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.

The Truth About TTAV Episode Seven: BUY MY STUFF!

Read this whole series by starting here.

Episode Seven: Natural Immunization, Homeoprophylaxis & Fundamental Freedom of Choice

The Cast

The Claims

Natural Immunization is the Best

  • The film claims that breastfeeding is the best immune defense for babies, but its effectiveness isn’t promoted because it would compromise the pharmaceutical industry’s interests.
    • Passive immunity through breastfeeding only protects infants from infections contracted through the gastrointestinal system. Airborne infections such as measles, chickenpox, influenza, rotavirus, and pertussis, are not covered by the immune passed from mother to child via breastfeeding.
    • Infant formula manufacturers do not manufacture vaccines.
  • The film also claims that healthy vaginal birth is the most important method to ensure a life of gut health for babies. I mean, whatever. Not dying in childbirth is pretty important to c-section mothers. There is some correlation with c-section delivery and asthma, Type-1 diabetes, celiac disease, and obesity, but the causation has not been proven. At this time, none of those conditions is vaccine-preventable. Why are we here? I don’t know.
  • The film claims that essential oils and probiotics provide natural immunity to viruses. But recent research shows that the claims of benefits from probiotics are overblown, and essential oils are a pyramid scheme and as reliable as one.
    • Were allegedly used to curb bubonic plague, gangrene, etc. But quarantine and hygiene likely ended the plague, and aggressive surgeries helped curb the high gangrene death rate, historically. Now we have antibiotics. 
  • The film promotes GcMAF – Gc Protein-Derived Macrophage Activating Factor
    • Claims by James Jeffrey Bradstreet that this diet could cure autism lead to an federal investigation shortly before he died by suicide.
  • It also claims that vitamin A is the cure for measles and reduces. incidence of mortality in outbreaks among children.
    • Children with serious malnutrition who are vitamin A deficient are at higher risk for severe measles infection. Supplementing these children is important, but there is no reason to believe a well-nourished child would see any difference in measles severity with Vitamin A supplementation. We can assume the children of the 1950s U.S. were well-nourished, yet 500 of them died each year before the vaccine was available.
  • The film claims that vitamin C is effective in curbing the spread of viral diseases, like whooping cough, because it energizes the immune system, loosens the secretions in the lungs, and frees the lungs (toxin-neutralizer)
    • Cited famed Dr. Klenner’s research on Vitamin C’s effectiveness, but health theories about Vitamin C have been repeatedly disproven, as early as 1938. But for people who promote natural health, they should realize that taking megadoses of any vitamin is unnatural and often dangerous.
  • The film states that health starts with the diet as feeding children real food, specifically breastmilk, fruits and vegetables, boots immunity, the microbiome and brain and boosting nutrition activates kids’ genetic code and invokes immune responses in a symptomless way (built-in immunology)
    • The idea of boosting immunity is a misunderstanding of how immunity works. Certainly, malnutrition hinders the immune system’s function. But there are two different types of immunity: innate and acquired. The innate immune system (the one that can be hampered by malnutrition) is the rapid-response to new germs the body encounters. The acquired immune system is the one that has been around long enough to recognize and fight off a particular germ. Real boosting immunity is what happens when the innate immune system encounters a germ and revs up: your body might respond with fever, phlegm production, and coughing. Your innate immune system cannot handle big germs like measles and chickenpox without you getting sick.
    • Put simply, measles doesn’t care what you had for breakfast.
  • The film claimed that a Norway study proved that folate taken through pregnancy prevented neurological disorders among children (autism rate was 1 in 1000 vs. 1 in 500 for mothers who didn’t take the vitamin). One study showed that oversupplementation is a risk factor for autism.
  • Finally, the film claimed that mortality rates from VPDs (vaccine-preventable diseases) were eradicated prior to the introduction of many vaccines because of basic improvements in quality of living. This is an extremely common anti-vaccine claim. Here are the facts:
    • Mortality and disease rates are not the same. The rates of mortality from VPDs declined, in part, because of many modernizations, including medical advances.
    • The incidence of VPDs remained somewhat steady even as many deaths from them were prevented. In order to eradicate a disease, the incidence has to drop to zero globally. The only human disease eradicated is smallpox, thanks to vaccines.
    • The drop in incidence in a disease followed the introduction of a vaccine for that disease.
    • Measles incidence dropped in the mid-1960s, chickenpox in the early 1990s, Hib in the early 2000s, and rotavirus in the mid-2000s. Quality of life improvements did not occur neatly at those particular times to coincide with reducing the cases of only one particular disease, except vaccines. Vaccines improved the quality of life.

