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’re banning me!

Like so many of you, I have been banned from Dr. Bob Sears’ Facebook page. While it isn’t headline-making news, I wanted to write about the comment that got me banned because it highlights, once again, that Dr. Bob is anti-vaccine.

The problem began when he posted something on his Facebook page that stirred in me the inability to stay silent:

“DEATH IS THE ONLY LEGITIMATE VACCINE EXEMPTION . . .”

. . . said the former doctor of one of my patients-to-be. I kid you not. My wife, Cheryl, who manages the office, sometimes picks up the new patient messages on our voicemail. She never has me listen to any of them because, well, that would be stupid. But she grabbed me the other day and said, “You have to listen to this. You’re not going to believe it.”

I didn’t. Believe it, that is.

A mom actually called our office and said she needed a new pediatrician because her old one wouldn’t even discuss vaccine medical exemption with her. Now, of course, that part’s believable. There are hundreds of thousands of doctors nationwide who won’t even discuss these exemptions. And if they choose not to offer informed consent for invasive medical treatments for their patients, that’s their decision. It’s also a patient’s right to leave their care.

But this doctor took it a step further. Well, a giant leap further. The message on our phone actually was “My doctor said death is the only legitimate vaccine exemption . . . and I disagree. So I’m looking for a new doctor.”

I can’t wait to hear the whole story. I hope this patient comes in soon. We’ll see if we can find something in her child’s medical and family history that qualifies for an exemption short of death.

Dr. Bob

Everyone I have spoken to has two reactions to this post.

  1. That sounds like something that never happened.
  2. Does that mean Dr. Bob is going to sell this woman an illegitimate medical exemption?

But my reply actually gave Dr. Bob the benefit of the doubt:

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“I hope that when this parent comes in, you share with her that the contraindications to vaccines are discrete and that if her child does not fit into any of those contraindications, she is not eligible for a medical exemption.”
I also directed Dr. Bob to the list of contraindications to vaccines. This comment does not attack Dr. Bob nor does it treat him or anyone else disrespectfully. It simply points out that there are only so many contraindications to vaccines, and that a medical exemption outside those contraindications is inappropriate.

It is possible the reason for my ban was the only other comment I left on that thread. Unfortunately, I did not get a screen shot, but it was in reply to a woman who was replying to my friend’s comment, a reply filled with references to Thalidomide and smoking as proof that vaccines are terrible. Here is her reply to me:

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I cannot imagine I was banned for pointing out that Thalidomide was never approved by the FDA (fun Women’s History Month fact) or that measles and chickenpox parties, like smoking, used to be acceptable health practices, but now that science has moved on, they no longer are.

But it is significant to me that the commenter above, and others like her, were left on the page to comment freely. The woman above, for example, began her reply to my friend with this dig about her as a mother and about how she gave birth:

Do you have biological children? If so, did you have them without any drugs? If you do, or did then that true bond would not allow you to push for all these vaccines and boosters in your flesh and blood. Other countries have excellent scientists who are against so many vaccines in such a short time. I bet you only had a fraction of the vaccines that babies are subjected to these days

Yes, you read that correctly. If you had a pain-free birth, you don’t love your children and that’s why you vaccinate them.

That comment, along with the mountain-loads of misinformation posted by Dr. Bob’s fangirls, was left untouched and uncorrected by Dr. Bob because it plays into the fear of medical interventions and other doctors he promotes in order to drum up his own business and grow his own brand.

Do me a favor, friends, and call him on it–because I no longer can.

 

 

 

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.

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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:

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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:

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.

Stealing from Dr. Bob

It’s hard not to be sarcastic about Dr. Bob Sears. His work promoting untested alternative vaccine schedules and stoking fears about vaccines (and autism and gluten and so forth) doesn’t seem to be enough for Time Magazine.

Dr. Sears writes: "DR PAN STOLE MY AWARD."
Dr. Sears writes: “DR PAN STOLE MY AWARD.”

Of course, Dr. Bob is joking. He’s always joking. That one time when he wrote a highly sexist Facebook post about how mothers and fathers parent differently?  “And to avoid offending both of you dads who read my blog, realize that this is a satirical poke at an unjust and inaccurate stereotype that has been unfairly thrust upon us men (insert emoticon that depicts me winking at moms everywhere).”

It’s always just satire–a joke with a winking emoticon. And so we can be assured that this, too, must be satire. Dr. Bob can’t really see himself as a hero of vaccination, can he?

After all, what is his record? According to Dr. Bob, he is pro-vaccine:

I give vaccines every single day in my office. I am pro-vaccine and understand that vaccines work and have reduced and eliminated many serious diseases. And that’s not just spouting a party line – I firmly believe that, and that’s why I give them in my office.

