Tag: exemptions

Hiding in the Herd

The term herd immunity has been used for almost 100 years, since about 1923.

Other terms relating to herd immunity, like ‘hiding in the herd’ and ‘free-riding’ have come into use more recently.

Hiding in the Herd

Some people can get away with hiding in the herd.

Actually, they depend on it.

“Herd immunity is present in a community when such a high percentage of its members have been immunized from a particular disease that the disease cannot gain a foothold in the community. Thus, achieving and maintaining herd immunity protects not only those who have been vaccinated, but also those with compromised or weak immune systems, such as the elderly, babies, and those afflicted with HIV.”

Anthony Ciolli on Mandatory School Vaccinations: The Role of Tort Law

That’s because we don’t need 100% of people to be vaccinated and protected for herd immunity to work.

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)

So people who are too young to be vaccinated or fully vaccinated, people who can’t be vaccinated because they were born with an immunodeficiency or get cancer and are on chemotherapy and other true medical exemptions, and even people who are vaccinated but their vaccine didn’t work, can still hope to be protected from vaccine preventable diseases because everyone around them is vaccinated.

These people still get the benefits of herd immunity. Even though they are unvaccinated and susceptible to getting a disease, they probably won’t, because most others in the herd are vaccinated and protected.

But it is not just those people with medical exemptions who try and hide in the herd.

“These numbers have led the National Vaccine Advisory Committee to conclude that religious and philosophical exemptions do not pose a threat to public health.”

T May on Free-riding, fairness and the rights of minority groups in exemption from mandatory childhood vaccination

And that was okay too for a while. It wasn’t that long ago that “free-riding” by those using philosophical or religious exemptions wasn’t a problem, because their numbers were small and herd immunity rates could still be maintained.

Can You Hide in the Herd?

Hiding in the herd can’t work for everyone though.

Surprisingly, Dr. Bob explains that well in his vaccine book that scares parents about toxins in vaccines, while reassuring them that it is okay to space out their child’s vaccines.

“I also warn them not to share their fears with their neighbors, because if too many people avoid the MMR, we’ll likely see the diseases increase significantly.”

Dr. Bob Sears in The Vaccine Book

Basically, if too many people are trying to hide in the herd and have skipped their vaccines, then we have a breakdown in herd immunity and we start to see the return of many vaccine-preventable diseases.

These aren’t people who can’t be vaccinated though.

They are people who refuse to be vaccinated and intentionally don’t vaccinate their kids.

“In other words, hide in the herd, but do not tell the herd you’re hiding; otherwise, outbreaks will ensue. Sears’ advice was prescient. Recent outbreaks of measles in 15 states, caused by an erosion of herd immunity in communities where parents had chosen not to vaccinate their children, were the largest in the United States since 1996.”

Dr. Paul Offit on The Problem With Dr Bob’s Alternative Vaccine Schedule

And that seems to be exactly what happened as more and more parents have walked into their pediatrician’s offices with a copy of Dr. Bob’s Alternative Vaccine Schedule.

While he predicted that it would “increase vaccination rates in our country,” as most others knew,  they went down instead, and we continue to see more and more clusters of unvaccinated children.

Of course, Dr. Bob didn’t create the modern antivaccine-movement, but the bandwagoning effect he and other “thought influencers in the anti-vaccine movement” have on parents isn’t hard to see. Parents get scared by their anti-vaccine talking points and they go on to scare other parents into not vaccinating and protecting their own kids.

Tragically, the consequences of all of this was predictable too.

“If more parents insist on Sears’ vaccine schedules, then fewer children will be protected, with the inevitable consequence of continued or worsening outbreaks of vaccine-preventable diseases.”

Dr. Paul Offit on The Problem With Dr Bob’s Alternative Vaccine Schedule

More outbreaks of vaccine-preventable diseases.

What to Know About Hiding in the Herd

When too many people try and hide in the herd, it makes it hard to maintain necessary levels of herd immunity, which puts everyone, including medically fragile children and adults, at higher risk for getting a vaccine-preventable disease.

More About Hiding in the Herd

New Vaccine Laws and Mandates

Every good vaccine bill doesn't make it into law.
NY passed a law in 2015 that  eliminated religious exemptions to getting vaccines.

California passed a new vaccine law, SB 277, in 2015.

Most states, including California, already had vaccine mandates though. The difference now is that in California, you need a medical exception to attend school if your kids aren’t vaccinated.

With the passage of SB 277, California joined Mississippi and West Virginia as the only states that do not allow either religious or personal belief vaccine exemptions.