Homeoprophylaxis (HP) is a Great Thing! (Shop My Store!)

  • Homeoprophylaxis is homeopathic immunization. Homeopathy is a method by which a substance is diluted down by water to such a degree that no active ingredient is left. Often the water is then shaken with a sugar pill and sold as a cure—or a vaccine—for something. The idea is that the medicine becomes stronger the more dilute it is because water has memory.
  • Homeopathy commonly uses the phrase “Like to cure like,” which means that any substance which can produce symptoms in a healthy person can cure symptoms in someone who’s sick. Which is nonsense.
  • The film says homeoprophylaxis has never caused deaths in anyone who uses the method. I mean, sure. It’s sugar pills with nothing in them.
  • These homeopathic nosodes supposedly prevent disease without “toxic” effects
    • Vaccines are not toxic.
    • Claims that you can use them to detox from vaccines are laughable. Your liver and kidneys detox for you. 
    • Nosodes are worthless.
  • The film claims a Cuban study showed that homeoprophylaxis was more effective in reducing the incidence of a swamp-related disease than pharmaceuticals.

Fundamental Freedom of Choice! 

  • Like many anti-vaxxers, the film disdain’s California’s SB 277, the bill that requires all children enrolled in schools be vaccinated unless medically contraindicated.
  • The film claims that Richard Pan was pressured by pharmaceutical lobbyists to push SB 277
    • In reality, Dr. Pan is a pediatrician who understand vaccines because he has seen what they do first hand.
    • Allegedly received $95,000 from pharma lobbyists before the bill passed, but I am not finding them among his top donors.
    • I mean, this film just spend a chunk of time being a commercial for homeoprophylaxis. They want to go to this direction?
  • The film claims the bill is an attack on parental rights. Of course, parents do not have the right to endanger communities, including school communities. 
  • The film claims that vaccine requirements will soon extend beyond education and employment; will be required for driver’s licenses, public events, etc. There is no way to debunk this because I can’t show something that isn’t happening. Prove to me that unicorns don’t exist. Ha! There! I win. 
    • Schools are reasonable places to require vaccine for entry because children are the most at risk for many diseases, the primary vectors of many diseases, and spend much time in close proximity to each other at school.
    • Healthcare settings, where vulnerable people congregate and where illnesses can also abound, are reasonable places to require vaccination for employment.
  • Healthy People 2020 – plans to get everyone vaccinated. Or more people, with the primary goal of reducing diseases.
  • Choose one of their crackpot theories that is the most offensive:
    • Plans to take away the right to vaccine refusal!
    • Plans to have extensive registries!
    • Mandatory vaccinations are completely contrary to America’s founding principles!
    • Forced vaccinations are legally assault and battery!
    • Can’t use one fundamental right to restrict another right; non-medical exemptions are at risk!
    • Losing informed consent makes us slaves!
  • The film proclaims that the anti-vaccine has united people of all backgrounds
    • In reality, most anti-vaccine activists are wealthy and white
    • They believe that they are a protected minority and their movement is akin to Black Lives Matter movement. This is a strategy that remind me of the Russian bot strategy recently discussed.
    • They call themselves “vaccine safety advocates,” claiming they’re against the toxins in them. This is where the film started, but I think the contents of this episode have proven that they are vaccine conspiracy theorists with something to sell you.

