

I’m not an epidemiologist. This morning, I had decided I was going to write a post about how I am not an epidemiologist, but that was before I saw this WIRED opinion piece, in which Sarah Fallon makes the point, essentially, that herd immunity is high enough in California and people can’t sue vaccine manufacturers (not true), so California doesn’t need a new vaccine law.

So that this post doesn’t come back to bite me at some point, let me also be clear that I am not in California, and I have no idea what kind of law California needs. No one in Minnesota is seeking to end all non-medical exemptions as they are in California, so the debate in California is not personal for me. (Very few of you will see what I just did there.) But many Californians whom I respect say that now is the time to end the personal belief exemption in California, and I trust them.

I’m also not a lawyer, so I will simply link to the estimable Dorit Reiss’ post about the fallacies of “we can’t sue vaccine makers so evil evil something” here.

Back to the meat of the post. I do try to avoid writing about scientific matters too often because I am not a scientist and because manner scientists are already doing the wonderful work of writing about vaccines. However, a few sentences in the aforementioned WIRED piece irked me:

Remember, vaccination rates have not suddenly plummeted. They are, and remain, high. And we remain at the upper end of the 83 to 94 percent “herd immunity” threshold that keeps measles at bay. To know how many kids in California are vaccinated against what diseases, we need to use the data-crunching tools and reporting methods that are available to us to count all the vaccines that have actually been administered. And I think we would be happy with what we found.

I do not have to be an epidemiologist or a scientist to understand that the description above is not how herd immunity works. Measles does not spread in a statewide manner, blanketing all of California with contagion or not based on the statewide vaccination rates. Measles is spread from in person, in a room or an elevator. Make no mistake, measles is crazy contagious. A measles outbreak in Minnesota illustrates this perfectly:

Lynfield said the virus can spread through the air, as it did in 1991 when 16 people at a Special Olympics event at the Metrodome were infected. A track and field athlete from Argentina was the original case in that outbreak. Interestingly, two of the infected people were sitting in the upper deck of the Dome — more than 30 meters above the athletes.

We definitely should be concerned about those large-view herd immunity issues. If California had an immunization rate of 60%, we would all be concerned.

But for measles or any other vaccine-preventable disease, we need to ask who is our herd? Where are our children most at risk for catching a disease?

A child in preschool or Kindergarten spends a great deal of time playing with toys his or her classmates play with, holding hands with friends, sitting side-by-side in group time. They may only have 15 or 20 classmates, but these children constitute their most important herd because of the amount of time spent with them and the proximity to them.

A college student living in a dorm has a different herd (and different vaccine requirements because of this different herd behavior). Those people sharing a bathroom with a college student or sharing a kitchenette in the floor lounge make up one herd. Classmates in a lab or a lecture hall or a study group are another herd.

If a preschooler is in a classroom with classmates who are all fully immunized, the chance that this child will contract a vaccine-preventable disease are greatly reduced. And if the child we send off to college lives in a dorm and attends classes with people who are all fully vaccinated, they, too, are at greatly reduced risk for catching a vaccine-preventable disease. And this is true whether or not our preschooler or college student in question is vaccinated. That’s the power of herd immunity.

The issue in California is not how many children in the state have parents who are making the choice to contribute to herd immunity. The issue is that too many communities have too many children who are unvaccinated and leaving those community-level herds at-risk. Even a classroom-level herd that has a high vaccine opt-out rate can be at risk if a disease is introduced into that classroom.

Those unvaccinated children who become infected then venture out into the greater community. Is their classroom a fluke, powered by an alpha-mom who has spread anti-vaccine misinformation like a contagion and frightened the classmates out of vaccinating? (See why it is so important not to remain silent during vaccine discussions?) Or is this classroom part of a greater community trend, waiting for disease to take over? Is the community made of tendrils that reach into other communities? How far can an outbreak spread?

“Our state vaccination rates are high enough” is never a cogent argument. Every community deserves protection, and every child in every classroom deserves the safety net of a highly vaccinated herd. I’m not an epidemiologist, but I am a mother with children, and I want them to have the protection of a highly vaccinated classroom. Until anti-vaccine misinformation is vanquished once and for all, we will need better laws to protect our children.

This is a Publicity Tour, Not a Public Service

I have been to a couple of hearings concerning immunization bills, and I have listened to and sent parents to many, many more hearings. I have heard the most passionate, intelligent, and well-respected doctors and nurses try to convey to lawmakers in minutes the complexity of our vaccination program and the importance of high immunization rates. These healthcare professionals who testify on the public health side are from in-state and work directly with the children and parents who are affected by vaccine rates. They are the people who, when bills working to raise rates do not pass or die, must intubate infants with pertussis, admit children to intensive care during measles outbreaks, and put children on ECMO machines when influenza attacks.

In other words, these doctors nurses testifying for tougher vaccine laws do so because they have seen children in their communities suffer, and they want to prevent more suffering. These are not people whose names you would know. They don’t make any money from their appearances in front of legislative committees. Their testimony brings them no further glory.

And then we have those who testify on behalf of the anti-vaccine contingent. Take Robert Kennedy, Jr., for example. In his latest stop, he is going to New York to persuade them not to make the meningitis vaccine mandatory. He claims that the vaccine contains too much mercury. And although he is an environmental lawyer and finds that experience relevant, it is clear he doesn’t understand medicine or public health. His stop might be unremarkable, except that he has also testified in front of legislative bodies in Vermont, Illinois, and Oregon.