They still aren’t forcing anyone to get vaccinated though.

“The term mandate is somewhat misleading, because there are exceptions — always on medical grounds, frequently on religious grounds, and sometimes on philosophical grounds. Moreover, the thrust of mandates is not to forcibly require vaccination but to predicate eligibility for a service or benefit on adherence to the recommended immunization schedule of vaccination. ”

Y. Tony Yang on Linking Immunization Status and Eligibility for Welfare and Benefits Payments

And in some countries that already have mandates, they aren’t even doing a very good job of making sure that kids even get vaccinated. Many people will be surprised to learn that 14 European countries already mandate one or more vaccines, typically DTP, polio, and MMR.

What’s New in Vaccine Laws

Internationally, the idea of vaccine mandates is a big issue as we continue to see outbreaks of measles in Europe and other areas of the world.

“Parents who vaccinate their children should have confidence that they can take their children to child care without the fear that their children will be at risk of contracting a serious or potentially life-threatening illness because of the conscientious objections of others. ”

Australian Prime Minister Tony Abbott on “No Jab No Pay”

Unlike the Disneyland outbreak in California, the outbreaks in Europe are on a much bigger scale.

And with more cases we see what everyone fears – more deaths.

That’s why we are finally seeing new vaccine laws, including some that mandate vaccines in some other countries, including:

  • Australia – the Australian government began a “No Jab No Pay” plan in 2016 that removed the conscientious objector exemption on children’s vaccination for access to taxpayer funded Child Care Benefits, the Child Care Rebate and the Family Tax Benefit Part A end of year supplement.
  • Estonia – A proposal was put before the Estonian Parliament, the Riigikogu, to make immunizations compulsory.
  • Germany – a new law, if approved (it has already passed the Bundestag or national parliament), will require parents to have a medical consultation before deciding to delay or skip vaccines or they can be fined up to $2,800. Even with the law, in Germany, “vaccinations remain voluntary. But some politicians have suggested that mandatory vaccination is on the way if concerted efforts to encourage vaccinations don’t work.”
  • Italy – the Italian Parliament has given final approval to the Decree-Law Containing Urgent Measures on the Compulsory Vaccination of Children, which makes vaccinations against 12 diseases mandatory for children as a condition of school registration, for both private and public schools.
  • France – is working to expand their list of mandated vaccines to now include protection against 11 diseases instead of just three (diphtheria, tetanus, and polio). All of these vaccines were previously recommended to attend school, but were only voluntary.
  • Romania – a draft Vaccination Law could bring fines to parents who don’t vaccinate their kids and would keep them out of schools. Doctors could be fined too! The draft law is headed to Parliament for debate.

Again, none of these laws mean that anyone is being forced to vaccinate their kids.

Even in the case of vaccine mandates, they are simply requirements to attend daycare or school.

We are also seeing some new vaccine laws in the United States, including changes for the start of the 2017-2018 school year:

  • Indiana – pharmacists can give more vaccines, any vaccine that the CDC recommends, either with a prescription or by protocol for kids over are at least 11 years old and adults
  • Iowa – now requires a meningococcal vaccine for students entering 7th (one dose) and 12th (one or two doses) grades
  • Nevada – now requires a meningococcal vaccine for students entering 7th grade (one dose) and college (a dose after age 16 years)
  • Pennsylvania – unvaccinated students now only have a 5 day grace period at the start of the school year to get vaccinated (it used to be 8 months) before getting expelled from school.

It’s easy to navigate the new laws.

Get educated and get your kids vaccinated. Vaccines are safe, vaccines work, and vaccines are necessary.

What To Know About Vaccine Mandate Laws

Vaccine mandate laws are expanding as we are seeing more outbreaks of vaccine preventable diseases.

More Information on Vaccine Mandate Laws:

Updated August 20, 2017

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Doctors Facing Disciplinary Actions Over Vaccines

mendelsohn
Dr. Mendelsohn was the Dr. Bob of his day.

There are many doctors and other health professionals who do and recommend things that are far out of the mainstream. They may tell their patients to skip or delay vaccines, that vaccine-preventable diseases aren’t that bad, or even that vaccines don’t work, etc.

And yet, many are surprised when some of them face disciplinary actions from their state’s medical boards, such as:

Dr. Ming Te Lin, the board certified pediatrician in Illinois who:

  • was preparing alternative vaccinations for children for more than a decade
  • gave patients modified vaccinations containing cat saliva and vodka
  • was signing state forms certifying he had given pediatric patients their conventional shots
  • used a WaveFront 2000 device to detoxify vaccines of mercury

Dr. Lin’s medical license has been suspended and he  was supposed to have “a hearing before the Medical Disciplinary Board is set for Oct. 11 in Chicago.” That hearing didn’t happen though and he is now supposed to have a new hearing on November 21.