That’s it folks. Ultimately, this series ended with a commercial for things you can buy instead of vaccines. For this reason, I refer to the anti-vaccine movement as primarily fear-based marketing to promote alternative remedies.

Here’s what you need to know. The vast majority of experts across the world working in public, private, and educational organizations agree that vaccines are safe and save lives. There are some outliers, and scientific outliers are usually wrong. 

I’m going to go watch Fried Green Tomatoes now.

Pro-Vaccine World Tour

On Friday, I found myself protesting an anti-vaccine bus. A decade ago, I could not have imagined even writing such a sentence, but there I was.

Some backstory, first.  (Scroll down if you don’t need the backstory.)

In 2011, amidst a growing measles outbreak among some unvaccinated Somali-American children in Minnesota, Andrew Wakefield flew into town and held a private meeting with them. Who knows what was said in this meeting since the people in attendance were parents of autistic children who are convinced of the vaccine connection and Wakefield–a defrocked pediatric gastroenterologist. I mean, what could he say? Who knows, but it was history.

Until April of this year when measles made a predictable comeback to the same community. Wakefield didn’t come back, but there was plenty of anti-vaccine outreach into the Somali-American community to convince them not to trust public health officials (to the consternation of many Somali-Americans). The Washington Post also reported talk about white parents of exposing their children purposely to measles and convincing Somali-American mothers that there was no measles outbreak, that it was all a trick concocted by public health.

And that’s all bad enough, but the anti-vaccine community in Minnesota has been actively working on translating Wakefield’s 2015 fraudumentary, Vaxxed, into Somali for further indoctrination. I’m not done. We were all disheartened when Tribeca announced (and eventually retracted) that Vaxxed would be screened, but now the film is available on Amazon Prime and a tour RV/bus (it’s an RV, okay?) containing Polly Tommy and her friends is making its way through the country and recording stories of so-called vaccine-injury (usually autism).

Enter self-described Pro-Vaccine Troll, Craig Egan. Craig asked his Facebook friends and fans if he should follow the Vaxxed RV/bus/it’s an RV à la Grateful Dead. $10,000 in GoFundMe donations later, he was pulling into Minneapolis and following the Vaxxed vehicle.

On the day the measles outbreak was finally declared over.

End of backstory.

Everyone wants to know what it was like confronting the Vaxxed jalopy, and so I thought I would write out my story. The day before, I wanted Craig to get a real sense of what we are really fighting for–preventing kids from getting sick. So I took him to Children’s Minnesota to meet Patsy Stinchfield and Joe Kurland, who worked directly with the measles cases and with system-wide infection prevention. He interviewed them on video (and they interviewed him back):

At this point, we still had no idea where the bus was going to be. The anti-vaxxers in Minnesota were being purposely coy about where they were filming. Even though it was the day before and we had had feelers out for weeks trying to figure out where it would be, we didn’t know. But one journalist got confirmation of where it would be, and I called him Friday morning and was lucky enough to find out. This is where I admit that we tipped off a few reporters, as well. When I arrived, Craig, his girlfriend Sharon, Joe Kurland, a few mothers, and a reporter were there, being filmed by an anti-vaccine mom standing at a distance. I waved hello because I am polite.

Not much happened other than some good conversation on our end and worried looks shot our way from theirs. Joe decided to do a Facebook Live video.

Eventually Patsy Stinchfield arrived and Joe left. She pointed out the Sunday Mail journalist Ian Birrell was over at the RV. He had interviewed both of us in the week prior, and we were both impressed with his depth of knowledge concerning science and the anti-vaccine movement–especially Andrew Wakefield in particular. I knew he had connected with Polly Tommey, and he allowed her to interview him aboard their transport.

Because Patsy is brave and I want to grow up to be just like her because she is also smart and pretty and amazing, she decided she wanted to get up close to see the Vaxxed wagon. A number of people had been staring at use almost the entire time we had been there, and they didn’t look happy that we were walking closer. I held out my hand and introduced myself to a few people, only because I wanted to convey to them that I was not there to belittle or harm them. I feel like giving people your name helps you connect as people rather than representatives of some opposing side. Most of them shook my hand and told me their names, too. They were polite.

