[NVIC] Taking Away Vaccine Exemptions

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National Vaccine Information Center Newsletter

e-NEWS

October 11, 2006

:: <#leftarticle1>Nonmedical Exemptions to School Immunization Requirements

:: <#rightarticle1>Vaccine exemptions may boost whooping cough cases

:: <#rightarticle2>Whooping cough cases on the rise

" 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. States should

examine their exemption policies to ensure control of pertussis and other

vaccine-preventable diseases. " - JAMA, October 11, 2006

" Concerns about vaccine safety seem to be the main reason parents claim

such exemptions, Salmon told Reuters Health. In an earlier study, he and

his colleagues found that 69 percent of parents who sought exemptions did

so because they feared vaccination did more harm than the diseases it

prevents. Salmon and his colleagues argue that states should have

" administrative controls " that make non-medical exemptions more difficult

to obtain. This, Salmon said, could look something like the process of

becoming a conscientious objector to the draft. Parents would apply for an

exemption and have to show a " strongly held belief " against vaccines, he

explained. Then the government would either have to demonstrate an

" overwhelming need " for universal vaccination or grant the exemption. " -

Amy Norton, Reuter's Health

" Barbara Loe Fisher, co-founder and president of the National Vaccine

Information Center in Virginia, said exemptions allow people to make

choices about health care for themselves and their children. In some cases,

risks are real and science has not caught up with vaccine policy, she said.

" The principle of informed consent is, you’re able to make a voluntary

decision. It applies to every other medical intervention, " Fisher said. " -

Misti Crane, Columbus Dispatch

Barbara Loe Fisher Commentary:

Are more American citizens standing up for their right to make voluntary,

informed decisions about vaccination which do not conform to

one-size-fits-all forced vaccination policies endosed by CDC officials and

the utilitarians at s Hopkins? Apparently they are and it is making the

government and industry funded M.D./Ph.D./MPH employees at the CDC, s

Hopkins and other academic institutions determined to take away all

exemptions to vaccination except those they and their colleagues personally

grant to citizens.

In the past 25 years, as the CDC has increased the numbers of vaccines

recommended for " universal use " by all children from 23 doses of 7 vaccines

to 48 doses of 14 vaccines by age six, more and more children have been

getting sick and regressing physically, mentally and emotionally after

vaccination. In the past two decades, there has been a tripling of the

numbers of highly vaccinated children who are now chronically ill and

disabled and suffering with learning disabilities, ADHD, asthma, diabetes,

and autism. America's children are in the middle of a chronic disease and

disability epidemic and the only solution government health officials and

professors of public health offer is to suggest ways to force more vaccines

on sick children.

The most common reason that parents exercise a philosophical or

conscientious belief exemption to vaccination for a child is because the

child or a close relative has a history of vaccine reactions and health

deterioration after previous vaccinations. Unfortunately, in the past two

decades, government health officials have so severely restricted the

medical criteria for contraindications to vaccination that few individuals

qualify. Doctors who write medical exemptions which do not fit the strict

federal government criteria, are often second-guessed and harrrased by

state government health officials. Because medical exemptions to

vaccination have become virtually non-existent, the only exemptions

available to parents acting to protect their children from vaccine injury

and death is the religious and philosphical exemption.

What is becoming more evident to more parents is that unvaccinated or

partially vaccinated children move through illness and heal more quickly

and are getting better grades in school because they do not have difficulty

concentrating or learning like their more sickly, lower functioning highly

vaccinated classmates. Empirical evidence and personal experience always

trumps methodologically flawed scientific studies and the words and actions

of government health officials employing strong-arm tactics to force their

ideology on others.

The tragedy of forced vaccination policies is that the immoral utilitarian

rationale is used to justify human rights abuses while distorting the truth

about what constitutes good individual and public health. If everybody is

forced to get vaccinated, then there can be no comparison of the long term

health of those highly vaccinated to those who receive fewer or no

vaccines. Public health officials inside and outside of government, along

with their colleagues in the pharmaceutical industry, have a lot of

prestige, power and money to lose if the health differences between the

highly vaccinated and unvaccinated ever become widely known. That is one

reason why they continue are pushing so hard to elminate all exemptions to

one-size-fits-all mandatory vaccination laws.

Nonmedical Exemptions to School Immunization Requirements

Secular Trends and Association of State Policies With Pertussis Incidence

JAMA

Vol. 296 No. 14, October 11, 2006

Saad B. Omer, MBBS, MPH; K. Y. Pan, DrPH, MS, MPH; Neal A. Halsey,

MD; Stokley, MPH; Lawrence H. Moulton, PhD; Ann Marie Navar, MHS;

Mathew Pierce, JD, MPH; A. Salmon, PhD, MPH

Context School immunization requirements have played a major role in

controlling vaccine- preventable diseases in the United States. Most states

offer nonmedical exemptions to school requirements (religious or personal

belief). Exemptors are at increased risk of acquiring and transmitting

disease. The role of exemption policies may be especially important for

pertussis, which is endemic in the United States.

Objective To determine if (1) the rates of nonmedical exemptions differ

and have been increasing in states that offer only religious vs personal

belief exemptions; (2) the rates of nonmedical exemptions differ and have

been increasing in states that have easy vs medium and easy vs difficult

processes for obtaining exemptions; and (3) pertussis incidence is

associated with policies of granting personal belief exemptions, ease of

obtaining exemptions, and acceptance of parental signature as sufficient

proof of compliance with school immunization requirements.

Design, Setting, and Participants We analyzed 1991 through 2004 state-level

rates of nonmedical exemptions at school entry and 1986 through 2004

pertussis incidence data for individuals aged 18 years or younger.

Main Outcome Measures State-level exemption rates and pertussis incidence.

Results From 2001 through 2004, states that permitted personal belief

exemptions had higher nonmedical exemption rates than states that offered

only religious exemptions, and states that easily granted exemptions had

higher nonmedical exemption rates in 2002 through 2003 compared with states

with medium and difficult exemption processes. The mean exemption rate

increased an average of 6% per year, from 0.99% in 1991 to 2.54% in 2004,

among states that offered personal belief exemptions. In states that easily

granted exemptions, the rate increased 5% per year, from 1.26% in 1991 to

2.51% in 2004. No statistically significant change was seen in states that

offered only religious exemptions or that had medium and difficult

exemption processes. In multivariate analyses adjusting for demographics,

easier granting of exemptions (incidence rate ratio = 1.53; 95% confidence

interval, 1.10-2.14) and availability of personal belief exemptions

(incidence rate ratio = 1.48; 95% confidence interval, 1.03-2.13) were

associated with increased pertussis incidence.

Conclusions 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. States should examine their exemption policies to ensure control

of pertussis and other vaccine-preventable diseases.

Author Affiliations: Department of International Health (Drs Omer, Pan,

Halsey, Moulton, and Salmon, Ms Navar, and Mr Pierce), Institute for

Vaccine Safety (Drs Omer, Halsey, Moulton, and Salmon, and Ms Navar), s

Hopkins Bloomberg School of Public Health, Baltimore, Md; National Center

for Immunization and Respiratory Diseases, Centers for Disease Control and

Prevention, Atlanta, Ga (Ms Stokley); Department of Epidemiology and Health

Policy Research, College of Medicine, University of Florida, Gainesville

(Dr Salmon); and School of Medicine, Duke University, Durham, NC (Ms Navar

Vaccine exemptions may boost whooping cough cases

Reuters Health

Wed Oct 11, 2006 2:39 PM BST

By Amy Norton

NEW YORK (Reuters Health) - State laws that make it easy for parents to opt

out of vaccinating their children may be contributing to outbreaks of

whooping cough, researchers reported Tuesday.

In an analysis of U.S. vaccine-exemption laws, investigators found higher

rates of whooping cough in states where parents can refuse to vaccinate

their child due to " personal beliefs. "

The disease rate in these states was about 50 percent higher than it was in

states that only allowed exemptions for medical reasons and religious

beliefs, the researchers report in the Journal of the American Medical

Association.

The same was true of states with " easy " exemption procedures, according to

the study authors, led by Saad B. Omer of s Hopkins University in

Baltimore.

This includes states such as California, where parents can take a

personal-belief exemption by simply signing a school immunization form.

Other states, such as land, officially allow only religious exemptions;

but again, parents have only to sign a form, making it likely that many

take the exemption for personal reasons.

The elevated rates of whooping cough in these states point to the " very

real consequences " of relaxing vaccination requirements, Omer said in a

statement.

Also known as pertussis, whooping cough is a highly contagious bacterial

infection of the respiratory system that causes fits of severe coughing and

breathing difficulties -- often with a distinctive " whoop " sound on

inhalation. People of any age can become infected, but it's most dangerous,

and potentially fatal, in babies and young children.

