Tag: religious exemptions

The New Medical Kidnapping Panic

Adults have the right, both morally and legally, to make decisions about their medical care.

What about kids?

Until they become adults, or are close to becoming adults, their parents or legal guardians have the right to make those decisions for them.

Challenging Parental Medical Decisions

There are situations in which a parent’s rights to make medical decisions for their kids can be contested. In general, you can’t make decisions that will obviously harm or put your child at extra risk.

“In most countries, parents have a legal right to make treatment decisions on behalf of their young children. Such rights are normally rebuttable: they can be set aside by courts where parents’ decisions pose a significant risk to the life or well-being of the child.”

Tim Dare on Parental rights and medical decisions

For example, if a parent continues to refuse antibiotic therapy and hospitalization for a life-threatening infection, like meningitis, then the child’s doctor will likely contact child protection services and get authorization to treat the child anyway.

What if you refuse a meningitis vaccine? Although a bad idea that puts your child at risk to get a vaccine-preventable disease, unless your child is in the middle of an epidemic, it is very unlikely that anyone would call child protective services on you. In the situations in which courts have gotten involved in getting kids vaccinated and protected, it was because an unvaccinated child was in foster care for another reason, two parents disagreed about vaccines, or rarely, there was an epidemic and the parents refused to either get vaccinated or stay in quarantine.

“The American Academy of Pediatrics (AAP) believes that all children deserve effective medical treatment that is likely to prevent substantial harm or suffering or death.”

AAP on Religious Objections to Medical Care

Why do these cases come up, cases which certain folks call medical kidnapping?

“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

It may be that the parents:

  • refused treatment because of religious objections
  • thought that the risks and side effects of the treatment were worse than their child having the disease
  • want to pursue alternative treatments for cancer or other life-threatening conditions, instead of chemotherapy and other standard therapies, especially in situations in which standard therapy has a good chance of success
  • don’t believe the diagnosis is real and are pursuing other treatments that are harming the child
  • want to continue treatments that doctors think have become futile
  • have lost custody of their kids 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

Fortunately, these situations are not very common, no matter how much some folks try to scare parents that the state is coming to kidnap kids away and force them to get vaccinated or get other treatments. Yes, courts do sometimes have to step in and do what they think is right for a child over a parent’s wishes, but there is no epidemic of doctors or child protective services kidnapping kids.

The New Medical Kidnapping Panic

Although you can sometimes challenge the decisions a parent makes when their kids are sick, and in some cases, ultimately treat their kids in ways that those parents might not agree with, again, you can’t simply take or kidnap a child and do whatever you like.

“Physicians have both a moral obligation and a legal responsibility to question and, if necessary, to contest both the surrogate’s and the patient’s medical decisions if they put the patient at significant risk of serious harm.”

AAP on Informed Consent in Decision-Making in Pediatric Practice

Except in emergencies, overriding a parent’s wishes is usually a long process, involving second opinions, an ethics panel or team, child protective services, and the courts. In most cases, a judge, sometimes after several appeals, decides what will ultimately be done, looking at all of the evidence from both sides.

That the process takes time is evident when you look at the timeline from the legal battle for Alfie Evans. Although most people likely think everything began when the tragic story finally made headlines, a few weeks before his death, it was at least four months earlier that the hospital began “liaising directly with the family after disagreements over his treatment.” And it was four months before that, when Alfie was 13-months-old, that the hospital had first started talking about withdrawing life-support treatment.

It took a hearing before judge in the family division of the high court, three court of appeal judges, a review by supreme court justices, and a review by the judges at the European court of human rights for Alder Hey Children’s hospital to withdraw Alfie’s life-support treatment.

That the process took so much time was missed by those who push the idea of medical kidnapping. These same folks, in the case of Alfie Evans, are also pushing claims of vaccine injury, a plot to illegally harvest organs, a plot to cover up a misdiagnosis and medical neglect by the hospital, a plot to kill him with a lethal injection, and that others had a plan to help him get better.

Many of the same issues were raised in the case of Charlie Gard, an infant who was taken off life support at another UK hospital against his parent’s wishes.

