A highly misguided concern about California SB 277 and cracking down on nonmedical vaccine exemptions

It never ceases to amaze me how very smart people can miss some very obvious points. Now, as most of my readers know, I was at NECSS over the weekend. Because I was busy giving a talk, doing panels, and then enjoying other speakers’ talks, I wasn’t paying much attention to some of the issues that had consumed my blogging in the couple of weeks before NECSS. Also, as I mentioned here yesterday, science communication was a big issue as well, which is why I appreciated Julia Belluz’s suggestions for how the media should cover pseudoscience and quackery.

There was, however, one point where I didn’t entirely see eye-to-eye with her, and that was her concern about making martyrs of quacks like Andrew Wakefield with critical coverage. Consider today’s post a follow up on that idea, although it’s more a variation on the same theme. This time around, the complaint comes from Brendan Nyhan at the New York Times’ The Upshot in a post entitled Why California’s Approach to Tightening Vaccine Rules Has Potential to Backfire. Yes, I could could tell from the title that the content of this post would cause my back teeth to start grinding, and, predictably, it did. Oh, did it ever.

First, a little background. There’s a bill wending its way through the California legislature, starting in the Senate. It’s sponsored by State Senators Richard Pan and Ben Allen and only became possible in the wake of the recent Disneyland measles outbreak, which started, as its name implies, at Disneyland and spread all over the country, although most cases were in California. As a result of that outbreak, legislators in some states started getting a bit of backbone and have tried to curtail nonmedical exemptions to school vaccine mandates. Unfortunately, they failed in Oregon. They might succeed in California, because the bill, SB 277, would if passed eliminate nonmedical exemptions. Predictably, the antivaccine movement has reacted to this as if it were mandating a government takeover by fascistic jackbooted thugs, who would immediately dispatch their Vaccine Gestapo to bust down doors and stick big scary needles into their children while destroying, Truth, Justice, Freedom, and the American Way. Indeed, right before I left for NECSS, Robert F. Kennedy, Jr. himself was in the state throwing around Holocaust analogies as though his brain had been chomped by the Hitler Zombie. (Remember him?)

So what irritated my about Nyhan’s post? Let’s take a look:

In a number of states, parents are allowed to opt out of legal requirements to have their children vaccinated before entering school by claiming a “personal belief” or “philosophical” exemption. These provisions have raised a great deal of concern since the Disneyland measles outbreak, including in California, where it began. Unfortunately, the blundering approach state legislators there have taken shows how direct attacks on exemptions can rally the anti-vaccine cause.

So, in other words, it’s the legislators’ fault that the antivaccine movement is letting its freak flag fly and going into full mental jacket meltdown over SB 277. If only legislators would be more…reasonable. After noting what I mentioned above, namely RFK, Jr.’s Hitler Zombie-worthy spewing of Holocaust analogies, plus some other antivaccine activity in California, such as an antivaccine group from Minnesota airing a television ad showing an infant having a seizure. Nyhan also noted the ridiculous antivaccine claims being made in testimony to the Health committee and how antivaccine activists jeered vaccine advocates from the audience.

Nyhan’s preferred solution to such a polarizing issue? This:

A smarter approach would be to retain a narrow personal belief exemption in states that already have one and avoid the kind of polarizing fight that California is now having. These states could tighten exemption rules as experts recommend to more appropriately strike the balance between parental choice and the health needs of the community. Given the potential risks that unvaccinated children pose to the community, the process of obtaining an exemption can be rigorous and demanding. Until a recent change in the law in California, for instance, it was easier to obtain a personal belief exemption than to document that a child was fully vaccinated, which gets the burden of proof precisely backward.

Yes, wouldn’t it be reasonable to tighten vaccine exemption rules while retaining nonmedical exemptions. Where have we seen this strategy before? I wonder…? Yes, we have indeed seen it in California just a couple of years ago. Nyhan, however, seems blissfully unaware of what happened when California tried to pass a bill to tighten nonmedical exemptions.

Let’s take a brief trip in the Orac TARDIS. (Come to think of it, wouldn’t a crossover between Doctor Who and Blakes 7 be awesome?) The year was 2012. The bill was AB 2109. The idea behind the bill was to make nonmedical exemptions to school vaccine mandates more difficult for parents to obtain, given that before AB 2109 all the parents had to do was to sign a form. In many ways, back then it was easier to claim a personal belief exemption to school vaccine mandates than it was to go to the trouble of getting your children vaccinated. So Richard Pan tried to do something about it. He introduced AB 2019, which required parents to receive counseling, in essence informed consent, from pediatrician or other named health care professional, who would inform them of the risks of not vaccinating. A signature from a pediatrician or other listed health care provider was then required on the exemption form.

I wonder what happend. Surely, if Nyhan is correct, the reaction of the antivaccine movement must not have been nearly as batshit crazy in 2012 in response to AB 2109 as it is in 2015 in response to SB 277. I mean, all Senator Pan was proposing back then was to add one little step, one relatively minor hoop that parents had to jump through in order to prove their dedication to wanting a personal belief exemption to school vaccine mandates. It shouldn’t have been such a big deal to them, should it? Surely they wouldn’t trot out Nazi and Holocaust analogies, the way RFK, Jr. just did last week, would they?

Of course they would.

Let’s step into the TARDIS and look at the reaction of the antivaccine movement to the very reasonable reform proposed in AB 2109. No big surprise, the reaction of antivaccinationists to AB 2109 in 2012 looked very much like the reaction of antivaccinationists to SB 277 in 2015. In 2015, we have RFK, Jr. speaking of a “vaccine holocaust” in response to SB 277 while a group called Californians against SB 277 use photos juxtaposing antivaccine mothers with Jews wearing the yellow Star of David in Nazi Germany. Echos of three years ago! For example, comedian Rob Schneider called the California legislature “Nazis” and likened school vaccine mandates to violations of the Nuremberg code. Then, as now, antivaccine rallies against AB 2109 were ubiquitous (as were Nazi and Holocaust analogies linking SB 277 to incipient fascism) as they are now against SB 277:

Same as it ever was.

Meanwhile, the grande dame of the modern antivaccine movement, founder and president of the Orwellian-named National Vaccine Information Center (NVIC), Barbara Loe Fisher, was saying things like this:

This bill, if passed, would effectively make the personal belief exemption in California another type of medical exemption. Because there is no religious exemption in California, this would make the only exemption option in California one in which a parent has to go through a state approved medical provider that they may not normally use for their child. Many families in California embrace complementary and alternative medicine for their family health care needs and AB2109 clearly discriminates against these families by defining such a limited subset of medical providers.

And this:

  • Especially in California, many families utilize health care providers not reliant on pharmaceutical drugs and vaccines, and only practitioners part of the pharmaceutical paradigm or medicine are allowed to provide the information and sign the form under this bill.
  • AB 2109 discriminates against families utilizing complementary and alternative medicine by forcing them into paying money to a medical practitioner they wouldn’t otherwise use who is already philosophically opposed to the parent’s personal and religious convictions regarding vaccination.

Hmmm. It sounds as though the antivaccine movement reacted to what Nyhan would consider to be a reasonable bill (AB 2109) with the same level of batshit crazy as it is currently doing with respect to SB 277, even though AB 2109 was not Draconian or even particularly onerous. Yet the antivaccine movement reacted to it as though it were a full-on frontal assault against their very freedom. That’s how the antivaccine movement rolls. Any attempt to limit what they perceive as their “freedom” to refuse vaccines for their children, consequences be damned, is automatically viewed as a direct assault on everything they hold dear—nay, on their very identity.

Indeed, “Dr. Bob” Sears was also on the warpath, even going so far as to pen a missive entitled California Bill AB2109 Threatens Vaccine Freedom of Choice. You can read it for yourself, but it contains the usual tropes about “freedom” and how even such a weak requirement as that which was embodied in AB 2109 was an intolerable affront to freedom and an obvious ploy by big pharma to crush any dissent from those who consider vaccines to be dangerous.

Now, I won’t dismiss everything Nyhan has to say. He does have a reasonable concern here:

What’s worse is that most of the votes for the bill so far have come from Democrats, which could politicize a decidedly bipartisan issue. The safety of our children and our communities shouldn’t become a partisan matter, which could spur some people to oppose vaccine requirements as a result of their political views.

Certainly, it is of concern that the thorny issue of vaccine mandates has been politicized more than it should be. On the other hand, it has commonly been assumed that antivaccine views tend to be the province of affluent, hippy-dippy, New Agey left wingers, when such is clearly not the case—and Nyhan knows that. As I’ve said before, antivaccine views are the quack views that are truly bipartisan. Be that as it may, let’s look at the two states that do not permit nonmedical exemptions. These states permit neither religious nor personal belief exemptions to school vaccine mandates. Can anyone guess which two states they are? Mississippi and West Virginia. Neither of these states is exactly what one would call bastions of liberal thought or strongholds for the Democratic Party, although to be fair it must be noted that in the case of West Virginia it wasn’t always that way. West Virginia has fairly recently flipped from blue to red, and it will be interesting to see what happens with its no compromise vaccine laws.

In any case, worrying about the bipartisan support for vaccines rather misses the point, which is that it’s not pushing for laws like SB 277 that undermines the bipartisan support for vaccine mandates. Rather, it’s antivaccinationists who have successfully co-opted the message of “freedom” (as in “health freedom”) in order to link tie vaccine mandates to a narrative of an overweening state seeking to control everything in the lives of its citizens and an affront to parental “choice.” It’s also certain elements of the Republican Party since the Tea Party became such a force. If you want to see detailed explanations and particularly annoying examples of this phenomenon, look no further than the recent bleatings of everyone’s favorite antivaccine pediatrician who claims he’s not “antivaccine,” Dr. Bob Sears, who fuses antivaccine rhetoric with anti-government rhetoric to perfect the antivaccine dog whistle.

Because of this unholy fusion of right wing, libertarian-leaning conservatives aligned with the Tea Party and antivaccinationists, even mainstream Republicans feel as though they need to pander to this group and are learning how to send out antivaccine dog whistles. For instance, Rand Paul is very much against vaccine mandates because, you know, parents own their children, not the state. Yes, I know. Everyone knows that Rand Paul is a perfect example of the apple not falling too far from the tree, but when New Jersey Governor Chris Christie starts tooting that antivaccine dog whistle, even tentatively and then followed by a rapid retreat after criticism, you know that there’s something going on there.

So, basically, although it is concerning that, even though antivaccine pseudoscience is the pseudoscience that is as bipartisan as support for vaccines has been, it is concerning that only one political party seems to feel the need to pander to these views, this was happening anyway. Moreover, the only way not to outrage the antivaccine movement is to weaken or eliminate vaccine mandates. Any attempt to strengthen or eliminate vaccine mandates will draw a response like the one we’re seeing now in California. The response was just as vociferous three years ago to a much milder bill, AB 2109, which, by the way, Governor Jerry Brown effectively neutered with a signing statement that ordered the California Department of Public Health to add a line to the exemption that let parents sign for a religious exemption to vaccine mandates without seeing a pediatrician, an utter betrayal of California children and an almost certainly illegal disregard for the legislature’s intent when it passed the bill, not to mention the statutory language that didn’t give him the power to do this. Oh, and Jerry Brown’s a Democrat and used to be known as “Governor Moonbeam” back in the 1970s; so maybe pandering to antivaccinationists isn’t as Republican a phenomenon as Nyhan thinks. After all, even Hillary Clinton and Barack Obama did it briefly back in 2008, along with John McCain.

So, when it comes to vaccines, legislators are right to push for a science-based policy to protect children. In an ideal world, that would mean no nonmedical exemptions to vaccine mandates, but I understand that the most that can often be achieved is tightening of requirements for obtaining vaccine mandates—and even that sort of strategy can get watered down. That’s because, regardless of what legislators do to try to increase vaccination rates, antivaccinationists will go full Godwin and react just as they’re reacting now. So legislators might as well go for broke, because the backlash from antivaccine organizations is not appreciably more intense now than it was three years ago for an incremental solution, and I don’t see the fence sitters or pro-vaccine parents rallying to their side now. Given the opening in the wake of the Disneyland measles outbreak, it might now be politically possible to begin eliminating—or at least making the requirements tighter for—nonmedical exemptions to school vaccine mandates. The time is now.

We might as well go for the policy that will be most likely to prevent future outbreaks. Even if we go for lesser measures, such as tightening requirements for nonmedical exemptions, I guarantee we’ll still see the NVIC paying for “no forced vaccination” advertisements and antivaccine “luminaries” like the banished Jake Crosby trying to link attempts to eliminate nonmedical exemptions to his favorite conspiracy theory.