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California Bill AB 2109: The Antivaccine Movement Attacks School Vaccine Mandates Again

Of all the preventative treatments ever developed through science- and evidence-based medicine, vaccines have arguably saved more lives, prevented more illness and disability, and in general alleviated more suffering than any single class of treatments or preventative measures throughout history. Given the obvious and incredible success of vaccines at decreasing the incidence of infectious diseases that used to ravage populations, it seems incredible that there would be such a thing as an antivaccine movement, but there is. Indeed, when I first encountered antivaccine zealots on the Usenet newsgroup misc.health.alternative about ten or twelve years ago, as a physician I really had a hard time wrapping my head around the fact that such people existed. No doubt the same is true of many physicians, who take the scientific evidence for the safety and efficacy for vaccines for granted. However, I am a cancer surgeon, and I do not treat children; so until I discovered antivaccine rhetoric on the Internet I was blissfully ignorant that such views even existed. Other health care professionals knew better. Pediatricians, nurses, and any health care professionals who deal with children and the issue of vaccinations know better, because they face antivaccine views on a daily basis. It is because of the incredible importance of vaccination and the danger to public health the antivaccine movement represents that we at Science-Based Medicine write so frequently about vaccines and the antiscientific, pseudoscientific, and misinformation-packed fear mongering about vaccines that is so prevalent today.

The success of vaccination campaigns has recently been endangered by a number of factors, in particular the antivaccine movement. Because of various groups opposed to vaccination, either for philosophical reasons or because they incorrectly believe that vaccines cause autism, neurodevelopmental disorders, sudden infant death syndrome, and autoimmune diseases, among others, one of the most potent tools for encouraging high rates of vaccine uptake, school vaccine mandates, have come under attack. Alternatively, increasing numbers of parents have taken advantage of religious or philosophical exemptions in order to avoid the requirement to have their children vaccinated prior to entry to school. As a result, of late some states with lax vaccination requirements have begun to try to tighten up requirement for non-medical vaccine exemptions. The arguments used by the antivaccine movement against such legislation are highly revealing about their mindset, in particular their attitude towards issues of informed consent, which I will discuss a bit. But first, here’s a little background.

Antivaccinationism throughout history

The success of vaccination campaigns depends upon as many members of an at-risk population as possible being vaccinated in order to achieve herd immunity. Herd immunity (also known as community immunity, a lovely rhyme) been discussed on this blog many times, most prominently by Drs. Mark Crislip and Joseph Albietz. Basically, when a sufficiently large percentage of the population is vaccinated against a disease, even those not immune to the disease obtain a measure of protection against infection because the immunity of a large percentage of the population prevents the infectious agent from being readily spread from person to person. The agent thus never gets a “foothold” in the community, and the greater the proportion of the population vaccinated the less the chance of a susceptible individual coming into contact with an individual carrying the infection. Herd immunity is very important because it helps to protect population members who can’t be vaccinated for whatever reason, be it immunodeficiency or other medical reason or because they are too young to be vaccinated. Vaccines aren’t perfect. Even highly effective vaccines only protect 90 to 100% of the vaccinated population in the case of an exposure to the infectious agent vaccinated against. The precise percentage of the population that needs to be vaccinated to achieve herd/community immunity varies depending upon the efficacy of the vaccine and the infectiousness of the disease being vaccinated against, but a good, serviceable ballpark estimate is usually somwhere in the 90% range.

Herd immunity is the reason why it is so important to vaccinate as large a percentage of the at-risk population as possible. To this end, public health officials have at times tried a number of strategies, ranging from cajoling to compulsory vaccination. Legislating compulsory vaccination, in particular, has traditionally been problematic, for almost immediately after vaccines were invented and public health officials started looking for ways to increase vaccine uptake rates, in response have sprung up antivaccination movements. For example, in the U.K. the Vaccination Act of 1853 ordered mandatory vaccinations for infants up to three months old, with failure of parents to do so punishable by a fine or imprisonment, a requirement that was extended to age 14 by the Vaccination Act of 1867. The 1853 act immediately provoked violent riots in Ipswich, Henley, Mitford, and several other towns, and resulted in founding of the Anti-Vaccination League later that same year. Over the next few decades, in response to compulsory vaccination laws a large number of antivaccination books, journals, and tracts appeared. The titles of these books and journals, at least, were more honest than titles of similar websites today. For instance, there were the Anti-Vaccinator (founded 1869), the National Anti-Compulsory Vaccination Reporter (1874), and the Vaccination Inquirer (1879). Meanwhile, similar movements flourished elsewhere in Europe and the United States, challenging such laws as infringements on personal liberty. Ultimately, in England, the Vaccination Act was amended to allow exemptions for parents, based on conscience, which introduced the concept of “conscientious objector” into English law.

A different strategy to achieve high rates of vaccination is the use of vaccine mandates. School vaccine mandates differ from laws requiring vaccination in that no one from the state will hunt parents down to force them to vaccinate. However, if parents want to take advantage of state services, such as public schools, for their children or if they want to use services that place a lot of children together (such as day care facilities) they have to have their children vaccinated. This is a practice with very old precedent. For example, in 1827 Boston became the first city to require parents of children enrolling in public school to present evidence of vaccination against smallpox. The trend continued, as described in this review of school vaccine madates:

The Commonwealth of Massachusetts incorporated its own school vaccination law in 1855, New York in 1862, Connecticut in 1872, and Pennsylvania in 1895. Other Northeast states soon passed their own requirements. The trend toward compulsory child vaccination as a condition of school attendance eventually spread to states in the Midwest [e.g., Indiana (1881), Illinois and Wisconsin (1882), Iowa (1889)], South [e.g., Arkansas and Virginia (1882)], and West [e.g., California (1888)], though not without considerable political debate.

School vaccine mandates, although they were opposed by antivaccination leagues from the beginning, tended to provoke less virulent opposition and better compliance, making them not only politically more palatable, but more effective. However, of late, the effectiveness of school vaccine mandates has been weakened by a steady expansion of non-medical exemptions, in particular religious or philosophical exemptions. Forty-eight states currently allow religious exemptions that vary in requirements, from parents simply signing a form stating that vaccination is against their religion to allowing exemptions only to religions that have a history of opposing vaccination, such as Christian Scientists and Jehovah’s Witnesses. Twenty states currently permit philosophical exemptions, in which parents must declare a personal belief against or philosophical objection to vaccination. Usually, parents must file a form, ranging from just once to annually, with their school district stating their personal objection to vaccination. Not surprisingly, in states that allow personal belief exemptions they are the most commonly invoked reason by parents to refuse vaccinating their children. Even in states that allow only religious exemptions, however, parents are not above lying about their religion in order to obtain a vaccine exemption.