Dr. Bob Sears is also facing disciplinary action from his state’s medical board.

With a long history of recommending his own alternative immunization schedule to parents, Sears is accused of gross negligence for the way that he granted a medical exemption for vaccines to a child.

An anti-vaccine doctor in Arizona, Dr. Jack Wolfson, a holistic cardiologist, was also investigated by his state’s medical board following several complaints that were made during a recent measles outbreak.

Joseph Mercola, D.O. is another anti-vaccine doctor who has faced trouble in the past. A frequent guest on the Dr. Oz show, he has gotten several warnings from the FDA for marketing a thermal camera as a cancer screening device and making false and misleading claims about natural supplemental products he markets.

Even Dr. Oz has gotten into some trouble in recent years, testifying before Congress about weight loss scams.

For More Information On Doctors Facing Disciplinary Actions Over Vaccines:

Vaccine Hesitant Parents

Every parent who skips or delays a vaccine isn’t so anti-vaccine that they believe every anti-vaccine myth and conspiracy theory on the Internet.

Some are simply scared or worried about what they have read or by what friends or family members have told them.

One study by Gust et al. has actually identified up to five categories of parents, including:

  • immunization advocates – the biggest group, who think that vaccines are necessary, safe, and important
  • go along to get alongs – think that vaccines are necessary and safe
  • health advocates – agree that vaccines are necessary, but aren’t so sure that they are safe
  • fence-sitters – slightly agree that vaccines are necessary and safe
  • worrieds – the smallest group, who slightly disagree that vaccines are necessary and strongly disagree that they are safe

The fence-sitters and worrieds, and some of the health advocates, are typically the ones who delay or skip one or more vaccines. They may even follow their own alternative parent-selected, delayed protection immunization schedules.

They are the vaccine-hesitant parents.

But what does it mean to be vaccine hesitant? Some people think of it as a kinder and gentler term, as opposed to someone who is anti-vaccine or a vaccine refuser.

The SAGE Vaccine Hesitancy Working Group says that:

Vaccine hesitancy refers to delay in acceptance or refusal of vaccines despite availability of vaccination services. Vaccine hesitancy is complex and context specific varying across time, place and vaccines. It includes factors such as complacency, convenience and confidence.

If you are hesitant about something, you are “slow to act or speak especially because you are nervous or unsure about what to do.” In general, you need reassurance and advice to address your concerns about what ever you are nervous or hesitant about.

That’s especially true when you talk about vaccine hesitancy. When a parent is worried and wants to skip or delay the MMR vaccine because they have been told it is going to make their child autistic or have read about toxins in vaccines, those are easy concerns for their pediatrician to address and refute.

That’s why many vaccine hesitant parents eventually get their kids caught up on all of their vaccines.

When a parent doesn’t want to believe the overwhelming evidence that vaccines are safe and necessary, then you are moving beyond vaccine hesitancy to someone who is truly anti-vaccine.

That’s not the vaccine hesitant parent though.

One study, “Validity and reliability of a survey to identify vaccine-hesitant parents,” described vaccine hesitant parents as a “heterogeneous group of parents who may purposefully delay or choose select vaccines, have moderate concerns about vaccine safety, and yet still want to trust and receive immunization information from their child’s provider.”

More importantly, the study also said that of vaccine hesitant parents,  “their child’s provider remains in a position of influence, their immunization attitudes are not extreme, and they are a larger group than those who completely reject vaccines.”

That makes it important to truly make dismissing families who don’t vaccinate from pediatric practices a very last resort that is saved for the “entrenched nonvaccinators” and antivaccination activists who are never going to change their minds.

After all, you can’t talk to your pediatrician about vaccines if you are no longer going to a pediatrician who advocates that vaccines are safe and necessary.

For more information:

 

National Catholic Bioethics Center on Vaccines

Although most states allow religious exemptions to vaccines, it is important to keep in mind that very few religions actually oppose vaccines.

That’s where the National Catholic Bioethics Center comes in.

They answer a lot of questions people might have on the Catholic Church’s teaching on vaccines, including “the Church’s teaching about the use of certain vaccines that have a distant historical association with abortion.”

