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.

You Can Stop Vaccine Hesitancy

Yesterday, while waiting to get his baby’s vaccines at the doctor’s office, Mark Zuckerberg did the one thing we should all be doing to combat vaccine hesitancy:

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And, no, I’m not suggesting you start your own social media empire. That’s not what you need to do.

You need to tell people that you are (or have been) vaccinating your children. You need to tell people publicly. Because if everyone who did vaccinate their children simply posted a photo like this on social media, the anti-vaccine movement would look like that tiny less-than-one-percent that they are instead of a loud, social media enterprise.

It’s called social norming, and it might be more effective than debating other people about vaccines and debunking their misinformation. A simple I VACCINATE statement, when made by everyone, shows just how ubiquitous this decision is, and also just how safe the decision to do so is. Imagine being a new parent and seeing photo after photo of friends saying “Time for vaccines!” on the internet (or heck–in person!). All those babies that you know who are vaccinated and are fine show just how safe immunizing can be.

Because I am so passionate about social norming, I am willing to insist that your duty speak up about vaccinating is just as important as your duty to vaccinate your children. If you truly want to protect your child and your community, it is your responsibility to help stem the tide of vaccine hesitancy. I bolded that because it is important.

In fact, there is evidence that your advice about vaccinating makes a difference. According to research by Dr. Emily Brunson out of Texas State University, “the variable most predictive of parents’ vaccination decisions was the percent of parents’ people networks recommending nonconformity” to the immunization schedule. In other words, the more people who recommend you not vaccinate on-time, the more likely you are not to vaccinate on time. Conversely, if everyone you know recommends you vaccinate on-time, you are unlikely to deviate from the vaccine schedule.

So get out there and tell your friends and family members and FarmVille collaborators that you vaccinate your children, end of story.

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.

Here’s the Good News Following the GOP Debate

Cringe-worthy. You could see the inner workings of their minds as they figured out how to straddle the different sides of the vaccine “debate” during the (actual) CNN debate. Some GOP Presidential candidates were trying to make everyone happy, like Ben Carson, who wants people to vaccinate and think some nebulous idea about spreading vaccines out is reasonable. I mean, if it makes parents feel better, who cares if they are leaving their children at risk for diseases longer than is safe?

Others have a core base that supports the idea of parents have freedom to do whatever they want to their children. And the last guy is a narcissist who isn’t used to his ideas being challenged and wouldn’t know a fact if it bit him in the rear.

These men who would rule the most powerful nation in the world and could easily unleash nuclear weapons also want to unleash measles on us. It’s easy to become disheartened if you stop at the debate.

But the debate isn’t the only thing that happened this week. Come Thursday morning, a torrent of backlash was unleashed on these candidates. They may not have expected it because anti-vaccine activists are loud and persistent and focused on only that one issue. They may have assumed that the debate was equally matched.

They were wrong. So many articles were written debunking these candidates and their misinformation that every word in this sentence has its own fabulous, lovely, pertinent, excellent hyperlink. The backlash was so great, I even had to add adjectives to my sentence. And I am guessing the backlash isn’t done.

The backlash is great enough that the campaigns are likely strategizing right now about how best to untangle themselves from their debate statements. If they want my opinion on how to do so, here’s my suggested language: “During the debate, I made statements about vaccines that were wrong. My wrongness was great and horrible, and I regret threatening public health with my wrongness. Children’s lives are too important to allow my wrongness to stand. Therefore, I retract my wrongness, and will gladly state now that vaccines do not cause autism and that parents should stick with the CDC schedule.” Not hard. Statements like this are made in marriages across the world.

Another presidential candidate has sniffed out this backlash. Bernie Sanders met with Rachel Maddow and stated:

I think the evidence is overwhelming that vaccines do not cause autism. It really is a little bit weird for Trump, who has no medical background, to be raising this issue. And obviously it is a concern because when somebody like that says it, thousands of people are going to hesitate to get their kids their shots, and bad things may happen.

I predict good news to come. Being pro-vaccine is now mainstream, and anti-vaccine statements are not allowed to stand. I predict a flurry of pro-vaccine statements by candidates and public figures  in the weeks to come.

But if you are listening carefully, pro-vaccine statements are embedded in our culture. References to the value and importance of vaccines are now part of casual allusion, such as the analogy made in the preview of Benicio Del Toro’s new film, shared on Jimmy Fallon’s show this week.

Despair not. Pro-vaccine voices are becoming more significant.
Although, if Donald Trump becomes President, you should despair. You should despair a lot.

