SB 277 advances, and antivaccine activists lose it (again)

Antivaccine activism endangers children. Of that there is no longer any doubt. As vaccination rates fall, the risk of outbreaks of dangerous vaccine-preventable infectious diseases among children rise. In the wake of the Disneyland measles outbreak earlier this year, several states introduced measures to restrict nonmedical exemptions to school vaccine requirements. The record in passing such measures has been mixed, at best, but California went one better in an act that was completely unexpected to me. Basically Senator Richard Pan, who also happens to be a pediatrician, introduced SB 277, a bill, that if passed and signed into law, would eliminate nonmedical vaccine exemptions in the state of California. It’s gotten a lot farther than I thought it would, actually having passed the California Senate, and not by a little, either.

Sure, there was some watering down. It’s politics. For instance, the authors were forced to agree to limit the number of required vaccines to ten in order to address the pseudoscientific “concerns” of “too many, too soon.” They also had to remove a requirement for schools to notify parents of their immunization rates, which is bad, but not fatal. Worse, they agreed in principle to adding a clause that would “grandfather in” public and private school students whose parents have already claimed personal belief exemptions. (Remember, medical exemptions fall under two categories, religious, in which parents claim vaccination is against their religion, or personal belief exemptions, in which parents claim vaccinating their children against infectious disease somehow violates deeply held personal beliefs. I like to call the latter the “magic man” exemption and the latter the “I don’t wanna because vaccines are icky” exemption.) Then, there’s Governor Jerry Brown, who betrayed California children by completely sabotaging the last attempt by California legislators to tighten up the requirements when he added a signing statement basically adding a religious exemption that wasn’t in the actual text of the law to the requirement that parents be counseled by a physician or other listed health care professional before an exemption would be granted. Disappointingly, the California Department of Public Health went along. Apparently, he might refuse to sign the bill if a religious exemption is not permitted.

As the momentum for the passage of SB 277 built, predictably, as they did for the AB 2109 (the aforementioned bill that Governor Brown neutered), the antivaccine movement has been becoming more and more outraged. Even more predictably, the Mike Adams, a.k.a. the “Health Ranger,” has posted rants about a “medical police state” and how there will be a “wave of medical police state refugees fleeing California if SB 277 signed into law” and Governor Brown will be declaring medical genocide against children if he signs the law. He even includes, as he has done in the past, historical pictures of Jews fleeing Nazi Germany. With this sort of hyperbole, it’s not surprising that the California Chiropractic Association has been encouraging antivaccine activists to stalk lobbyists advocating for SB 277.

Mike Adams is, of course, the lunatic fringe of the antivaccine movement. His hyperbole-filled rants tend only to fire up other members of the lunatic fringe. However, the arguments he uses filter up through the antivaccine crankosphere, where they are picked up by antivaccine advocates who are just as much believers in pseudoscience but, in marked contrast to Mike Adams, are also much better able (or willing) to control their—shall we say?—loonier tendencies. I’m looking at you, Barbara Loe Fisher, who happens to be the grand dame of the antivaccine movement and founder of the oldest modern antivaccine organization, the Orwellian-named National Vaccine Information Center (NVIC). Indeed, earlier this week she posted an article entitled Blackmail and the Medical Vaccine Exemption, complete with video:

She begins with the “special snowflake” argument:

Vaccine risks for you or your child can range from zero to 100 percent depending upon the genes you were born with; your microbiome DNA; the environment you live in; your age and health at the time of vaccination, and the type and how many vaccines you get. 1 2

Vaccines are not safe or effective for everyone because we are not all the same and we do not all respond the same way to pharmaceutical products like vaccines. 3 4

Our response to infectious diseases and the risk for complications can also vary, depending upon our genes, environment, and age and health at the time of infection. 5 That is why malnourished, vitamin deficient children living in impoverished environments, for example, are at higher risk for complications from gastrointestinal, respiratory and other childhood infections. 6 7 8