One woman, however, did refuse to shake my hand. I felt a little like Angela Merkel, and hey–that’s not bad company to be in. She also would not tell me her name. I don’t know if she was afraid of what I would do with her name (honestly, I am terrible with names, so forget is the correct answer) or if she was just being hostile.

She wanted us to say something about the names written on the bus. (The names are supposed to represent people who have been injured by vaccines. I did notice how many of the names were written in groups by the same hand, and it seems an improbability to me that anyone would have multiple people from the same family who suffered a true adverse reaction to a vaccine.)

In any case, we didn’t reply as she wanted, and she expressed her displeasure. She wanted us to know that the names were important, so I tried to prove I was listening to her by paraphrasing what I believed she was saying, but that also made her angry. I supposed she didn’t like my paraphrasing. I was trying, though! Perhaps she was just spoiling for an argument.

She told us that if our brakes went out in our cars, we would want to warn other people. Patsy commented that brakes are a good analogy, except that with vaccines, we need everyone to use their brakes or else we are all in trouble. We can’t allow people to opt out of brakes. This unnamed woman told us that we couldn’t use a car as a comparison because the human body is not a car. Craig pointed out to her that the car/brake analogy was hers, but that didn’t satisfy her. I’m also not really a huge fan of arguing about analogies. The thing about analogies is that they are always imperfect. The only thing that is exactly like the thing is the thing. So we moved on.

Another woman then approached us. She did give us her name (I am not going to disclose it here), shook our hands, and told us that she was vaccine injured. Patsy asked what happened, and she said she had a stroke after the flu vaccine.

I’ll just pause briefly for an evidence aside. The flu vaccine is, in fact, associated with a temporary drop in the risk of strokes and heart attacks. Unpause.

She disclosed some other information to us that isn’t pertinent to anything and I don’t think is appropriate to share publicly. It was a calm, polite conversation. No minds were changed. She probably doesn’t like us.

We returned to our picnic table, and Ian came over and chatted with us briefly. His photographer took a photo of us. He asked us not to smile, but he was standing next to an adorable baby who kept waving at us.

As we stood there, someone we called Frisbee Guy walked past and said, “I’m with you guys!” I guess while I was at the bus with Patsy, a family on a Surrey bike pointed at the Vaxxed vector and shouted, “They are the ones who caused the measles outbreak!”

Craig presented me with a check for Voices for Vaccines. He donated a third of his GoFundMe proceeds, which was incredibly generous.

As I drove home, I heard a reporter from Minnesota Public Radio give an in-depth (and really well-covered) report on the end of the measles outbreak and the Vaxxed cohort’s dealings. If possible, please listen rather than read the MPR report, as it is abbreviated in print.

If you live in Minnesota, please use the contact form on this blog to reach me and to learn how to combat the anti-vaccine movement. The next measles outbreak will happen if we do not act now.

Lessons learned:

  1. There is only one Craig Egan.
  2. Anti-vaxxers want to argue. Kind of. Not about car brakes.
  3. Read the dimensions on Amazon products carefully.
  4. Eric Clapton became a terrible person while I wasn’t looking, so I can’t tell you who I thought looked like him. (I now denounce that opinion. He was much handsomer than Clapton.)
  5. The Vaxxed tour is devolving into the end of the Spinal Tap tour. All they need is their miniature Stonehenge.
  6. Pro-vaxxers are awesome, and they are often huggers.

 

Filling Wakefield’s Coffers

Really, that’s all VAXXED is about. The movie, written by, produced by, funded by, and starring Andrew Wakefield is about Andrew Wakefield. It came to the city where I live and caused very little stir.

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The Uptown theater in Minneapolis didn’t even list VAXXED in its marquee while it was being shown there.

Nor should it. Andrew Wakefield is a fraud, but he is also a washed up has-been. It was no surprise when friends of mine went to see the film, sitting in nearly empty theaters.