Other cases have included:

What about when doctors disagree on a diagnosis and plan of care? Can parents simply pick which one they prefer?

In most cases you can.

Doctors have different styles and there are often different treatment plans for the same condition. The trouble typically comes when a parent chooses an alternative type treatment that has been shown to not work or is known to be harmful. Or provides treatments a child doesn’t even need.

Tragically, we often don’t hear about these cases until it is too late and the child dies before doctors and courts ever have a chance to intervene. When folks talk about medical kidnapping, they don’t seem to mention kids like:

  • Ezekiel Stephan – died at 19-months because his parents treated his bacterial meningitis with natural remedies, including “water with maple syrup, juice with frozen berries and finally a mixture of apple cider vinegar, horseradish root, hot peppers, mashed onion, garlic and ginger root”
  • Madeline Kara Neumann – the 11-year-old who died because her parents relied on prayer instead of modern medicine to treat her diabetes
  • Ryan Lovett – the 7-year-old who died with a Strep skin infection that his mother had been treating with “holistic remedies,” allowing it to progress to pneumonia, meningitis, and multiple organ failure
  • Louise Le Moaligou – an 11-month-old who died because her parents treated her pneumonia with “cabbage and clay compressions”
  • Gloria Thomas – died at 9-months because her parents pursued homeopathic remedies for her severe eczema, even as she developed malnutrition and sepsis.
  • Isabella Denley – a 13-month-old with severe seizures who died after her parents opted for alternative treatments over anti-convulsant medications, including a “vibrational kinesiologist, a cranial osteopath and a psychic who told them Isabella was suffering from a past-life trauma.”
  • Cameron Ayres – a 6-month-old who died with a likely inherited metabolic disorder that was treated by a homeopath with vinegar and honey
  • Eliza Jane Scovill – died of AIDS-related pneumonia at age 3-years. Eliza Jane was the daughter of Christine Maggiore, an HIV denialist who advised HIV positive moms to not take preventive antiviral drugs during their pregnancy, the one thing that would have kept Eliza Jane from getting HIV in the first place.
  • Alex Radita – the 15-year-old with diabetes who died because his parents wouldn’t treat him with insulin
  • Aidan Fenton – the 6-year-old with diabetes who died after undergoing slapping therapy by a Chinese healer, therapy that also involved fasting for “days on end.”
  • Garnett Spears – a 5-year-old who supposedly had multiple medical problems, but instead was poisoned by his mother, who was adding a lot of extra salt to his g-tube feeding bags
  • Gypsy Rose Blanchard – after a lifetime of being told she was “sick,” including having leukemia, muscular dystrophy, and seizures, Gypsy and her boyfriend stabbed her mother to death
  • the 6-week-old in South Texas with late onset vitamin K dependent bleeding who never received vitamin K prophylaxis at birth and died after developing brain bleeding and seizures
  • the 3-week-old in Indiana with late onset vitamin K dependent bleeding who was born in a birthing center and whose “parents signed a waiver to forego vaccination and prophylactic therapies,” and required an emergency craniotomy to evacuate braining bleeding, prolonged intubation, and difficult to control seizures
  • Tom, Roger, and Chrissy Williamson – the three children were taken to over 500 doctor appointments, put on medications for epilepsy, Crohn’s disease, Tourette’s syndrome, etc, and had unnecessary surgeries because their mother made doctors think they were sick
  • Amina Krouser – a 14-year-old who died after a neglected sore throat led to a life-threatening brain infection, for which her mother refused emergency surgery.
  • Christopher Bowen – an 8-year-old who had 13 major surgeries and 323 visits to the hospital because his mother fooled doctors into thinking he had a rare genetic disorder
  • the Oregon mother who’s three kids had unnecessary surgeries and were put on high dose “cocktails” of medicine, including one that she was trying to put in hospice

Trouble can also come when a child gets diagnosed or re-diagnosed with a more controversial condition. That seems to be what happened with Justina Pelletier, a teen who was kept and treated at Boston Children’s Hospital against her parent’s wishes. The doctors there doubted her original diagnosis, that she had a mitochondrial disorder.

