Tag: abuse

What Is Vaccine Choice?

Have you heard about the idea of vaccine choice?

The “right to choose” is being pushed by anti-vaccine groups in many states because they think that laws mandating kids to have vaccines to go to daycare, school, and college violates their parental rights and civil liberties.

“Their claim that vaccines are 100% safe and effective for all people all of the time is not based in science and is not supported by facts or evidence, making it more of a religious belief than an adequate basis for their mandate argument.”

Texans for Vaccine Choice

And of course, they use a lot of anti-vaccine talking points to try and scare parents into believing them. Vaccines are safe and they work, but no one says that they are 100% safe or that they are 100% effective.

What Is Vaccine Choice?

Right away, you should see another big problem with the vaccine choice movement.

No one is forcing anyone to get vaccinated. Everyone has a choice. It’s just that some folks don’t like the consequences that come with that choice of not vaccinating their kids – having to home school their kids instead of going to a public or private school.

So basically, vaccine choice is just the anti-vaccine movement moving the goal posts yet again.

“If you ask a parent of an autistic child if they want the measles or the autism, we will stand in line for the f–king measles.”

Jenny McCarthy

Study after study showed that vaccines are not associated with autism and what did we get, measles outbreaks in unvaccinated kids.

What’s Missing In the Vaccine Choice Argument?

In addition to facts, one big thing that is missing from the vaccine choice argument is that by pushing the idea that unvaccinated kids should be allowed to skip or delay any or all vaccines without consequences, that takes away the choice for the rest of us who want to keep our kids protected from vaccine-preventable diseases.

Can’t we just vaccinate our kids?

Many children with cancer and other medical conditions benefit from herd immunity.
Many children with cancer and other medical conditions benefit from herd immunity. (CC BY 2.0)

We do!

But that doesn’t take away all of the risk if you don’t vaccinate your kids.

“…the increased risk of disease in the pediatric population, in part because of increasing rates of vaccine refusal and in some circumstances more rapid loss of immunity, increases potential exposure of immunodeficient children.”

Medical Advisory Committee of the Immune Deficiency Foundation

There are kids who are too young to be vaccinated or fully vaccinated, kids who can’t be vaccinated because of true medical vaccine exemptions, and folks whose vaccine didn’t work, after all, vaccines aren’t 100% effective.

The “choice” folks don’t talk about those things though.

Make an informed choice about vaccines before you think about leaving your child unvaccinated and unprotected.

What To Know About Vaccine Choice

Listen to anti-vaccine propaganda, skip or delay vaccines and leave your kids unprotected or do your research and understand that vaccines work and are safe and necessary and get them vaccinated and protected – that’s your vaccine choice.

More on Vaccine Choice

Abuse of Vaccine Exemptions

Every state has laws mandating vaccines to attend school and daycare.

Every state also allows exemptions to those mandates, including:

The way that  these laws and exemptions are set up leaves a lot of room for abuse though.

Abuse of Religious Exemptions

How many religions are actually against kids getting vaccinated?

That’s right, almost none.

So why are there so many religious vaccine exemptions in most states, especially in states that don’t have a personal belief exemption?

Right again.

Folks who don’t want to vaccinate their kids, and can’t use a personal belief exemption, just say that vaccinating them would be against their religion.

Abuse of Medical Exemptions

There are some children who shouldn’t be vaccinated.

These children can get a true medical exemption to one or more vaccines because they have a real contraindication or precaution to getting vaccinated.

“If a child has a medical exemption to immunization, a physician licensed to practice medicine in New York State must certify that the immunization is detrimental to the child’s health. The medical exemption should specify which immunization is detrimental to the child’s health, provide information as to why the immunization is contraindicated based on current accepted medical practice, and specify the length of time the immunization is medically contraindicated, if known.”

Dear Colleague letter regarding guidelines for use of immunization exemptions

Fortunately, these medical reasons to skip or delay vaccines are not very common and are often temporary. They can include the contraindications and precautions listed in the package insert for each vaccine and by the Advisory Committee on Immunization Practices, with the most common medical exemptions being:

  • a severe allergic reaction to a previous dose
  • a severe allergic reaction to a vaccine component
  • a known severe immunodeficiency and live vaccines
  • a moderate or severe acute illness with or without fever (precaution)
  • a progressive neurologic disorder (precaution)
A family history of these conditions would not be a reason to skip or delay any vaccines.
Although it will get you a medical exemption for just $120 in California, a family history of these conditions would not be a reason to skip or delay any vaccines.

