The antivaccine movement wins in Oregon: Senate Bill 442 is dead

How quickly things change.

If there's one thing I always feel obligated to warn my fellow pro-science advocates about vaccines and the antivaccine movement, it's that we can never rest on our laurels or assume that the tide is turning in our direction. The reason is simple: Antivaccinationism is a powerful belief system, every bit as powerful as religion and political ideology. It's powerful not just among antivaccinationists, but also because it taps into belief systems that are very much part and parcel of being an American. In fact, depressingly, yesterday I learned of a perfect example of this unfortunate phenomenon. Remember my discussion of Oregon Senate Bill 442? It's a bill that was being considered in Oregon in the wake of the Disneyland measles outbreak that would eliminate nonmedical exemptions to school vaccine mandates. It's also the same bill that chiropractors (amazingly) wanted to have antivaccine guru Andrew Wakefield testify in front of the Senate health care committee, but that plan was rendered null and void by the justifiably negative reaction to the possibility of having a scientific fraud like Andrew Wakefield testify against a bill. At the time, I thought that was an indication that the bill might have a chance of passing.

I was wrong. I should have known better. The power of the antivaccine dog whistle is not easily denied. If you don't believe me, take a peak at the antivaccine crank blog Age of Autism and what it posted last night, basically a link to this article in the the Statesman Journal entitled Oregon senator to propose new school vaccine policy:

Oregon legislators are backing off a proposal that would have made it tougher for school children to opt out of vaccinations.

Instead, Sen. Elizabeth Steiner Hayward said Wednesday she will propose a different policy that would encourage more school children to get vaccinated but continue to allow nonmedical exemptions. It also would provide alternative paths for parents to comply with the law.

Senate Bill 442, which had one public hearing and attracted national attention, would have eliminated religious and philosophical exemptions from school shots. Only medical exemptions would have been allowed.

So why did this happen? Why did Steiner back off? Simple. pressure from an unholy coalition of antivaccine loons and "health freedom" advocates:

Before the bill's first public hearing, Steiner Hayward was confident it had the majority of votes in both the Senate and the House. However, on Wednesday, she said that support had weakened, necessitating an alternate course.

"Some of my colleagues changed their minds," she said. "They got a lot of pressure one way or another. This is an issue that really mobilizes a very small minority of people, but it makes them very loud. I get that. That's their right. But there were a bunch of people who weren't prepared to take on this controversial of a topic at this point."

While the bill had strong support from public health and medical leaders, including Oregon Health & Science University, Oregon Medical Association and Providence Health & Services, a vocal group of parents who either delay or avoid vaccines for their children has been active in opposing the bill.

While many are concerned about vaccine safety, some opposed the bill on grounds of medical freedom and parental autonomy.

If you want to know how bad things got in Oregon, consider this. After the furor over the invitation by chiropractors to Andrew Wakefield to testify in front of the Senate committee, Robert F. Kennedy, Jr—RFK, Jr.!—lobbied Oregon lawmakers not to pass this bill. As a result, the bill appears to be dead, although it sounds as though Sen. Steiner wants to try to pass a bill similar to California Bill AB 2109, which requires parents seeking a personal belief exemption to vaccine mandates to see a health care professional to sign the exemption form. the purpose, as I discussed before multiple times when AB 2109 was being considered, was to make it more difficult for parents to claim personal belief exemptions than just signing a form. Even then, Governor Jerry Brown neutered the new law with a signing statement instructing the California Department of Public Health to include on the exemption form a religious exemption that doesn't require a healthcare professional to cosign the form. It was a profound betrayal of California children and an almost certainly unconstitutional abuse of his authority as Governor in which he basically overrode the legislature's intent.

So, instead of a strong bill that eliminates nonmedical exemptions to vaccine mandates, Oregon is likely to pass a much weaker bill, although even that is not assured, given the fierce resistance of antivaccine groups, who have been relentless. In the meantime, there is even a legislator, Sen. Tim Knopp, R-Bend, who is considering this, ""Ultimately, we probably need to review whether or not Oregon needs a constitutional amendment to make sure parents are in control of their kids' health care." Meanwhile, another legislator, Sen. Jeff Kruse, R-Roseburg, published a newsletter saying he believed vaccines are linked to autism and accusing the CDC of mismanagement and corruption, both of which are talking points "made in the documentary Kennedy showed to lawmakers last week." What documentary was that?

Trace Amounts:

He showed the documentary "Trace Amounts," which centers on mercury in vaccines and its relationship to autism, at Cinebarre in downtown Salem. The documentary also accuses government researchers and public health agencies of corruption and fraud.

Kennedy made the trip to Salem with one goal. To influence lawmakers to vote against Senate Bill 442, the vaccine mandate bill.

It wasn't just Robert F. Kennedy, Jr., either:

Kennedy was accompanied by Brian Hooker, a California biomechanical engineer. Hooker wrote a reanalysis of a 2004 research that found no links between the measles, mumps and rubella, or MMR, vaccine and autism. In the paper, Hooker accuses the CDC of covering up data that showed black boys had a 3.4 times greater risk of autism associated with the MMR vaccine.

Hooker's study, which was published in Translational Neurodegeneration in October 2014, has been retracted. The retraction statement reads that "post-publication peer review raised concerns about the validity of the methods and statistical analysis, therefore the Editors no longer have confidence in the soundness of the findings."

Despite that, Hooker's findings continue to be used to argue against vaccines.

You remember Brian Hooker, don't you? Think "CDC Whistleblower" pseudo-scandal. Think a reanalysis of the 2004 DeStefano et al paper that was so utterly incompetent that even a brand new journal eager to attract submissions saw no other choice but to retract it. Think a biochemical engineer who believes that the simplest statistical methodology is the best and applied it to the DeStefano et al data in such a way that epidemiologists who saw what he did wanted to tear out their eyes to unsee the atrocity against epidemiology he had committed in the name of "simplicity." (Let's just put it this way: "Simple" often means not adjusting for confounding factors.")

I've discussed the concept of the "antivaccine dog whistle" on multiple occasions before. A dog whistle, of course, produces a sound at a higher frequency range than most humans can hear, but dogs can hear it. In politics, a "dog whistle" says something that most of the population finds admirable (or at least inoffensive), but people of certain groups recognize it as speaking to them, as telling them that the person blowing the dog whistle is "one of them." It's a technique that's been used of late by everyone from antivaccine-sympathetic pediatricians like "Dr. Bob" Sears to Rand Paul to the aforementioned Oregon Sen. Robert Kruse to, yes, Robert F. Kennedy, Jr.:

Kennedy made the trip to Salem with one goal. To influence lawmakers to vote against Senate Bill 442, the vaccine mandate bill.

"We can't solve a credibility problem by forcing people to undergo a medical procedure without informed consent," Kennedy said before the event.

That "health freedom" argument in which vaccine mandates are portrayed as denying parents "informed consent"? Pure antivaccine dog whistle, an appeal to parental "rights" over the rights of their children. True, it's not as blatant as Rand Paul's infamous statement, "The state doesn’t own the children. Parents own the children, and it is an issue of freedom." It does, however, do what most antivaccine appeals to "freedom" and "informed consent" do, and that's to ignore the child as an autonomous being. Rather, the child is simply an appendage of the parent, and it is the parents' "freedom" and "rights" that trump the child's right to good health care and preventive medicine.

More importantly, as I've explained multiple times, what antivaccinationists like Robert F. Kennedy, Jr. are really arguing for is something I've dubbed "misinformed consent." That's consent based on the antivaccine message, which massively exaggerates risks of vaccination, makes up risks that science has not found despite looking intensively (such as autism due to vaccination), and greatly underplaying the benefits of vaccination. If enough misinformation is aimed at parents to demonize vaccines as dangerous and ineffective and the parents accept that information, either because they don't know any better or because there is no counterbalancing source of information, then it becomes "reasonable" to refuse vaccinations. That is the very essence of misinformed consent.

Lately, the grande dame of the antivaccine movement, Barbara Loe Fisher herself, has been dog whistling up a storm, invoking language favored on the right of the "culture war" in a post entitled The Vaccine Culture War in America: Are You Ready?:

In this case, in addition to the usual appeals to "freedom" and "rights," Barbara Loe Fisher takes a particularly despicable turn:

More than 1.2 million people in the United States are infected with HIV 1 but government officials do not ban HIV infected children and adults from attending school, receiving medical care, being employed, or otherwise participating in society. In fact, there are anti-discrimination laws that guarantee civil rights protections for Americans infected with HIV or living with AIDS.

In 2012, public health officials reported that about two million people in America are infected with chlamydia, tuberculosis, syphilis and gonorrhea, 3 and they estimate another three million people are infected with hepatitis C. 4 Like those with HIV or AIDS, these citizens are not targeted for discrimination and blocked from getting a public education, being employed or moving freely in society.

Right off the bat, Fisher is being intellectually dishonest to a degree even beyond what I'm used to seeing from her. You can see her setting up a comparison to unvaccinated children by comparing how they are not allowed to go to school with how children with AIDS and various sexually transmitted diseases are. It's clearly and blatantly an attempt to argue that the government treats people with these diseases better than it treats unvaccinated children. Of course, HIV is not easy to spread. It requires sex or contact with blood or bodily fluids like semen, and even then it's not that easy to catch. Hepatitis C also requires direct contact with blood or bodily fluids, although it is much easier to spread by those means than HIV. The rest of the diseases, with the exception of tuberculosis, are all sexually transmitted diseases that won't spread unless the kids are having sex.

Tuberculosis itself is—fortunately—no longer that common in the US, and, if it has been treated properly, rapidly becomes no longer contagious. Moreover, if a case of active TB is identified in a student, health officials do take strong action. It just happened in Oklahoma a week ago, when a student with active TB was identified. This student was isolated and treated, and 315 students were ordered to undergo TB testing.

So what's the problem? The diseases vaccinated against, with the exception of HPV, vaccination against which is intended to prevent cervical cancer, the diseases vaccinated against for school are highly contagious. Measles, for instance, is one of the most contagious diseases known to humans, with infective particles hanging in the air for long periods of time after a measles victim coughs. To compare a bunch of diseases transmitted by sexual contact and blood contact with diseases spread through the air with droplets or through contact with fomites is as intellectually dishonest as it gets. In any event, the rest of Fisher's tirade is a "greatest hits" of recent antivaccine responses to the Disneyland measles outbreak (e.g., this one) and any whiff of a hint that states want to restrict non-medical vaccine exemptions, with complaints about censorship, "shaming," and concerns about revocation of the licenses of antivaccine doctors (this last of which, by the way, will almost certainly never happen anywhere).

Here's where Fisher goes into full dog whistle mode:

Rational thinking has been the first casualty in this 21st century equivalent of a 17th century witch hunt 43 led by defensive doctors in government, industry, academia and media, who are fed up with parents asking them questions about vaccine risks and failures they can’t answer. 44 45 46 47 Assisted by communication conglomerates 48 and Astroturfers, 49 50 51 52 53 they piously wave the science flag and call parents “anti-social” if they don’t vaccinate 54 but completely ignore parents with vaccine injured children talking about how their vaccinated children are never healthy anymore. 55 Some of the most vicious attacks have been on families consciously choosing to stay healthy a different way 56 57 and on doctors caring for families whose children are unvaccinated or receive fewer vaccines on an altered vaccine schedule. 58 59

After headlines like “What would Jesus do about measles?” 60 and “God wants you to vaccinate your children” 61 marked a new low in American journalism, it became clear that the so-called “vaccine war” 62 63 is really a culture war 64 on freedoms, values and beliefs that have long defined who we are as a nation. 65 66 67 How it is fought and where it ends will determine the kind of nation America will become in the 21st century.

Funny that Barbara Loe Fisher would make a reference to the 17th century, given that the views that lead her to spread fear, uncertainty, and doubt (FUD) about vaccines derive from ideas dating back at least that far. In any case, notice how neatly she co-opts the language favored on the right of the "culture war," language that was rose to prominence when Pat Buchanan, in his speech at the 1992 Republican Party Convention, declared a "cultural war," a "struggle for the soul of America." Her video is about as obvious an example of the antivaccine dog whistle as I've been able to find, in which it's not really about vaccines but rather about "freedom," "values," and what America should be.

If you want to know why antivaccinationists use this rhetoric, look no further than Oregon. It works. It taps into a very deep well of distrust of overweening government dating back to the very formation of our country and deeply embedded into the very DNA of our culture. Because of that, it attracts people who are not antivaccine to work for antivaccine goals, such as easier-to-obtain non-medical exemptions, all in the name of freedom. It's why antivaccinationists won in Oregon even in the middle of a major measles outbreak, an outbreak that's accounted for 119 cases in Quebec alone due to a the child of a missionary who visited Disneyland on the way home and brought measles to a religious community whose members don't vaccinate. It worked even though the Disneyland measles outbreak had seemingly turned the tide of public opinion against the antivaccine movement. Antivaccine loons will quite possibly win in California again against a similar bill designed to eliminate non-medical exemptions, SB 227 for the same reasons. Antivaccine activists appeal to emotion because they don't have the science, but it's a potent weapon, as emotion frequently does trump science. It's not enough for us to fight antivaccinationism with science. We have to find a message as potent as the invocation of freedom to counter the antivaccine dog whistle. Until we do, we will likely continue to lose.


More like this

Concerned Parent: "As far as the decline in measles, as I mentioned to the 2 other posters about smallpox – it does seem to point to a link, but correlation can’t be considered ultimately conclusive."

Answer my question which was about measles. You questioned vaccine effectiveness, therefor I chose a dramatic decrease of a disease in modern times.

Again why did measles cases in the USA drop 90% between 1960 and 1970? I repeat: Do not mention mortality, any other decade, any other disease nor any other country (despite Mr. Stone and Mr. Miller delusions, England and Wales are not American states).


Again why did measles cases in the USA drop 90% between 1960 and 1970?

Also worth asking, why did measles incidence remain the same over this period in the UK until 1970 when it dropped by 99% over the next few decades? What happened in the US around 1960, and in the UK around 1970 other than the introduction of the measles vaccine? Improvements in hygiene?

By Krebiozen (not verified) on 20 Mar 2015 #permalink

via Mike the Mad Biologist, an article (Vox) on prediction of a rise of measles as a result of decreased vaccination related to issues surrounding Ebola.
Note the death rates with measles in these countries!

@Concerned Parent

I suspect you have a lot of reading in front of you. I think others have provided you with more summarized answers than I did, but here are my key takeaways:

1. The evidence for vaccination isn't in any one study. That's true of pretty much everything in science and certainly true in medicine. The evidence builds year on year. The evidence is in the hundreds of thousands of studies done over a century. I’m not saying that to hype vaccination. I’m not saying that to put you off. I’m saying that to highlight that this is the kind of topic where people spend years and years to become experts.

2. I totally understand your correlation/causation argument, however I think that the best counter, as pointed out in several different ways above, is to look at how there is a pattern that virtually every vaccine follows. If the incidence of a disease dropped coincidentally with the introduction of a vaccine for that disease then I wouldn't expect that to happen again in another country and again with another disease. Yet we do. That is evidence to me that this is causative. Every new country, every new vaccine is a new experiment and we get consistent results.

3. Note that nobody is saying that there are no side effects associated with the vaccines. The fact-based argument is that the diseases are WAY worse and we are balancing risks. Unfortunately human beings seem to be biologically hard-wired to suck at probability and so we fear rare events more than common ones. As you can see above, we understand the biology involved in eliciting an immune response. The evidence to support vaccination isn’t just all the hundreds of thousands of studies of vaccines. It’s the entire field of immunology. We can definitely be wrong about details, but it is highly unlikely that everything we know about the human immune system is wrong.

By Niche Geek (not verified) on 20 Mar 2015 #permalink

Niche Geek: Please don't waste your time with Concerned Parent. They're just here to troll and aren't interested in hearing any evidence that doesn't support their belief that vaccines are bad.

By Politicalguineapig (not verified) on 20 Mar 2015 #permalink

@ PGP:

We don't necessarily do it for the scoffer alone: other people can benefit from our writing including us/

By Denice Walter (not verified) on 20 Mar 2015 #permalink

One thing that could help is to graphically remind people what it was like to live in earlier times when now-preventable or curable diseases wiped out whole families and towns. Maybe that could take the form of a mandatory health history class. Some episodes of PBS's "American Experience" tell the stories, last week I watched the one about tuberculosis. We have such luxury not to have to think about these diseases that, until recently, were huge epidemics. My great-grandfather died from TB, a horrible death. At one time, 1 in 7 Americans died from it. Blows my mind. Even studying your own family tree, you find out how early people died from diseases that are now rare or extinct.

By LinnieMae (not verified) on 20 Mar 2015 #permalink

@ LinnieMae

Last spring, my mother and I were walking through a very very old graveyard in Chester, Nova Scotia (Gorgeous spot, totally worth a visit but I'm biased). We were both in a contemplative mood, the weather was wonderful and the yard itself rather beautiful. We paused in front of a row of 8 or ten markers, all dating from the early 19th century. I'm sure you can guess where I'm going - Annual graves as child after child died, in some cases clusters that likely represented an outbreak. The whole line ends with the grave of the wife and mother. We found the father further down with his second wife and another string of children. Nature has never been friendly.

I don't know if Concerned is a troll or not. I read far far more than I comment on any site and I learn a lot from good comments, even when I lurk. Life is far too short to assume the worst of those around you.

By Niche Geek (not verified) on 20 Mar 2015 #permalink

@Denise Walter

what reasons do you have to believe that WHO, the CDC and other governmentally sponsored agencies around the world are not to be trusted?

Oh, I dunno, why not start here:

CDC's 'inconsistent' lab practices threaten its credibility, report says

But lemme guess... none of this will cause any of you here to question your unshakeable faith in government agencies. We're only skeptical when it suits our bias, right guys?

Who IS to be trusted?

I would trust my doctor... if I actually had enough time to establish rapport with them that is.

By DoesItMatter (not verified) on 20 Mar 2015 #permalink

Niche Geek: "Life is far too short to assume the worst of those around you."

Well, life is much, much shorter if you don't assume the worst of other people. Though, maybe I should try it- murder has the advantage over suicide or any other crime, since it's not usually considered the victim's fault.

By Politicalguineapig (not verified) on 20 Mar 2015 #permalink

Anyway, my point was that "Concerned Parent" reeks of troll, right down to accusing everyone of being emotional and presenting himself as the sole rational person, when he isn't.

By Politicalguineapig (not verified) on 20 Mar 2015 #permalink


Even if CP is a troll, I'd rather baffle her with civility than push her away with aggression. It's a national weakness.

By Niche Geek (not verified) on 20 Mar 2015 #permalink

@ DoesItMatter?:

Right reports on lab safety issues mean that multitudinous decades long reporting about reductions of VPDs via vaccination by governmental agencies WORLDWIDE aren't to be trusted.

AND who has unshakeable trust in governmental agencies?
Sh!t, I just listened to Glenn Greenwald- in Portugeuse yet.

And are you CP?
Orac doesn't like nymshifters.

By Denice Walter (not verified) on 20 Mar 2015 #permalink

DoesItMatter: "Oh, I dunno, why not start here."

Hmmm, let's see. I guess I should never ever fly in an airplane or drive a car, because surely somewhere in one of those many large companies a person has lost stuff or stored something inappropriately.

To those wondering about me - I haven't used any other names to post on this thread. As far as exactly where I'm coming from, I have children and I have been leaning against getting the full vaccination schedule due to the dangers, which seem undisputed. At the moment, I am doubting myself and honestly seeking sober, evidence-backed advice that could change my mind. I am currently looking into the studies that Chris posted, as time permits, and I will look at the links that others have posted. I will also be going back into seriously researching this for myself. This is going to take some time, since I have many other obligations in my daily life. Obviously I do believe that I should be able to make this decision myself, so I am against forced vaccination. It would be easier to trust the doctor's advice if they were more forthcoming about information and respecting the patient. Every pediatrician I've dealt with thus far has had an attitude of "do it my way or you're an idiot," which doesn't really help me trust them. I realize there are a lot of different vaccines and therefore it is a nuanced issue. Anyway, I'm not just trolling, I really am wondering if I have been wrong and looking for reliable information that could change my mind. Since the fact that there are dangers is undisputed, I need evidence that the benefits really do outweigh them. The rarity of adverse events is not enough for me, because even if it were only 1 in ten million kids that got damaged from vaccines, it's not a risk I would subject my children to unless I were convinced there was definitely a much greater benefit. If one of my children were that 1 in ten million, then I would have failed them in my duty to protect them.

By Concerned Parent (not verified) on 20 Mar 2015 #permalink

CP: "Every pediatrician I’ve dealt with thus far has had an attitude of “do it my way or you’re an idiot,” which doesn’t really help me trust them."

So you have not encountered the ones that say if you don't vaccinate to find another doctor? I don't believe they call you an idiot, it is just that they would prefer you not bring vaccine preventable diseases into their waiting room.

"The rarity of adverse events is not enough for me, because even if it were only 1 in ten million kids that got damaged from vaccines, it’s not a risk I would subject my children to unless I were convinced there was definitely a much greater benefit."

Why is a risk of one in a five chance for pneumonia (with one in ten chance of hospital care) or a one in thousand chance with measles better? Are you seriously thinking you can get a free ride by your community's immunity? If you do, please thank your responsible neighbors who vaccinate, because they are actively protecting your family.

In the mean time, you need to provide a reason of why the rate of measles incidence in the USA dropped 90% between 1960 and 1970.

@Chris - 1) I didn't say they called me an idiot, I said they had that attitude by their lack of respect for me to make my own decision - honestly the lack of information gave me the impression that they didn't know it. It's either that or they have a massive sense of superiority over their patients. Either way not trustworthy.
2) No, I don't need to provide you with anything. I came on here to get information and evidence, not to convince anyone of anything. I guess I've gotten whatever of value I'm going to get here. With all the research I've got ahead of me, I don't have time to bicker about all this.

By Concerned Parent (not verified) on 20 Mar 2015 #permalink

Concerned Parent, you still have not provided us with your specific concerns about vaccine safety. If you want us to answer your questions, you have to provide us with more information.

P.S. No one is forcing you to have your children fully vaccinated. You should be aware that your failure to meet vaccination school entry requirements in your State may result in your child(ren) not being eligible to attend school...and will definitely result in your child(ren) being barred from attending school if there are confirmed cases of vaccine-preventable-diseases in the school or in the school district.

CP -- they're doctors. They've sent years qualifying to do their job. You're telling them that you know better than they do.

Are you this disrespectful to your financial planner? Your dry cleaner? Your plumber?

CP: "2) No, I don’t need to provide you with anything. I came on here to get information and evidence, not to convince anyone of anything."

No, because it is all about you and no one else.

Seriously, do thank your responsible neighbors who vaccinate because they are the ones protecting your family by maintaining community immunity.

Though I would think you should scold your high school science and math teachers for failing to provide you with the basics because you lack any understanding of the issues under discussion.

Also scold your the folks who raised you who made sure you became a very selfish adult without any sense of empathy towards others because you are just so special. They must be proud to have produced a leech on society.

@Concerned Parent

"...due to the dangers, which seem undisputed."

I think you're missing the forest for the trees. You seem to assume that by avoiding or delaying vaccination you are reducing the risk of harm to your child. That isn't what the numbers seem to show. The diseases are still around and still very real. Is the risk of disease greater than the risk of vaccination - yes it is.

Look at this another way, I'm assuming you're driving your child in your car. What is the risk of a car accident? Why do you accept that risk?

By Niche Geek (not verified) on 20 Mar 2015 #permalink

Concerned Parent

I have been leaning against getting the full vaccination schedule due to the dangers, which seem undisputed.

Exactly what undisputed dangers? Can you specify them? Or could you at least list those which you fear the most?

The you say:

The rarity of adverse events is not enough for me, because even if it were only 1 in ten million kids that got damaged from vaccines, it’s not a risk I would subject my children to unless I were convinced there was definitely a much greater benefit. If one of my children were that 1 in ten million, then I would have failed them in my duty to protect them.

How will you feel once your child suffers a vaccine preventable disease? You will have have failed them in [your] duty to protect them.

Yeah, yeah, there's an extra "have" up there. I wish there were still a Preview function, but I'm not sure it would have prevented that error.

I hope Concerned Parent looks past the poor proofreading and considers the question.

The diseases are out there.

CP: Okay, let's take a look at, say, chicken pox. There is now a vaccine for it. I had chicken pox when I was a kid. I don't remember much of it, except for being itchy all the time and cranky. Twenty years later, I developed something called Bell's Palsy, a variety of shingles. I lost all movement on one side of my face, since it paralyzed a few facial nerves. Luckily, I got treated for it, and it cleared up. But..if I'd been older, I might still be paralyzed. And that's one of the LESSER effects of the disease. Imagine your adult kids, waking up one day and worrying that they had a stroke. So... is avoiding a less than one billion chance of an adverse reaction worth watching your kid suffer for a week? Or developing shingles later on?

And then there's measles and the rest. I'd advise you to read Eight Cousins, Little House in the Big Woods and the Mirror Crack'd- all mention consequences of measles and rubella.

Now would be a good time to ask yourself if you're up to the task of raising a child who's not perfect or may have disabilities. Most parents who are anti-vax proceed to make their autistic children's lives hell. (You say you're not anti-vax, but I'm seeing a lot of the talking points anti-vaxxers use.) Raising a child who's lost hearing or sight is at least as difficult as raising an autistic kid. Just sayin'.

By Politicalguineapig (not verified) on 20 Mar 2015 #permalink

Have I missed something here?

Did "Concerned Parent" actually articulate any specific concerns about vaccine safety that (s)he has for any specific vaccine?

We were all willing to provide reliable information and links to published studies and scientific papers to allay "Concerned Parents" fears about vaccine safety. Chris linked to the dozens of studies/scientific papers provided by the AAP with their excellent analyses of those 42 vaccine safety studies/scientific papers.

We're still waiting for "Concerned Parent" to comment again with specific questions...and to explain to us why (s)he found her encounter(s) with licensed physicians unsatisfactory.

I see that the respected and revered amateur epidemiologist Mark Blaxill, has offered his opinion about the expected end date of the Disneyland Parks measles outbreak. Blaxill's opinion is in direct opposition to the California State Department of Public Health's epidemiologist's statement about the time frame when that measles outbreak will be declared over.

I know it's an unusual step, but I have taken it into my head to raise an on-topic item.

Oregon, Washington, and Maryland (to be too lazy to bother fact-checking D'Ohlmsted) are not exactly the end of the story, and the former two were never all that promising to start with. The Dachelbot recently tried to make hay over RFKᴊ's* visit to, ah, Springfield, Illinois.

I was kind of wondering why, given that the descriptions of the bill that I'd seen were of the "notarized statement from church official" variety, making it dead on arrival.

It turns out that somebody seems to have clued in Munroe on this front (subsection 8). The whole "local school authority is responsible for determining if the content of the Certificate of Religious Exemption constitutes a valid religious objection" bit is an obvious problem, since nobody can afford to litigate enforcement, but it's an improvement.

* Yes, Unicode proves to be that dumb.

CP have you read On Immunity by Eula Bliss? She is a heck of a writer exploring the social reasons why such a reasonable thing as protecting your kids against VPD's has become so contentious.

I also agree that, as a species, we tend to rationalize the risks in everyday activity - driving for example - while exaggerating the risks of limited activities - I think of all my co-workers who are sure they're going to win the lottery.

CP "I have children and I have been leaning against getting the full vaccination schedule due to the dangers"

This is very vague. Based on this, your children are either not immunized at all or partially immunized and you're considering catching them up? The "full vaccination schedule" changes depending on the ages of your children. Once they get past a certain age, some of the shots they don't even need to catch up on. For example,

- Prevnar, a 4-shot series, is not needed once a child is over 5 (unless there are underlying conditions).

- The 5-shot DTaP series is replaced with one TDap shot if the child is 7 or older, and can be used in place of the Td booster at 11-12.

As for Hib, according to the CDC: "Previously unvaccinated children aged ≥60 months who are not considered high-risk generally are immune to Hib disease and do not require catch-up vaccination." (Depending on the vaccine used in the primary series, that is either a 3 or 4-shot series. So, maybe vaccines AREN'T just a big big money-making scheme.)

The reason why I know about these is because I am right in the middle of catching up our 8 kids (ages 4-18). Our 8yo needs the least amount of catch-up shots, because she is past the age of the Hib and Prevnar shots (and didn't need the 4th IPV because her 3rd shot was past 4yo), but too young for HPV and meningococcal.

You didn't mention whether you have any babies. Lest you be tempted to delay shots until he/she is older to reduce the number, I don't recommend that. We nearly lost our 3yo son to Pneumococcal Pneumonia last fall. Respiratory distress, emergency intubation, helicopter ride to children's hospital, 6 days intubated, 9 in PICU. Yeah, I don't recommend it.

You see, it turns out there really ARE reasons why these immunizations are recommend in the first 18 months of life.

While you're researching, I recommend spending some time getting familiar with this:…

By Still Shaking Mama (not verified) on 21 Mar 2015 #permalink

Oh, and if you really are who you say you are, and just a "Concerned Parent," you're doing a lot more than I did. I never did any research - just assumed much of the ant-vaxxers' talking points were true, or at least reasonable. I thought the debate would be very nuanced and it would be difficult to sort out right from wrong. So, I purposely avoided the topic ... and vaccinating. *After* our son's illnesses, I started reading and researching. And I was completely blown away by all the research showing the safety and effectiveness of vaccines. I couldn't believe I'd made all those assumptions without checking the facts. I'm just glad we didn't have to pay the ultimate price to learn all this. We came dangerously close to that.

By Still Shaking Mama (not verified) on 21 Mar 2015 #permalink

Narad (I'm not that old), but I recall my daughter's elementary school days, when a physical, dental and up-to-date vaccination record were requirements for school entry. Her doctor also tested for TB infection using the old (not very effective) TB Tine test and filled out the school physical form. We did not reside in an area where active TB infection was common. For those children whose parents did not have the financial resources, the school district (and every district in our County), had physicians and dentists available to provide those exams and school nurses would direct parents to call local clinics for vaccinations. Back then, no private medical insurance companies provided coverage for childhood vaccines and it was years before the VFC program was enacted.

Children who had a positive TB tine test reaction, were required to have a chest x-ray to check for the presence of pulmonary TB. TB Mantoux tests are now required and a chest x-ray is still required to rule out active pulmonary TB or the presence of a granuloma, which should be treated with antibiotics.

I never heard of a parental exemption to these physical and dental exams...and rarely, if ever, heard of vaccination exemptions for childhood vaccines.

Often a child moved into a school district during the summer and the school nurses had lists of children who had started the primary series of vaccines; the school nurse kept accurate records for the dates of each child's next scheduled vaccination appointments and those records were quite accurate. The school nurse also sent notices home if appointments were not kept.

Each private (religious) school had a school-district-funded full time school nurse who was up to the task of monitoring children's missing immunizations. We only had one Waldorf School within our school district...where school vaccination rates were not ideal..

Anytime we had a confirmed case of measles in a school, those kids who had not received at least one MMR vaccine were immediately excluded, because of the excellent records kept by those competent school nurses.

Concerned Parent,

I have children and I have been leaning against getting the full vaccination schedule due to the dangers, which seem undisputed.

The dangers, such as they are, are very remote. I'll use MMR and measles as an example, though I could make a similar argument for other vaccines and diseases. Severe reactions to MMR occur after fewer than one in a million doses, and are so rare it is difficult to establish for certain if they are caused by the vaccine at all.

Measles itself is far more dangerous, even in countries with good health care:

High numbers of measles cases in Europe which began in 2010 continued in 2011, with more than 30,000 cases in each of those years. Overall, with more than 30,000 cases of measles in Europe in 2011, there were 8 deaths, 27 cases of measles encephalitis, and 1,482 cases of pneumonia. Most cases were in unvaccinated (82%) or incompletely vaccinated (13%) people. France was the hardest hit, with over 15,000 cases of measles and at least 6 deaths last year, 651 cases of severe pneumonia and 16 cases of encephalitis.

Assuming you are in the US, you might think that your child's risk of getting measles and suffering pneumonia, encephalitis or death is small. This is true, currently, though recent outbreaks should give you pause for thought, thanks to most people vaccinating their children.

However, if you do not vaccinate your child with MMR, what happens then? Either he or she will contract measles as a child, with all the risks that entails, or s/he will reach adulthood with no immunity to measles. Since the risk of serious complications is much higher in adults, that really isn't doing him or her any favors. If s/he ever wants to travel outside the US s/he will be at serious risk of contracting measles and suffering serious complications. S/he will either put him/herself at that increased risk, or s/he will have to get the MMR as an adult. I can't find any information on it, but since measles itself is more dangerous in adults than in children it seems likely that the (tiny) risks associated with MMR are greater as well. Why not just get your child vaccinated with MMR without leaving him or her vulnerable to measles for years and then putting him/her at this increased risk.

At the moment, I am doubting myself and honestly seeking sober, evidence-backed advice that could change my mind. I am currently looking into the studies that Chris posted, as time permits, and I will look at the links that others have posted. I will also be going back into seriously researching this for myself. This is going to take some time, since I have many other obligations in my daily life.

Good luck with that. I spent two years studying immunology part-time and that was enough to make me aware of the extent of my ignorance of the subject (though I passed the exams). This isn't something you will be able to pick up from Google University, especially if you mistrust what most people consider to be reliable sources of information. You will very likely come across the vast reams of misinformation about vaccines and immunology that infest the internet.

The rarity of adverse events is not enough for me, because even if it were only 1 in ten million kids that got damaged from vaccines, it’s not a risk I would subject my children to unless I were convinced there was definitely a much greater benefit. If one of my children were that 1 in ten million, then I would have failed them in my duty to protect them.

How would you feel if your child got measles or whooping cough and ended up permanently injured as a result? Would that feel better than him/her suffering damage from a vaccine?

Do you travel in a car with your child? Let's assume the risk of a serious adverse reaction to MMR is 1 in 1 million (almost certainly an overestimate). The fatality rate for road traffic accidents in the US is about 1 for every 82,000,000 miles traveled. That means that you are subjecting your child to a greater risk of death by driving 100 miles with him/her in the vehicle than you are risking a serious adverse event by giving him/her the MMR.

Not vaccinating to reduce the risk to your child makes about as much sense as getting him/her to cycle to school on a busy road instead of driving him/her because you would feel worse if s/he was hurt while you were driving, even though the risks of cycling are far higher. In other words it seems to be about minimizing the risk of you feeling bad, not reducing the risks to your child as much as possible.

By Krebiozen (not verified) on 21 Mar 2015 #permalink

I'll wager that ConcernedParent will need treatment later in life for tinnitus after listening to (and blowing on) so many anti-vax dog whistles. *shrug*

By Scottynuke (not verified) on 21 Mar 2015 #permalink

Hi Everyone-

I kind of find "vax vs. anti-vax" to be a bit of a false dichotomy. For example, I feel a lot more comfortable with vaxes that have been around for a while- like MMR- and more skeptical about newer vaxes like HPV.

Background: I have an undergrad biology degree (immunology was one of my best courses!), so I have somewhat of a framework to discuss these things. Yet I find it kind of frustrating because it seems that having any kind of concerns about vaccines, whatsoever, results in me being labeled an "anti-vaxxer." I'm hoping that won't happen here.

Now my understanding about HPV (and correct me if I'm wrong) is that:

1. There are 30-40 strains of HPV.
2. Some strains are more dangerous than others.
3. Some strains might possibly confer protection against other strains.
4. Almost everybody will be exposed to HPV sometime in their life.
5. About 90% of people who contract an HPV-related disease will clear it on their own, with no intervention, within 2 years.
6. Even if somebody DOES get HPV-related cancer, it is very treatable with very good outcomes.

Now assuming all of those are true- I am having a hard time finding the justification for mandatory HPV vaccination. What is the rationale here?

Also- I'm wondering about cross-reactivity between different HPV strains. Do we know for sure that getting an HPV vax only induces immunity against the "bad" strains that cause disease?

By What About HPV vax? (not verified) on 21 Mar 2015 #permalink

Our 15 and 13yo got vaccinated against HPV this week and I still have the VIS. According to the CDC, about 20 million Americans are currently infected and about 6 million more get infected each year. If 90% of people infected clear the virus, that leaves about 2,000,000 with genital warts and an increased risk of a cancer which is the 2nd leader of cancer deaths of women around the world.

By Still Shaking Mama (not verified) on 21 Mar 2015 #permalink

To the basics of the timeline, the vaccine will allow your system much better odds to clear the virus before it can mutate a tissue cell.

That our immune system can clear a virus without a vaccine is only part of the big picture in disease progression. Most people who get the measles will recover without even needing to see a doctor/go to the hospital. But, then again 25% will need hospitalization for supportive care, and 1 out of every thousand to three thousand will die.

Along the same lines HPV developing into cancer is not common, but the vaccine does offer you an advantage so you don't go down the road of mutation to metastasis.

"... with no intervention, within 2 years"

Except for the occasional removal of genital warts. For up to 2 years.

By Still Shaking Mama (not verified) on 21 Mar 2015 #permalink

"6. Even if somebody DOES get HPV-related cancer, it is very treatable with very good outcomes."

Only if it's caught at an early stage. Deeply invasive/metastatic HPV-induced cancer (cervix, oropharyngeal and other sites) is difficult to eradicate and does not have a very good prognosis.

Even if HPV-related neoplasia or dysplasia is caught early, there's still a considerable toll on the patient, including regular followup and invasive (and sometimes painful) procedures like cryotherapy and cervical cone biopsies, which can also affect fertility. It is not currently possible to tell which dysplasias will clear up on their own, which results in invasive precautionary treatments, made unnecessary if one never contracts high-risk HPV infections in the first place.

I'm not convinced mandatory HPV vaccination is justifiable, but getting it voluntarily if in a high-risk group seems like a good idea.

"Yet I find it kind of frustrating because it seems that having any kind of concerns about vaccines, whatsoever, results in me being labeled an “anti-vaxxer.”"

Not at all. If you state those concerns intelligently and are receptive to good information that should allay them, you'll get a civil and even friendly reception. Those who reject solid evidence as "biased" and stubbornly repeat common antivax tropes over and over again are another story.

By Dangerous Bacon (not verified) on 21 Mar 2015 #permalink

"6. Even if somebody DOES get HPV-related cancer, it is very treatable with very good outcomes"

Why is it better to treat cancer instead of preventing it?.

"Now assuming all of those are true- I am having a hard time finding the justification for mandatory HPV vaccination. What is the rationale here?"

How many states have that vaccine as one required for school attendance? Last I looked it was not required in California nor the state I live in?

@What About HPV vax?

You seem to agree that there is benefit from the vaccine, you just question how much. May I suggest some additional questions:

A. Of the strains of HPV, which are most commonly associated with causing cancer? Does the vaccine address those strains?

B. What is the rate of complication associated with the vaccine? If you accept that there is benefit then you need the other have of the ratio before you can ask whether it is worth vaccinating.

C. What is the cost and trauma associated with your points 5 and 6? what is the complication rate of those two conditions and what is the complication rate of treatments implemented for those conditions?

I strongly suspect that the known incidence and severity of complication for the HPV vaccine is less than the incidence and severity of sequelae from HPV infection and HPV-related Cancer including complications from treatment of HPV and HPV-related cancer

By Niche Geek (not verified) on 21 Mar 2015 #permalink

Now my understanding about HPV (and correct me if I’m wrong) is that:

1. There are 30-40 strains of HPV.
2. Some strains are more dangerous than others.
3. Some strains might possibly confer protection against other strains.
4. Almost everybody will be exposed to HPV sometime in their life.
5. About 90% of people who contract an HPV-related disease will clear it on their own, with no intervention, within 2 years.
6. Even if somebody DOES get HPV-related cancer, it is very treatable with very good outcomes.

Now assuming all of those are true- I am having a hard time finding the justification for mandatory HPV vaccination. What is the rationale here?

Assuming all of those are true, the rationale is self-evident. If just about everybody gets it, then uncontrolled HPV infection puts ten percent of everybody at potential, unpredictable risk for a number of cancers that -- however treatable they may be in theory when detected early -- aren't always detected early.

The vaccine reduces that risk by two-thirds for cervical cancer.

That's a very significant gain.

And the downside is...?

What about HPV vax?:

I have to assume you've been living under a rock and are entirely apolitical. The HPV vax will never, ever be mandatory in the US. Heck, in five years, it'll be banned here, along with science education and birth control, since the next President and Congress will be Republicans.

By Politicalguineapig (not verified) on 21 Mar 2015 #permalink

finding the justification for mandatory HPV vaccination.

I can't be arsed looking for justification for something that doesn't exist.
(as PGP said).

By herr doktor bimler (not verified) on 21 Mar 2015 #permalink

Not only is the HPV vaccine not mandatory, if you're over 40 it's hard to get them to give it to you at all. Insurance certainly won't pay for it. They figure you either have it already or aren't at risk for it, I suppose.
It's pretty irritating, actually.

By sfbooklady (not verified) on 21 Mar 2015 #permalink

Now assuming all of those are true- I am having a hard time finding the justification for mandatory HPV vaccination. What is the rationale here?

Ignoring the 'mandatory' part of your question, which others have addressed, considering how safe HPV vaccines are, I'm having a hard time finding reasons for not getting them. These aren't live vaccines, they aren't even made from any pathogens, and it increasingly looks as if they confer lifelong protection against diseases that kill thousands of people every year in the US alone (despite them being "very treatable with very good outcomes").

By Krebiozen (not verified) on 21 Mar 2015 #permalink

HDB: Are you making fun of me?

By Politicalguineapig (not verified) on 21 Mar 2015 #permalink

Are you making fun of me?

The very concept is alien to my people.

By herr doktor bimler (not verified) on 21 Mar 2015 #permalink

The very concept is alien to my people.

A good man is hard to find.

@ hdb #550 --

The very concept is alien to my people.

Thank goodness, else this might have turned out much differently:

By Scottynuke (not verified) on 22 Mar 2015 #permalink

@Matt - "If my unvaccinated kid harms your vaccinated kid, then I should be held liable. But not until then."

How can an unvaccinated kid harm a vaccinated kid?

For the rest of my post please refer to the MMR package insert - a MUST READ for every parent, patient, shill, anti-vaccinationist, propagandist, blogger, Doctor who reads my posts.
11 pages of contraindications, adverse events, adverse reactions, warnings and precautions.


Merck, in the package insert, doesn't allow for healthcare providers to review records to determine the appropriateness and safety of vaccinating...
Merck REQUIRES parent/guardian/patient participation in COMPLETE safety evaluation and screening IAW the MMR package insert..

What healthcare provider reviews those 11 pages and responds to all the questions a caring/aware parent would ask?
Confusing, conflicting, unexplained or alarming screening criteria also JUSTIFIABLY contribute to this fear.

Take one of MMR's adverse reactions - DIABETES
There are many adverse reactions listed in the MMR package insert, but DIABETES is a shocking one!
Despite the CAUSAL relationship admitted by Merck personnel I spoke with, NO RISK-FACTORS ARE LISTED.

There is no criteria by which a parent or healthcare provider can make an informed decision about the risk of their child or patient contracting diabetes from an MMR shot!!!

This is one example of hundreds in various vaccine or drug package inserts that need to be completely addressed before many parents will permit vaccination of their children.

If parents would just start questioning Merck, FDA, CDC and their elected representatives about this ONE adverse reaction, I believe dramatic results in vaccine safety and compliance would occur.
Addressing this ONE issue would naturally result in the other issues with vaccine safety, exposed in package inserts, being addressed.
Creating proper organized screening criteria would go a long way to reducing/eliminating serious adverse events associated with vaccinations.

According to the American Diabetes Association childhood diabetes is increasing at epidemic rates, and has been for decades... Is MMR involved?
Merck listing diabetes in the 2014 package insert trumps any research done before that.

Merck attempts to deflect from this issue in the package insert by referring to the CDC's ACIP board statement that MMR does not cause diabetes.
But that's overstepping the authority and expertise of the ACIP.
Nothing can contravene the repeated listing of diabetes as an adverse reaction to the MMR vaccine, when that is what is described in the package insert... when that is what the vaccine maker states could happen with MMR vaccine.

Which kids die from natural measles infection?
Only kids with immune problems.
Those same kids are likely to be injured or killed by live vaccinations.

Complete science-based efficient screening criteria and ensuring the criteria are followed/applied are ESSENTIAL in stopping inadvertent vaccinations.
Injuries from inadvertent vaccinations are the direct cause of parents' reluctance to vaccinate.
Those mistakes are the adverse reactions and some or most of the adverse events that happen after the MMR shot.
Those reactions listed in the package insert reflect Merck's clinical trials and after-market research data.

Both the 2010 and 2014 package inserts warn that causal evidence has been found regarding MMR vaccine and diabetes... Merck admitted this when I called them. They told me they passed that information to the FDA, but wouldn't release it to me.
The FDA rep, at first, played dumb!!! Claiming never to have heard about the diabetes connection before, advising me to "find out for myself" who made the MMR shots, and not knowing the difference between adverse event and adverse reaction... that was shocking!
Then she advised me to submit an FOIA request, repeatedly reminding me I would have to pay for it, whether or not the FDA found anything and whether or not they would release anything to me.

As always,
for the protection of children,
In the interests of truth and science,
Michael Polidori

By Michel Polidori (not verified) on 30 Apr 2015 #permalink