Tag: ethics

Update on Vaccine Exemption Rates in California

Vaccination rates in California are dropping.

Wait, what?

Didn’t they recently pass a vaccine law that removed non-medical exemptions? How could vaccination rates be dropping?

Update on Vaccine Exemption Rates in California

While SB 277 did indeed remove all non-medical exemptions to getting vaccinated, some folks found a way around it. Since 2015, when it passed, some doctors are giving kids fake or unnecessary medical exemptions. These extra medical exemptions are likely making up for their previous personal belief vaccine exemptions.

The result?

It isn’t fewer exemptions since 2015.

Explain to me how it is ethical to misrepresent the rates of medical exemptions during a measles outbreak?
Explain to me how it is ethical to misrepresent the rates of medical exemptions during a measles outbreak?

While personal belief exemptions are certainly down, medical exemptions keep going up.

In addition to the 0.9% of medical exemptions, another 1.5% of kids, also up as a percentage, are unvaccinated “for other reasons specified under SB 277.”

There are also about 1.7% of kids in kindergarten who enroll as conditional entrants.

Why is that important? Among those conditional entrants are kids with temporary medical exemptions.

And how many kids aren’t vaccinated simply because they are “receiving IEP services?”

So it is not only wrong, it is unethical to try and say that only 0.9% of kids have vaccine exemptions in California this year.

Update on Vaccine Exemption Rates in California’s Clusters

Still, the big story continues to be what’s going on in the clusters of intentionally unvaccinated kids in California and other parts of the United States.

Are they getting vaccinated and protected under SB 277?

Wait, I thought Dr. Bob said that the vaccine exemption rate was just 0.9%. What happened at this Waldorf school? 30% of the kids have medical exemptions!
Wait, I thought Dr. Bob said that the vaccine exemption rate was just 0.9%. What happened at this Waldorf school? 30% of the kids have medical exemptions!

Some actually are!

The MMR rate at the Waldorf school in San Diego was just 44% back in 2014, as a whopping 56% of kids had a personal belief exemption. As sad as it sounds, even though it is still below herd immunity levels of protection, their current MMR vaccination rate of 68% is a big improvement!

Unfortunately, there are many schools with even lower immunization rates. And of course, that means even more students with “medical exemptions” at those schools.

SchoolPMEs
Marin Waldorf School31%
Yuba River Charter64%
Westside Waldorf School37%
Sebastopol Independent Charter45%
Muse Charter50%
Live Oak Charter41%
Nevada City School of Arts31%
Sunridge Charter47%
Santa Cruz Waldorf School34%
Cedar Springs Waldorf School30%
Journey33%
Waldorf School of Orange County33%
Coastal Grove Charter36%
Mariposa School of Global Ed31%
Waldorf School of the Peninsula36%
Maple Village Waldorf School30%

In addition to these permanent medical exemptions (PMEs), some schools also have high rates of temporary medical exemptions.

Medical Exemptions for Vaccines in California are Unusually High

What’s the usual rate of medical exemptions?

As there are few reasons to skip or delay a child’s vaccines, it is lower than those rates.

A lot lower.

In one recent report, Vaccination Coverage for Selected Vaccines, Exemption Rates, and Provisional Enrollment Among Children in Kindergarten — United States, 2016–17 School Year, the median rate of medical exemptions in the U.S. was just 0.2%, with a range of <0.1 to 1.5%.

Also unusual is that in some cases, many of those exemptions are written by just a few doctors. In fact, families often go to these doctors just to get their kids their medical exemptions!

“…the removal of nonmedical exemptions in California was initially effective in increasing vaccination rates, but the substitution between exemption types may render the repeal partially ineffective in improving immunization coverage and preventing VPDs over time.”

Richwine et al on Do Stricter Immunization Laws Improve Coverage? Evidence from the Repeal of Non-medical Exemptions for School Mandated Vaccines

How do we fix this and get more kids vaccinated and protected?

“Beyond fostering compliance, tightening the requirements around medical waivers will also aid in promoting public policies that protect public health.”

Richwine et al on Do Stricter Immunization Laws Improve Coverage? Evidence from the Repeal of Non-medical Exemptions for School Mandated Vaccines

In addition to closing the loopholes that allow some doctors to abuse medical exemptions, it will be important to help parents be more skeptical and see through the anti-vaccine propaganda that other doctors use to scare parents away from vaccinating and protecting their kids.

Vaccines are safe, with few risks, and are obviously necessary.

More on Vaccine Exemption Rates in California

Who Is Arthur Caplan?

Plenty of folks claim to be experts on vaccines.

Some are experts because they study epidemiology, others because they study immunology or infectious disease.

And then there are the experts in vaccination ethics.

Who Is Arthur Caplan?

With a Ph.D. in the history of philosophy of science, Dr. Art Caplan went on to co-found The Hastings Center, a bioethics research institute.

Arthur Caplan does a good job of calling out folks who push anti-vaccine misinformation.
Arthur Caplan does a good job of calling out folks who push anti-vaccine misinformation.

He has since written dozens of books and nearly a thousand articles in peer-reviewed journals, working most recently at New York University’s Langone Medical Center, where he is the founding head of the Division of Medical Ethics.

“When politicians ignore the evidence, fail to cite appropriate medical authorities, and rely on hearsay and rumor, with the result that people — out of ignorance or error — don’t vaccinate their children, we can and should deny them elective office. When a doctor does so, we should demand that he forfeit his right to use his medical degree to misinform, confuse or lie.”

Arthur L. Caplan on Revoke the license of any doctor who opposes vaccination

It shouldn’t be a surprise that Art Caplan has a lot to say about vaccines.

“Faulty ethical thinking is to blame. We are elevating parents’ rights to make misinformed decisions over the rights of children to get important vaccines. Infants and young children are blocked from receiving their routine childhood immunizations by parents who espouse an aberrant ideology of choice or are being duped by anti-vaccine groups. In so doing, they are violating children’s rights to health, welfare and equal opportunity.”

Arthur L. Caplan and Peter J. Hotez on Anti-vaccine misinformation denies children’s rights

He also has a lot to say about measles, other vaccine-preventable diseases, and how to get control back before these outbreaks turn into true epidemics.

“What should we be doing to protect our communities, our children, and ourselves? We should halt the spread of anti-vaccine misinformation and take steps to stop nonmedical vaccine exemptions. We need to restore vaccines and vaccinations as the “new normal” in America.”

Arthur L Caplan on Let’s Treat Measles Seriously

Are you still thinking about skipping or delaying your child’s vaccines?

After reading some of Dr. Caplan’s work, you should know that it’s not safe, has no benefits, and isn’t the ethical thing to do.

More on Arthur Caplan and Vaccine Ethics

Did Edward Jenner’s Son Die from a Vaccine Reaction?

Maybe people know that Edward Jenner first gave his new smallpox vaccine to James Phipps, the 8-year-old son of Jenner’s gardener.

What they might now know is that two years later, in 1798, he also vaccinated his own son Robert F. Jenner, when he was eleven months old.

Did Edward Jenner’s Son Die from a Vaccine Reaction?

Did he die after getting vaccinated?

Did he suffer brain damage?

Of course not!

Edward Jenner vaccinated his youngest son, Robert.
Edward Jenner vaccinated his youngest son, Robert.

He didn’t even have a reaction and was later inoculated after being exposed to smallpox.

“My two eldest children were inoculated for the smallpox before I began to inoculate for the cow-pox. My youngest child was born about the time my experiments commenced, and was among the earliest I ever vaccinated. By referring to the first work I published on the subject in the spring of the year 1798, page 40, you will find his name, Robert F. Jenner, and you will observe it noticed that on his arm the vaccine lymph did not prove infectious. It advanced two or three days, and then died away.”

Edward Jenner on the Life of Dr. Jenner

He died 56 years later.

Edward Jenner’s other children didn’t receive his smallpox vaccine. As they were all born before his experiments with cowpox, they had already received traditional smallpox inoculations.

