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.