WIRED published a neato piece of data analysis Monday, mapping what it called “anti-vax Twitter.” I like the data viz. But the bill it referred to, SB 277, is legislation every parent—whether their kids have all of their vaccines or some or none—should oppose.
The bill, coming before the California State Assembly Health Committee today, would end what's called a personal belief exemption to the vaccinations required for entry to school. SB 277 ostensibly is designed to increase vaccination rates by eliminating the personal and religious exemptions to vaccines and refusing enrollment in public or private school to any child who does not have every one of the approximately 15 required injections. Advocates say the bill is essential for increasing vaccination levels to optimum levels. Opponents have called it draconian and unnecessary. (Indeed, measles vaccine coverage in California is almost 93 percent and has bumped up slightly since last year.) There’s a better way to increase vaccination rates, without resorting to government-forced medical interventions: Start counting the kids who already are vaccinated.
For example, just shy of 7 percent of kids who enter kindergarten are what’s called “conditional entrants.” They may or may not have their shots, but perhaps they don’t have documentation on the first day of school, or perhaps they are missing the final shot in a series (the polio series, for example, requires four injections to be considered complete). The California Department of Public Health should do better follow up on these students to determine when and if they complete their shots so it might have a more accurate reflection of vaccination coverage.
Another way to raise these rates is to start looking more closely at the vaccine records for the 2.54 percent of California families with personal belief exemptions. Remember, school entry requires about 15 shots. If a parent wants to forgo even one of those, that child requires a PBE. But many children with PBEs have some (or many) vaccinations. For example, parents might elect to get their child immunized against measles, mumps, rubella, polio, and pertussis, but decide, not totally unreasonably, not to vaccinate their kid against hepatitis B. (Hepatitis B is not a readily transmissible disease—it’s mainly spread through sexual contact and intravenous drug use.) That family, too, must file a PBE for school entry, and that child’s immunity to polio, measles, pertussis and the like is never counted.
Now, there are those who might say vaccines are perfectly safe, so what’s the harm in requiring them. Like a seatbelt, right? But vaccines are not quite like seatbelts. For one thing, if your seatbelt goes wrong, or isn’t really that safe, you can sue the car manufacturer, or you can stop buying its cars.
Or, if a drug you take turns out to have severe side effects, and if it turns out the company possibly knew about those potential side effects and suppressed the research data, you can sue the company. (Or, less dramatically, if you’re taking a drug that makes you feel terrible, you can stop taking it.) The Merck/Vioxx scandal is a good example of this. Accused of withholding clinical research data about the side effects of the pain killer, Merck eventually paid a settlement of almost $1 billion.
This is how we keep drug companies and car companies and any other kind of company honest, at least in theory.
But if Merck or any other drug company produces a vaccine that is pretty safe (but not completely 100 percent always safe), well, it bears no liability for any problems with its product.
This doesn’t make Merck bad, and it doesn’t make vaccines bad. (For the record, here, I should say that no, I do not think vaccines cause autism and yes, people should protect those around them from diseases like measles.) But a mandatory drug for which the manufacturer bears no liability is not a setup I’m comfortable with. It means Merck, or other vaccine makers, don't have an incentive to study the safety and side effects of these drugs to the same extent as almost anything else it sells. And, in fact, an independent analysis suggests that studies on the safety of at least one vaccine are not as good as they could be. (The authors state: "The design and reporting of safety outcomes in MMR vaccine studies, both pre- and post-marketing, are largely inadequate.”)
So from a parent's perspective, I can well understand why parents might be wary of a mandatory vaccine policy. And from a public health perspective, the current underreporting situation creates an environment of fear and paints personal belief exemption holders as irresponsible cesspools of disease. This is simply not true. Remember, vaccination rates have not suddenly plummeted. They are, and remain, high. And we remain at the upper end of the 83 to 94 percent "herd immunity" threshold that keeps measles at bay. To know how many kids in California are vaccinated against what diseases, we need to use the data-crunching tools and reporting methods that are available to us to count all the vaccines that have actually been administered. And I think we would be happy with what we found.
Furthermore, we should take especial note of the fact that personal belief exemption use has dropped since the implementation of AB 2109, which requires California parents to meet with their doctor before receiving such an exemption. I think that's a good bill. Getting a vaccine exemption should be an experience with a certain amount of friction. It's a big decision. Also, that meeting gives the doctor a chance to say to the parent, "Ok, you know what, fine. Don't get the shot for Hib. Don't get rotavirus. But please, will you get the MMR, please? Get it when your kid is older if you want, but please get it." This maintains the all-important doctor-parent relationship, and, furthermore, could well result in more instances of MMR "uptake" than just kicking kids out of school. We should give that bill time to work.
Meanwhile, we should strive to repair the broken trust between parents and the medical establishment by holding drug companies more accountable for this particular product and by limiting vaccine requirements to diseases that really and truly represent a public health threat. If those measures fail, then by all means pass a bill like SB 277. But if those conditions are met—justified confidence in the current vaccine schedule and accountability for manufacturers—then such a bill would in all likelihood be unnecessary in the first place.
