Tag: mandates

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

Immunization Requirements to Start School and Daycare

If you are following the latest immunization schedule and your kids are up-to-date on all of their vaccines, then they will likely be ready to start daycare, kindergarten, high-school, or college.

There aren’t usually any extra vaccines that they will need to start school.

Of course, if you have skipped or delayed any vaccines, then they might have to catch up on some immunizations before starting school.

Another situation where you might need to do some catching up is if you move, and instead of following the CDC schedule, you were just getting the minimum number of vaccines that were required to attend school where you used to live. For example, your kids could have been all set to start kindergarten in Arkansas, but if you suddenly moved to Texas, they might need a second MMR, a booster dose of Varivax, and two doses of hepatitis A vaccine, as none of those are required in Arkansas.

Immunization Requirements to Start Daycare and Preschool

Daycare rules in Idaho give parents a month to stay on schedule with all of the CDC immunization requirements.
Daycare rules in Idaho give parents a month to stay on schedule with all of the CDC immunization requirements.

Since many new parents have to go back to work when their baby is only about two to six weeks old, they won’t have time to get their first set of vaccines at two months.

That won’t keep them out of daycare, but delaying too much longer, usually more than a month, probably will.

To start daycare or preschool, infants and toddlers need to get most of the vaccines on the CDC immunization schedule. This includes DTaP, hepatitis B, Hib, Prevnar, and IPV (polio), and then once they are 12 months old, booster doses of the primary series of vaccines and the MMR, Varivax (chickenpox), and hepatitis A vaccines.

The only vaccine that is missing from many state mandates is the rotavirus vaccine. And that simply has to do with the strict timing requirements of when you need to start (before 15 weeks of age) and finish this vaccine (by 8 months).

Some states do require rotavirus though, and simply state that kids must follow “age appropriate dosing.” That way, if they are too old, they just don’t need to get it.

Immunization Requirements to Start Kindergarten

In addition to most of the vaccines they needed to start daycare or preschool, to start kindergarten, kids need their 4 to 6 year old boosters:

  • the fifth dose of DTaP to protect them against diphtheria, tetanus, and pertussis
  • the fourth dose of IPV to protect them against polio
  • the second dose of MMR to protect them against measles, mumps, and rubella
  • the second dose of Varivax to protect them against chicken pox

If using combination vaccines, these four immunizations can be combined into just two shots – Proquad (MMR + Varivax) and either Kinrix or Quadracel (DTaP + IPV), which your preschooler will appreciate to help reduce the pain from getting these shots.

If your kids were missing any vaccines, they will also need to get caught up on those before starting school.

Immunization Requirements to Start Middle School

Preteens and teens get a few vaccines when they start middle school when they are around 11 to 12 years old, including:

  • a dose of Tdap to protect them against diphtheria, tetanus, and pertussis
  • a dose of Menactra or Menveo to protect them against meningoccocal disease

Although not required by most schools, the HPV vaccine is also usually given around this time.

Immunization Requirements to Start College

And then, before going off to college, at around age 16 years, kids will usually need:

They can also get the MenB vaccine, although it isn’t yet required for all students. This vaccine (Bexsero or Trumenba) has a “permissive” recommendation, in that parents are told they can get it if they want their kids to avoid meningococcal B disease, but it is not required yet.

What about a third dose of MMR?

While an extra dose of the MMR vaccine is now being given in some situations, it is mainly if your child is at high risk because of a current mumps outbreak. A mumps booster shot is not currently recommended just because your child is going off to college.

What to Know About Immunization Requirements for Incoming Students

If you have been following the latest immunization schedule and your kids are up-to-date on all of their vaccines, then they will likely be ready to start daycare, kindergarten, high-school, and college without needing any extra vaccines.

More on Immunization Requirements for Incoming Students


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


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


Slogans of the Anti-Vaccine Movement

Jenny McCarthy and Jim Carrey went on a mission to Green Our Vaccines in 2008.
Jenny McCarthy and Jim Carrey went on a mission to Green Our Vaccines in 2008.

We know that there is no science to support the anti-vaccine movement.

History isn’t on their side either.

So what’s left?

How do they push misinformation and myths about vaccines to scare parents away from vaccinating and protecting their kids?

Slogans of the Anti-Vaccine Movement

In addition to their celebrities and a relative handful of ‘experts,’ the modern antivaccine movement makes effective use of very catchy slogans to scare people away from getting educated about vaccines and vaccinating their kids.

If there is a RISK, there must be a CHOICE.

This is one of the more recent and also one of the more powerful slogans that we have seen. It implies that the choice over skipping or delaying vaccines is being taken away and that the only risk comes from the vaccines themselves.

But like most slogans used as propaganda tools, there is little behind it.

Parents nearly always have a choice on whether or not to vaccinate their kids, even if they live in a state without non-medical exceptions.

Vaccine mandates are laws that say you must be fully vaccinated to attend school. Instead of homeschooling their intentionally unvaccinated kids, some parents think that they must have even more choices though.

In addition to overestimating the risks from vaccines, these folks greatly underestimate the risks of getting a vaccine-preventable disease from skipping vaccines, both to their own kids and to the rest of us in the community.

They are simply increasing our risk and limiting our choices to keep our own kids safe and healthy.

You can always get Vaccinated, but you can never get Unvaccinated.

This slogan is likely a surprise to all of the folks who push (sell) regimens that claim to detox kids of their vaccines, or more specifically, all of the “toxins, poisons, and chemicals” that were supposedly in the vaccines they got.

It is also a sad reminder to all of those families who skipped or delayed a vaccine a little too long – long enough for their child to get a life-threatening vaccine-preventable disease.

This slogan really just highlights the fact that anti-vaccine do not really understand the risks of delaying or skipping vaccines. That’s despite the fact that studies have shown that following a non-standard, parent-selected, delayed protection vaccine schedule simply puts kids at risk for vaccine-preventable diseases, without any benefits of fewer side effects.

And for the record, you can get unvaccinated. It is one of the reasons that herd immunity is so important. Just ask the parents of any child who has had to have chemotherapy or a bone marrow transplant and is now immunosuppressed.

Green Our Vaccines.

Jenny McCarthy and Jim Carrey led the “Green Our Vaccines” rally back in 2008.

In 2008, Jenny McCarthy ran a full page ad in USA Today warning about toxins, autism, and the "whopping increase" in vaccines kids were getting.
In 2008, Jenny McCarthy ran a full page ad in USA Today warning about toxins, autism, and the “whopping increase” in vaccines kids were getting.

Although they always claimed they were not anti-vaccine, they helped pushed the idea that vaccines were full of toxins.

They aren’t.

Vaccine ingredients are safe.

Too many, Too soon.

Jenny McCarthy can likely also be credited with creating with idea that kids get too many vaccines at too early an age.

Our kids certainly do get more vaccines than they did in the 1970s and 80s, but that simply means more protection from vaccine-preventable diseases that used to be killers, like Haemophilus influenzae type b and Streptococcus pneumoniae.

Today’s vaccines have fewer antigens than ever too, even though kids get more vaccines than they used to. But certainly not more than they can easily and safely handle.

Vaccination is not Immunization.

This idea is pushed by a chiropractor, who also talks about “pure blood.”

If you believe that vaccination is not immunization, then how did vaccines help eradicate smallpox and how are they helping to eliminate and control other vaccine preventable diseases, like polio, measles, and rubella, etc.

And that’s the whole point. Many anti-vaccine folks don’t really believe that vaccines work. That helps them justify their decision to skip or delay vaccinating their kids.

Even if you thought that vaccines had too many side effects, if you also admitted that they worked to protect your kids, then your anti-vaccine views would likely produce a high level of cognitive dissonance. So instead you cling to these types of slogans. And if your kid does get a vaccine-preventable disease, you’ll still feel okay, because you will blame it on shedding from someone who just got vaccinated.

I’m not anti-vaccine, I’m pro-safe vaccine

The problem with this slogan, and in general, using it as an anti-vaccine argument, is that vaccines are safe. They are not 100% safe, but no one claims that they are.

Serious side effects from vaccines are very rare though.

People who rally against already safe vaccines, claiming that they say are full of ‘toxins’ and wanting even safer vaccines before they will vaccinate their kids, are not really pro-vaccine.

Neither are any of the folks who push these slogans, all of which are pure anti-vaccine propaganda.

What to Know About the Slogans of the Anti-Vaccine Movement

Catchy slogans are one of the ways that the anti-vaccine movement uses to push  misinformation about vaccines.

More About Slogans of the Anti-Vaccine Movement


Vaccine Exemptions

Vaccine exemptions to state mandates for immunizations can include medical exemptions, religious exemptions, and philosophical exemptions.

For information: