Tag: exemptions

Fact Checking the Truth About Vaccination Rates in California

In general, higher immunization rates should translate into lower rates of disease.

And it is true that in most states, including California, overall immunization rates are up.

So what’s happening?

Fact Checking the Truth About Vaccination Rates in California

Everyone knows what’s happening!

Clusters of unvaccinated kids and adults.

Pockets of susceptibles.

Abuse and overuse of vaccine exemptions.

And folks who continue to scare parents away from vaccinating and protecting their kids.

There are measles outbreaks in this part of northern California...
There are measles outbreaks in this part of northern California…

What’s the truth about California’s immunization rates and the reason they are still having outbreaks of measles and other vaccine-preventable diseases?

“Oh, but wait! What do you mean we have higher vaccination coverage NOW than we did back then? How can that be? I thought rates have been declining steadily for two decades putting us in a terrible position of falling wayyyy below herd immunity levels!?

I thought the reason we are now “in danger of disease outbreaks” is because of the increasing number of children being exempted from vaccines? Hold on, wait. You’re telling me there are LESS kids exempted now than there were in the year 2000 when we were free of outbreaks because of “high vaccination rates”? That can’t be right…can it?”

Melissa Floyd

You aren’t going to get it from anti-vaccine folks

73% is actually pretty good for a Waldorf school!
73% is actually pretty good for a Waldorf school!

But it’s not surprising that you get misinformation about herd immunity from folks who think vaccines don’t actually create herd immunity.

And it shouldn’t be surprising that you can’t hide in the herd when your herd is a cluster of unvaccinated kids at a Waldorf school.

Vaccines are safe, with few risks, and are obviously necessary. Vaccinate your kids and help stop the outbreaks.

More on Fact Checking the Truth About Vaccination Rates in California

Why Should Medical Exemptions Be Based on CDC Contraindications?

Getting a medical exemption for vaccines isn’t controversial.

Or at least it shouldn’t be.

Why Should Medical Exemptions Be Based on CDC Contraindications?

As many people know though, some people have been taking advantage of the fact that medical exemptions weren’t clearly defined in California’s vaccine law.

Who are the doctors handing out fake medical exemptions in California?
Who are the doctors handing out fake medical exemptions in California?

Are there just a few doctors taking advantage of the California law?

“But at 105 schools in the state, 10% or more of kindergartners had a medical exemption in the school year that ended last month, according to a Los Angeles Times analysis of state data.”

Pushback against immunization laws leaves some California schools vulnerable to outbreaks

Is 10% a lot?

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 US was just 0.2%, with a range of <0.1 to 1.5%.

In West Virginia and Mississippi, states that don’t allow non-medical exemptions and where criteria for medical exemptions are fairly strict, the rates were 0.1 and 0.3% respectively.

And that’s about what you would expect, as there are very few true contraindications or precautions to getting vaccinated.

So yes, 10% is an awful lot and that’s a good sign that it is more than just a few doctors taking advantage of the law.

“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

Why do most other states have so few medical exemptions?

Mostly because there are very few true medical reasons to skip or delay a child’s vaccines!

They include, but aren’t limited to, the contraindications and precautions listed in the package insert for each vaccine (the contraindications and warnings sections…) and by the Advisory Committee on Immunization Practices.

They don’t include many other things that are “incorrectly perceived as contraindications to vaccination,” such as things in the family medical history of the child, eczema (unless they are getting the smallpox vaccine), colic, sleep apnea, or being a picky eater.

Is everything a vaccine injury?
Is everything a vaccine injury?

It should be obvious.

Medical exemptions for vaccines should be based on CDC criteria because some folks think that everything is a vaccine injury.

More on Medical Exemptions

Why Is a Kentucky Teen Who Refused to Get Vaccinated Suing His School?

One extra consequence of the rise in cases of vaccine-preventable diseases we have been seeing lately, in addition to the fact that more kids are getting sick, is that we are seeing more kids being quarantined and kept out of school.

“The parents of 42 children affected by the ban at the school, the Green Meadow Waldorf School, sued the Rockland County health department, asking a federal judge to issue an injunction to allow the children to return.”

Parents Wanted Their Unvaccinated Children in School, but a Judge Said No.

And in a few cases, we are seeing lawsuits trying to get some of these kids, mostly intentionally unvaccinated kids, back into school.

Why Is a Kentucky Teen Who Refused to Get Vaccinated Suing His School?

While most outbreaks are related to measles, in Kentucky, a large outbreak of chickenpox at Our Lady of the Sacred Heart/Assumption Academy in Walton has led to the quarantine of a number of unvaccinated students.

A chickenpox quarantine sign

One student, a senior and the starting center on the school basketball team, is suing to get him back in school.

“The Kunkels filed their lawsuit Thursday in the Boone County Circuit Court alleging that the Northern Kentucky Health Department had violated Jerome’s First Amendment rights. Accepting the chickenpox vaccine would be “immoral, illegal and sinful,” they said, according to their Catholic beliefs. The lawsuit also alleges that the health department violated due process when officials enacted the extracurricular and school attendance bans without declaring an official emergency, which would have triggered the involvement of the state legislature.”

God, country and chickenpox: How an outbreak entangled one school in a vaccine showdown

So they are actually suing the health department, not his school, to get him back into school…

Wait a minute though?

Is the Catholic Church against vaccines?

“Since there is no Catholic teaching that the use of these vaccines is sinful, schools cannot allow Catholic parents to claim a religious exemption from the requirement of immunization.”

National Catholic Bioethics Center on Vaccines and Exemptions Granted by Schools

Are they against the chickenpox vaccine?

“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.”

National Catholic Bioethics Center

No, they aren’t, which is why most Catholics vaccinate and protect their kids.

“In the event that the county health department or state health department declares an outbreak of a vaccine-preventable disease for which proof of immunity for a child cannot be provided, he or she may not be allowed to attend childcare or school for up to three (3) weeks, or until the risk period ends.”

Kentucky Parent or Guardian Declination on Religious Grounds to Required Immunizaitons

A judge will have to decide the merits of the case, but from a moral standpoint, it seems like they are on shaky ground.

More on Quarantines for Intentionally Unvaccinated Kids

Why Will Paul Thomas’ Patients Be Excluded from School in Oregon?

Like several other states, Oregon is working to strengthen their vaccine laws by making it harder for parents to skip or delay a child’s vaccines.

An unvaccinated child in Oregon nearly died with tetanus recently...
An unvaccinated child in Oregon nearly died with tetanus recently…

This is in response to growing measles outbreaks in the area and the abuse of non-medical exemptions.

Why Will Paul Thomas’ Patients Be Excluded from School in Oregon?

Not surprisingly, a local pediatrician, Paul Thomas, who seems dead set on becoming the next Bob Sears, complete with a book that pushes a so-called alternative non-standard, parent-selected, delayed protection vaccine schedule, is protesting Oregon’s new vaccine bill.

“Although we give vaccines in my office every day, I oppose HB 3063. As you consider HB 3063, I thought you should have the real-world data from the largest pediatric practice in Oregon with the most patients who will be affected by your proposed bill.”

Paul Thomas

Paul Thomas goes on to explain why his patients haven’t received all of their recommended vaccines.

One reason is that he doesn’t even offer the rotavirus vaccine, although he doesn’t mention that. But how do you make an informed choice about a vaccine when the vaccine isn’t even available to you?

“Most of my patients make the educated decision not to give one vaccine-hepatitis B – to their infants. This is because you catch hepatitis B from sex and IV drug use so if a child is born to a mother that does not have hepatitis B, the child is at no risk of getting this disease. Preschool and young school-aged children are not at risk for hepatitis B, which is why most countries in the developed world only recommend this vaccine for at-risk groups and not for everyone.”

Paul Thomas

Since he doesn’t think they are at any risk when they are younger, does Dr. Thomas advocate that his patients catch up on their hepatitis B series when they are older? Does he mention that until we switched to a universal vaccination program, some infants were missed and developed perinatal hepatitis B? Or the risks of needle sticks, etc.?

“These are the kinds of details and nuances that we must discuss with every vaccine. Whether we are talking about vaccines, antibiotics, ADD medication, or even a surgical procedure, we spend a good deal of time with our patients providing what we in medicine call “informed consent.” We explain the risks and benefits of the recommended medical intervention, the risks and benefits of not doing the intervention, and the alternatives. These conversations are best had in the privacy of a doctor’s office, not in the state legislature. As each child is different, we do not believe there should be any one-size-fits-all medicine. “

Paul Thomas

Although Paul Thomas talks about informed consent, a very important part of medicine, it is important to keep in mind that like most folks in the modern anti-vaccine movement, he doesn’t really seem to offer it.

He provides misinformed consent, pushing propaganda that overstates that risks of vaccines, underestimating the risks of vaccine-preventable diseases, and rarely stating the benefits of getting vaccinated.

