Have you heard the “news” that Sweden banned mandatory vaccination in their country?
Is that true?
Did Sweden Ban Mandatory Vaccination?
Like most other anti-vaccine myths, this one isn’t true.
Sweden did not ban mandatory vaccination.
“…vaccination coverage is still high and stable, that the diseases covered by the programs are under control…”
Riksdag Social Committee report 2016/17: SoU7
In March 2017, the Riksdag, or Swedish parliament, did vote against a proposal that called for mandatory vaccination. This came as other countries in Europe are seeing lower rates of immunization, rising rates of vaccine-preventable disease, and calls for vaccine mandates. In fact, France and Italy recently implemented vaccine mandates.
“The general vaccination program has a good coverage, and most children are protected against measles and polio, for example. There are, however, skepticism about vaccinations, both the vaccinations included in the basic program and others. In our view, however, it is of societal interest that the vaccination program is implemented in its entirety, and many of the myths and incorrect data circulating about the vaccination program need to be treated and pinned. We therefore consider that the government should provide the appropriate authority with the task of designing an information campaign on the benefits and necessity of the childhood vaccination program.”
Riksdag Social Committee report 2016/17: SoU7
Although the Swedish parliament voted against a motion that would have started a mandatory vaccination plan, there was nothing to ban. Sweden has never had a mandatory vaccination.
The Riksdag did pass a motion to add the rotavirus vaccine to the immunization schedule in Sweden.
It is also clear that they see the problem that anti-vax groups are causing in their country and are working to combat them.
That will hopefully keep them from needing a mandatory vaccination program.
What to Know About the Myth of Sweden Banning Mandatory Vaccination
Sweden, with good immunization levels and low rates of vaccine-preventable disease, did not ban mandatory vaccination.
More on the Myth of Sweden Banning Mandatory Vaccination
The French immunization schedule is published in the Bulletin épidémiologique hebdomadaire and has never included the rotavirus vaccine.
So did France take the rotavirus vaccine off of their schedule?
Technically, France hadn’t yet added the rotavirus vaccine to their schedule, but it had been available since 2006 and they did formally recommend infants get vaccinated beginning in November 2013.
That recommendation was suspended in April 2015, after they recorded 47 cases of intussusception over an 8 year period. This included 14 cases that required surgery and tragically, two deaths, including one child who died at home without getting any medical care. The other developed intussusception after the third dose of vaccine, which is not usually linked to any increased risk.
It is important to note that at least 80 other countries, including the United States, Finland, Germany, Norway, and the UK, haven’t stopped using the rotavirus vaccine.
Why not?
Because the risks of a natural rotavirus infection are much greater than the risk of intussusception. In other words, the benefits of the vaccine exceed its risks.
In France alone, for example, it is estimated that rotavirus vaccines could prevent 30,000 emergency room visits, 14,000 hospitalizations, and 8 to 17 deaths each year, all in children under the age of three years.
And even without the rotavirus vaccine, there are about 200 to 250 spontaneous intussusceptions each year in France. Fortunately, infants with intussusception can almost always be successfully treated, often without surgery.
Why Did France Take the Rotavirus Vaccine off Their Schedule?
It actually makes no sense that France stopped recommending that infants get vaccinated with one of the rotavirus vaccines.
The decision was widely condemned and there are calls to reassess the decision and put the rotavirus vaccine back on the schedule in France.
“After the surprising decision of the CTV-HCSP of April 2015 to suspend its own recommendation for widespread vaccination against Rotavirus (following a false and misleading pharmacovigilance report) against the international recommendations, we advise you to read the meta-analysis on efficacy (in comparative studies) and the effectiveness (field efficacy) of these vaccines.”
The benefits of the rotavirus vaccines far outweigh its risks.
“The estimated benefits of vaccination in our study greatly exceed the estimated risks and our results should contribute to provide further evidence for discussions around rotavirus vaccination in France.”
Larmrani et al A benefit–risk analysis of rotavirus vaccination, France, 2015
Why did France take the rotavirus vaccines off their schedule?
In 1885, four boys from New Jersey went all of the way to France to get Pasteur’s new rabies vaccine, which wasn’t yet available in the US.
That’s a good question.
Another good question? How many infants have died of rotavirus infections since they did? And when will they put the vaccine back on the schedule? Fortunately, the rotavirus vaccines are still available in France, they weren’t banned as some folks say.
Of course, this isn’t the first time that France impulsively suspended a vaccine.
In 1998, France suspended the routine vaccination of teens against hepatitis B because of the possible association of the vaccine with multiple sclerosis. This was done amid “pressure from anti-vaccine groups and reports in the French media have raised concerns about a link between HBV immunisation and new cases or relapses of MS and other demyelinating diseases,” even though “scientific data available do not support a causal association between HBV immunisation and central nervous system diseases, including MS.”
“In 1998, official concerns were first voiced over a possible association between hepatitis B virus (HBV) vaccination and multiple sclerosis (MS). Despite a number of studies that have demonstrated no such association, ten years on the French population’s confidence in the vaccine remains shaken and immunization rates of infants have stagnated beneath 30%. With a chronic carriage of the virus estimated at 0.68%, it seems unlikely that France will be able to control the circulation of the virus. ”
Marta Balinska on Hepatitis B vaccination and French Society ten years after the suspension of the vaccination campaign: how should we raise infant immunization coverage rates?
