In the era of Donald Trump, will the states save us from antivaxers?

It seems hard to believe that the Disneyland measles outbreak occurred more than two years ago. It was during the Christmas holiday of 2014 that an measles outbreak occurred centered at—of course—Disneyland, thanks primarily to unvaccinated children facilitating the spread of the highly contagious disease at the “Happiest Place on Earth.” What made this particular outbreak so important, though, was that it provided the impetus Senator Dr. Richard Pan and Senator Ben Allen to introduce a bill (SB 277) into the California legislature for consideration. What made SB 277 unique and its introduction surprising is that it eliminated all personal belief exemptions to school vaccine mandates, leaving only medical exemptions. The long and winding road towards passage consumed a fair amount of my blogging throughout 2015. To my surprise, SB 277 actually passed. Yes, it’s true that antivaxers are protesting and doing their damnedest to game the system by selling medical exemptions, but in general SB 277 appears to be working.

After the election of Donald Trump, I expressed concern about what might happen to federal vaccine policy based, of course, on Trump’s long, sordid history of spewing antivaccine nonsense in interviews and on Twitter. Basically, he is antivaccine, and it’s hard not to worry about how Trump could undermine trust in vaccines and change federal vaccine policy for the worse, to the point where it’s hard not to be concerned that 2017 will be the antivaccine year.

As pessimistic as I’ve been sounding, I’ve recently realized that all is not lost. Remember, the vast majority of vaccine policy is made at the state level, not the federal level. It is the states that determine school vaccine requirements, not the federal government. The CDC publishes a recommended vaccine schedule, and the states use it to guide decision-making when constructing their school vaccine mandates. Aside from that, pediatricians also vaccinate based on the recommended schedule. That’s why, as depressed as I’ve been at the election of an antivaccine loon as our President, I was heartened to see an article published on GreenMedInfo. GreenMedInfo, as you might recall, is a website run by Sayer Ji, whom we’ve encountered before on multiple occasions mangling and misinterpreting science in the service of quackery. Indeed, his whole website is dedicated to doing just that, all in order to make pseudoscience seem scientific.

There, Jeffrey Jaxen has published an article entitled NVIC Tracking 134 Vaccine Bills Introduced in 35 States. Since it’s been a while since I wrote about the NVIC, I’ll just remind readers right here that the NVIC is the Orwellian-named National Vaccine Information Center, one of the oldest existing antivaccine groups out there, founded by the grande dame of the antivaccine movement, Barbara Loe Fisher. Although I realize that the idea behind Jaxen’s article is to stir up fear among antivaccinationists that the government is coming to forcibly vaccinate their children, much as the NRA routinely stirs up fears among its members that the government is coming to take their guns, the fact that the NVIC is worried about the number and scope bills being introduced in state legislatures around the country makes me feel perhaps a bit less worried about the future of vaccine policy in the era of Trump. I especially like that Jaxen starts the article out thusly:

A tidal wave of new bills has flooded 35 states in the U.S., threatening to either limit or completely eradicate vaccine exemptions. Clearly health freedom and informed consent is undergoing full frontal assualt right now. Please read, share, and take action accordingly.

Gee, Mr. Jaxen, you say that as though it were a bad thing. Rant on, dude. Rant on:

Yet, despite multiple whistleblowers within the Centers for Disease Control and Prevention (CDC) spotlighting research corruption and pharmaceutical industry collusion, over $3 billion dollars paid out in vaccine damages by the Vaccine Injury Compensation Program, widespread vaccine contamination, and overall ineffectiveness and dangers of the current vaccine schedule there has now been 134 vaccine bills introduced in 35 states in the first seven weeks of the US legislative session.

According to the National Vaccine Information Center’s (NVIC) Advocacy Team who track vaccine-related bills, 31 new bills have been added since the team’s last update two weeks prior. Eight of these new bills are in five states appearing for the first time. The coordinated legislative push represents nothing short of a full frontal onslaught by pharmaceutical companies, working through their lobbied politicians, to force dangerous vaccine products upon the backs of the entire US population.

So what are the kinds of bills that get the NVIC all hot and bothered—and not in a good way? It’s not too hard to figure out. The types of bills generally fall into the following categories:

• Bills that eliminate or restrict nonmedical exemptions to school vaccine mandates.
• Bills that expand vaccine tracking or eliminate “opt-in” Consent for vaccine tracking.
• Bills that mandate that parents or guardians claiming a personal belief exemption to vaccines undergo state-mandated education about vaccines prior to being granted one. (We have this policy in Michigan, and it’s worked well to decrease rates of personal belief exemptions. No wonder antivaxers hate it and have been trying to pass a law to reverse it.)
• Bills that require the public disclosure of vaccination and exemption rates for individual school districts and schools. Tellingly, the NVIC refers to these bills as “school shaming bills.” Funny how antivaxers are all for “full disclosure” about vaccines, except for when they aren’t.

However, the bills that really get Jaxen worked up are these, which the NVIC views as “persecution” (of course):

Perhaps the most disturbing trend and telling takeaway from this new surge of vaccine-related bills within the US is the clear move to legally persecute those choosing to not vaccinate. The new structure to implement vaccine persecution is appearing in two different forms. First, Connecticut, Idaho, Kansas, Massachusetts, Montana, New York, Texas, and Utah have filed bills to expand vaccine tracking or eliminate opt-in consent for vaccine tracking. Second, Arizona, Connecticut, Nevada, New York, Oklahoma, Texas, and Utah have filed bills that would allow ‘school shaming’ by requiring and normalizing the public disclosure of vaccination and exemption rates. Nevada has gone one step further than the rest by introducing AB 200 allowing parents to find out from the school if any children who are not vaccinated are attending.