Menses, Vaccines, and Slacktivism

Reading about the woman who ran an entire marathon menstruating without a tampon made me think of vaccine advocacy. I recognize it is an odd leap, but advocacy shares commonalities no matter the cause.

In case you missed it, People magazine reported that Kiran Gandhi ran a marathon in London last April while blood soaked her pants:

Gandhi let her blood flow freely to raise awareness about women who have no access to feminine products and to encourage women to not be embarrassed about their periods.

The value of what might seem like an odd stunt was debated all over social media. Some felt that it highlighted a real issue while others felt that it solved nothing and amounted to slacktivism. Slacktivism is a form of activism that requires very little effort on the part of the activist and often leads to no real involvement in the issue at hand.

Gandhi being accused of slackvitism hit me. Granted, I work day in and day out trying really, really hard to get people to engage their friends, neighbors, and school administrators in order to raise immunization rates in their communities. For all my work, I have found that people are most comfortable with far lesser forms of activism: sharing Jimmy Kimmel videos on Facebook, wearing a pro-vaccine t-shirt, or Tweeting at Jenny McCarthy. Are their efforts (and mine) worthwhile?

To answer that question, I really need to unpack what the cause is. Even though we bill ourselves as the pro-vaccine movement, we are really, at our heart, anti. We could see ourselves as anti-disease or as anti-vaccine hesitancy. In either instance, we are doing battle against things contagious that threaten public health.

If we are simply anti-disease, so-called slacktivism is not actually slacking off. The first course of action against preventable disease, after all, is to get your child (and yourself) vaccinated, since vaccines do battle against the diseases directly. The next step is simply to make vaccinating normal so that others will do it, too. Sharing that Jimmy Kimmel video certainly gives an air of “Normal people vaccinate” and might also remind people to check on their immunization status.

Vaccine hesitancy is a different monster, though. Jimmy Kimmel is not going to make a parent who has concerns about vaccines laugh those concerns away. As I wrote earlier, turning the tides of vaccine hesitancy requires people who care about the hesitant addressing concerns with them and sharing stories about why we vaccinate. This person-to-person, retail advocacy is the exact opposite of slacktivism. It is more akin to building a Habitat for Humanity house, except that no one will ever drive past the house and look at it because you cannot drive past outbreaks that never happened and note their lack of existence.

The pro-vaxxers who have vaccine hesitant friends whom they engage are the ones getting their hands dirty with activism. But they aren’t alone. The Washington Post reviewed a study on slacktivism and how to engage activists more deeply:

[T]hose whose initial act of support is done more privately (for example, writing to a member of Congress) are more likely to engage in deeper, more costly forms of engagement later on. Those whose initial support is public (i.e. through posting to Facebook or Twitter) are less likely to engage more deeply. Moreover, the researchers find that most appeals for token engagement “promote slacktivism among all but those highly connected to the cause.”

In other words, those who are engaging in pro-vaccine advocacy primarily through social media might be the people who appear to be the face of the pro-vaccine movement, but they may not be the ones moving the needle (pun intended) on vaccine advocacy. People who are writing legislators, engaging the media, talking to their school administrators, requesting pro-science books added to library collections, and a hundred other mundane, private tasks are pushing their neighbors to confront fears about vaccines in order to raise immunization rates. Their work is both anti-disease and anti-vaccine hesitancy.

Which is not to say that being pro-vaccine primarily on social media is inferior. Of course, there are ways that social media activism can effect real change concerning vaccine hesitancy and the grip the anti-vaccine movement has on Facebook and Twitter. For example, it was through social media that Chili’s was convinced to drop their support of an anti-vaccine organization. I’ve also used social media to prompt pro-vaxxers into private forms of advocacy, writing letters to congress and asking them to cancel a anti-vaccine hearing, for example.

Thus, being engaged in awareness raising does not preclude a person from making a real difference. However, the leap from sharing a funny pro-vaccine meme on Facebook to writing a company or a policymaker is wide, and often people engaging on social media are not ready to make that leap. My past personal experience has shown that in order for pro-vaxxers to take on get-your-hands-dirty activism, they have to be alerted to an immediate need that requires specific, short-term action (such as writing to have a hearing canceled or posting on Chili’s social media page). Between those actions, then, a little so-called slacktivism or awareness raising is necessary to keep people interested.

If you are waiting for me to rule on Kiran Gandhi, you may have waited in vain. While I don’t consider her cause one of those that drives me, I do donate feminine hygiene products to the local food shelf. And I hope that someone reading today’s post might write a letter to a school administrator and ask how the vaccine rates are and what might be done to raise them.

And why not. Here’s Jimmy Kimmel again.