Do you know where all of this has left France now?
With high rates of vaccine-preventable disease (15,000 cases of measles in 2011, with 16 cases of encephalitis and 6 deaths) and a move towards vaccine mandates. As of January 2018, all infants and toddlers in France must receive DTaP, Hib, HepB, pneumococcal, MMR, and meningococcal C vaccines.
What to Know About France Taking the Rotavirus Vaccine off Their Schedule
In no longer recommending the rotavirus vaccines, officials in France actually put infants at greater risk for sickness and death.
More on France Taking the Rotavirus Vaccine off Their Schedule
Listening to some parents talk about new vaccine laws, you would think that pediatricians are going to start kidnapping babies or simply hold them down to force them to get vaccinated and follow the latest immunization schedule.
Is there any truth to that?
Of course not.
The History of Vaccine Mandates
There have been vaccine mandates in the United States since 1827, when Boston became the first city to require all children attending public schools to be vaccinated against smallpox.
Surprisingly though, it took a long time to get vaccine mandates protecting more children. It wasn’t until the 1980-81 school year that there were laws in all 50 states mandating that children required vaccinations before starting school.
This followed continued measles outbreaks in the mid-1970s and studies showing that states with vaccine mandates had much lower rates of measles than states that didn’t. And it likely explains why there were 10 measles deaths in the United States as late as 1980, even though the first measles vaccine was introduced in 1963.
It took even longer for the vaccine mandates to cover kids in all grades and not just those entering school, to cover kids in daycare, and to cover kids in college. And tragically, it didn’t take long for politicians to chip away at those vaccine mandates. Over just a few years, from 1998 to 2000, 15 states added personal belief vaccine exemptions.
Even the Vaccination Act of 1853 in the UK, which required everyone to get a small pox vaccine, didn’t actually force them to get vaccinated. It originally levied fines on people until they got the vaccine, but they soon allowed a conscientious exemption to vaccination, which many people took advantage of. Over the years, so many people were claiming conscientious vaccine exemptions in the UK, that in 1946, they repealed their vaccine requirements altogether.
What Is a Vaccine Mandate?
Since a mandate is typically defined as an official order to do something, a vaccine mandate would be an order to get a vaccine. But it is hardly an order to hold down and force a vaccine on someone.
Likewise, state laws that mandate vaccines aren’t forcing kids to get vaccinated. They are typically mandates to get vaccinated before attending daycare, public and private schools, and/or college.
Is your child going to camp this year? They might mandate certain vaccines if kids want to attend.
Do Vaccine Mandates Force Parents to Vaccinate Their Kids?
Do vaccine mandates take away a person’s choice about getting vaccinated?
Anti-vaccine folks go to great lengths to scare you into thinking that someone is going to force you to vaccinate your kids. They aren’t…
Of course not.
Again. We are not talking about forced vaccination.
For example, if you work in a hospital that requires a yearly flu vaccine, you can decide to work somewhere else. Sure, you no longer simply have the choice between getting vaccinated or leaving yourself unprotected and continuing to work at the same job, but you can still decide to skip the vaccine and look for another job.
These are mandates with a choice.
The same is true with vaccine mandates for kids to attend school or daycare. If you choose to skip one or more vaccines for a non-medical reason, then even if you are in a state that doesn’t allow religious or philosophical vaccine exemptions, you won’t be forced to get vaccinated. While it may not be an option you are happy with, homeschooling is an option for those who don’t want to vaccinate their kids.
Public education is a benefit of those who comply with mandates or compulsory vaccination laws.
These state immunization laws and vaccine mandates have nothing to do with forced vaccination. They also don’t take away your informed consent, are not against the Nuremberg Code, and are not unconstitutional.
Have kids ever been forced to get vaccinations?
Not routinely, but there have been cases of health officials getting court orders to get kids vaccinated and protected, usually during outbreaks of a vaccine-preventable disease.
In 1991, for example, a judge ruled that parents of unvaccinated children who were members of the Faith Tabernacle Congregation in Pennsylvania had to get a measles vaccine. As a measles outbreak spread through Faith Tabernacle, an associated church, and the rest of the city, there were at least 486 cases of measles in the church, mostly among children, and 6 deaths.
“Parents are free to become martyrs themselves. But it does not follow that they are free, in identical circumstances, to make martyrs of their children before they have reached the age of full and legal discretion when they can make that choice for themselves.”
Prince v. Massachusetts
In addition to being unvaccinated, these children didn’t get any medical care, as their families instead relied on prayer. Finally, after the order was appealed all the way to the state Supreme Court, only nine children got vaccinated.
When parents disagree about vaccines, a judge might also step in decide that a child be vaccinated over one parent’s objections. A child might also get vaccinated against their parents wishes if they have lost custody for reasons that have nothing to do with the child’s medical issues and so a legal guardian, which might be the state, is making those decisions now.
Still, these are not the usual circumstances we are talking about with state vaccine laws. They are simply laws to get kids vaccinated and protected before they are allowed to attend daycare or school.
What to Know About Vaccine Mandates and Forced Vaccinations
Vaccine mandates do not force parents to vaccinate their kids.
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.”
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. (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.
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.
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:
a booster dose of Menactra or Menveo to protect them against meningoccocal disease
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.
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
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
a moderate or severe acute illness with or without fever (precaution)
a progressive neurologic disorder (precaution)
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.
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.
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.
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.