See what I mean? From my perspective, it would be a very good thing if all states published the percentage of children whose parents claimed personal belief exemptions. Yes, in a small number of cases there could be potential conflicts with HIPAA, the federal health privacy law, in that in small schools knowing the percentage of personal belief exemptions might in some circumstances allow some to surmise the identities of children whose parents claimed nonmedical exemptions, but in the vast majority of cases that will not be an issue. Moreover, it is certainly possible to craft policies that allow disclosure of vaccine uptake rates, both overall and for individual vaccines without violating HIPAA. Such information would be very useful to parents of children who for medical reasons can’t be vaccinated. Heck, it would be useful for all parents concerned about protecting their children from potentially deadly diseases.

Similarly, vaccine tracking is very important as well. Our state, for example, has MICR, the Michigan Care Improvement Registry, which tracks vaccine delivery. It’s basically a statewide database that makes it easy for providers to tell which vaccines a child has has had. It eliminates the need for vaccine cards and allows doctors and other providers to know which vaccines a child still needs and when. Overall, it’s a huge help, both for providers and children. No wonder antivaxers like the NVIC are opposed to making it easier for states to use such systems to track vaccines administration.

Not suprisingly, the NVIC doesn’t like laws requiring that parents seeking personal belief exemptions undergo education. For example, before it passed SB 277, California first tried a law like this requiring parents seeking personal belief exemptions to meet with a pediatrician or other listed health care provider for counseling. As I pointed out above, Michigan is another example. Our state has a policy requiring that parents seeking nonmedical exemptions not only undergo counseling and education, but that they go to a local state or county health department office for the educational offering, ensuring uniformity. Get a load of how the NVIC characterizes such laws:

Connecticut, Texas, and Utah have introduced new bills that require families that utilize vaccine exemptions to participate in a state-sponsored vaccine (re)eduction program. The discriminatory and presumptuous bills assume that those who exert their medical and parental choice are uneducated and ignorant. For the increasing populations of people that believe in health freedom and understand that vaccines are not necessarily safe or effective, attempted bills to force “education” are a sign that pharmaceutical companies and their paid/lobbied mouthpieces have lost control of the narrative and messaging.

No, such laws are an effort to reach parents who claim personal belief exemptions because it’s easier than getting their children vaccinated. Indeed, that was a large part of the rational behind California’s law, AB 2109, which mandated education but was unfortunately undermined by a signing statement by Governor Jerry Brown. Basically, such laws provide real informed consent instead of misinformed consent based on antivaccine pseudoscience that minimizes the benefits of vaccines while vastly exaggerating the dangers; that is, when it isn’t frightening parents with nonexistent risks due to vaccines, such as the long-debunked claim that vaccines cause autism. As for Jaxen’s claim that these bills are a sign that states assume “those who exert there medical and parental choice are uneducated and ignorant,” well, such parents are usually not uneducated, but they are generally ignorant of good science. No education session is going to deter hard core antivaxers, but it might give those on the fence the nudge they need to vaccinate their children.

Not surprisingly, antivaxers are also against quality metrics with respect to vaccinations:

Individual physicians will face a new angle of pressure to meet the “standard of care” as new bills are introduced to track, share, and publish vaccination data as well as restrict or eliminate vaccine exemptions. The National Committee for Quality Assurance (NCQA) collects data and issues “report cards” on health plans which meet “important standards of care.” Put simply, The NCQA ratings for health plans are partly dependent upon their ability to deliver pharmaceutical products. If the new bills chronicled by NVIC are signed into law, doctors wishing to allow vaccine choice or using their medical judgement in cases involving vaccine waivers may face a medical board investigation from their respective state. In addition, health plans being rated by the NCQA will likely put pressure on participating doctors who are not fully vaccinating all their patients.

Again, Jaxen says this as though it, too, were a bad thing.

Of course, it’s not all good news on the state front. There are also quite a few bills out there that would actually add or expand vaccine exemptions, and the NVIC is all for these, making them a “priority support alert. Apparently these bills have been introduced in Hawaii, Iowa, Idaho, Mississippi (where it didn’t go anywhere and died), New Jersey, New York, Oklahoma, Rhode Island, Tennessee, Texas, Washington, and West Virginia. Not surprisingly two of these states, West Virginia and Mississippi, are two of the three states (California is not the third) that allow only nonmedical exemptions. They’re particularly all-in for bills that would state that failure to vaccinated or the decision to delay vaccines does not constitute child abuse, such as Oregon SB 687. Then there are bills that would forbid physicians from refusing to treat patients who refuse vaccination, as Texas HB 1070 would, in addition to penalizing doctors who violate it by making them ineligible to receive funds from the state for services provided to patients.

If you want the non-antivaccine version of this, Jann Bellamy summarized some of the bills being considered by the states. My point is that things are not as bleak as having an antivaxer as President who, if he decides to focus on vaccine policy, could really screw up the CDC and federal vaccine policy. At the state level, however, things are not nearly so bleak. Sure, it’s a mixed picture, but my perception is that there’s probably more good than bad happening in state legislatures. In the age of Trump, that gives me hope.