Vermont Immunization Legislation – Round Two
Part of our civic duty is to get involved in legislative policies that have the potential to impact us within our communities. Last week we highlighted the Shot@Life champions who traveled to our nation’s capitol to speak out in support of global vaccines and we shared the views of an Arizona State Representative regarding legislation that may allow immunization exemptions among foster care families in her state. Today, we look to a post from Harpocrates Speaks, which details two new immunization related bills being discussed in the state of Vermont.
Just last year Vermont legislators attempted to eliminate religious and philosophical exemptions from school immunizations. The bill got a great deal of attention among the anti-vaccine activists and they rallied their troops to oppose the bill. While a bill was eventually signed into law, there were significant revisions so that parents in Vermont can still get a religious or philosophical exemption for their child. All they must do now is sign a statement saying they’ve reviewed the educational material provided to them and they understand that their decision increases the risk of disease for their child and those around them.
However, get ready for round two. The sponsor of last year’s bill, Rep. George Till (D-Chittenden), has joined with several others to introduced two new bills (H.114, full text available here, and H.138, full text here) that are more narrowly focused. While still addressing the concerns of religious and philosophical exemptions, these bills focus on pertussis immunization and exemptions within individual schools.
H.114 – An Act Relating to Immunization Against Pertussis
- Exemptions for religious or philosophical reasons would no longer be granted for the pertussis vaccine to children enrolled in a child care facility or public school. Only medical exemptions would remain.
- All adults working in a child care facility or public school who has contact with children in such facilities must provide evidence that their pertussis immunization is current and up to date.
Over the past several years, we have seen the number of pertussis cases dramatically increasing across the country.
CDC Pertussis Surveillance, 1990-2011
Vermont is one of the states that has been hit particularly hard in the past year, going from 94 cases in 2011 to 645 cases in 2012, or about 100.4 cases/100,000 people, giving them the second highest incidence of pertussis in the country. For a comparison, the national incidence for 2012 was just 13.4/100,000. Dr. George Till, the only medical doctor in the Vermont state legislature, has ample justification to be concerned.
The post goes on to suggest that the outbreaks of pertussis have been the result of a variety of causes: low vaccine uptake, lapsed adult boosters, waning vaccine immunity in teens and a less-than-perfect vaccine for a disease which appears to be mutating. One way that the proposed bill may help reduce the impact of pertussis is by requiring adults who have close contact with children to keep up to date on their boosters. Since infants are too young to be fully immunized against pertussis, they are at the greatest risk from infection. Therefore, requiring adult boosters, especially in child care facilities, appears to be a step in the right direction. However, the disappointment comes in the fact that bill does not extend to private schools, allowing students in these schools to continue to get religious or philosophical exemption. Not only does this lessen the impact of the legislation, but it also plays into the importance of the second bill.
H.138 – Focuses on Immunization Rates of Students for Specific Vaccines At Individual Public Schools
- If the immunization rate for a required vaccine at a particular school drops below 90%, then religious and philosophical exemptions from immunization requirements will be suspended for that school for the particular vaccine until their rate returns to 90%+ uptake.
- Adults who work at and come into contact with children at a school where the religious and philosophical exemptions have been suspended will need to provide evidence that they are up to date for the immunization in question.
Although this bill still allows for religious and philosophical exemptions, it addresses the concerns that public health professionals have when pockets of unvaccinated students are concentrated in a specific area, which may be a reasonable compromise for all. Many vaccines require at least 90% coverage in order to establish decent herd immunity. Therefore, when immunization rates fall below that level, it becomes more likely that an infectious disease will be able to spread within the community, especially among those individuals who are not adequately immunized. Sometimes this impacts those who have philosophical reasons to skip their vaccinations, but can also impact children with medical reasons, as well as vaccinated individuals who didn’t confer complete immunity.
However, I can’t help but wonder if this kind of legislation may make vaccine refusers less likely to suggest exemptions to others. Clearly, if they convince more people to forego vaccines, than the privilege that they have to exempt their own child may be revoked. But once again, since this bill is limited to public schools, it may not provide protection where it is needed most – among private institutions such as the Waldorf Schools, who tend to have the highest exemption rates.
While these bills could help reduce the risk of infection and serious injury to the people of Vermont, there is question as to whether they will have enough support to pass.
According to one news report, Governor, Peter Shumlin (who can be contacted here), said he will not support legislation designed to deal with a pertussis outbreak. Additionally, Representative Mike Fisher, chairman of the House Committee on Health Care, is not keen on dealing with immunization issues again:
“We addressed vaccinations last year, and I think we should give that law time to play out before coming back to it…I don’t think we’re interested in taking it up at this time.”
Based on the enormous amounts of testimony provided last year, it is clear that some legislators may be reluctant to address the issue again. However, if these bills are to have a chance, we need passionate voices willing to speak out in favor of strong immunization policies.