Measles Outbreak Brings Vaccine Debate Back to Vt. Legislature

Friday, February 06, 2015
Montpelier — There is widespread agreement that Vermonters are less likely to get a measles shot for their children than parents almost anywhere else in the country, but that’s where the agreement stops.

Far more divisive are questions about whether that’s a significant public health concern, or whether the state should address that concern by forcing unwilling parents to vaccinate their children.

Right now, parents who don’t want to vaccinate their children can check a box on a state form that says they have a philosophical objection to the vaccination; last year, about 400 kindergarteners statewide, or 6.1 percent of the population, used this “philosophical exemption” to avoid the measles vaccine.

That’s the second-highest rate in the nation, after Oregon’s 7 percent.

An ongoing national outbreak of measles — 102 cases in 14 states, most of which can be traced back to a single case at Disneyland in California — has reignited a push from Vermont lawmakers to eliminate the philosophical exemption, which has been in place since 1979, as an option for parents.

State Sen. Kevin Mullin, R-Rutland, who introduced a bill seeking to remove the philosophical exemption from state law in 2012, said he plans to reintroduce the issue this session.

The 2012 bill, which was opposed by lawmakers and Gov. Peter Shumlin, resulted in more detailed reporting of vaccination rates, but the push to end the philosophical exemption was defeated. Whether the scales of public opinion have tipped in a way that would make the bill more politically feasible remains to be seen.

Josh Allen, a father of four — two preschoolers and two students at Bradford Elementary School — said that he and his wife are big supporters of vaccination.

Allen said he supports taking the philosophical exemption out of the law because he doesn’t want children to be put at risk from an unvaccinated schoolmate. Vaccines greatly reduce the chance of contracting a disease such as measles, but a small percentage of those who have been vaccinated can still contract the disease.

“They’re endangering other people by not doing it,” Allen said.

On the other side of this debate are parents such as Dorian Yates, a Strafford mother of three who has been active with the Vermont Coalition for Vaccine Choice.

Yates did not vaccinate her children, who are now adults, because of fears that the vaccine itself could harm her children’s health. Yates began parenting in the 1980s, when the public debate was centered on the potential dangers of vaccines, not the threat posed by those who refused them.

“The climate was so different. This was a nonissue,” she said. “Nobody ever, ever mentioned you might be harming somebody else.”

Yates said that parents of vaccinated children should be focused on the efficacy of the vaccination, not other parents’ choices.

“That makes no sense,” Yates said. “You’re blaming a product that is faulty on the person who is not using the faulty product.”

Yates said many of the 12,000 people who signed a petition supporting the goals of the Vaccine Choice Coalition in 2012 actually favored vaccinations — they just didn’t want to be forced to do so on a government-mandated timetable.

“It’s not that they don’t vaccinate,” she said. “They just choose to delay vaccines, and that can be for a whole host of personal reasons.”

As evidence of this, Yates points to the state data about Vermont’s vaccination rates.

Last year, 7.82 percent of young children did not receive their measles vaccination by the time they started kindergarten. Of those, 192 opted for the philosophical exemption.

But a much larger group, 288 students, received “provisional admittance,” a term applied to those who don’t claim an exemption, but simply haven’t gotten the vaccine. By the time that same cohort of students reached first grade, the number of students on a provisional admittance dropped from 288 to 62.

Yates said that points to a large group of people who are willing to vaccinate their children but who just need a little more time than the government’s timetable allows.

Vermont public health officials said it can be difficult to know how to persuade that small minority of parents to opt in.

“I think we need to understand where the fear is coming from and where the concern is coming from, and try to address that,” said Christine Finley, Immunization Program director for the Vermont Department of Health.

Some public schools have far higher rates of vaccinations than others, with about 25 schools reporting a 100 percent rate of vaccination.

In the Upper Valley, that includes the Hartford School District’s Regional Alternative Program; Bethel Elementary in the Windsor Northwest Supervisory Union; Bridgewater Village in the Windsor Central Supervisory Union; and Rivendell Academy in the Rivendell Interstate School District.

But there are also 22 schools in the state that reported a vaccination rate of less than 90 percent, meaning at least 1 in 10 children has not been inoculated against the measles. None of these schools are located in the Upper Valley.

The three lowest rates of vaccination in the state are all within the Windham Central Supervisory Union, where only 60 percent of the 15 students at Windham Elementary were vaccinated. Marlboro Elementary has 71.3 percent and Dover Elementary has 75.3 percent.

Finley said that some of the variation between districts comes down to how actively schools pursue those who have entered on a provisional admittance.

Under state law, students have six months to come into compliance. Some schools take that deadline seriously, and others don’t.

“Enforcement varies,” Finley said. “We know it does.”

The debate over the government’s role in vaccinations has deep historical roots, beginning in 1784, when Vermont’s state legislature authorized selectboards to quarantine infected people “to prevent the spread of small pox,” according to the Vermont Department of Health.

In Vermont and elsewhere, the measles vaccination was greeted by public health officials with wide-open arms.

In 1969, about 39,000 Vermont school-aged children were vaccinated by a new version of the vaccine, and in 1979, the state Legislature passed a law that made a slate of immunizations, including measles, mandatory for children entering school.

The number of measles cases continued to decline. During the three-year period between 1989 and 1991, 55,000 Americans caught the measles, and 123 died.

As vaccinations became the norm, cases of measles became rare, and deaths became virtually nonexistent.

Homegrown measles have been absent in the U.S. since 2000, although there are regularly cases that originate in other countries and travel to the U.S.

Vermont has seen only one case of measles in the past decade, in 2011.

Brendan Nyhan, an assistant professor with Dartmouth College’s Department of Government, has published research about how to convince reluctant people to accept a message that has been almost universally accepted by the medical 

“The general point we should take away is that throwing facts and science at people is not the best way to convince them, especially when it’s coming from government agencies or the media,” Nyhan said. “The most effective way is reaffirming the social consensus around the science.”

That can be done, Nyhan said, by working to ensure that people who have the public’s trust — family doctors, school teachers and religious leaders — have the facts, and spread the message in a way that is not clouded by a political fray.

“The challenge,” Nyhan said, “is to appropriately balance the needs of the community with the autonomy of parents.”

Matt Hongoltz-Hetling can be reached at mhonghet@vnews.com or 603-727-3211.