Another example of an anti-vaxxer willing to travel to testify against immunizations is Dr. Toni Bark, whom I watched testify in Minnesota (where she was schooled on misusing a local doctor’s research.) She has also testified in Texas and Vermont, and there is talk of her traveling to other states to testify as well.

Part of me takes heart that being anti-vaccine is so rare that the same expert must be flown from place to place to testify. After all, the pro-vaccine forces need only look to their local hospital, university, or health department to find someone who both thoroughly understands the value of vaccines and is passionate enough to give their expert opinion to lawmakers. Apparently anti-vaxxers are not so lucky.

But the other part of me is annoyed. Much of the anti-vaccine belief system is predicated on an assumption that a conspiracy exists to suppress the evils of immunization so that the very many people involved can profit from the near universal usage of vaccines. This conspiracy means that all the doctors, nurses, research scientists, public health officials, and pharmaceutical company employees in the world aren’t in it to save lives. They are in it for cash. Thus the admonition from the anti-vaccine lines to “follow the money.”

Every time I see RFK Jr. or Toni Bark or whomever travel to yet another state legislature, I do follow the money. And I note that Kennedy has a book out–on the topic of thimerosal, of course! He has also been heavily promoting a pseudo-documentary which implicates thimerosal, which has been removed from childhood immunizations, in autism. Meanwhile, Toni Bark has her own horrible pseudo-documentary, starring multiple people with online supplement stores. When I follow the money, I realize that all this fear of vaccines is being used to sell me something. Movies! Books! Supplements!

It comes down to this: public health advocates find local people with expertise to educate lawmakers about bills. Anti-vaccine activists fly in profiteers on publicity tours to promote the very fear that sells their wares. The worst part is that their efforts are sometimes successful.

The Anti-vaxxers Might Wish that What was Lost had not been Found

The anti-vaxxers went wild after the recording of the Minnesota Senate hearing regarding an immunization bill (SF380) was lost. They had brought Dr. Toni Bark (who runs a website called SkinandchocolateDOTcom and recently helped release an infomercial-disguised-as-documentary) whose testimony was long. And that’s the end of my positive description of her testimony. Actually, one pro-vaccine advocate told me they heard a senator at the hearing say to an anti-vaccine organizer that they should never have her testify again because she was so unimpressive. Yet, the anti-vaccine word was that the recording was purposely hidden because her testimony was good and a threat to all things pro-vaccine. I don’t know whether or not they are rejoicing, though, at the found recording, which can be found here and on the Minnesota legislature website. If I were them, I would be particularly embarrassed at this exchange between Senator Carla Nelson and Dr. Toni Bark, where Senator Nelson questions how Dr. Bark could point to Minnesotan Dr. Greg Poland‘s research to support her position. I will transcribe the important part (about one hour in) here:

Sen. Nelson: My question, Dr. Bark…is you’ve referenced Dr. Gregory Poland and his study The Paradox of Measles, and I couldn’t tell exactly from your testimony if you were indicating that he was in opposition to this bill or support.

Dr. Bark: Oh, I don’t know how he would feel about the bill, all I know is…I have no idea how he would feel about the bill. So I spoke to him when I was writing my papers for my medical, my graduate school program which is a two year program in medical science and disaster medical management, and I focused on vaccines in that two years, and he has written extensively about measles outbreaks and talks about the paradox of measles and he’s not the only one. There’s mathematical biologists who actually because it’s a live viral vaccine and you shed and there’s going to be about 15 to 20 percent of the population that might not get an antibody response from the vaccine and then we know from certain outbreaks that even with an antibody response, you are not necessarily protected. So the mathematical biologists, and Poland has agreed, state that you can never eliminate measles and that, in fact, part of the reason because of what was said before is that women who didn’t have measles as children do not impart the same immunity. The immunity to their infants does not last as long, and so we tend to see measles in a vaccinated population going from a younger age and an older age, and not the normal age that you would normally see. So it is kind of complex, but he does, it’s the paradox of measles because the paradox does seem that most people with measles have been vaccinated.

Sen. Nelson: Madam Chair and Dr. Bark, well, I did just get off the phone with Dr. Greg Poland.

Dr. Bark: Oh wow!

Sen. Nelson: Because I had visited with him about this bill myself. It was a very important bill, and I know he is an expert on measles vaccines particularly. So, I will just tell you what he reiterated to me on the phone now. He is not in favor of mandated vaccines, except in certain cases such as healthcare workers, something like that. But this bill does not mandate vaccines.

Dr. Bark: Right.

Sen. Nelson: So we want to be very clear about this. It does not mandate vaccines. He also talked a little bit about the paradox in measles, and talking as a scientist, how exactly, as you said, he doesn’t believe that measles will ever be eradicated, for maybe all the reasons you said. But he also said that sometimes people who oppose the vaccines will pick out one sentence in the scientific study and extrapolate it to mean things that it does not mean. So he did say that he does support certainly informed exemption, such as this bill is, and his closing comment to me was also the first part is what you said, but perhaps not the second. He said that measles is the most contagious disease that we know, and yet we found that fear and ignorance is more so. So I just wanted to clarify the record on that Madam Chair. 

This exchange is, of course, full of anti-vaccine misinformation and smacks of anti-vaccine desperation in the Gish Gallop Dr. Toni Bark provides. I could do an in-depth analysis of how the measles vaccine does not shed or how most people who contract measles during an outbreak are unvaccinated, but I think the fact that she tries to hang on the words of a pro-vaccine doctor in his own state, to his own state senator, shows just how insulated and clueless the anti-vaccine movement is. That and the fact that they had her testify again in Vermont. Cue sad trombone.