One can’t help but note that the references to which she links are mostly speculative and mostly about differences in response to vaccines rather than adverse events. One also can’t help but note the subtext, a subtext that is often to be found in appeals by antivaccine activists to differences in genetics and their mentioning children in Third World countries suffering more complications from vaccine-preventable diseases. I’m referring to the attitude, sometimes implied, sometimes explicitly stated, that such diseases are no longer a threat to our affluent, white, highly privileged children any more because we’re wealthier, healthier, and better than those poor brown bastards who die from the measles in Africa. Let those poor savages be vaccinated because they live in squalor and malnutrition! We don’t need it here (‘Murica!) because (or so ignoramuses like Barbara Loe Fisher argue) measles is not harmful to us. In fact, to them it’s a harmless childhood disease that everyone got and did well with (except for those poor kids who got pneumonia, encephalitis, or subacute sclerosing panencephalitis, or SSPE). Oh, and “natural” immunity is supposedly better. Never mind that the child has to suffer through the disease to get it and that even natural immunity wanes. Again, natural does not necessarily mean better. Indeed, in the case of the measles, acquiring natural immunity appears to require surviving more than two years of subsequent immune system suppression that results in more deaths from other infectious diseases, an issue that the measles vaccine prevents. In the case of measles, at least, natural immunity may well not be better.

Same as it ever was.

In any case, although Barbara Loe Fisher doesn’t explicitly say this, the attitude is there, and she’s made the sorts of arguments I’ve mentioned before. What she concentrates on here is what I like to call the “special snowflake” argument. It’s the invocation of genetic diversity and variability as an excuse not to vaccinate or to claim that vaccines are incredibly dangerous based on unknown genetic variations, biological differences, or in—the latest buzzword in antivaccine circles—the microbiome. She cites a lot of references, but for the most part they tend to be speculative or, as is the case in most antivaccine tracts, don’t actually support her claims (except perhaps peripherally in some cases).

From there the tropes, misinformation, and pseudoscience fly fast and furious. The claim that the courts have ruled vaccines “unavoidably unsafe” (not quite) to shield pharmaceutical companies from liability? Yep, it’s there. This is a claim that the courts have somehow taken away parents’ rights because it requires them to go through the Vaccine Court to seek compensation for vaccine injuries. Basically, claimants have to go through the Vaccine Court if “injury or death resulted from side effects that were unavoidable even though the vaccine was properly prepared and was accompanied by proper directions and warnings.” What if the vaccine was not “properly prepared”? What if it was not accompanied by “proper directions and warnings”? Presumably, if that were the case, parents could still bypass the Vaccine Court and sue directly in state or federal court. So is the usual trotting out of the figure of $3 billion in compensation awarded by the vaccine court since 1988, which should actually tell you that the court is not such a huge barrier to compensation but to antivaccinationists is evidence of the sheer evil of vaccines.

She goes on to refer to complain:

This cruel utilitarian rationale, also known as “the ends justifies the means,” has been used by public health officials and medical trade groups to narrow the medical vaccine exemption so that, today, almost no medical condition qualifies as an “official” reason (contraindication) for a doctor to grant someone a medical exemption to vaccination. At the same time, there are no good biological mechanism studies or large clinical trials validating the safety of severely restricting the medical vaccine exemption. But, then, there is no independent oversight on the quality and quantity of the science used to make vaccine policies and laws in the U.S. either.

Basically, the Centers for Disease Control now tells doctors that a medical vaccine exemption should only be granted if you are one of the estimated 320,000 children and adults annually receiving chemotherapy; or one of the estimated 47,000 Americans who have had a recent organ or blood cell transplant; or your child is one of the 40 to 100 children born every year with Severe Combined Immune Deficiency, known as SCID.

Once you are done with chemo, no medical vaccine exemption for you. Once you have recovered from your organ or blood cell transplant, no medical vaccine exemption for you. And if you are immunosuppressed but don’t have SCID, the rarest and most severe of all immunodeficiency disorders, in most cases no medical exemption for you.