“Unfortunately, mitochondrial genetic disorders can be difficult to diagnose, and many affected people may never receive a specific diagnosis. They are often suspected in people who have a condition that effects multiple, unrelated systems of the body.”

NIH on Mitochondrial genetic disorders

Similar to mito disorders, there are other conditions that are often difficult to diagnose, including Ehlers-Danlos, Postural Orthostatic Tachycardia Syndrome (POTS), and Pediatric Autoimmune Neuro-Psychiatric Disorder Associated with Streptococcus (PANDAS).

Getting diagnosed or treated with these conditions wouldn’t usually be an issue, except that some alternative, holistic, and integrative health care providers take advantage of them. They might even stretch the disease definitions to make them fit almost anyone with vague symptoms and use treatments that many others would consider harmful, or at least unnecessary. It isn’t hard to see that even when a child gets a genuine diagnosis for one of these conditions, it might get questioned because they might have seen others that turned out to be misdiagnosed.

To be clear, these are all very real conditions that are almost certainly under-diagnosed because many doctors still don’t understand them. If you suspect that your child has one of these conditions, or any other rare condition, try and seek out a true expert to confirm the diagnosis. Does everyone who comes to the clinic get a diagnosis and list of supplements to buy? Then that likely isn’t the “expert” you want your kid to see.

Did you know that many of the DAN (Defeat Autism Now) doctors that once pushed biomed treatments to “cure” autism are now some of the same doctors continuing to push autism biomed treatments, but are now also diagnosing and treating kids with mito disorders.

And remember when all of those kids in LeRoy, New York developed tics for no good reason? One doctor, who actually runs a PANDAS institute, diagnosed many in the cluster with PANDAS.

It shouldn’t be surprising that many of these DAN doctors, including many who are not actually medical doctors, are also in the PANDAS Physicians Network Practitioner Directory.

Are they all cutting edge doctors helping to diagnose and cure kids when no one else can? Or as in the case of their autism biomed treatments, are they taking advantage of people looking for hope wherever they can?

Complicating matters further, some providers also diagnose kids with conditions like adrenal fatigue and chronic Lyme disease that most doctors don’t even think exist!

“Government should not get involved when doctors disagree about a diagnosis or course of treatment, the doctors have full knowledge of the child’s medical record, and a parent chooses one doctor’s opinion over another’s.”

Maxine Eichner on The New Child Abuse Panic

Government should not have to get involved when doctors disagree, but quack doctors shouldn’t be out there taking advantage of people either, especially to the point that it is going to harm a child. When they do, someone needs to step in and protect those kids.

And when you hear a story about a “medical kidnapping,” remember that you typically just get one side of the story. Because of privacy laws, the doctor, hospital, and CPS likely isn’t going to release any details that will help you understand why they felt the child was at risk.

Even more importantly,  when folks tell you that medical child abuse isn’t real and doesn’t happen, tell them about about the victims named above.

What to Know About Challenging Parental Medical Decisions

Challenging and taking away a parent’s right to make medical decisions for their child is something that is typically only done in extreme situations.

More on Challenging Parental Medical Decisions

The Catholic Church and Vaccines

We hear a lot about the Catholic Church and vaccines.

The Catholic Church teaches that it is lawful to get vaccinated to protect
The Catholic Church teaches that it is lawful to get vaccinated to protect “our children, public health, and the common good.” The National Catholic Bioethics Center

Maybe it is because Pope Francis led a polio vaccine campaign when he visited Mexico.

Pope Francis helped launch a polio vaccine campaign when he visited Mexico in 2016.
Pope Francis helped launch a polio vaccine campaign when he visited Mexico in 2016.

Or because Pope Francis thanked members of the Rotary International during an Audience at the Vatican, where the Pope “emphasized the importance of vaccinations against polio and urged Rotary to continue.”

History of the Catholic Church and Vaccines

Pope Francis isn’t the first Pope to promote vaccination.

Way back in the early 1800s, Pope Pius VII said the smallpox vaccine was “a precious discovery which ought to be a new motive for human gratitude to Omnipotence.”

But wasn’t there an anti-vaccine pope too?

Some claimed that Pope Leo XII had said that “Whoever allows himself to be vaccinated ceases to be a child of God. Smallpox is a judgment of God, the vaccination is a challenge toward heaven.”