Screen Shot 2016-06-07 at 1.35.19 PM

My gut feeling is that this film, like many of the other anti-vaccine endeavors preceding it, will fizzle out with a whimper.

But not without a fight. The anti-vaxxers are goading each other to buy tickets to the film, even if they have no intention of using the tickets. They hide this racket by terming it a donation or calling it their “Angel Ticket” program. But what they are trying to do is to make this film seem like more of a success than it is so that they can push it out to more theaters across the country.

Screen Shot 2016-06-06 at 7.01.13 AM

The Hear This Well Facebook page is only one of many encouraging people to “donate tickets” (to whom? they don’t say) in order to sell out the theaters in Florida and pressure Regal theaters to show the movie nationwide.

I have to believe that Regal will notice that no one is actually in these so-called sold out theaters, although they might not care–as long as they are selling tickets. I have heard rumors from insiders that the VAXXED DVD is coming out next month, though. I don’t know any theater that would show a movie that is also out on DVD.

All this brings me back to the beginning. The movie itself is made by, written by, promoted by, and starring Andrew Wakefield. He tried to swindle us all once with a phony study and a media tour aimed at frightening us away from the MMR vaccine. Andrew Wakefield doesn’t do anything that doesn’t benefit Andrew Wakefield, and once again–even in the promotion of this film, the main beneficiary is Andrew Wakefield (and the main victims are public health and autistic people).

 

Why You Shouldn’t Shop for Medical Exemptions

Recently, filmmaker Leslie Manookian wrote a post for vaccine hesitant parents about how to pester physicians into giving them an inappropriate medical exemption. This interest in medical exemptions stems from the newly passed law in California that eliminates all non-medical exemptions. Parents who are now too scared to vaccinate their children are forced to make some tough choices. (Well, tough for them because of their misperceptions of the risks of diseases and vaccines.) They can either vaccinate their children or homeschool them.

Anyone following the anti-vaccine movement can understand how an otherwise reasonable but vaccine-hesitant parent feels about this choice. For them, the choice feels like deciding between certain death or certain economic doom. After creating the fears about vaccines, woopreneurs like filmmaker Leslie Manookian (and Bob Sears) have stepped in to capitalize on this fear by offering parents a way out of the vaccinate-or-homeschool conundrum. Thus Manookian’s “How to Claim a Medical Exemption in CA.”

Of course, the decision to shop for a medical exemption is unwise. To get a greater understanding about medical exemptions and how unwise they are, I asked two friends to weigh in. I talked to Dr. Anna Saporito, a family physician from New York, and Dorit Reiss, a professor of law in California.

Manookian claims:

More and more research is showing that individuals with a variety of conditions and genetic mutations are more susceptible to vaccine reactions.

These conditions and disabilities include already existing or a family history of previous vaccine reaction, eczema, food and environmental allergies, asthma, gut issues such as Crohn’s and IBS, autoimmune disease such as diabetes, lupus, MS, rheumatoid arthritis, ASIA, and others, chronic ear, sinus, strep or other infections, Lyme disease, PANDAS, POTS, learning disabilities, speech delay, ADD, ADHD, autism, seizures, bipolar, schizophrenia, thrombocytopenia, genetic variance, impaired methylation, detoxification impairment, and more.

Of course, most of us recognize this claim as fishing for an exemption. After all, can you imagine asking a doctor to forego vaccines for your child because he is prone to strep throat? (Why isn’t there a vaccine for that?) My supposition about this laundry list was right, according to Dr. Saporito, “There are actually very clear guidelines written by the ACIP and CDC outlining medical contraindications for vaccines.” You’ll notice that almost everything listed in Manookian’s litany is missing from the CDC’s guide to who cannot be vaccinated. In fact, many are actually listed on the CDC’s Commonly Misperceived as Contraindications list, including autoimmune diseases (such as diabetes, lupus, MS, etc.). Other items on her list are not included because learning disabilities and neurodevelopmental disorders are not contraindications to vaccines.