If the threshold for a vaccine hero is someone who does what every single other pediatrician and family physician in the country does, then all the doctors that give vaccines are heroes. And there is some merit to that, but it would be hard to feature them in Time. It would be an awfully thick magazine.

Of course, Dr. Bob doesn’t want to be remembered for preventing infectious diseases. He wants to be remembered for being nice to parents. He likes making parents like him (thus the sexist satire–oh wait). In a HuffPo article, Dr. Bob claims that he is one of the few doctors who respect parents by giving in to their fears and creating an alternative vaccine schedule for them. The need for doctors like him is apparently so great that he’s created a list of doctors who will eschew science in order to elicit warm fuzzy feelings from parents:

I’ve been creating a growing list of Vaccine Friendly Doctor’s on my website who WILL listen and respect these patient’s wishes and who will provide an alternative vaccine schedule for patients who want to vaccinate differently.

Earlier in that article, he claims that the AAP recommends creating alternative vaccine schedules for parents. This claim, of course, is untrue, as a recent statement about on-time immunization from the AAP shows: “There is no ‘alternative’ immunization schedule. Delaying vaccines only leaves a chil​d at risk of disease for a longer period of time; it does not make vaccinating safer.”

So actually, Dr. Bob isn’t doing what every pediatrician and family physician across the country is doing. Almost all of them (save those listed by Dr. Bob) are following a standard of care and AAP guidelines by giving those vaccines to their patients on time. And for patients who are nervous or hesitant, they are still recommending on-time immunization and doing their best to navigate parental fears while being aware of the needs of the child to be protected against disease. That last part, where we protect children, is lacking from Dr. Bob’s insistence that we respect parents’ fears.

Still, Dr. Bob bravely runs a Facebook page–wait, two Facebook pages, and writes his books and sells his supplements. Meanwhile, Dr. Pan, stealer of magazine hero awards, has not sold supplements. While being one of those doctors who follows the standard of care and the AAP guidelines, Dr. Pan, a state Senator, has also taken on legislation amidst outbreaks of measles to prevent future outbreaks and create healthier, disease-free schools.

Dr. Bob earns profits from his books and his supplements. Dr. Pan, meanwhile, received death threats from anti-vaxxers. He is facing efforts to recall him from office. Anti-vaxxers have portrayed him as Hitler. In fact, some of Dr. Bob’s supporters have gone full Godwin on Dr. Pan:

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On the other hand, Dr. Sears has used the California legislation to travel the state, speaking to parents about ways to circumvent the law. Dr. Gorski uncovered evidence suggesting Dr. Sears might be selling illegitimate medical exemptions for vaccines at these events:

At one point, a woman approached and told Dr. Bob that her pediatrician whom she otherwise liked would not issue an exemption, asking if he would see her for a one-time visit. His response? “I would be happy to provide that service.” He also confirmed that a one-time medical exemption visit is $180 and that he’d be willing to issue such an exemption and send the child back to his primary pediatrician.

In short: the legislation Dr. Pan crafted based on best medical practice earned him taunts, threats, and recall efforts. But this legislation that Dr. Bob opposed has earned him more earning potential.

While he might be joking, Dr. Bob’s assertion that Dr. Pan “stole” something from him has the kernel of truth that all satire (good or bad) has. Dr. Pan didn’t steal any prestige or accolades from Dr. Bob, but he did steal some publicity that would have been profitable to cash in on. Perhaps for that we can be glad.

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.

Let’s Teach Olivia the Truth About Vaccines

Of course passing SB277 in California (the bill that ends the personal belief exemption) does not end discussions about vaccines or about the best way to raise immunization rates in every community and every school. In fact, there’s a legitimate debate we should still have about how to legislate vaccine requirements.

What isn’t legitimate, however, is a newly-released YouTube video that frames the discussion about the legislation (and the hoped-for referendum to repeal it) in terms of all the anti-vaccine tropes one fictional girl could throw at us.

The video features a young, partially vaccinated girl named Olivia. Olivia tells us that SB277 is bad and unfair, but–like many children–she is ill-informed about vaccines. One can only assume that Olivia’s parents have read scary things on the internet or taken her to see a charlatan-pediatrician who peddles books and supplements along with medical advice. In fairness to Olivia, I’d like to take the time to correct some of her misstatements.

1. We give too many vaccines at once (or at all).

Parents often worry about how many vaccines their children are given, despite the fact that vaccines today contain thousands fewer antigens than they did when I was a child. In fact, even though vaccines might make a child come down with a fever or feel sluggish for a day or two, each one contains only a handful of antigens and challenge the immune system much less than the thousands of germs a baby encounters while eating, breathing, and generally being alive. If Olivia’s parents are worried about too many vaccines, they might want to put her in a bubble because germs (and the other ingredients in vaccines) are literally all around her always.