He didn’t say it though – the anti-vax edict from the Pope was imaginary!

There was no anti-vaccine pope.

Endorsement of vaccination by the Catholic Church had started long before the smallpox vaccine. As early as the 1720s, Jesuits were inoculating Indians in the Amazon against smallpox.

Other noteworthy events in the history of the Catholic Church related to vaccines include:

  • 1757 – Pope Benedict XIV was inoculated against smallpox
  • 1780s – introduction of public vaccinations by the archbishop of Bamberg, Germany
  • 1821 – Council of Vaccination
  • 1800s – priests routinely led processions of people to get vaccinated against smallpox
  • 1862 – Catholic missionaries vaccinated the Quwutsun in the Pacific Northwest

Sean Phillips, in examining the records of the Osler Library, has also found “a story of close cooperation between clergy and the state from the earliest stages of the vaccine in France…” That was important, because when smallpox epidemics were raging, the clergy functioned “as a conduit between the medical community and the majority of cities, towns, and communes in France throughout the nineteenth century.”

Vaccines and Abortion

Of course, one of the main reasons that vaccines and the Catholic Church comes up at all is because of abortion.

The Pontifical Academy for Life reaffirmed the "lawfulness" of using vaccines to protect children and those around them.
The Pontifical Academy for Life reaffirmed the “lawfulness” of using vaccines to protect children and those around them.

What does abortion have to do with vaccines?

While much of what you hear about abortion and vaccines isn’t true, some of it is:

  • Vaccines do not contain aborted fetal tissue.
  • Some vaccines are made in cell lines that originated from fetuses that were aborted over 40 years ago.
  • These vaccines are made in descendent cells from either the WI-38 and MRC-5 cell lines, which have been duplicated over and over again and are grown independently. So, “it is important to note that descendent cells are not the cells of the aborted child.”
  • The descendent cells don’t remain in the final vaccine after it has been purified.

It should be clear now why they say that these vaccines are said to have a “distant association with abortion.”

“For its part, Catholic social teaching entails a duty to vaccinate in order to protect the vulnerable.”

Paul J. Carson on Catholic Social Teaching and the Duty to Vaccinate

And why it is said that Catholics are “morally free to use the vaccine regardless of its historical association with abortion” and that “it should be obvious that vaccine use in these cases does not contribute directly to the practice of abortion since the reasons for having an abortion are not related to vaccine preparation.”

“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

Catholics can seek an alternative vaccine when available and “register a complaint with the manufacturer of the products as an acceptable form of conscientious objection,” but the The National Catholic Bioethics Center states that “there is no moral obligation to register such a complaint in order to use these vaccines.”

Not only are we morally free to get vaccinated and vaccinate our kids, but the National Catholic Bioethics Center says that parents actually “have a moral obligation to protect the life and health of their children and those around them.”

What to Know About the Catholic Church and Vaccines

From measles to HPV, the Catholic Church recommends that your family be vaccinated and protected.

More About the Catholic Church and Vaccines

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How to Claim a Vaccine Exemption

Don’t want to get your kids vaccinated?

You might be surprised to know that no one is out there trying to force you into vaccinating them.

Want to enroll your kids in daycare, preschool, school, or college?

Then they will need to be vaccinated.

How to Claim a Vaccine Exemption

Of course, depending on where you live, you could get a vaccine exemption and leave your kids unvaccinated and unprotected.

Does your child qualify for a medical exemption? All states allow kids to claim medical exemptions to getting vaccinated. True medical exemptions are rare though, as you can see from the rates in states that actually require screening and approval of medical vaccine exemptions.

Are you a Christian Scientist? In 47 states, laws allow religious exemptions to vaccinations. Ironically, these exemptions are often abused, as you don’t actually need to belong to a religion that is against vaccines to claim a religious exemption to vaccinations.

“When you are challenged by the viewpoint of a denomination, pastor, publication, or atheist authority: You do not worship any pastor, church, religious publication, or denomination. Your pastor’s personal view on vaccines is irrelevant to your stance because pastors do not learn about the biblical implications of vaccinating during seminary and your pastor isn’t God. (Though if you have a pastor willing to go to bat for you, use him.)”