“Finally, I am also concerned that thousands of families will either leave Oregon-as tens of thousands of families have left California – or leave the public school system and homeschool instead. While I have nothing against homeschooling, I believe this would result in a large and unfortunate loss of revenue for Oregon’s already underfunded public schools. “

Paul Thomas

Perhaps Paul Thomas missed it, but California is doing just fine after they passed their vaccine law, despite issues with some California doctors have taken advantage of fearful parents, and instead of doing the work to help parents understand that vaccines are safe with few risks, they are writing unjustified medical exemptions.

After years of declines, the vaccination rates for kids in California entering kindergarten in 2017 were at the highest rate since at least 1998!
After years of declines, the vaccination rates for kids in California entering kindergarten in 2017 were at the highest rate since at least 1998!

It’s a good reminder that the one lesson Oregon can learn from California is to make stricter rules on what counts as a medical exemption…

“We all have the same goal, which is to help Oregon’s children survive and thrive. No one wants a recurrence of infectious diseases in Oregon or anywhere in the United States. “

Paul Thomas

If Paul Thomas’ real motivation was to stop the outbreaks of vaccine-preventable disease and keep states from passing new vaccine laws, then maybe he should stop scaring parents away from vaccinating and protecting their kids.

“I hired an independent data expert, Dr. Michael Gaven, MD, to analyze the outcomes from my practice as part of a quality assurance project. Dr. Gaven studied the outcomes for those patients born into my practice during the past decade, since I opened my doors on June 1 2008.”

Paul Thomas

What outcomes? Is it how many of the kids in his practice developed vaccine-preventable diseases unnecessarily?

No, Paul Thomas published data that he thinks says that his unvaccinated kids get less autism than everyone else, except that there is a lot of bias in the numbers, we don’t know how many kids left his practice (especially any who might have developed autism), or even what criteria he uses to diagnose kids with autism. The numbers likely aren’t even statistically significant.

Vaccines are safe, with few risks, and they are necessary. And they are not associated with autism. Stop listening and spreading propaganda, vaccinate your kids, and let’s stop these outbreaks.

More on Paul Thomas

The History of Vaccine Exemptions

As we are starting to see some states get rid of their exemptions with new vaccine laws, it is important to understand that many non-medical exemptions came on the scene relatively recently.

After vaccine mandates to start school helped eliminate measles in the United States, over just a few years, from 1998 to 2000, 15 states added personal belief vaccine exemptions. Texas and Arkansas added theirs a little later, during the 2003-04 school year.

The History of Vaccine Exemptions

What happened in 1998 that made state lawmakers in 15 states allow parents to use personal belief vaccine exemptions to opt out of vaccinating and protecting their kids?

Andrew Wakefield happened in 1998...
Andrew Wakefield happened in 1998…

Oh yeah, that’s when Andrew Wakefield published his infamous paper in Lancet that was later retracted.

That’s right, these exemptions had their origins in perhaps the biggest anti-vaccine myth of them all!

Not that there weren’t warnings. Many of us knew adding the exemptions was a bad idea at the time…

The Austin American Statesman published an editorial in 2003 urging Legislators to fix the mess they had just created.
The Austin American Statesman published an editorial in 2003 urging Legislators to fix the mess they had just created.

And now, here we are with rising rates of vaccine-preventable disease as folks use and abuse their exemptions.

So while you are thinking about whether or not your state legislators should be taking away your personal belief vaccine exemption, a better question would likely be why they added them in the first place.

More on the History of Vaccine Exemptions

Vaccine Op-Eds

The Editorial Boards of the leading newspapers in the United States are making sure we know their views about vaccines and vaccine hesitancy.

One of the first vaccine op-eds appeared in The New York Times.

It started with The New York Times, but certainly didn’t end there.

Vaccine Op-Eds

In addition to two hearings before Congress, many other major newspapers have published vaccine editorials of their own.

“It’s no mystery how we got here. On the internet, anti-vaccine propaganda has outpaced pro-vaccine public health information. The anti-vaxxers, as they are colloquially known, have hundreds of websites promoting their message, a roster of tech- and media-savvy influencers and an aggressive political arm that includes at least a dozen political action committees. Defense against this onslaught has been meager. The C.D.C., the nation’s leading public health agency, has a website with accurate information, but no loud public voice. The United States Surgeon General’s office has been mum. So has the White House — and not just under the current administration. That leaves just a handful of academics who get bombarded with vitriol, including outright threats, every time they try to counter pseudoscience with fact.”

The New York Times on How to Inoculate Against Anti-Vaxxers

“The wretched pox is getting closer. We hope you and yours are vaccinated.”

Chicago Tribune on Major new study adds to our plea: Vaccinate your children against measles

“But a child with fragile health, whose doctor advises to delay vaccines for health reasons, could be in extreme danger in Washington state because so many parents use philosophical exemptions. Vulnerable children are much more likely to be exposed to measles than they should be because Washington allows parents to skip required immunizations based solely on their personal beliefs.”