2. Parents have the Constitutional right not to vaccinate their children.

I am not a Constitutional lawyer, but I’m going with no. And the Second Circuit U.S. Court of Appeals agrees. Just this year, they rejected a challenge to New York’s law that mandates all children be vaccinated for school.

3. Children receive 49 doses of 14 vaccines. And that’s a scary big number.

Olivia’s parents are upset that vaccines prevent 14 disease in children before they reach the age six. These are the diseases that used to maim and kill children–diseases like diphtheria, polio, Hib, and even chickenpox.

Unfortunately, Olivia’s parents have also taught her to add wrong. Looking at the CDC schedule, I count 29 doses of vaccines (and 37 if you count the yearly flu vaccine). How are the anti-vaxxers getting 49 doses? I think they are counting each component of each vaccine separately. For example, they are counting the MMR as three vaccines.

Still, even counting boosters as separate vaccines is sort of silly. Boosters help strengthen immunity (or catch those who didn’t mount full immunity the first time). Except in the case of the yearly flu vaccines, boosters are not new vaccines and do not present brand new challenges to the immune system. So the real number to be concerned over is 14, and the number 14 signifies the diseases you are working to protect your children from.

4. The Disneyland measles outbreak wasn’t a big deal because only a few kids got sick.

In other words, the herd is robust enough for Olivia to hide within that no one should ask her parents that she contribute to it. Dr. Wendy Sue Swanson brilliantly pointed out the success story behind the Disneyland measles outbreak: most people were vaccinated, so it wasn’t worse. But Disneyland pointed out a crack in herd immunity and showed us that if we allow more children to hide in the herd, the strength of the herd could disappear and more of those children could get sick–especially consider how infectious measles is.

5. No one has died from measles.

Besides this Washington woman, who should have been able to rely on herd immunity to keep her safe but couldn’t.

And though her death is billed the first in 12 years, Dr. Ianelli has found other measles deaths in the U.S., including those who have died from the horrifying SSPE complication that can occur years after measles infection.

6. Herd Immunity in California is fine.

I argued before that while herd immunity might be high across the country or the state, the statistic that really affects the individual child is the vaccination rate where the spend the majority of their time in close proximity with germy people: their classroom and their school. And sometimes those rates are really, really low. In fact, the Atlantic highlighted during the outbreak that some communities in Los Angeles have immunization rates as low as the South Sudan.

7. The government claims that vaccines are 100% safe.

What? Where did Olivia’s parents hear this? Everything I have seen from the government and from pharmaceutical sources shows that vaccines are not 100% anything, but that the risks of not vaccinated are far larger than the risks of vaccinating. Here’s a little quote from the CDC not saying that vaccines are 100% safe:

Vaccines are the best defense we have against infectious diseases; however, no vaccine is actually 100% safe or effective for everyone because each person’s body reacts to vaccines differently.

8. Thousands people are injured by vaccines.

The original source of this is Dr. Bob Sears, and he is using VAERS to add up reported adverse events, even though the VAERS website itself states that anyone can report anything on VAERS (including turning into the Incredible Hulk) and that those reports do not prove that vaccines caused the event.

PolitiFact analyzed Sears’ numbers and allowed him to comment, but concluded that this claim is “Mostly False.”

9. Vaccine Court has paid out thousands of settlements.

I call this the “If the glove doesn’t fit, you must acquit” argument since courts are never definitive proof of anything. Vaccine Court (NVICP) provides a valuable service to the very few families who suffer suspected vaccine-related injuries. However, the burden of proof for winning a settlement is very low, and the court may compensate cases that are not genuinely caused by vaccines.

But let’s assume for a moment that all the cases settled in Vaccine Court (NVICP) are caused by vaccines? Even those numbers show how amazingly safe vaccines are. As Allison Hagood explains:

If you included all adult vaccinations, and counted number of injections rather than number of vaccinated persons, you’d get something that probably looks like 99.9999999999999999% of child and adult vaccinations resulting in no serious adverse events.

10. Hundreds of vaccines are currently being developed.

The insinuation Olivia is making is that soon, children will be required to get hundreds of vaccines before entering school. The truth is, though, that very, very few vaccines under development ever make it to mark. Developing a new vaccine is very difficult, and most fail to show effectiveness and safety at some point and the work on them ceases.

But what of these vaccines under development? They include vaccines for Alzheimer’s, HIV, and pancreatic cancer. These are not vaccines that will be added to the childhood schedule.