I could counter that Barbara Loe Fisher and many antivaccinationists advocate a cruel, selfish rationale known as, “I’m perfectly happy to sponge off the herd immunity without having my special snowflake take even the infinitesimally small risk of being vaccinated to contribute.” As for medical exemptions, here are the usual reasons:

  • The child’s immune status is compromised by a permanent or temporary condition. For example, the child might have a congenital condition leading to an impaired immune system. Or, the child might take medications, such as chemotherapy or steroids, that impair the immune system. In either case, vaccination could be harmful to the child’s health.
  • The child has a serious allergic reaction to a vaccine component.
  • The child has had a prior serious adverse event related to vaccination.

In fact, West Virginia, one of the two current states that don’t allow non-medical exemptions, uses exactly those criteria for granting medical exemptions. The problem, of course, is that what antivaccinationists claim to be a vaccine-related adverse event usually is not. For instance, autism is not caused by vaccines. It’s just not; evidence is overwhelming that it is not. Yet antivaccinationists will argue that if they have an autistic child that’s a vaccine reaction and should serve as a reason for a medical exemption. Barbara Loe Fisher’s rant basically encompasses how the antivaccine view of what constitute reasons for medical exemptions and real, science-based reasons for legitimate medical exemptions to school vaccine mandates are related only by coincidence, if even that.

But why, why is the evil medical-government-pharmaceutical cabal insisting on eliminating non-medical exemptions? It couldn’t possibly be because it’s good for children (which it is) and because unvaccinated children pose a risk (they do), of course. It has to be…a conspiracy:

Now public health and medical trade groups are pressuring legislators to pass laws that would not only eliminate non-medical religious and conscientious belief vaccine exemptions for children to attend school, 77 but also would require children to get every one of the 69 doses of 16 federally recommended vaccines – unless a parent can get a medical vaccine exemption from a doctor. 78 This vaccine dragnet, which is already being applied to health care workers, is also pulling in childcare workers and teachers as proposed new vaccine laws threaten them with loss of employment if they cannot find a doctor to write a medical vaccine exemption.

Zealously pursuing a 99.99 percent vaccination rate and using very small groups of immune compromised individuals as an excuse to eliminate all non-medical vaccine exemptions, liability free doctors want permission from lawmakers to blackmail virtually every American into playing vaccine roulette. And they want to do this in the absence of sound vaccine safety science, even for those potentially at higher risk for suffering vaccine harm.

Philosopher and human rights advocate Elie Wiesel has said “When you take an idea or a concept and turn it into an abstraction, that opens the way to take human beings and turn them, also, into abstractions. When human beings become abstractions, what is left?”

Nice touch, that Elie Wiesel quote! By citing Wiesel’s famous quote about Nazi-sim, Barbara Loe Fisher can invoke the Holocaust without actually using the words, “Hitler,” “Nazi,” or “Holocaust,” because it was originally published in the foreword to a book about the horrors of Nazi medical experiments. Using the quote is a wonder of plausible deniability. In fact, that particular quote seems to be a favorite among antivaccinationists. Just Google it. Many of the hits that come up are in antivaccine articles. Indeed, Barbara Loe Fisher has been using this quote for at least five years now, probably for a lot longer. It’s a way to liken vaccine mandates to the Holocaust without being as offensively blatant as, say, Heather Barajas.

Barbara Loe Fisher concludes by whistling up a storm of antivaccine dog whistles, just like one of our favorite antivaccine pediatricians, “Dr. Bob” Sears, has been doing ever since the Disneyland measles outbreak concerned his patients’s parents enough to start besieging his office with phone calls asking what to do. She invokes “freedom.” She invokes “conscience.” She refers to being forced to play “vaccine roulette” and likens vaccination to “cruel and inhuman” punishment.

I’m heartened, however, that SB 277 has gotten this far in the face of this sort of rhetoric. As full of pseudoscientific appeals to emotion and American values like freedom as Fisher’s rhetoric is, SB 277 has passed the California Senate, and that is a big deal. Its chance of becoming law has gone from low to quite good. Maybe there is hope after all.