They also state that:

One is morally free to use the vaccine regardless of its historical association with abortion. The reason is that the risk to public health, if one chooses not to vaccinate, outweighs the legitimate concern about the origins of the vaccine. This is especially important for parents, who have a moral obligation to protect the life and health of their children and those around them.

On the question of “Am I free to refuse to vaccinate myself or my children on the grounds of conscience?,” the National Catholic Bioethics Center answers that:

One must follow a certain conscience even if it errs, but there is a responsibility to inform one’s conscience properly. There would seem to be no proper grounds for refusing immunization against dangerous contagious disease, for example, rubella, especially in light of the concern that we should all have for the health of our children, public health, and the common good.

So they are saying you are both “morally free” to use the vaccines and “have a moral obligation” to get vaccinated.

For more information:

One-Size-Fits-All Immunization Schedule

Some people say that they are not anti-vaccine, instead they oppose our so-called one-size-fits-all vaccine policy and immunization schedule.

With so much flexibility and exemptions built into the immunization schedule though, it is wrong to call it one-size-fits-all.

For example, infants and toddlers can get their:

  • third dose of IPV and hepatitis B vaccines any time between 6 and 18 months
  • first dose of MMR and the chicken pox vaccines any time between 12 and 15 months
  • fourth dose of DTaP any time between 15 and 18 months
  • first dose of the hepatitis A vaccine any time between 12 and 23 months, getting the second dose six months after the first
  • get their “four year boosters” any time between four and six years of age

Jenny McCarthy who was one of the first to champion the one-size-fits-all argument against vaccines once said that:

Should a child with the flu receive six vaccines in one doctor visit? Should a child with a compromised immune system be treated the same way as a robust, healthy child?

It is easy to see that they don’t have to with our current immunization schedule. Your child’s pediatrician has the flexibility to temporarily delay one or more vaccines if your child has any precautions at the time of the visit, such as  a “moderate or severe acute illness with or without fever.”

There are also medical contraindications that keep some children from getting one or more vaccines on the immunization schedule. For example, children with severe combined immunodeficiency (SCID) should not get live vaccines. They are not treated the same way as children who do not have immune system problems.

This is reaffirmed by the American Academy of Pediatrics:

The schedule is not “one size fits all.”

It is considered the ideal schedule for healthy children, but it has flexibility built in. There are established medical reasons why some children should not receive certain vaccines; for example, allergies to one or more ingredients in the vaccine, or a weakened immune system due to illness, a chronic condition, or another medical treatment. Sometimes a shot needs to be delayed for a short time, and sometimes it may need to be skipped altogether .

Your pediatrician is educated and updated about such exceptions to the immunization schedule. This is one reason your child’s complete medical history is taken at the pediatrician’s office, and why it is important for your child’s health care providers to be familiar with your child’s medical history.

Delaying or skipping one or more vaccine to create a customized alternative vaccine schedule for your child, a non-standard, parent-selected, delayed protection vaccine schedule, isn’t safer than the immunization schedule from the CDC. It simply puts your child at greater risk for vaccine-preventable diseases.

For more information:

Latex Allergies and Vaccines

Can you get vaccines if you have a latex allergy?

“Dry, natural rubber is used in the tip of syringe plungers, the tip on prefilled syringes, vial stoppers,” and could cause a problem for some people with latex allergies.

According to the CDC:

If a person reports a severe (anaphylactic) allergy to latex, vaccines supplied in vials or syringes that contain natural rubber latex should not be administered unless the benefit of vaccination clearly outweighs the risk for a potential allergic reaction. In these cases, providers should be prepared to treat patients who are having an allergic reaction.

For latex allergies other than anaphylactic allergies (e.g., a history of contact allergy to latex gloves), vaccines supplied in vials or syringes that contain dry, natural rubber or natural rubber latex may be administered.

Many vaccines use synthetic rubber or synthetic latex though, so getting vaccinated with one of these vaccines would be a good alternative if your child has a severe allergy to latex.

Keep in mind that you aren’t supposed to simply remove the latex stopper from a vaccine vial to try and avoid triggering an anaphylactic reaction. That did work for one patient in the case report “Anaphylaxis after hepatitis B vaccination.” She got her second dose using “rubber free technique” and didn’t have a reaction.

Still, latex allergies with vaccines doesn’t seem to be a big problem.

One study “Vaccination of persons allergic to latex: a review of safety data in the Vaccine Adverse Event Reporting System (VAERS),” in the journal Vaccine “revealed only 28 cases of possible immediate-type hypersensitivity reactions in vaccine recipients with a history of allergy to latex.” And only two of those required hospitalization.

For more information: