Vermont Immunization Legislation – Round Two
Feb 19, 2013

vtstatePart 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.

In a recent post, Vermont Rolls Up It’s Sleeves Again, you can review the details of these two bills:

H.114 – An Act Relating to Immunization Against Pertussis

  1. 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.
  2. 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

  1. 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.
  2. 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.

If you are a resident of Vermont, consider contacting your representatives and the members of the Committee on Health Care to let them know how important this is for you and your community.  Let this be a reminder that vaccine advocates need to raise their voices in support of legislation.

If you would like to receive updates on legislative actions in your state sign up to Get Involved through the Vaccinate Your Baby website.

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32 responses to “Vermont Immunization Legislation – Round Two”

  1. Hudson says:

    Still trying to take away our right to choose? What will be next?

  2. Lawrence says:

    @hudson – you have a choice. Don’t send your kids to public schools where not only are they putting other students at risk, but are actually at a greater risk themselves (if they aren’t vaccinated), since they will now be exposed to a much larger number of people who may or may not have been in contact with various VPDs….in a way, this is as much for your safety (and that of your children) as it is for the safety of others.
    So, your choice – there are plenty of kids that are home schooled or perhaps you could chose a private school with a much more lenient vaccination policy (though several have seen severe outbreaks of VPDs in recent years).
    You have all the choices you want – this is a free country & you don’t have to send your kids to public school (and abide by the regulations there), since you have alternatives….which would probably better fit your philosophy anyway.

  3. Gray Falcon says:

    I don’t have the right choose whether I can stab other people or not. Is that a form of oppression?

  4. Hudson says:

    @Gray…..when your vaccinated kid gives me a disease, what are my rights or what should be done to your kid for harming me?

  5. Lawrence says:

    @Hudson – or more likely, when your kids come down with the measles or some other vaccine preventable disease & passes it along to others (like newborns or perhaps even someone who is immuno-compromised – like a Cancer patient), does that mean they can sue you for not getting vaccinated (or your kids)?
    Seems that all of the most recent measles outbreaks have been started by unvaccinated individuals (like San Diego & Indianapolis)……makes me wonder where you get your information, because it seems to be patently false, misleading & full of misinformation.

  6. Hudson says:

    Lawrence, my last comment was suppose to read that way. I thought it was language Gray Falcon would understand in regards to his/her comment.
    My point is….if Gray claims that getting a disease from somebody is some sort of crime, then it goes both ways. Not just for those who aren;t vaccinated but also for those who are. As we both know….vaccinated people spread disease all of the time.

  7. Hudson says:

    Please state one false statement I have made Lawrence. I’d be careful with your accusations Lawrence.

  8. Lawrence says:

    @hudson – I only stated that your statements seem false and misleading because they fly in the face of decades of research and mountains of evidence, since you refuse to back them up with snyder real evidence of your own…..
    Like citations were vaccinated individuals are spreading diseases like measles or mumps, for example….care to actually provide any real evidence at all?

  9. Todd W. says:

    Hudson, you would still have choice under these bills. 1) As long as vaccination rates at your kid’s school doesn’t drop below 90%, you can still claim an exemption. 2) Homeschool. 3) Enroll your child in a private school with lax vaccination requirements, such as a Waldorf school.
    In the first case, herd immunity should keep your child safe, as well as limit the impact of any potential outbreaks. If the vaccination rate for a vaccine that you have refused for your child falls below 90%, then you can keep your kid home until the rate improves or switch schools. In the second case, your kid isn’t going to expose anyone else to disease, nor be exposed to anyone with a disease, other than family and friends with whom you come into contact. In the third case, your child is much more likely to get infected by others or to start a larger outbreak, thanks to the low level of herd immunity.
    So, you have choices.
    As to suing if a vaccinated kid infects your child? Vaccination is a reasonable precaution to prevent infection and spread of disease. Like everything else in life, it is not a guarantee, but it does greatly improve the odds.
    Suppose you have a staircase. The person who built it put traction strips on it, railings on both sides, gave each step an 8″ rise and 10″ run to make it more comfortable and less likely to cause tripping. The staircase is well-lit. In short, the builder took plenty of reasonable precautions to minimize the risk of injury to people using it. You take the stairs and, despite all these precautions, you still trip, fall, and get hurt. Are you going to sue the person who paid to have the stairs built or the person who built them?
    Well, maybe you are litigious and would actually do that, but I wouldn’t consider that very reasonable.

  10. Hudson says:

    Lawrence, so you deny that vaccinated people spread diseases? Then you haven’t done your homework.
    Todd, thanks. Lawrence did explain all of that regarding my choices and the other part regarding the vaccinated kids giving me a disease was a big joke. I was speaking to Gray on a level he/she could understand. It wasn’t suppose to make any sense. BTW…you are famous on this site….Lawrence sites your web page all of the time, I feel honored.

  11. Hudson says:

    How are they going to keep the non-boostered parents out of the schools?

  12. Todd W. says:

    Glad to hear that Lawrence is among those who find my posts useful. As for your comments to Gray, well, I guess I just don’t see the joke. Getting a disease from a vaccinated person and getting a disease from an unvaccinated person are not, necessarily, equivalent. Yes, the outcome is the same (you get sick), but in one case, reasonable precautions were taken, in the other, no precautions were taken.
    Going back to the stair analogy, it’s the difference between the staircase I described vs. one not built to code or not cleared of ice, debris or otherwise rendered unsafe.

  13. Gray Falcon says:

    @Hudson- People still commit crimes. Why do we bother having laws?

  14. Hudson says:

    Todd, you have some good information on your site, can I use it?
    Gray….no idea what you are talking about. If you can’t stay on topic, please don’t bother commenting. I really don’t have time for your games or your riddles or whatever.

  15. Gray Falcon says:

    @Hudson- You said “when your vaccinated kid gives me a disease, what are my rights or what should be done to your kid for harming me?” Your complaint was that the vaccine wasn’t a perfect solution, I was pointing out the critical flaw in your argument: There are no perfect solutions. Ever.

  16. Hudson says:

    Gray…no – incorrect. That is not my complaint and that wasn’t the point.

  17. Gray Falcon says:

    Hudson- Yes it was. Unless you can prove otherwise.

  18. Hudson says:

    Gray….now you are telling me what my own complaint and point is? Ridiculous. I will no longer be responding to you. I feel like you are only trying to cause a fight and I find you quite combatitive.

  19. Gray Falcon says:

    Hudson- You seem to be doing the same. After all, why say “that wasn’t my point” without bothering to say what your point really is?

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  26. Laura Condon says:

    Looks like Rep. George Till isn’t current with the science on Tdap boosters. ACIP no longer recommends them because the don’t work.

  27. Nathan says:

    ACIP never did recommend adult Tdap boosters with the exception of one Tdap at adolescence or later, and one with each pregnancy, which has not changed. I don’t see Till referring to any additional boosters above, just to be up to date with current recommendations.
    Further, your own link says that the ACIP did not recommend regular boosters because the cost ratio is high, as per your own link.
    More reading: (paywalled)
    “Modeling a best-case scenario of Tdap protective effectiveness of 74% within the first year after revaccination, subsequent waning of protection of approximately 15% per year, and the relatively low burden of disease in older adolescents and young adults, revaccination at 21 years or 16 years of age would be expected to lead to only a 3% and 5% reduction in the number of cases, respectively, and would be extremely costly.
    The work group and the ACIP concluded that data do not support universal revaccination. The work group has been asked to explore potential revaccination of special groups, such as health care personnel and those in close contact with infants.”

  28. Rob says:

    But independently of what the ACIP may say, I”ve seen lots of ads saying that in order to protect babies from pertussis, all adults are urged to get a Tdap booster so as not give them the illness. What are the current recommendations? By whom? How many agree? I’ve seen that in many, protection wears off in only three years. Is everyone supposed to get another shot every three years?

  29. Lawrence says:

    @Rob – on the chance it would save a newborns live, you sure as hell bet I’d get a shot every three years.

  30. Nathan says:

    “3) Prevention of pertussis among infants aged <12 months by vaccinating their adult contacts: Adults who have or who anticipate having close contact with an infant aged <12 months (e.g., parents, grandparents aged <65 years, child-care providers, and HCP) should receive a single dose of Tdap at intervals <10 years since the last Td to protect against pertussis if they have not previously received Tdap. Ideally, these adults should receive Tdap at least 2 weeks before beginning close contact with the infant. An interval as short as 2 years from the last dose of Td is suggested to reduce the risk for local and systemic reactions after vaccination; shorter intervals may be used."
    Since Tdap came out in 2005, many adults of child-caring age have probably not had a Tdap at all, and are recommended to do so, and the upcoming ACIP recommendation does not appear to change this. There is not, and has not been to my knowledge, a recommendation for adults to get repeat Tdaps, even with regards to newborn care, with the exception of Tdaps for women with each pregnancy.

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