California responds to the increasing use of personal exemptions

Over the last couple of decades, the percentage of parents claiming personal exemptions to vaccination has more than doubled. In California, a state with a particularly lax personal exemption law that only requires that the parent sign a form stating that they have a personal belief against or philosophical objection to vaccination, although statewide the percentage of children with parents claiming the personal belief exemption remains low (2%), there are schools where exemption rates are as high as 58% (one kindergarten reported a 76% exemption rate) serving as incubators for outbreaks of measles and other contagious diseases. After all, unvaccinated children have a 23-fold higher risk of contracting pertussis and a 35-fold higher risk of contracting measles than vaccinated children. Unfortunately, the non-vaccinating populations tend to cluster, and their refusal of vaccines leads to there being areas with large pockets of unvaccinated children, ripe for outbreaks of vaccine-preventable diseases.

Part of the problem in California is that philosophical exemptions are so easy to obtain that they are actually easier to obtain than it is for parents to have their children vaccinated according to California requirements for school entry. It is, in effect, so easy to obtain a personal belief exemption from vaccination requirements for school entry that even parents with no strong feelings who are simply too harried to claim this exemption just to make their lives a little easier. Just sign a piece of paper. That’s it.

To try to make sure that parents who refuse vaccines on a personal belief basis do so with full informed consent and to make it just a bit more difficult to obtain such exemptions, Assemblymember Richard Pan (D-5th District), who also happens to be a physician, introduced California bill AB 2109. (According to Liz Ditz, as of March 24, the bill is still in the Assembly Health Committee.) The bill is very simple and not a major change from California’s current lax policy. Basically, in addition to signing a personal belief exemption form, if AB 2109 is passed, parents will be required to obtain a signed form from a pediatrician stating that they have been counseled on the risks and benefits of vaccines. The law would, in essence, require that the parents make such a monumental decision only after having had a physician provide them with informed consent, so that they understand the potential consequences of not vaccinating, as well as the risk-benefit ratio for vaccination. The text of the bill can be found here.

Unfortunately, even so mild a change in the law designed to boost vaccination rates has not gone unnoticed among the antivaccine movement.

The antivaccine movement and its sympathizers react by advocating misinformed consent

I’ve discussed the concept of “misinformed consent” multiple times before. Quacks in general, particularly the “health freedom” movement proclaim their dedication to “informed consent.” “All we’re asking for,” they will say, “is informed consent.” The antivaccine movement in particular demands “informed consent” about vaccines. Be it founder of the National Vaccine Information Center (NVIC) Barbara Loe Fisher, the bloggers at the antivaccine crank blog Age of Autism, or any of a number of antivaccine warriors, demanding “informed consent” seems to be every bit as much of the antivaccine arsenal as the “toxins gambit” or ranting about “fetal cells” in vaccines. None of this is to try to say or even imply that informed consent isn’t incredibly important. It is critical to everything we do in medicine, both in clinical practice and research in the form of clinical trials. It is, quite correctly, considered a major failure when adequate informed consent is not given, and when the failure to provide informed consent is intentional or comes about through neglect it’s considered highly unethical. Medical ethics demands that patients be aware of what it is they are getting as well as what the potential benefits are relative to the potential risks, and that they have the freedom to choose to undergo or refuse the proposed therapy.

However, what the antivaccine movement means when its representatives demand “informed consent” resembles true informed consent only by coincidence–and, let’s be frank, not even then. In fact, as Todd points out, the actions of the antivaccine movement are profoundly inconsistent with a real desire for real informed consent, and California Bill AB 2109 is a golden opportunity for the luminaries of the antivaccine movement to prove that they support informed consent. As he also put it, “Parents are still free to put their children and their communities at risk of disease outbreaks based on personal opinions rather than facts. They just aren’t allowed to be quite as lazy about it any more.”

Unfortunately, the antivaccine movement has rallied not for AB 2109, but against it. Barbara Loe Fisher, all her protestations for “informed consent” notwithstanding, has issued what is in essence a call to arms to her fellow antivaccinationists to try to defeat the bill. It’s full of appeals to “personal freedom,” claims that doctors would not sign such forms, and the like:

AB2109, introduced by Assembly Member Richard Pan, who himself is a pediatrician, would impose these additional costly and time consuming burdens on parents wanting to use a personal belief exemption to:

  1. pay for an expensive appointment at a medical doctor’s office to be given vaccine risk and benefit information that is already available online for free; and
  2. jump through the bureaucratic hoops of obtaining yet additional new forms provided by the Department of Public Health which state that the health care practitioner has provided risk and benefit information to the parent; and
  3. find a health care provider actually willing to take the appointment and then sign the new forms within 6th months of starting school for the exemption to be valid.

This raises many questions legislators need to answer including:

  • How will the state pay for all these extra required office visits for families on public assistance and for the kids of state employees who have their health coverage provided by the state?
  • What happens to a parent who can’t find a provider willing to make these types of appointments and then sign the form?
  • What will stop doctors from using this law to deny access to philosophical exemptions? It is already hard enough for families to find providers who are willing to just treat children in their practice at all when they deviate from the required vaccination schedule.

Then, to hammer home the connection between quackery and antivaccine beliefs, the NVIC adds these reasons for opposing AB 2109:

  • Especially in California, many families utilize health care providers not reliant on pharmaceutical drugs and vaccines, and only practitioners part of the pharmaceutical paradigm or medicine are allowed to provide the information and sign the form under this bill.
  • AB 2109 discriminates against families utilizing complementary and alternative medicine by forcing them into paying money to a medical practitioner they wouldn’t otherwise use who is already philosophically opposed to the parent’s personal and religious convictions regarding vaccination.

Barbara says that as though prodding parents who take their children to quacks to take them to a real doctor for just one visit is a bad thing. Of course, it’s “health care providers not reliant on pharmaceutical drugs and vaccines” who tend to promote antivaccine beliefs. Of course, I expect such nonsense from someone like Fisher. I don’t expect such nonsense from a physician. In fact, call me naive, way too optimistic, or just someone who falls into the occasional temptation to defend his tribe too much, but I don’t expect nonsense this ridiculous even from someone like Dr. Jay Gordon.

Or Dr. Robert Sears.

Unfortunately, I was quite wrong. Dr. Sears has joined Barbara Loe Fisher’s voice against AB 2109 by writing an editorial that was published first on that other wretched hive of scum and antivaccine quackery, Mothering.com, entitled California Bill AB2109 Threatens Vaccine Freedom of Choice. Not surprisingly, two days later Dr. Sears crossposted the very same article on the original wretched hives of scum and quackery, The Huffington Post. His reasons for being opposed to AB 2109 are virtually indistinguishable from the reasons posted at the NVIC website, right down to Dr. Sears claiming that doctors won’t sign the form:

However, what gravely concerns me is that some doctors will refuse to sign this form. I know how doctors think. Many doctors strongly believe that vaccines should be mandatory, and that parents should not have the right to decline vaccines. Some doctors are willing to provide care to unvaccinated kids, despite this difference in philosophy. But now the power over this decision will be put directly into doctors’ hands. He or she can simply refuse to sign the form. Doctors who oppose vaccine freedom of choice have been frustrated for years over this issue. Finally, they will have the power to impose their beliefs on their patients. Patients will be forced to find another doctor to sign the form, submit to vaccines, or get kicked out of public school.

And, of course, there’s the question of liability fears, which leads Dr. Sears to state that he knows for an “absolute fact” that some doctors will not sign the form “out of principle or fears of liability.” How he knows this “for an absolute fact” he doesn’t say. The only part where Dr. Sears makes a modicum of sense is that some doctors might be reluctant to sign the form for a child based on a single visit, particularly when it’s obvious that that’s the only reason the parents brought the child in to be seen and evaluated. That might be so for some doctors, but how many doctors do sports physicals, insurance physicals, physical exams for workers’ compensation, and the like, even though they know that the patient probably won’t come back to see them again? How many physicians in California, for that matter, refuse to sign medical exemption forms for vaccination? Not very many.

If you don’t believe me that Dr. Sears is cribbing from the NVIC playbook, though, read this passage:

Natural and alternative health care providers can NOT sign the form; it must be a “regular” medical professional. Some families only see naturopathic or holistic health care practitioners instead of pediatricians. These families will have a difficult time getting the form signed.

Again, Dr. Sears, you say this as though that were a bad thing. Also note how his language is almost indistinguishable from that of the NVIC. Getting kids whose parents are using quacks for their primary care physicians brought in, even just once, to see a real doctor can only be a good thing. Here’s a hint for Dr. Sears: It’s not a good thing when passages of your blog post look as though they’ve been directly cribbed from an NVIC position statement! If you don’t want to be perceived as antivaccine, then don’t use NVIC arguments in language that could fit right in on the NVIC website without raising a single eyebrow of Fisher’s fans. Besides, there are plenty of antivaccine-sympathetic (or even antivaccine-friendly) doctors like yourself, Dr. Janet Levitan (who, it should be recalled, is perfectly happy to encourage parents to lie about their religious beliefs in order to obtain religious exemptions from vaccination for their children), or Dr. Jay Gordon out there, who will probably be more than happy to sign such forms after having provided a generous portion of misinformed consent to the patient’s parents.

In fact, it wouldn’t surprise me at all if one result of this law would be the creation of a cottage industry of antivaccine-sympathetic pediatricians advertising their willingness to sign philosophical exemption informed consent forms in California with only the most perfunctory of visits. It could be quite the little cash cow. Unfortunately, requiring that parents see a real pediatrician for real informed consent is no guarantee that they will actually get real informed consent based on science, but it makes it more likely. Certainly it’s far more likely that parents will get something resembling informed consent if they go to a real pediatrician than if they go to a chiropractor, naturopath, or homeopath. Moreover, chances are that insurance will pay for most, if not all, of any visit required to obtain a vaccine exemption informed consent form from a physician. It’s largely a win-win situation, although Dr. Sears doesn’t see it that way. In fact, he doesn’t even seem to agree with the purpose of the bill, namely to try to increase vaccination rates:

The sponsors of this bill may have some good intentions, as their primary “public” reason for the bill is to make sure that parents who don’t vaccinate their children are making an informed medical decision under the guidance of their doctor. But it isn’t difficult to see the REAL reason for the bill: to increase vaccination rates in our state by making it more difficult for parents to claim the exemption.

Again, Dr. Sears, you say that as though that were a bad thing. Or, to put it another way, why don’t you think it’s a good thing to try to increase vaccination rates? Certainly that seems to be the implication of your argument, that the real “hidden” reason for AB 2109 (hidden presumably because it’s so nefarious) is to increase vaccination rates and decrease the number of pockets where there are schools in which 50-70% of the children aren’t vaccinated because their parents claimed personal belief exemptions. Except that the reason isn’t exactly hidden; the sponsors and supporters of AB 2109 are quite explicit that the goal is to increase vaccine uptake rates. They’re intentionally trying to make it a little more difficult to get a philosophical exemption approved. Hard core antivaccinationists will take that extra step; those who are more lazy than actually committed to not vaccinating their children will probably not. In any case, the real reason that Barbara Loe Fisher, Dr. Sears, and the rest of the antivaccine movement don’t like AB 2109 is exactly because it makes it a little harder to get a philosophical exemption. More importantly, it will require some parents to take their children to a physician and have a talk about vaccines and maybe—just maybe—get a science-based perspective and something approximating real informed consent. Dr. Sears points out that by the time a parent has made up her mind to get an exemption that talking to a physician about it will probably not change her mind. That’s probably true, but the current state of affairs in California is that it’s so easy to get a philosophical exemption that it’s much easier than actually bothering to get one’s children vaccinated.

Personal belief exemptions from vaccination in the 21st century

A strictly public health standpoint results in the conclusion that non-medical exemptions do nothing other than decrease vaccination rates and degrade herd immunity. Thus, from a strictly scientific standpoint, eliminating all non-medical exemptions to school vaccine mandates would be the most effective means of making sure that children who attend public school are fully vaccinated. Moreover, there is no Constitutional issue involved in doing so, either. We do not, however, live in a world where only scientific considerations prevail. As various SBM bloggers have pointed out on numerous occasions, science-based medicine is based in science, but it is not, strictly speaking, pure science. Science informs and guides what we recommend as treatments, but sometimes other factors play a role. School vaccine mandates, I believe, are just such a situation when other factors cannot be avoided, at least in most states. We must accept that we live in the real world, and in the real world religious and philosophical exemptions to vaccination are not going away.

The reason is that, in the U.S. at least, there is a long history of being wary of government mandates, particularly in health care. Compulsory “anything” laws tend to be very politically unpopular, as has been so thoroughly demonstrated by the political resistance to the Patient Protection and Affordable Care Act (or, as its opponents sneeringly refer to it, Obamacare), for example. Vaccine mandates that go too far politically, as scientifically justified as they may be, have the potential to provoke major backlashes against vaccine programs, as compulsory vaccination laws for all children did in the 1800s in England, Europe, and the U.S. Going too far, even for public health, risks a very real backlash, and even supporters of mass vaccination campaigns (myself included) worry about government overreach and intrusion into personal medical issues. That is probably why only two states do not allow for either religious or philosophical exemptions, and in at least one of those states (West Virginia) there is a movement to allow such exemptions. It is also why it is unlikely that religious and personal belief exemptions will ever be eliminated. We can and should, however, decrease greatly the ease with which such exemptions can be obtained, as California is trying to do through AB 2109.

We can, however, apply a rule to religious and philosophical exemptions by twin approaches. First, vaccination should be free. Parents who cannot afford it or who are uninsured should be eligible for state-funded vaccination. This is true to varying degrees in many states, but it should be universal. Second, I support a general principle described by Douglas S. Diekema, MD, MPH, at the University of Washington, published in a recent issue of the New England Journal of Medicine:

Although eliminating exemptions for religious and personal beliefs may seem logical, such efforts would encounter substantial resistance and probably increase antivaccinationist fervor. Some states might improve immunization rates by addressing the ease of obtaining exemptions and enforcing school-entry requirements. The exemption process should not be easier or less costly than the vaccination process. Obtaining a religious or personal-belief exemption should at least require a visit to the physician’s office, including counseling on the risks posed by remaining unvaccinated; insurance should pay for such visits. States could also require that exemption requests be signed by both parents (if both possess legal decision-making authority). Although such measures wouldn’t change the stance of the most resistant parents, they would eliminate many exemptions sought because of convenience rather than conviction. Finally, lax enforcement of school-entry requirements sends the message that vaccination is merely a bureaucratic requirement, rather than a prerequisite for school attendance and a mechanism for ensuring students’ safety.

One notes that Dr. Diekema’s philosophy is actually not as strict than what was recommended by the Pediatric Infectious Disease Society in 2011. Here is an excerpt from the PIDS position statement regarding personal belief exemption from immunization mandates:

It is recognized that in some states, failure to pass personal belief exemption legislation or regulation could result in public backlash that will erode support for immunization mandates. If legislation or regulation is being considered in this situation, it should contain the following provisions, which are intended to minimize use of exemptions as the “path of least resistance” for children who are behind on immunizations (whereby it would be easier to obtain an exemption than to catch-up the child’s immunizations):

  • The personal belief against immunization must be sincere and firmly held.
  • Before a child is granted an exemption, the parents or guardians must receive state-approved counseling that delineates the personal and public health importance of immunization, the scientific basis for safety of vaccines, and the consequences of exemption for their child as well as other children in the community who are vulnerable to disease and cannot otherwise be protected.
  • Before a child is granted an exemption, the parents or guardians must sign a statement that delineates the basis, strength, and duration of their belief; their understanding of the risks that refusal to immunize has on their child’s health and the health of others (including the potential for serious illness or death); and their acknowledgement that they are making the decision not to vaccinate on behalf of their child.
  • Parents and guardians who claim exemptions should be required to revisit the decision annually with a state-approved counselor and should be required to sign a statement each year to renew the exemption.
  • Children should be barred from school attendance and other group activities if there is an outbreak of a disease that is preventable by a vaccination from which they have been exempted. Parents and guardians who claim exemptions for their children should acknowledge in writing their understanding that this will occur.

The decision not to vaccinate one’s children is every bit as much a medical decision as the decision to vaccinated, and it needs to be made with adequate informed consent. Moreover, although any competent adult has the right to choose or decline any treatment he chooses, society has an interest in protecting children. Contrary to what some seem to believe, parents do not have an unrestricted right to decide medical treatments for their children, particularly if their decisions are very likely to cause harm compared to alternatives. The least that can be asked of parents refusing vaccination for their children is that they listen to a science-based assessment of the potential consequences of that decision.

The real reason antivaccinationists are so opposed to AB 2109 is because they fear informed consent, As I’ve pointed out on more than one occasion, both here and at my not-so-super-secret other blog, the antivaccine version of “informed consent,” like the “alternative” medicine version of informed consent, is a parody of real informed consent. It is, as I have characterized it many times before, in reality misinformed consent, in which the risks of vaccination are hugely exaggerated while the benefits downplayed to the point that any rational person, if she accepted such “risk-benefit” analyses at face value would decide not to vaccinate her child. Unfortunately, the average person doesn’t have the background knowledge and understanding to see through the misinformation at the heart of misinformed consent. They have a hard time knowing that the claims of people like Barbara Loe Fisher that vaccines cause autism, neurodevelopmental disorders, autoimmune diseases, and so many other ills that they attribute to vaccines are without a basis in science, epidemiology, or clinical evidence. A pediatrician can help them do that by providing them with genuine informed, rather than misinformed, consent.

And that’s exactly what the antivaccine movement fears.

Posted in: Politics and Regulation, Public Health, Science and the Media, Vaccines

Leave a Comment (39) ↓

39 thoughts on “California Bill AB 2109: The Antivaccine Movement Attacks School Vaccine Mandates Again

  1. art malernee dvm says:

    Of all the preventative treatments ever developed through science- and evidence-based medicine, vaccines have arguably saved more lives, prevented more illness and disability, and in general alleviated more suffering than any single class of treatments or preventative measures throughout history>>>>>

    Clean water may be first,vaccines second.
    Art Malernee dvm

  2. cervantes says:

    It is still somewhat mysterious to me why there has always been such a substantial anti-vaccination movement, from the time of Jenner. I am just young enough to have escaped the polio epidemic, but I well remember my parents speaking of the dread that hung over the country. My aunt had polio and suffered some permanent impairment, as did my late mentor Irving Kenneth Zola, and I had a classmate with braces on his legs. The iron lung and the wheelchair were ubiquitous images when I was a young child.

    Dr. Salk was a towering cultural hero because he saved us from this terrible scourge. It has vanished from our lives. This happened in the lifetime, or just before, of many of the people who are leading this anti-vaccine mishegos today. And how can they ignore the eradication of smallpox from the earth? Anyone with even a nodding acquaintance with history knows how different the world today is from that of our ancestors for this reason alone.

    What is the source of this bizarre belief structure, that requires willful blindness to the obvious? I find it baffling.

  3. lizditz says:

    Thanks for the shout-out, Dr. Gorski.

    The bill will be heard by the Health Committee Update on TUESDAY, APRIL 17, 2012 1:30 p.m. – State Capitol, Room 4202 http://ahea.assembly.ca.gov/hearings has a link to where you can listen to this hearing.

    There is still time for readers to make the case for AB 2901 to the Hearing Committee. Here’s the link to the post with the Committee members’ contact information Support AB 2901.

    If you want to keep up with the whole story, I’m keeping a list, as I often do.

  4. stanmrak says:

    Blame the pharmaceutical industry. They haven’t bothered to convincingly prove that vaccines are safe over the long term (years, not weeks), and many of us are fed up with their lies on all sorts of issues to ever trust them about anything.

  5. windriven says:

    @stanmrak

    “They haven’t bothered to convincingly prove that vaccines are safe over the long term (years, not weeks)”

    I’m dumbstruck. The scientific evidence supporting the safety and efficacy of numerous vaccines has been discussed in these pages ad nauseum. The evidence proving otherwise is nonexistent. What exactly will it take to convince you?

  6. cervantes says:

    It is a legal requirement that vaccines be shown to be safe before they can be licensed. And we now have decades of experience with the most controversial vaccines — MMR and influenza — and there is overwhelming proof that they are very, very safe. Yes, pharmaceutical companies have lied and it’s understandable that people don’t necessarily trust them — I don’t, as a matter of fact — but I don’t need to trust pharmaceutical companies to know that vaccines are safe. The questions are separable.

  7. David Gorski says:

    Quite true. However, antivaccine activists intentionally conflate the two questions because most of them cannot separate their suspicion of pharmaceutical companies, or “Western medicine” or science from the actual question of whether the scientific evidence supports the safety and efficacy of vaccines. The latter question has been asked and answered many times, and the answer is a resounding yes; vaccines are safe and efficacious.

  8. stanmrak says:

    Aren’t the safety studies controlled by the same people who stand to profit from the approval of the vaccine? Why would you trust that the studies are valid? Fraud is all too common in the drug industry. Supposed benefits are overblown and exagerated to increase marketing appeal. We have seen many times in the past that the pharmaceutical companies are willing to accept the deaths of thousands of people from the use of their products, as long as they make a profit on them.

  9. Chris says:

    Stanmrak:

    Aren’t the safety studies controlled by the same people who stand to profit from the approval of the vaccine?

    Please tell us your evidence for that. The final arbitrators are departments in the Federal Government, so explain how they work.

    Supposed benefits are overblown and exagerated to increase marketing appeal.

    Okay, tell us which benefits are overblown and support it with real evidence.

    We have seen many times in the past that the pharmaceutical companies are willing to accept the deaths of thousands of people from the use of their products, as long as they make a profit on them.

    Okay, document which vaccine has caused thousands of deaths. Then tell us how it is more cost effective to treat a disease (pertussis, measles, Hib, etc) than to prevent it. Provide actual documentation. Because according to Economic Evaluation of the 7-Vaccine Routine Childhood Immunization Schedule in the United States, 2001 there is a cost savings with vaccines. Prove them wrong.

    Author Affiliations: National Immunization Program, Centers for Disease Control and Prevention, Public Health Service, US Department of Health and Human Services, Atlanta, Ga. Dr Yusuf is now with UNICEF, New Delhi, India.

    Also prove to us that the pharmaceutical companies paid for that study starting from the above author affiliations.

  10. Mrs. N. says:

    Article posted on Bob Sears facebook page… I wonder if it will last.

    https://www.facebook.com/permalink.php?story_fbid=211392108962306&id=116317855073374

  11. DW says:

    Cervantes:

    “It is still somewhat mysterious to me why there has always been such a substantial anti-vaccination movement, from the time of Jenner … What is the source of this bizarre belief structure, that requires willful blindness to the obvious?”

    Religion. The origin of antivaccine sentiment is religious. Some of the antivaxers today are essentially unaware of the history of their own movement. Others have religious motives that they are hiding behind rhetoric about safety and “going natural,” etc. A good example is the anthroposophists, who run the Waldorf schools (of which there are many in California, one reason California is such a hotbed of antivaccine nonsense).

    It is difficult for rational people to grasp that some people WANT children to suffer. I’m not referring to the vast majority of people who question vaccines, who are simply concerned parents – badly misinformed, but motivated to protect their children’s health. The anthroposophists, on the other hand, believe that the vaccine-preventable diseases are good for children, spiritually. Diseases are karmic – punishment for misdeeds in a past life, usually – and if a young child dies, it is because his or her spiritual “tasks” were completed in the present incarnation.

    We had a thread about anthroposophic medicine here awhile back. In the comments section there I explained some more about these beliefs.

    http://www.sciencebasedmedicine.org/index.php/a-university-of-michigan-medical-school-alumnus-confronts-anthroposophic-medicine-at-his-alma-mater/

  12. lizditz says:

    Cervantes,

    I am old enough that I remember the first polio vaccines, and of course I wasn’t vaccinated against measles, mumps, rubella and so on because I had the diseases before the vaccines became available.

    I wonder if any social scientist has done a study of anti-vaccine sentiment from say, 1971 (when the MMR was introduced) and 1982 (when DPT: Vaccination Roulette aired). I’d venture to say it was small, and then from 1982 through to the point of internet ubiquity.

    My daughter was born in 1988 and although I was part of a pretty crunchy, my-baby’s-better-cared-for-than-your-baby young mother’s group (ugh, but that’s part of living in a small town), I don’t recall any anti-vaccine sentiment at all, so maybe the DPT phobia didn’t get to California or something.

    Then a couple of things happened: the internet, AOL, and e-mail discussion lists. This let lousy ideas spread like … well, viruses. The foundational “autism is mercury poisoning” article, “Autism: A Novel Form of Mercury Poisoning” was published in 2001; Generation Rescue was founded in 2005 and began a national PR campaign talking about the dangers of vaccines, specifically autism.

    I don’t think that Wakefield’s claims got much traction here until about 2000. Claims to the National Vaccine Injury Compensation Program for autism as a vaccine injury started in 2001, but really exploded in 2003.

    I think a lot of the vaccine fears now are mother-to-mother handwringing and misinformation (just go to Mothering.com and see).

  13. MerColOzcopy says:

    “arguably saved more lives” not even close. I could probably name a dozen more profound. I’ll bet in the last 25 years the condom alone has saved more lives than vaccines.

    For those promoters of vaccines, if they are so damn good and effective get vaccinated, and all those shots for your kids. For those who don’t, let them die horrible deaths and what ever else awaits them.

    I am still waiting for that vaccine that will protect all of society from the cesspool of perversion!!!! I am hearing nothing but rave rewiews for the HPV vaccine, not!!! I wonder how many teenage daughters of Doctors and SB Researchers of that vaccine have been vaccinated. Yea, that’s what I thought!!!!

  14. weing says:

    “I wonder how many teenage daughters of Doctors and SB Researchers of that vaccine have been vaccinated. Yea, that’s what I thought!!!!”

    Mine was. She’s 22 now.

  15. Mrs. N. says:

    @Mercolzacopy
    I’ll take that bet.

    And regarding HPV, if I ever have a daughter, I will want her to be vaccinated. As a woman who was sexually assaulted in college, I am very aware of the fact that even someone like myself (one sexual partner in my life, my husband, after marriage) can easily be exposed to disease. Sometimes you can’t control the behavior that puts you at risk, even for an STD. It only takes one mistake or one forced act to contract it… and I would not accept the possibility of such a devastating disease for a daughter of mine!

  16. Chris says:

    MerColOzcopy, then name those dozen things, plus show us how condoms in the last 25 years saved more than the smallpox vaccine over the last two centuries or the measles vaccine since 1963. You can start with the figures from Historical Comparisons of Morbidity and Mortality for Vaccine-Preventable Diseases in the United States. We wait with baited breath for you to educate us with the scientific documents supporting those statements.

    Why are you so hung up on the HPV vaccine? How is it a perversion? Especially after you just raved about condoms. Plus, it not even one of the vaccines required for school entry in California, especially since it isn’t given to four and five year old children. Seriously, where is it required for any kid to start kindergarten? So mentioning it is a bit off topic.

    My daughter had the series when she was in middle school, and even though she is almost eighteen she is not dating. At most she and her friends get together and work on cosplay outfits (which we are fervently working on now, the con’ is in two weeks, and the elaborate outfit is also her senior project). She is a late bloomer just like I was. The HPV vaccine did not change her nature. And if you have a way to predict if her future husband will be free of HPV, let me know (and then apply for the JREF Million Dollar Challenge showing you can predict the future!).

    I am now going to be providing the university that accepted her with evidence that she had two MMR vaccines. Due to the year she was born she could have had her second dose at age twelve, but she got it when she was about six years old (just after the 2nd dose age was lowered to kindergarten age). She received it early due to a measles outbreak in a nearby private school.

    Stanmrak, I am still waiting for the evidence that it is cheaper (less money to Big Pharma) to treat the disease than to prevent it. Will that be coming along soon? Make sure that you provide verifiable documentation that treating one out of five hundred casesof measles in the hospital (or one hospitalization out of four cases presently in Europe) is much cheaper than providing two MMR doses to each child.

  17. Chris says:

    A link disappeared:
    http://www.euro.who.int/en/what-we-publish/information-for-the-media/sections/latest-press-releases/european-countries-must-take-action-now-to-prevent-continued-measles-outbreaks-in-2012

    It says:

    The WHO’s newest measles summary in the Weekly Epidemiological Record reports more than 26,000 cases of measles in 36 European countries from January-October 2011, with more than 14,000 of those in France. Despite strong health systems, Western European countries have reported 83% of these cases. These outbreaks have caused nine deaths, including six in France, and 7288 hospitalizations.

    Yes, I really want know how it would have been cheaper to skip vaccinating every one, especially when the article also says:

    The majority of European cases (90%) were amongst adolescents and adults who had not been vaccinated or for whom vaccination history was not reported.

    I have recently seen reports that those attending the 2012 Olympics in London need to make sure to have their MMR vaccine. We don’t need anymore imported cases.

    This weekend high school seniors like my daughter will find out if they are accepted into UC Berkeley. If she decides to go there (and finds the money for the out of state tuition) I will get her a third MMR vaccine. I had mumps twice, and since they had an outbreak of mumps last year I do not want to take chances with her health.

  18. lilady says:

    @ stanmrak: “They haven’t bothered to convincingly prove that vaccines are safe over the long term (years, not weeks), and many of us are fed up with their lies on all sorts of issues to ever trust them about anything.”

    Really?

    How about the Vaccine Safety Datalink Project?

    http://www.cdc.gov/vaccinesafety/Activities/VSD.html

    It has been in existence for 23 years and set up specifically to monitor vaccine safety and efficacy. Each vaccine, administered by health care providers from each of 10 regional health care organizations is entered into the database. The member regional health care organizations care for > 1,000,000 patients/health insurance policyholders.

    Any untoward reactions at the time of immunization are entered into the database. Any follow-up doctors visits and any emergency room visits or hospitalizations at their affiliated hospitals, that might be associated with a vaccine, are also entered into that database.

    The Vaccine Safety Datalink Project has generated more than 75 reports, which are available for your perusal on that website.

    Is 23 years long enough for you, to evaluate each vaccine’s safety record.

    Now, about some of the newer vaccines that protect kids against invasive bacterial diseases…

    Look at these pictures of kids who didn’t have the benefit of these newer vaccines, that you disparage:

    http://www.immunize.org/photos/hib-photos.asp

    http://www.immunize.org/photos/meningococcal-photos.asp

    http://www.immunize.org/photos/pneumococcal-photos.asp

    Wanna see some more pictures stanmrak?

  19. mmetzger says:

    Just a little correction:

    Jehovahs Witnesses generally support vaccinations. As they care about their children only a minority will not vaccinate. Exemptions are based on personal opinion and not on religious beliefs.

    For the rest: keep up the good work.

    Greetings from Berlin from a regular reader of your blog.

    M. Metzger, MD

  20. David Gorski says:

    I was merely citing a source that pointed out that some states allow religious exemptions for Jehovah’s Witnesses because they have a history of not vaccinating on religious grounds:

    http://www.historyofvaccines.org/content/articles/vaccination-exemptions

    One also notes that until the 1950s, vaccines were condemned by Jehovah’s Witness doctrine:

    http://en.wikipedia.org/wiki/Development_of_Jehovah's_Witnesses_doctrine

    Some quotes:

    The Golden Age, October 12, 1921, Page 17: “Vaccination never prevented anything and never will, and is the most barbarous practice … We are in the last days; and the devil is slowly losing his hold, making a strenuous effort meanwhile to do all the damage he can, and to his credit can such evils be placed … Use your rights as American citizens to forever abolish the devilish practice of vaccinations.”

    The Golden Age, January 5, 1929, Page 502: “Thinking people would rather have smallpox than vaccination, because the latter sows seeds of syphilis, cancers, eczema, erysipelas, scrofula, consumption, even leprosy and many other loathsome affections. Hence the practice of vaccinations is a crime, an outrage, and a delusion.”

    The Golden Age, April 2, 1935, Page 465: “As vaccination is a direct injection of animal matter in the blood stream, vaccination is a direct violation of the law of Jehovah God.”

    So, yes, historically Jehovah’s Witnesses didn’t vaccinate but then for some reason the leaders of the religion changed the doctrine.

  21. Dawn says:

    @MerColOzcopy: I’ll take that bet, too. BOTH of my daughters have had the full HPV series – on their own decision. I simply got the literature (which was full of pros, cons, risks, benefits) and let my daughters read it. Both were already sexually active but HPV free. And they both decided – without any parental input – to have the series of vaccines. My one daughter is terrifed of needles but she still drove herself to the 3 visits for her injections. Outside of some minor soreness at the injection site, neither had any adverse reactions (and I didn’t report the sore arms to the VAERs database, either).

  22. mmetzger says:

    Thank you for the prompt clarification. It was important to me that Jehovah’s Witnesses today are not opposed to vaccinations. Some quotes you cite stem from times when they did not even call themselves Jehovah’s Witnesses (before 1931).

  23. DugganSC says:

    Honestly, I’m seeing some funny parallels between the refusal of the anti-vaccinationists on the extra cost of having to consult with the doctor and the fear of meeting an unfriendly one who won’t sign them off, and the various arguments against pre-abortion counseling claiming the extra cost of having to consult and the fear of meeting an unfriendly one who won’t sign them off.

    Me, I’m all for the vaccines. They’ve been shown to be safe and efficacious. Although, I will admit to starting out with some degree of skepticism whenever a new one comes out, asking whether the disease they’re innoculating against is all that prevalent or the vaccine all that effective. I want to see evidence so that I don’t wind up being told to buy a rock to drive off tigers when they were never in the area to begin with and they don’t report cases of people who got eaten, rock and all.

  24. WilliamLawrenceUtridge says:

    Point of logic – you can’t prove a negative; the reviews of vaccines before licensing are efforts to determine if side effects exist. For all we know, every single vaccine could cause you to die of a head cold at the age of 120, or cause one in every 10 billion people to explode in a shower of gore – but we won’t know about it unless there is a visible signal in the noise. Fortunately, because of the way medicines are developed we know about common reactions, and have a pretty good and robust process for finding uncommon ones.

    Asking for ultimate and absolute safety of any and all forms of medical treatment is unrealistic (just like it is for anything – even locked in a steel room in a concrete bunker under a mountain presents risks of suffocation, rockslides, dehydration and death by world-destroying meteor).

    Aren’t the safety studies controlled by the same people who stand to profit from the approval of the vaccine? Why would you trust that the studies are valid? Fraud is all too common in the drug industry. Supposed benefits are overblown and exagerated to increase marketing appeal. We have seen many times in the past that the pharmaceutical companies are willing to accept the deaths of thousands of people from the use of their products, as long as they make a profit on them.

    Your question assumes that vaccine manufacturers are the only people conducting research on vaccines, that they are so interested in profit that they will invariably do anything they can to minimize any side effect reports, that there is no independent review, and the idea that the diseases vaccines prevent have few or no risks. All of these assumptions are questionable, to put it politely. The assumption that no pharmaceutical employees have any qualms about putting billions of lives at risk is both offensive and insulting, not to mention illogical. Big Pharma employees are still people, and people do whistleblow.

    @MerColOzcopy

    “arguably saved more lives” not even close. I could probably name a dozen more profound. I’ll bet in the last 25 years the condom alone has saved more lives than vaccines.

    What sexually transmitted diseases are actually deadly? Even AIDS is only deadly over a very long term. The smallpox lethality rate on the other hand, was up to 90% in unexposed populations (vis. Aboriginals in North and South America). That’s an astonishingly ignorant statement to make.

    For those promoters of vaccines, if they are so damn good and effective get vaccinated, and all those shots for your kids. For those who don’t, let them die horrible deaths and what ever else awaits them.

    As always, antivaccination nutters miss the point. Vaccines prevent death, but also suffering, even time off of work. They are also not 100% effective, and many populations (particularly the ones most vulnerable to diseases) do not respond to vaccines very well. I get vaccinated for seasonal influenza so I don’t give it to my grandmother, who is unlikely to benefit from the vaccine but is very susceptible to influenza and its complications.

    I am still waiting for that vaccine that will protect all of society from the cesspool of perversion!!!! I am hearing nothing but rave rewiews for the HPV vaccine, not!!! I wonder how many teenage daughters of Doctors and SB Researchers of that vaccine have been vaccinated. Yea, that’s what I thought!!!!

    I’d get mine vaccinated for HPV if I had a kid. I’m even tempted to get the vaccine myself despite being in an incredibly low-risk group. As for a vaccine to prevent a “cesspool of perversion”, you might want to try realistic sex education, not the abstinence-only crap that’s so popular among the religious right. So keep your exclamation points under wraps, we’re already well-aware that your decisions are based on emotions and ideology rather than reason.

  25. DugganSC says:

    @WilliamLawrenceUtridge:
    As for a vaccine to prevent a “cesspool of perversion”, you might want to try realistic sex education, not the abstinence-only crap that’s so popular among the religious right. So keep your exclamation points under wraps, we’re already well-aware that your decisions are based on emotions and ideology rather than reason.

    While not on the topic of discussion, I somewhat take exception to the idea of abstinence-only being unrealistic. Between my parents and my health classes (well, mostly my parents because the health classes were loath to introduce any kind of statistics for fear of undermining their position), I grew up knowing the details of most forms of birth control and their efficacy in both ideal and typical cases. I came away from it bolstered by the knowledge that abstinence really was the only way to avoid pregnancy or disease.

    Although, arguably, one could probably indicate a “ideal versus typical” rate for abstinence too. :) After all, there’s everything from people who don’t realize the mechanics of it out there (“But I thought it happened with french kissing!”) to not realizing that situations short of sex can also cause issues (technically speaking, a girl sleeping adjacent to a guy who has a wet dream can have the semen soak through her clothing and impregnate her. It’s about as unlikely as pregnancy while properly using oral contraceptives or a symptothermal methods, but more likely than pregnancy with tubal litigation or vasectomy).

    Personally, I plan to do the same as my parents, give my kids all of the information. Some of them will probably still take risks — warning them that a bedsheet isn’t likely to save them jumping off the roof doesn’t generally stop them from trying — but the most you can do is make sure your kids are well educated.

  26. Scott says:

    @ DugganSC:

    Your tale actually demonstrates why abstinence-only is unrealistic. What’s meant by that term is not the message “abstinence is the most effective form of birth control,” which is part and parcel of standard sex ed, but the complete refusal to even admit that other forms exist. In an abstinence-only “sex ed” course, the very word “condom” is never mentioned.

  27. Chris says:

    Since this about vaccines required to attend public school, it is amusing HPV was even mentioned in the comments. The schools only real care about the diseases that are transmitted by children starting at age five (or three for preschool, which are usually special ed. or other programs). Which is why Hib and rotavirus vaccines are not required to attend kindergarten.

    This is also why when those who are exempted must keep their children at home when there are outbreaks of certain vaccine preventable diseases, like chicken pox:
    Chicken pox outbreak causes unvaccinated students to miss class for 7 weeks
    Chickenpox outbreak confirmed at Western School Corp.

    Those districts now have parents who refuse to have their children vaccinated but are upset their kids are missing weeks of school. They were warned when there was an outbreak this would happen, they have no excuses. And they don’t care if their kids get chicken pox, which does not make sense. If the kids were too delicate for the vaccine, then they would do worse with the disease:

    The Goldbergs want to be able to sign a waiver that says they understand their children could get the chicken pox if they go to school, and they’re OK with it.

    Fortunately that offer was not taken up:

    But Maine Department of Education and the Department of Health and Human Services teamed up on this rule because they say chicken pox is a public health threat. Unvaccinated kids are kept home not just for their safety, but for the safety of those they might infect.

    Hey, stanmrak! Where are those financial stats that show treating a disease makes Big Pharma less money than preventing it!? Come on! You made the claim that vaccines are big money makers, now you need to back it up. Especially in light of one out of four cases of measles requiring hospital care in Europe.

  28. WilliamLawrenceUtridge says:

    DugganSC, you didn’t get “abstinence only” sex ed. Abstinence only sex ed only discusses abstinence and failure rates of other forms of birth control. And I believe it actually includes medically inaccurate information. On top of that, it’s empirically a flop in the US. What you got appears to be a form of comprehensive sex education, discussing the realistic risks and benefits of each type of behaviour. That is actually associated with delaying intercourse and improved outcomes. Abstinence is presented as one option among many, and the most reliable form of birth control and STI avoidance. Your plan for your own children is not only close to the opposite of abstinence-only education, it’s also associated with better outcomes.

    http://www.ncbi.nlm.nih.gov/pubmed/17885460

    Abstinence-only sex education is to real sex education as creationism is to biology.

  29. DugganSC says:

    @Chris
    Actually, there was an article on this site, http://www.sciencebasedmedicine.org/index.php/hpv-vaccine-for-boys/, which was discussing how there’s a recommendation for males getting the HPV vaccine to avoid transmitting it to women. The argument is that as long as some males carry it, it will remain live in the wild and it’s safer as a whole to eliminate it. The only real way to make sure that everyone takes it, particularly since it is a disease which males, for the most part, are only carriers, is to start mandating it. So yeah, there is noise that it may become required.

    As regards sex education and “abstinence only”, I’m a little hazy as to how, if they’re informed of the failure rates of the other methods, that they can be considered uninformed on them. If nothing else, in this Information Age, they have a bevy of keywords to plug into Google. And as regards what was presented in high school, abstinence was mentioned briefly, with an eye roll by the teacher, and then we went on to the pushing of other methods, probably with the assumption that none of us would practice abstinence. To me, that’s… well, it’s underselling the student body for one. For two, that’s like having a class on fire safety and forgoing how to avoid fires starting in favor of discussing the most effective extinguishers.

  30. DugganSC says:

    And as regards Creationism and biology, I think that’s accurate in practice albeit inaccurate in details. Creationism and evolutionary biology are basically two completely different points of view. There are rare cases of integration like the Roman Catholic position that evolution has happened, but there’s no evidence that it was random and therefore could have been guided, but for the most part, it’s been one side or the other, and the Creationists are as loathe to teach biology as the science-based group is loathe to admit any possibility that humans might not have been cosmic accidents. And in practice, most sex education classes I’ve seen have been that way. The “abstinence only” group doesn’t want to admit that other forms of safe sex work, albeit imperfectly, and the standard sex education classes in high schools paints methods like symptothermal and abstinence as jokes and focus their attention on other methods. I think there’s room for both sides.

  31. Chris says:

    DuggenC, what does that to do with vaccine requirements for school entry? Especially at the kindergarten level. How many schools have sent home notices that there is an HPV outbreak in the school and those who are unvaccinated must stay home?

    (Only one state has a secondary school requirement for HPV, so again: it is not a vaccine that is part of the California vaccine mandate! Hence I am amused by it being brought up, because it is a way to divert the discussion.)

  32. Harriet Hall says:

    @DugganSC,
    “The argument is that as long as some males carry it, it will remain live in the wild and it’s safer as a whole to eliminate it. ”

    I’ve never heard that argument in regards to the HPV vaccine. Do you have a reference? The only arguments I’ve heard are that it reduces the males’ risk of warts and reduces the chance that he will infect his partners. Remember that it only covers a certain strains of the virus.

  33. DugganSC says:

    @Harriet:
    That’s what I thought I remembered people discussing in the comments. Admittedly, that was months ago and I may be misremembering. I didn’t have time to plough through the 126 comments to see where that was. Assuming I’m not misremembering. The article itself does not support that conclusion itself. My apologies in posting hastily and potentially confusing the issue.

  34. DugganSC says:

    Although, re-reading through, http://www.law.uh.edu/healthlaw/perspectives/2010/%28CM%29%20HPV.pdf does indicate that it was mandated for in February 2007 in Texas for 6th graders returning to school, although the legislation was subsequently struck down and that some other states did pass legislation mandating the vaccine (albeit with the ability to opt out).

  35. Chris says:

    Texas is not California.

  36. Chris says:

    And, still in every state there is no mandate to give HPV vaccine to children starting kindergarten.

  37. papertrail says:

    As to why many refuse to vaccinate, other than inaccessibility or ignorance of how important it is, I see disproportionate distrust of drug companies, modern medicine, doctors, science, government agencies, plus a fear of all synthetic chemicals along with over-confidence in all things “natural”. I see a trend toward the “spiritual” with great credence given to personal perceptions, logical or not, and anecdotes from like-minded people. Feelings and intuition rule, as do unknown and unknowable forces (and magic potions supposedly endowed with these forces), more than empirical science and medicine. It’s a growing movement. Too bad it impacts the health of children, and community-immunity, or else I’d just say “to each his own”. It’s not entirely incompatible, though, for someone to hold this world view and still decide to vaccinate their kids. Many do. I think most of these same people will run to a mainstream hospital and take regular drugs if push comes to shove.

    The bottom line, I think, for most anti-vaccine parents is protectiveness (same as for pro-vaccine). They fear the known and unknown side-effects from chemical and biological substances injected into their babies. I think we have to recognize that the roots of these fears are grounded in reality: the history of vaccinations includes some deadly outcomes (Cutter, for one http://yalepress.yale.edu/book.asp?isbn=9780300126051); “big pharma’s” profit motivation and competing interests at the CDC and FDA are reasonable concerns. Parents don’t know if their own child will be the one struck with a rare serious reaction or a yet-to-be-discovered one. Close monitoring for serious side-effects is great but it does imply that some have not been ruled out, and that some people will be harmed before these reactions are discovered to be vaccine related. Injectables of any sort are frightening and carry some risk (e.g.contaminated needles); vaccine supplies can become contaminated or spoiled, which often comes to light only after harm is done. And, the CDC and WHO and IOM would be the first to point out that gaps do exist in our knowledge of the safety and efficacy of all vaccines.

    So, I try to be understanding when addressing or responding to vaccine-refusers, at least until they start pushing misinformation and distortions at me. I try not to say “vaccines are safe” because they aren’t perfectly safe. Many don’t realize you’re talking about risk verus benefits, and so they just see it as a lie.

    I have mixed feelings about this CA bill. I can see it becoming just a hoop without much substance. I don’t see a lot of doctors wanting to take on the rath of resentful anti-vax parents at office visits, but maybe I’m wrong. I would prefer to require parents who don’t have a medical exemption for their kids to take and pass a mini crash course on the importance of vaccination, risks versus benefits, etc. – perhaps a continuing education class type of thing offered by school districts.

    I don’t think I just thought of that on my own, but if I did, you’re welcome ;-)

  38. Linda Rosa says:

    I think the California bill will doubtlessly strike many people as a paternalistic and intrusive way of providing vax information, in the same way that some proposed legislation that would require women to receive educational instruction before they can have an abortion is resented. I also have concerns that the California bill can potentially create an antagonistic environment between physicians and parents. (Note that the anti-vaxers can’t be pleased with anything but winning on their own terms.)

    If there is no medical reason for religious and philosophical/personal exemptions (which are all essentially the same thing), and if the courts have ruled that there is no constitutional right to those exemptions, then why not be fearless about calling for their repeal? Fear of backlash should not override the right of children to be protected from vaccine-preventable communicable diseases. As Dr. Gorski points out, parental rights are not absolute. The courts rule that the child’s rights to health and to a future override parental rights.

    Many parents who are on the fence about vaccination might well be reassured if health care professionals and policy makers make a *strong,* unambiguous stand for universal vaccination. If not, parents may suspect that there actually are legitimate reasons to be concerned about the safety of vaccines.

    I don’t think legislation based on the recommendations by Pediatric Infectious Disease Society would hold up in court. The way they set it up, there would be a test for what is a “sincere and firmly held” belief. This test would be judged on the parents’ statements describing “the basis, strength, and duration of their belief.” Otherwise why ask at all? This is very much akin to various tests for the religious exemptions which have not held up in court as constitutional, being ruled as too much of an intrusion by government into religion. In this case of PIDS’s requirement to prove a “sincere and firmly held” belief, I suspect it would be ruled a privacy violation.

    Why cede ground to the anti-vaccination movement when they have no grounds to stand on except that created by their own propaganda? Non-medical exemptions clearly undermine vaccine mandates. A policy calling for universal vaccination is simple and best, being strongly supported by science, the Constitution, and court law. Such a policy furthermore has the moral edge of putting the well being of children first. This policy is working in two states. It’s only up to us to fight the good fight and make it 50.

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