Megan on How To Get a Vaccine Religious Exemption Like a Boss

It is not even a secret that parents abuse the religious vaccine exemption, claiming them even when they don’t have a sincere religious belief against getting vaccinated.

And in 20 states, it is even easier to claim a vaccine exemption. These are the states that allow philosophical or personal belief vaccine exemptions, in which you can typically just say that you are against vaccinating and protecting your kids “for reasons of conscience.”

Vaccine exemptions are too easy to get in some states, but even with an exemption, your child will still be excluded if there is an outbreak.
Vaccine exemptions are too easy to get in some states, but even with an exemption, your child will still be excluded if there is an outbreak.

What reasons? You don’t usually have to go into much detail…

Why Parents Abuse Vaccine Exemptions

It is not hard to understand why some parents abuse vaccine exemptions.

They abuse vaccine exemptions because they can.

In many states, it is easy to abuse vaccine exemptions because medical exemptions aren’t verified and approved and it is often easier and more convenient to get an exemption than to get vaccinated. Believe it or not, some doctors will even sell you a medical exemption for your child. Also, parents are made to feel so scared by anti-vaccine propaganda that they think that they need to get an exemption.

“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.

But just because you can claim an easy exemption in a state without strong vaccine exemption laws doesn’t mean that you should.

While there are no benefits to delaying or skipping vaccines, there are plenty of risks. And the risks aren’t just to your unvaccinated child. We continue to see and hear about kids who are too young to be vaccinated or who couldn’t be vaccinated getting caught up in outbreaks caused by others who simply chose to not get vaccinated.

“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

Not surprisingly, websites and organizations that give advice on getting kids easy vaccine exemptions never mention these risks. They also overstate the risks of vaccines and don’t mention the benefits of getting vaccinated.

Vaccines are safe and necessary. Unless your child has a true medical contraindication to getting one or more vaccines, do a little more research before getting a non-medical exemption.

What to Know About Claiming a Vaccine Exemption

While it is typically not hard to claim a vaccine exemption for your child, since vaccines are safe and necessary, be sure you understand the risks of delaying or skipping any vaccines if your child doesn’t need a true medical exemption.

More on Claiming a Vaccine Exemption

 

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

 

The Moral Responsibility of the Anti-Vaccine Movement

It shouldn’t be surprising that talk of morality comes up around the issue of vaccines from time to time.

“Scientists and clinicians confront moral and ethical choices daily and often observe a religious faith that helps guide their own personal conduct. Indeed, the religious beliefs of countless historical and contemporary researchers and clinicians have been a source of motivation to help relieve human suffering by means of immunization.”

Grabenstein on What the World’s religions teach, applied to vaccines and immune globulins

It is most often because some vaccines do have a “distant historical association with abortion.”

Even then, the National Catholic Bioethics Center states 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.

That seems pretty easy to interpret.

They are saying we are both “morally free” to use these vaccines and that we “have a moral obligation” to get vaccinated.

What about those parents who feel like they shouldn’t have to vaccinate their kids, exposing them to the risks of vaccines, simply to “protect the herd?”

“Putting aside arguments about social good, herd immunity, discouraging free loading and preventing harm to others, vaccinating a child for the child’s sake is not just the right thing to do, but also the only thing to do.”

Ogbogu on Vaccines and the Ethics of Parental Choice

They should understand that:

  • they aren’t vaccinating their kids just to protect levels of herd immunity in the community – they are also providing their own kids with individual levels of immunity and protection, so it is not just about preventing harm to others
  • vaccines are safe, so the risks of getting vaccinated are very low
  • by intentionally not vaccinating their own kids, they are free-riding and benefiting from the fact that most of the rest of us do get vaccinated and do vaccinate our kids

And they should understand that there is no ethical way to defend intentionally skipping or delaying their child’s vaccines, which puts kids who can’t be vaccinated at risk.

“The society of the 21st century, just as many societies and cultures in the history of human civilization, use religion as an excuse for wars, discrimination, and now for vaccination refusal.”