Conclusion

Once again, the anti-vaccine movement is trying to push policy by promoting misinformation and obfuscation. Policy debates ought to have facts at their center. Pushing through a referendum with misinformation is par for the course for anti-vaxxers, and that’s why they are being given fewer seats at the policy discussion table.

You Do Not Own Your Children

Nothing irks me more than the anti-vaccine rally cry of “My Child, My Choice” or the insistence by parents of unvaccinated children that their decision to eschew preventative care is a parental right.

The moment the nurse hands your baby to you, you cannot help but examine every square centimeter of her. Those tiny fingernails, those puffy eyelids, those little ears–every piece of the baby needs a nibble or a nuzzle. The feelings of being forever tied to this little body and this young life or overwhelming.

But those feelings do not give you ownership rights over your child. As your child grows, it becomes obvious that you cannot make your child be or feel or live the way you choose. Your child’s life belongs to your child. Your child ultimately owns his own body and is growing into the responsibility of caring for himself. As your child grows, it is your responsibility to take care of him. You are not your child’s owner; you are his caretaker.

Yet, the anti-vaccine movement gets far in framing the vaccination as a freedom-of-choice and parent rights issue. Mothering magazine maven Jennifer Margulis argues:

Unlike in the United Arab Emirates, in America we believe parents are capable of making their own decisions about their children’s health. We believe in freedom of choice. This freedom of choice extends to when — and even whether— parents vaccinate their kids.

Her wording is clever. We aren’t those terrible un-American Arabs, we are American (cue John Philip Sousa). Either you believe in some sort of vague, repressive, Sharia law philosophy, or you are for freedom, America, and allowing parents to refuse vaccines.

What exactly is this choice that anti-vaccine activists think they have a right to? One conservative magazine published an article that claimed: “If parents think that getting measles is a lot better than acquiring a lifelong mental disorder, they should be able to make that choice, especially for diseases that aren’t generally deadly.”

In other words, if parents believe, despite all evidence to the contrary, that vaccines cause autism and that autism is worse than measles, it is only American to give them to right to make medical decisions based on these falsehoods. The right to refuse vaccines for your child is the right to believe fear-mongering about autism, to believe that autism is the worst possible outcome while also believing that measles isn’t a big deal, to deny that globally, 17 people die from measles every hour every day. It is to think that those measles deaths happen to the other people far away and to choose to believe that the woman in Washington state who just lost her life to measles is part of some conspiracy.

Anti-vaccinationists assert that they have the God-given right to make medical decisions about and for their children, but basing these decisions on the worst possible misinformation casts doubt on whether or not they are capable of making such decisions.

In the end, however, their capabilities are irrelevant. No parent has complete and unfettered rights to making medical decisions for their children. Just ask the parents of Daniel Hauser, who were ordered by the court in 2009 to bring their son in for chemotherapy for his Hodgkins Lymphoma.

The Journal of Ethics summed up the issue of medical care and parental rights well:

Medical neglect statutes examine whether appropriate care was provided, not how it was provided. A parent who refuses care based on an objection to treatment, whatever the basis, is just as likely to have the state intervene to make medical decisions as a parent who is not physically able to provide care or not mentally capable of making decisions.

Anti-vaxxers love their children and their beliefs are sincere, but they don’t own them and they do not have complete, unobstructed say over their children.

But what of choice? Isn’t choice American, even if the choice is wrong? After all, many people choose to listen to Nickleback or cheer for the Packers. Isn’t it American to defend the wrong choices of others because we believe in freedom?

Unlike putting cheese on your head or listening to bad music, the choice to refuse immunization for your children has consequences for other people: people going through chemotherapy or people who have undergone organ transplants or people who are new and too young to be immunized. America might be about freedom, but we are also about responsibility. If Nickleback carried the potential to kill children with cancer, we would outlaw them forthwith.

Lastly, children have rights. Parental rights are equal to the rights of the child, not greater than them. Children have the right to be taken care of and to be protected against things which might harm them. For this reason, we mandate by law car seats, educational standards, and bicycle helmets for children. A parent’s belief system is never factored into the freedom to choose these mandates. If we hand over full ownership of a child to any parent, we might as well erase decades worth of work gaining rights for children.

I have no doubt that anti-vaccine parents want the best for their children and want to protect them. However, their intentions and beliefs ought not to overrule the rights of their children to best medical practices. Though an anti-vaccine parent wants the best for her child, the science tells us that they are not providing the best for their child. The issue has nothing to do with freedom or choice or parental rights. It’s about keeping kids from getting sick.

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.

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.

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.

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

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.

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:

Screen Shot 2015-06-26 at 3.17.45 PM

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 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:

Screen Shot 2015-06-26 at 2.17.47 PM

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.

Screen Shot 2015-06-22 at 8.31.54 AM

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.
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.