Manookian moves on to claim that parents can demand allergy and genetic testing before being vaccinated (with the assumption that something will pop and be used as reason for a medical exemption.) Again, Dr. Saporito notes that this approach is not warranted:

There is no evidence that genetic testing would provide any useful information in the prediction of vaccine reactions. Allergy testing might make sense, but not genetic testing. (If SCID [severe combined immunodeficiency] is suspected, that should be tested for, but usually that diagnosis is already known.) The American Association of Allergists and Immunologists have great guidelines about allergies and vaccines.

It is important to note that the American Association of Allergists and Immunologists’ document discusses how to test for allergies to vaccines after a vaccine is administered. It is not a standard of care to test children without a history of allergies for possible allergic reactions to vaccines they have never received.

Finally, I asked Dr. Saporito her stance on parents shopping for doctors who are more willing to provide medical exemptions for conditions that are not contraindications and whether or not family physicians are more likely to provide a spurious exemption:

The science is quite clear that vaccines are safe. I have vaccinated myself and my own child for this reason. I find it suspect that the doctors who offer this “service” of vaccine exemptions often do no take insurance. It seems there is more of a profit motive than a motive towards public and personal preventative healthcare, something I signed up for when I took my medical oath. In fact the AAFP [American Academy of Family Physicians] just this month came out against non-medical exemptions for vaccines.

From a medical perspective, the answers about medical exemptions to vaccines are as clear-cut as the case for vaccines themselves. However, I did want to find out about a legal perspective. What could happen, legally, to a parent or a doctor who presents a school district with a spurious medical exemption to vaccine requirements?

Dorit Reiss, who is becoming the foremost legal expert concerning vaccine issues, told me:

Manookian’s post is assuming someone can just pressure or get a doctor to give an exemption on false premises. First of all, I think doctors can and should consider reporting parents who are asking them to act dishonestly. The physician’s signature on a medical exemption should be based on true concerns/facts.

A parent getting a medical exemption based on things that don’t justify it doesn’t deserve the exemption.

But what about the doctors? What issues might they face if they become a mill for false medical exemptions?

The reality is that the doctor can probably get away with some of that. There is no mechanism in place for oversight now, and if doctor only gives a few, no one will look.

If a doctor is suddenly giving a lot of medical exemptions, there are a number of things that can happen. First, the Department of Health can try denying them as unjustified – which will probably be challenged in a court, and the department might lose. Second, the Department can bring a complaint with the medical board – and prove the problem. Third, the law can be changed to provide a penalty for abuse.

The doctor has to specify the conditions for exemptions. If a doctor is found to have lied, that could be a reason for disciplinary action.

Arguably, if a doctor provides an argument based on something that clearly shouldn’t be a contraindication that’s also reason for potential action. Most of the conditions Manookian lists aren’t caused by vaccines and are not contraindications. For example, a doctor choosing to help a parent not to protect a child with asthma from pertussis is arguably violating their responsibility.

The legal issues surrounding inappropriate medical exemptions for vaccine requirements, but there is enough gray area that parents should reconsider shopping for a family physician who will give them an exemption when none is warranted. Of course, the greatest disincentive to seeking an inappropriate medical exemption is the consequence of disease for a child left unprotected.

For a parent who has fallen prey to anti-vaccine scare tactics, skirting ethics and the law might seem a risk worth taking, but the real risk comes from the diseases that have historically sickened, maimed, and killed children.

Doublespeak: A Dr. Bob Special

Dr. Bob Sears is the author of a bunch of books, the salesman of supplements, a Fellow of the American Academy of Pediatrics, and a master of doublespeak about vaccines. According to Dr. Bob, he gives vaccines in his office every day. Why, then, does he work so hard to frighten parents about vaccines and downplay the effects of the diseases they prevent?

His newest venture, a supposed non-profit organization called Immunity Education Group (Do Not Link hyperlink), is a case in point. The website itself says almost nothing useful to anyone, but it appears that the real meat of his work is on the associated Facebook page, co-adminned by self-proclaimed data analyst Melissa Floyd.