Pelčić on Religious exception for vaccination or religious excuses for avoiding vaccination

Although a few folks haven’t gotten the message, and may even lie to get a fake religious vaccine exemption, most others see it the same way.

“Giving children a healthy start in life, no matter where they are born or the circumstances of their birth, is the moral obligation of every one of us. It is heartbreaking to think that three million children die each year from diseases that we can prevent.”

Nelson Mandela (2002 Vaccine Conference)

Most parents vaccinate their kids because they understand that vaccines are safe, vaccines work, and vaccines are necessary, just as they likely also understand that there is a moral obligation to vaccinate.

“The argument relating to public goods can be added to the harm-to-others arguments. Where a public good, such as herd protection, exists we must take care not to damage it. The need to create and maintain such a good provides an additional reason, should one be needed, to argue in favour of a moral obligation for the traveller to be vaccinated in advance for infectious disease.”

Dawson on What are the moral obligations of the traveller in relation to vaccination?

And if there is a moral obligation to get vaccinated, then what does that say about those who push propaganda that scares parents away from vaccinating and protecting their kids?

“The anti-vaccine argument is wrong in both the scientific and moral sense.”

Sarah Kurchak on Here’s How the Anti-Vaccination Movement Hurts Autistic People

Dr. Vytenis Andriukaitis, the EU Health Commissioner, is the latest to call out those in anti-vaccination movements, who he says have the “moral responsibility” for the death of unvaccinated children.

“I would like to draw attention to the fact that all these movements, which use different arguments, do not understand what they are doing. It would be a shame if the families belonging to this movement were to bury their children, as happened this year in the Member States where children have died of measles.

I would like to invite those who are against the vaccines to visit families, to visit the tombs of the children of those families, and to think what they are doing. I would like to invite all these anti-aging movements to visit the European cemeteries of the nineteenth century, of the eighteenth century, beginning of the twentieth century: they will find many tombs of small children, because there were no vaccines.”

Vytenis Andriukaitis, MD (translated from Italian)

Dr. William Osler's vaccine challenge in his 1911 essay Man's Redemption of Man.
Dr. William Osler’s vaccine challenge in his 1911 essay Man’s Redemption of Man.

This brings to mind another challenge that was made to anti-vaccine activists just over one hundred years ago by Dr. William Osler in his essay Man’s Redemption of Man.

Dr. Osler jokingly proposed a small vaccinated vs unvaccinated study and challenged ten unvaccinated people, including “three anti-vaccination doctors, if they could be found,” to join him in the “next severe epidemic.”

Tragically, Dr. Osler wouldn’t have a hard time finding three anti-vaccination doctors today.

He would have an easy time recognizing their arguments, as they really haven’t changed over the past 100 years.

Neither is the fact that kids are still dying of diseases that are now vaccine-preventable.

What to Know About the Moral Responsibility of the Anti-Vaccine Movement

Many people believe that we have a moral responsibility to protect ourselves, our families, and those around us from vaccine-preventable diseases by getting vaccinated and it is immoral to push misinformation that scares parents away from vaccinating and protecting their kids.

More on the Moral Responsibility of the Anti-Vaccine Movement

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

Tetanus and Tetanus Shots

Tetanus is a vaccine-preventable disease that is caused by the Clostridium tetani bacteria.

Can an unvaccinated child really get tetanus after a toe nail injury?
Can an unvaccinated child really get tetanus after a toe nail injury? Photo by Petrus Rudolf de Jong (CC BY 3.0)

Unlike most other infections though, tetanus isn’t contagious. Instead, spores of Clostridium tetani get into dirty wounds and then begin to grow into active bacteria.

The now “awake” Clostridium tetani bacteria then begin producing exotoxins that cause the symptoms of a tetanus infection.

In the pre-vaccine era, there were about 500 to 600 cases of tetanus in the US each year and about 165 deaths.

Fortunately, tetanus is rare now, as most folks are vaccinated, but we do see some cases in kids who are intentionally not vaccinated or in seniors who haven’t gotten a tetanus booster in a long while.

The unvaccinated child with the toe nail injury?