Most other things are “incorrectly perceived as contraindications to vaccination” and should not be a medical exemptions, including having :

  • a mild acute illness with or without fever
  • a mild to moderate local reaction
  • relatives with allergies
  • a family history of seizures
  • a stable neurologic condition
  • an autoimmune disease
  • a family history of an adverse event after DTP or DTaP administration

A medical exemption can also exist if your child already had the disease and so has natural immunity. In most cases, except for chicken pox disease, titers will likely need to be done to prove that your child already has immunity.

Stopping the Abuse of Vaccine Exemptions

We know that vaccine exemptions are being abused.

How do you stop it?

“Permitting personal belief exemptions and easily granting exemptions are associated with higher and increasing nonmedical US exemption rates. State policies granting personal belief exemptions and states that easily grant exemptions are associated with increased pertussis incidence.”

Omer et al on Nonmedical exemptions to school immunization requirements: secular trends and association of state policies with pertussis incidence.

You likely have to make it harder to get a vaccine exemption.

Strong exemption laws, which are needed in many states, make it clear that:

  • many exemptions are temporary
  • medical exemptions are based on ACIP guidelines, current accepted medical practice, and evidence based medicine – not anecdotes
  • religious exemptions specifically exclude philosophical exemptions and must reflect a sincere religious belief
  • exempted students will be excluded from school during outbreaks
  • exemptions should include a signed affidavit that is notarized
  • exemptions should be recertified each year
  • a separate exemption application will be needed for each vaccine

Getting an exemption shouldn’t be easier than getting vaccinated! And it should include some degree of education against the myths and misinformation that scares parents away from vaccinating their kids.

“Because rare medically recognized contraindications for specific individuals to receive specific vaccines exist, legitimate medical exemptions to immunization requirements are important to observe. However, nonmedical exemptions to immunization requirements are problematic because of medical, public health, and ethical reasons and create unnecessary risk to both individual people and communities.”

AAP on Medical Versus Nonmedical Immunization Exemptions for Child Care and School Attendance

You could also get rid of nonmedical vaccine exemptions.

Of course, for that to work, you can’t allow just anything to count as a medical exemption.

“Review of all medical exemption requests will be conducted at the Mississippi State Department of Health by the State Epidemiologist or Deputy State Epidemiologist.”

Mississippi Medical Exemption Policy

In Mississippi, for example, where medical exemptions are reviewed and approved by the State Epidemiologist or Deputy State Epidemiologist, there were just 208 medical exemptions in the whole state during the 2016-17 school year.

In some states, rates of medical exemptions might be six or seven times higher. This is mostly seen in states that don’t allow personal belief exemptions and make it difficult to get a religious exemption.

That seems to be the case in Nebraska, where there are no personal belief exemptions and you have to submit a notarized statement to get a religious exemptions. Their high rates of medical exemptions likely reflect some abuse and the fact that medical exemptions aren’t reviewed or approved by anyone, they just reflect “that, in the health care provider’s opinion, the specified immunization(s) required would be injurious to the health and well – being of the student or any member of the student’s family or household.”

As we are seeing, that simply invites vaccine exemption abuse.

Very few states currently require that exemption applications go to the health department for review. Those that do include Alabama, Arkansas, Michigan, Minnesota, Mississippi, and West Virginia.

California is notably absent. I guess they didn’t see the potential for abuse when they passed their latest vaccine law. I mean, who could have guessed that doctors would actually be selling medical exemptions to parents based on unrelated conditions, like a family history of diabetes, celiac disease, or autism?

The non-medical vaccine exemption form in Colorado includes information on the risks of each vaccine-preventable disease.
The non-medical vaccine exemption form in Colorado includes information on the risks of each vaccine-preventable disease.

At the very least, until we have stronger exemption laws, parents who want to get a nonmedical exemption should acknowledge that they understand the risks they are taking when they skip or delay their child’s vaccines.

What to Know About Abuse of Vaccine Exemptions

While medical exemptions are necessary for kids who have true contraindications to getting vaccinated, stronger laws can help decrease the abuse we see in medical, religious, and personal belief vaccine exemptions.

More Information on Abuse of Vaccine Exemptions