“Edward is growing tall, and has long looked over my head. Catherine, now eleven years old, is a promising girl; and Robert, eight years old, is just a chip of the old block.”

Edward Jenner on the Life of Dr. Jenner

Edward Robert Jenner did die young, but it certainly wasn’t an effect of his father’s smallpox vaccine. He died of tuberculosis, which was a common killer at the time. He was 21 and had always had health problems, but again, he never received his father’s new vaccine, so how could he be the “first child to suffer vaccine damage???”

This myth is easy to debunk. Jenner's son that died young was never vaccinated!
This myth is easy to debunk. Jenner’s son, Edward, that died young was never vaccinated!

What about the ethical implications of giving an experimental vaccine to your own child? A vaccine made with cow pus?

Remember, Jenner’s smallpox vaccine was made with cowpox virus. It was replacing variolation, a procedure in which people were actually inoculated with smallpox virus. While much better than getting smallpox, variolation was still dangerous and some people died from the procedure.

His smallpox vaccine was a much safer option.

More on Edward Jenner’s Son

Is the MMR Vaccine Licensing Being Called into Question?

Why do some folks think that the MMR vaccine licensing is being called into question?

Yup. That’s what the usual suspects are trying to make you think.

Is the MMR Vaccine Licensing Being Called into Question?

Taking advantage of the fact that many sites publish all press releases, these folks want you to think that a major news site is following their latest bombshell, which of course is just another dud.

The MMR was licensed in 1971. The ICAN papers are from 1978…

You mean there really isn’t an FDA coverup?

“Clinical studies of 284 triple seronegative children, 11 months to 7 years of age, demonstrated that M-M-R II is highly immunogenic and generally well tolerated.”

MMR II Package Insert

Not only is the package insert very transparent about the studies used to approve the MMR II vaccine they are talking about, since only a minor change was made to the original MMR vaccine, which was approved in 1971, it isn’t surprising that larger trials weren’t required at the time.

So there were earlier, larger trials?

Yup.

But did they use a saline control group?

Nope.

A Vaccinated vs Unvaccinated Study - Stokes et al on Trivalent combined measles-mumps-rubella vaccine. Findings in clinical-laboratory studies.
A Vaccinated vs Unvaccinated Study – Stokes et al on Trivalent combined measles-mumps-rubella vaccine. Findings in clinical-laboratory studies

The control group was actually unvaccinated.

It is also important to keep in mind that this study, and a few other MMR studies, followed much, much larger studies of the individual measles, mumps, and rubella vaccines.

“The large majority of children in the United States have been vaccinated against measles and a sizable portion have been given mumps and rubella vaccines. It is estimated by us based on vaccination distribution that about 41 million children have received measles vaccine, 7 million mumps vaccine, and 21 million rubella vaccine. The combined triple vaccine provides a simple, safe, and effective immunization procedure using a single vaccine dose against three important diseases in children who have not yet been immunized.”

Stokes et al on Trivalent combined measles-mumps-rubella vaccine. Findings in clinical-laboratory studies.

Much larger double-blind, placebo-controlled studies of the individual measles, mumps, and rubella vaccines.

This is why you don’t routinely do vaccinated vs unvaccinated studies anymore. It is unethical to let kids get measles, mumps, rubella or other diseases.

The bottom line is that the measles (1968), mumps (1967), and rubella (1969) vaccines were safe when they were approved by the FDA.

The MMR (1971) was safe when it was approved by the FDA.

And MMR-II (1978) was safe when it was approved by the FDA.

Since then, there have also been studies showing that getting a second dose of MMR-II is safe and effective and that ProQuad, the combination measles, mumps, rubella, and chickenpox vaccine is safe and effective, although it is associated with a small increased risk of febrile seizures if given as a first dose.

There is no FDA coverup. No bombshell.

Just anti-vaccine folks continuing to try and scare you away from vaccinating and protecting your kids.

More on the Licensing of the MMR Vaccine