“A 4-year-old Caucasian boy presented with a one-week history of general malaise, mild fever, indolence and anorexia. He subsequently developed dysphagia, sialorrhoea, difficulties opening the mouth and eventually dehydration… Together with the lack of immunization and a toe nail infection, this lead to the suspicion of a generalized tetanus infection… The frequency and severity of paroxysmal muscle spasms increased progressively during his PICU stay, despite high doses of sedatives. Not before two weeks after admittance, extubation and careful weaning off sedatives was achieved.”

Generalized tetanus in a 4-year old boy presenting with dysphagia and trismus: a case report

He was unvaccinated “based on religious grounds” and had recently injured his toe, resulting “in a small local hematoma and loose toenail.” It also resulted in his getting tetanus and a 30 day stay in the hospital.

What Are the Symptoms of Tetanus?

Unvaccinated children can develop symptoms of tetanus two days to two months (average incubation period is two weeks) after getting a wound that is contaminated by tetanus spores.

“It was hideous. He was spasming every three minutes. He was biting his tongue and bleeding. His arms were spasming and he was arching his back and his whole face and jaw was completely locked.”

Linda Williams on her unvaccinated 7-year-old son’s bout of tetanus

The most characteristic symptoms are painful muscle spasms that gradually get worse over a week, including:

  • spasms of the muscles around their mouth, giving the typical “lockjaw” appearance of tetanus
  • spasms of the muscles around the throat, which can make it hard to swallow
  • spasms of the chest muscles, making it difficult to breath
  • spasms of the muscles in the neck, back, arms, legs, and abdomen

Other associated symptoms can include fever, headache, irritability, tachycardia (high heart rate), urinary retention (secondary to bladder muscle spasm), low blood pressure or high blood pressure.

How Do You Diagnose Tetanus?

Tetanus is usually diagnosed in someone with painful muscle spasms and history of a dirty wound.

It is important to keep in mind that your child is not only at risk for tetanus following the classic case of stepping on a rusty nail – a classic myth about tetanus.

Tetanus spores live in the soil and so almost any dirty wound can lead to tetanus infections. Although puncture wounds are the most common that lead to tetanus, scrapes, burns, snake bites, dog bites, and even spider bites can also cause tetanus if the wounds becomes contaminated with dirt or feces.

Testing for the Clostridium tetani in the original wound is sometimes possible, but is not necessary for a diagnosis of tetanus, since it is technically difficult to do.

Neonatal tetanus can occur in newborns if their mother isn’t immunized against tetanus and their umbilical cord stump gets contaminated.

How Do You Treat Tetanus?

The treatments for tetanus can include sedation and mechanical ventilation and:

  • human tetanus immunoglobulin (TIG) to try and neutralize the tetanus toxin
  • antibiotics, such as penicillin G, metronidazole, erythromycin, or tetracycline
  • muscle relaxants, such as diazepam, magnesium sulfate, midazolam, and baclofen
  • neuromuscular blocking agents, such as vecuronium and pancuronium, which cause paralysis

If you have ever read a story about a child who has needed treatment for tetanus, you will likely opt for a tetanus shot instead.

Do I Need a Tetanus Shot?

Like other vaccine-preventable diseases, keeping up-to-date on your child’s immunizations can help to prevent your child from ever getting tetanus.

One thing that complicates tetanus is that your child may still need a tetanus shot, even if they are fully vaccinated, if it has been five or more years since his last tetanus shot and he has:

  • a wound that is contaminated with dirt, feces, or saliva
  • a puncture wound
  • an avulsion wound, in which part of the wound is pulled away from the other part
  • a wound caused by crush injury, burn, or frostbite

So if your child had a tetanus shot at age four (the DTaP vaccine kids get before starting kindergarten), then he may need a tetanus shot if he gets a dirty wound before he gets a tetanus booster when he is 11 or 12 years old (the Tdap vaccine).

And yes, a tetanus shot will work in these situations, even if you have already been exposed to the tetanus spores. But no, letting a wound bleed a lot won’t flush out the spores. These are other myths about tetanus and tetanus shots that you might hear.

What to Know About Tetanus and Tetanus Shots

See your pediatrician as soon as possible if your child needs a tetanus shot after getting a dirty wound.

More About Tetanus and Tetanus Shots