The Seattle Times on End philosophical vaccine exemption

“We can get kids vaccinated, or we can be in danger together.”

Chicago Sun-Times on Measles, anti-vaccine myths and some advice for Illinois

“Treating a disease like measles and stopping its spread is an expensive proposition. Not to mention, it endangers those who can’t get vaccinated, including vulnerable newborns.”

The Baltimore Sun on It’s about time for a backlash against anti-vaxers

“Recent outbreaks underscore the risks of allowing nonmedical exemptions.”

USA Today on Measles outbreaks underscore risks of allowing nonmedical vaccination exemptions

“The point is, people who do not get vaccinated are threatening the whole population, and DeFoor’s letter is a reminder that failing to get vaccinated can have lifelong consequences.”

The Gainesville Sun on Anti-vaccine myths are dangerous

“The best solution, however, is for parents who are tempted to claim a religious exemption to look at the facts. If your fear of vaccines is based on information repeated in social media or by an anti-vaccine group, you need to try again. Look at medical studies or talk to your doctor.

The measles vaccine can save your child’s life, and it can save the lives of those who are medically unable to take the vaccine.”

Tuscaloosa News on Measles vaccine a must for your child and others

“This isn’t one of those scary epidemics in which the cause and solution are unclear. The cause is a reckless embrace of myth over scientific fact. The solution is vaccination.”

St. Louis Post-Dispatch on Measles is back, thanks to misinformation and loopholes in vaccination rules.

“Yet the distrust of anti-vaxxer parents is a threat to everyone’s children and not just their own.”

The Guardian view on vaccination: a duty of public health

“The anti-vaxxers’ hypothesis rests largely on the shoulders of bunk science that has been discredited and disproven by a number of sources. But this hasn’t stopped their ideas from taking hold.”

Pittsburgh Post-Gazette on Preventable problems: Anti-vaxxers rely on bunk science

“We identify with parents’ desire to protect their children. But shunning proven vaccinations is making families and communities less healthy, not more so. We urge lawmakers to champion educational efforts to help parents understand that lesson before a major outbreak strikes here.”

Austin American Statesman on Austin’s anti-vaccination rate is nothing to brag about

After reading these Op-Eds, it is even more amazing to realize how far we have come from when the media used to be part of the problem.

Whatever you think about Andrew Wakefield, the real villains of the MMR scandal are the media.”

Ben Goldacre on The MMR story that wasn’t

It’s nice that they are advocating for vaccines and our children now.

More on Vaccine Op-Eds

A Legislative Guide to Advocating for Stronger Vaccine Laws

Having to get vaccinated to attend school isn’t a new idea.

In 1827, Boston mandated that all children attending public school must receive the smallpox vaccine.

Believe it or not, it wasn’t until the 1980-81 school year that there were laws in all 50 states mandating that children receive vaccinations before starting school. The smallpox vaccine wasn’t one of them…

A Legislative Guide to Advocating for Stronger Vaccine Laws

Not surprisingly, as vaccines did their job and rates of vaccine-preventable diseases dropped, politicians were able to weaken our vaccine laws.

Over just a few years, from 1998 to 2000, 15 states added personal belief vaccine exemptions!

We are now paying the price, with increases of vaccine-preventable diseases among clusters of intentionally unvaccinated children whose parents claim non-medical vaccine exemptions.

And that’s why we are seeing more and more states work to strengthen their vaccine laws.

Legislators who want to combat vaccine exemption abuse should enact laws that make it clear that:

  • medical exemptions are based on ACIP guidelines, current accepted medical practice, and evidence-based medicine – not anecdotes
  • medical exemptions should be reviewed and approved by the State Epidemiologist, Deputy State Epidemiologist, or other designated professionals at the health department
  • religious exemptions, if included at all, should specifically exclude philosophical exemptions and must reflect a sincere religious belief
  • philosophical exemptions, if included at all, should require some degree of education against the myths and misinformation that scares parents away from vaccinating their kids
  • exempted students will be excluded from school during outbreaks
  • exemptions should include a signed affidavit that is notarized
  • exemptions should be recertified each year
  • most exemptions are temporary
  • a separate exemption application should be required for each vaccine
  • exemption rates should be tracked at the school level and should be posted on school websites

Getting an exemption shouldn’t be easier than getting vaccinated!

Become an advocate and help get more kids vaccinated. You can also help stop bad vaccine laws from being enacted in your state, including some that would make it even easier to get an exemption.

More on A Legislative Guide to Stronger Vaccine Laws