Childhood vaccination with the combined diphtheria, tetanus and pertussis

vaccine can prevent whooping cough, but the rate of infection in the U.S.

has been climbing in recent years.

This trend is one reason the current study was undertaken, said Dr.

A. Salmon, an associate professor of epidemiology at the University of

Florida College of Medicine and the study's senior author.

All U.S. states require children entering school to have proof they've

received standard vaccinations, though all also grant exemptions for

medical reasons. In addition, nearly all states also allow exemptions for

religious beliefs, while 19 grant waivers for personal beliefs.

In these latter states, more and more parents have been opting out of

vaccination in recent years, Salmon and his colleagues found. On average,

the rate of non-medical exemptions grew by 6 percent per year between 1991

and 2004.

Concerns about vaccine safety seem to be the main reason parents claim such

exemptions, Salmon told Reuters Health. In an earlier study, he and his

colleagues found that 69 percent of parents who sought exemptions did so

because they feared vaccination did more harm than the diseases it prevents.

In part, such concerns stem from the proposed link between the

measles/mumps/rubella (MMR) vaccine and autism -- a link that a number of

international studies have since refuted.

Salmon and his colleagues argue that states should have " administrative

controls " that make non- medical exemptions more difficult to obtain. This,

Salmon said, could look something like the process of becoming a

conscientious objector to the draft.

Parents would apply for an exemption and have to show a " strongly held

belief " against vaccines, he explained. Then the government would either

have to demonstrate an " overwhelming need " for universal vaccination or

grant the exemption.

SOURCE: Journal of the American Medical Association, October 11, 2006.

Whooping cough cases on the rise

The Columbus Dispatch, OH

Wednesday, October 11, 2006

By Misti Crane

States that make it easy for parents to send their kids to school without

vaccines have more whooping-cough cases and should reconsider their

policies, according to the authors of a study in today’s Journal of the

American Medical Association.

Rates of whooping cough, formally known as pertussis, were twice as high in

states that allowed people to opt out for nonmedical, nonreligious reasons,

the researchers found.

Last year, 1,094 pertussis cases were reported in Ohio, up from 175 a

decade earlier.

But Ohio’s numbers don’t appear to be linked to a high number of parents

opting not to vaccinate.

The percentage of Ohio children whose parents ask for exemptions is

consistently below 1 percent, said Amy Bashforth, interim immunization

program manager for the Ohio Department of Health.

In Ohio, parents can either send an immunization record to the school

district or provide a written statement describing why they want to opt

out, which means explaining their " reasons of conscience, " including

religious objections.

For the 2005-06 school year, 0.6 percent of kindergarten students were

granted exemptions for reasons of conscience and 0.2 percent for medical

reasons.

All states allow exemptions for medical reasons, 48 for religious beliefs

and 19 for personal beliefs.

The researchers who conducted the study found that overall, states that

allow people to opt out for personal beliefs saw an increase in exemption

rates from 0.99 percent in 1991 to 2.54 percent in 2004.

Numbers of whooping-cough cases have increased around the country and have

been attributed to various things, including better disease reporting by

doctors and more cases among adolescents and adults whose vaccinations have

worn off, Bashforth said.

Dr. Dennis Cunningham, an infectious-disease specialist at Children’s

Hospital, said he’d like to see no exemptions for personal beliefs.

" Why should only some children get the vaccine? " he said.

Yesterday, Cunningham recalled a 7-month-old girl who spent a week in the

hospital last year with the disease. Her parents didn’t believe in

vaccination, he said.

Many parents who choose not to vaccinate are convinced that vaccines can

cause harm, including autism, he said, adding that no major medical

organizations recognize a link.

" It’s such a dead horse, " he said. " But it’s like politics and religion,

you ’re probably not going to sway the other side. "

Barbara Loe Fisher, co-founder and president of the National Vaccine

Information Center in Virginia, said exemptions allow people to make

choices about health care for themselves and their children.

In some cases, risks are real and science has not caught up with vaccine

policy, she said.

" The priciple of informed consent is, you’re able to make a voluntary

decision. It applies to every other medical intervention, " Fisher said.

Diane , associate director of the Immunization Action Coalition in

Minnesota, said she’s always felt that exemptions are reasonable as long as

they aren’t too easy.

When she worked for that state’s health department, she thought their

policy of requiring a signed and notarized statement was good.

" I thought it was quite workable if it was something that was enforceable, "

said.

mcrane@...

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