The past few weeks, I have been ignoring Dr. Bob’s new Facebook page because sometimes ignoring them makes them wither and fade away. But one post last week drew in my attention (and some of my precious time and efforts):

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Since Dr. Bob is so long-winded, I didn’t screen capture the entire post. But this is the part that caught my attention:

Do you see it now? This press conference wasn’t about disease information; it’s the beginning of a hunt for pockets of vulnerability. And, I gotta hand it to them, the CDC’s answer was sheer brilliance. “No, we’re not the bad guys. We won’t share the data. School vaccine laws and sharing exemption information is a STATE and local matter. We’re are staying out of that.” The quotes are my paraphrase of the CDC answer. But the CDC wrapped it up this this statement (my quotes again, but it’s almost word for word):

“We encourage parents to find out their local vaccine exemption levels so that they can work together to help everyone do what’s good for their community.” Yes, they actually said that. It sounded so righteous, useful, and proper yesterday. But when you look at the whole picture, I worry that it’s a portend of what’s to come.

This is why we must work hard to come together, understand one another, start having conversations, accept one another’s varying medical beliefs, and learn to live together in peace and harmony. The current system is working well; diseases are under control, and we have very high vaccination rates. Less than 1% of families make the medical decision to forego vaccines. Coercion is unnecessary and divisive. The alternative, as laid out by the Centers for Disease Control and Propaganda, almost seems like the beginnings of a which hunt: which kids are unvaccinated in YOUR neighborhood, and what are YOU going to do about it?

– Dr. Bob Sears, Immunity Education Group

In other words, Dr. Bob doesn’t want vaccination rates at the school level (or district level, county level, whatever level) shared because he is afraid that it will turn into a “which hunt” for his patients. Or unvaccinated patients in general.

So much about this caught my attention since I was on that same CDC media call. Here’s a screen grab of my less-alarming notes:

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Yes, I cannot use less than symbols properly when typing quickly.

You’ll note the lack of CDC intimating that parents should go out and harass the parents of their children’s unvaccinated classmates. Since 21 states now offer this information, you would think the anti-vaxxers would be recounting these incidents if they were happening. But they aren’t. In fact, most parents I know who seek out this information want to know their child’s chances of being exposed to measles or chickenpox. Others want their children going to schools with high science literacy.

In fact, I’d venture to guess that most parents looking up immunization rates for their schools are using them far more legitimately than those looking up free and reduced lunch rates at schools. All sorts of data is available to parents in ways that preserves the privacy of students.

At one point on Facebook, Melissa Floyd, who is not a doctor, took over the reins of moderating the thread. And things went downhill.

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At that point, I asked Melissa for a citation showing that the CDC claims that immunity against measles lasts for a maximum of 15 years after MMR. I also pointed out that a woman in Washington died from measles. My comment asking for a citation seems to have disappeared, and Melissa moved on claiming that no school district with high PBEs was part of the measles outbreak and other such fabricated bologna. Fortunately, others asked her for a citation, and Dr. Bob jumped in to correct this piece of misinformation, right?

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Oh dang.

So we know that Dr. Bob isn’t very good at math (by his own admission) or at getting information about vaccines correct. He’s not good at social media, and he’s not good at choosing which side has the larger market base (hint: it’s the side with the 95% of parents who vaccinate).

But he’s great at doublespeak.

See, it’s not that measles lasts a lifetime. It’s that the package insert shows antibodies after 11-13 years. Dr. Bob still has antibodies from his MMR. But some adults might not have antibodies. How many adults? Not important. But the vaccine wears off and the CDC recommends boosters for people like pregnant women because of their rubella immunity. Oh, and if you spread misinformation, he will ban you.

It’s almost magnificent, the amount of obfuscation. In fact, he’s saying almost nothing. He is saying both that immunity from measles lasts 13 years, and that it lasts for much longer. He is saying that immunity from the MMR wanes and that it doesn’t for most people. And he is using pregnant women and their need to be immune to rubella as proof that measles immunity…something.

He might as well have posted a William Carlos Williams poem and told people to interpret it as they see fit.

His comment regarding the woman who died in Washington, though, was much clearer. He says we cannot know if she died from measles, and his actions show that he would prefer to believe that she didn’t because then he can’t lull people into believing that protection against death from measles is a matter of nutrition.

But here’s the thing. The coroner and the state department of health think she died from measles:

The death of a Clallam County woman this spring was due to an undetected measles infection that was discovered at autopsy.

The woman was most likely exposed to measles at a local medical facility during a recent outbreak in Clallam County. She was there at the same time as a person who later developed a rash and was contagious for measles. The woman had several other health conditions and was on medications that contributed to a suppressed immune system. She didn’t have some of the common symptoms of measles such as a rash, so the infection wasn’t discovered until after her death. The cause of death was pneumonia due to measles.

Dr. Bob can dissemble and juggle with the truth all he likes, but had this woman not been exposed to measles because of unvaccinated people, she wouldn’t have died.

That one fact, that someone in the United States in the year 2015 has died from an illness we can easily and safely prevent, is not something to ploy coy with. And because of her senseless death, parents want to make sure that their children are in places where such diseases are not spread. And I think that it’s every parent’s right to know how vulnerable their schools are to the spread of preventable disease.

Is Vaccinating a Private Choice?

Last month, the Nursing program at Simmons College contacted me and asked me to respond to this question:

Would you consider vaccines to be a public health issue requiring that they are mandated by the government, or that the issue is a personal choice to be made within the home?

It took me a while to respond because I felt it was a bit of a false dichotomy. However, it is a fair question to ask, and writing a question that balances the idea of rights and responsibilities without making them seem opposed to each other is difficult. Fortunately, along with some other smart people, they did publish part of my answer.

Here is my full, un-edited response:

The primary reason we immunize a child is to protect that child against disease. The science supports the decision to immunize individual children, and vaccines that are not effective for individuals or pose a greater risk than a benefit for an individual are not licensed or are pulled from the market. Because the primary focus of immunization is the individual, it is, in a sense, a personal decision. And we hope that parents and patients make the right decision based on a consultation with their physician where the best medical evidence is used.

However, vaccines also have the intended consequence of community immunity. Immunization is a public health issue that affects not only the individual, but those around him or her who rely on other people vaccinating, either primarily–because he or she cannot be vaccinated–or secondarily–because even the vaccinated benefit from not being exposed to diseases. So vaccines are not a solely private decision. They are a decision that affect entire communities. So public health policy has to be crafted carefully in order to encourage that the best decision is made for the greatest number of people. What the best public health policy is varies from community to community based on many confounding factors.

The question is an intriguing one, and they included some other great answers, and one terrible response from Barbara Loe Fisher that was a rehashing of the word salad I dissected before.

The heart of the question, of course, gets at the nature of rights and responsibilities. Parents have certain rights, but they do not have unrestricted rights when it comes to their children, mostly because their children have rights as well. A child’s right to be healthy and to be protected against harm needs protection. Mostly, we rely on parents to make the correct choices. Usually, I am glad for this liberty because I do like to take my children to get ice cream and let them stay up late and other things that could be seen as potential threats to optimum health.

Disease is different than ice cream, of course, because preventing things like chickenpox, measles, and so forth yields health benefits orders of magnitude greater for a child than saying no to Dairy Queen might. It’s also different because my son’s banana split doesn’t affect the nutritional health of his classmates. Infectious disease is contagious. Brain freeze isn’t.

So parental rights and a child’s right to health are also weighed against community responsibility. Society doesn’t force a parent to vaccinate her child, but it can impose certain consequences for vaccine refusal–restricting access to school being the most severe. Schools, too, have the responsibility to keep students safe and promote good health. My kids can’t buy ice cream at lunch, and they shouldn’t be able to bring chickenpox into the building either.

Ideally, we would live in communities where everyone agrees to these principles and everyone accepts the science behind immunization. But we don’t live in an ideal world, so we each have to do our part to combat vaccine hesitancy.